Document 3NMGm9yaXQb0Nm12a7n1v7wR6

It ^reword \ v THE Transactions of the Silver Jubilee Congress and Fxposition of the National Safely Council, October 10-14, l'GS, are published in two volumes. Volume I contains the geiuial and subject sessions and the sessions of the various ' Industrial Sections. Volume 11 contains the Street and* Highway Trallie, the Commercial Vehicle, the Transit, the Child I'.dneation. ami the llome Safety sessions. Volume 1 is distributed automatically to all industrial mem bers of the Council. Volume 11 is sent to members who are believed to be interested chiefly in the sessions it contains, lion ever, other Council members may obtain Volume II upon request. Many members have found it of benefit to distribute copies of the Transactions volumes to both executives, foremen and supervisors, who have used the practical information they Contain in safety programs and tor general reference pur poses. Extra copies of the Transactions may be obtained as follows; One to 10 copies of Vol. 1, at $2 each; 11 or more copies, $1.75 each. Extra copies of Vol. II cost 75 cents, each. i Till7. Transactions are a condensed record of. the pro ceedings of the Silver Jubilee Congress. The papers am) addresses have been edited to delete extraneous matter, ab breviate the less important portions, anil emphasize what may be of particular usefulness and value in promoting ef fective safety organization anil other accident prevention measures. These volumes, therefore, are a somewhat abridged version, compact, practical and of particular value to the student and executive interested in achieving more thomngli accident prevention success. The original manu scripts are available for additional reference, if desired, in the tiles of the National Safely Council. THE National Safety Council, at its Congresses, seeks to eliminate from discussion matters which are not pertinent | to the aim> of the Congress or which may be contrary to the t'lumeil .s policies. It cannot accept responsibility, lion evi l, for all views expressed either in the papers which have been delivered or in the discussions based upon these papers. NATIONAL SAFETY COUNCIL,!TM. 20 North Waclcer Drive Chicago , Contends Council Officers and Directors...................................... 4 Council Purposes and Policies...................................... 9 . Annual Meeting of Members........*........... .................... 11 Annual Banquet.............................................................. 3_1 Special Subject Sessions-- . Agricultural Safety ............................................... 33 Dusts, Fumes, Gases and Vapors.......................... 45 Falls of Workers........... >....................................... 59 Fire Prevention ...................................................... 69 Governmental Officials ......................................... 85 Health Service in Industry.....................................101 Industrial Accident Investigations..................'..115 Industrial Explosion Hazards................................. 125 Industrial Nursing .................................................139 Industrial Safety Lectures.....................................163 Maintaining Interest in Safety............................. 185 Midwestern Rehabilitation Meeting......................201 Occupational Disease..............................................211 Off-the-Job Accidents............. ..............................229 Safety Fundamentals..............................................249 Safe Use of Electricity........... ............................... 257 Sate Use of Petroleum Products............................ 269 Aeronautical Section .................................................... 281 A. S. S. E.--Engineering Section.................................295 Automotive and Machine Shop Section....................... 301 Cement and Quarry Section......... 4........................... .313 Chemical Section................................................... Construction Section......................................................373 Food Section ................................................................. 385 Marine Section.................................................................407 339 Meat Packing, Tanning and Leather Industries Section ......................................................................... 455 Metals Section................................................................ 473 Mining Section .............................................................. 521 Paper and Pulp-Section................................................. 555 Petroleum Section...........................................................613 Power Press Section..................................... 665 Public Utilities Section................................................. 671 Refrigetation Section..................................................... 691 Rubber Section................................................................ 703 Steam Railroad................................................................. 733 Textile ..Section*.............................................................. 753 Wood Products Section..................................................775 Safety Exposition--List of Exhibitors.............................. 799"~- Index .. '............................................... '...................... 805 .ational afety Council, Inc. . HONORARY MEMBERS . ' A'.'-fi i \iion nr Iron and Sim. KNuiNEEits K.h i in W. C.'Mrin i.i. I.i w R. Pai.mek OFFICERS (1938-1939) I *. I*. l-'l.SM.I.I., 1'lc-iiUnt L. \\ . DtMi'EsV, \ icc-I'rcsiilcnt for Piiuiucc and Treasurer lm\K H. Harrison. Vice-President for Industrial Safety Dr. Mii.i.m McCuntdik, Vice-President for Public Safety Wai.iik S. Paine, Vice-President for Engineering A. \" Rohweder, Vice-President for Safety Councils R. T. Siii.knsten, \'ice-Prcsidcnt for Membership A. W. Whitney, \'icc-President for Education W. II. Cameron, Secretary and Managing Director . EXECUTIVE COMMITTEE (1938-1939) II. I. At.ijkich, Spencer Kellogg & Sons, Inc. J. I. P.\N.\sH. Pa-t President C. \\. lit.Riajt l>r, Past President II. W. Bora.ess, Sinclair Prairie Oil Company ' l . I!. P.ni iKT, Wi-cim-in Public Service Corporation Romm W. CamiuiH.i.. Past President GA'merHS.1'. "National-Safety Council; Inf. " ......... .. I.. C. Ca si I'iiei.I, Mining Section ' ` Robert I. Can.in. Aetna Casualty Surety Company, ............... I.r.wis A. Ib.lli.ms. Past President C. W. Demim.sy, The l.ii|uid Carbonic Corporation " If. E. Donovan, ASSE-Enginccriug Section . ! ' Matters A. Dow, Past President U'aiiiii A. Everson, Lehigh Valley Safety Council F.aui. E. Grover. Safety Conneil of the Columbus Chamber of Coni ine re> D. It. I'i.nnh i, I'nii-nlling Engineer Harry (icu.iittiT, The Pullman Company Prank II. IIakhisoN. International Harvester Company IIaroiii G. IIoIImin, l"uemplojmeiit ( oiupvilsation Commission, New Jel'vy S I! ItoUMUl, Food Section . . II. II Is'mia, lutersla,te Comineree Commission A OFFICERS AND DIRECTORS, Continued Walter li. Kinu, Past President Wm. C. Knoeik, Milwaukee Safely Commission John F.. I.onc, Past President Tuns. II. MacDonai.ii, lb S. Department of Agriculture Aktiuik W. Maoi.k, Commissioner of Motor Vehicles, New Jersey Dr. Miller McCt inmii'K, Yale University U. S. Metiukr, Pnldie Utilities Section I. W. Mii.i.akii, Industrial Gloves Company IIaiiiii.d I.. Miner, K. I. (In Pont do Nemours & Company Ei.urr N'r.ss, Director of Public Safety, Cleveland E.J. O'IIhie.v, Jr,, Louisville Safely Council W.u.ri.u S. Paine, Aetna Life & Affiliated Companies Lew K. Pai.mer, Past President C. E. Plttiiio.nk, Past President II. 0. Pickard, Marine Section Ai.in.itT S. Reoula, Industrial Relations Counselors, Inc. Lt. Coe. Henry A. Kknincek, Past President E. A. Roiickts, Textile Section A. V. Ron wider, Duluth, Missahe & Iron Range Railway Company Geokle E. Saneoro, General Electric Company Charles li. Scott, Past President Prank T. Sheets, Portland Cement Association Ge.v. John H. Shekiiuhne, Massachusetts Safety Council C. \V. Smith, Standard Oil Company (Indiana) Walter Dent Smith, Delaware Safety Council W. A. Snow, Construction ScciitJi R. T. Soi.ensten, Elliott Service Company Leslie J. Sorenson, City Trallie Engineer, Chicago , , . Co).. John Stiiavell, Consolidated Edison Company of N. Y., Inc. .C..P. -.TjU-MaN, jl'^sjj^^esident . ............................ J'j`. ,. ^ U.'oki.e i. Traiik. Greater Chicago Safely Council, Inc. Dr. II. L. Vosiiurc.h, (icueral Electric Company , | >k. C. H. Watson. Past President . A, \V. Wiii'inev, National Conservation Bureau ' D. A. Ilviuii.r, Cariicgic-lllinois Steel Company . Arthur H. YmiNfi, Past President , DIRECTORS (1938-1939) II. J. Aldrich, Spenevr Kellogg it Sons, Inc. A. L. Akustmiini:, Eastman Kodak Company 1. I. IV\N \sll, Past President (*\ri. Barker. St. Louis Safety Council a l.io II. IIeaui.ac, Blackslonc Valley Safety Council W. A. IIiliiiiI, Automotive fk Machine Simp Section lJj\KNi:sr \V. Beck, United States Rubber Pioduets. Inc. ' S ICERS AND DIRECTORS, Continued C. W. Hekc-quist, Past President i'.. F\ Blank, Jones & Laughliu Steel Corporation It. W. Ituc.r.i.ss, Sinclair Prairie Oil Company 11. E. Iloi.r, Soutli Bend Civic Safety Council ' (.. I!. IIouii.t, Wisconsin Public Service Corporation I'. S. Bkow.v, Standard Accident Insurance Company J. 11. I (mown, Petroleum Section V.'. A. Brown, Safety Dept., Nashville Chamber of Commerce It. A. ftuu ock, Rubber Section W. H. Cameron, National Safety Council, Inc. I.. C. Cami'iif.i.l, Mining Section Roiiert \V. CamPuli.i., Past President Kwsio.vd A. Carey, Evanston Safety Council R\v Carney, Kenosha Safely Council Romair J. Catun, Aetna Casualty & Surety Company Maurice CiiMU.tr, Rahway Safety Council L. O. CtttiLVKK, Employees' Publication Section \V.m. M. Ci.Mm, St. Joseph (Mo.) Safety Council Ki:nm:tii R. Coi.max, Seattle Tratiic & Safety Council J. E. Cui.usly, Bethlehem Steel Company Frank J. Dean, FJansas City Safety Council Lewis A. DeBlois, Past President C. \V. DtMi'tsv, The Liquid Carbonic Corporation R. E. Donovan, ASSE-Engincering Section ' J a vies li. Douglas, The Pliiladclphia Gas Works Company .Marcus A. Dow, Past President Dr. Louis I. Duuun, Metropolitan Lite Insurance Company O. M. Eowakos, Jr., Safety Div., Syracuse Chamber of Commerce W. A. Everson, Lehigh Valley Safety Council D. D. Fennell, Consulting Engineer .. Donald A. Finkueinek, Toledo Safety Council Dr. J /art E. Fisher, Chicago Rapid Transit Company Chester C. Fisk, Iierkelcy Traffic Safety Commission Howard R. Fonda, Burroughs Wellcome 5; Co. (U.S.A.) Inc. Arthur C. Frey, Worcester Safety Council John R. Giuso.v, Western Electric Company Lyle H. Gut, Peoria Association of Commerce Safety Council Howard F. Ch-Uert, Elizabeth Safely Council Edgar H. Guk.sUCIi, Grand Rapids Safely Council \Y. A. Gurus, American Telephone & Telegraph Company Earl E. Grover, Safety Council of the Columbus Chamber of Com mcrce Harry Guiliii.kt, The Pulhnan Company C. If. Hmut.k, Refrigeration Section D. T. IIauuinctON, IJnited Stales Bureau of Mines 1 , Frank If. Harrison, .International Harvester Company 6 OFFICERS AND DIRECTORS, Continued Citxs. K. Him, New Ymk Central Lines IIuioed G. Huffman, Unemployment Compensation Commission, New Jersey Evi.io.et IIorii, Madison County Safely Council S. II. llouui.t.t. Food Section Fred R. Hunt, Cement fie Quarry Section Wit. F. James, Philadelphia Safety Council T, B. Johnson, Commercial'Vehicle Section Thomas I*. Kearns, Industrial Commission of Ohio H. H. Kelly, Interstate Commerce Commission Walter G. Kino, Past President W.u. C. Knoci.k, Milwaukee Safety Commission ' Wm. S. Knudsen, Detroit Industrial Safety Council Otto C. Kuiikt, Greater Springfield Safety Council C. L. LaFountaine, Great Northern Railway Company J. H. Lee, Wood Products Section Mili.ard C. Lefi.er, Child Education Section Juris E. Lonc, Past President Titos. H. MacDonai.d, United States Department of Agriculture Roiiekt A. McArthur, Transit Section Dr. Mili.er McCuntock, Yale University Arthur W. Macee, Commissioner of Motor Vehicles, New Jersey F\ W. Matson, Minnesota Safely Council