Document Bvdbe8L22ndma8jD5Bxy39vkX

PLAINTIFF'S EXHIBIT isrsc-7 - CHICAGO OCTOBER 10-14a < 1933 NATIONAL SAFETY COUNCIL, ,NC 4rrisM, 193i, Nlioft*l Safety Courcil. Ine. PnnUd ;n tfcv u. S. A. 1 ^reword THE Transactions of the Silver Jubilce Congress and Ex position of the National Safety Council, October 10-14, are published in two volumes. Volume I contains the genual and subject sessions and the sessions of tbc various Industrial Sections. Volume 11 contains the Street and Highway Traftic, the Commercial Vehicle, the Transit, the Child education, and the Monte Safely sessions. Volume 1 is distributed automatically So all industrial mem* , hers of the Council. Volume II is sent to members who are believed to be interested chiefly in the sessions it contains. However, other Council members may obtain Volume If 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- po.scs. lixtra copies of the Transactions may be obtained as follows: One to 10 copies of Vol. I, at $2 each; 11 or more Copies, $1.75 each. Extra copies of Vol. II cost 75 cents each. , THE Transactions are a condensed record of the pro ceedings of the Silver Jubilee Congress. The papers and . addresses have been edited to delete extraneous matter, ab breviate the less important portions, and emphasize what may he of particular usefulness and value in promoting ef fective safely organization and 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 thorough accident prevention success. The original manu scripts are available for additional reference, if desired, in the flies of the National Safety Council. , rPllE National Safely Council, at its Congresses, seeks to X ilimiuau- from discussion mailers which are not pertinent I to the ainiN of the Longivs- or which may be contrary to the 1 Council's policies. It cannot accept ropunsihilily, liuncvci, lor all views exploded cither in the papers which have been blue od or m the duenisioii-. ba>cd upon these papers. NATIONAL SAFETY COUNClLJnc. 20 North Wacher Drive Chicago Contents Council Officers and Directors..................................... 4 ^ Council Purposes and Policies.................................... 9 Annual Meeting of Members....... ........................ 11 Annual Banquet........................................................... 31 Special Subj'ect Sessions-- A/Dtgugrsriticcsu,uuFltuuuimMrae*ls,SwG-au-afn-es.-t*e-yj-s--a-....-.n.....a.d........V........a......p.....o......r....s......................................._..._...._...._.... 443S53 Falls of Workers.......... V.................................... 59 Fire Prevention................................................... 53 Governmental Officials ....................................... 85 Health Service in Industry...................................101 Industrial Accident Investigations.................T..11S 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......... i.......................... .313 Chemical Section......................................................... 339 Construction Section.................................................. 373 Food Section .............................................................. 385 Marine Section.............................................................407 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 Refrigeiatiou Section........................................ 691 Rubber Section.............................................................703 Steam Railroad...........................................................733 Textile Scct*or*-...........................................................753 Wood Products Section...............................................775 Safety Exposition--List of Exhibitors...................... 799 Indcx ............................................'..................... 805 national afety Council, Inc. HONORARY MEMBERS ,\"imiu.N or luu.v axu Sim. Kxiunitrs Kiiiil kt \V. Cami'iu i.i. I. 1 W Is. PaIMI.K OFFICERS (1938-1939) I*. II. l-l.SMi.i., Prc-idcnl C VV. Dimcksv, Vice-President fur l-iiiancc and Treasurer I-hwk H. Harrison, Vice-President fur industrial Safely tin. Miliar McCustuck, Vice-President for Public Safety VVai.uk S. Paint., Vice-President for Engineering A. \' kuiiuiiii k, Vice-President for Safety Councils R. T. Siu.knstkx, Vice-President for Membership A. \V. VViiitxkv, Vice-President lor Education U. 11. Camtkox. Secretary and Managing Director EXECUTIVE COMMITTEE (1938-1939) II. .1. Ai.hkICII, Spencer Kellogg & Sons, Inc. J. I. It wash, Pa-l President C. \\. Iti.kiayi isT, Pam President 11. VV. tlooi.rss, Sinclair Prairie Oil Company I . I!. tliifiKr, Wi-eiiU'in Public Service Corporation koinei W. C.vuimt.t.. Past President <l.MMtfiSr,`National-Safety Council; Ini.'. . ........................ I.. 0. CAMfin;i.i.. Mining Section knlicrl I. C.vrlix. Aetna Casualty Sb Surety Cuinpauy I. r.ui-. A. Di.lti.iiis. Past President C. \V. I b Ml'l.sv, The l.itiuid Carlionie Corporation ........ k. la. Donovan, ASSE-Enginecring Section M a net's A. Dow, Past President VVaiiir A. Evckson, Lehigh Valley Safety Council Kami. K. Ckou.k. Safely Cuuneil of llie Coliuobus Clianilier of Cunt- merer D. 11.. |-`l.NSI11., Cun-nlling Engineer IIaura tipiuiLKT, Tbe Pullman Company Prank II. IIakkisoS, lutcruatioual Harvester Company llnniili ti. I lot 1M vx. Unemployment Compensation Commission, .Yen Jeiey S It. llonnl.ll, pond Seelinu II. II. Is* i.i IA, loler-la,le Cunmieree Coimiiissioii 4 J OFFICERS AND DIRECTORS, Continued Wai.ikk ti. Kin;:, 1`asl President VVm. ti. Knoiik, Milwaukee Safety Commission John 1C I.oni:, Past President Tuns. H. MacIIonai.u, U. S. Department of Agriculture Autiuih W. Maiu.k, Coumiissioner of Motor Vehicles, Nccv Jersey Die. Mu t.rn McG intim'k, Yale University R. S. M tut.nr, Public Utilities Section I. \V. Mii i aho, Industrial Oloyes Company IIamoi.0 I.. Mixkk, K. I. du Pont de Nemours & Company Ei.tor .Vr.ss. Director of Public Safety. Cleveland E.'J. O'lluikx, Jk., Louisville Safety Council VV.u.n.K S. PainK, Aetna Life & Altiliated Companies l.Kcv k. Pai.mcv, Past President C. E. Pcttiimink, Past President It. O. PtcKAku, Marine Section Ai.iu.kt S. Rki.ula, Industrial Relations Counselors, Inc. l.T. Cot.. Hcnuv A. Ki.ninclr, Past President E. A. kntiCKTS, Textile Section A. V. UomviDtK, Duluth, Missabe & Iron Range Railway Company Gloria: E. Santoro, General Electric Company Chaku:s 11. Scott, Past President Prank T. Siikets, Portland Cement Association (iKX. John* H. Shkriiuknk, Massachusetts Safely Council C. VV. Smith, Standard Oil Company (Indiana) Wai.ti'.m Dknt Smith, Delaware Safety Council VV. A. Snow, Const ruction Scctiili U, T. Soi.knshcn. Elliott Service Company Lksi.ii: J. Sohksson, City Trallic Engineer, Chicago , , V'nV. Jons Sth.wcll, Consolidated Edison Company of X. Y., Inc. iCoP.-.TiM.M.W, jl'^st j^ejideut # . ......................... [o ' `, I,.U.foK'.i; (|i. Tkavi.k. Greater Chicago Safely Council, Inc. .. i. I)k. It. L. VoMUKCH, General Electric Company |)k. C. H. Watson. Past President A, VV. VVtui.NCV, National Conservation Bureau l>. A. llvHKi.r, Carncgic-Illinois Steel Company Aktiiiik H. YntiNfi, Past President DIRECTORS (1938-1939) 11. J. Ai.iikilii, Spencer Kellogg & Soils, Inc. A. L. Aksisthoni:, Eastman Kodak Company J. I. IIw snii. Past President (*ski. I'.ahmh, St. Louis Safety Council 'A Liu II. Hi.aUi.sC, lilaekslone Valley Safety Cnnncil VV. A. Ilrciuii, Anlomoiivc Jfc Machine Shop Section ^RNKsr VV'. Ht.cK, Uniled Stales Rnblu-r Pimhicls, Inc. S i II ''ICERS AND DIRECTORS, Continued C. W. Bkhcquist, Pail President K. I". Blank, Jones & Laiighlin Sleet Cor|iuralion It. W. Ilmxi.ss, Sinclair Prairie Oil Company II. li. Hoi.t, Sonili Hem! Civic Safety Council ` C. II. liouii.r, Wisconsin PuMic Service Corporation 1\ S. Brown, Standard Accident Insurance Company J. 11. Brown, Petroleum Section V. \ A. Brown, Safety Dept., Nashville Chamber of Commerce U. A. Rut.i ock, Rubber Section W. II. Cameron, National Safety Council, Inc. I. , C. Campmell, Minins Section IvOiiutT W. Cami-iili.I, Past [`resident R vvmosu A. CakLY, Evanston Safety Council U\Y Carney, Kenoilta Safely Council Uour.kr I. C.vtLtx, Aetna Casualty & Surety Company Maumee Cuati.t.i.r, Railway Safety Council L. O. Ciielvkr, Employees' Pidilicalion Section \Vt. M. Ct.aKic, St. Joseph (Mo.) Safely Council Kenneth B. Colma.v, Seattle Tratlic & Safety Council J. E. (.'uui.nev, llelhlchciti Steel Company Frank J. Dcan, lyansas City Safety Council Lewis A. DeBi.ois, Past President C. W. Demi-lsY, The Liquid Carbonic Corporation R. E. Donovan-, ASSE-Enginccring Section Janes Li. Douglas, The Philadelphia Gas Works Company M \ Kelts A. Dotv, Past President Dk. Louis I. Dublin, Mctro|iolitau Life Insurance Company O. M. Eowahds, Jk., Safety Div., Syracuse Chamber of Commerce W. A. Everson, Lehigh Valley Safety Council D. D. Fennell, Consulting Engineer Donald A. Finkueiner, Toledo Safety Council l)k. IIakt E. Fisher, Chicago Rapid Transit Company Chester C. Fisk, Rcrkclcy Traffic Safety Commission Howaku B. Fonda, Burroughs Wellcome S: Co. (U.S.A.) Inc. Amtiiuh C. Frey, Worcester Safely Cuuucil John R. Giuson, Western Electric Company Lvle H. Gut, Peoria Association of Commerce Safely Council Huvvakii F. Gii.uekt, Elizabeth Safely Council Etm.ik II. Guksucti, Grand Rapids Safety Council W. A, Orihtn, American Telephone & Telegraph Company Eakl E. Grover, Sai'cty Council of the Columbus Chamber of Com merce Harry Guiliii kt, The Pullman Company C. If. Haritr, Refrigeration Section D. T. 11 vkringtON, United Stales Bureau of Mines 1 Frank li. Harrison, .Interiuliuiial Harvester Company 6 OFFICERS AND DIRECTORS, Continued Cues, K. Kil t, New Ytuk Central Lines i (vitoid (i. Ilnit'MAN, Uuemploymiut Compensation Commission, New Jersey F.vekett I limn, MiuUsuu County-Safety Council S. It. IIoumi.1.1, Fond Section I'HKt) 15. Hunt, Cement & Quarry Section Wit. F. J.asses, Philadelphia Safety Council T. U. Johnson, Commercial Vehicle Section Tiiomas I*. Kearns, Industrial Commission of Ohio H. II. Kelly, Interstate Commerce Commission Walter G. Kino, Past President W.M. C. Knoli.k, Milwaukee Safely Commission Wji. S. Knudsen, Detroit Industrial Safety Council Otto C. Kuiirt, Greater Springfield Safely Council C. L. LaFountaine, Great Northern Railway Company J. H. Lee, Wood Products Section MtLt.AkO C. Lefi.er, Child Education Sectiuii John E. Lonc, Past President Titos. H. MacDonai.o, United States Department of Agriculture Uoiickt A. McArthur, Transit Section Dk. Miller McCi.intock, Yale University Atmtuu W. Magee, Commissioner of Motor Vehicles, New Jersey F. W. Matson, Minnesota Safety Council R. S. Metzger, Public Utilities Section I. W. Mili.ard, Industrial Gloves Company Harold L. Miner, E, l. du Pont de Nemours & Company R. D. Moki.ev, Industrial Accident Prevention Associations I'kOF. 