Document Oz8ZmXkX1D0ZN166rZ5vNnLDv

Current Topics in : -;r. 32 and 33. KQO 4, ILL 00--349--WHP As preseated is the Horn* Safety Session of ike 1948 Nofiooal Safety Coagress Patterns in Home Accidents................................................... 4 -?...; The Accident Prone Individual............................................ 9 Accident Prevention--A State Health Department's . Responsibility ................................................................ '.v> 12 / "Built-in" Safety in the Home............................................ 16 Safety is a Family's Business.................................... 19 Volint 32 Transactions 1948 National Safety Congress PLAINTIFF'S EXHIBIT WV" OlS&de PLAINTIFF'S EXHIBIT Q3Q<,,5.31 In safety, as in all other human activities, the question is repeatedly asked, "What's new?" Many answers to that question are given every year by those who participate in the various sessions of the National Safety Congress. Many new methods, devices, and ideas which later became generally accepted first were presented at a Congress session. Because of this fact, safety directors throughout the nation have always found the Transactions of die Congress a valuable tool in 'their accident prevention programs. Publication of the Transactions in small volumes--one for each Section or Division--permits wide distribution of pertinent portions of the Congress material to man agement and supervisory personnel at small cost The 34 volumes of the 1948 Congress Transactions are listed on the last page. Distribution of these volumes to key personnel is suggested as a valuable aid in the safety program. In preparing these Transactions die proceedings of the Congress have been condensed and edited for reference purposes. Complete original manuscripts, with any charts or illustrations which were used, are available in National Safety Council files. Views expressed at the Congress or in this record are those of die Congress participants, and not necessarily those of the National Safety Council. THE HOME SAFETY CQMFEREICE This volume is a record of the sessions held at the 1948 National Safety Congress by the Home Safety Conference. The conduct of these Congress sessions each year is only one of the many cooperative activities which the Conference carries on for the benefit of accident prevention work in the home. The activities of the Conference are under the direction of the officers of the Conference listed on page 23 of this volume. . \. ~: ; | ..** i-w-i US* --' 4 4 Patterns in Home Accidents Patterns in Home Acddents By DR. JOHN E. GORDON Professor of Preventive Medicine and Epidemiology, Harvard University, School of Public Health The responsibilities of physicians in the tient depends first on a dear recognition problems presented by health and disease of the character and extent of a disease have been stated in simple fashion as die process!, upon diagnosis, and secondly upon obligation first to prevent disease; if that a treatment designed for that particular cir is not possible; to effect a cure; and if that cumstance and that particular person. The proves impossible, to alleviate suffering. same principles hold when the community Doctors of medicine as a profession ap is the patient... proach the problem of prevention in two The counterpart of the discipline of clini ways. The first is through that intimate cal diagnosis is that of epidemiology, with and universal relation, which exists between the obligation to evaluate the Ills of a com the individual practitioner and a single pa munity. It is that of which I wish to speak. tient The advice he gives and (he measures I have purposely refrained from using that he takes are preventive medicine. The con torn in the title of this paper, and I shall tribution that results is a major part of in the discussion to follow. After all, epi what doctors give to the prevention of dis demiology consists of-no more than defining ease, first because of the numbers of doc the patterns of disease; but that is most im tors and of people concerned and secondly portant because it determines to a great because the action is directed toward a degree the reasonableness and the success determined need a known cause, and to a. of measures that are applied to remedy a specific circumstance. situation. But the health problems of man are not the simple summation of the ills of the in dividuals who make up a given population or community. The misfortunes of one act on the well bong of others. There are causes of disease and injury which are be yond the control of the individual, to be eliminated only by group, action. There are side communities as wdl as sick individuals, and it is the community that the public health physician has as his patient This, then, is the second way in which the physician ap proaches prevention, as a problem of popu lations rather than individuals, and the medium is known as public health. I would make one more point before turn ing to the special question of home accidents When the problem is that of the cure or alleviation of disease in the individual, that is a function wholly of the physician through his special skills and the knowledge derived from his profession. Prevention .is some thing else.' The principle is firmly established that the control of community health is a community obligation, a team effort requir ing a variety'of skills, that'of tire engineer, die public administrator, experts in sciences allied to medicine; the social service worker, the sanitarian, the safety officer, jand of course the phyridan. While toe primary objective of public health is to prevent disease of the com munity, circumstances commonly require the same compromise as In clinical medicine, the need to be satisfied with something less than the perfect result of prevention, to control or limit disease that cannot be prevented and to decrease the costs in terms of com munity health when neither is successful. All three are a positive contribution to pre vention although in progressively lesser de gree. A successful and intelligent practice of medicine as it relates to the individual pa The doctor Iris his contribution to make because his business is health. But `depend ing on the nature of a community problem, his part may be dominant; as it is in the health of tiie new born ami of infants, or secondary, as I fed it is in acddents, taking the problem as a whole. But he does have some obligation in every community problem that leads to death, defect, or disability. I venture that .one of the reasons that physi cians have failed to interest themsdves as they should in the prevention of acddents is a failure to dissect the problem. Many fields in accident prevention are dearly the recognition f a disease condly upon uticular drperson. The s community line of diniliology, with Is of a cotnish to speak, tt using that and I shall iter all, cpihan defining is most imto a great the success 0 remedy a before tnmne accidents, the cure or Ividnal, that d? rough sdgc derived n .is somer established health is a BFort requirhe engineer. 1 in sciences vice worker, ier, jand of on to make But `dependity problem, it is in the infants, or ients, taking e dots have lity problem disability. 1 that physiemselves as )f accidents item. Many clearly the Home Safety 5 primary, responsibility of others, the safety engineer in industry, the police and other taw enforcement authority in motor acci dents, these and many others, in the diverse accidents that occur in public places. Never theless, the physician has a recognized doty in all these fields, as a technical expert and as a public health officer. The aeddents that occur in hones are something apart This important group ac counts for more deaths and far more dis abling injuries than arty other of the four great categories into which aeddents are divided. I believe that the home is the par ticular province of public health and pre ventive medicine, and I see no other promise of successful approach except through these agencies. If home aeddents be a primary problem of community medicine then it seems rea sonable to apply to its solution the tech niques upon which all community health practice is based, whether the question is of the communicable diseases or cancer, dia betes, nutrition or other. In essence, this includes first an epidemiologic analysis of the broad problem and then a focal attack where the condition is determinably most pronounced, through specific educational techniques and the demonstration of. preven tive measures Ity public health nurses or other health visitors in the homes of people. The definition of patterns Is the first requi site. In presenting this method of medicine as an approach to aeddents that occur in homes, the suggestion is left that these techniquesmay be. applied to advantage in other fields of accident prevention not so dearly within the responsibility of the doctor. . Objectives The reasons for an interest in the pat terns of home aeddents are simple--to find out when and whde these events take place; how they occur, which is to say the mechan ism involved; and finally to leam who gets hurt These matters are vitally practical. Remedial measures are costly. They are time consuming and interest flags if return is not evident If universally applied, and blanket-wise, they lead to diffuseness of ef fort and minimal accomplishment When the death rates from tuberculosis in Detroit were judged some years ago to be beyond reasonable titbits, the attack .on the disease was not through a dty wide campaign, but through search for those fac tions'of. the population contributing in inor dinate degree to the total tuberculosis of the dty. They were found in the population of three wards, predominantly negro, where in tensive control measures produced a signifi cant Improvement in the rates for the dty as a whole. The reason then for an interest in the patterns of home aeddents or any other community health problem is to direct avail able preventive. measures intelligently and specifically. The demonstration and inter pretation of these patterns lead straight to the question of cause, and that is more than the simple tangible object so- commonly in terpreted as the sole responsible factor in disease or injury, a genu in infectious dis ease or the loose board in a home accident. Rather it is a combination of forces of origin from at least three sources, neither one nor the other regularly exerting the principal effect Because this suggests that similar disease phenomena may arise from dissimilar causes, it is necessary to speak briefly of the biologic origin of disease and injury. An Ecologic Interpretation of " Mass Diseases / The direct causes of disease or injury are many, ranging from microscopic living things to chemical agents such as lead, physi cal agents of heat; cold, electridty, dusts, fire and a host of others. Disease may also result from the lack of an essential element such as vitamins. Collectively these are the agents of disease. A statable host is essential to the produc tion of disease; apd our interest here is in man as the host The essential considera tion-is in that qualifying word "suitable." Some ages and some races are individually susceptible to a disease or an injury, and there are variations from condition to con dition. There are important differences in organic and psychologic makeup that relate to resistance or to the likelihood of disease. These and many others are the host factors in disease. Finally there is the'environment in which qgent and host find themselves. First is the physical environment which includes climate; weather, and similar influences. Secondly, the biologic environment, the whole of the other living things with which man