R. S. Metzcer, Public Utilities Section I. W. Millard, Industrial Gloves Company Harold L. Miner, E. I. dn Pont de Nemours & Company . R. B. Mori.ev, Industrial Accident Prevention Associations Prof, Roger L. Morrison, Street & Highway Traffic Section Ernest Murphy, Albany Safety Council C. L. Murray, Mason City-Cerro Gordo County Safety Council Eliot Ness, Director of Public Safety, Cleveland E. J. O'Brien, Jr., Louisville Safety Council O.eorc.f, C. A. Oi'P, The Detroit Edison Company Waiter S. Paine, Aetna Life & Affiliated Companies Lew R. Palmer, Past President Du to A. Patton, Newark Safety Council C. K. Peacock, Chattanooga Safely Council Charles \V. Pendock, Safety Division, Milwaukee Association of Commerce C. E. Pettidone, Past President 11. O. Pickard, Marine Section Alderr S. Recula, Industrial Relations Counselors, Inc. Dr. A. R. Runke, Contra Costa County Safety Council Lv. I nl.. Henry A. Kenincer, Past President ..PiiimeC. Riioads, Meat Packing, Tanning ft Leather Industries Section , 7 OFFICERS AND DIRECTORS, Continued c A. C. Rismierger. Rochester Safely Council Marini's Ritkk. Paterson Safety Council E. A. Roiiekts, Textile Section jr Bestok Roirnson, East hay Safety Council F. A. Koiiinson. Paper Sr Pulp Section K. E. Rookhoit, Power Press Section Ralph l.. Rogers, Ik., Chemical Section v, A. V. Roiiwkdek. Duluth. Missahc & Iron Range Railway Company Walter Roseniiaum, Western Pennsylvania Safety Council G. E. Sanford. General Electric Company Hf.nky G. Sciiaffnf.u, Eric Safety Council . Harkv A. Schultz, United States Steel Corporation of Delaware Charles B. Scott, Past President Eaki. S. Shautzeii, Utica Safety Council Frank T. Shf.ets, Portland Cement Association Gkx. John H. Sherburne, Massachusetts Safety Council Dr. L. A. Shoudv, Bethlehem Steel Company Ehnkst L. Simonds, Xew Haven Safety Council . Judge Lee E. Skeki., Cleveland Safety Council . C. W. Smith. Standard Oil Company (Indiana) " Wai.tek Dent Smith, Delaware Safety Council W. A. Snow, Construction Section R. T. Soi.enste.v, Elliott Service Company Lesi.ie .1. Sorenson, City Traffic Engineer, Chicago E. C. Spring, Philadelphia, Pa. George R. Stephens, Safety Bureau, Buffalo Chamber of Com merce Cm.. John Stilwfj.l, Consolidated Edison Company of X. Y. Inc. Arthur M. Tode. Consulting Marine Engineer C. P. Toi.man, Past President Mm. E. Trammell. Metals Section George G. Traver. Greater Chicago Safety Council, Inc. Major R. D.'Trimiii.e, Richmond Safety Council . Frank E. Yitz, Superior and Douglas County Safety Council Dr. B. E. Yosiiukoii, General Electric Company Dr. David E. Wkci.ein, Baltimore Safety Council Dr. C. H. Watson, Past President G. Wise Wf.scott, Safety Dept., Auto Club of Rhode Island S. E. Whiting., Liberty Mutual Insurance Company . A. W. Whitney, National Conservation Bureau Charles E. Wilson, General Motors Corporation F. B. Winsuiw, Safety Div., Birmingham Chamber of Commerce W. E. Worth, International Harvester Company Arthur H. Young, Past President E. J. Zaltt, Safety nnreau, Duluth Chamber of Commerce , r- - _ The purpo The throw prove: plies direct nlatio Kcc condit disea acciih live i Tin profit tion. It I rc'en of tie -inn f hers'n indie. ot'l'ici: lion. and i arc i steel the r moto impo Th the i mule Iron w au!. taut the ! in X of III hersl Th gram unnci level link. '' have K> be a dual agencies and ways ns; opportunities for r the physically dist he summed up by a equal quantities oi pplicanl's ability and add an unlimited cr<everance. interest. iork and success will Occupational Disease THURSDAY MORNING SESSION October 13, 1938 The session for the discussion of out standing problems in the field of occupa tional disease was called to order by tlie Hon. f*. .1. Arigstcn. Chairman, the Illinois Industrial Commission, Chicago, who pre- sided. The Chairman emphasized the im portance of the selected subjects to be pre sented by eminent speakers, and promptly introduced the first scheduled speaker. The Trend of Occupational Disease Legislation By HENRY D. SAYER Manager of the Casualty Department. Association of Casualty and Surety Executives Let us consider the differences between the accidental injury and the occupational disease, h'or these distinctions are important and must constantly be borne in mind when wc consider either legislation on the sub ject of disease, or engineering methods of prevention or control. Generally 'peaking, accidents occur at a specific moment in point of time, and, from the standpoint of fixing liability under any policy of insurance, it is in the future; that is to say, at the moment of the acceptance of liability under any insurance contract the accident for which liability may lie as sumed lias not yet happened. That fre quently is not so with the occupational dis ease. Insurance by its very nature van only assume liabilities that have yet to arise--not those that have already accrued! Again, speaking generally, the industrial accident is something that can he seen-- even though unforeseen. It may he visual ized and described in words, setting forth specifically the time, place and maimer of happening. It can then be determined, after the happening of the event, whether it was preventable or inevitable; blame, if any, can he assessed; the worker involved, or his foreman or superintendent, can lie shown the fault, ami effective measures can lie taken to guard against a like future hap pening. But some will say. truly, not all accidents happen in the manner described; that not always are they held to occur only at a specific moment or under circumstances where they can lie visualized and described, lly administrative and court decisions, it is true in some jurisdictions that the definition of "accident" has been greatly broadened. Wc find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, and even the specific time and place not definitely known, except.that it is shown to have probably occurred in the employment, being held to he an accident. _ tillers vs. lltill. 17S l)iv. .tsO. 1Z4 N.Y. 7f7. .in .milirax can*: Vcnttcn v*. NVw lfll 1.um ber Co., \f*\ \VU. 3/G, a c.iim . ami other*.) Poisoning of the Iiodv through the effects of. a deleterious or toxic substance used in the employment, the dangers of which were unknown to the worker, the employer hav ing been negligent in safeguarding properly the use of such substance, has been held to he the result of an industrial accident. (Victory Sparkler & Specialty Co. vs. Franck*. ` 147 Maryland, J6S: and tlie very rcccui case of Dlack vs. Crcstnn Amo Co., tow*a Supreme Court, August 5, 19JS. 2SI, N.W. 1S9.1 And where negligence of the employer has been shown, an injury to health, even though not occurring through a happening . at a given time and place, luit hv repealed ^,,.iirc* over mnnlh* nf time, lias hcen islatively \or administratively. These include ^ f In* an mritlrnt. the well-known metallic and rhcmical )>ni- . NVrly is CAf**lin.i .\>Ih,*Io> Cu. I *f,M, .hi .vIh'Iosis C\1C.) X'onfi sons that are so definite amt characteristic a part of suutc industrial processes: Were ..--c :iinl other ca-cs I file are the diseases arising from the use of these .vcepth'iis anil iml I In' general rule substances the only occupational di-tta-cs i vvliat von-tilutes ;ui necidrulal injury, with which we need concern ourselves, the ink nr may faiilv assume llial the legislative dilhcully would lie hugely re is n( ndiniuislralnrs of llie lave .mil moved, and we could safely entrust the emu Is have heeii directly iuspiicd hy prohlem to the doctor and the engineer. ^ hi-lief ill the necessity <if finding a inr an industrial ill for which no remedy had heen provided by specific :.iee of the statute. May we consider a< straws in the wind, showing a I inward industrial disease liability? ay observed that the tendency of the is is to construe the term "accident" more limited inainier in those states c there is specific provision in the law ing occupational diseases. Thus, wc . clear instances of what has hcen d "judicial legislation." that is. the - broadening the imaiiing of the law over situations not clearly included ii the terms or the law by the duly con ed legislative authorities. lfiit nr have seen that the legisl.iiive problem is not so simple. Nor is it simple administratively. Wc find ourselves lloimdcrin.g in a veritable morass, either because of the inherent difficulties of the situation, or because we have not or cannot agree on our objective. If all parlies would rec ognize the difficulties and the limitations on what industry can do, or can fairly he ex pected to do, we could much more con fidently face the future. If wc could agree that provision for "occupational diseases" is not .synonymous with general health and life insurance for industrial workers at indus try's expense, then I am sure wc could get somewhere very definitely. ' ns now consider what wc mean or in ky the term "occupational disease." ue find a more difficult field--difficult the standpoint of administration and nl interpretation; and difficult from taudpoint of the doctor and the cu- Hut has there not keen too much loose thinking on the subject? Wc are met with a curious situation. Wc find the advocates of so-called '`all-inclusive" statutory cover age deliberately seeking indcfmitcucss. This is unlike them, for when they know vvliat their objective is, and are willing to dis :it is disease? We think wc know, and .st to laymen the term conjures up : minds somethin:' of a rather defi- atnrc. W hen vve pause to consider it, irse, infinite i|ualilicntinns of the term to us. and vve are confronted with conditions that (all into the /.one of -such as. for example, whether lier- a disease. At any rale, wc say it is -normal condition, and let it go at close it. they have not refrained from press ing their advantage with definite ami spe cific purpose, and with exact language to accomplish that purpose. That, at any rate, is correct legislative procedure. Hut in this field, even where the liability of tin: employer is made inescapable, the voiislant suggestion is put forth that it is futile (or the legislature to attempt a defi nition or delimitation of occupational dis eases, and. therefore, words of the most when we come to arid to the donhlin "di-ease" the even more indefinite iccupation.il" or '`industrial," uc find \es in an area '`of highlight surcd hy a vast and increasing zone of 'it shading off into Frcbiau night, "iw then shall wc define the term ilinnal disease"? e diseases stand out in our minds as and definitely occupational. As to > ha'vc no great difficulty, cither leg general character should be employed, leav ing to the courts the interpretation of the law as they sec fit. 1 submit that it is not tin1 function of the courts to make up the legislative mind; that is the function and the right and the duly of the legislature. N'or should I lie legislature seek to avoid and evade responsibility by transferring to courts and commissions the determination of question* of liability which the legisla ture finds too dillicult for it to determine for itself. CA'l nj'tllli/nu, ///.,. use il'.' To effect coverage under the compensa tion law, Ihvrefoiv, hv any slicli gcncial and vague language as the term "any and all ovi up.ilioiial diseases," or hy adding to the definition uf "accidental injury" the phiase "and shall include occupational dis eases." is to civale an uncvilaiii liability - one that may mpiirc endless ami pci haps disappointing litigation - -before the meaning of the law is established; and will most cvilaiuly In- a dis>i rvicc to workers and employ vis. , An excellent rule--a cardinal rule--in statutory drafting, is to Use words of defi nite, certain and understandable meaning, used in their common acceptance, rather than to resort to vague, uncertain and meaningless words, or words the meaning of which may have the clTcet ot distorting the objective that is sought. Controversy is bred hy uncertainly of language, and controversy leads to litigation in courts. Litigation is expensive for all parties; it causes delay; and it frequently causes bitter disappointment. It breeds rancor. It may even breed disrespect for the law and for orderly process of government. Why then shoii^l there he this continuing demand for the all-inclusive coverage? Is it with the vague hope that satisfaction may result in some cases of misfortune to workers who fall victims of the disease that Lcscts us all anrl lurks in waiting for us in our play, in our homes, yes, and even in our sleep, as well as in our employment? 