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 Safely, Cleveland E. J. O'Brien, Jr, Louisville Safety Council George C. A. Oit, The Detroit Edison Company Waiter S. Paine, Aetna Life & Affiliated Companies Lew R. Palmer, Past President David A. Patton, Newark Safety Council C. K. Peacock, Chattanooga Safety Council Charles W. Pendock, Safety Division, Milwaukee Association of Commerce C. E. Pirnbone, Past President It. 0. Pickard, Marine Section Ai.ukrt S. Recula, Industrial Relations Counselors, Inc. Dr. A. R. Reinke, Contra Costa County Safety I'.mncil Lt. (><i,, Henry A. Klninclr, Past President , Pun i m C. Rhoads, Meat Packing, Tunning Jfc Leather Industrie.-. Section , 7 OFFICERS AND DIRECTORS, Continued A. C. Rissiikkgf.r. Rochester Safety Council Marini'S Ritkk. Paterson Safety Council E. A. Robert*. Textile Section , Bestok Ruiiinson, Easthav Safety Council I'. A. Koihnsox. Paper Sr Pulp Section It. E. Rockhoff, Power Press Section Ralph l.. Ruckus, Jk., Chemical Section v> A. V. Koiiwkdkk. Duluth. Missahe & Iron Ranee Railway Company Walter RosenIiaum, Western Pennsylvania Safety Council G. E. Sanford. General Electric Company Henry G. Schaffner, Eric Safety Council Haurv A. Schultz, United States Steel Corporation of Delaware Chaklf.s It. Scott, Past President Eaiu.S. Shartzek, Utica Safety Council Frank T. Sheets, Portland Cement Association Gen. John H. Sheriiurne, Massachusetts Safety Cnttnri! Mr. I,,. A. Shouov, Bethlehem Steel Company Ernest L. Simonds. Xew Haven Safety Council Judge Lr.e E. Skef.i, Cleveland Safety Council C. W. Smith. Standard Oil Company (Indiana) Walter Dent Smith. Delaware Safety Council W. A. Snow, Construction Section R. T. Soi.kxsten. Elliott Service Company Leslie J. Sorenson, City Traffic Engineer. Chicago E. C. Spring, Philadelphia, Pa. George R. Stephens, Safety Bureau, Buffalo Chamlicr of Com merce C<m_ John Stilwell. Consolidated Edison Company of X. Y. Inc. Arthur M. Took. Consulting Marine Engineer C. P. Tolman, Past President Mi:ll E. Trammell. Metals Section George G. Traver. Greater Chicago Safety Council. Inc. Major R. IVTrimiile, Richmond Safely Council Frank E. Yitz, Superior and Douglas County Safely Council Dr. IV L. Yosiiurch, General Electric Company Dr. David E. Wf.cu.in, Baltimore Safety Council Dr. C. H. Watsox, Past President G. Wise Wescott. Safety Dept., Auto CIuli of Rhode Island S. E. Whiting, Liberty Mutual Insurance Company A. W. Whitney, Xatumal Conservation Bureau Charles E. Wilson, General Motors Corporation F. B. Winslow, Safety Div., Birmingham Chamber of Commerce W. E. Worth, International Harvester Company Arthur H. Young, Past President E. J. 7..U.FT, Safety Borcao, Duluth Chamber of Commerce 8 Occupational Disease THURSDAY MORNING SESSION October 13, 1938 TIu- 'essioti for the discussion of out standing problems in the field of occupa tional disease was called to order hy the Hon. I', .f. Angstcti. Chairman, the Illinois Industrial Commission, Chicago, who pre- sided. The Chairman emphasized the im portance of the selected subjects to he pre sented hy eminent s|tcakcrs. anti 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 I.et us consider the differences between the accidental injury and the occupational disease, h'or these distinctions are important ami must constantly he home in mind when we consider cither legislation nn^fhc sub ject of disease, or engineering methods of prevention or control. Generally speaking, 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 be as sumed has not yet happened. That fre quently is not so with the occupational dis ease. Insurance hv its very nature can 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 manner of happening. It can then he determined, after the happening of the event, whether it was preventable or inevitable; blame, if any, can lie assessed; the worker involved, or his foreman or superintendent, can lie shown the fault, anti effective measures can be taken to guard against a like future hap pening. Hut some will say. truly, mu all accidents happen in the manner described: that not always are they held to occur only at a S|iccific moment or tinder circumstances where they can lie visualized and dcscrdietl. lty administrative and court decisions, it is true in some jurisdictions that the definition of "accident" lias liccti greatly broadened. W'c find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, ami even the specific time and place not definitely known, except.that it is shown to have probably oerttrred in the employment, being held to lie an accident. titters vs. Hull. I7S Atm. Div. ltd. Id jf.y. "fi', ait amlirax cac: Venncn v. NVw lWI l .tint, her Co., I/ t Wi*. j"G, a cum . ami oi!ur.) I'oisotting of the liody through the effects of.a deleterious or toxic substance used in the employment, the dangers of which were tmknotvii to the worker, the employer hav ing liccn negligent in safeguarding properly the use of such substance, has been held to he the result of an industrial accident. (Victory Sparkler A Specialty Co. vs. Franck*. 147 Maryland, 363: amt the very recent case of Black va. Creston Auto Cn., Iowa Supreme Court, August S, IMS. 7St. S.W. ISO.) 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, hut hy repealed 211 . 1> V - i over months of lime, ltA-% licen to Ik- nil ai-riili-nl. . Vivljr tv C-in-linl AtfN-Kitt Cu., jM, N'mlli Ihi.i iM, an ,|iIh'iI<ni ca*cl -e ami oilier cases I might rile are \c<|i|iuu< ami iiol tin- general rule < ulial inu-l il ulc- an accidental injury. ink nr may faiily assume (licit the In of adiuiuisirnliirs of I In- taw ami mm In have Invn itirerlly iuspiicd hy In-lii-1 in tin- ii-vi'v-ity of finding a !v for an industrial ill for wliieli no reiiu-ily hail licen |iroviileil by specific :age ol llic statute. May wc consider - a straws in I lie wind, showing a I Inn aril industrial disease liability? ay illumed that the tendency of the is is to roust rue the term "accident" more limited manner in those states e there is specific provision in the law in-' occupational diseases. Thus, wc . clear instances of wliat has been d "judicial legislation," that is, the - broadening the meaning of the law -ivcr situations not clearly included n die terms oi the law by the duly con ed legislative authorities:. - n< now consider wliat wc mean or inhy the term "orcupatinnnl disease." nc find a more difficult field--difficult . the standpoint of administration and d interpretation; and difficult from laml|Hiint of the doctor and the cu nt is disease? We tliiulc wc know, and .-I to las iiivii die term conjures up : minds srum-lliing of a rattier defiature. When we pause to consider it, ir<c, infinite ipialilieatioiis of the term to ns. and wc are confronted with conditions that fall into the zone of "Such as, for example, whether hera disease. At any rate, wc say it is -normal condition, and let it go at when we come to add III the dotihtiii "di-case" die even more indefinite iccupation.d" or "industrial," wc find 'es in an area \>f 11iKhIi"111 surcd by a \-ast and increasing: zone of M shading off into Frehiau night, -w dim shall wc define Ific term ii--n.il ^ll'ca'c", I- tits ,i , i,i i,hi H, f,ur minds .i, 1 -til.,>.I, I, S)i<M|>lll<iii.ll \s to liit no [mi dune ully, I III.cl leg- islativclv -or administratively. These include the well-known niclallic and chemical )uiisons that arc so definite and char-lti fistic a part of some iudiiNirial processes.- Were the diseases arising from the use of these Mihstnnccs the only occupational di-ifca'cs with which we need cnucs-ru ourselves, the leei'lalivc dillis'ully would lie laigtly reiiimed, and we i-ould safely entrust the problem to the doctor ami the engineer. ^ Hut ssi- have seen that the legislator problem is lint so simple. Nor is it simple administratively. Wc find ourselves (1mmdcring 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 oil what imhiNtry ran do, or can fairly he expeeled lo do, nc could miidi 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. Hut has there not been too imirlt 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 indefinitene-s*. This is unlike them, for when they know wliat their objective is, ami are willing lo dis close it. they have not retrained from press ing their advantage with definite and spe cific purptiNC, and with exact language lo aecompli.Nli that purpose. That, at any rate, is correct legislative procedure. Hut in this field, even where the liability of the employer is made inescapable, the constant suggestion is put forth that it is futile for the legislature to attempt a defi nition or delimitation of occupational dis eases, and. therefore, words of the most general character should be employed, leav ing lo the courts the interpretation of the law as they see fit. I submit that it is not tin- function of the courts to make up tinlegislative mind; that is the function and the right and the duty of the legislature. Xur should the legislature seek to avoid ami evade responsibility by transferring to tom I- ami commis-ioiis the determination ol i|nc.in.ns of liability whiili the Icgislati.ic find* loo dilhciill for it to determine lor iiscll. Oil Kj'ililiJnUi /Jij.ilM 2i- To effect coverage under the compensa tion law, llivrefnii-, l>y any such genetal and vague language as the term "any and all nvi itpatiunal diseases," or hy adding to the definition of "accidental injury" Ihe plnase "and shall inelmle occupational dis eases," is to create an uncertain liability- line that may require endless and pciliaps disappointing litigation--before the uieuiiiie; of the law is established; and will most eeilaiuly In- a disservice lo ssurkers and employ eiS. All 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 i-aguc, uncertain and meaningless words, or words the meaning of which may have the elfeel of distorting the objective that is sought. Controversy is bred hy uncertainly of language, and controversy leads lo litigation ill courts. I.iligation is expensive for all parties; it causes delay; and it frequently causes bitter disappointment. It breeds rancor. It may even breed disrespect lor the law and for orderly process of government. Why then sliuu^l there he this continuing demand for the all-inclusive coverage? W it with the vague hope that satisfaction may result in some eases of misfortune to workers who fall victims of the disease that besets us all and lurks in waiting for us in our play, in our homes, yes, and even in our sleep, as well as in our employment? l'erliaps not--yet if that were the design, a unite simple way ol suceccding in it could not otherwise he contrived. Are wc to understand that imy disease of the ino-t common and ordinary risk of life may become an occupational disease if 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 licen ag gravated hy such condition? That is a large order. It would mean that industry would heroine liable for any ordinary di-ea-e of life, provided tli.il disease could lie, 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 been made for tuberculosis and heart disease, the two iiiii-i mimcruus diseases and the cause of more deaths than any two utlicr diseases. Add to these pneumonia, asthma, arthritis, rlumualism. and a host of others; and wc discern in this the beginning of a sysl.