associ ates, and finally the socio-economic environ 6 Patterns in Home Accidents ment, those things of the surrounding world cidents are the principal factor in the health which arise from man's association with his losses from accidents since they represent fellow man such as crowding, economic about 35 per cent of the total reported for status, housing, clothing and many others. the United States in 1947. The proportion An established and satisfactory equilib rium or adjustment between man and his environment leads to the situation called health. A significant disturbance of this equilibrium results in disease or injury. The disturbance may follow through the princi pal action of the agent or of the host or of the environment, more commonly through their combination. But what is the practical relationship of ail this to the causation of disease or injury? How is it concerned with our particular problem of accidents ? May I return to my previous example of the loose board that caused a home accident through a fall. A loose board exists. The likelihood of trip ping and falling is exaggerated by its posi tion in the environment, whether that be attic, cellar or front steps, by the influence of weather, of season and'of daylight or darkness. The host may determine the whole event. A careful individual may avoid the most evident danger over long periods, while a minimal provocation suffices for the opposite sort of person. And of the agent itself ? Big boards may cause little accidents and little boards, big ones. The cause is the summation of these three forces, and what is so frequently looked upon as cause is actually mechanism. These principles are believed to apply equally to disease and in jury of the individual and to mass disease of communities. Many facts are known about accidents in the home. Their interpretation and the re lation one has to another are presumably improved by looking at them in these terms of agent, host, and environment These are the fundamental factors in producing acci dents. The mechanism of how they, act to gether in the eventual production of an acci dent is an equally practical consideration-- through bums, falls, crowding and what not --but not the essential question. Basically, what caused the fall? varies, in different parts of the country and from* one time to another. The experience of Tennessee shows home accidents to be somewhat less important than those due to motor vehicles, while the data for New York State during the years -1942 to 1946 show almost one half of accidental deaths to have occurred in the home. Geographic Distribution--Not only is the relative proportion of home accidents to all others a variable feature of geographic regions, but the actual frequency as judged by the number of such events among each 100,000 people differs from state to state The differences in respect to all accidental deaths are well known and have been re corded over a number of years. .The less comprehensive information about home accidents shows great differences from one. part of the country to another. Rates vary from 34.5 in Missouri to those of Utah with 16.8 per 100,000 population. The gross differentiation by states scarcely permits the individual community logically to judge its problem of home accidents. Much depends on the concentration and character of the population as becomes evident when the fre quency of home accidents is considered in relation to place of residence, as' urban, farm and rural non-farm, for home acci dents are dearly a greater problem of turban 'communities than rural non-farm areas. The reasons are not well defined but the differ ences are sufficiently great to suggest ma terial variations from community to com munity. This,has been recognized to the extent that some few dries have determtried the frequency of home aeddents by political subdivision such as wards or census tracts, and states like Tennessee and Kansas have effected divisions by counties. The* results emphasize rite need for individnalized infor mation if communities are toapply proper stress to control measures. Largely .because of the interests of a few investigators, much is known of the inner Environment--The primary classification structure of the home as an environmental of accidents by the National Safety Council factor in home aeddents. The data are is on the basis of environment, four great familiar to most and appreciation is gateral categories to include the accidents that oc? of the extent to which direct educational cur in homes, in relation to motor vehicles, measures have followed the demonstration in public places and where men work.. -of the hazard pertaining to various features Judged by the deaths that occur, home ac of home life.. in the health ey 'present rt ;ed for le proportion country and ic experience idents to be those due to ta for New 1942 to 1946 ienfal deaths t only is the udents to all geographic V as judged among each ate to state ill accidental ive been re- mation about erences from other. Rates lose of Utah l The gross ' permits the to judge its [uch depends acter of the then the freanswered in it urban, huue acri[em of urban n areas. The it the differsuggest mality to com used to the e'detennined s by political ensus tracts, Kansas have The'results alized inforapply proper sts of a few of the inner avironmenta! ie data are m is gdieral educational emonstration ious features Home Safety 7 Seasonal--Accidents as a health problem are a steadily recurring phenomenon cor responding to what is termed endemic be havior in terms of disease occurrence. Little variation occurs from month to month, as illustrated by the experience of Wisconsin for 1946. - Specific kinds of accidents are recognized as common to certain seasons, suffocation of infants and falls at all ages predominating in winter. Generally, the in formation is none too extensive and the knowledge of home accidents would profit by methods used in the study of motor vehicle accidents to determine such time factors as die influence of weekends, of holidays, of periods of bad weather, and of daylight hours as contrasted to those of darkness. Biologic Environment--The biologic fac tor of environment has minor significance in home accidents compared with the dominant part in such mass diseases as malaria and rabies. That the principle holds and that environment is rationally interpreted in terms of physical, biologic and socio-eco nomic components, is demonstrated by the home accidents associated with pets, with poisonings through action of snakes and insects, and other events related to the ani mate things that live with man. Socio-economic Environment--Whatever the kind or nature of mass disease or injury, whether it be infectious, metabolic or trau matic, the part exerted by the socio-eco nomic environment is probably the most neglected and underdeveloped of any epi demiologic influence, with accidents no dif ferent from any other. Only scattered in formation can be put together, that arising from the National Health Survey of 1935 being the most instructive. The.quality of housing as judged by the amount of income or rental paid has been repeatedly demon strated to have an influence on the fre quency of both communicable and" non-com municable diseases. It is not surprising that the same causative influence can be shown in the frequency of accidents. Indeed, many of the physical factors of environment al ready presented and thos of the host to follow will be seen as scarcely independent in their action, bat representative of a solid admixture with this component of socio economic environment ment the scalding hot water, the unguarded poison--is so evident the tendency to think only of that factor in a causative relation is completely human. An enveloping darkness or rainy wet weather, or a crowded tortuous thoroughfare are also readily viewed as con tributing to the causation of accidents. But the people who get hurt--they are only the poor victims of circumstance. And yet, when we examine the question, probably more causes of accidents lie within what we choose to call "host factors"--within people themselves--than in any other of the three parts of the triad which explain the causes of disease and injury. Age is an important determining factor. Considering deaths, the very old are most affected, with the loss of life far less during the active periods of life* when conceivably the opportunity for accidents is far greater and the risks much enhanced. The contrasting liability of the two sexes to accidents is best demonstrated by exam ining deaths from accidents of specific types. Those associated with falls serve to good purpose. The factor of age is well indi cated, with more deaths among those of advanced years than in younger age groups. Equally striking differences are related to sex, in that younger males are far more frequently involved than females of the same age. At advanced ages females out number males in deaths from falls by a wide margin. Deaths from cutting mid piercing instruments fail to show these dif ferences according to age. The sex differ entiation is just as definite. At younger ages males surpass females, but with ad vancing age the susceptibility becomes more nearly even and from persons past 75 years the differences are non-essential The relation of race and likelihood of death from accidents is best illustrated by the particular condition of accidental death from suffocation. Again the age differences are well marked, in that the rates for in fants under one year of age are completely out of proportion to those of children aged 1-4 years, but the data are chosen to illus trate another point and that is the discrep ancy in respect to race. For this unusual cause of accidental death more than twice the numbers of children succumb among colored than white. Host--Because the cAfject that directly These differences in liability to accidents gives rise to an accident--the faulty pave among the gross divisions of the population 8 Patterns m Home Accidents are striking. Each may be subdivided by all manner of other factors which make up the whole of the constitution of the host Acci dent proneness is a host factor related to social attitudes and psychologic differences, a subject to-be developed in detail.by die speaker next to follow. The increased lia bility to accidents in the wake of fatigue and other physical and mental stresses, the effect of alcohol, all manner of physical de fects of which those of the eye and the ear are especially significant, are further examples of host factors, too little developed in relation to home accidents, despite the emphasis they have had in industrial and motor accidents. Agent--The information about the precise agents involved in home accidents is none too satisfying because of the common con fusion with mechanism by which the acci dent results. The mechanism is not die cause of the accident It is the means by which it is brought about, while die causative fac tors have been seen to reside not only in the agent but in the host and in die environ ment as well. ddents in urban areas are expectedly differ ent from-tbose of rural homes. The several lands of people vary in their susceptibility to accidents from a single potentially danger ous aged. Either sin agent .or & host can be particularly unlikely to ive rise to an accident under rate set of environmental cir cumstances; under, others' the agent may be rendered particularly dangerous or the host unusually susceptible to injury by ac cident This is not a complicated, but a rational approach to a better understanding of acci dents. It is a scheme followed by several state health departments. The National Safety Council has made a special analysis of home accidents according to this pattern. The investigation forms used in Kansas pro vide a ample means for recording and acquiring these data. The method. needs wider application if the problem of the in dividual community is to be adequately de fined, `and better definition has tire practical end of permitting more intelligent and spe cific programs of prevention. A log lying in a park gives rise to a fall The Existing Status of the which ends in a broken arm. The log is the agent the fall is the mechanism which char Home Accident Problem acterizes the type of accident Hie'*'cause Much attention has been given in this may well be a combination of first theagent discussion to tiie recognition mid evaluation as a fundamental essential, of a-host with of the various kinds of home accidents. This faulty vision, and a rainy day. The broken is the sort of intellectual exercise'that doc arm is die accident the result arising from tors call diagnosis.