Document R2agQYdrOLdGg4yJL7GgozwEn

FILE NAME: Mobil (MOB) DATE: 1954 Oct DOC#: MOB003 DOCUMENT DESCRIPTION: Published Conference Proceedings with Socony-Vacuum Oil Rep listed page 235 PROCEEDINGS--40h Annual Cmmeni&n o f th e International Association of Industrial deciderti Boards and- Commissions? Quebec? Canada October 3-7? I9S4 If ilM Ifli S Compensation Problems 1954 BULLETIN 180 UNITED STATES DEPARTMENT OF LABOR j&mes P MiteiaeH* S ecretary ROSEAU OF LABOR STANDARDS Basil E, Qus&kfg Mrepi&x IlR fll Tmm Bs h No. !S0?mntm fcbe prccsodkgs of th& 4tk m m m m of the &tsm&h&sl Industriel Accident- Boards arai cm- mkmm} wMck wm M d is Qubec, Cased, (k M h m &~7} i m . PMCsediags cl .he eos-restlos hm bees prepared 1er puMk&ticn I>y th at&ff o fe ik sm o of ber Stsedardk m w u Mm w o f ia u m o Csonner H axa?d8 W, B,, H um us, M, B,,* hh^, Bwdi-&?mmi%d thmce? Szs&m, Qwet im tkvi& i Ih , P id d k E m k h B , Wmkiitgi&r^ I k C, 'xft*-^tjftkrtLUQLAf Occupational sauce? hazards h aw plagued mankind for thousands of ym m , Undue exposure to agents of ot? natural m rim n m m i such as solar radiation or infections with the 'worm., Schistosoma k u n aiobium ? h a w doubtlessly beau responsible for &h oceurrsaea of emsors of tbs exposed skin among outdoor workers and of cancer of fin bladder among farmers of fbe Mils Talley oTsn during prehistoric times. hwmm% it w m m i until th s adw nt of modem indostrisdism some led yearn ago th a t occupational and imdustry-Folated agents bays attained a preeminent position in tbs human cancer problem. Mot only are occupational carcinogens the only well defined known causes of human em m n ? but their number and y&riefy bane steadily increased since P o tt in 1775 first related the occurrence of scrotal uaacor among chimney sweeps to ihoir exposure to soot, Bur real knowledge and appreciation of occupational canes? pro ducing agents as phenomena of modern mdustrialism dates hack some Fssmm I, 127 75 years with the discovery of the relation between the occurrence of akin cancer and an occupational exposure to coal ta r (fig. 1). The d ata given in the following tables (1 and la) briefly summarize the salient additions to the information on occupational cancer hazards made since that time. They list the various chemical and physical agents so far recognised or strongly suspected as causes of cancer in man. They show, moreover, the different organs and tissues representing the target organs of these agents and the number of occupational cancer cases placed on record or leaown to have been recognised as caused hv them. T A9LE 1.--Occupational Cancers Recorded in {he United States and Foreign Countries up to M 8 &*& Sitesfwiser (sNtnteva?ba?^eos;ii>Ky>aos$aibrocar&oxis intT<S,A>j to A r s e n i c . . . ___ . . . . . . . . . . . . . . . . ikm.>__ . . . Coal tar. piteh. . . . ,, . . . . . . . . . . . . . . ...d o ...___;. Petroleum._______________ ..____ _ .....'10. .... ... . Shale o iis ..._ .____ . . . . . . . ----- ------- __ d ,....... ....: Lignite tar ad paraflio. . . . d o . . ____ Oreosote c il..______ _____ _____ . . . nthr&ene olL__. . . . . . . . . . . . . . . . . ...d o ........... Soot-carbon black.__,.___ .________ roaiaiie Sarthes__. . . . . . . ___ Bladder----- goo id k ia .____ _ Eoentgi- and radim*radiaon. . . . | Leukemia. . l'huog...,,......... Arsenic.. . . . .___ ____ __________ _ L ung.. . . . . . sbestos.. -- . . . . . . . . . . . . . . . . . . . . . . .d o .. . . . . . Chromtes____ ____ __________ __ (..d o ..,.,... Niekei----- --------. . . . . . . . . . . . . . . . . . . . .1. N. .a.sal *&v- ] ity, |l,Nvssal suciSvd Coal t&r, p itc h ,.......... ................... j fineo;.. . . . d Petroleum ____ __________ . ,,_J ,,. .d o ..,,,. , .f Beoaol--------------- --------- -- :--------; L*seu-<fa...,,i fLm ig.,,.-...; Isopropyl.. ....................- . . . . . . . . *,.. juInLaarryy;nx... . . 1 |(Nasal sums. Radioactive chemicals. I1Banes.--. . . sums. 7 ItG 70 7 78 0 | o 1 7 U 25 i 3.150 ; 20 i 1, 900 ; 14 1 40 I 20 190 1 1,200 ?:> | 13 1 650 I it) 63 05 f 84 | 81 j os : 88 1 8! 1 9 i l 0 )1 32 3,200 99 1, 907 14 41 20 191 l, 000 (?) M 850 JS*<6 85 140 84 51 S3 10 42 I 4 0 3 3 Total................. 7,050 | ' Apiirosimate. 3054 im E 'm tQ O f IAIABC Tabbb 3a,---Fir;? T&Uepf DUcmsries of Oeeupaiional Comers K ssk efasaat Dstv ; B&cimrsr Orgarsa aascUU f.aitSXiB'jf SXpOSUTSy Ciik:s-"0rgsriifi: i Sysi................................ 1 in s ; xw tt....................... Btf&j 'tatoftj.aU UeOupaiiofifS. .Sb#! U> (SgiiaO-..........y iSVS i Cos; tas (UiamioaS5.--J x m : - t i i i .......... .................... , VAy .y..yv.y . j . no. CU&r (ssthm iU ).......1 S85C ? 2w{g...................... . .w;u ;,4 rt>av.w.va,.yw.,w.vj m . Coxi fesr (ia iacs)....___ :: 1CU6 ; Kirs'SfcGfco.... v. . . . . . .. 0?.................. ........i Bo. OfOSsbViOU................ .....i 19U! i O ^ a o i s a , , ............. (Baks..,.........................; 0. An&KK'ao; isBv*___y**yi | 8 ; OJ<-V?y->v.wVAy.y~yyavv.y .......tin ____ , Do. BinSin 3 (skats dii3__-1 t m 1 Bfii..........................- ...... A*........ ............... i n s. FetUfesaa si seAc:.......J \ m sanrsss bku oaer- .......& .........................i Bo. ::::" : BXicr'fss. BmS-r:ompsraSSu cii__ i Sts ! SchtsBiborg------ y----- 1. y.,,.,..........| Bo. BotaAfasn aibrisstSug at.:; 3838 | Haiisr..... ........ ....... .... :................... ................ j : Be. ShfiSft iubrSmitag cU........; ;s> i Wilson........ . , . .., Bo. BiXJioi............................: im Beicre St Bigsxi&EK>.l Bb>iKi'8*ss; !( ns. Aromatic wx-.ism idss i 18 H eha.. . . . . . . . . . . . . . . . : %M6e*r m>Ht . a i-t i Bo> iaiarsaeilistest j i car. | >8, Smyth & K ata. | Kasai sifiiia, ibsyax, * Bo. Ohaailaais--iBOfsaaia: | !!;; , iS5g. j Ares!;te.......................... . j SSS2 iw is ...................... Bo. $ m Hiiiotass.j................. MeaSeissS. 5800 Saajii!... . . . . . . . . . . . . . . ! Uisas;..........................; OacispatisiijaJ, Assssios..... .................... i i m Uvrjifc & SiaiiSj........ j.,.,.;...4...... Be. Chrossaias.......... ~w& U fe?!.................. . X)o. 3STiek.ei.,,,,___________ : x m OrtsmtelS..................... KaaS tas'ity aafi si* Bo. [ sesUuiig, ! BAjsicse agents: , 'OlfcaUslei raUfcsiion___J m U a n a ...___. . . . . . . . . . i m -;w ........... ............1 So. i .-: ............ 5802 F riebsa..... . . . . . . . . . :................................ Unviraniaeatat Oopai!c33si. 3808 3Vyiss... . . . . . . . . . . . . . . !....(} __ ... y... Modiclosi. 580 ITdjx 36h%yorfc$ & 1 UiirsS-Oi'uaa isfSiti Oooixj>atfi?asL ton SSibaaroek, 1828 Bt-ek,.. . . . .............. ! Bob...... ............. ....: MiidJUnsiJ. PsUkUiidve siihsim m ... 5S!U Hiso.'tifig Sr Hess;'..... i B!;... ..................... Ocsni;f>Uoa!. me; WcXosS, Want anti iio. wim$, | im ,,:*., ..>v:.v,v.. ... 1 tissues. *. iSS.i Mrt'OrWsA............. . i Bos.............. .... . . Bo. >.W.A.W............ .... ..... ^.wy.vv...;..v^vy.....yv..v...v..>.w.v^.. AV,.(.A However, an indiscriminate acceptance of these figures -as redacting the actual scope of the occupational cancer haa&rds would seriously he misleading for the following reasons. The presence of occupational cancer hazards has m far been established for only a few worker groups having contact wi#> one or several of tbs carcinogenic agents listed. While, foe instance, it is generally known th a t workers em ployed in gas works and coal f ar distilleries or engaged in the cleaning of petiTilon.ro stills and having skin, and respiratory contact with coal and petroleum pitch, and tar show ae excessive liability to cancer of the skin., and apparently also, of th e lung, there does not exist any official record of similar cancerous complications among electrode workers in aluminum prodnetion plants where an exposure r.o fumes from tio electrodes consisting--of a mixture of eoa! tar, pitch, and petroleum coke exists. Sellable information, however, is on band th a t these workers suffer from cancers of the akin and, possibly, also the respiratory tract. The extent of this exposure hazard may he estimated by the fact that approximately two-thirds of a pound of electrode carbon is consumed for each pound of metallic aluminum produced, of which 800,000 short tons were consumed in the United States in 1845. I t is equally significant th at agents which have been reported to have caused occupational cancers among workers of an industry of one conn try, do not seem to have the same effect upon the workers