Document 93GQMLdV14GM22obg19MRn6rD

FILE NAME: BF Goodrich (BFG) DATE: 1954 Oct DOC#: BFG071 DOCUMENT DESCRIPTION: Presentation from the Workmen's Compensation Problems Convention, 1954 [Occupational Cancer Hazards] & Convention Attendance List PH0CEEDlNGSr~~4th Annual Convention of the International Association of Industrial Accident Boards and Commissions9 Quebec, Canada, October 3-7,1954 Workmen's Problems 1954 BULLETIN m UNITED STATES DEPARTMENT OF LABOR la m e s P . MiteheU* Secretajpy BUREAU OF IABOR STANDARDS Faul E Gunfcef Dircclor mw Tm s BmwmK No, 180, cootsim the proceedings of th 40th earntai m m m iion of the ntem&ibn&i A roehtion of Indu&iri&i cds&t Boards and Commissions, which was held in Quebec, O&n&da, October 8-7, 1954. Bpocsodiogs of the convention hove been prepared for publication by the at&t! of the Bureau of Labor St&nd&rde. m 120 1854 MSETOfO OF TAlAEC O eeupm ti& sm i Cam era H ssstad b W, 1>. H&mm? M. Chief* E m im m m M *Csmw $&eon* Ommr Imtiiu&i Uo S* PaUb Hmkh Sm4m* Wmhinpm* B, ,, A Bmps 0 ccap&tional cancer h&sards h a w plagued mankinds for thousands o f years, 0du exposure to agents of our natural environment such as solar radiation or infections with the w orn, Schistosoma hama~ t o b im , have doubtlessly been responsible for the occurrence of cancers of the exposed skin among outdoor workers sod of cancer of the bladder among farm er of the M e valley m m during prehistoric times. However, it w not until the advent of modem industrialism some ISO year ago that occupational and industry-related agents have attained a preeminent position, in the human cancer problem. H ot only are occupational carcinogens the only well defined known causes of human cancers, but their number and variety bare steadily increased sines Pott in 1775 first related the occurrence of scrotal cancer among chimney sweeps to their exposure to soot. Our real knowledge and appreciation of occupational cancer pro ducing agents as phenomena of modern industrialism dates back some OCTOBER 6-~MOEHrNG SESSION 127 75 years with the discovery of the relation between the occurrence of akin cancer and an occupational exposure to coal tar (%. 1). The data given in the fchowing tables (1 and l&j briefly summarise the salient additions to the information on occupational cancer hazards made since that time. They list the various chemical and physical agents so far recognised or strongly suspected as causes of cancer in man. They show, moreover, the different organs and tissues representing the target organs of these agents arid the number of occupational cancer cases placed on record or known to have been recognised as caused by them. T A.BLK1.--Occupational Cancers Uncorded in the United Stales and Foreign Countries up to 1&5% Nuxatw o, Number of Sitesof,mim cariowvm&wtmr eases; V.id : in U.S.A. |(a Europe : l > W V < V A V > V > V M W M ,. Arsenic...................................................,,,, # k m ............. 7 ; C o a l t&r, p i t ................ . ................... J HO j Pfiroleuin,,............................................... I WA,. (K^AA *AAVA 70 ; Sh ale o ils....... ........................ . ................j . . . d o ........ 7 j L ig n ite tor and p& raflrn,..,................... i . . . d o . . . . . . . ' aVAVAVAA'I Creosote o i L ____- ___________ _______ i . . . . d o . . . . .... 3 i Anthracene oil._____ . . . d o .............; .. AVAAAAaJ Soet-earbon b la c k .. . ________ |. ,..d o ........... J i ; A rom atic t o r n . . , . , . ______ B la d d e r------ 3SO-OQ , j LSk Su ............ (?) Roentgen- and radium -radiation____j 1L e u k e m ia .. ill | U < n a g ........... A rsenic...................................... ............... b o n g ............ A s b e s t o s - . - . . . - . . . . . . -- ......... . .......... 22 Chrom ates....................... - ............ .......... .....d o . . .. ..... 75 | jb .,d o ........... 0 1 j Nasal <`&v~ N i c k e l . . . . . . . . | lH<< I n sal ainus. i1 ^ C o a l t&r, p i t . ..................................... L u n g . . . . . . 0 Petroleum ................................................. . . . d o . . . . . . . . 7 j Beiifco!____ ____________ _____ _______ Leukemia... ii : ,[h u ft ............ i Is o p r o p y l.................. ............................ R L a ry n x ......... 4 (.Nasal amu s. 6 ij Bo nes______ 0 R adioactive ch e m ica ls.. . . . . ________ I[N&e&l sinus. ! 3 T o t a l . . . . . . ......... ...................... . 1.............. 1............. .. ; i 750 1Ay>fMmate. 25 : a. 150 i 20 I 1,900 | 14 \ 40 \ 20 \ 190 \ 1,200 j (?) i 13 ] 650 ; 18 83 , 05 | 84 i 51 j 53 38 \ 81 S 0 o; 0 1 0 j ! 7, 650 j 32 3,260 99 1,907 14 41 20 1M 1,600 (7) 29 50 23 85 140 84 53. 53 10 42 1 4 $> 9 3 3, 400 l&r>4 ME&TLVG OF IAXABC Tabix 1a.--Timr Table / Dwcmsties i\f Otmpaiioml Cancels Ji&G cfag&at j !>:4o \ Diseawror | -------------------------------- mw ixr.Mww/wvi\ Otiaiios'is--Ovgftsifc' 5 | Organa a Scotch Vataieii exposure ------------ Bool............................. in s , rst,,,v, ................... - Sfcit! {anratna)......... Occupational. C arter (lignite)............ , ISIS , Vaifco&oo......__ ,_J m ' i ,,,. . . . . . . . . . . . . . . . T>u Cositai (&Hu3Blr.ous)..,J . Butita......................: ,,,wv^,wv*...... *vv*/u! X>o. Uo-Uis* aathracit*)........ 1810 ! Xssfelg.-- J .....C o ___ Di. o&3 tar (fames).......... 1180 '} Kawahate.__ . .. .. .. .j Liam ___ V>. Creosote at*.............-__ 1820 j 0 'l>,aaaa. S8i ....................... Oil. Anthracene oil.,,......... . . J tSfiS j Oliver,.................... | .... wv..vw. r>. Paiai&n as) <shaU nii)__ | l?a f Bell........................... | 0. relroteMttstili coke..__ ! S&& i 4 Gaer- *...... 4o ................ ; Ho i i raoaim. 1 ; Pefaxfkma paraf&a oCw. . 3816 SSe&oBifesrg...... .. do . . . . ; Da. Petroleum Itibrleat-ig &sJ 188 j HeSer ............... ...... Or.......... .............; Oo, SiiftJonBrienttag Oil,,. .. 5810 {W ilson............... . i,, A ,w ,, . , A, ,j Do. Besi1...... .................... 1825 I Delcre & Stone.forte' ttnyi-hj tin. Aromatic smloes {ye 18te Stelm......................... ! BfoiMer, ittili/. 8to j Do. (aterajeiiBtes). Isopropyl 13............ i i Vh-S, j 1852 | Wet!, SmyOi A itow .; Nasal siauaca, `aryax, j 1>0. * ; tilBg. Cham'isis-XBflfsanie; , Arsenic..... ................. . )SS2 \ peris ........................ Bidn.............-- ,. .5 Do. IftST Uuiifeteat................. .$>},__ *................ Metlieittsi. i ___***,,*...,***..* ta n s........................ Occupationaf. Abt$los....................... 195S ' XivTish & Smith......... ...... ft.*......... ........... i Do. Chromates.... ................. )83S <Bfel!.......................... , ,0c ....................... Bo. Iftekel........................... 10)2 j Orenleii.... . . . . . . . ..... Nasal as-ity and at- : Do. Buses, lung. Ubytctetl sgeota: Ulhaviofei raUtioa..... 581K { U nra........................ Sfrlsl,....................... Bo. BnvtroKrneatal. Six'iageS'fAunoiiB____ 38Q2 | f'rieben.. . . . . ____... Oceupatien&i. iSaH ; Wyss,................ Medtcinai. J811 j Yen f&jgie, Schwarts & OeeupatkmsL i voa SfctettrccSt. 1S2S iBook,...... ................. Bone...... ................ Mittiftaa). Radioactive suhtt&MtKS... 3878 i iiaenirig 4<Hesse...... Baag....................... . OmiTioitiinat. 3828 MeXe!, Ward and S3cia......................... Ou. : WilliS, i 1828 ' Ox-wy... ............... . Btaod-forteiag tissue. On. l .1931 MiVrlhlM...... ........... Bil8...... .................. ! bo. However, an mdiscrmuoato aecspfcaneft of those hgwroa m reflecting the actual scope of ike occupational cancer Itawards would seriously be misleading for the following reasons. The presence of occupational eanecr hazards has so far been established for only a few worker groups having contact "with one or several of the carcinogenic agents listed. While, for instance, it is generally known that workers em ployed in gas works and coal tar distilleries' or engaged ^ the cleaning of petroleum stills and having skin and respiratory contact noth coal and petroleum pitch arid tar show an excessive liability to cancer of the skin, and apparently also, of the lung, there docs not exist any official record of similar cancerous complications among electrode workers in .alnmmnm production plants where an exposure to fumm ocfsmm b-^MornwG session m from the electrodes consisting of a mixture of coal tar, pitch, and petroleum, coke exists. Soli able information, however, is on hand that these workers suffer from cancers of the ski and, possibly, also the respiratory tract. The extent of this exposure hazard may he estimated by the fact that approximately two-thirds of a pound of electrode carbon is consumed lor each pound of metallic aluminum produced, of which 800,000 short