- I have likewise made duly defined cause. . it evident that the reason we are Interested An accident may be described as due to cutting or piercing, to collision or to crush in diagnosis is because it so largely deter mines the; efficiency of treatment ing, and yet the agent in all three instances But there is always one other feature of may be a glass panelled door. Conversely, a medical problem with which physicians a fall may be due to such dissimilar agents are concerned, and that is the future outlook, as a faulty ladder, a playful pup or a mis will the patient get well and how long will placed handbag. it take, a question of equal significance in tiie mass diseases of populations and specifi The Epidemiologic Approach to Accidents cally that of home accidents. I wish to nuke ^-sthree points: The sort of analysis that has been de / The 1947 record for accidental deaths in scribed is believed fundamental to an under-- "the United States, of all kinds and front all standing of the origin of accidents. It in causes,,was appreciably improved over other volves first a recognition of the agent in years, but largely related to a better record volved; second the mechanism by which that for accidents of industry, of motor vehicles agent comes into play; thirdly a'determina or those which .occur in public places. The tion of cause in terms of agent as the direct frequency ,'of home accidents goes along inciting cause, the qualities of the host who _y_e_a_r__a_f_te_r_y_e_ar__w_i_t_h__re_l_a_ti_v_el_y__l_it_t_le_ changue. is involved in the accident; and finally the - As indicated by the mmTwr of deaths that influences exerted by environment. occur, no great progress has been made in The lands of agent involved in home ac- home accidents. Doth, is by aoriden mass heal! exists witi home and. on deaths^ situation 1 fuUy near indicate th accident a) a ratio gr accidents; dents being Death i portant co lem, tiie i At this emphasize lance of a economy, men, psyc ticianS ha' lish preeh the causa vention re The era most aed are cause position it servation. an ocatrr a person* pedestrian event, pas warned t likely to Mostfr ever, are of the ac causation, was dum he ought Sdentil fished tin by such ! entific <& edly differIV ~everal 1st aility Uy oangerSi host can rise to an mental tiragent nay ms or the ury by ac- a rational ig of actiby seven! i National ial analysis bis pattern. Kansas protrding and hod. needs of the inluately deie practical it and spe- he in at in this evaluation ton*. This ft docsrist made : interested fely deter- feature of physicians re outlook, ' long will ificance in ud sperifiih to nuke deaths in d from all over other ter record sr vehicles aces. The oes along tie change, ieaths that i made in Home Safety 9 Death* is not the only healthcost exerted ample. The losses from temporary disability by accidents or for that matter with any and from permanent defect may be the more mass health problem. A common tendency serious consideration. Just how important exists with accidents, and particularly with that is in connection with home accidents home accidents, to base, judgment entirely . rests upon insecure information. cm deaths. To an extent this ..is a forced situation by reason, of deaths bring care fully recorded while cases are not Estimates indicate that for every death from a home accident about 150 disabling accidents occur, a ratio greater than for any other class of accidents, the ratio for motor vehicle acci dents being 1 to 32. The problem of home accidents cannot be approached in its entirety without much better information than now exists. There is neither provision nor opportunity for official reporting of cases as is true of com municable disease. The information so nec essary to an evaluation of defect and dis ability from home accidents would appear Death is not necessarily the most im to be had most readily through visits to the portant cost exerted by a mass health prob homes of people in the course of the ordi lem, the common cold being in good ex nary activities of recognized health agencies. The Accident Prone Individual By FRANZ ALEXANDER, MJX Psychoanalysis Institute, Chicago At this conference it is not necessary to emphasize the tremendous practical impor tance of accidents in relation to our national economy. It is not surprising that medical men, psychiatrists, psychologists and statis ticians have tried for a long time to estab lish precisely what is the human factor in the causation of accidents. Effective pre vention reprises such precise knowledge. The contention of modern psychiatry that most accidents are not accidents at all but are caused largely hy the victim's own dis position is but a confirmation of common ob servation.. Strictly speaking, an accident is an occurrence, tire causeof which is outside a person's control. A bride falling on a pedestrian's head is a completely accidental event; particularly if die pedestrian- is not warned by a sign 'that such an event is likely to occur at a particular place. Most industrial and traffic accidents, how ever, are of a different nature. The sufferer of the accident has some active part in its causation. It is popularly assumed that he was clumsy, tired, absent-minded; 'Otherwise he might have avoided the accident Scientific scrutiny, however, has' estab lished .that- most acridents are not .favored by such simple human Qualities. Many sci entific discoveries appear at-the first moment unexpected and improbable. So is the fact that certain people are prone to have more accidents than others, not because they are clumsy or absent-minded, but because of the total structure of their personality. The significant factor is not a particular isolated feature such as slow reaction or lack of intelligence bat something much more basic which pertains to the totality of the person as an individual. Let me first mention a few startling facts concerning the human factor in accidents.. More than twenty years ago; Marbe, a German psychologist, established the re markable fact that the person who had one accident is more than likely to have another one than the person who had never suffered an accident Statistical studies in large in- dustrial companies have shown that accidents are not evenly distributed among the em ployees, that a very small percentage of employees has a very high percentage of the accidents. / \ One might conclude from tiffs that possibly those employes^ who have more accidents are those whose* assignments are most dan gerous. That;tius is not scvbbwever, is dem onstrated by the fact that those persons who have the most accidents in one kind of job have also the most accidents in other 10 The Accident Prone Individual kinds of jobs. Moreover, those employees who have the worst accident records in their jobs have also the most frequent accidents at home or on the way to work. One large company which einploys a great number of truck drivers became concerned about the high cost of its automobile acci dents and tried to analyze the causes of ac cidents in order to reduce the frequency Among other procedures, they examined the accident records of each driver, and finally they transferred those who had the most accidents to other occupations. By this sim ple device they succeeded in reducing the accident rate to one-fifth of its original level. The most interesting fact in this study is that the drivers who had a high accident rate retained their accident habit in their new occupation. This shows irrefutably that there exists an accident prone person, and that accident prone individuals are accident prone in any occupation and in their every day life.. After this highly significant fact had been esablished, the next problem was to deter mine those qualities in a person which make him inclined to have accidents. It was discovered that the total personality structure was to be held responsible for tike accident prone individual Dunbar who, with the modem methods of psychiatry, studied a large number of fracture patients describes the accident prone person as follows: He is decisive or even impulsive; he concentrates upon immedite pleasures and satisfactions. He is apt to act upon the spur of the mo ment He likes excitement and adventure, he does not like to plan and prepare for the future. A large number of persons with accident habit have had a strict upbringing and have derived from this an unusual amount of resentment against persons in authority. Briefly, they are men of action and not of planning, persons who do not - interpolate much deliberation and hesitation between im pulses and their actual execution. There may be various reasons for this impetuousness, but apparently rebellion against restrictions by authority and all form of external coer cion is its most common origin. Planning and deliberation are potent fac tors which make one refrain from imme diate rash action. The accident prone person is essentially a rebel. He cannot tolerate even self-discipline. He rebels not only against external authorities but against the rule of his own reason and self-control. Intensive psychoanalytic study of a few cases has allowed an even deeper insight into the intricacies of the emotional life of the accident prone person. Particularly re vealing were studies which scrutinized the emotional state of the person immediately before his accident Dunbar, Menninger, Ackerman, Rawson and others have shown that in most accidents there is an element of intention, though this intention is by no means conscious. In other words, most accidents are un consciously intended. They belong to that category of phenomena which were described by Freud as die errors of everyday life such as misplacing an object forgetting to mail a letter and carrying it for days in one's pocket- misspelling or mispronouncing a word. Freud showed convincingly that such errors are not accidental in the strict sense of the word but are unconsciously intended When a president of parliament erroneously declared a meeting closed instead of opening it he had some good but hidden reason for having the meeting over with before it started. A person who carries a letter in his pocket for days has some definite; although unconscious, reason for not mailing it Most accidents are similarly caused by unconscious motivations although they usually are of much graver consequence than these more harmless errors of everyday life. Psychoanalytic instigations have re vealed the nature of die unconscious motives which induce people to act in a way which inrites accidents. The most common motive is a sense of guilt which the victim tries to expiate by self-imposed suffering, by selfimposed punishment. The unconsciously in duced accident serves this purpose. Since this may sound improbable to you, I shall try to illustrate it with a few