of an identical industry of another country, if the available data would he accepted a t them face value. Since carcinogens behave in their fundamental disease-producing properties like pathogenic microorganisms, there is no sound reason to assume th a t carcinogens make any distinctions in their activity or effectiveness for any national reasons. In fact, it can be shown th at such scientifically incom prehensible discrepancies are mainly due to local differences of report ing of occupational cancer eases, The existence of an excessive liability of gas house retort and coke oven workers to cancer of the lung has been reported from dapan, Canada, and England, hut not from any other country despite the fact th a t the exposure conditions for workers employed, in such opera tions are identical. The occurrence of an appreciable number of arsenic cancers of the skin among German tisera of arsenical in secticides was placed on record during recent years. If full credence would be given to reports on arsenic cancers observed in the United States, one would be led to believe th a t arsenicate ih Opr p art of the world are carcinogenic for almost exclusively medicinal reasons. Again, it is hard to assume th at arsenicate would make such dis tinctions, A similar situation seems to exist concerning the car cinogenicity of lubricating oils obtained from petroleum in different parts of the world. Although there were placed on record by English investigators during recent years, several hundred eases of skin can cers due to occupational contact w ith hihrieating oils, practically nothing is officially known as to the existence of such mdnstrial diseases from the countries on this side of the Atlantic. One seems to be content with attributing here the English observations to the carcinogenic action of shale oils, the large-scale industrial use of which was discontinued during the 1920's, and therefore cannot account for the more recent English cancer cases observed among spinners, mechanics, engineers and other workers having had exclusive con ta ct with lubricating and cooling oils of petroleum derivation. 1854 MiSETNB OF IAIABC I t is worth noting in tins connection th a t during the last 20 years, there has bea an almost complete lack of published additions to the list of occupational coal tar, pitch and creosote oil cancers of the skin from the United States, although such cancers have been observed and are recorded as such in industrial records, and despite the fact th at the annual reports of the Chief Inspector of Factories of England and Wales have regularly listed notifications of such lesions to the extent of from 100 to 250 cases per year. One m ay also reflect' on the fact th a t the last published figures on occupational cancers in American dye workers appeared in 1938 and listed less than 100 cases, all occurring among employees of one com pany. During the intervening IS years, the total number of such cases has risen several fold and no official data have become available from any of the other companies producing and handling carcinogenic aromatic amines used in the production of dyes and rubber anti oxidants. In contrast, recent reports by English investigators sup ported by the English chemical industries have supplied adequate figures on the number, incidence rates, and attack risks of bladder cancer among English dye and rubber workers who had been exposed to the same carcinogenic aromatic amines with which the correspond ing worker groups in this country have occupational contact- Finally, some consideration must bo given to the fact th at the general population has varying degrees of contact with some of the carcinogenic agents through their presence in industrial wastes released into the environmental air and bodies of water, and entering subsequently the soil and the fauna and fiora living in such a polluted environment and used in p art for nutritional purposes. In the past, claims as to the occurrence of so-called "neighborhood" Cases of cancer have rarely been made. The Well established former occurrence of arsenic cancers among inhabitants of a Gorman region in which the drinking w ater supply wan polluted with arsenic from mine slag heaps represents the first occurrence of this type. Following the discovery of bladder cancer hazards among German dye workers, it was asserted that an environmental plant contamina tiou with carcinogenic aromatic amines was responsible for the production of bladder cancers among persons living in the vicinity of this plant. While the actual existence of such conditions was denied at th at time by other inveatigatora, tho recent demonstration of "neighborhood eases" of berylliosis makes such claims appear as not unreasonable possibilities since a highly potent carcinogen, such as beta-naphthylamino, is involved which might have produced such results if the waste disposal and housekeeping methods of the plant were inadequate. I t is probable th at the future oe&urrenee of cancers of the lung and bone among individuals who lived near herylliump ru im in g or processing plants might fnmish additiomd evidence of OCXOBBB 6-- MOliNING SESSION cancer hazards related to environmental plant pollution il and Its compounds are not only carcinogenic for rats and. rabbits b u t also lo r man. Similar conditions of industrial atmospheric pollution egist around arsenic smelters, chromate producing plants, carbon black factories and oil refineries, as well as uranium ore mills. Tbs recent compensation claims advanced on the basis of as ; existence between cigarette smoking and lung cancer possibility of a greater future importance of the compensation aspects connected with the occurrence of cancers from industry related sources, such as exposure to carcinogens contained in the exhaust fumes from diesel and gasoline engines, or present as additives and cont aminants in foodstuffs. I t appears from these considerations that there can be no doubt th at the actual number of occupational cancers is considerably higher than the number of cases placed on record. I t is of some interest, moreover, th at the number of eases recorded in medical journals is appreciably higher than the number of occupational cancers which during the last M years have come for decision before compensation boards be cause compensation claims in many such cases have been settled out of court. W ith a few exceptions, such as the incidence of lung cancer among American chromate manufacturers and among German and Chechoslovakian radioactive ore miners, of nasal sinus, larynx and lung fumom among American isopropyl alcohol manufacturers, and of skin cancer among English coal far manufacturers and processors, no reliable iniommtion is available on the incidence rate of occupational cancers of the various types among different occupational population groups, $h Special Aspects q f Occupu ti&smt Canrumrs A fait* and competent adjudication, of compensation claims for cancers allegedly caused by occupational: agents or conditions requires an adequate knowledge of the special aspects related to the production and development of these tumors and of the criteria by which they may be distinguished from non-oecupaftana! environmental (medi cinal, dietary, cosmetic, habitual) as well as *`spontaneous" cancers. I . D cftnifim qf the Term "Occupational Cancer" .--The term 0C~ eupaiioaai c&neort, is applied to malignant tumors originating in individuals during the course, and/or as the result of the regular and usually prolonged exercise of certain occupational activities entailing contact with some exogenous, physical, chemical or parasitic agent acting in proper intensity. Occupational cancers thus arc caused by specific agents or etfelogically related to well defined occupational conditions which form an integral part of the ordinary working environment. They differ through these aspects from the accidental yaneers which result from or follow upon some xii&or- ir? Ol; I! p 132 ISM MB'STIN' F BC dinary, unforeseen, neeidentnl injury sustained at work and being of a nonspecific nature. B, Types and Nature oj OecMpatimal Carcinogens.-*^Occupational agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals. Some of these chemicals are well defined, others consist of variable mixtures of a large number of chemical com pounds, a few of which possess carcinogenic properties. A second group of occupational carcinogens is composed of agents characterised by their ionizing or nonionizing radiation A third group is repre sented by environmental agents and conditions which sometimes have an occupational association, and which may bo related to certain infections or several specific climatic, gologie, dietary, and nutri tional conditions, and which in part have more or less indirect relations to carcinogenesis (table 0 , Tabus 2.