tons were consumed la the United States in 1045. I t i* equally significant that agents which have boon reported to have caused occupational cancers among workers of an industry of one country, do not seem to have the same effect upon the workers of an identical industry of another country, if the available data would be accepted at their face value. Since carcinogens behave in their fundamental dkeasc-prodttemg properties like pathogenic microorganisms, there is no sound reason to assume that carcinogens make any distinctions in their activity or effectiveness for any national reasons. In fact, it can be shown that such scientifically incom prehensible discrepancies arc mainly due to local differences of report ing o f occupational cancer cases, The existence of an excessive liability of gas house retort and coke oven workers to cancer of the lung has been reported from Japan, Canada, and England, hut- not from any other country despite the fact that the exposure conditions for workers employed in such opera tions are identical. The occurrence of an appreciable, number of arsenic cancers of the skin among Gorman users of arsenical in secticides was placed on record during recent years. If M l credence would be given to reports on arsenic cancers observed in ilu> United States, one would he led to believe that arsenic&is In our part of the world are carcinogenic for almost exclusively medicinal reasons. Again, it is hard to assume that arsenical would make such dis tinctions. A similar situation seems to exist concerning the car cinogenicity of lubricating oik obtained from petroleum in different parts of the world. Although there were placed on record by English investigators during recent years, several hundred cases of skin can cer due to occupational contact with lubricating oils, practically nothing is officially known as to the existence of such industrial diseases from the countries on this side of the Atlantic. One seems to be content with attributing here the English observations to the carekrogenie action of ahalo oils, the large-scale industrial use of which was discontinued during the 1920k, and therefore cannot account for the more recent English cancer cases observed among spinners, mechanics, engineers and other workers having had exclusive con tact with lubricating and cooling oils of petroleum derivation. 130 1054 MEETING OF IAIABC It is worth noting in tins connection that during the last 20 years, there has been an almost complete lack of published additions to the list of occupational coal tar, pitch and creosote oil cancers of the skin from the United States, although such cancers have been observed and are recorded as such in industrial records, and despite the fact that the annua! reports of the Chief Inspector of Factories of England and Wales have regularly listed notifications of such lesions to the extent of from 100 to 250 cases per year. One may also reflect on the fact that the last published figures on occupational cancers in American dye workers appeared in 1938 and listed leas than 100 cases, all occurring among employees of one com pany. During the intervening IS years, the total number of such cases has risen several fold and no official data have become available from any of the other companies producing and handling carcinogenic aromatic amines used in the production of dyes and rubber nunoxidants. In contrast, recent reports by English investigators sup ported by the English chemical industries have supplied adequate figures oti the number, incidence rates, and attack risks of bladder cancer among English dye and rubber workers who had been exposed to the same carcinogenic aromatic amines with which the correspond ing worker groups in this country have occupational contact. Fin ally, some consideration must he given to the fact that the general population has varying degrees of contact with some of the carcinogenic agents through their presence in industrial wastes released into the environmental air and bodies of water, and entering subsequently the soil and the fauna and flora living in such a polluted environment and used in part for nutritional purposes. In the past, claims as to the oecorrence of so-called "neighborhood" eases of cancer have rarely been made. The well established former occurrence of arsenic cancers among inhabitants of a German region in which the drinking water supply was polluted with arsenic from mine slag heaps represent the first occurrence of this type. Follow!tig the discovery of bladder cancer hazards among German dye workers, it was asserted that an environmental plant contamina tion with carcinogenic aromatic aminos was responsible for the production of bladder caimers among persons living in tho vicinity of this plant. While tho actual existence of such conditions was denied at that time by other investigators, the recent demonstration of "neighborhood cases" of berylliosis makes such claims appear as not unreasonable possibilities sines a highly potent carcinogen, such as bata-naphthylamine, is involved which might have, produced such results if the waste disposal and housekeeping methods of the plant were inadequate. It is probable that the future occurrence of cancers of the lung and bone among individuals who lived near beryllium'"prodirchig or"procgssirg ptevrs migliT'fwniRii ^>dditioo,ri evidence of 0 CTOB3S& g~ ~ m o r n in g s e s s io n 131 cancer hazards related to environmental plant pollution if beryllium aod its compounds are not only carcinogenic for rate and rabbits but also for man. Similar conditions of industrial atmospheric pollution exist around arsenic smelters, chromate- producing plants, carbon black factories and oil refineries, as well as uranium ore milk. The recent compensation claims advanced on the bask of an alleged existence between cigarette smoking and lung cancer also point to the possibility of a greater future importance of the compensation aspects connectod with the occurrence of cancers from industry-related sources, such as exposure to carcinogens contained in tbs exhaust fumes from diesel and gasoline engines, or present as additives and cont aminants in foodstuffs. It appears from these considerations that there can be no doubt that the. actual number of occupational cancers is considerably higher than the number of cases placed on record. It is of some interest, moreover, that the number of cases recorded in medical journals is appreciably higher than the number of occupational cancers which during the last 20 years have come for decision before compensation boards be cause compensation claims in many such cases hare been settled out of court. With a few exceptions, such as the incidence of lung cancer among American chromate manufacturers and among German and Chechoslovakian radioactive ore miners, of nasal sinus, larynx and lung tumors among American isopropyl alcohol manufacturers, and of skin cancer among English coal far manufacturers and processors. no reliable information is available on the incidence rate of occupational cancers of the various types among different occupational population groups. Ih Specks! A spects o f Occup&timud Cancers A fail' and competent adjudication of compensation claims lor cancers allegedly caused by occupational agents or conditions requires an adequate knowledge of the special aspects related to the production and development of these tumors and of the criteria by which they may be distinguished from non-occupaikm&i environmental (medi cinal, dietary, cosmetic, habitual) as wel! as "spontaneous" cancers. L Dejirtition of the 7\'fm 11Occupational Cancer",--The term "oc cupational cancer" is applied to malignant tumors originating m individuals during the course, and/or as the result of the regular and usually prolonged exercise of certain occupational activities entailing contact with some exogenous, physical, chemical or parasitic agent acting in proper intensity. Occupational cancers thus are caused by specific agents or etblogically related to well defined occupational conditions which form an integral part of the ordinary working environment. They differ through these aspects from the accidental occupational cancers which result front or foEow upon some oxtraor- 132 m NL&mim m iaabc dinary, unforeseen, accidental injury sustained at work and being of a nonspecific nature. A Types m d Nature, oj Occupational Cartinogim.--Occupational agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals. Some, of these ehem kab are well defined, others convrii of variable mixtures of a large number of chemical com pounds, a few of which possess carcinogenic properties. A second group of occupational carcinogens m composed of agents characterised by their ionizing or nonionizing radiation. A third group is repre sented by environmental agents and conditions which sometimes have an occupational association, and which may be related to certain infections or several specific climatic, geologic, dietary, and nutri tional conditions, and which in part have more or less indirect relations to carcinogenesis (table 2). Table 2.