brief exam ples. Ackerman quotes the following case: "A youth was driving his mother on a shopping tour. He begged her for the use of the car for a fishing party the following day. She refused, whereupon he fidgeted angrily, `accidently1 stepped on the accelerator and sent the car into a ditch, injuring both himself and his mother." The combination of revenge and guilt was obvious, in ished his punished 1 Accord! tures stud and resent person in illustrated as the foil "A 1< was rea supper out I 1 ding m; way, I i with mi "A 2 down a off aim with he I ough have be sense, person "A s. `I aske ished s done a done sc The ba emotions alent in < ing expi somethin) the suffe makes u; and rega same era our crim his punk to the cc expiated science ; the per internals self, ant wrongdo of a gu! peace. The nr in child) against person r persons He also t tolerate nr Tily jai. the ntrol. >f a few t insight al life of llarly renized the mediately [enninger, ire shown i element is by no are tml to that described life such [ to mail in one's incing a that such rict sense intended roneously f opening ason for iefore it ter In his althongfi : i' ast con_<ous ' are of cse more lave res motives ay which n motive 1 tries to by selfously ine. Since i, I shall *f examng east: her on a for the arty the eupon he edonthe a ditch, other." |Uilt was \ Home Safety 11 obvious , in this case. This young man pun ished his mother, but at the same time he punished himself. According to Rawson, 60 per cent of frac tures studied psychiatrically confessed guilt and resentment in their relationship to some person in connection with the accident. He illustrated this by such revealing examples as the following: "A 16-ycar-old Puerto Rican said: `It was really my fault because Mother said supper was ready, and I was not to go out I went out anyway, got into a wres tling match and got my arm broken. Any way, I guess Mother's sorry she's so strict with me.' "A 27-year-old woman was hurt sliding down a banister. She bad always worked off annoyances with her parents and later with her husband by such tricks. `Perhaps I ought to know better, but I wouldn't have been like that if they had had more sense, and had treated me more like a person instead of bring so strict' "A secretary fell and fractured her hip. `I asked my friends why I must be pun ished so. I can't remember ever having done anything wrong, but I must have done something terrible'." The basis of this strange combination of emotions is a deeply ingrained attitude prev alent in our present civilization, that suffer ing expiates guilt If the child commits something wrong, he is punished. Through the suffering caused by the punishment he makes up for his guilt and thus deserves and regains the love of his parents. The same emotional attitude is at the basis of our criminal procedure. The offender serves his punishment, after which he can return to the community as a free person who has expiated his wrongdoing/ Tlie human con science apptis this same principle within the personality. The conscience acts as an internalized judge whom we carry in our self, and who demands suffering for our wrongdoings. Suffering relieves the pangs of a guilty conscience and restores the inner peace. The most common causes of guilt feelings in children are hostile, rebellious impulses against the parents. The accident prone person retains his childhood rebellion against persons in authority eveh in his later life. He also retains the guilt reactions originally felt towards his parents. The combination of these two, resentment and guilt, is the most common factor in accidents. Those people who have a great deal of this selfpunitive urge constitute the majority of the accident prone individuals. The guilt feel ings are convincingly revealed in the fre quent question of the sufferer right after his accident; "Why did it happen to me? What didt I do to deserve it?" These ques tions show that the guilt feeling, although not quite conscious, is vaguely sensed by the patient , It was 20 years ago that I first became convinced of the unconsciously intended na ture of certain accidents. I was consulted by a very intelligent man in middle life suffering from a severe depression which developed out of an unsuccessful struggle for existence. He came from a well-to-do socially eminent family but had married into a different social stratum. After this alliance his father and family refused to have any thing more to do with him. His unsuccess ful struggle for existence through many years terminated (on account of neurotically determined inhibitions) in a total psychic collapse. I advised him to begin an analysis with a colleague, because I had personal relations with him and his family and was well ac quainted with his previous history. He found decision difficult One evening when the final derision about the analysis was to have been made, he asked to visit me in .order to talk over the pros and cons once more. But he did not arrive; he had been run over by ah auto in the neighborhood of my home. He was taken to a hospital suffering from many severe injuries. It was only the following day that I heard of the accident When I discovered him in the third-class division of the hospital, he was bandaged up like a mummy. He could not move and all one could see of his face were his eyes, shining with a euphoric light He was in good spirits, free from the oppressive melancholy of recent days. The contrast between his physical condition and his mental state was striking. The first words with which he greeted me were, "Now I have paid for everything, now I will at last tell my father what I think of him." He wanted to dictate a determined letter to his. father immediately, demanding his share of his mother's estate. He was full 12 Accident Prevention--A State Health Department's Responsibility of plans and was thinking of starting a new life. What is most impressive in this story is the emotional relief which this patient gleaned from his injury. It freed him from the pressure of his guilty conscience which was stirred up by his extremely hostile feel ings against his family who refused to rec ognize his marriage. After the injury he was ready to express freely all his resent ment and tell his father what he thought of him. Occasionally there are other unconscious motives at work in the causation of acci dents such as the wish to avoid responsi bility, the wish to be taken care of, even the desire for monetary compensation, but time does not allow me to go into further de tail concerning these secondary motivations. There is also some evidence of a correla tion between accident proneness and cer tain isolated faculties such as side vision which cannot be discussed here. Another interesting correlation is between accident proneness and low blood pressure. Since blood pressure is correlated with certain per sonality constellations, the significance of this finding will haw to he elucidated by future studies. In summary, the accident prone individual is an impetuous person who converts im mediately into action his momentary im pulses without deliberation and planning. He harbors - a deeply ingrained rebellion against the early excessive regulations of his upbringing--a deep resentment against persons in authority. At the same time he has a strict conscience which makes him feel guilty for his rebellion. In the un consciously provoked accident he expresses his resentment and revenge, at the kune time atoning for his rebellion by his injury. What can we learn from all this for the momentous practical problem we are inter ested in at this conference: the prevention of accidents. Since the major factors in accidents are not external, such as defective machinery or unfavorable conditions like weather, darkness, etc. but He in the person who has the accident, the primary measures must be directed towards the person. There are only two effective ways to approach this human factor: one is to change the individual and the other, to take the accident prone person away from those occupations where the danger is great' Both measures require reliable methods by which the accident prone individual can be spotted. Because the psy chological factors which predispose an in dividual to accidents are not simple isolated qualities, they cannot be detected by the usual methods of psychological testing. The psychiatric interview, conducted by ex pert, which reveals the whole previous life history-of a person is the most, if not the only, reliable method. The accident habit develops early in life and manifests itself in the youngster, in a noticeable inclination to contract physical injuries even if only minor. Also, the com bination of excessive resentment-and guilt manifests itself in early childhood in vari ous ways familiar to the trained psychia trist To alter such an ingrained emotional pattern as is characteristic for the accident prone individual by psychotherapy is a major therapeutic task It requires pro longed treatment and. is, therefore, in the present state of psychiatric facilities, of no practical significance. The recognition of the accident prone person and his re moval from occupations which are danger ous for him and for the public is at the present moment the only effective measure. Accident Prevention--A State Health Department's Besponsibility By F. C. BEELMAN, HD. Executive Officer, Kansas State Board of Health There `was a time when hazards to life were so great that the. annual toll from accidents passed unnoticed. The ravages of uncontrollable disease .brought fear and de- spair--not only to individuals and families but to large cities. Just a lifetime ago recurrent epidemics decimated the younger population groups in entire communities. ire interre ion dents are nachinery weather, who has i must be : are only is human idual and ae person here the i require ent prone the psyle an ine isolated i by the ting. The y an exvious life f not the ly in life ster, in a physical the comand guilt I in varipsychia- on nal ! accident py is a ires proe, in the lities, of cognition 1 his re: dangeris at the measure. families i ago re- yotxnger nities. Home Safety 13 The compound microscope, 'with its oil emersion lens and. the new world of baoteria, advanced medicine from its dark ages into a new era of scientific truths. Since the 1890's, in almost every state there have lieen constantly increasing efforts to avert preventable diseases and deaths. Public health and preventive medicine, the applica tion of new medical skills, immunizing agents, and drugs, have changed the leading causes of death. In no group is this change more striking today than in the younger population. The first reliable mortality sta tistics for Kansas were, tabulated in 1916, and by comparing causes of death in 1916 with those for 1947, a graphic story emerges concerning health progress, in only 31 years. In 1916 there were 1,548 deaths from acute communicable diseases. In 1947 there were only 290 such deaths. For children of school age the mortality decrease is even more remarkable. In 1916--318 children between the ages of 5 to 19 died from acute com municable disease, as compared with only 20 in the year 1947. There is one leading preventable cause of death and disability which has not kept pace with its mates of half a century ago-- accidents. The estimated acute communicable disease rate, as mentioned for Kansas in 1916 for ages 5 to 19 was 61 per 100,000 population, as compared with- the rate of 4 for the year 1947--a decrease of 93 per cent The accidental death rate for the same years and the same ages was 40 for 1916, and 35 for 1947--a decrease of only 12 per cent Unfortunately, there are only meager sta tistics* available indicating the