-n ol liealth in-ill.one of the most costly type a sys|, hi mot t over that wiiol-l discrim inate liilleily agaiu-l the many niilliniiwlm emit i act such di-ia-v-. in pel haps ac tually the same way. hut who have no tinplin mi nt at all against which to assess tin liiIiIy. Should not the mail wlni falls \irliui to a disease of nidiiiaiy life while searching for a job lie just as null li the cultceru of the stale as the man who becomes disabled from the same disease ami who is so fortunate as to have a job? l et us lie realistic about this thing called health I III health is a deviation from the annual. Hut what is "normal?" How great a devia tion is abnormal? Disease is of ninny and varying degrees. To what extent docs tint mind affect the working status? Or what part in the situation is played hy "will power"? These arc not fanciful question-, they arc encountered and will obtrude themselves continually in determination of compensation for disease where wc dc'eirl from the known and characteristic occi na tional diseases. -! From these remarks perhaps sonic will say we arc opposed to coverage of oveup i- timial diseases under compensation law-. Not so! The stock casualty companies represented in the Association have not op posed and do not oppose the piinciple of compensation for occupational diseases, if thereby is meant compensation lor llm-e diseases that arise from a "trade risk," nr from conditions that arc normally and usu ally present in the particular employment, as distinguished from those oi dinary hu man ills that beset all of us. Our \iew oi it is that the policy of coverage under the law is a mailer of local concern, to he de termined hy local legislatures in the light of local demand and with due r ;aid In local opinion of both hi nit ami industry. No employer in this age can re.tnm.-lli object to fair compensation for (list i-e arising from such occupational ri-ks, ` inmore than lie can object to reasonable co[npensation for disabilities due to accideii.al injuries. This conception of industry's iihlignliiiii is. however, quite dilfcieut from the ionccpliou of a I'uhlic obligation to care fm I i V II Silver Jiihilct' Stiffly Cnnorcsx itl cmti|ivih:iU` |nr all >!v,l;iu,\' ami iltalli acteristically ' the obligation ijf industry, ult-r :i I'm m nf hvallli iiihI lilV in-iiianci-. why continually insist upmi the u-e'of Ian- !ir l.illn uliligatimi. if il In.' a vuliil mir, (piage which is stisci-plildc nf niisiutei prv- tin- obligation ul llu- stale ami tin- uulimi tatinn? He well assured, if legislatures du ml tin- obligation nf industry alum-. nut perform their duly and lay down dear Tlu- rra-mialilr, llu- inlilligonl, I lie sane .ii- for industry disc-haigi- its ohiig.iiion ill tmikir* ini' conditions ul' lu-allli is |ir>>viili- for tin* ^ri-nlcil reasonable re* .;ri-ini-iils for industrial higiciii-, ami In viilc compi-il'alioii niily fur those von-, -.iiiii* lliat aiise lrum specific nann-il ili--i-s that an- truly nvetipatiimal, characMil- nl, ami peculiar tn the process*-* in di-liiiilious of liability, industrial lio.trds and vnniuiissjniis cannot in tin- |iri-scurc nf I lu ll blows. orphans, ami industrial cripples, hi- expected In exercise greater courage than the legislatures. The law in the hands of snch an administrative body will he scanned, and ( fear scanned in vain, for limiting words or language to stay Un hand of industry's self-coiislitutvd aliiuuu-r. mil the in ker |* engaged. The legislative trend, I am happy tu re Industry uill. I am sure, meet the dial-' port, in recent years lias hecii toward tin- n( the iivru|-aliniial di-easc iirnhlem. definite, rather than the indefinite. Despite it is presented muter a lave that pre In-iiiciiduiis pressure, no li-gisl;|turc has, in lims ilie liahility ni industry in umler- the past three years, adopted a hliud, "all-in- iitlahle terms. In the early day.*, the clusivc" occupational disease law-, except nrrat rule was In include ocru|ialional New York, of which I shall speak more in ca*es in the cnm|n-nsalion law hy specify- detail presently. Michigan, Rhode Island, the particular diseases nr the parlicu- Pennsylvania, Delaware, North Carolina, 'iiiditinus lending to diseases that arc ami Washington, among the slates most im d to he ccii|i.itinual and compensable. in- vail a "schedule" law. It is the recently enacting occupational diseases laws, j have adopted the "schedule" or specific m in which compensation for occtipa- method nf coverage. Two years ago, Ohio ual di-eases is covered in all of the amended its scheduled occupational disca-e nilries of Kiirnpe and of South Amcr- law- hy adding dust diseases to its existing It is so simple; it is so sensible; it is schedule. In two other slates, nanii-ly, Illi easily administered, that the wonder is nois and Indiana, occupational disease laws l llu- aeiTplance ol the principle is tint have liccn enacted in gcmrnl terms. How ii-rsal. ever, in identical language, tlu-sv two stales have undertaken to limit and NlTntc occupa i we ssill keep ever liefnri- us the priu- tional diseases and have attempted thi-rciu le that a di-ca-c, to lie di-cnn-d occup.v to safeguard industry agains)..liability tor -i.al, must he "characteristic of and pc- the diseases of ordinary life, o' ur to" the occupation, there should lie great diliicully in arriving at a proper Although doubtless faindiar-'to many, the nlnry setup for the coverage of all true ilifmilion in the laws of ihosc'tivn stales upaliniial di-cases. Metallic poisonings will lii-nr repetition, as indicating the ex characteristic nf occupalimis in which treme of dillirulty in attempting tn exactly h un-tals are ii-ed. The diseases iliarac- define au occupational disease. -tic uf clu-micals, of acids, of alkalic*. "See. 6. In this Act the term 'Occupa s and iiimi-s, ai e characteristic of and tional Disease' means a disease arising mil 'liar in those occupations in nliicli the of ami in the Course of the employment. hijecs arc so exposed. The diseases of Ordinary diseases ol" life to which the gen re-piraiory system, due to the inliala- eral public is exposed outside of the em uf dusts, arc the natural arconipani- ployment shall nut be compensable, except 1 and the characteristic effect of work where the said disease* follow as an in uli diMS. cident of an occupational disease as defined hln Midi clear ami specific language is in this section. aide, why should wc lie asked in use "A disease shall be deemed to arise out e, hrnad terms, the use of which may of the employment, only if there is apparent 'tuic the giving of a blank check by to the rational iniml upon consirli-raliuii nf -fry? If the purpose is nut to charge all the circumstances, a direct causal conIry si itli di-.ea-.es which are mil char ncrlinn lulu ecu the conditions under which Ocfiif'tiliontil Dixeuu'1 21; the. wink is pt-i formed ami the. occupational di-ease, and uliiili can lie seen to baitfollowed as a naluial incident of llu- wotk as a result of the exposure occasioned hy the iialoro uf the employment and u-liicli can he fairly Iraei-d to the employ mint as the proximate cause, ami which dues lint emne from a hazard to which ivoikmcit would have been equally exposed outside of the employment. The disease must lie incidental to the rharacter of the hiisiucss ami not independent of the relation of em ployer ami employee. The disease need not to have lii-cii foic'Ccn or expected hut after its contraction it must appear to have had its origin in a risk cotmi-clcd with the em ployment and to have flowed from that source as a rational consequence." I'niler this definition no industrial man ager ran, with any assurance, be informed what his obligation is to liis workman, and assuredly no workman sufTering from dis ease can surely know whether he is cntitlcd^to compensation under that law. Of course* as is to be expected, litigation over the interpretation of this definition is al ready in progress in both of these stales. And situations will arise constantly in the future where the facts will he such that only litigation in the courts will determine the liability of industry, or the right of the worker to be compensated. The claims actually filed with the In dustrial Commission of Illinois alrcaily includc imdulant fever (a disease said to be cumnuiiily communicated by milk and lin-at products), tularemia, rheumatic fever, arthritis, rhi-um.-ilic heart, heart disease, aimhic dysentery, varicose veins, Hat feel, athlete's fool, cerebral hemorrhage alleged to he line to overwork, syringomyelia, ami nerve disorder. T have not mentioned the claims tor characteristic occupational dis eases, such as silicosis, carbon monoxide poisoning, and the various other toxic con ditions which clearly come under the Act. 1 have rt ferred to the fact that New York, alone, has in recent years enacted a law coloring 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 iu 19?0. Tlie law was a schedule type law. (It so happens that I had the privilege of being one of those who collaborated in the draft ing of that law.) We were dealing with a iii'w siibjicl. We i-vainiiV d tin- i <i- lni : law* in otlui iiniiitrivs ami udopti d tin futiii tti.it siiiiwtl best ail.q-tiil ;r, uiir mi ditiims, mum ly, tin- l-.itgli'li Ian an occup.i tinnal di*ea*cs. The wliidulv was, fiom time to lime, enlarged as new iadiMi ial processes ilcvcbq-crl new diseases. dy I'lpl, the schedule hail been enlarged to indndi every disease that was a putcrdial 'ba/anl to the workers in New York Slat, with the single exception of the dust t. -.ca-cs of the lungs. In order sorely and i-crtainly to bring such conditions within lie pur view of the law, then: was enacted au ad diiiimal item in the schedule, reading "am ami all occupational diseases." The sched ule was nut repealed, ami the admitiis alive provisions in the law with respect tu tinschedule were cmitimii-d. One of tin- lit-I questions that arose under this new law was whether 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 prcvioiist.- included therein. The legislature, having evaded the duly of defining the term "occupational disease," the Industrial Hoard, which administers the laiv, adopted a definition. That definition is well worth repeating: that the Hoard deems a disease to be occupational only illicit it is "characteristic of and peculiar to the trade, employment, or occupation" in which a worker was engaged. This defi nition was adopted almost verbatim in tinRlioilc Island and Michigan Laws. The Appellate Division of the Supreme Omul, however, di-clim'd to follow it. and hi a vote of three to two, held that nny din-U'C that arises out of a condition iuridciilal to the employment must he dci-nn-il to he .in occupational disease. (llisluip vs. Comer tv Poll,,, l, J-, 1 || ,i, .................. ibll.llillK Vs. -Ill .11.11,) Clll|..O.I linn, g5l Appill.ilc Divbion, 9l)t ) The Goldberg case was appealed to the Court of Appeals--the court of last resort in New York. So completely do the facts in the Goldberg ease bear out wliat I ban- said about indefinite liabilities under an allinclusive law, that they- will bear icpctilioii. Shiclcy Goldberg was employed to sell tickets in a moving picture theater. Her booth was on the sidewalk. It was kept hcali-tl, in cold weather, by a small clvitiic In-ali-r. opi i iti d fi,.i.i , . . i - ./ > >ili. Stic coutt acted what she <lcacriln.il .