--Occupational Onrcirtageas--Their Rente 4/ Txjwstiri and Their Target Organs Den*! type Spesife: i}'!>6 `V A W /A M a cassa!ss8J<!e!no;w.si; Orissa!ehami- Bansot,........................ . Cls--anac, ' poiycycllc, h'a RoUi at exposure .Wt* >V> Tarfat or$i'. ...... ...-rS- ; i CaUot-aus, respira- icad-frralcs argani ; tory. ` iUmkcmin. lymphosar- ' : conm, siyeicm al. L-iocycle ; at'la-jjflpatiiytmiJiii, bens- ' HospraU>n\ ratne- Cr&genous orsata (fcaAt* ! alee. 4.tainoipiicriy!<aarB>1 ous, slimenUtry. j Ser, unscer, t o n e y ). ] mine, magenta?) itMni- ; ; din ti, ' \ : Ooa! m , pitch, soot, tapiwH, \ Catene...... . Sii, ; iar osi, ernssotosu, jUru- iRespiratory........ , . J Ouag, ! cene oii iamp baek, iigatlis ; | ; taf end parsili ali. j ! Synihctfe coni <iA end tnr | Cutaacotts...-- . -- S to. ; Scrut), i : ' Sbae oii and p s f i n <>i3______' -- io ................! TV>. ! \ Respiratore........ .. . j a r y m . 'Pctooie? furi oil, die*!! ot, !Cutaneous..,,....... j S to, j lubrimtlng o! afi>3 grame. i Respiratory.............. j cutting ni!, wtrtm Mudi, j : ' ttsph&H, taf, colse, cto>i i parafn oli. \ Aliphatic.............j Isopropyl MI................................................................| .Vasal sinus. Isrjra, Sung. inorganic ehessi j Aramle-..,............ ........... J rotane*, SgraSr<-,,, Skin. (ssis. j ' aR)irSXiary.. : Long. ; Nickel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i , . 0 . . . . . . . . . . . . . NmsMes'Ui.y>n&isUsisms1 j : j Imst. j Cteaishm ......................... . . . . S o ---------------------------- .! Otmg. ] Asbestos............................... I.......ao........................j Un. SthysU! <sfehg?B8: j X-radiation........... .............. ., Cutaneous.................. S to, ionising Md&Uoz, ; 'i'raas<siiaixy.s$.......... Connective tim a, bon, I . : Wood-fomag gsm. j 5t&dSaactifcr-i!iBtion<slpha, ' Unan*.... ............' Stun. j beta,codcsmaja-rcdiotiop). ! Vobsohawvm ....... Cc-unra-me tissue. Mood" ; ' fejrrolas organs. i : Respiraia r y , Naso! m>us j ) X.-nng. \ 1 inoraee. ... .... Bone. ?>Cpi50 cauriK8*BS..i SPlPasamahemMo^*... -jCvfianwos.................. >0!(iUw TOBEK &... MOENMf SESSION l a addition to these established occupational carcinogens there are a number of potential human carcinogens which hare been shown to elicit cancers in axparimental animals and to which workers become exposed during their regular occupational activities. These po tential agents which also must ho considered in the adjudication of compensation claims, are listed in tables 3 and 4. Ta&ls it--Potential Environmental Human Carcinogens M<mi i Sit* oftaisor j ; i i I Typeaoftamaa isoataete Xwrogeas.................... Breast.____ ftm kiw .. th iim i............. Lysajtfj node.. .1 i.`atAnmsi.. SyatheUc.............. VW as.............. j Oral.......... \ nypophysis.,,,.,i,...., Cars TitracWoridB..* Liver....... . .......; fistl........ S ! tinner-.,.,, Miuiuiaetyfa. .; Hat.... Dtitivy atMilive. .j n&Bajt .... ; Cosnaetoisgredieni .j Oiiinwpig .1 Mw- ,... ' lsSirial advent. Begra&sing njSK. , Bry-Wnsis Msaat, Firmtfsgimbteg agent 1 M&PfiU'tr' \ Production f treou. | 0ain famigisat. Cbicrofom.............. . J ...........i w n i....... . bl,i'M-tii. . . . . \ EUraatfve Of oiis. . J Mamiffir.tiire. , J AtigetfteUe- j So)vent atKi Xxiwtetsy* of i otis, resins, rubber, wares, i Mam;, iUkskbSs. , ' ' lugfedimi oi JfKquir, Omt | palish, (Henning Said. ' Projection oi artificial ailg, ' plasties. o b t r&.A-BtsCvehio-; ropbeRyHiSjKi'i* eWeroelbane)Tsnsieaeid ........ . A *> , / v.. ,...... + Ors!.,.-fc__ >Y>rvimi . . . . . Rol........ ,,,,j Manisfftitor, < laaecticifie. Poor! eoniaja&siat __ <&> . Ingredient of foofisruffa limits, wine, See, anti 'I Mteadei)c.inal agent l Tanning agent HtSenreft &Kt1 derive- , ........... O te;,,...,.. .,., j OitRiR fruit preservative. tves. "5!>Tl'<i . . . . . js-Fiirtyifea tn-al- nH'vf .. , . .. dnk , ,, , a* , ......AO ........ -*A?> Medicinai flvant. Mamtiaetiirt. Sweetening event. . . Anfiffeeee, XnU'rmerfiete in vimnbuAnrd. axpesive ' Softener oi laeguer late, vreoii stains, glue, textiin, lenes. tsf. blcltt.. . . ........... CnpftSW/,___ : M-VliSv , bnmeetsut ttobaaoo). Vshsala of laseetiddea. ,*..dc...... gubsuianeoiss Usas?. Cnueeaps,,,.,, i Mouse,, .,d Maaniectura. iYrenwni....... im ,.... . . j Fuel. \ Labriesnts. \ FtsziAv- production. S'iajitr-Trofsi'.'h i o;!, Uws, ares, j greasesi J Retrocliafoicisi!. CtiXKeeu$...... . I Manuiaetttfe. Ibmatera! ... , i V?0t3^Vv...,j Rue!. tabriaunl 154 METING' OF IAIABC T&S&& 3,-- HoienHal H u m a n CartirutQm-- Continue} h.m& Sits oi tumor U M M M V A W W / 'l'TP* i>t expr&SFi 8iCxSS light gmsfi 3? 'oid- \ Subeut&aoooa rmwatcsAi,,, Ximt bto* TCT fsai j Masse, | rasa FCF, ! 1 Butter yeSttsr...............: Biver..... ........ v{ OnH.................. j ! Hat__ _ Mmis. Kta..,. OUSepbane, $lytiyi-1 SutamUaeoas.., g*rm><HiL,,,,,, ...,,.do, (mo, poiyajpide (nj- ; ioa), bakelit teSos, ; ' ?5yxaUsy5 xaathse- : \ ry&te, i i B r n r y i i n j a i . . , B o a ..........,, ,, f Besow sd,.,,.,. \ Bjargfmtacy,,,.. feat*,. Be.ium____ <,,,......* Lifer, .byioidE Oral................. :.,,..da. Cobalt. i Subouiaasoa t'&fsiticr&i,,,,.......... 4,. tinsus. i j Tyim oi fsumsvs onUet? Textii dyes. Food &fs<Sosaxaetie dys. ; Food dye (ertoot), : O s i o t o dye. ; FS&r celts-. Film. fiber, pisetie-industrisl i sB&nufsctui- and uses. : vmppto m&terM, | Medicinal agent. .! Metai alloy, X-ray tufeo, .: pbaspbor msnufector, j Beb-ictoty vessels : Atomic aergy production. . Bail oatssatnaat. Coloring matter of glass, cerataies. paloi, rubber. Metal alloys. Bs3bi>er arcotemior. Fliotoslf-rtrlf oppaiptas Beeofofis, FlrrprooSag goaf. MtoHiBia&l &gmk . littaS oBoys aud plating. Oidtirtog matter of glass, iko, paid;. rubber. MisMn&S seat. T abXi# 4.-- Carcinogenic Qhtsmimis H U m naied as Em-iron-mental ifu w au CsrcinageM Ayev, - Sit f nwr i Type* c? axposura Spccios j fcteaded us StyryJii............ Sisbcut&aoons 1 tlSWi. j Mmsss,,,.,, |T i y i U i w x i s U i S-A<XK;ySiiuft-deiSrestiS,: Subsutsasous > tissue. Bladder............. ' L i v e r . . , .......... i'm i. . . . . . . . . . . . Fstai. .,. , ... UcU'emui, U & l .......... t i-Vig,. . . . . . .. V ( M ........ ' grata, | ; Thyroid. j \ , Acoustic duct, I | i Breast, ; l \ i/iBtcmia, I | i Sidney. } j 1 i/uag, i \ \i 8. Em.hiai.isn of E d d m st--- For the establishment of c&usal rsk~ lions between an exposure to these agents and the subsequent development of a cancer of an occupational genesis and therefore compensable nature, the following prerequisites most be fulfilled; OCTOBER fr-MORNING SESSION (a) Definite evidence must be available indicating that the claimant bad occupational contact with any one of the various agents listed, that this contact was either of prolonged nature extending as a rule over periods of at least 6 months^ and was of adequate intensity for eliciting a cancerous response, according to any previous experience which might be available on this point. Single exposures may be considered to be effective if the casual agent consists of external ionizing radiation or the exposure mechanism favors the production of a carcinogenic depot in the tissues from which a prolonged exposure of the host organism may ensue. (h) The route of exposure to or introduction of the carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cancer is elicited. Therefore, not any cancer, but only cancers of specific sites are related to any particular carcinogenic agent. (c) The type of exposure does not need to be continuous or extend up to the time of appearance of the cancer, but may be intermittent. In fact, any contact with the occupational carcinogenic agent may have ceased many months to years or, occasionally, even decades before the cancer becomes manifest. Effective carcinogenic exposures may be sustained not only by the ordinary operators employed in operations with occupational carcinogenic hazards, but also by workers entering such operations on a transitory basis, such as supervisors, maintenance personnel, repairmen, truckers, loaders, yardmen, find workers employed in rooms and buildings near the hazardous opera tions, if housekeeping and exhaust disposal methods arc inadequate and onvironrnenfal coni animations result. (d) Occupational Medical Stigmata.