status of ac cidents as a factor in non-fatal, temporary disability or crippling. Death statistics, however, are complete and indicate clearly the current risk from accidental death as compared with all other causes. For Kansas, , in 1947, accidents were the fourth leading cause of death for the total population, but for all ages, up to 35, they were the leading cause of death. Further analysis shows that for ages 5 to 19, accidents represent almost one-half of die total deaths. Specifically, 172 children in Kansas between the ages of 5 to 19-years were accidentally killed in 1947. Favorable mortality trends for the first eight months of 1948 in Kansas were high lighted By die exceptionally low death rate from acute communicable diseases and the exceedingly high death rate from accidents. In eight months of this year, Kansas is near a record breaking accidental death rate. Both motor vehicle and other accidents are reaching nearly an all-time high for the State. If this trend is true for other states, 1948 may see a national record breaking year in the number of lives lost through accidents. ^ Accidents are, perhaps, the most prevent able of all the misfortunes of mankind. People cannot be immunized against them. They must know how to avoid them. From the past available records it seems that some small progress may have been made in accident prevention. Yet; at the present rate, it will be many decades before acci dents have undergone a decline comparable to the experience in the control of com municable diseases. Are state health depart ments, which, in* the past, have initiated and put into operation programs that have contributed so much to the saving of lives through communicable disease control, fid dling like Nero while the accident death rate mounts--or, fully aware of the devas tating scope of die accident problem? Are they- convinced that nothing actually can he done about it? To answer this question fairly, and with out prejudice, a questionnaire was prepared and mailed to every state health officer. An excellent response was obtained. Forty-one --or 85$4 'per cent--completed and returned the questionnaire. Three state health officers replied that, in their departments, nothing was done toward accident prevention. AH the others carried, on accident prevention activities to some degree. The questions and information secured follow: The first question asked was--"In what place do accidental deaths, rank as a cause of death in your state?" In two states-- Nevada and Idaho--they are the second cause of death; in nine states--Texas, Utah, Louisiana, Montana, New Mexico, Cali fornia, Arizona, North Dakota, and Florida --they were the third, cause of death; in nineteen states--the fourth cause of death; and in seven states--the fifth cause of death. One state each reported accidents as the sixth, seventh, and-eighth cause of death. In 31 out of 41 states, 75 per cent, accidents ranked fourth, or better, as a cause of death. , 14 Accident Prevention--A State Health Departments Responsibility The second question was--`To what ex 26 states carry on special statistical studies tent should state health departments engage on accidents in accident prevention activities?" Ten 6 states promote organization of local state health officers replied that it should Safety Councils be a major activity; 27 stated it should be 4 states coordinate state-wide accident pre a minor activity; three did not commit vention activities themselves, and one stated it should not 16 states furnish consultation services to be a function of state health departments. other state departments on accident pre Recognition of the responsibility of the vention state health department in the field of acci I state health department lends personnel dent prevention is clearly indicated by the to other state departments 25 per cent which felt it should be a major 19 participate in State Safety Council ac function, and the 66 per cent which indi tivities cated it should be a minor activity. 11 prepare and publish special reports on The next question, entirely in the realm of speculation, was--"In your opinion, what would a major accident prevention program accidents 5 prepare and publish pamphlets 7 prepare and publish posters in the state health department, operating on a divisional basis (comparable with tuber culosis control) accomplish in decreasing the accidental death rate for your state?" 5 state health officers replied that it could be reduced 25 per cent 12 state health officers replied that it could Under Safety Inspection Services 18 states carry on safety inspection services in industry II states inspect public buildings for safety measures 7 states inspect mines for safety practices. be reduced 15 per cent Under Health Education Services 9 state health officers replied that it could be reduced 10 per cent 6 state health officers replied that it could be reduced 5 per cent 27 states prepare and release articles 15 prepare radio releases 21 talks are given by personnel newspaper 9 state health officers gave no opinion. 27 distribute pamphlets on accident preven Even the reduction of 10 per cent, or more, tion which 64 per cent of health officers believe 16 distribute'posters could be accomplished, would result in a greater saving of lives than in many other areas of intensive activity. The fourth question--"What is the extent of your state health department's organiza tion responsibility for accident prevention?" None of the states, at the present time, have a major division with full-time per sonnel engaged entirely in accident preven tion activities. New York is the only state with a minor bureau with full-time per sonnel. Many of the states are carrying on some accident prevention work as a part of the activities of various state health de partment divisions. 24 distribute films on safety. It is evident that health department ac`tivities now concern themselves largely with the study and educational aspects of accident prevention. A few are entering on more specific control programs such as promotion, assisting in forming local safety councils, co-ordination and inspections. Sixty-six per cent of those replying are developing pro grams. The sixth question concerned itself with personnel, and it is an important question-- "Indicate the number of health department personnel engaged in accident prevention activities." Answers to this question were Health Education Services -----31 states disappointing as the totals indicated rela Maternal and ChildHealth..........13 states tively few persons are actually engaged in Industrial Hygiene......................29 states accident prevention programs in state health Vital Statistics...............................24 states departments. Division of Sanitation...................15 states No activities.................................. 2 states 1 state--full-time employment.............. 2 1 state--full-time' employment.............. 1 The fifth question was--"What type of - T 'state--half-time employment............. 2 accident prevention activities are carried on 1 state--half-time employment.............. 1 in your state health department?" -30 states--small amount of time."7........ 170 The as to 1 spent "What expend state h 15 stat pro 4 stat pro 1 stat mat 2 stat app 1 stat mat 2 stat pro 12 stat Ansi tions i have i task o: progra time t budget kills a; her la parent have a at lea: terestii if fon and fu ventiot In t made 1 officers meats were tion. 24 stat 6 stat 5 stat 3 stat mis 7 stat In 31 on sat depart the di listed states marsh; were: stical studies >n local accident pre services to accident pre ds personnel Council ac- I reports on ts Terences rtion services js for safety sty practices. Terences i newspaper I dent preven- partment aclargely with s of accident ng on more is promotion, ety councils, Sixty-six per eloping pro- ! itself with it question-- i department t prevention nestion were iicated rela' engaged in i state health .............. 2 ............... 1 t............. 2 t............. 1 ne.*?........ 170 Tfie seventh question gave some indication as to the amount of money that was being spent for accident prevention programs-- "What is the estimated amount of funds expended on' accident prevention by your state health department?" 15 states indicated they were spending ap proximately $1,000 or less 4 states indicated they were spending ap proximately $2,000 1 state indicated it was spending approxi mately $3,000 2 states indicated they were spending approximately $5,000 1 state indicated it was spending approxi mately $8,000 2 states indicated they were spending ap proximately $10,000 12 states did not make a statement Answers to the sixth and seventh ques tions indicate that state health departments haw not as yet seriously undertaken the task of accident prevention. Any state-wide program, to be effective, must have full time trained personnel, with an adequate budget In the control of tuberculosis, which kills approximately 60 per cent of the num ber lost through accidents, state health de partments are spending over $10,000,000 and liave a small army of trained personnel of, at least 10,000. It would be decidedly in teresting to see what might be accomplished if forces of that magnitude were available and functioning in the field of accident pre vention. In the eighth question an attempt was made to secure information from the health officers relative to organization and depart ments outside the health department that were active in the field of accident preven tion. 24 states listed a State Safety Council 6 states had a Safety Commission 5 states had a Safety Committee 3 states had an Industrial Safety Com mission 7 states had a Public Safety Department. In 31 states the highway department carried on safety programs, and in 16 states the department of labor; 21 states mentioned the department of education; eight states listed the department of agriculture, and 17 states listed the office tof the state fire marshal. Other state departments mentioned were: state police, commerce department. insurance department, and workman's com pensation commission. In most states, one or more organizations were active in the field of accident prevention. Twenty-five states had regular appropria tions for safety to a state agency; 11 had no state appropriations, and six gave no answer. Twenty-eight states had full-time personnel, which totaled approximately 212 persons; nine did not have full-time per sonnel, and four gave no answer. One ques tion was asked as to the limit of accident prevention activities by these various state agencies: 13 carried bn programs to control all acci dents 25 carried on only highway and traffic ac cident prevention programs 15 engaged in home accident prevention 15 included farm accident prevention 15 industrial accidents 14.school accident prevention 15 included fire prevention safety programs. This brief review of information, secured within the last few weeks from forty-one state health officers, presents a fair picture of the accident prevention problem and the progress which is being made toward the development of effective accident control programs within state health departments. A number of conclusions can be drawn. State health officers are aware of the seriousness of the accident problem and the majority feel that it is a responsibility of the official health agency. They further be lieve that control measures can reduce the death rate. In fact, 26, or 60 per cent of the questionnaires returned, indicate that acci dent prevention on a divisional basis com parable to tuberculosis control would reduce the accidental death rate 10 peixeept or more. Yet, only 10 of these 26 health officers thought that accident prevention should