1`cihaps not--yet if that wire the design, a more simple way of succeeding in it could not otherwise he contrived. Are wc to understand that nny disease of the most common and ordinary risk of life may become an occupational disease it its source or supposed source had its origin in an incident of the employment or a con dition there present, or if claim was made that a pre-existing disease had hcen ag gravated hy such condition? That is a large order. It would mean that industry would hecomc liable for nuv ordinary di-ca'c of life, provided that disease could he, with a show of plausibility, related to a condition or incident of the employment. Such diseases arc almost too numerous to enumerate. Hut we know that claims have hcen made for tuberculosis and heart disease, the two most uuuicriuis diseases and the cause of more deaths than any two other diseases. Add to these pneumonia, asthma, arthritis, rheumatism, and a host of other-; and ur discern in this the beg inning of a sysl.-o of_ health iii-m.inec of the 1110-t cmlly type a sv-tv in moicovcr that would discrim inate hitleily again-l the many millions who coutiucl siieh di-cases in pel haps ac tually the* saint* vvay, Imt who have no vmploy un ut at all against w hich to us-css |i.i hilily. Should not the man who falls vic tim to a di-case ol tntlmaiy tile* while searching for a job he ju-t as much the con cern of the stale as the man who becomes disabled from the same disca-c ami who is so fortunate as to have a job? f.et us lie realistic about this thing railed health! . Ill health is a deviation from the mirnial. Hut what is "normal?" How great a devia tion is abnormal? Disease is of many ami varying degrees. To vvliat extent docs the mind affect the working status? Or what part in the situation is played hy "will power"? These arc not fanciful questions, they arc encountered and will obtrude themselves continually in determination of compensation for disease where vve dc'eirt from the known and characteristic occt na tional diseases. y From these remarks perhaps some will say wc arc opposed to coverage of occupa tional diseases under compensation law-. Not so! The stock casualty companies represented in the Association have not op posed and do not oppose the principle of compensation for occupational diseases, if thereby is meant compensation for lliu-c diseases that arise from a "trade risk." or from conditions that arc normally and usu ally present in the particular employment, as distinguished from those ui dinary hu man ills that beset all of us. Our view of it is that the policy of coverage under the law is a matter of local concern, to be de termined by local legislatures in the light of local demand and with due r ;aid to local opinion of both lalnu ami industry. No employer in this age van re.ison.-blv object to fair compensation for disv i-e arising from such occupational ri-ks, . nv more than lie can object to reasonable cifi'i- pensation [or disabilities due to aceivlen,.d injuries. - This conception of industry's obligation is, however, quite dificicut from the ionccplion of a public obligation to care for I I I Silver Jubilee Safety Conqresx hI rompm-alr -ill -iikufss ami death aclerislically the obligation i^f industty, hi. r ;t hum tit lic.illli ami lilt' in-mamc. why conliimally insist upon the ii-eof lan hr lallrr obligation, il it 1*0 a vali.l imc, guage. which is susceptible of misiiiteipre- llir iililitiatii.il til tlit* stale anti Ihe n.ilii.ii tatiou? He ttell assured, if legislatures do iml flit- ..Miralii.ii nl industry almn'. not perform their duly ami lay down clear Tin- rca-on.ihlc. I lit" inti lligcnt. llic sane av inr iinlii'-iry In di-chai re its obligation ils uoiktrs inf fi.iulili.nij i>f lic.illli is pr.>viilc inr tlic greatest reasonable re:rtiihi11s inr intlii-.lri.il hygiene, anil In niilc compcii-alinii mily fur those con-. '.ii*11that arise irnin >pcciIic: iiamcil tli<-c< that arc truly neen|iatitnial, charac* i'tit* nl, ami |ifruliar In lltc provv-se-. in dcliiiitioiis of liability, industrial hoards ami commissions cannot in the presence of the union's, orphans, ami industrial cripples, ht expected to exercise greater courage than the-legislatures. The law in the hands of such an administrative bode nil] he .scanned, and f fear scanned in vain, for limiting nurds or language to stay the hand of industry's self-roustitutcd almoner. .nil the worker is engaged. The legislative trend, I am happy to re Imlu-try will. I am suit, meet the dial-i nf tint occupational ilisrasc |irnhlcin. it is pri-st nidi uniter a laic that pro tins the liability of iu.lii-lry in umler.ii.lalilc terms. In the early day-, I lie mit.iI rule ivas In inelntlc occupational ea-cs in the enni|icns.ition lau liy specify the particular ilisc.isc-s or the particuetintlilions leading to diseases that arc nifil to he neeup.itinual and compensable. no call a "schedule" late. It is the in in iihicli comptiisatii.it lor occupai.il di-ca-es is covered in all of the mlries of Kurnpe and of South Amcr- It is so simple; il is so sensible; it is a-ili administered, that the icmulcr is t the acceptance of the principle is not i cr.sal. i ice nil! keep ever before uj the prinlv that a disease, to he deemed occupa nt, must he "characteristic of and pcur to" the occupation, there should he -rent diiiiciilty in arriving at a proper ulory setup for the coverage of all lute upatinnal diseases. Metallic poisonin.es characteristic of occupations in ivliich h tucl.ils are u-cd. The di-c.l'cs tharac- port, in recent years has been loir aril the definite, rather than the imlclinilc. Despite tremendous pressure, no legislature has, in the past three years, adopted a hliml, "all-in clusive" occupational disease law, except New York, of which l shall speak more in detail presently. Michigan, Rhode Island, Pennsylvania, Delaware, N'orlli Carolina, and Washington, among the states most recently enacting occupational di.sca.-cs laws, have adopted the `schedule" or -perilie method of coverage. Ttio y ears ago, Ohio amended its scheduled occupational disease law by adding dust diseases In its existing schedule. In two other states, namely, Illi nois and Indiana, occupational disease laws have been enacted ill gem ral terms. Iloucvcr, in identical language, these two stales have undertaken to limit and Mi-fine occupa tional diseases and have attempted therein to safeguard industry againsj liability for the diseases of ordinary life, o' Although doubtless familiar-'tsi many, ihe definition in the laws of those Two stales will hear repetition, as indicating the ex treme of ilillirnlty in attempting to exactly define an occupational disease. -tic of chemicals, of acids, of alkalic-. "See. 6. In this Act the term Oeeup.i s and fimies, aie rharaclvri-liv of ami tion.il Disease' means a disease arising out diar to those occupations in tihiclt the of and in Ihe cour-e of the employ mi nt. loiccs arc so exposed. The diseases of Ordinary diseases of life to iihicli the gen respiratory system, due to the iuhala- . eral public is exposed outside of the em of dusts, arc the natural accompaui- ployment shall not he compensable, except 1 and the characteristic effect of work uherc the said diseases follon as an in nil dusts. cident of an occupational disease as defined hln such clear ami specific language is in this section. able, it lie should ivc lie asked to use "A disease shall he deemed to arise out e, hroad terms, the use of which may ol the employ incut, only if there is apparent ituic the giving of a blank check by to the rational mind upon consideration of Iry? If the purpose is not to charge all the circumstances, a direct causal con try with diseases which arc not char- nection hrlwccil the rnmlitioiis under 'illicit Oceufatiomil liisease ' 215 tin: milk is performed ami the. occupational ili-e.ise. ami uhiili can he seen to lime folltined as a n.itmal im'ideiit of Ihe umk as a result of the exposure occasioned by the miltin' of the employment and which ran he fairly traced to the employment as the proximate cause, and which does not come from a lia/artl to which ivoi kitten would have been equally exposed outside of the employment. The disease must he iiieideiit.il to the character of the business and not independent of Ihe relation of em ployer and employee. The disease need not to have hern fore-cen or expected hut after its contraction it must appear to have had its origin in a risk connected with the em ployment and to have flowed from that source as a rational consequence." Duller this definition no industrial man ager ran, with any assurance, be informed what bis obligation is to his workman, and assuredly no workman suffering from dis ease can surely know whether he is cntitlcd^to compensation under that law. Of course, as is lo be expected, litigation over the interpretation of this definition is al ready in progress in both of these slates. And situations will arise constantly in the future where the facts will he such that only litigation in Ihe courts will determine the liability of industry, or the right of the worker to be compensated. The claims actually filed iiilli the In dustrial Commission of Illinois already include iiiKlulant fever (a disease said to he commonly communicated by milk and meal products), tularemia, rheumatic fever, arthritis, rheumatic heart, heart disease, amchic dysentery, varicose veins, Hat feel, athlete's font, cerebral hemorrhage alleged to be line to overwork, syringomyelia, and neric disorder. I ban- not mentioned the claims for rharaclcri-lie occupational disea-c-, such as silirn-is, carbon monoxide poi-oning, anti Ihe larious oilier toxic con ditions iiliich clearly come unJer Ihe Act. 1 have referred to the fact that New York, alone, has in recent years enacted a law covering occupational diseases in gen eral terms. New York was the first state, I believe, to enact an outright compensation law, for occupational diseases. It did so in 1970. The law was a schedule type law. (It so happens that I had the privilege of being one of those islio collaborated in the draft ing of that law.) We siere dealing nilli a m is -object. We I'xnintivd tin- i xi liie; Ians in otbii lotmtriv- and adnpti d tbc fttriti tlial -t t iiu-tl bc-t atlaplt tl ;r, our eon (lillous, iiaimly, the I'.ngli-h lau on ntviip.itional di-ca-es. Ihe stlndnlr sta-, fmin time to lime, enl.ii geil as new iudii-ti ial procc-si's dcvcloptd nets ili-e.i-e-. '>y IWf the schedule had been enlarged tit iniludf every disease that was a iiolenti.il 'hazard to the ssorkers in New York Slat, nidi the single exception of the dust t, sta-es of the lungs. In order surely and certainly to bring such rontlilions ssilhin !l c pur lieu of die law, then: uas ciiactci! an ad diliona! item in the schedule, reading "am and all occupational di-ca-es." The -ehitlule was not repealed, anti the adiuiui- alive provision* in die laic \s ilh respect to the .schedule were continued. One of the hi-t questions that arose under this new lau was uliether the new classification super seded the schedule and the limitations set forth therein, or whether it was an addi tion to the schedule and applied only to those conditions not previously included therein. The legislature, having evaded the duly of defining the term "occupational disease," the Industrial Hoard, which administers the law, adopted a definition. That definition is well worth repeating: that the Hoard deems a disca-e to be occupational only ii lien it is "characteristic of and peculiar to the trade, employment, or occupation" in which a uorker was engaged. This delinilion was adopted almost verbatim in the Rhode Island anti Michigan I.aus The Appellate Division of the Supreme Omit, lumever, declined to follow il, ami by a vole of three to two, held that uuy di-va-c that arises out of a condition iuridculat to the employment must he deemed lo be .in occupational disease. v's. Corner K* JSI I )i \ isiiiii, -I9J; I ioIiIIht t; vv `>>4 M.tfvj lion, JSl A|i|>cIl.iie |)i\i>ion, 901 ) The Goldberg ease uas appealed to tlie Court of Appeals--the court of last resort in New York. So completely tin the faeliu the Goldberg case bear nut uh.it 1 liaie said about indefinite liabilities under an allinclusive law, that they will hear repetition. Shirley Goldberg was employed lo sell tickets in a moving picture theater. Her booth was on the sidewalk, ft was kept healed, in cold weather, by a small electric healer. oper.ili.I fr.,..