--For the establishment of causal relations between occupational exposures to carcinogens and sub sequently appearing cu-ncors, it is of distinct value to analyze the medical history of the affected persons for functional or anatomic disease manifestations characteristic of a pathogenic action of the particular carcinogen allegedly involved, Such noncaneerous and often preparatory or precancorous symptoms of etiologic specificity act as stigmata or biologic finger prints supporting not, only the actuality of a previously sustained specific exposure, but also its causal relationship to the cancer present. Symptomatic manifesta tions possessing such a significance are, for instance, chronic radiodermatitis, chronic tar dermatitis, arsenic dermatosis, chronic solar dermatitis, chrome radiation periostitis, asbeslosis of the lung, and leukomoid reactions after exposure to benzol and ionizing radiation. Chemical analyses of tissues for the incriminated chemical also may sometimes be of assistance in establishing previous contact with any radioactive substances, and benzol. 136 1954 MEETING " IABC It is important, however, to note that both these procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any etioiogio&lly characteristic symptoms, in fact, they may not elicit any preliminary toxic or other disease phenomena despite a persistent and prolonged carcinogenic exposure. Tims,, cancers of the bladder in dye and rubber workers may develop in the absence of any preliminary local or general warning symptoms after more than one or two decades of continuous, intermittent, or dis continued exposure to certain carcinogenic aromatic amines. There also does not exist any parallelism between the toxic and/or irritative properties of any chemical and its potential carcinogenic qualities, nor, is there a relationship between the degree of toxicity of any particular carcinogen and its relative carcinogenic potency. (a) Extensive experience with occupational cancers indicates rhat there usually elapses a latent period of years, if not decades, between the onset of exposures to a carcinogenic agent and the appearance of the resulting cancer {table 5). ft is for this reason most unlikely that occupational cancers become manifest within the first year following the inception of contact with &carcinogenic agent. In fact, all cancers which make their appearance during the first three years of occupation in a carcinogenic environment, should be subjected to severe scrutiny for a more probable nonocoupational origin before they may be considered from any occupational viewpoint. Tabus 5.--Latent fmodg of Occupational Cancers Orgsa and agent Average frutmf Range of jsarfod j iataut perltC Skin rsgfoc; i Medicinal........... ......................... ................ *............ i Occupational............................................................. \ Tar-- ............. ........................... .............. ...................i Creosote oil.. ...... ............ ...................... . ...................... Mineral oil___ __________,,____________ ________ j Crude paraSn o____ ____ _________ _________ Solar radiation--------------- ------ ------- . ---------------- ! X-radiation.,. . . . . ........... ...............................................; Lung . Asbestos.................... ................................................. ... Chromates......................................... ......................... .,,J Nickel carbonyl... ........ ................................................... j Tar fumes---------------------- ------ --------------------------: lonirg r&di&ticm------------- ------------ --------- ---------- < 1 Bladder j Aromatic amines.. . __________________ ____ . . . __ _j Years i 8 25 | 20-24 25 i 50-51 | 16-18 ! 20-80 1 ? ; l> 18 I 16 22 1 16 ; 25-35 | 11-15 <I Year 3-40 4-46 1-0 15-40 4-75 3-85 15-40 1-12 15-21 5--1? 0-80 0-28 7-50 2- 10 OCTOBER ci---MORNING SESSION 137 (/) A successful production of cancers in experimental animals by the administration of any particular chemical or occupational agent supplies weighty support to a claim that such a factor may have an identical effect upon man, especially if the route of exposure, tike physioehemical status of the agent during contact, and the cancer produced in experimental animals are identical with the corresponding aspects in human experience. However, because of the pronounced species specificity of axogenous carcinogenic agents, even positive experimental evidence provides merely strongly suggestive but not entirely conclusive evidence as to the existence of carcinogenic proper ties of such agents for man. Only human experience gives a definite anil irrefutable answer in such matters. (7) Pathologic and histologic evidence is in general of only limited importance in the establishment of the occupational causation of eanoera, since neither the clinical behavior nor the gross appearance and histologic structure of cancers arc etiology specific. How over, in some occupational earners histologically or lustochcmically demon strable manifestations are present which give conclusive or suggestive evidence as to their particular etiology. The presence of asbestos bodies and asbestosis in a lung affected by cancer provides practical and scientific proof as to the asbosto?in origin of such a pulmonary carcinoma. Of similar causal significance would be the demonstration of chromite dust by histoehemieal methods and by inoineratio of sections of the lung of an individual with pulmonary carcinoma. The histoehamicftt demonstration of arsenic hi the skin affected by a carcinoma represents another illustration of the value of histologic studies in the determination of the etiology of a cancer. Likewise the presence of extensive endarte.ritie changes in a fibrosed subcuta neous tissue containing a carcinoma or sarcoma would arouse the sus picion that X-rays or radioactive energy was causally responsible for the malign am lesion. It appears from these considerations that a competent and critical evaluation of the enUre evidence related to the exposure of the individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, some histologic or histoehenuoal characteristics and the existence of corn's ponding ob servations on cancer production in experiment,! animals aside from peri meat epidemiologic data represents the scientific basis essential for medicolegal decisions in litigations of alleged occupational cancers. C. C om pen sation Laws Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types 0! oc cupational carcinogenic agents, industrial operation? with carcinogenic 3-S058-S-6X---- if> 138 i m m m im of im abc hazards, and occupational cancers covered. As of October 1, 1054, full coverage laws applying to all kinds of occupational diseases in cluding cancers had been passed in 26 States of tbs United States and the District of Columbia; schedule coverage laws not always covering occupational cancers, or all types, were in force in 20 States and no occupational disease laws had been enacted at that time in 2 States (Mississippi and Wyoming). W ink workmen's compensation laws based on the principle of schedule coverage may provide some degree of compensation against disability and injuries resulting from occupational cancer hazards, such legal provisions designed for the protection of workers are totally inadequate, if riot obsolete, in an. era of a rapidly changing and in creasing occupational disease panorama. Such static laws reflect a legal and sociologio state of mind which is maladjusted to the dynamic state of modem industry. However, even the blanket or general coverage compensation law which is sufficiently flexible to include not only the present but also any future occupational cancer hazards, usually has a statute of limita tions which is inadequate for providing fair protection under certain and not too unusual circumstances mot with in occupational cancer. Since occupational cancers may become manifest many years after cessation of exposure to occupational carcinogenic agents, a statutory time clause of from 6 months to 6 yearn may be too short for occupa tional cancers which may appear after a longer period, it is advisable for this reason to adjust all existing laws in such & way that such eventualities are properly covered. In the workmen's compensation laws existing in m ost States, certain groups of workers or employees, such as especially farm labor and domestic servants, are excluded from coverage by the law. Since fanning as well as housework have become and are increasingly liecoming occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilizers, antisprouting agents, hormonal fattening agents of livestock, lubricants and fuel of farm machinery, residual oils for smudge pots, soil improvers, antibiotics, detergents, waxes, polishes, dry cleaning agents), there is no sound scientific reason for excluding members of such occupations from coverage by the workmen's compensation laws and from adequate protection against cancers arising from exposure to potential and