be a major activity of the state health organi zation. The majority of state health de partments, at the present time, are carrying on studies and limited educational programs in accident prevention. A number of states have expanded programs fo include promo tion and co-ordination of activities. If the responses of the health executives of the United States are accepted only in part, it is clear that health departments are allocating grossly inadequate funds for acci dent prevention activities. Funds and per- : i* i i ; - .I : ;. jv ; " , "i ' i ` f.' > . i `i i f 16 "Built-in" Safety m the Home sonnel should be provided in sufficient quantities to construct active safety pro grams and to coordinate safety activities within the states. State-wide accident prevention programs are still in the experimental and planning stage, as evidenced by various divisions within the state health department carrying on separate activities. Many state departments are interested and active in accident prevention. Probably the most active, operating in a greater percent age of states, are programs of highway agencies aimed at motor vehicle and traffic accidents. Occupational accidents are pos sibly second in their coverage by state labor departments. Home and public accidents (other than, motor vehicle) receive the least attention from state agencies and might logically be the entering field for state health departments. There is, apparently, no uniform wellorganized agency, either official or volun tary, with full-time personnel and funds actively covering the broad field of accident prevention. Many states have funds appro priated for various phases of accident pre vention. No specific federal funds, or na tional voluntary agency funds, appear to be available to states for demonstrations, pro gram planning, or the training of personnel in the field of accident prevention. These conclusions might be compared to the conclusions drawn by the Sub-committee on Accident Prevention of the American Public Health Association and published in the March, 1945 Journal of the American Public Health Association. The article en titled, "Accident Prevention---An Essential Public Health Service" resulted from a study in which some three hundred state, county and local health departments were asked to outline their past and current acci dent prevention activities. Conclusions reached were as follows: "1. Health departments on the whole are now doing very little as regards actual or contemplated studies in the home accident field. "2. Some casual educational work is being undertaken, generally in cooperation with other agencies and frequently through nursing staffs. - "3. There is considerable awareness of the importance of the field and the logic of health department participation in it There is also evidence of a desire for suggestions and information which health departments can utilize in connection with integrating safety with health educational activities." It is evident that progress is slowly being made by state health departments in assum ing responsibilities in the accident prevention field. The increasing seriousness of the problem warrants greater effort on the part of all interested state and national organiza tions. Only through organized and coor dinated activities embracing the concerted action of official and nonoffidal organizations 'can we hope to curb this needless loss of life. "Built-in" Safety in the Home By TYLER 3. ROGERS Owens-Coming Piberglss Corp., Toledo, Ohio When someone falls on a steep stairway at home, part of the blame for the accident should rest on the man who designed the stairway. When someone falls on an ice-covered doorway or terrace, part of the blame should rest on the man who failed to provide an overhead shelter that would keep out the ice. When Fibber McGee gets banged on the head by the contents of an over-stuffed closet, part of the blame--but only a small part--should rest on the designer or builder who didn't provide enough storage space in the McGee home. The accident prevention phase of home safety is partly a matter of original design. It is this part of the safety problem with which I shall deal. If we take .the records of home accidents he American ic 'tde enAA ssential ted from a undred state, rtments were current acci'onclusions le whole are igards actual n the home rork is being cooperation 1 frequently reness of the nd the logic apation in it a desire for ition which ilize in consafety with s." slowly being its in assumnt prevention ness of die t on the part nal organizad coorhe -^ncerted organizations dless loss of over-stuffed only a small er or builder age space in ise of home igiual design, iroblexn with me accidents Home Safety 17 and `sort out those which are due to im proper design from those which are due to human factors of carelessness, ignorance, foolhardiness and the like, we find a rela tively small list of causes. But this list is important, for it is a contributory cause of thousands of injuries. And it is important because it contains elements that should not be perpetuated by repeated usd in the mil lion new homes the building industry is erecting each year! Here are die major items on the list: 1. Interior stairways: too steep, badly proportioned steps, carving winders, lade of handrails, lack of head room, inadequate lighting, slippery or uneven treads. It would be nice if everyone could live in one-story houses without basements or attics; that would eliminate stairways altogether, but then we would not know how to handle our selves when, we had to visit same school or office building that did have stairs. 2. Outside walks and steps: subject to the same troubles as indoor stairs plus the haz ards of ice and snow and rain. Terraces and entrance porches are induded here. 3. Unsafe floors: uneven, slippery, or sloping floors, high thresholds or changes of level due to changes of surfacing. We cannot blame loose scatter rugs on designers, nor the degree of slipperiness due to polish ing, even though they are major hazards. 4. Cupboard and cabinet doors that swing out where they can be bumped into by the busy housewife. Induded here are im properly designed doors on refrigerators, ranges, dothes- and dish-washers, launder ing devices, etc. 5. Closets and their fittings: inadequate in size, containing shelves above safe reach, with projecting fittings that cause bumps in the dark. To be sure, most people abuse the closets they have; the art of disposing of useless junk is not well developed. 6. Doors that swing the xordng way. They are often blamed for black .tyes they didn't cause; but on* the other hand, the skeptics are often wrong. 7. Poor traffic arrangements: the en forced' use of living rooms, dining roans and kitchens as traffic ways. Hallways are very desirable for traffic, but other rooms have furniture that causcg; accidents in the dark, or clashes between running children and busy adults. 8. Inadequate lighting: not only in halls and passageways, but on stairs, in closets and in rooms that must be used for traffic. The ability to pass through the house, turn ing fights on ahead and off as you leave is a minimum safeguard when rooms serve as necessary passages. 9. Safety from fire, involving not only proper design and construction and the use of low-hazard materials, but provision for rapid and safe exit from any part of the house if fire should start 10. Safety in the use of electricity, gas, oil and coal fuels and proper protection of boilers, water tanks, refrigerators and similar domestic appliances. These last two, you will note, are the only items on the list that are well covered by universally recognized building codes and ordinances. In ratio to their potential dan ger, they are probably the cause of the fewest accidents. That is due, I believe, to the fact that everyone recognizes the im minence of high personal danger in these sources of power and in the hazards of fire; hence they respect the codes and sup port their enforcement Stairs and stairways are -also within the province of. most building codes. Neverthe less, statistical evidence of home accidents points sharply to the question of the ade quacy of code provisions or to the degree of their enforcement I have seen too many houses being built today that have obviously hazardous stairways to believe that the code requirements are adequate, or that the sound codes are being enforced. The pressure of cost is making small houses smaller; the stairs are being squeezed down, inch by inch, to make space for other rooms. We are, I fear, building brokeri legs and arms, necks and heads, into altogether too many new houses. What can be done to prevent these "built-in" accidents? The job is big. There arc many people concerned. And a good share of the work rests on us who have an acknowledged in terest in home safety. The designer comes first The term" "de signer" may mean a professional architect or it may mean any builder or owner who draws the plans from which the house is built The professional architect is least likely to plan without a conscious thought 18 "Built-in" Safety in the Home for safety. It is part of the training of the experienced architect--although there are altogether too many young practitioners and complacent oldsters who can be swayed from good design by the demands of clients who insist on details that are unsafe in daily use. It is more important to reach the amateur designer and the builder who plans more with an eye to low cost or high profit than to the living safety of the houses he creates. Only stricter codes, vigorously enforced, can reach these people and force the adop tion of safe design practices. Quite a measure of responsibility attaches to the owner for whom the designer or architect plans the house Some of them are entranced with the narrow, steep, wind ing staircases found in many old centerchimney salt-box or Cape Cod houses of colonial days. Others want a winding, gracefully curved staircase reminiscent' of the grand manor houses they have seen in the movies--but they don't have the space to make them reasonably safe. Others.