* - * ' ' ` '  / nth. Stic contracted what slit; described . Motrin'* or a r.vdi on her leg*. The mtehes or rash she clainicJ were tine to. ic allrrnatc healing and chilling of her g* u hni 'lie switched on or olf the heater, hey diil not cmi'lltntc a disability. IIounr. on complaint to her employer, she was iltl to see her doctor. While on her way ability follows immediately, and in which prompt report to the employer is made. This is not far different from'{he rule in regard to hernia ns an accident. Hut in Xciv York, during the past ycyr, it ha< become somewhat the fashion id regard almost every hernia as cither an accident or an occupational disease. > see her doctor, on her own time, she. lipped on the sidewalk and fell, fracturing >i ankle. Although the rljy was cold anti r testified there was ice ami -now on the Icwalk. the claimant alleged that *he fell l.-ly due to weakness re-rilling from v-o lilotchc*. and I he Industrial I'.oanl inuiiil; ami foiuitl that the ruii'C ol the ill wa> an ot'eiipalioiial disca-c, ehaiaelt i lie of amt peiuhai* to Ini ciuploiincut. The Uomt of Appeal*, in an opinion that islles with Ionic ami .sound sense, struck i' free-for-all system from the language ; the Xciv York Act. They unanimously iii-eil to concede that this was an occu- This followed on a decision of the Court of Appeals, sustaining an award for hernia as an occupational di-ca-c whcrciif the In dustrial Hoard specifically found that no accident had occurred. In the ease pre sented, the worker was required, in the course nf hi* employment, at freqmnl intervals, to rotate his body on the hips. This man was employed in a glass factory, lie gathered innllni glass on the cud ol a puutiy, which he, in Hun, swung about and placed in a mold. The weight was not excessive, being only a matter of a few pounds. In alii ruling this awaj-d, the Court of Appeals said: , itional disease. To make every disease at nro.-c out of and in the course of cmo\ mint compensable as an occupational ;sea*e. they said, would he to make the mpeitsalinn law "the equivalent of life mI health iii'iimncs'.'' The court further id that to he- "occupational," the disea-e list he one which "results from the naic of the eniploymenl": and that In nare of the emplii) meiit is uuant--condition* which all employees of a class arc .subject :d which attach to the occupation--"a /aril which distinguishes it from the u-ual >t of occupations, ami is in excess of the zard attending employment in general." "The finding, supported by evidence, is that the continuous gathering and lifting of glass from a furnace involved a constant twisting and straining of the body. This process, from gradual stretching, resulted in a hernia which is a disease (Mailer of Alpeit vs. Lowers 22.1 X. Y. 07. 101.) There is medical testimony that claimant's occu pation would produce this disease and there are judicial decisions in other jurisdictions holding that hernia is an occupational dis ease (Marathon Taper Mills Co. vs. Iml. Comm. 20.1 Wis. 17; Travelers Ins. Co. vs. Lorke 50 I'cd. (2nd) HJ, -14-1)." (l'ti.-rcr vs. CillemtiT nrn[hrri Inc., 2/S X. Y. i ..tltllicri: v-. 9s4 M.-ircy Corpor.niun, dccitlcl J4.S 16 X. E. .'ml .160.) t, l.inn.iry II, I9.IS, .suit rc|torlctl in 276, X. V. It 1 2 X.K. 2ml. 111.) Perhaps the most controv*eirrsi.al questi.on Thus, after more than two years of at uncertainty as to the meaning of the c. the Court of Appeals has eliminated un the New York Statute the disease* ordinary life which are only incidental spcculatiicly related to the occupation, involved in occupational disease legislation is the treatment of liahiliticy^Tor dust dis eases of the lung*. In no.class of case* is the marked difference between accidents arising at a given time and place and occu pational diseases more pronounced. In this category of rases, we find silicosis, anlhraco- lust a word ah.itil hernia as an oceupa- silieosis', and asbestos!*, all of them form* nal tli-ea*c. Never heretofore regarded of pncumuuocouio.'i \ While these disca-e* an occupational di.-rasc. but quite gendly rccogui/cd under certain circiimnccs as an accidental injury--the Occuininl Disease Law of Michigan, enacted in some of their forms arc among the most ancient, their ravages having been rec ognized generations ago, little has been known until recent jears of their causation, t year, specifically included hernia in of their pathology, and of their complica schedule of diseases. Not all herniae. 'ever, are so included, hut only those trlv of recent origin, as to which dis tions with other diseases. A vast fund of knowledge of these diseases has been gath ered in the past ten years, and intensive i Yt'l/y il/iOlU'- I'lSi . studies of their etiology and pathology are Mill going forward. industry who may have in the pa-.t in curred some degree of fibrosis of the lung*. Hut if industry cannot assume these liabil One fact stands out clearly, and that ities. how much less justification i\ ihcfC is, that these diseases do not progress to to call upon in-iiraiuc, out of the premiums the point of disability until after many of next rear, to pay for disablement- ac years of exposure to dust. The length of quired over the past fifteen jears, and time, varying from five to twenty-five or for which it received no premium? more years, is dependent in large measure upon the concentration of dust, the compo-ifinn of the ilu-t, the time actually ex posed dining winking hours, and the in dividual susceptibility or ijesistancc of tinworker. Another fact th:(l stands out is that tin- fibrosis of llie lungs, once ac quired, is permanent and incurable, and, in uncomplicated eases is not susceptible to nit-dical liealmiiil. Many (hoitsaiids of wutkers today, under no law hut the rouunon law, have been employed in employments exposing them to mine or less heavy concentrations of dust for many years. In the event of the enact ment of an occupational disease law in cluding those diseases, industry will find itself, at the stroke of a pen, liable for conditions already acquired through long years of employment, and which may be come disabling at any moment. In this sit uation, the best guaranty against disable ment is continuous and steady employment. Many a man, actually able to work and earn good wages, while he has a job, will he able to demonstrate by x-ray and clin ical examination the presence of a marked degree of silicosis, when bis job stops because of depression or otherwise. Hciicc arises the question of the so-called "accrued liabilities)" This term which has Come into common use is perhaps not an exact term, in that "liability" docs not occur until disablement, and the liability In this difficult situation, it has been found necessary in many stale*, if em ployment i* to be continuous and uninlrr rnpled, and if men are eventually to ! compensated (or the fibrosis acquired due to fiiI it: exposure*. to ahsolic, to a great extent, industry liorri the obligation of compcn-alion for pa*l exposures, and to lei.e compensation upon the extent of expo.me ailer the cti.nlrin nt of an ociiipalioii.il disease laiv. Tims, tbere has come into acceptance in several stales the principle of graduated compensation benefit* for dust disease*, limited to future exposures, and eliminating in large measure the ex posures of the past. Under this system compensation for dis ability or death occurring during the first month under the new law would be only a nominal amount (it ha* been set a* low as $500 to start with). A person disabled during the second or third month after the enactment 'of an occupational disease law will have been cxpo-cd, to a small extent at Ica-t, tinder that law.' The ex posure is perhaps in itself insullieient to actually result in any harm Hut the max imum benefits will ho increased, month by month by small increment*, until in the course of two or three years the full limit chargeable to industry in the particular slate will have been readied. This system is not so complicated as it might sc in. is only "accrued'' at that time. What we The effect of it is rather to pox Ip, me the have in mind when we discuss accrued going into effect of a ilusl disca-c aw for liabilities is the condition of fibrosis of a matter of two or three jvars, and experi the lungs which has accrued and has been ence under this law has dcmon.xtrati ' that acquired our a period of years. This lew claims ari-c where the compi-c-alinii condition, being permanent, remains with henclils arc so limited, the workni. pie the worker, whatever and wherever may he lcrring to slay at work as long a- tin;. his employment. Perhaps a more exact carl. It may be said that it works har-hli expression would lie "potential liabilities," in the case of the person who become* and yet they arc more than potential; the really totally disabled in the caily months condition giving rise to them is actually of laiv. When measured by the liabiliti existent. with which the employer may fairly hi Industry tells us quite truly that it can not now pay full compensation out of cur rent income to all of the men employed in charged, it doc* not. in fact, work a hard ship, ami when compared, with the exist ing system in stales not now under occu- disease laws, it not only is not .1 li.iriKhiji lint is. in fact, a ffrrnt hoiin. Tlie principle of limited and Kr.vliulcd li.diililv of tlie nii|dnycr for du-t diseases lias lieen rccoyiiizvil liv enaclnienls in N\w VinU, MietiiKan. I'cmisjlvania and Oliio. \n miii-ital lnovishiit lias lieen adnpled ill die slate of Wa'liinytnn. |in>viilim; under llieir selivdiile form of law llial tlie rod if eiiiii|M-ns.ilioii lor oei n|i:itioiiat diseases -hall lie divided vi|Ually lielneeii tin* -in I'lover and tiis vvoilers, and dedilvlions hall lie nude fiom the employees* uaees as eoiiiiilnilioiis louanl the hr.ni after preiniunis involvid. terest must he given to industrial health. The care for the health of the worker must not be confined to thy guarding again-t those conditions that are mentioned specifically in the law. Tlie engineer's re sponsibility is a broader ri?xponxiliilily Ilian is tlie legal liability for ronipiiisatimi. Tlivic can he no doubt (hat the enumeration in ilie law of specific conditions for vvhiili liability is absolute will he of great ad vantage In the industrial engined* in seek ing lo culorec pmper health slamlariK. It is far easier for him to obtain approval of his recommendations, if lie ran point out lo management that the use of hen/ul or lint vvliat, \on Inav say. Inn all this in some lieu/.ol derivative is specifically men- lo se ill* llie silelv eiii*imer? tinned, and point lo the xpeeilie. paragraph It has mill h. The safely viiy.ineer v an in the law that cite, the liability nl the no hmeer leeatd li ini'd I as ilnim; his employer for (hat rniidilinu. No argument ioh if lie siehs mile wavs and means to is needed to eonvinee management of it* eliminate the industrial aeeident. The in obligation in siteli a ease. dustrial liv yields! must heennie the c olleague The same is Inn- with rcgaid to all of of the imlii'lrial eitj;iiieer. Medieal seivne'e the metallic poisonings and all of Ihr other inn 'I yive intensive tlinuyht and study to wide range of chemical exposures. Psycho ih terininiui- the elVeets u|ioil the human logically there is great power in the printed system of various iudu'liiut puitesses, and word, and even the most backward manage exposure lo various materials therein. All ment may be made to respond when the exposures vannot he eliminated and still have indiisirv perfotin its functions. Most clear mandate is set forth ill the law. .Not so easy