* I>l.>trlit't or a ra-li on licr legs. The Hitches or rash she claimcJ crc- line to. ic alternate healing ami chilling of tier . gs winn she switched on or oil the healer, lu-y tliil not constitute a disability. I low - eer, on complaint to her employer, she was ild to see her doctor. While on her way t see her doctor, on her own time, she. ability follows immediately, and in which prompt report lo (he employer is made. This is uni far dilferent from'.fhc ride in regard to hernia as an accident. Hut in New York, during the past ycyr, it lias become somewhat the fashion 10 regard almost every hernia as cither an accident or an occupational disease. lipped on the sidewalk and (ell, fracturing n ankle. Although the day was crdil and This (ollowcd on a decision of the Court o( Appeals, sustaining an aunrd for hernia e testified there was iee and sunn on the as an occupational di-ease uhcrcid the" In letealk, the claimant alleged that she fell hly dm: to weakness iC'iilling from dustrial Hoard specifically Initiul that no acciilvut had occurred. In the case pre ;--e hhilehes, and llie. Industrial lloaid sented, the worker was required, in the iiiiunl; and loiiiiil that llie cause ni the ill ua> an oeenpali.iiial disease, din acli I- course of his employment, at fnqmnl intervals, to rotate his Iindy on the hips. lie of and pemhar to Ini employment. This man was employed in a glass factory, The Coml ot Appeals, in an opinion that .islles with logic am! sound sense, struck is I'rcc-l'or-all .system from the language : the N'eiv Vork Ad. They inianimou'ly lie gathered molten glass on the end of a plumy, uliielt he, in tout, swung about ami placed in a mold. The u eight was nut excessive, living only a matter of a lew tii-eil to roueede that this was an oeeutlioual disease. To make every disease puimds. In affirming this award, the Court of Appeals said: it arose out of and in the course o( cm- "The finding, supported by evidence, is oviueut compcii'alile as an occupational that (he continuous gathering and lifting of iscaso, they said, ivould he to make llie glass from a furnace involved a constant -mpcm-alion tare "the equivalent of life twisting and straining of the body. This id health insurance." The court further process, from gradual stretelling-, resulted id that to he "occupational," the disease in a hernia which is a disease (Matter of list l<e one uliicli "results front the mu Alpvil vs. ('oners 22.I N. Y. V7, 101.) There re of the employment": and that hy na- is medical testimony that claimant's occu re of the employment is meant--conditions pation would produce this disease ami there uliielt all emplojees of a class arc subject arc judicial decisions in oilier jiiri-dieluuis :d uliielt attach to the occupation--"a holding that hernia is an occupational dis /aril uliielt distinguishes it from the usual ease (Marathon Paper Mills Co. vs. hid. >i of occupations, and is in excess of the Comm. 203 Wis. 17; Travelers Ins. Co. rard attending employment in general." vs. Lorkc 50 1-cd. (2nd) HJ, 343)." *:.,li|l,tfri: < s. Os4 Marcy Corporation, dcctitot ...... ary II. 19 IS, ami rcjHSrlcii in 276, X. V, <l-u.-irr vs. Cillcnili-r tlrotlicrs Inc., 27S X. V. its 16 X. E. .'ml SCO.) V* .|. | It 12 X.K. 2nd. ill.) Perhaps the most controversial question Thus, alter more than tuo years of it uncertainty ns to the meaning of (lie e. (he Court of Appeals has eliminated mt the New York Statute the diseases ordinary life which arc only incidental spcculaliiely related to the occupation I list a wind about hernia as an oceupaoa| disease. Never heretofore regarded an oceupalional disease. hut quite gendly recogni/id under certain circuninecs as an accidental injurs--the Occnional Di-ra-c Law of Michigan, enacted l .'ear, specifically inehided hernia in schedule of diseases. Not all heriiiae. 'v'vgr. are so inehided, hut only iho-e irli of recent origin, as to uliielt dis involved in occupational disease legislation is the treatment oi liabililies^lpr dust dis eases of the lungs. In no class of cases is the marked difference hefd-vcn accidents arising at a given time and place and occu pational diseases more pronounced. In this category of cases, we. find silicosis, anthracosilu-osis, and asbestos!*, all of them forms of pncuiiuiuocnnio-i'. While these disea-cs in some of their forms arc among the most ancient, their ravages having been rec ognized generations ago, little has been known until recent years of their causation, of llicir pathology, and of their complica tions with other diseases. A vast fund of knowledge of these diseases lias been gath ered in the past leu years, amt intensive ) i 'ci t// nhoini ':Si . . studies of their etiology ami pathology are still going forward. One lari stands out clearly, and dial is, that these diseases do not progress lo the point of disability until after many ycars of exposure to dust. The length of lime, varying from five to twenty-five or more years, is dependent in large measure upon the concentration of dust, the com position of the du-t, the time actually ex posed dming winking hours, aod the in dividual susccptihilily nr liesislancc of the worker. Another fact tli.-ft stands out is llial die lilnosis of the lungs, once ac quired. is permanent ami incurable, ami, in uni'iiniplicali.'il cases is mil susceptible in medical Irealmeiil. Marty dumsatids of workers today, under no law lull die rommon law, have liceit employed in employments exposing them to mure or less heavy concentrations of dust fur 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 irfsahting at any moment. In this situaliurt, the best'guaranty against disable ment is continuous and steady employment. Many a man, actually able lo work amt earn good wages, while lie has a job, will he able to demonstrate hy x-ray and clin ical 'examination the presence of a marked degree of silicosis, when his job slops because of depression or otherwise. Hence 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 imlil disablement, and the liability is only "accrued" at that lime. What we have in mind when we discuss accrued liabilities is tire condition of fibrosis of the lungs which has accrncil and has been acquired over a period of years. This condition, being permanent, remains with the worker, whatever ami wherever may he his employment. Perhaps a more exact expression would lie "potential liabilities," ami yet they are more than potential; the condition giving rise lo them is actually existent. Industry tells us quite truly that it can not now pay loll compcn-atiou out of cur rent income to all of the men employed in industry who may base in the past *' cnrrctl some" degree of fibrosis of the huq?x. Put if industry cannot assume these liabil ities. how much less justification i< llwrc to call upon in-uranec. out of the prcmiiuus of next year, lo pay for disablements ac quired over tire past fifteen years, ami for which it received no premium? In this difficult situation, it has liven found necessary in many slates, if em ployment is to he eiinliiuious ami imiiili r rupled, ami il men are eventually to I" compensated for the fibrosis acquired due to future exposures, In absolve, to a ;[.|'t'nl cMciil, industry ft uni the obligation of Com pensation for past esposiiu s, and to ha .c eniitpcit'Ulioii upon (lie exlml of wpo-nnalter the eiucliiunt of an occtip.ilioii.il disease law. Tims, there has emne iolo acceptance in several stales the principle of graduated compensation benefits for dust diseases, limited lo (iitiui: exposures, ami eliminating in large measure the ex posures of the past. Under this system compensation for dis ability or death occurring during (lie first month under the new law would be only a nominal amount (it lias been set as low as $51X1 to start with). A prison dRiMcd during the second or Ihird month alter llie enactment 'of an oceiipalional dio a-c law will Ii.kc been expo-rd. lo a small extent at least, under that law.'The ex posure is perhaps in itself iiisullicient to actually result in any harm Hut the max imum benefits will tie increased, uiniitli by month hy small increments, tmlil in the course of two or three years the full limit chargeable' lo indu-try in the particular stale will have liven reached. This sy-lem is tint so complicated as it might se -m. The effect of it is rather to postpnie the going into etleet of a dust di'ca-e aw tor a matter of two or three years, and ixpvriencc .... ler this law has demount rati that few claims ari-c where the compi-e-alimi benefits arc so limited, the wmtaii. p;e (erring lo stay at work ax long a- lb. . can. It may he said that it works bar-lily in the ea-'C of the pcrsmi who heemuercally totally disabled in the eaily m-niiliof law. When measured hy the liability with which the employer may faitlv l charged, it does not. in fact, work a haul ship, and when compated. wuli (lie exist ing system in stales not mm under ou.it-  III! i-alimixl ilisvace laws, il not only is not .1 liaril-hip lint is. in fact, a great Imon. The |>ritwi|>lc of limited and graduated liability of the cn|dnycr for <1un| tli-ca-cs lias lieeu rtcoguircil liy etiaclmciits in New Voile, Michigan. Pennsylvania ami Oliio. \u iiunsiial luotision lias lieeu :iilo|>ted in tic slate of \Wliiuglmi, providim; under tlieir seliedide form of law lltal live cost of eoiii|i`ii-.iiinu lor on ii|ialioiial ili-ca-c-t hall lie divided vi|ii.dly lielneeil tin' ini' :>liner and Ids uinfers, and dedm linns dull ( made ft mil the employees* uaees as eoiiliiliiuiuns ton aid llte in-<ui:mee preoiinnis inenliid. lercsA must he given lo industrial health. The care for the health of the norkrr must not he confined to thg guarding against those conditions that arc mentioned specifically in the law. The engineer's re sponsibility is a broader responsibility than is the legal liability for coinpensalimi. Theic can lie nu ihmhl that the eimmeratiim in the taw of specific conditions for uliiih liability is absolute u-ill he of great ad vantage hi the industrial engiiieir* in seek ing hi enforce pinpt-r liealllt standards. Il is far easier fur him tu obtain approval of Ids rcvumiiiciulalinus, if he eau pi'ini out hi management that the use of hen/ol or Uni ulial. you \uuy say, lias all lliis lo some licn/id dciivuliw is specifically men- In with litv i-ngiiii cr? li<'mil. and point lo the specific paragraph Il lias iiuii li, The safely citginc*-v an no longer Ivganl liini'elf as lining Ids inh if lie steles only ways ami means It) lioiinale llte industrial aeiideiil The in- in the law that cite-, the liability of tincniphncr for that eotidilion. No argument is needed to eonvinei: management of its obligation in such a case. hi'lrial h\gicni-l tiiiisl hecome the rollengue The same is true with rcgatil to all of I tin* inihi'trial engineer. Medical seittiee the metallic poisonings and all of the other imisl give intensive thought anil simly to wide range ol chemical exposures. INyrlin- It Ivriididng tin: elietls U|on the litituaii logically tilers' is great power in tin; printed '>'lem oi various imlitstiial piocvsscs, ami word, ami even the most backward manage t .vpostirc to various innicrinls Iheiein. All ment may he made to rcs|>ud ulieii the siuisiires eaiinot lie eliminated atul still clear mandate is set forth in the law. Not hate industry per tot in its functions. Most so easy will it lie, tinder a general, vague, important, theiefurc. is the medical deter- and all-inclusivc occupational disease sialute, idiiatioii of what arc safe limits in cv- to convince management that it has specific po.