-- Occupational Oafcinogmz^Tktir Mont 6f xposins and Their Target Organ* C ifr a i lypa \ i O botsi cafcinogitisii \ iyyb &m'j& <stfixpt&iiv# Target Org cais-~&roniot!c, | tory. tonto!. tyiriptosar- soma, siyclccas^v etcaseile i Btovaspbtftyissaine, bens- Respiratory, catana- Vrosenom orcaas (b;ad> | <Ur, i.airjisodirtiii'iiyUaans- eus, aiti/ioTtary. dor, arsici, kkiney}. ; triS, csagcBta?) {Coiai- i Siti?}. : Csi i&r, piSOi, scoi, $pP% Ctt&fttt&'jtta............... Ski. I t e Gii, creosoti s ii rubra- Respiratory..,............ Luug. ; no oii iarap blacfc, iigait i; lar s to parsiUn il. j Sportoti osai vii a taf Ofitimeous...'j Skip. j iB0'4iws5. '"t Shao oH atid pataffi 3____ ___<6............ .......... Ik>. 1 PetroJe* ft3 oB, tltesei 8, j iObneatSag oii ats<1 gemo, Respiratory__ . . . . . . . J:ryt-.a. ,. ... ..... .. 3k1n. Respiratory............... t.-HOg, \ cuti!?; sii, arto trtak, i asphait, ter, auto. erada 1 parasi; oi. a ie M so ,.......... i noprooy a ., ............. Xassi sinijs. !srjt s , isg. iaorgsnfe efeOBi" 1 Arsosi........, .......... ............... tm em u, ingo-ev,, Ski. aaEs, | 0}itriSXAty. . . . . . . . . . . Lunp. ; Wicfcd.................. . Kara! cavity, ai sisma, | Crotai!................. ....... ..... | Asbrstos....... ,,........................:, lung. nug. Do. FbysisO w t i a m n x 1 XSaaistiba___,,.................A Ceumaons____ _ Skin. tiiMg rsdteiis, 1 P m m m r n m ^ ^ Cpofifeotiv tissa, tona, bioto-ferrniag rgaas. t Kadioacdve rWistio (alphay ^ Skin. I beta, asti saram-radtatk:). Vr*r>Xiir,to:t Csmieetive iisaaa, bieca- Ormiixg organs. RaspiAUry>v--TM __ Nssa! sioas Rung. >:< >'><.>:'><.> Rone. 'Poai&ifc SOtiatoa; towaferu ai___ ibftaswtrwi V--,"V->Y-VV-V^V>NV->V>V-V-w.^y.^^.v.y.y.y..v.>y.>xyto>>>>>>>x/.v>...v.'.>v-...-w.-.>>>y.>w.-. . Ri;ipxr: -- ...... >'' Lv,.... ............... wv^.w..^v mmmm s --utymm mmsm l a addition to these established occupational carcinogens there are a number of potential human carcinogens which have been shown to elicit, cancers in experimental animals and to which workers become exposed during their regular occupational activities. These -pe* tontial agents which also m ust he considered in the adjudication of compensation claims, are listed in tables 3 and 4, Tasls 3,--Potential Environmental Human Carein&pem Site of tumor Typo si ex posure Types of imrnm, Wisstecie Nulutfii.... flyasbeUe., CarSoe It-ttachtorMe. B rea st,,,,,,,. Lytpb nodes 0twits__ ... Hypophysis.. Liver............ riWifttttiit:. G m m m -. <3*Of MKi.afe,,, im .....,. mtiia. Ou&ea 3 Mois*., | MaiiuiaetxJ/*, | Ck'Piry ftiMitfve, 4 Oosmefioiitgretii^ i; ih>3Bstr!&l stciveat, i Degreasing agent. t. | prypftSSSng a*aat, i| BirtH>siigttiOtSg agftSfc i tiafSiifeu'.W. I Crocltieitos of freoo. 0?3ia JumigsBt. . CSioroRatn..................!,,,. <,tpp ,.,,,,.; ...| Mo :E>;i.rfttfye of oils: TvisnufftOCnre, AwStSotii- Solvent ad Bxir&etms of biis, resiati rubber, weres, iotSiae, alks&kls. , Xogr<lnt OS feoisuer, Sctof fioSish, cfesnixtg SafA. XfrcK<el>oa oi artSSeftsf aiSSp, go >b v S-!,3,ist f dsfetoetSttiBS). 'iteisie aoSi! ..........;v.s,,.-.4rt .'..... . ----- ,,--,, ysrepfw-sS. ,.,,v. pasties. ISiSCiiticidS, Wo<t<i cmi&mixxmL Xagredient of foodstuffs {.traits, wine, ocifoe. aasS tee). Msdieisal agent. fives. I'Clwijt*: tin). DiOi,,,, IBytOfb.... ..... Uvsr. ........... .,M, Tanaiag agent. __ do..,..,,.. Ottitis fruit preservative. Vv. MsmiSsefirre, Bktlffer . ...itfv.......... Sweetening agent. Aiitifreose, intermediate in jpgsfea tanuticUtre. Softener oi Saeptter Safes, weed stains, pat-, testiie, 'Metbyiatcti napfetba- Sbist........... Senes. Citjptitwtftftv. hmneeiant (tabaeoe), Mouse...... VOhtoie of iaseiiieidest. BsrgStta aoai Oiis aa<J ---- .do...... ....... DoPisstpft.s, S u bettianeoiis \ tOwssOjStn tissue. j ,{ MOOS*, J ?<M: kiamBsetisr*. j Fad, f Babtiesafs. | -HSatfe ssrodaetioss, Bteber-tVepselt tel i Liv__ 08. tews, wtsies, \ greases, Tratmuiro!.. J Mosse, > CefrvvS:e!icsl. | MSaiHaefuffe, j mo. {. X.abpi<ser>t. t Beer<s<sasfe&><..... 1IS4 M ATING OF IABO Tas,s .-- PcdenMfd mir<mment< Human Caretnagma--Contino!. SI si tassar Typ dt ex> gsurs Specls* j TypesoffcsmiihChists Light gr*aa SF ta ih Stet tau FSF &st gemi FCF, Sutteryate;..... .... OiiUopbaae, polyethyl ene, peiyatade (nyta}, taiketae taffen, p5ytaUtyl taettaM* tjfecuanaoas i Fsxcntacs!... tissas. .-i'-'cr.... .........Ots.1......... Sssl>ci3a5eoBS., 5 Baros&stUv, Bctayitim.. Ba.... J Fassetar&i,, \ netsptaetre Hat. Mssta.,. lit...... ... .do,. Babbit:. Stak...,. 8eienia23...,,>vy,v. v... ..: Lis';'.. taytaid,., Orad__ . . . . . . . . ....>36...,. Ccbslt..... ........... ....: Salittaase j FScstarai.. Teriile dyes. Food ead ossajsts dyes. Fond dyft {Fsatj. Flare oofcr. Fas, ber, piasle-teestrisl Ktecniacture and uses. Wrappta? material Medicinal agsi. Metal ebay, X-ray tafea, phospitoe aaafaetar. Bcttactery sreatais. Atassia energy pradurtSon. Soil tjoat&taiiaut. i tawtag ra&ttsr af glas, uumis. pete!, rubber, j Metal alloys, i Kssbber ectaPtata, ! Pfeotoglcetrleappavaips. Beeoiraisaf, IFireprceSag agent. Mediatasi agt;i. Meta aSays and piatta?, i Ools-tag naitter of siea, I tarassi?, palai, tabbed i Mediaba! seseas Tbbs 4.-- rimgmic Chemical* 1leninatee ? E m irm m n M Mumm Careimgeus gapi Sit ofsaaeet 8tyry3a-.,,,<:,v,.>.,..>. Ssbeatsaseas Typpoesaorfe. gettas atded asa ,VW>/WAWWMW FdtaMCtaf______ j Mhitak>,,.><.j Kryppio/isioS gtai, frM&tm&mmtitii. Sabeut&aeoas OstL,......V.. , , ..ta x ......I M M . tissue.;; iostatai.. , .........I B at............. I Bladder............ . ------------------:V*,....... ' L ita f.___ ____ :.......,.,,....,: i no'.......... i Brain, Thyroid. Acoustic duct, AuFasBia, Kidney, I,o'.yj $ E valuthn o f Evidence.-- or the establishm ent of causai ralalions between an exposure to these agent and the subsequent develop m en t of a cancer of an. occupational genesis and therefore compensable nature, the following prerequisites m ust be fulfilled: OCTOBER frTMMORNING SESSION IBS Denite evidence must be available indicating that the claimant liad, occupational contact with any one of the various agents listed, that this contact was either of prolonged nature extending as a role over periods of at least 6 months, and was of adequate intensity for eliciting a cancerous response, according to any previous experience which might ha available on this point. Singhs exposures may he considered to be effective if the casual agent consists of external ionizing radiation or the exposure mechanism favors the production of a carcinogenic depot in the tissues from which a prolonged exposure of the host organism may ensue. (b) The route of exposure to or introduction of the carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the Organ or tissues in which a cancer is elicited. Therefore, not any cancer, b u t only cancers of specific sites arc related to any particular carcinogenic agent, (c) The type of exposure does not need to bo continuous or extend up to the time of appearance of the cancer, hut may be interm ittent. In fact, any contact with the occupational carcinogenic agent may have ceased many months to years or, occasionally, even decades before the cancer becomes manifest. Effective carcinogenic exposures m&v be sustained not only by the ordinary operators employed in operations with occupational carcinogenic hazards, b u t also by workers entering such operations on a transitory basis, such as supervisors, maintenance personnel, repairmen, truckers, loaders, yardmen, and workers employed in rooms and buildings near the hazardous opera tions, if housekeeping and exhaust disposal methods are inadequate and environmental contaminations result. (d) Occupational Medical Stigmata,--For the establishment of causal relations between occupational exposures to carcinogens and sub sequently appearing cancers, it is of distinct value to analyze the medical history of the affected persons for functional or anatomic disease manifestations char&eteristic of a pathogenic action of the particular carcinogen allegedly involved. Such nonuancerous and often preparatory or preeancerous symptoms of tiologie specificity act as stigm ata Or biologie finger prints supporting not only the, actuality of a previously sustained specific exposure, but