will it he, under a gem nil, vague, important, therefore, is the medieal deter and all-inclusive occupational disease statute, mination of what are safe limits in ex to convince management that it has specific posures--the so-ealled "threshold limits." duties with regard lo the elimination of The engineer cries aloud today lor expert health hazards. Thus, we see there is an medieal giddanec on this subject. Armed other and potent argument for the schedule with siteli medieal opinion and adviec, the taw, rather than the all-inclusive law. fa-k oi the engineer then is to devise prac tical ways and means for attaining condi There is perhaps yet another and oven tions where such threshold limits apply. more compelling reason for applying the Kverv industry presents a problem or -erics of problems in itself. No two in dustries are exactly alike. What is tolerihlo in one may he intolcral.de in another. What is good practice in one industry may be totally inapplicable for practical reasons in another. The task of the en.incer then i< to find how right principles nav he made applicable. rule of sanity and coinnutji. justice to leg islative mandate in the complex field of occupational disease. Slialt employment he limited to those who are physically per fect? All liunians are not examples of physical perfection, nor can-',we by legisla tive fiat reverse tlie laws of nature which immutably decree that wc shall grow older with the passing years. We luve seen ami discussed the dangers Industry today, 'more than at any time inherent in the all-inclu'ivc themy of in its history, must bear the burden of stretching the lave lo cover every sort responsibility for the health as well as for and condition of disease, and to try to the safety of live industrial worker, and if make them employment-related. When that !is health and his safety are adequately stretching is complete, when administrators -afeguarded his happiness and the happiness of the law find it easy and possible lo if .those about him will be increased. There burden industry with the responsibility of fore,. it is of prime importance in the field health insurance under the guise of an `jt safety that intensive and increasing in occupational disease statute, what of llio><. who. wanting employment or seeking to re tain it. arc not physically perfect yet cer tainly arc not disabled? Much is heard today of the dread fortyyear-line for employment. Whatever the facts may he as to that, is it not possible- if not prohahle--that industry, in despera tion and against its desiie, will he foieed evenlu.illv (o accept only (hose among whom the health lia/aids are hast iiiirrrlaiu- the phvsieallv pet feet, the young ami the strong? \J'v may well pait'r to run sidyr the devastation such a siijatimi went.; produce. . In the interest of all workers, the young and the old, the perfect and tin iiupcrlev'. hr us not 'embark upon legi-lali.'c policiv - that can hail only lo enlarging the field of unemploy meul, and lo closing the dooi of industrial opportunity to llio-c skill, d and faiilifnl winkers who, having pa-st.| Ihe nitii'li.to of life, a ir -uh/i 11 to lbo ualiiiul infii inilirs and ills of the. Ilv-li In which all men, in four, umst Ih,u. Handicaps in the Diagnosis of Occupational Diseases Hy CAIIKY 1*. McCOUl). M I). Detroit, Midi. I( i" a popular medical belief that ocenpalionul diseases air lur mint' dillicult to rec n;.*ni/i: and prccisi-ly to class as such limn any other type of disease stair. So firmly is this iiha rooted in the minds of some physician* lhal tlu-y argue that nccupa- lionat diseases never should he made com pensable because of extraordinary diag nostic diliicullie*. ' l.alcly, Kettering Inis said, "The doctors Icll us (here ate certain diseases that arc incurable. Do you know what an incurable disease is? It is one that the doctors don't know anything about. The disease has no objection lo being cured at all." This may he paraphrased by saving: There are no njidiagnosahlc occupational dkea-cs. The only ones that appear tnjdiaguosaldc are ttic ones the physicians have not learned bow lo diagnose. No occupa tional diseaNC lias ever offered any resis tance of its own to being diagnosed. The disease is perfectly willing to he diagnosed. At least one-half of all occupational di seases are ahno>t .self-diagnosing, particu larly when arising in groups; the remaining hall present no greater difficulties than attend the diagnosis of some other classes of diseases. To maintain that occupational diseases are beyond the diagnostic skill of the physician is pure defeatism. With equal propriety, it might be suggested that all neurology he abandoned because the ma jority of conditions arising in this field may not he diagnosed with ease. While it may be said that (here arc no UiidiaemiN.ihh; neeupalional dKra <| tint. hi* recognized that many j-m;:in nndia iioM'd, <>r more ollcii mi'diagnost d. IT pi inn* rr.i'-iMi lor this is lhal the U'ii.< physician 'iv** onU small nuntlii of an out- l\pr of occupational di>ea-c. Tnkin Ohio i> a I > picul industii.il stall, the torn number of occupational diseases, omptn able and otherwise, repoitcd to ..*: Slat Di pai tim.nl of llcalth dm in.: the \r:ir lr)' was I.Ofrf). On the other hand, ihr:c me ! this slate `^(M) physicians. Thu*, only "n-| occupational disease arose for every 5 doctors in the .slate. Here then is the foremost handicap i*, the rccoirrirfiiio and diagnosis- of o* eu/. tional diseases and at the same time hack handed compliment P> industry. ! dustry, because of its pievcntinn m hit v ineuls, has m> limited the number of %% cupational diseases that da> by dav |l physician is ordinarily not spurred to tl possibility that any worker who seeks h professional guidance max have a disease occupational origin. Here, too, is the fund* mental reason why more medical sclio*. do not develop training department* in tl livid or organize special hospital 'cm u for tlie care of occupational disease \ tients. While there are icasous for rejoicing ib. there are comparatively so leu occup.itim diseases, wc should recognize tl* *t th arc specific situations which introduce di nostic difficulties. A number of these . noxe presented, as separate entities. '.,.<i i ...i Definition and Terminology uncertainty that this condition represents a Mwlt confusion is caused l>v lack of characteristic occupational disease. :'iii-irmilj' and clarity in definition Scarcely :n tun states in their statutes accept (lie line ilelinition of an occupational disease, i a few stales, hernia is !>y law s|ccified - an occupational disease. However, in llic i.ijnrity of states it is, when related to inlu-try as a cause. classed as a tiaumatie ijme. Ill a fcie stales, (lie definition of u occupational disease inovided hy statute such that I'l'ilain items later appearing n liedides themselves do not conform to f definition furnished. Well meaning legislators might enact a in1 declaring that (Vo and two make seven, it the mathematical facts still might rr- i.iin otherwise. So with legislation in-. living occupational disease diagnosis, there av In: ill-mauds for legal acceptance of rtaiu conditions as occupational diseases, hen elementary medical facts point otlicri-c. One group of phv-icians may reserve e term "injury" for exclusive u-c in con'Ctimi with trauma, while another with fopricty may assert that occupational disises of many natures represent "injury" the same extent implied hy the term mutualism." Between these extremes, tliirc is some point at which difficulties would arise in distinguishing occupational diseases from accidental injuries. This same situation ap plies to many other liili-lanccs and many oilier occupational diseases. There is per haps no warrant for any attempt at a hard and fast demarcation in terms of .time, in dicating where an accidental injury expo sure leaves olT and an occupational disease expospre begins. However, there may he some justification for the practice of many physicians, who hold that if the exposure leading to damage is less than one work period, the ensiling injury should he recognized as an acridont. Conversely, if the exposure period extends (or more than one work period, then the resulting damage may with propriety he ac cepted as an occupational disease. In gen eral, it may he claimed that one of the disturbing handicaps to uniformity, clarity, and precision in connection with occupa tional disease diagnoses stands in relation to awkward legal situations, inadequate defi nitions, unsuited classifications and such. Let us consider, for example, the occur- Fallacious Medical Histori.es iice of an accidental injury on the one md and a clear-cut occurrence of an ocpaiioual disease on the oilier, hnlli caused As a result of rare fill training, every physician is disposed to attach significance to the history statements given hy a pa mi one and the same substance, hut tinder tient or members of his family with re lie-rent circumstances. It might come gard to any disease. The less a plit-iciaii nit in a given factory that a workman may know about the possible etiologic facts ii'rrd a lank car, lately emptied of hen- in any situation, the more consideration he I. ami in the absence of suitable protcc- is likely to give to history^sfatements. It c and precautionary measures might, is human nature to associate alt of our thin ten minutes, become asphyxiated as ills with some particular happening or series result of hrcatliing benzol vapors. Mnn- of happenings. A cold may^he associated -lly, such an occurrence as this would with a particular period of silting in a nercplcd as an accidental injury and no ihnft. A gasti'O-inleslinal iipcVt is prone to mpvnsntion hoard would ever raise a lie associated with some particular nlco- e-lion that such was not the ease. .holic bout or food engorgement. 'tn the other hand, this same benzol. :en from this tank car, might be utilized ibis same factory in sonic productive '.ration, giving rise to heuzo! vapors. Day day, another workman might inhale some these vapors. In due course, this work ''"lire might prodnre the usual and rartcrislic features of that occupational ease known as benzol poisoning. Here 'in* it is most unlikely that any physician compensation board would entertain any In the case of industrial workers, there i- an especial (ironcucss to associate any Lo<lily ailment with some aspect of work. Inasmuch as almost every workman hopes, openly or secretly, that any and all dis eases from which lie may suffer may lie laid at the door of his employer, he is most likely to stress and emphasize the high probability that this condition unfailingly was produced by the chemicals, gases, va pors, dusts, etc. that attend his work oper CA. iifull itul L>i.ii'Uj,' alions. This docs not necessarily repre sent dishonesty or cupidity on the part of the patient and only may involve those hu man frailties shared by all of us. h'o less, the history statement may un duly influence the physician in his diagno-is, may lead to mi-diagnosing, may pave the way for unwarranted claims or law suits without any evil intent on the part of the physician. It is most unfortunate that the physician is all too often unable to appraise the worth of,Avork history statements pro vided by a patient. Let us, for the moment, assume that a specialist in car diseases is visited by a patient on account of deafness. hi connection wit It the history, the physi cian.may record that this patient is a drop forge operator. The physician may go ahead and make many careful examinations, looking for the cause of the deafness, from iniection, from syphilis, from heredity, etc. if, however, he had obtained a complete work history, and was in position to evalu ate this work history, he might conic at once to know that this drop forge operator is perhaps exposed to ns much noise and con cussion as ever arises in ordinary indusT tria/ work and that the deafness present clearly is an occupational disease, resulting from sustained noise exposure. It may be asserted that well meaning physicians, without any evil intent, through their misunderstanding of patients' descrip tions of work operations have become re sponsible for a high percentage of the large