-nres--the so-ealled "threshold limits." duties with regard to the elimination of The engineer cries aloud today fur expert lu-alth hazards. Thus, we sec there is an medical guidance on this subject. Armed other and potent argument for the schedule with siicli iiivdical opinion and advice, the law. rather than the all-inclusive law. ta-k ol the engineer then is to devise prac tical nays and means for attaining condi tions where such threshold limits apply. There is perhaps yet another and even nunc compelling reason for applying the livery industry presents a problem or erics of problems in itself. No lun in dustries arc exactly alike. What is lolcr- rule of sanity ami couumlji. justice to leg islative mandate in the complex field of occupational disease. Shall employment he limited to those who are^jiliysically per ihlc in one may he intolerable in another. What is good practice in one indu-try fect? All humans arc not examples of physical perfection, nor ean-'.wc by legisla may be totally inapplicable for practical tive fiat reverse the laws of nature which reasons in another. The task of the en- immutably decree that we shall grow older .iuccr then is to find liotv right principles with the passing years. nay he made applicable. We have Seim mid discus-ed the danger- Industry today,'more than at any time inherent in the all-mcln-ivc tlieoiy of in its history, intist hear the burden of stretching the law to cover every sort responsibility for the health as well as for and condition of disease, and lo try tu the safety of the industrial worker, and if make them employment-related. When that : is health and lii> safety are ailei|uately stretching is complete, when administrators safeguarded his happiness and the happiness of the law find it easy and possible lo I.those about him will he increased. Thcrc- burden industry with the responsibility of furc._ it is of prime importance in the field health insurance under the guise of an oi safely that intensive and increasing in- occupational disease statute, tvhat of those who, wauling employment or seeking to re tain it, arc not physically perfect yet cer tainly are not disabled? Much is heard hulas of the diead fortyyear-line for employment. Whatever the facts may he us lo that, is it not possible- if iml probable--that industry, in despeialion and against its tlc-iie, will he foieed vvciilunllt hi areept only those among whom the health h.i/ards are least uiieertain- tin* phisieally perfect, the yuiing and the strong? \}'c may well pause to eon sidyr the devastation such a sii-ialinti "'ml produce. In the interest of all workers, the ynin ami the old. the perfect and llit. impvrfcihi us not 'embark upon Icgi-kilite polieii that eau h ad only to enlarging tin' lii I of iim-inpliiymint, and lo closing the dmof imhisiiinl opportunity to iho-c skill, ami faithful uni hers uho, hating |'n -s, I In* uuiidinu of life, aie -aihjt 11 h< tlio u.ilmnl inlii milics and ill, of the. l|e-li 1 which all nu n, in lime, most l-.u. > Handicaps in the Diagnosis of Occupational Diseases f By CAKKY I*. McCOKI). M.D. Detroit, Midi. It In a popular medical hdiil that occupa uiidiaunosddi: orrupaimti.d di'it nm tional diseases air far irnur to lee- hr no;;ui/rd (hat many mo;.in imdu ngui/e ;im! picrtsdy to class as such than mM-d, or mnv n|tlm misdi.igmisifl. `II any oilin' type ol* disease slate. So lirutly prime iea->M for, this is that the u-n is tIn': idea rooted in the minds of some phsMciail -*vv nidi -mall iituiihi . *!** ai physicians that they arum- that occitpa- our t\pr il occupational disease. laid' tional diseases never should he made com- Ohio as a Hpical iitduMii.d itu* (oj peusable because of extraordinary diag number of occupational diseases, uiopm nostic diliicuHics. able and otherwise, rcpoiicd lo Sl. I.alvly, Kettering has said, "The doctors tell us (here are certain diseases that are , incurable. Do you know what nu incurable diM-a^o is? It is one that the doctors don't know anything about. The disease has no lKpaitim.nl of Health dtoit..: the ycai l'1 was Iri. On the other hand, these .or tliis state <1200 physiciaus. Thu-. milt occupational disease arose for evcr\ doctors in ile slate. objection to being cured at all." Hue thin is the foremost handicap *rhis may be paraphrased by saying* There arc no tuidiaipmsaldc occupational diseases. The only ones that appear imdiaguosahle are the ones the physicians have not learned how hi diagnose. No occupa tional disease has ever offered auv resis tance of its own to being diaeiioscd. The disease is perfectly willing to he diagnosed. At least one-half of all occupational di seases are ahmt self-diagnosing, particu larly ohm arising in groups; the remaining half prc<eiit no greater difficulties than attend the diagnosis of some other classes of diseases. To maintain that occupational disca>cs arc bc>tnd the diagnostic skill of tb<* and iJiaeiuot* of muij tional diseases and at the same linn back handed compliment lo imhisiii. I dtiMry, because >/ iis pievcution n hit \ mints, has m` limited the mmihcr of cupatioual di-eases that dai by dai P physician is ordinarily nut -purred to \ po-'-ihihty that any worker who m ik I professional guidance max ha\c a di-i a-c occupational origin. Here, too, is the fun* mental reason why more medical scho do not develop tr.Vmmcc departments in t lieUt or organize special hospital *cni for the care of occupational dis.-a-e tients. the physician is pure defeatism. With equal While thci c aic leasous for rejoicing i propriety, it might be suggested that all there arc comparatively no lew occtipali< neurology be abandoned because the ma diseases, we should recognize lb *t th jority of conditions arising in this held are specific situations which iutroibu e dt may not be diagnosed with ease. noslic diflicullics. A number of these While It may be said that there arc no now presented, as separate entities. . . . .1/ . I V l ..I Definition and Terminology iinccilaiiity that this condition represents a Much riiiifii'inn is caused lv lark of characteristic occupational disease. :-iiforinitv ami rlarily in (Icfinition Scarcely :i\ tun stairs in tlicir statutes accept tlic line dvfiuilinii uf an occupational disease, i a few stales, hernia is hy lae specified an nerupalion.d disease. I ion ever, in the ajnrily of slates it is, when related to inIn-try as a cause, cla-scd as a traumatic limy. In a few states, the definition of u occupational disease pinvided hv statute -m il that eeit.iiu items later appearing on hedidcs themselves do not conlorm to a- definition furnished. Well meaning legislators might enact a t.e declaring that t\rn ami two make seven, ut the mathematical facts still might re tain ntherui-e. So uilli legislation in-, oiling occupational disease diagnosis, there ay lie demands for legal acceptance of Main conditions as occupational diseases, lieu elementary medical facts point othcri-e. One group of physicians may reserve e term "injury" for exclusive ti-c in conctioii uilli Irpmna, while another with ropricty may assert that occupational disiscs of many natures represent "injury'' the same extent implied by the term raunsali-iii." rielwccn these extremes, thirc is some point at si hit'll difficulties would arise in di-lingui-hiug occupational diseases from accidental injuries. This same situation ap plies to many other ifnh-lnnrc* and many other occupational diseases. There is per haps no warrant for any attempt at a hard and fast demarcation in terms of lime, in dicating where an nrcidcnlal injury expo sure leaves olT and an orrujialional disease ex|i-urc begins. However, there may be some justification for tlic 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 accident. Conversely, if the exposure period extends fur more than one work period, then the resulting damage may with propriety be ac cepted as an occupational disease. In gen eral, it may be 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. I.rt us consider, tor example, the occur- Fallacious Medical Histories in'C of an accidental injury on the one As a result of careful training, every uwl and a clear-cut occurrence of an nr- physician is disposed to attach significance palioital disease on the other, Imtli caused to the history statements given hy a pa mi one and the same substance, hut under tient or members of his family with re tie-rent circumstances. It might come gard to any disease. The less a phy-ivian nit in a given factory that a workman may know about the possible ctiologic farts :vrcd a tank car, lately emptied of hen- in any situation, tlic more consideration lie I, and in the absence of suitable protcc- is likely to giic to hislorjdjfjlatcmcnts. (t c and precautionary measures might, is human nature to assoriale all of our thin ten minutes, heroine asphyxiated as ills with some partiridar happening or series result of breathing benzol vapors. Man- of happenings. A cold iiiay'^he associated -lly, <ucli an nrcurrcncc as this would with a particular period of sitting in a niTeptcd as an accidental injury and no (h a ft. A gasiro iiitcstiii.il up-'et is prune to Mipensation hoard would ever raise a he associated with some particular alco- clion that such was not the ease. .liolic bout or food engorgement. 'hi the other hand, this same benzol. ;cu from this tank car, might be utilized this same factory in some produrliie .ration, giving rise to benzol vapors. Day day, another workman might inhale some these vapors. In due course, this work -lire might produce the usual and raclcri-tic features of that occupational i-.i-c known as benzol poisoning. Here mi- it is most unlikely that any physician compensation hoard would entertain any In the ease of industrial workers, there is an especial pronencss to associate any bodily 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 snffer may he laid at tlic door of his employer, lie is most likely to stress and emphasize the Itigli probability that this condition unfailingly was produced by the chemicals, gases, va pors, dusts, etc. that attend his work oper- ) lAi Ilf'Ull III// t-h.i.