actual occupational carcinogenic agents. OCTOBER 6---MORNING SESSION 139 D. Mb&r Cosa and Standards Any attempt toward achieving an adequate compensation by finan eial means for a cancerous condition acquired through contact with occupational agents not only presente considerable economic dif ficulties but is also of questionable humane merit. While such a procedure is evidently the best that can be done after an occupational cancer baa become an accomplished fact, the wiser, more rational, and in tho long run, more economical approach to a reasonable con trol of occupational cancer hazards lies obviously in their prevention wherever this is possible. This goal can be achieved to a large degree by the enforcement of proper work conditions in operations in which cancer hazards exist, so that cither any contact of workers with such agents is eliminated or reduced to an ineffective level. As to the fundamental step for accomplishing such a control of occupational cancer hazards, it would bo advisable to have all factories, workshop, laboratories and other establishments producing, handling or using known or suspected carcinogenic materials to register with State public health and labor agencies. This information would provide the basis for establishing the supervision of plants by health aiid labor agencies and would croate the proper machinery for familiarizing managers of such opera tions with the potential carcinogenic properties of the substances and devices used in their establishments and with the methods and pro cedurcs by which they might be controlled or avoided. The relative effectiveness of any medical, sanitary and technologic control measures to be adopted can best bo determined by ascertaining the changes in the occupational cancer incidence among the total population at risk occurring during some 10 to SO years alter their introduction. It is therefore desirable that provisions be marie for routinely recording all cancer cases occurring among worker groups exposed to occupational carcinogens. All precanccrous and cancerous lesions observed among members of such groups should for this reason be made notifiable with the Stale health agency. All persons having knowledge of those cancers should bo held responsible for such report ing. Thu adoption of sued mon-urn's represents an important step from a public health viewpoint, because there is a growing urgency to deformine the environmental causes responsible for significant changes in the incidence rates of several cancers, A great doid of circumstantial and direct evidence incriminates recent changes in the industry-related environmental factors for the startling and progressive increase in the lung cancer frequency observed 140 1854 MEETING O f XAXABC m a)] indnstri&iked countries during the past 50 years (graph 1). A similar, while not as marked, rise in mortality rates has been observed during the last two decades for cancers of the blood forming tissues, especially leukemias, for which the crude mortality rate increased from 1.0 per 100,000 of the population In 1800 to 4.3 per 100,000 in 1944. This development coincides with a marked increased use of ionizing radiation as well as with &widespread industrial and medicinal employment of chemicals having distinct hcm&iotoxk* effects. OCTOBER fr--MORNING SESSION 141 i t also may fee of significance that he age-specific, total and ageadjusted mortality rates per 100,000 population for skin cancer in white males and white females in the United States have shown between 1030 and 1050 a marked shift in favor of the younger age groups (table 6). Whether such changes in the age distribution of skin cancers for both sexes may have resulted from the modem habit of sun bathing or a more intense environmental, occupational and dietary contact of the general population with arseme&ls, or with products of the coal tar and petroleum industry, remains at present a matter of speculation. For determining the possible causal signifi,eanee of such factors in this development, it would be necessary to ascertain data ou occupational, dietary, environmental and habitual contacts of the affected individuals, tbeir complexion and race, and T aVi.e C--Age-xpecifir, Total, and Aqe-ndjmhd Mortality Rake Per m , m Population for Shin Cancer in White Malee and While Petalee: United States, im , m s, md M 0 wi>a* maN <u*s i 1930 | 1945 i wx : Under 15.................................... 15-24... ,,...... .............. 2 5 - 3 4 .......................................... 35-44 ,,. _............ ......... ............. 4 5 -5 4 .__ ,,____ ................ 5 5 - 8 4 .......................................... 85-74. . . ,, .................................. 7 5 - 8 4 .......................................... $5 and over_______________ _ All ages......___ . . . . ....... ......... Age adjusted 1................... .. ..................; ........ ,75 ................. .................. ; ................ J .................. ! .................. ; 0.06 . 12 . 22 2.5 ao 23.7 08.2 104.2 ________ i 4. 7 ; ..... \""AWM,w ` 0.08 ; o. os ; . 11 ; .34 .46 j .81 . 85 j 1 4 2. 1 ; 2. 7 ' o. 3 i f>. 9 ' 16,0 ! 12.8 i 52.3 ] 32.6 ; 172. 4 1 77.5 ! 3.2 ; 2.0 ;l 3. 6 j 2.9 v*ww^...v..^vw. i Wbtis femfos --02 r209 + 76 + 85 " 11 ~20 ~38 ~55 WWM1 Under 1 5 . .. . ...................................... 0.07 15-24..................................................... . J .08 25-34........................................................ i .23 35-44..........................................................: . 03 4 5 -5 4 .............. ............................... . . . . j 1.5 55-M_.___ _______________________ i 3.6 65-74......................................................... 11. 4 75-84........................................................ : 44. 8 $ 5 + . . ........................................... . 182. 7 All a g e s . . ....... ............ ........... 2, 1 Age adjusted 1____________ _________' 2. 0 0.07 . 13 . 23 ! . 5.5 ! 1,0 J 2.0 \ 8. 7 | 26.3 I 132. 7 ( 2.0 j 2. 1 j 0.02 i " 71 . 31 i " 133 j +213 1. 2 | +118 1.8 + 80 a 6 | +24 8. 8 i -2 2 18, 3 ? --2 68. 5 ; " 48 2.0 +* . >> 1. & 'V , , tie tei&lpoimlaCaa.{ikeWftttoS l&ifr,------ -- 142 1954 MEETING OF IUBC ou th location of the eaneera in the exposed Or unexposed parts of the skin (site distribution), All such data could readily be obtained for occupational factors if all occupational cancers would be made notifiable. A t the same time this measure would be instrumental in ascertaining to a much greater degree than heretofore the scope of occupational c&ucer hazards and of the cancers resulting therefrom, The effectiveness of this pro cedure is strikingly illustrated by a graph (graph 2) published several CUTANEOUS CANCER IN RELATION TO OCCUPATION number or cases or cutaneous c a x m m a u m m > s fOMtessw e^ o jw ,wales i sc& njm m m & m m w t FROM i$U ~ 194$ BCLU&Vg. Gbavk 2. OCTOBSK 6 --MORNING SESSION 143 years ago by Henry in which lie showed the striking rise in the number of oases of cutaneous carcinoma in males and females in England, Wales and Scotland attributable to occupational exposures to coal tar, pitch, shale oil and mineral oil after statutory notification went into effect in 1920, Conclusions 1, The rapid development of modern industrialism has been asso ciated with the appearance of many new occupational health hazards of which those causing cancers occupy an important position. 2, Tire increasing rate &t which occupational carcinogens have been discovered during recent decades suggests that only a fraction of the actually existing bid ustrial carcinogens is known and that here tofore imlmowo and now occupational carcinogens may he added io the present Industrial environment through the development and use of new chemicals and production methods. 3, There is a great deal of evidence indicating that only a relatively small fraction of the cancers produced through contact with occu pational carcinogens baa been recognised and/or placed on record. Because of the established widespread industrial contact of large worker groups with known occupational carcinogens, the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported number of occupational cancer eases and hazardous industrial operations. 4. Medicolegal decisions in compensation procedures of occupational cancer claims should bo based on a competent and critical evaluation of the entire evidence related io the exposure conditions of the claim ant, the presence or absence and the typo of any etiology, specific symptomatic manifestations observed during the latent and develop mental periods of the cancer, the length of the latent period, the site of the cancer, any specific histologic and histochcmical characteristics, the production of corresponding cancers in experimental animals by the incriminated agent and pertinent epidemiologic data. 5. Schedule coverage laws are Idadequate for providing proper protection against occupational cancer hazards because of the dynamic state of modem industry resulting in the constant, addition ef new chemicals ami production methods which may entail heretofore unknown occupational eanecr hazards. The statute of limitations contained in the general coverage law's represents its main defect in the fair and equitable application of this type of workmen's com pensation law to occupational cancer hazards. 