number of unwarranted suits that have flooded the country in recent years. In short, one of'the handicaps to the proper diagnosis of occupational diseases is to he found in the attaching of undue significance to the patient's statements as to work con ditions, when the physician himself is un able to appraise their reliability and merit. Some physicians need to make themselves more remote to the fallacy that just because a workman is employed in a dangerous trade, inevitably any ailment must neces sarily be the result of work exposure. There still may be a few persons who may believe that lead poisoning ntay arise from work in making lead pencils. Time as a Handicap in Diagnosis Too often the physician well qualified in the field of occupational diseases, does not see (he (ialien! or claimant whose condition is to be appraised until long after tliat time within which the disease might have been iliagqoscd with precision. _ Without any puipo-c of condemning or finding fault, the fact mlist he faced that in many in stances the decision of a patient to Idaim. his ailment on work causes was not made within that period when some or all of the characteristic manifestations wcic pres ent. Then, at some later time, a physician qualified in occupational disease work ma. he called upon to examine the claimant ui to reach a decision based upon the exam ination of inadequate records of another physician who himself did not carry out any examinations with particular reference to that occupational dista-c for which a claim later has been filed. This is asking too much of the diagnostic ability of any good physician. On the witness stand, the charlatan al ways makes the better impression on a jury, because lie is unhampered hy the caution and reserve that guide the up right witness. Being positive is often merely a matter of being wrong in d loud voice. The point is that the time to make a diag nosis of an occupational di'ea-c is ilia', period during which the disease exist-. Otherwise, the most accomplished physi cian may be placed in an unfortunate po sition in the reaching of his decisions. Insufficient Training and Experience An outstanding drawback to li e propci diagnosis of occupational disease; may be found in inadequate training in . medical schools for this aspect of medical work. This is not a thrust at the doctor, :.or may any complaint he made against mci *al ed ucation today. It may not be expected that medical schools will markedly enlarge an already over-crowded curriculum to pro vide extensive instructions witii reference to occupational diseases when '.lie numhci of eases yearly is so small ns in pi.-vide only one tor every five or six phi -icianRcalizing his own shortcomings in this field, a good genera) practitioner may hon estly shun this type of work, bui this step on his part may eventuate in c cn more undesirable situations.' The patient, instead of being referree to a belter qualified physicist in lie- field is given no advices, w hereupon h grai i .'tii/zxr Jubtin Sti/Hy t unyrcss ti:< toward an inferior physician, less conrnril with the lack of qualifications. The cut to which lack of qualifications in ocI'.nional disease work may 50 is reflected the fad that recently a duly licensed :\'ician in the Slate of Michigan reported nti -tinal pcristal'is" as a diagnosis of ait .cupatioiial disease. W hile the unwillingness of a phjsician to cept re-pousiliility for pathologic stales nli which ho is not conversant is eoni lulalilv, there still remains a duty to di et his patient into channels wherein adcinte services may he procured. of the chest of this workman may strongly susgest the possibility of silicoses, nowhere on the work record may it be Shown that for a period of seven years at some much earlier time lliis workman was employed a* a laborer in a pottery fn this same connection it should be em phasized that one of the many handicaps to the physician in making an accurate diagnosis is to be found in the widespread practice of hospitals, of clinics, insurance records, etc., in merely naming the trade of a workman rather than describing his exact occupation. It is quite insufficient for med Industrial 'Terminology One of the most anno) ini; handicaps in -tahlidiing the exact etiology of a possible .cupatioiial disease resides in the wide-; read practice of industry in using code .minds in the designation of its substances. 11 inquiry, the patient may state to his i\-iciau that his work consists of fillin'.' 'iitaiuers with "I1-72." Hut, inquires the issician, ''What is B-72?" The patient ical purposes for a record merely to show, for example, that the patient was employed as an "automobile worker." Under this heading, there are perhaps not less than 200 different and dissimilar types of em ployment leading to different exposures; such tor example as to silica in the foundry, cyanide in the heat treating rooln, chromium in the plating department, lend in body fin ishing, and on and on. anilines, "11-72 is a mixture of M-20 with Lack of Library Facilities . 10 and 1.-07." Completely the physician hit in the dark, lint ii the truth were >wii it might he shown that this patient a- engaged in the filling of cans with a irnish remover, which consists of a mix- With some temerity the statement is made that regardless of many hunk publi cations in the field of industrial hygiene and occupational diseases, special maga zines, and articles appearing in general ire of wood alcohol, benzol and a syn medical magazine publications, there is, at dic wax. this time, no condensed, informative ma Such situations may become so coufus. terial mi occupational diseases well suited e that it may he almost impossible for to the needs of the family practitioner. c physician to obtain proper in[01 notion It is of course impossible and undesirable to work exposures. Medical, safety, so il service or insurance departments all ay have diliieiilly in obtaining full in- rnialiim as to actual chemicals and mix ies of chemicals designated in production 1 rations only bv code iiiunhcrs. that any attempt should lie made to reduce all of the lore of oceiipnlion.il diseases lo some lliiii book to which the prartiliouiT may refer and with certainty obtain all the guiduiici: needl'd in Ihc trcalmqit and man agement of occupational diseases, tlianliu;; The Absence of Records Die majority of industrial plants fail maintain sullicicnt medical and work cords to serve the physician properly in nnectiun with occupational disease work. 1 a given instance an afllicted workman ay give as his occupation some innocuis job as "elevator operator." He may rc- all this, there still is occasion to asscit that a real need now exists for a book publica tion on occupational diseases designed (or services lo the neighborhood physician who in the aggregate sees far more occupational disease eases than the small number of specialists in this held. Attitude Toward Industrial Medicine inibcr that the job before that was a< In times long ago, when mine workings, "truck driver." There his memory may sawmills, and railroad construction camps d. His work record may show no items , were established in remote sections of the to transfer within the factory of his country, far removed from the usual sources -t employment and no record of any pre- of medical services, it became necessary nts ' employments. Although the x-ray that the management bring into these iso- r ih f.'t.u./w ' latcd work places a physician who might New Chemicals . carry out all manner of medical services. A further deterrent to accurate diag These physicians set the broken arms of nosis of occupational diseases is linked,up injured miners; delivered the babies of the with an almost endless flow of new rhern- miiicr>* wives; treated the miners' children icals into industry's processes. Year by for measles and mumps and otherwise at year, a far greater number of new chem tempted to meet the medical needs of these detached communities. Usually the com panies contributed to Ihc income of these icals are introduced than the mini' er of investigations referable lo their to deity. It is often true that nowhere in the entire physicians and every family and every literature concerned with industrial -tox single man was taxed a stipulated sum each icology may any word he found aidin, tin- month tn~-urder lo cover the physician's physician in determining if a given chemical salary. Thus arose the term "Contract might be responsible for a series of objec Physician." This perhaps did not always tive and subjective symptoms in any patient. . represent the best of medicine and not in . One of the most desirable changes needed all instances were these contract physicians in connection with worker health protec of the highest type. tion is the requirement that no new sub Later some of these communities became stance he introduced into industry on a . larger towns, or cities, and other physi production basis until it shall have been cians sought to gain a livelihood, only to established to the extent possible, through find that the contract physician was in the animal experimentation, that such a sub saddle. This gave rise to complaint and stance is without dangerous potentialities. out of this "Pandora's box" have come in numerable evils that even to this day at Significance of Handicaps in Diagnosis tend the highest type of industrial medical A recital of the type just presented supervision under the most ethical ami might he continued almost imlchiiiic))', lml commendable circumstances. It has be perhaps without profit. The entire situa come a tradition on the part of many of ' tion may he summarized hv stating that the medical profession lo blame almost any whereas occupational diseases thcm-rlves manner of their economic dllicultics upon are probably as diagnosable as any other industrial physicians. So real is this dis difficult class ef diseases, just about every affection that some organized medical stumbling block that may be produced is groups have sought to legislate against al laid at the door of the physician smccrtly most any form of industrial medical prac seeking to acquire sufficient evidence uptni tice and in some instances to deny mem uhit'Ji lo make exact diagnostic dcci-ion. bership in medical societies to indu-trial The greater number of these stumbling pliysicans. As a result, industrial physi blocks represent no willful desire to hamper cians in some respects have been branded the pliysirian, hut instead arise from Ihc with a scarlet Idler. lewilts of peculiar ciicimi'lanvi's that in This queer situation, strange lo say, some iiica-aiic separate industrial di-ea-es may serve as a handicap in the diagnosis from the general run of alllictions. of occupational diseases, since some of the lust physicians, and particulai ly the more limid ones, fear lest they may become be smirched h_v cooperating in this type of medical endeavor and to some extent slum any dose affiliation that might lead to lifted eyebrows by those regarded as the leaders As a consequence, huge numbers of un warranted diagnoses of occupational dis eases have been made and are being made. Scores of suits have been instituted and some have been won hv claimants whowclaims possess 110 whit of merit, chiefly be cause well meaning physicians unhappily of the profession. implanted the seed of possibility that hi- Now that the American Medical Asso ciation is somewhat alert to this situation and has organized a Council on Industrial Health, including some members with in dustrial medical experience, it is to be hoped that after all the industrial physi cian may become respectable. disease might have been caused by work and that the responsibility might be laid at the door of the cmplo)cr. W'liilc the re suits may have appeared to work an in justice and monetary loss upon the em ployer, in the long rim the interests of the worker himself are not served by these 221 Pilfer Jubilee Safely Couyreis. \ spurious claims predicated upon improper medical adtiev*. The usual trial of an ocnipational disease ease is a travesty. The hotiihaslic statements of some physicians, unattended hy any iota of fact, bring into disrepute the entire mcJic.il profession ami lake away its