-Uj,' aliens. This docs not necessarily repre sent dishonesty or cupidity on the part of tlic patient and only may involve those Iminan frailties shared by all of us. No less, the history .statement may un duly infiiieiicc (lie physician in ids diag nosis, may lead to mi-diagnosing, may pare tile way for unwarranted claims or law suits uilliunl any evil intent on the part of the physician. It is most unfortunate that (lie physician is all lou often unable to appraise tlic wottil of ,Svork history statements pro vided by a patient. Let us, for tlic moment, assume that a specialist in car diseases is visited by a patient on account of deafness. In connection with the history, tlic physi cian,may record that this patient is a drop forge operator. Tlic physician may go ahead and make many careful examinations, looking (or the cause of tlic deafness, from infection, from syphilis, from heredity, etc. is to be appraised until long after tha1 time within which the disease might hav* Iveen di.igqoscd with precision.. Wilhoin any pm pose of condemning or finding fault the f.icl must lie faced that in nv.iiiy in stances the decision of a patient to fd.iiin his ailment on work causes was not ninth iiiIhin that period when some or ad 01 the characteristic in.mi testalinns neie Pres cut. Then, at some later time, a physician qualified in occupational disease work na. be called upon to c'xamiuc the claimant cm to reach a decision based upon the cxaiuj innlion of inadequate records of aiiolhiii physician who himself did not carry om any examinations witli particular rcfcrciin to that occupational disease for which .< claim later lias been filed. This is askin; too much of tlic diagnostic ability ot any good physician. I f, however, lie had obtained a complete ' On tlic witness, stand, the charlatan ai work history, and was in position to evalu ways makes the better impression on a ate this work history, lie might come at once jury, because lie is unhampered by tin to know that this drop forge operator is caution ami reserve that guide the up perhaps exposed to as much noise atid con right witness. Being positive is often merely cussion as ever arises in ordinary indus-: a matter of being wrong in a fond voice tria/ work and tiiat the deafness present The point is that tlic time to make a ding, clearly is an occupational disease, resulting nosis of an occupational di'ea-c ir tin' from sustained noise exposure. period duritjg which the disease exists1 It may be asserted that well meaning physicians, without any evil intent, through their misunderstanding of patients' descrip Other wise, the most accomplished physi cian may be placed in an imfortunate po sition in the reaching of his decisions. tions of work operations have become re sponsible for a high percentage of tlic Insufficient Training and Experience large number of unwarranted suits that An outstanding drawback to the pvopci have flooded the country in recent years. diagnosis of occupational disease; may be In short, one nfithc handicaps to the proper found in inadequate training in, medical diagnosis of occupational diseases is to lie schools for this aspect of medical work. found in the attaching of undue significance This is not a thrust at tlic doctor, :.or may to (lie patient's statements as to work con any complaint lie made against met -at cd ditions, nlien the physician himself is un ucatiou today. It may not he expected that able to appraise tlicir reliability and merit. medical schools will markedly enlarge an Some physicians need to make themselves already over-crowded curriculum to pro more remote to the fallacy that just because vide extensive instructions with reference a workman is employed in a dangerous to occupational diseases when die minihci trade, incvilaldy any ailment must neces of eases yearly is so smalt as In pi.nidi sarily lie the result of work exposure. only one for every five or six pin -ici.iii.- There still may be a few persons who may Rcalizing his own shortcomings in tlii. believe that lead poisoning may arise from field, a good general practitioner may hon work in making lead pencils. estly shun this type of work, bu'; this Hep Time as a Handicap in Diagnosis on his part may eventuate in c cii more undesirable situations.' Too often the physician well qualified in (lie field of occupational diseases, docs not sec tlic patient or claimant whose condition The patient, instead of being rcfcirc to a belter qualified pliy s'iei.V' in lh\ field is given no aJviccs, whereupon h gran Silver Jului, r Au/c/j- l vmjress c let toward an inferior physician, less con- of the chest of this workman may strongly moil willi the lack of qualifications. The suggest the possibility of silicoses, nowhere tout to which lack of qualifications in oc- on the work record may it he Shown that q-.ilioiial disease work may go is reflected the fact that recently a duly licensed n'ioian in (lie Stale ill Michigan reported for a period of seven years at some much earlier time this workman was employed a a laborer in a pottery nic-tinal peristalsis" as a diagnosis of an .ciipalional disease. W hile the unwillingness of a phisicintt to cept responsibility for pathologic Males nh which he is not conversant is com ndahle, there still remains a duty to (li st his patient into channels wherein adc- In this same connection it should he em phasized that one of the many handicaps to the physician in making an accurate diagnosis is to be found in ibc widespread practice of hospitals, of clinics, insurance records, etc., in merely naming the trade of a workman rather than describing his exact late services may lie procured. occupation. It is quite insufficient for med . Industrial'Terminology One of the most anno) mg handicaps in lahlishing the exact etiology of a possible ,'cupational disease resides in the wide-.; road practice of industry in using code . mhnls in the designation of its substances, n inquiry, llir patient may state to his n-ioian that his work consists of filling in.liners with "lt-72." Hut, inquires the avsician, "What is H-72?" The patient ical pur|io.cs for a record merely to show, lor example, that the patient was employed as an "automobile worker." Under this heading, there are perhaps not less than 200 dilTcrcnt and dissimilar types of em ployment leading to different exposures: such for example as lo silica in the foundry, cyanide in lire heat treating rooln, chromium in the plating department, lead in body fin ishing, and on and on. miinies, "11-72 is a mixture of M-20 with Lack of Library Facilities . 10 and 1.-07." Completely llic physician With some temerity the statement is left hi the dark, hoi if the Irulh were made that regardless of man)' book publi "II it might he shown that this patient cations in the field of industrial hygiene a- engaged ill the filling of cans with a ami occupational diseases, special maga irniah remover, which consists of a mix- zines, and articles appearing in general ire of wood alcohol, benzol and a syn medical magazine publications, there is, at dic wax. tins time, no condensed, informative ma Such situations may become so s'on 1 u - - terial on occupational diseases well suited c that it may lie almost impossible for to the needs of the family practitioner. e physician to obtain proper infoimation It is of course impossible and undesirable to work exposures. Medical, safely, so that any attempt should he made to reduce il service or insurance ilcpui lim-nls all all of the lore of occupational diseases to ay have diuirtilly in obtaining [nil in- some thin lunik to which the practitioner rmaliou as to actual chemicals and mix - may refer and with certainly ohlaiit all the les of chemicals designated ill production guidance needed in the treatment ami man rations only hv code numbers. agement of occupational diseases, t hauling The Absence of Records Die majority of industrial plants fail maintain sufficient medical and work cords to serve the physician properly in -imcction with occupational disease work, i a given instance an afllicled workman iv give as his occupation some innocit- all this, there still is occasion lo asseit dial a real need now exists for a hook publica tion on occupational diseases designed for services lo the neighborhood physician who in the aggregate sees far more occupational disease eases than the small number of specialists in this field. "> iob as "elevator operator." He may rc- Attitude Toward Industrial Medicine mbcf ili.it die job betorr that was as In times long ago, wlien mine workings, iimk iliorr " Tlnrc his mrmot) ml) -awmilL, and railroad construction camps i Hit m.iL i((Oid nil) 'bow no ilcms wvic established in remote sections of the In 111".(cr w I lull the fisloi) of lot (omiliy, far rrmosed from the usual sources i ci iplojincut and no itcmd ol an) pic- of medical services, it became necessary nit .employments. Although the x-ray that the management bring into these iso- ;.\c r ihiiiihil /.'/ >.-m' latcd work places a physician who might New Chemicals carry out all manner of medical services. These physicians sit the broken arms of injured miners; delivered the babies of the miners' wives; treated the miners' children for measles anil mumps and otherwise at A further deterrent to accurate d'aGnosis of occupational diseases is linked up with an almost endless flow of new rhcniicals into industry's processes. Year by )car, a far greater number of new (hem- tempted to meet the medical needs of these detached communities. Usually the com panies contributed to the income of these physicians and every family and every icals are introduced than the mini' cr of investigations referable to their to (icily. It is often true that nowhere in the entire literature concerned with industrial 'tox single man was taxed a stipulated sum each month tn-urder to cover the physician's salary. Thus arose (lie term "Contract Physician." This perhaps did not always represent the best of medicine and not in all instances were these contract physicians icology may any word he found aidin.