also its causal relationship to the cancer present. Symptomatic manifesta tions possessing such a significance arc, for instance, chronic radiodermatitis, chronic tar dermatitis, arsenic dermatosis, chronic solar dermatitis, chronic radiation periostitis, asbestosis of the lung, and Icukcmoid reactions after exposure to benzol and ionizing radiation. Chemical analyses of tissues for the incriminated chemical also may sometimes bo of assistance in establishing previous contact with any nptfi..o.ecapatinn&L.carftin.ogens, such as arsenic, .chromium,..nickel,., radioactive substances, and benzol 1954 MEETING OF illA S C I t 38Important, howevers to note th a t both these procedures are no t applicable for all occupational carrears. Some of the carcinogens do not produce any etiologloally eharaoteristio symptoms, In fact, they m ay not ollcil m y preliminary toxic or other disease phenomena despite a persistent and prolonged carcinogenic exposure. Thus, cancers of the bladder in dye and rubber workers m ay develop in the absence of any preliminary local or general warning symptoms after more than one or two decades of continuous, intermittent, or dis continued exposure to certain carcinogenic aromatic amines. There also does not exist any parallelism between the toxic and/or irritative properties o f m y chemical and its potential oarcinogmnc qualities, nor, is there a relationship between the degree of toxicity of any particular carcinogen and its relative carcinogenic potency. () Extensive experience with occupational cancers indicates that there usually elapses a latent period of years, if not decades, between the onset of exposures to a carcinogenic agent and the appearance of the resulting cancer (table 5), It ss lor this reason most unlikely that occupational cancers become manifest within the first year following the inception of contact with a carcinogenic agent. In fact, all cancers which make their appearance during the first three years of occupation in a carcinogenic environment should ho subjected to severe scrutiny for a more probable nouoceupaiional origin before they may he considered from any occupational viewpoint. Table 5 Latent Periods of Occupational Cancers Organ 3Kd agent Shin m nko. Medicinal......... Occupational... T sr_________ _ Creosote oil...-------Mineral oil.....__ Crude paraffin oil.... Solar radiation......... X-radiation., ,,,,,,...... Asbestos................ C h ro m te s _____ . . . . Nickel carbonyl..... Tar fu m e s.....___ loxitong radiation.. Lung Aromatic amines. Madder Average Sap.sfc Bang at psrSo4 \ latent jKaasa Y sa f 48 25 20-24 m 60-54 15-18 20-30 7 Yearn 3-40 4-4.6 1-50 15-40 4-75 3-35 15-40 1-12 18 15 22 10 25-05 15-21 5-47 6-30 0-23. 7-50 11-15 2-10 OCTOBER 6-- MORNING SESSION (/} A successful production of cancers in experimental animals by the admiraatratlon of any particular chemical or occupational agent, supplies weighty support to a. claim th a t such a factor may have an Identical effect upon man, especially if the route of exposure, the phyaiochemical status of the agent during contact, and the cancer produced in experimental animals are identical with the corresponding aspects in human experience. However, because of the pronounced species specificity of axogenous carcinogenic agents, even positive experimental evidence provides merely strongly suggestive but not ent irely conclusive evidence as to th e existence of carcinogenic proper ties of such agents for man. Only human experience gives a definite and irrefutable answer in such m atters. x- (p) Pathologic and histologic evidence is in general of only bruited importance in the establishment of the occupational causation of cancers, since neither the clinical behavior nor the gross appearance and histologic structure of cancers are etiology specific. Hon ever, in some occupat ional cancers histologically or histoehemically demon strable manifestations are present which give conclusive or suggestive evidence as to their particular etiology. The presence of asbestos bodies and asbestoses in a lung affected by cancer provides practical and s e ip tlic proof m to the ashcstotie origin of such a pulmonary carcinoma. Of similar causal significance would he the demonstration of chromite dust, by hisiochemical methods and by incineration of sections of the lung of an individual with pulmonary carcinoma. The hintoehemieal demonstration of arsenic in the skin affected by a carcinoma represents another illustration of the value of histologic studies in the determination of the etiology of a cancer, Likewise the presence of extensive endarfertiie changes in a fibrosed subcuta neous tissue containing a carcinoma or sarcoma would arouse the sus picion that X-rays or radioactive energy was causally responsible for the malignant lesion. If appears from these considerations that a competent and critical evaluation of the entire evidence related to the exposure of the individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, some histologic or histoehemieal characteristics and the existence of corresponding ob servations on cancer production in experimental animals aside from pertinent epidemiologic data represents the scientific basis essential for medicolegal decisions in litigations of alleged occupational cancers, C. & m p e n m tm n Lau>$ Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types of oc cupational carcinogenic agents, industrial operations with carcinogenic .......... 3osaa - i>....... " TM ... 138 i54 im m m Q o f m m b o hazards, and occupational cancers covered. As of October I, 19541 full coverage laws applying to all kinds of occupational diseases inchiding cancers bad been passed in 26 States of the United States and the District of Columbia; schedule coverage laws not always covering occupational cancers, or all types, were in force in 20 States and no occupational disease laws had been enacted at th a t time in 2 States (Mississippi and Wyoming). While 'workmen's compensation laws based on th e principle of schedule coverage May provide some degree of compensation against disability and injuries resulting from occupational cancer hazards, such legal provisions designed for the protection of workers are totally inadequate, if not obsolete, in an era of a rapidly changing and in creasing occupational disease panorama. Such static lavra reflect a legal and soeiologie state of mind which is maladjusted to the dynamic state of modern industry. However, even the blanket or general coverage compensation law which is sufficiently flexible to include not only the present but also any future occupational eaneer hazards, usually has a statute of limita tions which is inadequate for providing fair protection under certain and not too unusual circumstances m et with in occupational cancer, Since occupational cancers may become manifest many years after cessation of exposure to occupational carcinogenic agents, a statutory tune clause of from f>months to 6 years may be too short for occupa tional cancers which may appear after a longer period. It is advisable for this reason to adjust all existing laws in such a way that, such eventualities are properly covered. In the workmen's compensation laws existing in most States, certain groups of workers or employees, such as especially farm labor and domestic servants, are excluded from coverage by the law. Since fanning as well as housework have become and are increasingly be coming occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilisers, antbprtuiling agents, hormonal fattening agents of livestock, lubricants and fuel of farm machinery, residual oils for smudge pots, soil improvers, antibiotics, detergents, waxes, polishes, dry cleaning agents), there is no sound scientific reason for excluding members of such occupations from coverage by the workmen's compensation laws and from adequate protection against, cancers arising from exposure to potential and actual occupational carcinogenic agents. mmmm 6 session lS9i JJ. Mb&r Cdes a n d Sf&nddrs Any attem pt toward achieving m adequate compensation hy finan cial means for a cancerous condition acquired through contact with occupational agenta not only presents considerable economic dif ficulties but is also of questionable humane merit. While sueh. a procedure is evidently the best that can he dose after su occupational cancer has become an accomplished fact, the wiser, more rational, and In the long run, more economical approach to a reasonable con tro! of occupational cancer hasards lies obviously in their prevention