time honored traditions of integrity and skill. A further significance in the tnisdiasnosis ol occupational diseases on the part of physicians is to lie found in unwarranted hardships imposed upon cmplojers. Re cently a physician made a diagnosis of silicosis in two workmen in a given depart ment. As a result, widespread apprcnhciisiens arose among the remaining workers, strikes were threatened, talk developed as to demands for high wages because of tinusual exposures and the expectancy ot a short work life. The employer was com pelled to spend some JS5.000 in the installa tion of no elaborate dust control system. badly needed under postgraduate auspices. (b) In every industrial community, or at least in every industrial state, there should be available for cooperation with the general medical profession- a number of much experienced and highly skilled occu pational disca-c consultants, who, through limiting thcir^profcssioiial activities to this one aspect of medicine, may become highly proficient in the solution' of occupational disease enigmas. (c) In every slate and in some of the larger industrial cities, there should be maintained public institutions devoted to industrial hygiene and occupational dis eases whose technical services may he avail able to the physician in charge ol patients who may lie suffering from occupational diseases, and these public bureaus should serve as fact finding bodies, equally inter ested in the worker aud^iis employer. As a mailer of fact, these two workmen did not sutler from silicosis, were not in any wise disabled, had never been exposed to silica; no silica or any other harmful dusts were created. There was no need for the expulsive installation made and cuiitruriu ise other departments did present practical exposures tor which this $85,000 (d) Mile'll will be gained if all physicians responsible for the health of industrial workers in any capacity may make greater clfort to obtain precise work histories, both present and past, and may seek to gain an adequate understanding' as to the work en vironment, its materials, machinery and possible exposures. might have been spent to better adenutage (c) Controversies should be eliminated in procurement of needed protection. in the largest possible measure from occu The Road to Betterment pational disease work. Many abler physi cians eschew all connections with this type This entire discussion would be without . of medical practice because of the sad ex any raluc if present day practices and sit perience that nearly every ease may he so uations only were condemned. More ac involved in controversy, litigation, disaf curate diagnoses' as to occupational diseases fection, until the good physician may fee) arc badly needed. These better diagnoses that lie may be degraded. will come in proportion to the extent that . (f) A need exists for greater disclosure the changes now listed arc brought to ac to physicians of the rhcmicnl nature of tuality. work materials to the harmful nature of (a) The general level of knowledge of which employees may lie subjected. In occupational diseases on the part of the dustry may have excellent reasons for hidmedical profession should be increased iiig the nature of some of its chemical ma through the introduction into medical col terials under code terms, but more often lege training of a practical amount of in these code terms arc designed only for struction on industrial hygiene and occu convenience and not for secret formulae pational diseases furnished by men who purposes. A greater degree of cooperation have had first hand experience in this Held on the part of the manufacturer will even and arc not wholly dependent upon textbook tuate in the belter health protection of his lore. However, it is emphasized that in workers through the more intelligent min undergraduate medical training this form istrations of the patient's physician. of instruction necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is (g) Lastly, it may be pointed out (hat better diagnoses of occupational diseases will tome when the general medical pro Ot'i ufui'-uul i'..i i/a. fession, through its organizations, shall alter in attitude toward industrial midi-' cine, shall recognize this type of work as just the antithesis of the undesirable as pects of slate medicine, and may come to realize that industry, under the guidance of aide medical directors, is the meritorious source of numerous cases to be referred to almost every specially in mt'dicinv. 1 organized medical profession whole-lie:cdly should render its appro', al and, supp. to the efforts of the physiciic.is came, seeking to protect workers .rum the m:. dangers connected with industry's lbon-ai of substances and work conditions. Necessity for Uniform Absenteeism Record In the Industrial Health Program By MILTON H. KRONENBERG, M.D. _ C Ftn( Tnrtiiclrial H VP rv___/f Pnhlir Hr.llth. Chicago You are all aware of the value of acci dent statistics. You know that without fre quency and severity rates there would be no solution of (lie safety problem and we would be groping in the dark. Hut, since they are available, we know where correc tive measures are needed and this affords us an opportunity to correctly judge the value of one method of prevention over another. Today, the grip of statistical methods is closing down upon industry, medicine, public health and safety. Vital statistics, however imperfect, arc one of the chief means now available for measuring health, longevity and the progress of medical services in the battle against diseases.. So well recognized is this fundamental principle (hat the effectiveness of a city or state health department is judged, in a large measure, by the accuracy and com pleteness of its morbidity and mortality reports and records. The same principle obviously should hold true for the groups of workers employed in a factory, mine, quarry, public utility or department store. These rccuids are of value not so much to indicate what has been done, although this is important enough in demonstrating to management the value of certain work and, therefore, the advisability of contin uing it, as they are to chart future action. Insufficient data have thus far prevented the recognition of some health problems peculiar to wage-earners and there is ample evidence to indicate that morbidity and mortality rates are higher for some groups. These excessive rates arc especially i able for unskilled workers as shown the accompanying table. These death rates could only haw I prepared by statistical methods of an sis and, therefore, clearly point out wl one phase of our problem lies. If : nothing more than this we would I plenty to do trying to uncover the men. to health among the unskilled group workers. The morbidity and mortality data down hy uniform and aJcqualc icpmof cases can also serte as a bads for i vent ion and health education among ers, the same as is and has i ecu done accidents. It may interest you to know Ilia' Eastman Kodak Company, Ed.mui lilt Illuminating Company, I lin'd I iblnr * pane, Westinghuiisc, Metropolitan Life.1 cral Motors, and several others have years made sickness studies with tin of statistical methods. In this way were able to evaluate the dilTcmil -.it 1 problems confronting them and those ing attention, and at the same lime these sickness records propci ly apt" and evaluated, they were able to i_d their employees regarding iligc-tin eases, cold-, pneumonia, tuberculosis, ccr, skin disorders, as well as oilier ments. Furthermore, studies conducted in citic industrial undertakings have shot- value of statistical methods in rev the incidence of such diseases as ; iiionia, tuberculosis, and degencrativt Jo Oilier Jubilee Safety Coihjres.f \ Death Ratal by Occupation Oil ttp.lll'Kt 1 *i iii.i | in**it Sl.illfl wnrl.fr Si*ini"<kitti>| w rL**r t.'ii'killrtl U'trlt*r .1// Cutt*r% 6:0.5 8 H. 9 1009..1 mi; ; Tn*<fr, ti/jfit ,,t |/| I.U .*!, f If* 2 72.1 " 102.1 IXIV i*i ll HblHli .IH 8 59 7 71 9 1.15 9 rniit.r f/H'i 'i'lltlllfft 70...I 85 1 90 8 106 6* |vr lOO.Ooo jccii|iicl iiult-s. on 1' S. CVttittK iUu In t* svUrcivd St.itv*. .a-cs lo be higher than the average for c eitlirc industrial population. This was irk demonstrated in a i>nelimonia study mnng steel woikcrs which was conducted t the li. S. I'nhlie Health Service. dents, the /piality of his work is of a lower grade, team work is disrupted, fac tory processes are dislocated, undue burdens are placed on other winkers and the worker himself becomes dissatisfied. If he is oc I truly, some years ago. was able to show cupied with weighty mailers uf policy and high rate of tuberculosis among workers production then someone ill that mganiza- the ax-grimling industry, and the llarre, lion must assmne the leadership and ac- " 'mumt, study revealed a high luhcrcu- ipiainl him with (he problem by understand --is rale among granite workers. Xodoulil. able and intelligent faets ami' figures. liter occupational undertakings would ru ral data lor prevention, control and cdualiott were it possible lo have adetpialc latistiral reconls ns revealctl in the slide i-t shown ;mi. There are progressive . bullish ial organ izations who may and have spent large sums of money for the improvement of working conditions and for the care of wnrkcis who become ill, hut withiuit cur I Selby of lienrral Motors, in calling Meniion to his slati-ties shritvs (hat about o of a day per annum is lost due to oc- rent plant information ahmil the human factor much of this money and cllnrt has been spent on "general principles" or per upntional injuries and that includes occu- haps concentrated upon the eliminaiioii of alional diseases as well, whereas, eight, only- one or two publicized health hazards, inc or ten days per year is the total and only from the standpoint of existing >st time from all illnesses. In Ur. Ncw- compensation laws, as for example, sili iii-t's report lor the American College of cosis. Hut the extent of the health problem urge-oils, the figures arc about the same, in a plant necessarily- may not cud here. his shows us that our industrial illness mhlcm is approximately fifteen limes the ire of our accident problem. It is evident that industry could well fiord lo roucititrate on illnesses among .tgc-carncis, other Ilian the occupational i.-eascs, because they arc the oiks that aii-c the greatest amount of absenteeism id arc the biggest drain on industry. With the progress of industry c-pccially on the chemical side, new health problems will arise resulting in physiological ami pathological upsets. The elicit on health will, therefore, have to l>c nieastiied and evaluated. We must have data in order for one lo judge the cl'liracy of methods employed to combat disease, so we must first know where health is being menaced, In ilie recent National Conference on the relationship of occupation to tlic-e dis Icaltli Conservation, it was estimated that eases ami the causative factors responsible. ue nation's bill for illness and premature The records you keep will lie a guide lo ac baths amounts lo approximately ten bil- tion as well as a record of action. .nii dollars annually, and that on every ivragc day about four million persons in e United States arc incapacitated by illc-s. No doubt many industrial workers ic in that last figure. Therefore, I say, prove your value to industry since many a skilled industrial medical department has been limited in its budget and activities because it overlooked the necessity and value of absenteeism re Thy industrialist of today should rccog- ports and records which could hare been i/e-that a sick worker is prone to acci used to enlighten manage-, .cut icgaidii ... its Occupational Oiseusc health problems. Perhaps in some cases up and maintaining records of irknes the iiidu-trial establishment may find it dif their particular plants. ,\u an ly.