- the physician in determining if a given cln'mual might he responsible for a series of objec tive and subjective symptoms in any patient. One of the most desirable changes needed in connection with woikcr health protec of the highest type. tion is the requirement that no new sub Later some of these communities hccanic stance lie introduced into induilry 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 tliis 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 and might he continued almost indefinitely, hut commendable circumstances. It lias be perhaps without profit. The entire situa come a tradition on the part of many of tion may he summarized by staling that the medical profession lo blame almost any whereas occupational diseases themselves maimer of their economic dfiicultics upon are probably as diagnosable as any oilier industrial physicians. So real is this dis difficult class af diseases, just aliout every affection that some organized medical stundiling block that may be produced is groups have sought to> legislate against al laid at the door of the physician sincerilx- most any form of industrial medical prac seeking lo acquire sufficient evidence mmii tice and in some instances to deny mem which to make - exact diagnostic dcci-ii-n. bership in medical societies to industrial The greater number of these stumbling physiraus. As a result, industrial physi blocks repre-ent no willful desire to hamper cians in some respects have been branded the physician, hut instead arise from the with a scarlet letter. results uf peculiar ciiciiiii-tanccs that in This queer situation, strange to say, some mca-iiie separate indtisliiaj di-ci-es may serve as a handicap in the diagnosis from the general run of alllictioiis. of occupational diseases, since some of the best physicians, mid parliculai ly the mure timid unes, fear lest they may become hesmiiclw.ll by cooperating ill this type of medical endeavor and to some extent slum any close alliliation that might lead to lifted eyebrows by those regarded as the leaders of the profession. As a consequence, huge iminlu-i s of imw an anted diagnoses ol occupational dis eases have been made and are being inade. Scores of suits have been instituted and some have been won liv claimants whose claims possess no whit of merit, chiefly be cause well meaning physicians unlmiq-il) implanted the seed of possibility that hi' Now that the American Medical Asso disease might have been caused by work ciation is somewhat alert to this situation and that the responsibility might be laid and has organized a Council on Industrial at the door of the cmplo)cr. While the re Health, including some members with in sults may ha\e appeared to work an in dustrial medical experience, it is to he justice and monetary loss upon tlic cm hoped that after all the industrial physi ploycr, in the long rim the interests oi cian may become respectable. the worker himself are nut served by these 221 .'ulvcr JitbiLw Sajity Conyra*. v spurious claims predicated ii|>on improper medical advices. Tlic usual trial of an oc cupational disease case is a travesty. Tlie |iuml>astic statements of some physicians, niiatteiidcd l>y any iota o( fact, Lrininto disrepute the entire medical profession and lake away its lime honored traditions ol` intcgiiiy and skill. A further significance in the misdiagnosis of occupational diseases on the part of plnsieians is to he found in unwarranted hardships imposed upon cmploj cri. Recciilly a physician made a diagnosis of silicosis in two workmen in a given depart ment. As a result, widespread apprvnlicnsions arose among the remaining workers, strikes were threatened, talk developed as to demands tor high wages because of tinu-nal exposures and the expectancy 01 a short work life. The employer was com pelled to spend some $S.\00Q in the installa tion of an elaborate Jn;t control s> stem. As a matter 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 contrariwise other departments did present practical exposures tor which this $S5,000 badly needed under postgraduate auspices. (b) In every industrial community, or at least in every industrial state, there should he 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'profcssional activities to this one aspect of medicine, may become highly proficient in the solution' of occupational disease enigmas. . (c) In every state 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 of patients who may lie suffering from occupational diseases, and these public bureaus should serve as fact finding bodies, equally inter ested in the worker and ,1ns employer. (d) Much will be gained if all physicians responsible for the health of industrial workers in any capacity may make greater clTort to obtain precise work histories, both present and past, ami may seek to gain an adequate understanding'as to the work en vironment, its materials, machinery and possible exposures. might have keen spent to heller advantage (c) Controversies should be eliminated in procurement of needed protection. The Road to Betterment in the largest possible measure from occu pational disease work. Many abler physi cians eschew all connections with this type This entire discussion would he without any value it present day practices and sit uations only were condemned. More ac curate diagnoses as to occupational diseases arc badly needed. These teller diagnoses of medical practice because of the sad ex perience that nearly every ease may he so involved in controversy, litigation, disaf fection, until the goorl physician may feel that lie may be degraded. will come in proportion to the extent that . (i) A need exists for greater disclosure the changes now listed arc brought to ac lo physicians of the chemical nature of tuality. work materials to the harmful nature of (a) The general level of knowledge of occupational diseases on the part of the medical profession should he increased through the introduction into medical col lege Iruinin;' of a practical amotiiil of in struction on industrial hygiene and occu pational diseases furnished by men who have had first hand experience in this field and arc nut wholly dependent upon textbook lore. However, it is emphasized that in undergraduate medical training this form which employees may lie subjected. In dustry may have excellent reasons for hid ing the nature of some of its chemical ma terials under code terms, but more often these code terms arc designed only for convenience and not for secret formulae purposes. A greater degree of cooperation on the part of the manufacturer will even tuate in the better health protection of his workers through the more intelligent min istrations of the patient's physician. of inslrmlion necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is (g) Lastly, it may lie pointed out that belter diagnoses of occupational diseases will come when the general medical pro Oci u/'ui'<'iiu/ i <>. fession, through its organizations, shall alter its attitude toward industrial medi cine, shall recognize this type of work as just the antithesis of the undesirable as pects of state medicine, and may conic to realize that industry, under the guidance nf able medical directors, is the meritorious source of numerous cases to he referred lo almost every specialty in mcdici"v. organized medical profession whole-ln cclly should render its approval and sup lo the efiorts of the physicians cam. seeking to protect workers join the u dangers connected with iudustry's (Inin-, of substances and work conditions. Necessity for Uniform Absenteeism Record In the Industrial Health Program By MILTON H. KRONENBERG, M.D. Chief, Division of Industrial Hygiene, Department of Public Health, State c Illinois, Chicago Yon arc all aware of the value of acci dent statistics. You know that without fre quency and severity rates there would he no solution of the safety problem and we would he 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.. These excessive rates arc especially able for unskilled workers as sliow the accompanying table. These death rales could only bate prepared by statistical method.- f a sis and, therefore, clearly point out \ one phase of our problem lies. If nothing more than this we would plenty to do trying to uncover the nn to health among the unskilled grim workers. The morbidity and morlalilt data down by uniform and adequate icpu of cases can also scric as a ha-is fur ventiun and health education among t ers, the same as is and has i ecu dmi. accidents. So well recognized is this fundamental principle that 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 (rue for the groups of workers emplojcd in a factory, mine, quarry, public utility or department store. These rtcouls are of value not so much lo indicate what has been done, although this is important enough in demonstrating lo management the value of certain work and, therefore, the advisability of contin uing it, as they are to chart future action. It may interest jott to know Ilia Kastman Kodak Company, Mil sun l lIlluminating Company, I loud I iM cr 1 pane, WeslingliuiisC, Mctropolit.ui Life cral Motors, and several others ha\ jo.tis made sickness studies wiili Hi of statistical methods. In tlii> :ii were able lo evaluate the dillcunl si> problems confronting them and tlmse ing altviiliun, and at the same time these sickness records pmprily app and evaluated, thej were able to c their employees regal ding dige-lin eases, colds, nucmntmi.i, tllhciculn-i ccr, skin disorders, as well as nth. ments. Insufficient data have thus far prevented the recognition of some health problems peculiar lo wage-earners and there is ample evidence to indicate that morbidity and mortality rates are higher for some groups. Furthermore, similes conducted ii eilic industrial undcrtjkir.gs lute dm, value of statistical methods in ret the incidence of such ilisea-es amonia, tuberculosis, and dcgcncralit 2<j Stiver Jubilee Safely Congress \ Death Rates by Occupation .1// Cuutri 7 nt'ift h/jiii /.*? I /*H< HM'Hfitl IVsttV'i'di.i! mi'ti - *-** .....................- si.til,.I Hnflv*r 670 5 ..... ---- . ...l.. . . . . M..IM--N .... Milt.*7 IM 5*7 7 --**** --- - . - - --- ....... ... ~ioj.s .. Un'iiiirti u.iiivcr m 7 . . ...... . --------..--1 ui.v _ . 71 ft 1.15 V K.t |vr 10*MMhi (H.cu|>k'il itMk*a based on I S. Cvinu* iUu in lu Kvtctiifl Xt.Ura. ('miter rlN<( I'umuki 70vl Its 4 W$ 1116 * .a-es tu be Iiiylfcr Ilian the avciage for .v entire industrial population. Tliit was ally demonstrated in a pneumonia study along steel uothers nliicli uas conducted > (lie U. S. I'nblic Health Service. dents, the quality of bis work is of a lower grade, leant work is disrupted, fac tory processes are dislocated, undue burdens are placed 011 other workers and tbc worker himself become- dissatisfied. If be is oc Drury, some years a;;u, was abb: In slimy cupied with weighty matters of policy and high rale n( tuberculosis aiming workers production (lien someone in that nrgauiza- (lie ax-grinding industry, ami llie Harry, limi iiiiisI assinue lilt- leadership and ac- iiiii/iiI, sliiily revealed a high tnhvnn. plain! him with the problem by understand -is rale among granite workers. N'oiloiibi. able and intelligent fads and' figures. llier occupational undertaking* would reeal ilala lor prevention, control and cdualion were it possible to liavc adei|iiatr talislical records as revealed in tbc slide i-l shown you. There are |irngrcssi\v industrial organ izations who may and have spent large sums of money fur the improvement of working conditions and (or tile care of workers who become ill, but without cur Dr. Selby of llvncral Motors, in calling Mciilinii |,, his slalislies shows llul ahoiil u of a day per annum is lost due to ncupalional injuries and that inclmlcs ocvu- rent plant information alH.nl the human factor much of this money ami iTli.rl has been spent on `'genera! principles'' or per haps concentrated upon the elimination ul alioiial diseases as well, whereas, eiy'bt. only one or two publicized health hazards, inc or ten da>s per year is llie total and only from the standpoint of existing >sf time from all illnesses. In Dr. Xcw- compensation laws, ns for example, sili ui-t's report ior llie American College of -urge,ms, tbc Azures arc about tbc same, bis shows us that our industrial illness rnhiem is approximately fifteen limes llie izc of our accident problem. It is evident llml industry could well fiord to roiicuilratc on illnesses among age-earners, other than the occupational i.