wherever this is possible. This goal can be achieved to a large degree by the enforcement of proper work conditions in operations in. which cancer hazards exist, so th at either any contact of workers with sueh agents is eliminated or reduced to an ineffective leve!. As to the fundamental step for accomplishing such a control of occupational cancer hazards, it would he ailvisable to have all factories, workshops, laboratories au.d other establishments producing, handling or using known or suspected carcinogenic materials to register with State public health and labor agencies. This information would provide the basis for establishing the supervision of plants by health and labor agencies and would, create the proper machinery for familiarising managers of such opera tions with the potential carcinogenic properties of the substances and devices used in their establishments and with the methods and pro endures by which they might be controlled or avoided. The relative effectiveness of any medic id, sanitary and technologie control measures to be adopted can. best be determined by ascertaining the changos in the occupational cancer incidence among the total population at risk occurring during some 10 to 30 years alter their introduction, ft is therefore desirable th a t provisions he made for routinely recording all cancer cases occurring among worker groups exposed to occupational carcinogens. All prec&noorous and cancerous lesions observed among members of sueh groups should for this reason be made notifiable with the State health agency. All persons having knowledge of these cancers should be held responsible for such report ing. The: adoption of such mea.urns represanis an im portant step from a public health viewpoint, because there is a growing urgency to determine the environmental causes responsible for significant changes in the incidence rates of several cancers. A great deal of circumstantial and direct evidence incriminates recent changes in the industry-related environmental factors for the st artling and progressive increase is the long cancer frequency observed l| IJI I ill i T 11Ifi l |||| 140 154 MEETING OF L4IABC in all industrialized countries during the p ast 50 years (graph 1), A similar, while not as marked, rise in m ortality rates has been observed during the last two decades for cancers of the blood forming tissues, especially leukemias, for which the crude m ortality rate increased from 1,0 per 100,000 of the population in i860 to 4.3 per 100,000 in. 1844. This development coincides with a marked increased use of ionizing radiation as well as with &widespread industrial and medicinal employment of chemicals having distinct hematotoxie effects. OCTOBEE 6-- MOBNINtl SESSION 141 Xfe also may fee of significance th a t the age-specific, total and ageadjusted mortality rates per 1 0 0 ,0 0 0 population for akin cancer in white males and whits females in the United States fence shown, between 1930 and 1950 a marked shift in favor of the younger ago groups (table 8). Whether such, changes M the ago distribution of skin cancers for both sexes may h are resulted from the modem habit of sun bathing or a more intense environmental, occupational and dietary contact of the general population with arsenical*. or with products of the coal ta r and petroleum industry, remains at present a m atter of speculation. For determining th e possible causal signifi cance of such factors in this development, it would he necessary to ascertain data on occupational, dietary, environmental and habitual contacts of the affected individuals, their complexion and race, and ' T arse 6.--~Agespecifin, Tidal, and Age-adjnsted Mortality Roles Per 1GO,W0 Papulation for Shin Cancer in White, lee and White Females, United States, WSO, 1345, and 1950 MWWMVWVii ivmm 1330 me m Xlader 15________ ___ 15-24...... .......... . . . . . . . 25- 34. . . . . . . _______ 85-4.4.................. ........... 45-54....... .. 55- 64. . . . . . . . _____ 65-74........... ................... 75-84.......................... 85 and o v e r .._______ AH ages................... Ago adjusted J______ 0, 06 0.08 12 <11 v 22 . 46 75 .85 2. 5 2. 1 8. 0 53 7 18.0 88. f- 52. 3 194. 2 172. 4 & 0 >' a 2 4. 7 i 3.6 a 03 c34 , 81 i4 2. 7 59 12. 8 32. 6 77. 5 2, 9 2. 9 --62 +200 + 76 +85 +20 + 11 --20 --38 -55 XA,v.*o,,.AA. waits %'uHiks Under 15........... 15-24................... 25-34_____ . . . . 38-44...... ............ 45-54-- . . . . . . 55-84______ 68-74................... i 75-84................... 8 5 4 - ........... All ages._____ Age adjusted 5. 8. 0? 06 . 38 !*88 X. 5 3. 6 II. 4 44. 6 162. r %I 0Jo 9 t 0.07 . 13 .23 . So 1.0 2. i:.: 8. 7 [ 26. 3 132.7 2,0 2 .1 0. 02 -71 31 + 130 * 72 +218 1. 2 ' +118 I. 8 +80 3. fs +24 &8 -22 is. 8 -22 68. 5 -- 48 2. 0 . . . . . . . . . 1. 0 1954 MEETING E IAIABC on the ioe&iipn of the csneers m t i e exposed or unexposed parts of the akin, (site distribution). Ail such d ata could readily be obtained for occupational factors if all occupational cancers would be made notifiable A t the same time this measure would be instrumental in ascertaining to a much greater degree than heretofore the scope of occupational cancer hazards and of the cancers resulting therefrom.. The effectiveness of this pro cedure is strikingly illustrated by a graph (graph 2) published several CUTANEOUS CANCER IN RELATION TO OCCUPATION s femalesm Cf cuwcoys * urn$ 8 s c m i A m Nemngp & m m lly v o L tM A ir r *N0WUCATO4S s m w c m m r ir e m e m s 4624 'srSW s if <x*<?<$*$ A Tt SNMH 8 $ rxC Gkaph 2< F CAMS OCTOBER 6-- MOENIKG SESSION years ago by H enry 1 which be showed the striking rise in the number of casos of cutaneous carcinoma m males and females in England, Wales and Scotland attributable to ooeupauonal exposures to coal tar, pitch, shale oil and mineral oil after statutory notification went into effect in 1920, Conclusions 1. Tbe rapid development of modern industrialism has been asso ciated with the appearance of many new occupational health basars of which those causing cancers occupy an important position. 2. The increasing rate at which occupational carcinogens have been discovered during recent- decades suggests th at only a fraction of the actually existing industrial carcinogens is known and th a t here tofore unitnown and new occupational carcinogens may bo added to the present industrial environment through the development and use of new chemicals and production methods. 3. There is a groat deal of evidence indicating th a t only a relatively small fraction of the cancers produced through contact with occu pational carcinogens has been recognised and/or placed on record. Because of the established widespread industrial contact of large worker groups with known occupational carcinogens, tbe potential scope of the occupational cancer problem evidently is much large? than apparent from the reported number of occupational cancer eases and hazardous industrial operations. 4. Medicolegal decisions in compensation procedures of occupational canesr claims should be based on a competent and critical evaluation of the entire evidence related to the exposure conditions of the claim ant, the presence or absence and the type of any etiology, specific symptomatic manifestations observed during the latent and develop mental periods of the cancer, the length of the latent period, the site of the cancer, any specific histologic and hlstochemical characteristics, the production of corresponding cancers in experimental animals by the incriminated agent and pertinent epidemiologic data. 3. Schedule coverage laws are inadequate for providing proper protection against occupational cancer hazards because of the dynamic state of modern industry resulting in the constant addition of new chemicals and production methods winch may entail heretofore Unknown occupational cancer hazards, The statute of limitations contained in the general coverage laws represents its main defect in the fair and equitable application of this type of workmen's com pensation law to occupational cancer hazards, 8. Since the prevention of occupational cancer hazards and not financial compensation for established occupational cancers appears M. be the more sensible and humane m ethod of omsp&tion&l cancer 144 1954 MINTING OF lAiASC control, labor codas should be properly adj usted and enforced sc as to eliminate or rcasonaMy contain occupational cancer 'Hazards m mod em industries. 