-is ficult lo tindii take a complete record system evaluation .of these reports an-i .ccord of absenteeism. [ do urge you, though, to another service ottered by them lo mana make a start somewhere. It need not he mini. loo elaborate. I have heard it said that the lust way lo detect illnesses which arc causative of absenteeism friuu work is by periodic phys ical evaininalious. I am not fully in accord with this type of prevention. It may he helpful where the illness lasts longer than a week or ten days, but something should Ileforc showing you a form on which collect your absenteeism data, and which . he termed the "master sheet," 1 -linuld b In acipiaiut you with several import, items that must he had lor your men before they can lend themselves to anak and evaluation. The form is self cxpl.i. tory except for a few general remarks. be done about the frcrpient one, two or A card should lie made out for each a three day absences, aiul I fear that periodic every employee on the payroll, regard! physical examinations will not help tre of whether he or she gets s,ck or not. T mendously. This, of course, does not mean is mccssaiv in order to ascertain the ra that imhisliial medical services should aban of those siek lo the luunhec on the pay i don or inininii/e that phase of health serv The winkers' age, sex, enlor and nccupal ice. The industrial hygiene divisions of Stale Health Departments and that of the United Stale Public Health Service arc urging the employment and use of a uniform code for recording and reporting absenteeism of tin- are important to record since they will h. to he related to the spccilu* exposed pin laliou. Under "occupation" state the wink which the employee was engaged when sickness began. The "date ili<nhility l*cg worker due lo sickness. Forms and meth ods have been developed after a study of some twenty years by the Public Health .Service and also as a result of the ivccnl National Health Inventory of chronic dis ease affecting workers. The aforementioned health agencies will gladly assist and co- should only he rceoided for one lull i or longer. In the column "work days In we refer to calendar days and this is tin sary to put lost lion- on a cnmpui.d.lc ba for all employees. For `'ili.igiiiisis'' . should list the sickness or injury when d nitcly known; if there is any doubt ah opciate with industries desirous of setting the correctness of the diagnosis, a statem ,Xo>n< or Ct(k \o D*pl. Occupation lr Sex Sickness Record Form Pi/.' Pi J. af'ihty *'IM Pah' Pm* nhihiv La,lot MV* !)i \ i i.ott (Cat. ftt-lar Jayi) Piit(* UOitS >h M /(>*! null J .. 7Vrri*'i.i.'i of ('<Hi / * ' ........ -- -- - -- . .-- -- -- -- -- -- -- -- -- -- -- -- -- -- - -- - - --- -- 1 1i l of the symptoms experienced by the patient <ltou!tt be recorded. The point is that facts should be recorded and not {jnesses. It is more important, for example, to know that ten men in a given occupation were dis abled by "pain in the stomach" than to getten different guesses of the disease or ail ment causing the pain. Another item of importance on the record is "by whom diagnosed," and should show whether the diagnosis was made by the family phys ician, plant physician, nurse or the patient himself. Under "termination" of case, one should record whether the illness terminated in recovery, death, relapse or ended in a chronic condition. Tite following statistical information and data are. therefore, possible if thc' items listed in the slide just shown you are care fully prepared. - 1. The frequency or severity rate of any given disease for the entire plant, individual departments or occupations. 2. The time lost due to any given dis ease or to all diseases combined in the en tire plant or by departments, or occupation. 3. The mortality rate. d. The case fatality rate, expressed as the percentage of cases of a given disease which terminates fatally. \ The intelligent application of preventive measures, of control of health preservation must have statistics and they will always he an integral part in the solution of any problem. That h holds true in industrial hygiene is represented in my next slide which shows that the strength of any wheel is dependent on each and every spoke and each is dependent upon the other, otherwise your structure is unbalanced or collapses. ADJOURNMENT TUESDAY AFTERNOON SESSION October 11, 1938 Tlie fir<t meeting of delegates to the Steam Railroad Sessions was railed to order by Mr. \V. W. Wood, Superintendent of Safety and Welfare, lialtimorc & Ohio Kailroad Company, Baltimore, Maryland, who presided. Chairman Wood hriclly out lined the significance <jf the programs of the two sessions planned, and then intro duced the first speaker. "Hidden'Causes" By FRED W. SARGENT President, Chicago and North Western Railway Company, Chicago ^ We have seen the evolutionary growth J of accident prevention work from its in- ccption, as applied to the American rail- i roads. /Many of ns here knew Air. Ralph f C. Richards intimately, and discussed his hopes and ambitions with him frequently. i Though he met from time to time with dis- i couraging results, yet lie never surrendered, r He laid the foundation for safety work that i is vastly enlarged and is rapidly ripening t into collateral lines that arc of benefit not \ only to employees and managements but to J the entire economic and social structure of j the country. . * In the beginning, and even until rather ; recent times, the greatest emphasis was laid * upon working rules and physical conditions T of plant and facilities: in other words, a r safe place ti5*work. There was every rca ; son in the world why the greatest emphasis * should he placed upon these factors, and, f indeed, we arc not yet so far along that f ire can alTord to lessen our efforts with relation to these matters. In the beginning, the idea of a surgical J department was to care for men .ind women ' f after they were injured. Gradually this "i conception has licctt enlarging and changing J into a broader field and greater service, if .<} a greater service is possible. This depart ment no longer has as its sole objective healing of wounds and the saving of human lives after injuries. Gradually. steadily, the whole enneeption of safety work has progressed and evolved until to day it has heroine a nationwide activity, drawing to its cause the bc-t minds and the finest characters in our social structure. And with this greater interest in the work it lias been hut natural that the whole scope, theory and conception of the under taking should gradually enlarge to embrace the wider field of accident prevention, to which l am about to refer. In recent years many, of the railroads have enlarged their conception of this work anil have come to the realization that safety work involves not only safe tools, safe was and structures, and safe surroundings, but involves likewise, and with ctptal impor tance, the very physical anil mental condi tion and attitude of the employee or officer himself. With this thought ill mind we have changed the title of the head of our surgical organization from that of ''Chief Surgeon" to that of "Medical Director,'' because if men arc to avoid accidents we know that they must nut only be sur rounded with safe working rules and safe working conditions, hut they themselves must lie physically and mentally fit; and that the so-called human element, always and ever present, must constantly he reck oned with if we arc to achieve the ultimate beneficial results so earnestly desired. And so it is that in all this work, whether 733  ' *. ,*l.> ViVw (oil railroad right ,'i( be permitted nlicn tcas- retnoved. irning should lie given of i ("rains by sounding the ui accordance with the law ! regulations. ' of these requirements will .'elves stop crossing acci- only an aid to a general Responsibility ' are involved in 90 per mg accidents. Since there automobiles and 232,002 ide. the opportunity for is apparent. The public. . definite responsibility in . and enforcement of such result in: ection of motor vehicles cars will be barred from lation of the licensing of those mentally and pliyst and those with a record g will not be permitted to ; the highways not only its at grade crossings hut msclvcs that the way is .ipting to cross the tracks. early show that the rail,s their opportunity peractual progress in rcducents. However, they have he motorists and they arc reach in an effective mattil is necessary that the the cooperation oi state .lie officers in policing the ossings in connection with .ies on the streets and plan of this nature--bc- Is and the public--would tfcctivc means of check- md reckless driving over The railroads as a rule lxpaycrs in the cities and fich they operate and are peration. .- s in education and law ation is merely a method Steam Railroad 743 of informing the public as to the number of accidents, their causes and bow they may be avoided. With this limited application of effort, automobile accidents of all kinds have been constantly increasing. We have found in our efforts to prevent accidents to employees that we must supplement our educational methods with rules regulating the conduct of the individual and that such rules to be effective must be enforced. It is imperative that a similar procedure be followed if we arc to curb the recklessness inherent in certain motor drivers. Ninety-live per cent of the motor drivers of this country arc competent and careful, [t is to them that we appeal to aid us in the enforcement of such rules and regula tions a< are necessary to eliminate from our highways the one and one-half million drivers who arc reckless and incompetent. THURSDAY AFTERNOON SESSION October 13, 1938 . Safety and Public Relations By ROBERT S. HENRY Assistant to the President, Association of American Railroads, Washington, D. C. The safety movement, which constitutes one of the proudest chapters of American industrial achievement, naturally falls into two main divisions. Safe conditions must be created, in the first place, but there must lie also created a safe state of mind. No doubt the pioneers of the safety movement encountered industrial managers willing enough to install sate equipment, but skeptical as to the need or the value of the education and exhortation needed to instill safe ways of thinking. Every man knows that to get hurt will cost him time and money and suffering, these skeptics might have said, so what's the use of going to a lot of trouble to tell him so? He'll take care of himself Fortunately, the safety pioneers realized that safety was a matter of the minds of men jut as much as a matter of machines, ami that the safes: equipment and the safest rules did not. in and of themselves, make a sate man. They fought their bat tle for safety on both fronts--safe condi tions, yes, but safe thinking as well, achieved through constant iteration and reiteration of simple principles. The early leaders of the safety move ment pioneered in a field broader than their direct goal of promoting personal safety. They pioneered in the field of se curing and organizing the wide-spread un derstanding and cooperation without which their movement must have failed of its full measure of success. How well they and their successors did the job is told in the statistics of declining accident rates, of lives and limbs saved. _ In thc'c latter years, Amcriran industry is faced with the need for another sort of understanding and cooperation on the partnot only of those employed but of the whole public which our industry serves. In the short space of little mure than a century, our American scheme of enterprise lias settled and civilized a continent. It lias made possible a standard of material plenty and well-being unknown before :n the his tory of the world, and unknown elsewhere in the world tudav. We are ;v!d that onethird of the people of the nation are Ill-fed. ill-housed and ill-elad, but it 'h.' uld bborne in mipd that when this American way of enterprise began to functor a century and a half a;Ju. practically the w :e pop ulation was ill-fed. ill-housed at.d ill-clad, according to our modern standards. Mis takes have been made, perfection i- a long way olT, hut there is in the record of achievement much solid ground for pride. Today, n never before, the best opera tion. the safe functioning, llicNvry exist ence of the vast and varied organization of our economy of free enterprise, depend upon public understanding and appreciation of what it is, what it docs, how it works, what it means to all of us. The safety movement is built upon sate