Document Z4LNamE5pXR628pK07vQoaOmV

838 OCCUPATIONAL TUMORS AND ALLIED DISEASES post-mortem examination is performed through which the disputed neoplastic character, its source and type, can be established in the overwhelming ma jority of cases beyond any doubts, providing thereby a sound basis for fixing the liability, reliably and definitely. The medical expert, thus, depends in his evaluation of a case upon the availability of a certain amount and type of information, without which he cannot be expected to render an intelligent opinion and judgment. The medical adjudication of traumatic cancers relies upon the observation of certain gen eral principles, which should not be followed dogmatically, as our present knowledge of the causation of malignant growths is still greatly defective. In the practical medicolegal application of the existing information in this matter, due consideration should be given to the concept of general common sense concerning the interrelation of cause and effect recognized and applied by courts and compensation boards. The decisions rendered by these agencies cannot be based purely on scientific deliberations, but must rely in part upon reasonable, circumstantial evidence, to prevent undue hardship to the afflicted individual (Woodward; Dandy; Behan; Sappington; Fenster; FischerWasels; and Roussy). If the criteria and requirements essential for a fair and just recognition of the allegedly traumatic cancers, dealt with in courts and industrial commissions for adjustment, arbitration, or litigation, are followed, there will remain only a rare case which is acceptable medicolegally, mainly because of lack of evi dence to the. contrary. The relatively small practical importance of acute traumatic carcinogenesis is illustrated by the fact that Biingeler was able to collect not more than ioo recognized cases of this type from all German University clinics. Hauser, who analyzed 262 cases reported in the literature as traumatic cancers of various organs, concluded that in only 13 of them a traumatic factor entered into their etiology beyond any doubt; in 48 cases this appeared to be probable, in 94 cases such an influence was considered possible, but not probable, while in 107 cases there was definitely no causative accidental rela tion present. Single trauma as the primary factor in cancerigenesis is, there fore, no longer a matter of genuine interest among medical men (Knox). The medicolegal attention, which is extended to this subject to an increasing degree in recent years, is attributable, according to this investigator, to the efforts of commercial agencies, because of the increasing accessibility of com pensation for any injuries sustained while in discharge of any kind of employ ment. In view of the higher legal responsibility of employers to employees, these are encouraged by such parties to give countenance to the idea that a tumor may have had a traumatic origin, in order to collect compensation grants. With the scientific, while not entirely medicolegal exclusion of a single trauma as a cause of cancer in normal tissue, this principle does not greatly