7. For ascertaining the actual scope of the occupational cancer problem and for the institution of adequate control measures, it is essential that occupational cancers and preeancerous conditions are made notifiable with local and State health and labor authorities. 8. A comprehensive study of occupational cancer hazards will provide & sound basis for an equally urgent investigation of the apparent extension of industry-related cancer hazards to large parts of the general population, BiBUOGRAPHY t. Hvkt&k, W. Occupational Tumors and Allied Diseases, 0 < G. Thomas, SpringSekl, HL 1942, p. 89?. Bevent Developments its F.nyIronmental Cancer, A. Review, Arch. Pathol. In press. A Methodology for Environmental and Oveupatkmai Cancer Surveys. PubL Health Tech. Monograph No. I. IT. f t Pnblift .Health Service, Depart moat of Health, Education and Welfare, 1950, p, 37. 2. T a ts so, V. M,, Occupational Disease Reporting. TL 8 . Department of Health, Education and Welfare, Publ. Health Service Pohl, Ho, 288, 1053, p. 80. 3. SrxxxaR, L. K., Recent Treiida its Occupational Disease Deglliatido, Uolv. Illinois Bull. 48; No. 69, 1953, p. 30. 4. Moasm, <3. G., and DAyswrOB*, 8, j>, State GdJupeosatery ProviMuns for Occupational Biseasa. Bateau of Minas Information Circular 7650, |J. S. Department of the Interior, 1952, p. 125. 5 'vVatuks, Tsr., Industrial Physician and Workmen's Comptmsation--Current Trends sn Comjseneatiou Legislation. J. Xndust. Pyg. and Toxicol. 31: 251-255,3949, 6. Swcosjum*8 oar Legkjlatjo Parsicseass, A EattoP&i Approach to Air Pollution Legislation. Manufacturing Chemists' Assoc., 1952, p. 23. ?. TouaAXOBAxi, P. 5., Health of Workmen: Appreciation of Bisks to Wiaieb Health of Workmen Are Exposed in Industry In Province of Quebec, Oan&d, M, A. J, 54: 352, 1946. T h e Aeeiclesst 'Prerentimi Ame>ci&tkm& Vml&r ih& Quebec W orkm ens C om pensation Law L, H, T. CLEGG, President, Quebec Association, for the Preventien of Industrial Accidents fid Iks absence of Mr. Clegg, Mu statement was read by J. Armani Desrsckers, vice president, Quebec Association f&r the Prevention of Atd*s| I will outline briefly the setup of the various safety assdekHdits, and later, being more familiar with the organization which I represent, I shall endeavour to elaborate on a few of its major promotional ,.at4Mt.ies,............................................................... ......... ....... . APPENBM Official A tten d an ce a t th e Fortletlx Ah im s ! M eeting e.f th e In te rn a tio n a l Ammzmthm. o f In d n s trla l Aeeiden t Boards and Cnmmisalons CANABA Alberta A. Fa&mao, M. . E, Oojftiaissioner, Workmen'* Compensation Board, Ed monton. B< H. K. Hbpbcrk, Chief Medical Officer, Workmen's Compensation Board, Edmsmton. C. M, kisonnoo, Q- C., Chairm&n, Workmen's Compensation Board, Edmonton. Brit%h Columbia F, P, ac'H'isAL&, Secretary, Workmen's Compensation Board, Vancouver. AoM:Bxul., Chairman, Workmen's Compensation Board, Vaacoxtver. C. W. I t e c a t t o , Commissioner Workmen's Compensation Board, Vancouver. Manitoba (3 I*. C*tJHr> Q. C,, Commissioner, Workmen's Compensation Board, WSn- P. . . Assistant to Commissioner, Workmen's Compensation Board, Net Bmmmek A. . Caiaadha, President, New Brunswick Accident Prvention Association, Moncton. B. <3. J ohnstok, Vice Chairman, Workmen's Compensation Board, St. John, J. A, LaBtANC, Ci&ima Officer, Workmen's Compensation Board, St, John. Newfoundland CoASSN'es V. Hancock, Commissioner, Workmen's Compensators Board, Sr, John's. Anrnon Parara, Commissioner, Workmen's Compensation Board, Halifax, E s ana Bows, Chairman, Workmen's Compensation Board, Halifax. Ontario J. F, Cas.t, Vim Cbairomn, Workmen's Compensation Board, Toronto. Max Bonos, Ontario Federation of Labor, Toronto. F, FitsfCKA, Workmen's Compensation Board, 'Toronto. GkosoK:C abhow Cjkessb, Director, Federal Government Employees Compensa tion Branch, Department of Labor, Ottawa. W. J. JouAsroM, Workmen's Compensation Board, Toronto. J,, B. Lass, Department of Labor, Ottawa. ............BkB................ . . . . . . . . . . . . . . . . ..,,,.......... . . ....... .................................. L. B. Leepaeb, Physicist, Division of Industrial Hygiene, Department of KeaSth, Toronto. Wnxe M&cuic.m,m, President, Canadian Industrial Safety Conference, Toronto, V. C. Peusux, Director, Canadian Branch of tire L L. 0 ., Ottawa. G. R. Foots, Workmen's Compensation Board, Toronto, Allan P oktkb, Department of Labor, Ottawa. A. Roemson, Workmen's Compensation Board, Toronto. E. E, Seak&ow, Chairman, Workmen's Coiapensafcio Board, Toronto. Wae&sn W. Sxeauns, Claims Manager, Liberty Mutual Insurance Co., Toronto, Da, B. C. Steele, Workmen's Compensation Board, Toronto. Da. Bbooe Yowko, Director, Rehabilitation, Workmen's Compensation Board, Toronto. Quebec B m rw oe Bsk, Safety Director, Quebec Iron & Titanium Corporation, Sore!, , G, Ballaohey, President, Quebec Metal Mining Association, Noraada. Da. Bebtbak Belle&saee, Workmen's Compensation Commission, Quebec. W. L. Bhn&t!, President, Quebec Pulp & Paper SMety Association, Quebec. Jacques Bkknau, Montreal. De. L, A, Bboghu, Workmen's Compensation Commission, Quebec. Jacques Oasgsan, Department of Labor, Quebec. , B, Cook, Secretary-Manager, Quebec Pulp Paper Safety Association, Quebec. Paul A. Cooke, Joint Manager, Quebec Industrial Accident Prevention Associa tion, Quebec. A. Heeman Cots, Safety Director, Canadian Car A Foundry Co., Ltd,, Montreal. J. Atmatro Dbshoohers, Yioe President, Quebec Association for the Prevention of industrial Accidents, Quebec. J, A. Duoasur, Montreal, Dasabnyas!, Bhawimgan Water A Power Co,, Montreal, Paul Da&iAumm, Assistant to President, Casgrain & Charbonoeao, Montreal, J. E, Drok, Workmen's Compensation Commission, Quebec, J, E. XL D s &sbhs, Workmen's Compens&tksn Commission, Quebec. J. H. Deusoe, Commissioner, Workmen's Compensation Commission, Quebec. J oseeh D o tage, Workmen's Compensation Commission, Quebec, Honokable M. L. Duanssis, Q. C., Premier of Quebec. AatfKua Poste, Vice President, Workmen's Compensation Commission, Quebec. HonoSAB.e OwagjM Gagnon, Minister of Finance, Quebec. Dm Gustavs Ginobas, Medical Director, Rehabilitation institute, Montreal. Wxlseam Gallaghse, Montreal. S. Gbeooey., Chief Claims Agent, Canadian National Railways, Montreal. Jean Gabneau, Workmen's Compensation Commission, Quebec. Joachjss Gbenieb, Q. C., President, Workmen's Compensation Commission, Quebec. Bssnaeo C. Hamel, Quebec Power Co., Quebec, Rusoouhe Hamel, Pice President, Catholic Conference of Labour, Asbestos. Horn Wsnenno Hasnp, Mayor of Quebec. A, H. XIoeoeeeqsh, President, Quebec Metal Mines Accident Prevention Associa tion, Nor&nda. H. H. Hough, Chief Claims Agent, Canadian Pacific Railway, Montreal Laonol. H obbet, Safety Director, Quebec North Shore Paper Go., Baie Conxeau, ML Maso Lacoste, Edifice Cadillac, Montreal. MaueiCe LAEKasreEE, Quebec Iron & Titanium Corporation, SoreL 230 1854 MEFl'ING OF TABC E tk&nb XAKocKEk&B, Secretary General, Quebec Metal Mining Assooiatioxi, Que. Nss. Lak&css, Wwkmms Compensation Commission, Quebec. J>8. Akhur Lecheec, Chief Medie&i Office?, Workmen's* 'C om pilation Com mission, Quebec. Ds. D, Leonae, Workmen's Compensation Commission, Quebec. T. E. Lrrrm, Dimeter, Quebec Metal Missing Association, Nor&nda, W. E. Montgomery, Safety Director, Seonetli B. S, Robertson, Ltd., Montreal, PasoiPsE Mouette, Q. G., Coxonissboner, Workmen's Coiopetisatiop Com mission, Montreal. J. Ammo nss Mobency, Workmen's Compensation Commission, Quebec. Jean Phxnxx. Orthopedist Tedimeiaa, Montreal, R omeo Paquet, Workmen's CompetiBaikm Commission, Quebec. Donat Qcmteb, Deputy Minister of Labor, Department of Labor, Quebec. G. Ant. Rousseau, Workmen's Coiapsusatsoo Commission, Quebec. E. M. Rocheesau, Cooxmmioner, Workmen's Coovpeusat-lan Gomirdssiorij Quebec. Davsu Robejuam, Workmen's Compensation Commission, Quebec. Eyaeiste Rooneyt, Commissioner,, Workmen's -Compensation Commission* Quebec. I, H, Sx.oane, Safety Director, Canadian JoMis-Manviiie Co,, Ltd., Asbestos. W. K. Boutas. Assistant to Mme Manager, Canadian Johs-MasviUe Co., Ltd., Asbestos. Bib CamHvOk Sjmako, Workman's Compensation Commission, Quebec. Da. F, J. T ourangeau, Division of industrial Hygiene, Montreal, Dk. E. A. T obcot, President, Industrial Mdis! Association, Montreal, GeRar T rkm&eay, Deputy Minister of Labor, Department of Labor, Quebec, L. F. TBksrs, Workmen's Compensation Commission, Quebec. Jacques VEREEAtxor, Secretary, Workmen'a Compensation Commission, Quebec. A, . Waeees, Superintendent of Safety, Crane Limited, Montreal Da. E. . L. Watson, Medical