6. Since the prevention of occupational cancer hazards and not financial compensation for established occupational cancers appears to he the mure sensible and humane method of occupational cancer 144 1954 MEETING OF iAlABC control, labor codes should be properly adjusted and enforced so as to eliminate or reasonably contain occupational c&neer hazards in mod ern industries. 7. For ascertaining the actual, scope of the occupational cancer problem and for the institution of adequate control measures, it is essential th&t occupational cancers and precancarous conditions are made notifiable with local and State health and labor authorities. 8. A comprehensive study of occupational cancer hazards will provide a sound basis for an equally urgent investigation of the apparent extension of industry-related cancer hazards to large parts of the general population, Bibliography t, B vbpek, W, C,, Occupational Tamers and Allied Diseases, C. 0. 'Thomas, Springfield, fit, 1942, p, 897. Rwrnt Developments in Environmental Cancer, A. Review, Arch. Pathol. In press, A Methodology for l&nviroaraental and Occupational Cancer Surveys. Pubs. Health Tech. Monograph Ho. 1. fJ. 8. Public Health Service, Depart ment of Health, Education and Welfare, 1950, p, 37. "2. Tjusko. V. M<, Occupational Disease Reporting. II. S. Department of Health, Education and Welfare, Pobl. Health Service Pub!. No. 288, lOSS, p, 80. 3. ftmxjsH, L- K,, Recent Trends in Occupational Disease Legislation, Univ. Illinois Bull. 48; No. 69, 1951, p, 30. 4. Mobojs, G. G., and DA'/S-srO)*, 8, 1,, State Compensatory Provisions lor Occupational Dise&t. Bureau of M(?> Iixformatioxs Circular 7050, Lb S. Department of the Interior, 1932, p. 125. 5. Waters, Th., Industrial Physician aitd Workmen's Compensation--Curreiit Trends an ComjaensaUoii Legislation. J. Induot. Pyg. and Toxicol. 31; 251-25$, m 8. SuBcouxaTTEB ok LsosstATiON Pjustem.as, A flahoual Approach to Air Pollution Legislation. Manufacturing Chemists' Assoc., 1982, p. 23. 7. Tookakoeax), P. J., Health of Workmen*. Appreciation of Risks to Which Health of Workmen Are Exposed in Industry in Province of Quebec, Oanad, M A. J. 54: 352, 1846. T h e A c cid e n t Pyeventiox* A sso c ia tio n s Lender th e Q u eb ec W o rk m e n 's C o m p en satio n . L aw L. H, T. CuEUU. President* Quebec Association for the Pretention of Industrial Accidents f/n the absence of Mr. Clegg, his statement teas reed by J. Armond Desrnchers, sice president, Quebec Association for the Prevention of Accidenis] 1 will outline briefly the setup of the various safety associations, and later, being more familiar with tins organization which I represent, I shall endeavour to elaborate on a few of sU major promotional . A.wivitiww. APPENDIX O fficial A tteisdaiice a t tise P oH ietia A n im al M eeting i k e In te ra a ti sx a i A sso c ia tio n I n d u s tr ia l A cci d e n t B oards an d C om m issions CANADA Alberta A. Taimmo, M, B. ., Commissioner, Workmen* Compensation Board, Ed monton. B a H, H< Hmmsm, Chief Medical Officer, Workmen's Compensation Board, Edmonton. C. M, H ACneon, Q, C., Chairman, Workmen's Compensation Board, Edmonton. Brilith Columbia P< F, AsoKiBAto, Secretary, Workmen's Compensation Board, Vancouver. A&m Brix, Chairman, Workmen's Compensation Board, Vancouver. C. W. Pmtchak, Commissioner, Workmen's Compensation Board, Vancouver. Manitoba Q. L, Comm, Q. C., Comaiiasioner, Workmen's Compensation Board, Win nipeg, P. V, E. Jos**e, Assistant to Commissioner, Workmen's Compensation Board, Winnipeg. Now Brummck A. A. Csisim m , President, New Brunswick Accident Prevention Association, Moncton, XL Gy jo userok, Vico Chairman, Workmen's Compensation Board, St. John, j. A, LeBlakc, Claims Officer, Workmen's Compensation Board, St, John, Nowfoundhvid CtASSKCE V. H ancock, Commissioner, Workmen's Compensation Board, St. Joint's. Nom Scotia Am d s Farm, Commissioner, Workmen's Compensation Board, Haidar, Fkank Rows, Chairman, Workmen's Compensation Board, Halifax. Ontario J. P, Caomby, Vice Ciwdm&n, Workman's Compensation Board, Toronto. M a x Bonne, Ontario Federation of Labor, Toronto. F, Fixm Ate, Workman's Compensation Board, Toronto. &KO&OB G akkow G k s e n s , Director, Federal Government Employees Compensa tion, Branch, Department of Labor, Ottawa, W. J. JoKKsroK, Workmen's Compensation Board, Toronto. J. B. Laws, Department of Labor, Ottawa. S2x Avmmm e 229 L. B, Lefpasd, Physicist, Division of industriai Hygiene, Department of Health. Toronto. W ras Maclachlak, President, Canadien Industrial Safety Conference, TorontoV. C. PHKu.iT, Director, Canadian Branch of the L L. 0., Ottawa. G. R. Foot, Workmen's Compensation Board, Toronto. Allah Poktbs, Department of Labor, Ottawa, . Hobhsoh, Workmen's Compensation Board, Toronto, E. B. Svarkow, Chairman, Workmen's Compensation Board, Toronto, Waeeew W. Stearns, Claims Manager, Liberty Mutual Insurance Co., Toronto. Dm E. G, Steele, Workmen's Compensation Board, Toronto. Dm Banes Youno, Director, RehabiHtation, Workmen's Compensation Board, Toronto, Quebec Stepken' Babiw, Safety Director, Quebec Iron & Titanium Corporation, Sorci , G, Ballachky, President, Quebec Meta! Mining Association, Nomade., Da, BaBANo Bbllemahk, Workmen's Compensation Commission, Quebec. W. h. Bennett, President, Quebec Pulp & Palier Safety Association, Quebec, Jacques Bbenab, Montreal. Dt. L< . Bbochu, Workmen's Compensation Commission, Quebec. Jacques Casosan, Department of Labor, Quebec. . B. Cook, Secretary-Manager, Quebec Pulp Paper Safety Association, Quebec. Faut, A, Cooke, Joint Manager, Quelle Industriai Accident Prevention Associa tion, Quebec. A. Herman Cots, Safety Director, Canadian Car 4 Foundry Co., Ltd,, Montreal J, KMAtro Bb&rqchbbs, Vice President, Quebec Association for the Prevention of Industrial Accidents, Quebec. J. A. D uckett, Montreal, J ean B absauluss, Sh&wirngan Water Power Oo., Montreal Page Ds&saboins, Assistant to President, Casgrain & Ch&rboaneau, Montreal, J, E. Dion, Workmen's Compene&tioo Comraiaeioo, Quebec, J, E. R. Dsmbss, Workmen's Compensation Commission, Quebec, J. H. Dbusms, Commissioner, Workmen's Compensation Commission, Quebec. Joseph Dation, Workmen's Compensation Commission, Quebec. Hokobable M. L. Duplessis, Q, C., Premier of Quebec. Aktkuk Fosteb, Vice President, Workmen's Compensation Commission, Quebec. Honobabl Onesjme Gaisnon, Minister of Finance, Quebec. De, Gustave Ginobas, Medical Director, Rehabilitation Institute. Montreal. Williass Gaelagheb, Montreal S. Geeooet, Chief Claims Agent, Canadian National Railways. Montreal Jeah Gabneau, Workmen's Compensation Commission, Quebec. Joachim Gkekxbh, Q, C., President, Workmen's Compensation Commission, Quebec. Bsbnab C. Hamsl, Quebec Power Co., Quebec. Rulphe Hamel, Vice President, Catholic Conference of Labour, Asbestos, Row. Wilsbeo S aan, Mayor of Quebec. A, H. Howseessb, President, Quebec Metal Mines Accident Prevention Associa tion, Noranda. H. H. Hough, Chief Claims Agent, Canadian, Pacific Rsilway, Muntesi, Lsopo, Hvaan-f, Safety Director, Quebec North Shore Paper Co., Bale Comeau, M. Marc Lacoste, Edifice Cadillac, Montreal. Maori ck Labebbijsrk, Quebec Iron k Titanium Corporation, Sorsi <>! 1054 M UTING 0 ? IAIARC Extern^ I asochellb, Secretary General, Quebec Metal Mining Association, Quebec, Nokl Lakoche, Workmen's Compensation Commission, Quebec. Db. Ahthub L&clbbo, Chief Medina! Oifseer, Workmen's Compensation Com mission, Quebec. Du. I). Leonab, Workmen's CompeM&tion Commission, Quebec. T. E, Little, Director, Quebec Metal Mining Association, Noranda, W. E. Montgomery, Safety Director, Kenneth B. S, Robertson, Ltd., Montreal. Paru?? Moksitb, Q, C., Commissioner. Workmen's Compensation Com mission, Montreal. J. Alpkokse Mobbncy, Workmen's Compensation Commission, Quebec. Jban pKXNtx, Orthopedist Technician, Montreal Romeo Faquet, Workmen's Compensation Commission, Quebec. B onat Quimpeb. Deputy Minister of Labor, Department of Labor, Quebec. 0 . A nt, Rousseau, Workmen's Compensation Commission. Quebec, F. M. Rccbblsag, Commissioner, Workmen's Compensation Commission, Quebec. Davie IfomELAB, Workmen's Compensation Commission, Quebec. Eyabutte Rocisa'rai, Commissioner, Workmen's Compensation Commission, Quebec. 