-imbued with the modern trend, will take freak stairways that resemble ships companionways, modified ladders, slippery ramps or almost anything that is not like an orthodox safe stairway. And these owners are largely responsible for improperly designed closets, cupboards, outside walks, steps and terraces and for poor traffic arrangements. Builders, millwork companies, manufac turers of prefabricated cabinets, ranges, re frigerators and similar appliances, the pro ducers of some types of floor finishes, all must accept some share of the responsibility for home accidents whenever their products are so designed that they can be hazardous in service. It isn't enough merely to require these products be safe when properly used; we should insist that they be designed so that they cannot become hazardous even when improperly used. That is a tough at titude to take, but I cannot absolve a manu facturer of building items, or a builder who uses them, unless they have taken every' possible step to make their products fool proof, and show clearly how their products should be installed for maximum safety. But we who profess an interest in home safety also must accept some of the re sponsibility. Our statistics show us the magnitude of home accidents and fairly well define their causes. We know that a great many accidents are built-in to modem homes. We know how they can be elimi nated. It seems to me we have a job to do >that has not yet been done. When Mr. Fansler wrote me about this talk, he made some very keen observations. "The architect can design and the builder can fabricate a mechanically fool-proof home," he said. "But could the average per son afford td pay for it? However, granted a fool-proof environment, there still remains the problem of fool-proofing the people, who live in such an environment--which is, essentially, an educational problem." To my mind, we have not made adequate progress in this necessary educational proc ess. First, we should define far more dearly the good design practices that will diminate the most common built-in hazards. We should give spedfic dimensions, tolerances, clearances, approved details where necessary. We should set up spedfic minimum criteria based on currently available accident sta tistics and modify them later on as further knowledge is gained. Second, we should publish a "homesafety code" as a pattern for progressive communities that want to write these prin ciples and criteria into their local regula tions.' And we should make this suggested code available to architects, builders and ail other designers through the professional, trade and consumer publications that reach them. Third, we should encourage the develop"ment of local counselling services to home builders and home owners. Fourth, we should encourage local safetygroups to analyze their existing building regulations in the light of our proposed home-safety code, to determine what devia tions can be corrected-'' Fifth, we should encourage study of the enforcement of existing code provisions to assure better compliance, both in new'houses and in all existing residential structures. And finally, through local displays and exhibits, we should demonstrate to all home owners the most common home hazards and practical means of eliminating them. To my mind, such a program is our re sponsibility. We cannot prevent people from doing foolish things that cause accidents. But we can go a long way toward seeing that they do not, through ignorance or in difference, build accidents into their dwel lings. How i how rea George ago, the You set consciou his appe pie don't ster am him as 1 Georg because he was bed and ceived a and left a disfigi did not and exp to com outgrow tional s been sa now try scars, b of safet The safety : man at thought on the : heavy't steel m handset zest of physica for hin he mat But . he kne world i take tb ting so that he spoosib hernia. True Itad tri receive in be elimitt Job to : about this )bservations. the builder fool-proof average perver, granted still remains the people, it--which is, ten." tde adequate itional proc- nore dearly rill eliminate zards. We , tolerances, re necessary, num criteria cddent sta1 as further a "homeprogressive these prinocal regulais suggested ders and all professional, > t reach the developzes to home local safety ng building ur proposed what devia- itudy of the trovisions to i new*houses tructures. lisplays and to all home hazards and them. a is our re people from ie accidents, ward seeing ranee or intheir dwel- Home Safety Safety Is a Family's Business 19 By MRS. MARTHA LOU GUNDELACH District Secretary, Southwest District Office, Family Service Bureau, United Charities of Chicago How important is safety to you? 1 mean, how really important? If you were young George whom our agency met two years ago, then you'd know that safety is precious. You see, George is now 14--a very selfconscious adolescent. He's sensitive about his appearance--he feels ugly--he feels peo ple don't like him. George is a lonely young ster and he's carried these attitudes with him as long as be can remember. George has gone through life this way because his safety was not assured. When he was eight mouths old he rolled off the bed and fell against the radiator. He re ceived a third degree burn of the right cheek and left hand. The wound healed and left a disfiguring scar on his face. The family did not see the need for the plastic surgery and expensive treatments that were advised to correct this. They hoped the boy would outgrow the scar--instead he has an addi tional scar--his whole outlook on life has been scarred. The Family Service Bureau is now trying to help George correct his inner scars, but the recognition of the importance of safety could have done a preventive job. The recognition of the importance of safety is very necessary. The plant fore man at the steel mills felt it keenly as he thought of Mr. Timothy who used to work on the forge. Mr. Timothy had enjoyed this heavy work for years. He had come to the steel mills as a young fellow. He was a handsome, dynamic young man, full of the zest of living and very proud indeed of his physical strength. No job seemed too much for him to perform, and for several years he maintained an excellent work record. But as the plant foreman now reflected, he knew he would give anything in the world if he had insisted that Mr. Timothy take the precaution of playing safe and get ting someone to help him on that last job that he had attempted. That last job was re sponsible for Mr. Timothy getting a double hernia. True enough, the company and everyone had tried to make up to* Mr. Timothy. He received his compensation and excellent med ical care and was offered a job that he could do--that of sweeping floors. Everyone was aware of the seriousness of his physical in jury, but no one had considered that every physical injury has its accompanying injury of attitude. Mr. Timothy, the steel worker--the man envied by his buddies for his physical strength--flow a floor sweeper. How did they dare offer him such a job--why he could never face his buddies--it was down right degrading and a constant reminder of the loss of his vitality. His wife was even stronger than he was now. That was a bitter thorn in his side, and it made him very irritable. Mr. Timothy was suffering not only from a physical injury but was also suffering from the loss of his self-esteem. It was in this frame of mind that he wan dered into the office of the Family Service Bureau. Mr. Timothy needed some help to make the adjustment with which he was faced, and it was this kind of help that the Family Service Bureau was prepared to give. We are beginning to see that this job of safety involves many things, and that the broadest of understanding as to causes and results can in many instances eradicate acci dents and in many others can re-establish a sense of safety. The Family Service Bureau often becomes acquainted with families as a result of accidents which have disrupted family life and have caused severe suffering. Chaotic social conditions increase the pos sibility for accidents. Very often accidents cause dislocations in family living and result in tensions that -disrupt the family unit I think of Mr. Mack, a discharged war vet eran, who was faced with the impossibility of finding adequate housing for his wife and baby because of the acute housing short age. Mr. Mack cherished his family and he wanted a home of his own. The only thing he could find was a garage. It was just about impossible to heat this garage in zero weather and one bitter cold night while her husband was away working, Mrs. Mack got desperate. She couldn't bear to see her little boy so uncomfortable with i: i l.. - ! V:p * ' * :'4 v m sfl `; 1 &1 /-Viv UN 20 Safety Is a Family's Business cold. She decided that she might make the coal bum better if she poured kerosene over it, and this she did. Mrs. Mack's parents had neglected a very important part of her safety education. They had never stressed the danger of pouring kerosene over live coals, and as a result of this she suffered a terrible tragedy. Her clothing became ignited and she suffered such severe bums over her entire body that the doctor said it was a miracle that she lived. , Doctor and hospital bills were tremendous and impossible for Mr. Mack to meet on his earnings as a mechanic. Even after Mrs. Mack left the hospital, she had to have months of convalescent care and the couple were forced to move in with in-laws. Over crowded living, the responsibility for a con valescent and for the Macks' young baby put a considerable burden on everyone. Moreover, Mrs. Mack's parents held a deep resentment toward their son-in-law, as they blamed him for their daughter's plight. He should have provided better for her. These burdens were just too much, and, as a result, family tensions developed. This tension retarded Mrs. Made's recovery. The baby was affected by all of the confusion and when Mrs. Made was able to again be a mother to her own child, she was wor ried and hurt by his shy responses to her. As you can imagine, Mr. Made had more than his share of worry and debts. There was no place to live that he could call a home of his own, and, on top of this, he bore the brunt of the resentment of his in laws because of the disruption in their home. This accident meant an illness of over a year for Mrs. Mack with the family's home life completely disrupted. It is difficult to estimate the damage done to this family group. The Family Service Bureau did hdp dilute the intensity of the suffering of the Mack family for we were able to hdp Mr. Mack work out some settlement on his debts. The agency through a trained case worker was able to permit Mr. Made to give vent to his fedings of frustration and loneliness so that he was able to keep a better hold on himsdf and not givfe in completely to his worries. Finally he was able to coral .bis strength and bejpn to rebuild his family life and look toward the future. Accidents cause inevitable physical suffer ing and family disruptions. The few ex amples I have cited could be multiplied many thousands of times. The price of accidents is human suffering. Acadent prevention requires many tvpc> of effort The National Safety Council is doing a job by educating us all in the causes of accidents and what can be done to pre vent them. We can all enumerate many reasons for accidents. We know that some times It is ignorance of possible dangers-- sometimes, carelessness and sometimes, un resolved social conditions such as unsafe housing. Again, the cause of an accident may lie in the fact that a person is absorbed in worry. In addition to these more familiar causes for accidents, I would like to very briefly touch on one cause to which we have given very little attention until recently. pie story of Mr. Gale will make this point more clear. Mr. Gale sought help from the Family Service Bureau on three occa sions. Each time the circumstances that bro&gfat him in was a need for temporary financial assistance; while he was awaiting compensation for an injury. Each time he had injured himself to the extent that he could not work. On the' first occasion that Mr. Gale came to the Family Service Bureau, he had in jured his aim while working on a truck. This accident occurred a couple of months following the birth of his first child, and he was especially worried about bis son's welfare. The second time Mr. Gale came to the Family Service Bureau occurred about three years later. Amazingly enough, the circum stances were almost identical to those under which we first became acquainted with him. His second child had just been born and Mr. Gale was very worried about how his family could manage since he again was awaiting compensation for an injury that had just taken place. He bad been employed by the Good Humor Company and his bi cycle had run into a hole. He had been thrown and bad hurt the arm that had previously been injured. Three years later Mr. Gale again came to Family Service Bureau for temporaryhelp. This time he had suffered an injury to his shoulder. He had accidentally knocked over some heavy boxes on himself when he was rummaging- in his basement for ston time hom< ill ai As somi stam dent folio dido first aftei acck need horn A cnee expl and Gale Fror need him, the ` was Y< in tl angr he'd feell fello he t so n time an a care wha atter M pare worl up . comi frusi he v acck give cour expL an u he fa trol to n Fc Dr.  