Director, Crane, Limited, Montreal, Sr, George White, Workmen's Compensation Commission. Quebec. Sagkakhevjan M. D, T hompson, Commissioner, Workmen's Compensation Board, . W. Vauueau, (Rmirman, Workmen's Compensation Board, Regina, C. C. WrlrtAu% Minister of JaA, Department of Labor, Regina. Regina, UNITED STATES labanla Joe L. Oos-man, Director, Department of Industrial Relations, Montgomery. Arkansas G. L. Gant, Attorney, United M to 'Worker-,- 'Fort. -Smith. O. W, R o m m , Commissioner, Workman'?; Compensation Commission, Little Rock. sEopn B. Bises, Commissioner, Workmen's Compensation Commission, Little Rook, CsUfmiifi Chet F rames, Guarantee Insurance Co., Los Angeles. Joseph J. Gax.uaghee, Manager, State Insoranao Fund, Burlingame, S- 'Vr:kW ^^'6^'An>>TAAkici&.. H d ls W k ^ S fm x m x c Pso ScoAKoeear.nn, Direct-or, Department of Industrial Dlation, San Francisco, Dr. Bbe? S. Tsomas, Department a Emsdovuaent, Sacramento. H. M. Wxraoss, Department of Employsuent, Sacramento. tiorada Bt II, BbaKssS, Ch&iman, Industria.; Commission of Colorado, Denver. MaE,i> , Tums'.sox, Difertor of Clami, Sfato Compensai? Inaura Fwad, Denver. Gmmdioul .B, E. CoHnts;, Hartford eeidonf A Indenmiiy Co., Hartford. v H. C sass, President, Tod Oats House, vorykm-n. W. S. MoCossox, Th Asina Casual*? & Burety Co,, Hartford. dfixmw bp. Klaw, Epeei&i Cosmesi, E, I. du 'Pont,.d Nnmcmrs & Co., Wiiinngioh. Dr, i, J MacCo^ pm, Mefnber, industriai Accident Board, Wyo*oSg< $Atm A. Mvuhn, ProsidOiif, Industriai Accident Board, Wdoiagtn. Toso N. WaS3so ro s, Member, industriai Aeekim-t Board, Laurei, Dlrci al Columbia Aso&ga- J. BiOintisa, M?nbrs\ National Legislativa Committee, America Ferlerai ion of Labor. Fa* Ka FeasmAea, Associais Direktor of Education 4 lesearch, Cftgrass of IneUisiraU Organisai inos, Bauern . C esses, U. S. Department f Labor. Pape K. C rsssE , Ssretary.Tfasursr, ! AIABC, U. S. Department of Labor. Dr. W. , I ppeee, hlei, Environmental Cancer Section, Cancer Institute, Department of He&itfe, Education and Heifaro, Betbssda, Md, Ho. Asrnba Labsok, Under Secteiary of Lahor, im m E. iWT** Chairman, Employe Compensation ppa? Board, H, S. Department of Labor. Mask V. LKTOKutvEta, Office of fhe Spamtary-Trenaurw, I A ABC, U. S. Dpart osent oi Labor, Wiu -am MoCwesy, Director, Bureau of Ersploye&s' Compensation, U. S. Department of Labor, Fa* McEnsor, . S, Department of Labor. F sascss G. Starr, U. B, Department of Labor. HsBKE-r Vas Htsjsp, United Aisne Workers Weiiare and Rereraent Fund. Fl&rida iatsas Camssos, Meaiber, Iduirial Commission, Tallahassee, B, T. Couak, Cenerai Counsel, Industrial Commission, TaUa'naasne, Hooaav D sxance, Direot-er, Worknmrbs Compensation Division, Industrial Commissiisn, Taiiahssse. dnsaen A. Parks, Ortando, J ames T. Voceu-s, Qmirmae, Industrial Conralsiois, Tall&bassee. Georgia E ckass W. Bpse, Seeroiary-Treasurar, Board of Workmord Compensation, College Park. W. E. Bucasim, Member, Board of Wsrkmon's Compensation, Atlanta. IIM bf lliilp : W M m eeting of aabc Carer J. Kor&rKs, President, National Association o? Sel Insurers, Lewistn. B. W, 0 ? m x $ w itt Ch&imm> sdustria! Accident P.oard, Boise, B Asma, National Safeiy Council, Chicago. M x m r Bvvbmaxi, Superintendent, Compensation Claims Beparfraeut, Sprich Cenerai Accident & Liability nsnrance Ce., Ltd., Chicago. D&ro M, G a s O , Commissioner, Industrial Commission, Chicago, FscOT B, Passas, Director, Industrial Division,, Dations! Association of Motus! Casualty Compsnie, Chicago. Mrs. MasfOBas W. Gruosnr, Council on XadffiftrM Health, A. M. A,, Chicago. S. J. Holoeusa?-;, Clmirtn&n., Industrial Commission, Chicago. Rssm<S. Hows, Lmnbemeo's Mutual Casualty Co.? Chicago. B. W. Johnston, Commissioner, Industnal Commissioni Chicago. Br. M 6s H, K&eiEsss, Medical Services Manager, Caterpillar Tractor Co., Peoria, l. Gsme Mu-tsa, National Safety Connell, Chisago. dorm Mobu s, Commissioner, Industrial Commission, Chicago. Br. C. T. Oasohs Chairman, Commission on Workmen^ Compensation, indus triai Medical Association, Chicago. J, A. Psaainwroa, Hmois Department of Labor, Chicago. 8. J. Brave , Westers Electric Co., Chicago. Faun 8 W m , America Mutual Alliance, Chicago. Indiana Howaan T. Barnar?, Ceserai Manager and Counsel, Lynch Coal Operators Reciprocal Association, T arn Haute. Dr. . K. HaaconsT, Indianapolis. Bmahubu F. Msansa, Hearing Member, industrial Board, Indianapolis. Jo&acH P. MxE, Chairman, Industrial Board, Indianapolis, Iowa C. H, Gns& xim , Deputy Commlrakmor, Worksnen's Compensation Service, Des Moines, Eisw&n C osar, Commissioner, Office of Workmen's Compensation Commis sioner, Topeka. Aasaar M. Ross, Esamioer, Office of Workmen's Compensation Commissioner, Kansas City. Raj,eh ,1. Thgsks., Examiner, Office of Workmen' Compensation Comsnissioaer, Hutchinson. Ssmsok W asa, Examiner, Office of Workmen's Compensation Commissioner, Pittsburg. Patm Cosxss, Acting Commissioner, Department of Industrial Relations, Frankfort. H. Wbxtams, Attorney Gesserai, Department of Labor, Frankfort, J ohn W Bancou, Lawyer, Bangor, Mrs. Mansauna Baunabo, Induatri&l Accident Commission, Augusta, Gt&u M. J oe, Member; Industrial Accident Commission, W&tervle. J ases E, Mrec tacut, lawyer, Bangor. F. E. Rxchaboson, Portland. Afarpiad M&tvtn L. Pxnb, Chairman, Industrial Accident Commission, Baltimore. Br. J ohn F, H os'Hns, Baltimore. W. .teraiar Ma sens sas, Commissioner, Industrial Accident Commissioxs, Baiti* mora. Pam> Sbmkss, Jr., Manager, Compensation Department, Maryland Casualty Co., Baltimore. Hamaf B. Burea, New Amsterdam Casualty Cs., Baltimore. M&sakuxes Ds, AaxAKOsa P. A rrias, Ch&im&n, Subcommittee on Industrial Eolations, American College of Surgeons, Brookline. A.oeosse S. Bacbobowssx, Attorney, Salem. B aux B. Basas, Enrolyere Crimps Xmmnmce, Boston, T homas W. Borra, Member, Division of Industrial Accidento, Boston, R. B. Coorna, Director of Medical Relations, American Mutual Liability Is* anranee Co,, Boston. Rimana H, Gx&oeos:, Chairman, Divisin of Industrial Accidents, Boston. F hak:s E> Geoimay, Director Of Self-Insurance, Division Of Industrial Accidents, Boston. Svanwogo L, H anson, Assistant Vice President, Liberty Mutual Insurance Co., Boston. G. 8. Mahlsj, Vice President, American Mutual Liability Insurance Co., Boston, J ambs G. Habnedv, Attorney, Massachusetts Bonding and Insurance Co,, Boston, Mabcelus J. lirons, Boston, Mabv F, Hrsn, Member, Bivision of Induatrinl Accidents, Boston. F<oxas J. Kos.onn.XAS, Mess)ber, Division of Industrial Accidents, Boston. Eurea 3. Mubfht, Attorney, Boston. Maev A. Noonan, Boston. Asas,!?,r Sr, &, Conosci, Liberty Mutual Insurance Co., Boston. J oskvh A. SunmvAN, Chief Baaxraner, Liberty Mutual Insurance Co., Boston. Mss. Emma S. T ousant, Past President, AIABC, Quioey. Michigan W. C. Btsaor, Manager, State Accident Pond, Lansing. H auhv F. Rjuems, Sijperinfcendeot of Claims, State Accident Fund, Lansing. WxwuamE. Buchanan, Chxyslcr Corp., Detroit, C. IS. CaHorsans, Ford Motor Co., Detroit. J ohn C, Cun,dees, Lincoln Mercury Division, Cenarsi Motors, Detroit. H. A, Comvbau, Attorney, State Accident Fund, Lansing, Wuxsam 3, Davssi, Chrysler Corporation, Detroit. Cram? E, Bonxo, Chrysler Corporation, Detroit. J ames L, Hue, Supervisory Attorney, Workmen's C-ompesxsatios Section, Ford Motor Co., Detroit. ... ............................................. ................................................................... 