1. H, Bx.oanb, Safety Director, Canadian Johns-MariviUe Co., Ltd., Asbestos. W. E. Sotar, Assistant to Mitre Manager, Canadian Jolms-Manvilie Co., Ltd., Asbestos. Db. Caju,e Stmard, Workmen's Compensation Commission, Quebec, Da. F, J. Touanau, Division of industrial Hygiene, Montreal. Da. E. A. T urcot, President, Industrial Medical Association. Montreal Debar Tremblay, Deputy Minister of Labor, Department of Labor, Quebec. L, P. Tsssrs, Workmen's Compensation Commission, Quebec. Jacques Vbeseatjut, Secretary, Workmen's Compensation Commission, Quebec. A, C. Walker, Superintendent of Safety, Crane Limited, Montreal. D b , R. E. L. W atson, Medical Director, Crane, Limited, Montreal. Sr, George White, Workmen's CompetieBtiun Commission. Quebec. Saskatchewan M. D, Thompson, Commissioner, Workmen's Compensation Board, 0. W. Vau.uao, Chairman, W'orkmen's Compensation Board, Regina, C. C. WiluamSj Minister of Labor, Department of Labor, Regina. Regina, UNITED STATES A iaia/tm Joe L, Colkmam, Director, Department of Industrial Relations, Montgomery, Arkansas 0 . L. Grant, Attorney, United Mine Workers, Fort Smith. O. W, Holmes, Commissioner, Workmen's Compensation Commission, Little Rock. AGNOLO B. 8ie.es, Commissioner, Workmen's Compensation Commission, Little Rock, Caiiforma Chet F babhsb, Guarantee Insurance Co., Los Angeles. Joskbh J. G allagher, Manager, State foMiranee Fund, BurJing&m. S. \\\ MAftaONA'ao, Chairman. iiidnsicia! leekRm Ccmnnwron, Sab WAmhxo ' kvmm nx c Famo Scuseresrene, Diraetor, Department of fadnstrial Relatione, San Frssmeo. Dr. Bee? S. Thomas, Department of Employsent, d&e-ramiemto. H, M. Wlsos, Department of Employmonti Sacramento, Culorado E a r if, BeAXKSrtAR, ciiairman, Indusfcms Commisnes of Colorado, Denver, Haeop C, Thompson, Id reedor of Claims, Sfate Compensatio Inunramm Furai, Denve r. C'rmpsc&cm IX E. Coochar, Hartford Accident & Indemnity Co., Hartford. . H, Gekrs, President, Toll ii&te? House, Tvery-towm. W. 8. VSoCoRsncjc, The Aetna Casualty & Surety Co,, Hartford. l'ki<i\mw A&e l K laxv, S p e c ia l Counsel, , I, d u Pont t ie Rumours & Co., Wilmmgiua. Dr. f> J. MacC ou.e'.m, Member, Industrial Accident Hoard, Wyoming, J amba A. Mruass, President, Indiisiiial cekleat Board, Wlbaisgton. Poro IL WAHSisro, Member, Indxsstrial Accident Board, Laurel, Dislrid (if Columbia Akorsw J. BjesiSUiSa, Member, National Legislative Committee, American Federai ion ol Labor, F&aylk F bkkkaok, soeiaie Dsrecior of Education A Xiesearoh, Congress of Industriai OrLmnisarions. B&ocb A. Okepxs, U. 8, Department of Labor. Papa E, Grumes, fkerei&ry-Tra&uior, I Ai ABC, U, 8. Departmeof of Labor, Dr, W. C. iisESBE, Chief, Envirmmient&l Cancer Section. Carnee?- Institute, Department of Health, Education and Welfare, Bethesda, Md. Hort Arthur L aesos', Under Secretary of Labor. Jon?' E. Lawyer, Chairman, Employees Compensation .Appeal Board, LL S. Department erf Labor. Mause V, LemwevrE;,!,., Off of the Sceretary-Tmmsrer, I IABC, U. S. Depart meut of Labor, Wxluam M cCauley, Director, Bureau of Employee' Compensation, U. S. Department of Labor. FraKK McElboy. U. 8, Department of Labor. Frarces C. Ssurru, U. 8. Department of Labor. Roasrcr Vas Hyrsno, United Mine Workers Welfare and Retirement Fund. Fl&nds James CaU&&ou, Afriober, Indurtrial Commission, TDlabiWico. B. T. Couemak, Generai Counsel, Industrial Commission., T&is&hasaee, Roomky D ur&.aSsce, Director, Workmen's Compensation Division, Industrial Commission, Talfhasse, d iss io r u A . P a &Rs , O H & odo, J ames T. 'Co c k l e s, Ch&irma, Industrial Commission, Tallahassee. (mwijza Ricea&d W. Best, Secretary-Treasurer, Board of Workmen' Compensati) College Park. W. E. Lucres, Member* Board os Workmen1.-*Compensation, Atlanta. 1954 MEETING O* iASC ltib Oi' J. Hoams8, Plaident; National Association of Self Insurers, Lewiston. B. W. O^maumu, Chairman, Industrial Accident Board, Bosse, Minois B an Asms, National Safety Council, Chicago. H w w BofrssaN Supersisteudent, Compensation Claims Department, Zurich General Accident . Liability Insssrance Cm, Ltd., Chicago. E&srt, M. Caussnoo, Commissioner, Industrial Commission, Chicago, Fpot B, P&axs&, Director', Industrial Division, National Association of Mutual Casualty Companies, Chisago. Mrs, W> Gaseas?, Council m IridwiriM Health, A, M. A., Chicago, g. J. Houmbha, Ch&m&u, Industrial Commission, Chicago. Roskut S. Hows, Lumbermen's Mutual Casualty Co., Chicago. D. W. Johnston, Corrarosriemet', Industrial Commission, Chicago. Dr. M aton H, K&qssssnbexs, Medical Sendees Manager, Caterpillar Tractor Co., Peoria, XL O&m Uibhmi National Safety Council, Chicago. J ohn Mobun, Commissioner, Industrial Commission, Chicago. Dr. C. T. O ison, Chairman, Commission on Workmen's Compensation, indus trial Mfiriia&l Assoei&iion, Chicago. J. A. Paskkwcs!, Illinois Department of labor, Chicago. S, J. Sraverb, Western Electric Co., Chicago. Papp S. Wmeb, American Mutual Alliance, Chicago. indiana Howas T. Batman, General Manager and Counsel, Lynch Ooai Operator Reciprocal Association, Terre Haute. Dr. . K. H ABCouss, Indianapolis. &uahu&l P. Mulsa, Hewing Member, Industrial Board, ladi&n&polis. Jo&acu P, Mrixais, Chairman, Industrial Board, Indianapolis. i e tun C, H. Omenmsy, Deputy Commissioner, Workmen's Compeasarioxs Service, Des Moines, Kamos E o'wa&u C o s b t , Commissioner, Office of Workmen's Compensation Commis sioner, Topeka. tMn? M. Boss, Examiner, Office of Workmen's Compensation Commissioner, Kansas City, R*ia>BJ. Tu<semss Esc&mmer, Off of Workmexs's Compensation Comsnissinacr, Butch imon, t e r on W'sbb, Examiner, Office of Worktneu's Compensation Commissioner, Pittsburg. Kentucky P ath. Coscas, Acting Commisalencr, Dcpartncnt of Industrial Frankfort H. WtuJAMa, Aitoraey Gesteras, Department of Labor, Frankfort. Relations, appendix g Maim W. BaUtOti, lawyer, Baxigor. Mrs. Majmsmnsi Baenahb, Industrial Accident Commission, Augusta, G n r t M. Jon?, Mesaher, Industrial Accident Commission, Waterville, S&Mm E, M neatu,, Lawyer, Bangor. F. IS. Bkskabsn, Portbad. Maryland Mssuvm L. W tm, Ch&irm&a, Industrial Accident Commission, Baltimore. Dr, Jons V, H o ra ss, Baltimore. W. Albert Msscjixk, Commissioner, IndyeteiM Accident Commission, BaBi* more. Pato Sxekbhb, Jr., Manager, Compensation Department, Maryland Casualty Co,, Baltimore. H nsar , Soraa, New Amsterdam Casualty Co., Baltimore, s . iMXAm^ii P, Arrxns, Chairman, Subcommittee on Industrial Halations, American College of Surgeons, Brookline, A&p&omz S. Bachoeows&x, Attorney, Salem. TMma D, Bssxa, Employers Groups ixisuraxtee, Boston. Tborab W. Bowk, Member, Division of Industrial Accidents, Boston. It. B. Coopee, Director of Medical Halations, American Mutual Liability In* auranee Co., Boston. E pokne H. XBOUJS, Chairman, Division of Industrial Accidents, Boston, P hasic, E. oom sy, Director of Self-Insurance, Division of Industrial Accidents, Boston, SfANvoon h. Hanson, Assistant Vice President, Liberty Mutual insurance Co,, Boston. G. 8. Hasuan, Pice President, American Mutual Liability Insurance Co,, Boston. James G. Haas;any, Attorney, Massachusetts Bonding and Insurance Co., Boston. Maucmaa J. Hicks, Boston. Mab? F, Hscjss, Member, Division of Industrial Accidents, Boston. Exam J. KonomAAS, Member, Division of Industrial Accidents, Boston, EnwAan J. Mtmrxrr, Attorney, Boston. M a st . A. Hookas, Boston, Aaawsr 8?, Cfeer, Counsel, Liberty Mutual Insurance Co., Boston. Joseph A. Sou.;van, Chief Examiner, Liberty Mutual Insurance Co., Boston. Mas. Emma S. Tonsant, Past President, IAIABC, Quincy. M ichigan W, C. Btscof, Manager, State Accident Fund, Lansing, Habrt P. Biases, Superintendent of Clams, State Accident Fund, Lansing. WawAA. B. Buchanan, Chrysler Corp,, Detroit, C. E. Cahovxekus, Ford Motor Co., Detroit. J ohn C. Caaoaas, Lincoln Mercury Division, General Motors, Detroit. H. A. Compeao, Attorney, State Accident Fund, Lansing. WiaaAM J, Dsvsms, Chrysler Corporation, Detroit, Cvans E. Dusio, Ohrysl*vs Corporation, Detroit. James L. Hex, Supervisory Attorney, Workmen's Compexisatsoe Sectio. Ford Motor Co., Detroit. -- so I$54 MSJETXN OF 1AiABC W. Q, Hoskkjims, Compensation Supervisor, Cbrysbr Corporation., Detroit. ROTS 15- JotstreftK, Manaster, Employee A vises Department, Ford Motor Co., Da&rbom. Wkawm J, J oses. Laeey, Jones & Boeile, Detroit. P. A. Lax, Staff Atturrmy* Workmen's Compensation Section, Ford Motor Co., Detroit. Wads H, MoChee, Je,, Member, Workmen's Compensation Commission, Lsnsiog. W. It, MacGsoook. Vic President,, Michigan Mutual Liability Co., Detroit. BssiAKiJr Marcos, Representing Samuel B> Horavitss, Muskegon, ftsc-smse R. No?;;:'., Chrysler Corporation, Detroit, Rooks? h. O'Co.wsu,, Rot-he, Marston, Bohn & Maray, Detroit, TrfKomssK P. Ryan. Chairman, Workmen's Compensation Cato mission, Dim-on- dale. Rs'C'oak L. Schaum1, International Representative, Compensation Department, 0 AW- CIO, Detroit, , A. VRa President in Charge of Claims, Corporals Service, ?