-eascs, because they arc the ones that ause the greatest amount of absenteeism id arc the biggest drain on industry. In the recent National Conference on Icaltli Conservation, it was estimated that cosis. Hut. the extent of the health problem in a plant necessarily may not end line*. Willi the progress of industry especially on the chemical side, new health problemwill arise resulting in physiological and pathological upsets. The effect cm health will, therefore, liave to be measured and evaluated. We inu.-t have (lata ill order for one to judge the efficacy of methods employcd to combat disease*, so wc must first know where licallli is being menaced, the relationship of occupation In tlic-c dis eases ami the causative factors responsible. ue nation's bill lor illness and premature baths amounts to approximately ten bil.011 dollars annually, and that on every tcrage day about four million persons in c United Slates arc incapacitated by ill< No doubt many industrial workers ie in that last figure. Thy indusliinlisl of today should rccog- The records you keep will be a guide to ac tion as well as a record of action. Therefore, I say, prove your value to industry since many a skilled industrial medical department lias been liiniled in itbudget and activities because it overlooked the necessity and value of absenteeism re ports and rceorils which could ha.a* Iren i/c -that a sick worker is prone to acci used tu enlighten manage: .cut icgaidit ... its .) Occupational l>iseuse health problems. Perhaps in some eases up ami maintaining records of irkrrethe indmtrial establishment may find it ilif- their particular plants. An an *)>'* ficull to imdei lake a complete record system evaluation of these reports ari-i ,cc'ril of absenteeism. I do urge you, though, to another service oticrciMiy them to ol.iti.. make a stait souiewliere. It need not he mint. too elaborate. Hcfurc showing you a form on width I have hvard it said that the lust way to deled illnesses which are causative of absenteeism from work is by periodic phys ical examinations. I am nut fully in accord with this type of prevention. It may he helpful where the illness lasts longer than a week or ten days, lint something should collect your absenteeism data, and which he (cimcd the 'Toaster sheet," I should I to acipiaiut you with several imi.oii items that mu-t he had for your rero before they eau li ml themselves to anal and evaluation. The form is sell e.vpl.. lory except for a few gcn-iat remarks. be done ahold the frc(|tient one, two or A carrl should lie made nut for each three day absences, and I (ear that periodic every employee on the payroll, regard physical examinations will not help tre of whether he or she gets -ifk or iml. 'I mendously. This, of course, does not mean is necessary in order to ascertain the 1 that industrial medical services should aban of those sick to the iiiuuhcr 011 tin* t< ty don or minimize that phase of l.callli serv The winkers' age, sex, color and ocvup.i ice. The industrial hygiene divisions of Slate Health Departments and that of the L'uilcd arc important tu record since they v ill I to he related to the specific cxpnstil p. latino. Slate Public Health Service arc urging the kinder "occupation" state the vvml, employment and use of a uniform code fur which (Ire employee was engaged when recording and reporting absenteeism of the sickness began. T he ``dale disability In-, worlu-r due to sickness, 1'orms and meth should only he rccoidal for one full ods have been developed after a study of or longer, fit the rniiiuiu "work day.- ! some twenty years by the Public Health wc refer to calendar days anil thi- is n,, Service and also as a result of the recent sary to put lo-l lime on a cnmp.u.d.lv h National Health Inventory of chronic dis for all employees. For '`iJiagiio-is" ease alfjjcliug workers. The aforementioned should list the sickness or injury when il health agencies will gladly assist and eo- nitcly known; if there is any doubt al opciate with industries desirous of setting the correctness of the diagnosis, a siatci. 22S !> liver Jubilee Safety Congress of the >vmptums experienced liy tltc patient should be recorded. The point is that facts should be recorded and not guesses. It is more important, for example, to know that ten men in a' given occupation were dis abled hv "pain in the stomach" than to got ten different guesses of the disease or ail ment causing the pain. Another item of importance on the record is "hy whom diagnosed," and should show whether the diagnosis was made by the family phys ician. plant physician, nurse or the patient himself. L'nder "termination" of case, one should record whether the illness terminated in recovery, death, relapse or ended in a chronic condition. The following statistical information and data are. therefore, possible it lhe''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 hy departments, or occupation. 3. The mortality rate. 4. 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 it holds true in industrial hygiene is represented in my next slide whicli 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 Sfesam Heifliraad TUESDAY AFTERNOON SESSION October II, 1938 The first meeting; of delegates to the Steam Railroad Sessions was called to order by Mr. W. W. Wood, Snperintemlciit of Safety and Welfare, lialtimorc & Ohio Kailroad Company, lialtimorc, Maryland. who presided. Chairman Wood hriedy out lined the significance t>f 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 of accident prevention work from its in ception, as applied to the American rail road*. Afany of ns here knew Mr. Ralph C Richards intimately, and discussed his hopes and ambitions with him frequently. Though lie met from time to time with dis couraging results, vet lie never surrendered. He laid the foundation for safety work that is vastly enlarged anti is rapidly ripening into collateral lines that are of benefit not only to employees and managements but to the entire economic and social structure of the country. In* the beginning, and even until rather recent times, the greatest emphasis was laid upon working rules and physical conditions of plant and facilities; in other words, a safe place l<5*wnrk. There was every rea son in the world why the greatest emphasis ihniild lie placed tiiioit these factors, and, . indeed, we arc nut yet so far along that ire can afford to lessen our efforts with ; relation to these matters. In the beginning, the idea of a surgical department was to care for men and women ' liter they were injured. Gradually this , conception has been enlarging amt changing [ into a broader field and greater service, if j a greater service is possible. This depart. stent no longer has as its sole objective ! the healing of wounds and the saving of i human lives after injuries. Gradually, steadily, the whole conception of safety work has progressed and evolved until to day it has heroine a nationwide activity, drawing to its cause the best minds and the finest characters in our social structure. And with this greater interest in the work it has iieen hut natural that (he whole sco|ic. theory and conception of the under taking should gradually enlarge to embrace the wider field of accident prevention, to which l am nltotit to refer. In recent years many, of the railroads have enlarged their conception of this work and have conic to the realization that safety work involves not only safe tools, safe wav anti structures, ami safe surroundings, hut involves likewise, and with equal impor tance. the very physical and mental condi tion and attitude of the employee or olliccr himself. With this thought in mind ur have changed the title of (he lieati 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 not only he sur rounded with sate 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 lie 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 V**l Steam Railroad 'dd of informing the public ns to the number of accidents, their causes and how they may be avoided. Will* 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 bo followed if we are to curb the recklessness inherent in certain motor drivers. Ninety-five per cent of the motor drivers of this country are competent and careful, ft is to them that we appeal to aid us in the-enforcement of such rules and regula tions as 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 full measure of success. How well they one of the proudest chapters of American and their successors did the job is told in industrial achievement, naturally falls into the statistics of declining accident rates, of two main divisions. Safe conditions must lives and limits saved. be created, in the first place, hut there must In these latter years, American industry lie also created a safe state of mind. is faced with the ttcct! for another sort of No doubt the pioneers of the safety movement encountered industrial managers willing enough to install safe equipment, understanding and cooperation on the parr not only of those employed hut of the whole public which our industry serves. but skeptical as to the need or the value In the short space of little more than a of the education and exhortation needed to century, our American scheme of enterprise instill safe ways of thinking. Every man has settled and civilized a continent. It has knows that to get hurt will cost him time made possible a standard of material plenty and money anti sutfering, these skeptics and well-being unknown before m the his .might have said, so what's the use of going tory of the world, and tmkunun elsewhere to a lot of trouble to tell him so? He'll in the world today. We are :>M that one- take care of himself! third of the people of the nation are ill-fed. Fortunately, the safety pioneers realized that safety was a matter of the minds of men just as much a# a matter of machines, and 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 ill-honsed and ill-clad, hut it -.'.uid hbome in mind that when this American way of enterprise becan to futxti-.r a century and a half a-Jo. practically she vi'-.le pop ulation was ill-fed. ill-housed and 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. of simple principles. Today, as never liefore, the best opera 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 tion. the safe functioning, theNvry exist ence of the vast and varied organization of our economy of tree enterprise, depend upon public understanding ami appreciation of what it is, what it docs, how it works, derstanding and cooperation without which what it means to all of us. tbtir movement must have failed of its The safety movement is built upon safe