234 1984 MS&TITO OF IA1A.BC W* , Horimssas, Compensation Supervisor, Chrysler Corporation, Detroit1?. J oBsoj, Manager, impioyee A v ise s Dep&stmnfc, Ford Motor Co., Dearborn. Wk&um J. 3m m , Lacey, Joses & DoeUe. Detroit, F. A. Ltot, Staff Attorney, Workmen's Compensatio Section, Ford Motor Co., Detroit. Wads H. McGkkk, Js ., Member, Workmen's Compensation Commission, Lansing. W R. MacGb<3s, Vice President, Michigan Mutual Liability Co., Detroit. BtfAMtf Marccs, Representing Samuel B, Horovits, Muskegon. ItOgsp ii. Noams, Chrysler Corporation, Detroit. lio asar L, O'Coskku.., Eothe, Marston, Bah & Massy, Detroit. TmsonoroR P, Ryan, Chatman, Workmen's Compensation Commission, Bimon- dale, EronBs L> Bensons, International Eepresentatsye, Compensation Deoartnmnt, UAW-CID, Detroit, . A, SesmiT, Viefc President in Charge of Claims, Corporate Service, lue., Detroit. Paso S. Wahns, Attorney, Auto Owners Insurance Co., Lansing, Minnesota. Robbe.? C. Fae5cy, Commissioner, Industrial Commission, St, Paul Mississippi Sam S, Aobrbo, Commissioner, Workmen's Compensation Commission, Jackson. John A. Osais, Chairman, Workmen's Compensation Commission, Jackson, Missouri WrnAM G. Brno, Superintendent, Workman's Compensation, American* Associated Insurance Companies, St, Louis. Csaslss E. Gates, Member, Industrial Commission, JeEerson City. Earn, F. Charr, AasM&ut Professor, St. Louis University, St. Louis. R. Rcmgtrr Cohn, Attorney, Kansas City, W. E. FnasLAjrn, Member, Industrial Commission, Jefferson City, Srsm sn S . G ivsss, Director, Division of Workmen's Gn-ps&tion, Jefferson City. BrsranN- J. Moaoirr, Cbairmao, Industrial Commission, Jefferson City. Montana W. W. Cassbe, 'Secretary, Industrial Accident Board, Helena. Now Jersey Winston Bsass. Chubb &Bone, Managers, Fdrai Insurance Co., Rixort Hills. Dp, H. E. Bsiana, Nose LisbonCaei, HormsmMAN', Commissioner, Department of Labor A- Industry, Trenton. Dashko . Simon, Director, Division of Workmen's Compensation, Department of Labor & Industry, Trenton. New M m 'i> iil&kumsma Jonas, Assistant Commissioner, Labor and Industrial Commission. Santa Fe, appehm n c 235 Nets York E rsassr R. Au>ga, Manager, Claims 4i Safety Department* 8ee?nv~&es$s.m Oil Go,, Sue., Mew York. 7 ' Louis Anssrr, AeBsary, Woodward & Fondiiler, Now York. H. BvmM* BieRau, Director, Compensation A Safety, Locomotive Go,, Schesoet&dy. Miss GdRrsesE Oavanapok, Workmen's Ctmrpmimlhn Board, Albany. R am onE Ay Caykely, Vice Preside!, Fidelity & Casualty Co., Mew York. Oliver T, {Ratton, Hew York, Maxskajx Dawson, Past Secretary-Treasurer, iAIABC, New York, ,L Ay PMSScKEESj Secretary-Comptroller, National Council on Compensation imxeme&, Mew York. B>;s<?ASrs? B sssin, State Insur&nee Fund* Mew York. Miss Maby D om es, Chairman, Work men's Compensation Board, Hew York. ,L Rax,i P yxes, United State .Casualty Co,, Hew York. Jo ssra Beak Low.nos. Attorney, New York. StCKASn Fosoiller, Woodward & Fm-diller, New York, G, Ease, Fox, Secretary, Casmdty Division, Glens Fails Insurance Co., Cions Fails. Bit. Leonas J. GoLawAtnat, Katbstal Chairman, CarBLaodaHadustry Com mittee, Asneriean Heart Associm ion. New York. W aiisC , Gootby, 0 . E,, Director. 1cstdnie for i he Crippled and Disabled, Hew York. Miss AbaRette H asson, Associate Eomiomisi, Workmen's OoinpetmtloEs Board, Mow York, Akfbsd H siken%United Bteelworker of America, Buffalo. t m m m m Wsm<m, Ja>, Attorney, Nations! AAioeistbss of Mutual Casualty Cos., Mew York. R, H. M vm nim m, A. C. F. Industries, Hew York. H. M. Jacaaon, Manager, Industrial Health Program, Johns ManvIUe Corp.. Mew York. Anskew K amyrow, Hew York. Ewsse P- R yle, Couasel, How York Compensation Iiseuranc Bating Board. Mew York, M. L. LasaowsKt, Western Efeetrie Up., In?., Hew York, Johk M, M oDokals, Director, Workmen's CompmusaHon, Associated InduatBes of New 'York State, inc,, Albany, Honear E. Massskap!., Administrative Deputy. Workman'* Cmnpzm&Upn Board, Mew- York. GbosCvE E. M ueuioar, Manager, WorkieeoY Compeoeb lots A Disability Claims Division, American Surety Co., Hew York. Mioka351j. M irnw r, Coporal Manager, Association -of New York-State Mutual Casualty Cos., Mew York. Rat i . Oakley, State Insnranee Fond, Mow York. Miss Maes ok Pglaxgy, Secretary, United Steelworkers of America, Buffalo. Atrss M aur Polokov, Buffalo. J aBes J. Heoa, Secretary, The Self-Insurers Association, New York. B. V. Rtak, Fidelity & Casualty Co. of Mew York, New York, Kerry B, Sayrb, General Manager, Mew- York"Compensation Insurance Hating Board, Mew York. A, Mi, SouMiST, Insurance Manager, Rations! Council of State Belf-Insmcrs Assoeiatba, Hew Yack. 1854 MEETING OF IAIAE J ames E, Sansnas, Attorney, American Telephone & Telegraph Co., New York. C raos F. Smttsb, Claims Attorney, New York Telephone Co., New York. WimAM M. Srmatn% Associate Attorney, State Insurance Fond, Near York. J. Hasst T ikxnan, Attorney, United Steelworkers of America, Buffalo, WAimm C, T ockke, Counsel, Utica Mutual Insurance Co,, Ctlea. O*o. B. Wsu4, Western Electric Co., Inc., New York. N. Mb&o&tr Woooa, Association of Casualty & Surety Cos., New York. Da. M. W uisau Z gcb$&, Director of Studies, Commerce Industry Association of Now York, New York, North Carolina J. W. Beam, Commissioner, Industrial Commission, Balelgh, North Dakota Qrm B a ra nt, Chairman, Workmen's Compensation Bureau, Bismarck, B. M> Eras?, Member, Workmen's Compensation Bureau, Bismarck, Ohio H. D. Banquet, Emile E. Watson, Columbus. J acob C-ja-man, Secretary-Treasurer, Ohio CIO Council, Columbus. J. Maytiaao Djcpojuon, Yice Chairman, Industrial Coismission, Columbus. B, G, CoTTSKOsamn, Superintendent of Claims, Farm Bureau Mutual Auto Insurance Co,, Columbus. W. G. H astman, Attorney, Squite, Sanders & Dempsey, Cleveland. M, IfoenANO Kates, Director, Workmen's Compensation, Frigidaire Division, General Motors, Dayton. J ohn Muhwx, United Rubber Workers, Akron, ExesAao W, hi ossa, Chairman, Industrial Commission, Columbus. Chaeaks F, N irrrss, B. F. Goodrich Co., AkronT a o m s hi, Haemas, Jones, Day, Ooekley Xieavis, Cleveland. Oklahoma Fs* Aebebt, Industrial Commission, Oklahoma City, Make OmoouES, Industrial Commission, Oklahoma City. Jnuus Aabsbt 0 . H unt, Industrial Commission, Oklahoma City. Toss G. Mastsn, Commissioner, State Insurance Fund. Oklahoma City, Mam E. Powsuo, Chief Attorney, State Insurance Fund, Oklahoma City, JS. I. SrmrSEnANO, industrial Commission, Oklahoma City. Oregon L, 0 . Aeons, Member, Industrial Accident Commission, Salem. Woauan A, Cau<aban, Chairman, Industrial Accident Commission, Salem. Pennsylvania F. E, Baehaso, Manager, Compensation and Safety, Bethlehem Steel Co., Bethlehem. Peaks: E , Boat.-, Deputy Secretary, Department of Labor and Industry, Harris* burg. A. 'G; GmmoeMX, Chief Supervisor, Indemnity Insurance Go. of North America, Philadelphia. W. D. Coaelet, Secretary, fire Association of Philadelphia, Philadelphia, E. Gwhauak, Manager, Stats Workmen's Insurance Fund, Harrisburg. E. M. H autman, Assistant Manager, Compensation and Safety, Bethlehem Steel Co., B'thtekess. A&mssmx c Rmstrr C, Hssom, Superintendent, Compensation Claim Department. Asoerfenr, Casualty Co., Reading, Russeo 0 . Ksisna, Assistant Manager, State Workmen's Jhsura&ee Fund, Harrisburg, WMisss Lttfw, Secretary-Treasurer, National Council of State Mf-Xxiaersrs Association, Philadelphia, J ohn L. N ays,o&, Director, Bureau of Workmen's Compensation, H & m sim ri. F. Parr sx&n, Chief Safety Inspector, State Workmen's Insurance Fsmdi, Barrie- A. Sosmoansa, General Attorney, Pennsylvania Railroad Co,, Philadelphia. Davis M. IVax.tsa, Secretary, Department of Labor & Industry, MarrMsurg. PmHo Rico Miss E aoixsp Njcaouoxx, Member, Industria} Commission, San Joan, ExKxsBob A. Santjaco, Actuary, State. Insurance Fund, Sas Juan. Rhode Island A n t o n i D P in t o , Executive Assistant Curative Center, Department of Labor, Providence. Ila . J ohn E. Downer, Medical Director, Curative Center, Department of Labor, South Carolina Mrss Fa s CtATros, Commissioner, Industrial Commission, Columbia. JaSB8 J. Bern, Fine Chairman, Industriai Commission, Columbia. Mas. H. 8. T ate, Columbia. Tmneesee W. H, Pa$kam,, Commissioner, Department of 'Labor, Nashville. Faux, A, Pim-ups, Safety Engineer, Department of Labor, Nashville, Dnwgv W a m ts , Director, Division of Workmen's; Compexssation, Departmoni of Labor, Nashville. Texas Da, . C, Batno, Chief Physician, Humble Oil & Refining Co., Houston. R, L. E c&ak, Wen President, Petroleum Casualty Co., Houston. L. H. FaswattEN, Chairman, Industria' Accident Board, Austin. Fsmx A, RAYMna, President, Petroleum Casualty Co., Houston, Virginia Mss. C. R. Hrrcix, Richmond. W. H, MxcHHiiS, J&, Chairman, Deportment of Workmen's Cdxapena&tion, Richmond. Wmhin^ton Esmeb H. ICenneov, Supervisor, Rehabilitation Center, Department- of Labor and Industries, Olympia. Wesi Virginia Dm J ohn P, Baron, Chairman, Occupational Disease Medical Board, Charleston. Fsanxxuu W. Knag, Executive Secretary, Workmen's Compensation Fund, Charleston. SunouFU J, M unsssav, f.*g&f Assistant, Workmen's Compensation Fund, CnoaoE W, Ssoxas, Commissioner, Workmen's Compensation Fami, Charleston. m U M H E M S m IM BC Wvmmin % m m m S. U&rmy, MMwmkss. B; E, Kimtmm, i& Pim diteV Bs&f&>ys* Mvtlas, W atmu, MssmB L&nvM, z m m i Atm m sg J: & ItOTfc* Claims Causasi, Employsrs MateaMls,MWismaatm, u BL&b i sa?ss Bbsai-sr, Wx&fea'a Cosipsasaiioici, Industrial OmaiMa, Msis&a, __ m is p j ^ikmm> IMmiBM. Osaimisskaa M&dmth Wmrnrn P> ihsm r, M&s&ger, Wrk8K8ss Omps85sfJo Ctomasissiea, O hsjeam tiiiltietpf : t f |||i i : l i a-aI ::i?C :'? | | | | A--: f i l l 1ftlS tfi H iS