<., Detroit. Faso S, Washer, Attorney, Auto Owners Insurance Co., Lansing. Minnesota ItosKnr E, Faricv, Commissioner, Industrial Commission. S'. Paul Mississippi Sam >$. Anna.so. Commissioner Workmen's Compensation Comsrxission, Jackson. Jons A- Crao, Chairman. Workmen's Compensation Commission- Jackson. Afitseu Wii-EAAM G. Burch, Suffenntftndeat, Workmen's Compensation, AmericanAasoel&ted Insurance Companies, St, Louis. Charles E. Cayss, Member, Industrial Commission, Jefferson City. Earn. F. Oman-, Asd-duot Professor, SC Louis University, St. Look R. Roy,sms Chs, Attorney, Kansas City, W. E. FassKASiD, Member, Industrial Commission, Jefferson City. Spencer H. Ciivss% Director, Division of Workmen's. Ooroiwimtioa, Jdferano City, SrsiOiKa; J, MiwiSot, Chairman, industrial Commission, Jefferson City, M ontana W, W. Casper, Secretary, Industrial Accident Board, Helena. fhm /ereey WlHftOH Blaes. Chubb & Sims, Managers, Federal Inseran' Cm, Snort Ribs. Da. H. E. BsioKKR- Mew Lisbon. Carp Bonutmman, Commissioner, Department of Labor A Industry, Trenton B aksei, A. 8pair, Director, Blvdskm-of Workmen's Compensation, Department, of Labor & Industry, Trent*. <Ve? Mexinn Esw*e J okes, Assistant Commissioner, iaibor and Industrial Commission. Santa Fe. APPKNBEK. N& ath Evstsasrt R. Ai.ogt*, Manager, C lsim & Safety Department, tk^ouy^Vsumam. Ol Co,. Ine,, Mew York. Lotos &BKrr, eiuary, Woodward & Fondilkir, New York. H. Dmousy Bm&AUj Director, Comptmsstlon &Safety, ftre&n Locomotive Co., Schenectady. Msss GksTSOBB Cvanauoh, W<irkie`s Compensatio Born, Albany, Fav to , Cayslt, Vice President, Fidelity & Casualty Co.. New York. Gtves T, C.avToh, New York, Masrkajx Dawson, Past S^eret.ury-'i'raasur, ABY New York, J. A. s s im a is m , Secretary-Comptroller, MsAion&l Council oh Compons&tioa Insurance, New York. XhssfW, State Insurance Fund, New York. Mim Ma&y ortLOH, Ch&tnria, Workmen's Compe?iKatks Board, New York. J. IIAi yrnss, United State Casualty Co., Nere York. Jssprr Dbam Eow'arus, Attorney, New York, Ri-CUasa Foson.j.rs, Woodward & Fnudiiicr, New York. <). EA&m Fox, Secretary, Casualty Division, Giens Falls inmirance Co., Giess Falls, Ds, LaoKASa J. Godwatc,, National Chairman, Cardlaa-krltxdostry Com mittee, Americas Haart Associsi ion. New York. WfUi* C. Cortot, C. E.. Director, Icstitote for Hie Crippled and Disabled, New York. Afras iiAiismn Ha.sj.oh, Associalo Economist, Workmen's* Compensation Board, Now York, lfssd H ejmem, United Steelworkers of America, Buffalo. Tkeooosk He m x s .Ja,, Attorney, Mattonai A.-wociattou of Matua Casualty Cos,, Mow York, F, H. H OMiomsE, . C. F. Induri ries, New York* IL M. J acsaon, Afanador, industrial Health. Program, Johns Mmsvilte Corp., Kerr York. Aokkw Halmr stow'}New York. Ewxs D. Krs.a, Counsel, Now York Compensation laauran; Rating Ruar, Mew York. M. L, I.AsaowBKi, Western l lootrie Co.. Ist*,., New York. J ghm M. M cJ oS asj, lYireaior, Workmen's Compensation, Associated luduat.fies of New York iffate, Inc,, Albany, Roboex E. Maksmau., Administrative Deputy. Workmen'* oip&nss>tioa Board, New York. Gaofir.K F. MmxfiSAM, Manager^ Workmen' Compensacin A Disability Claim BivNioo, Amenrar, Surety Co., Now York. MrcwAKt J. Mrmrsv, Cenerai Manager, Association of Mew York State Mutual Casualty Cos., Near York. Rat J, Oasxey. State insurance Fared, Mow Y'ork. Mise Masoos; Polajcov, Serrutery, United Hteeheorkers of Amorios, Buffalo. Miss Mar* Pojxukov, Bufalo. James J. Began, Secretary, The delf-Ltsurera Association, New York. B. V. Rtak, Fidelity & Casually Co. of Mew York, New York, Hjskrv D. 8am a, Cener! Manager, New Y'ork Compensation Insurance R&Hny Board. Now/ Toth. , M, Schmisst, Insurance Manager, National Council of State Seif-Iniotreta Association, New York. m 1954 MEETING OF XAIA8C J am&s R, Smarms, Attorney, American Telephone k Telegraph Co., New York. Cy&us F. Shtteb, Claims Attorney, New York Telephone Co., New York, W&uam H, SOTfli-rra, Associate Attorney, State Insurance Fund, New York, J, Harrt Tsksnak, Attorney, United Steelworkers of America, Buffalo, Waumn C. Tvc%m, Counsel, Utica Mutual Insurance Co., Utica. Gao, 3D. Wanas, Western Electric Co., Xne., New York. N. M8am Woo&, Association of Casualty & Surety Cos., New York, Da, M. Wbxuss Zockss, Director of Studies, Commerce & Industry Association of New York, New York. North Carolina J. W. 2A*r, Commissioner, Industrial Commission, Baleigk, North Dakota Ons Bbyant, Chairman, Workmen's Compensation Bureau, Bismarck. B. M. Etan, Member, Workmen's Compensation Bureau, Bismarck, Ohio H. D. Banuzst, Emile E. W&taon, Columbus. Jacob Clayman, Secretary-Treasurer, Ohio CIO Council, Columbus, J, Mamax Dic&smott, Vice Chairman, industrial Commission, Columbus. B< 0 . GomsMOBUzn, Superinteadoat of Claims, Farm Bureau Mutual Auto Xnaur&ace Co,, Columbus. W, C. Haswas?, Attorney, Squire, Sanders k Dempsey, Cleveland. M, Holland Kkisk, Director, Workmen's Compensation, Frigidaire Division, General Motors, Dayton. John Kxmmty United Rubber Workers. Akron. iiwnm o W, Mesas, Chairman, Industrial Commission, Columbus. CaamaKS F. Nowes, B. F, Goodrich Co., Akron. Thomas M. Haema, Jones, Day, Coekiey & Heaths, Cleveland. Oklahoma Fez Ansaar, Industrial Commission, Oklahoma City, Mark Ckmusza, Industrial Commission, Oklahoma City. Janas Aubkht C. Hunt, Industrial Commission, Oklahoma City. Tom G, Martin, Commissioner, State Insurance Fuad. Oklahoma City, Mon? it. Powfcu,, Chief Attorney, State insurance Fund, Oklahoma City, E, J. Sbyebbaano, Industrial Commission, Oklahoma City. Oregon L, 0. Akzns, Member, Industrial Accident Commission, Salem. WtuuAU A. CAtnAHAN, Chairman, Industrial Accident Commission, Salem. Pennsylvania F. E. Baakako, Manager, Compensation and Safety, Bethlehem Steel Co., Bethlehem. Feans SL Boat,, Deputy Secretary, Department of Labor and Industry, Harris- burg. A. C. Chssstoaw, Chief Supervisor, Indemnity Insurance Co. of North America, Philadelphia. W, D. Coaxuby, Secretary, Fire Association of Philadelphia, Philadelphia, E. G w tm itt, Manager, Stats Workmen's Insurance Fund, Harrisburg, R. M. Hautman, Assistant Manager, Compensation and Safety, Bethlehem Steel Co,, Befhkih&s. AS'FENMX C 237 Rir C, Ha&os, Superintendent, Compensation Claim Department, American Casualty Co., Heading. Essbcel C. Ksiske, Assistant Manager, State Workmen's Inswmsee Fund, Harrisburg. Walter 1 ) ', Secretary"Treasurer, National Council of State Self-Xsaurars Association, Philadelphia John L. XUvs.a, Director, Bureau of Workmen's Compensate!!, HmMmzg. F, PartcsA., Chief Safety Inspector, State Workmen's Inaumsoe Pupd, Harris burg. A. Sckro&okr, General Attorney, Pennsylvania Railroad Co., Philadelphia. D ayib M . Wawcbic, Secretary, Department of Labor & Industry, Harrisburg. Piii-ria Rko Mxm RapusxXiCAOMONr, Member, industrial Commission, S&n Juan. Eouasdo A. SANmoo, Actuary, State Insurance Fund, San Juan. Rhoik aland Antonio Dr P into, Executive Assistant Curative Center, Department of Labor, Providence. Da. J ohn E. Dowmst, Medical Director, Curative Center, Department of Labor, Providence. South Caralim WLim Fait CtArmu, Commissioner, Industrial Cornmissbn, Columbia. Jambs J. Earn, Vice Chairman, Industrial Commission, Columbia. Mss. H. S. Tam, Columbia. Tmtmm W. H, P a&ham, Commissioner, Department, of Xuxbor, Nashville. Pauu A. Piiiir.if'S, Safety Engineer, Department of Labor, Nashville. Dewbt W n m , Director, Division of Workmen's Compensation, Department of Labor, Nashville. Pesos Da, V. C, B ax, Chief Physician, Humble Oil t Eeduiag Co., Houston. E. L. Ec&man, Vice President, Petroleum Casualty Co., Houston. L, H. Puswhlusn, Chairman, Industrial Aecideut Board, Austin. Fbusc A. liArssua, President, Petroleum Casualty Co., Houston. Virginia Mas. C. B. Hrrcfi, Ksehmoad. W. H, Nickels, J r., Chairman, Department of Workmen's Compensation. Richmond. Wa$hinytr/n Elmkb H. Kbnnkbv, Supervisor, Rehabilitation Center, Department of Labor and Industries, Olympia. Khssi Virginia Dm John P, Brick, Obairmaa, Occupational Disease Medical Board, Charleston F ran Hots W. K sskr, Executive Secretary, `Workmen's Compensation Fund, Charleston, Rsmoiunit J. M.W&trss.&c.r, i.eg&l Assistant, Workmew's Oompen&atioo Puad, Charleston. G&OM3&W, Sroxas, Commlsaiooer, Workmen's Compensation Fuad, Charleston m 1964 Muamsa a t uiuse W.m m sK m zm w & & m m m t Attorney, Milwmske&. BAU K fern, Ym Yrmmif EmpfoyOT MaFmls, Wsxma. k w a , amtmb A toraey tssemij Mrs>m J; H litsgyxi&j CMms Ckmnjsel, 8s&p!s>yg MMu, W te , R&Bm? A. M o w s, Bimsto?, Wwkoe&a's Cfompsass, ssdatris3 Commssloa, lM i, _ y& m Wsa?%S i m , itsdasfcm! Cosasaissksa,, M&dsoii, Wyoming f f n i F, F ' 1?', M&s&gt, Werkassa's Omg>e!ftifeft C-omsmssfea, Chaye. S itviH xxftt Y w m t* W '-z?)