The few exmr"'*)lied manr ici accidents res many tvj>c> ifety Council is all in the causes be done to prenumerate many HOW that somessible dangers-- sometimes, unsuch as unsafe of an accident rson is absorbed * more familiar lid like to very i which we have at& recently. will make this ought help from on three occamnstances that for temporary e was awaiting Each time he extent that he Mr. Gale came sail, he had inDg a truck, up f months first child, and about his son's le came to the xed about three gh, the dreumi to those under tinted with him. been bom and about how his he again was an injury that I been employed tny and his hi- He had been arm that had ale again came for temporary rered an injury' entally knocked himself when basement for Home Safety 21 stored clothing. This accident occurred at a time when he'was faced with additional home responsibilities in that his wife was ill and heeded expensive medical care. As you have probably noticed there are some striking similarities in the circum stances surrounding Mr. Gale's three acci dents. Each time he suffers an injury this follows circumstances that have meant ad ditional responsibility for Mr. Gale. His first and second accidents occurred shortly after the birth of his children. The third accident occurred at a time when his wife needed medical care, and the burden for the home was placed on him. A knowledge of Mr. Gale's life experi ence gives some clue as to his bdtavior and explains the coincidence of his accidents and increased responsibilities. You see, Mr. Gale had been left to "grow up like Topsy." From a very early age, just when he most needed some one to depend on and guide him, a little brother was bora who became the "apple of his parents' eyes." Mr. Gale was neglected and forlorn. You can appreciate that a little fellow left in this sort of a spot would have a lot of angry feelings at being so deserted. Also, he'd naturally be guilty about his angry feelings toward his parents. As a little fellow, he did get attention, however, when he hurt himself. He didn't have to take so much responsibility for himself at those times, and he really did suffer when he had an accident and somehow that suffering took care of some of the bad conscience he had when he became angry about not being given attention. Mr. Gale grew into an adult man ill pre pared to meet the demands of an adult world. A piling up of responsibilities stirred up earlier feelings that had never been comfortably worked out. His feelings of frustration; anger and guilt piled up and he was "ripe" for an accident Having an accident was the one way he had found to give him an out from these feelings. Of course; Mr. Gale was not aware of this explanation for his behavior. It was quite an unconscious pattern and one over which he had no control. He could only gain con trol over his behavior, if he were helped to understand the causes for his actions. Fd like to cite one striking example from Dr. Dunbar's book, "Mind and Body," that re-emphasizes the importance of this aspect of the problem. In Chapter VIII, Dr. Dun bar tells of a large public utility company which operated a fleet of trucks. The com pany had cause for serious alarm as they noted that the accident rate of their em ployees was interfering in the profitable operations of their business. They went to great lengths to test their employees, to put in an intensive educational program for safety and to impose severe penalties on employees who had accidents. They shifted truck drivers who had frequent accidents to other jobs. Careful study showed that many men who had been shifted went right on getting themselves injured. This example Illustrates very well the point that the person who has the "accident habit" needs more to correct the situation than a manipulation of his circumstances of safety education. Dr. Dunbar makes this understandable through many individual his tories that illustrate the way in which one's emotions can affect the personality that leads to the "accident habit." In such in stances the individual needs help with his emotional problems. The responsibility for safety belongs to each and everyone of us. Individually, we can make important contributions by taking the proper precautions in our own homes. Don't risk putting a box on a chair to stand on when you are in a hurry to hang that shade. If you're tempted to hasten the fire in your stove remember the story of Mrs. Mack. Safety begins at home and that's where our children will begin to get the idea of its importance. Parents in the home; the policeman on the street, the teacher' in the school and the foreman in the plant contribute individually by bring sure that safety measures are en forced. If the plant foreman had insisted that Mr. Timothy not take the additional risk on his job, a life-long tragedy would have been averted. The responsibility for safety belongs to us collectively, and as a community we make important contributions by supporting nec essary institutions for our protection and safety. We are glad to support the fire de partment and the safety division of the police department In the past year, the citi zens of Chicago have crusaded for adequate ambulance service. At the present moment we are pressing for safer and more adequate iI 22 Safety Is a Family's Business housing so that people like the Macks will not be forced to live in unheated garages. We, as citizens, support the National Safety Council out of our recognition of the importance of a co-ordinating agency in the community. We realize the worth of the very' fine educational program of the Na tional Safety Council. We as citizens realize the worth and fundamental value of safe and happy living, and we contribute to the promotion and protection of families in many ways. Real izing that safe and happy family living depends on the security of employment; die security of a home to live in; the security of a safe community; we work together toward these goals. When the security of our environment is threatened in any way the family suffers. It is in this area that the family service agency makes its contribution. Family strains, tensions and disturbed personal rela tionships become acute if safety in all its meanings is not protected. The Family Serv ice Bureau is making a contribution by being at hand to aid the Georges, the Macks, the Mr. Timothys and the Mr. Gales in re establishing their sense of safety and thus strengthening the security of the family. But more than that, the Family Service Bureau is on hand to do a preventive job, to help families ease their tensions and worries before a disaster occurs. Would it not have been more beneficial for Mr. Gale had he been helped to ease his feelings about his responsibilities rather than solving them through developing the "accident habit" You, who have worked with local safety councils have become very familiar with ways in which you can most effectively work with industry in relation to safety. We would like to ask that you get acquainted in your own communities with another com munity .channel through which you may broaden your program. I am referring to the council of social agencies. Most com munities have such a council with which the social agencies affiliate for the purpose of considering community needs and com munity resources. The council is, therefore, in a. position to make use of this broad un derstanding of the community and to work out a program that wilt help to strengthen and enforce safety measures. safety and thus of family. Fe Service preventive job, r tensions and curs. Would it il for Mr. Gale se his feelings ler than solving accident habit" ith local safety familiar with effectively work to safety. We get acquainted th another comduch you may un referring to ies. Most comcil with which for the purpose seeds and com:il is, therefore, : this broad unty and to work p to strengthen Ofttcer&ofthe HOME SAFETY CONFERENCE NATIONAL SAFETY COUNCIL 1948-49 Chairman--DR. DONALD B. ARMSTRONG, Second Vice-President for Health and Welfare, Metropolitan Life Insurance Company, New York City. Vice-Chairman--DR. MARGARET C LEWIS, Health and Safety Adviser, Girl Scouts National Organization, New York Gty. Secretary--THOMAS FANSLER, Director, Home Safety Division, National Safety Council, Chicago, Illinois. Chairman of Committee on Research and Technical Studies--DR. A. L. CHAPMAN, Assistant Chief, Division of States Relations, U. S. Public Health Service, Washing ton, D. G Chairman of Committee on Education and Public Information--DR. I. JAY BRIGHTMAN, Assistant Director, Division of Medical Services, New York State Department of Health, Albany, N. Y. Chairman of Committee on Community Resources and Services--MRS. GEORGE WELLES. JR, Duluth, Minn. OTHER VOLUMES in this Series Many users of this volume will also find much value in its companion volumes. Here is the list: TITLE VOLUME No. Annual Meeting, Banquet, Women's Activities^-Judex to all Volumes and Exhibitors.... 1 American Society, of Safety Engineers and Subject Sessions.............................................. 2 Aircraft Manufacturing Section............ 3 Air Transport Section..........................-. 4 Automotive and Machine Shop Section.................................................................................. 5 Cement and C3iisirv Section 6 Chemical Section....................................................................................................................... 7 Coal Mining Section................. 8 Commercial Vehicle Section.. 9 Construction Section ............. 10 Electrical Equipment Section.. 11 Food Section............................ 12 Glass and Ceramics Section............................................ 13 Industrial Nursing Section............................................ . 14 Marine Section................................................................ . 15 Meat Packing, Tanning and Leather Industries Section. 16 Metals Section .................................................................. 17 Mining Section........ 18 Petroleum Section ... 19 Power Press Section. 20 Printing and Publishing Section..................................... 21 Public Employees Safety Committee.............................. 22 Public Utilities Section................................................... 23 Pulp and Paper Section.................................................. 24 Railroad Section.......................................... .................... 25 Rubber Section......... ................................... .................... 26 Textile Section ......................................................... 27 Traffic Section ................................................................ 28 Transit Section................................................................ 29 Wood Products Section................................................... 30 Farm Safety .................................................................... 31 Home Safety.................................................................... 32 School and College Sessions............................................ 33 The Human Side of Safety (Early Morning Sessions) 34 Currei sat SAFI PRICES OF EXTRA COPIES OP INDIVIDUAL VOLUMES TO MEMBERS VOLUME SIZE lto9 copies Each Less than 24 pages-- $025 24 to 48 pages-- 20 49 to 96 pages-- .40 Over 96 pages-- .60 10 to 99 copies Each $020 25 25 25 100 to 999 copies Each $0.15 20 20 20 1000or more Each $0.15 20 20 20 Complete set of Transactions (34 volumes)--$6.00 ___ * NON-MEMBER prices are double member prices, except volumes 28, 31, 32 and'33. NATIONAL SAFETY COUNCIL 20 N. WACKEK DRIVE CHICAGO 6, ILL