Document dY2BzjZJkbeLVnZed09j7403q

FILE NAME: AT&T and other Phone Companies (ATT) DATE: 1954 DOC#: ATT012 DOCUMENT DESCRIPTION: Presentation from Workmen's Compensation Problems Conference 1954 - Occupational Cancer Hazards - z . ' C 7 t t = o- -L a m K c w iS S h r * / c ls .t, A j y r = S w ~ Q tjfe PM0 BMB$NGS~~~4$th Annual Ccnmntmn, c f the InterrmU&iwl AssacwU&n of Industrial Accident Beards and Cemmissmm? Quebec? Canada^ October 3- 7?29S4 Problems 1954 B U L L E T IN ISO UNITED STATES DEPARTMENT OF LABOR Jam es P MitefeelL Secretary BUREAU OF LABOR STANDARDS R* Gess&e, Pimslw TB S T FmediBp of tibe m m m m hm hm n pt&p for pfelk&tioB by ih s ta f o ih Boro&o of L m I B M M l g l t m C J m UXMV C teeofM ifcoal C b m v m r d s W* H ffenr&a* M . I>,9 CJdef* f i w r i *msr $^Mm^ m m r miti&i IX I* &mp@ P i M k B m k k Sm m g* Wmhffigm* 1h . fenptom tl canear hm m s h&m plagued mimMad f t iouasms 4$ f&?%y adtm exposure t ageste w a&twal amrmmme$ mivh m solar radiation r k d m m m with m w orn, 'ch kkm m n hmm~ thsm&f h&m i m b i l m j hm n responsible for tk& oeeisrrene o cancers of iba exposed sMn mmzig m M m t workers m of am m r I the bladder among farmers of the M T i f w en d m o g prekktork times, lowetrar, it was so t until ike adorni of modem indnairialkm 8m led jeans gf th a t i^np-ationsl and mdmfry-rolated agents hm& attained preeminent positi, in tb s h m n m a m m t problem, Wot only gre scopati! e&rdngans ilm o&ly well defined known, zmmm of human cancers, ho t their im m m' r m m rieiy h&m gmdMj inarm m sisee F o li la 177B m i related th omwmne f m m h cancer among cM m m j sweeps t thok expos? t soot, Oor real knowledge m appreciation of oeenpatiooal eaaeer pro ducing egeot as phenomena of modem industrialism dates back some 'ftmm n O C T B E K &~~~MOW& S E S S I O N 12 7 75 years with the discovery of the relation between the occurrence of 8. cancer m d ax?occupational exposure to coal tar {%. l) . The data m ^ 0VPnS ^Mes (1 and la) briefly surxxmarbe the salient addition to the information on occupational cancer hazards made ernce that time. They list the various chemical and physical agents ^ far recognized or strongly suspected as causes of cancer In man. hey show, moreover, the different organa and tissues representing the target organs of these agents and the number of occupational cancer cases placed on record or known to have been recognised as caused bv them. & T able 1^-Qccwpalimal Cower, Recorded in he United States m d ^ r d g n Countries up to iMB VAWMWMVWMWMVM'V/ | isifies e ciscer Nua&er of, Kaxafisr o i now esm.wam ms! \ in i.vS.A., j Swepe ; 1 Coat tar. p i t ........... Petroleum__ ______________ _ Shale oils___ ______________ _ lignite fiar arid paraffin.... _........ Creosote G i l . . . . . . ____________ Anthracene oxi... Soot-carbon black_______ ...___ Aromatic taim es..*,,._____ _ Eoentgeu- and mimn-.mui\m. A m nio.______ ____ . . . . . . . . . . . . Asbestos. Chromates___________ . . . S t l e l .................. M t&r, piteU ................ Petroleum......................__ Beasel. ____________ Isopropyl............ . Hadk.&etive hexoe&s... . ^- v fikio.,.____ _ 7 . . . .]..., xlo......... 110 i . 70 ! . . . . -;...,,do....-.,,J 7| |...d o..,. .... ^v v A.! 1j . . . . !..,.do..,,...., AMAVAMJ -- I....do............ : I . . . f Bladder....: m ~ m \ || m d e.. . . . . ..i CO | . . . ii lAok&nda. id 1 ;U<nog,,..,,...J, v.>oV* x < . . . . i Inxig____ ,? ... 22 1 . . . I..... d o .. ,..... ..i i f . .,d o ... . . . . . i ">$ I 01 d Cumi e&v~ ; j :f' 0 |>vssai spins.: j 0 ...d o ....,, ..i 7j Lensemia...! U Itiin g ... 1 Ibswysxx.....: 4; (isf&s&l sinus.! 6 j Bernes..__ 0 i iN&s& &iji3s.i 3 25 ! s, m i 20 ; 1, 900 | 14 j 40 l 20 j 190 | 1, 200 1 (?) 1 13 l 650 ; 10 : 03 ; ^ 1 84 1 l j 58 38 j 81 \ 0 j o; o 1 0 1 0 | "tom 32 3,260 02 1,007 n 41 20 101 1,000 (?) 29 650 23 m 140 84 SI 53 40 42 I 4 6 9 8 . . . | . . . . . . . . . . . . j * 780 7,050 | 8,'100 *Approximate. ir>4 w $ m w & o f i a u b c Tabs. I a.-- Time Table of ZHmmriet of Oompaiional Canmrs | Ksm^cf&g&ai ; 0* i Diseeoma' ! {rigataaffected <Xatauiiiexposo O&taksSsMt-gssm' ; Sosti.... .................. tr;s ; ro ti...,,............,J B&Ut(assaii)....,...... Oceo^ioasl. Cmi Or (%U0.......--1 ST9 j Vdtemaa...............J FASo................... no. Cositas (fciltmiaous)...J w i Satila.................. ; Po. Oasi & isntBrsciO)......; mo 1Z-tg...,,___...J.....Cs................. n*. Cos!tar (fames)....---.i 1036 i K&w8h8te**vv*vv**v*.. %,!&>$.w s ISO. CrmmtM..._ 626 f OUSobcyb. S b U t , . .......... Bo, &ttt&ssseEs _,,,,,,J 6 | ..... no. &S<$&OU}_\ l??g i a?8....... .......... ~.j .....itt... . rm. FetroBisiastibcoke---- * 5S86 > .....do.. --------- ... Do. \ l sntiiaiifiiS. 1 FsiyataBt paratiaoa.-- ! JS16 | SaBaftifessieg........... 4 ... ft................... Bfh Pstroisaai feftrtesiingaSJ ...... DO, ClisilabHeotfcgbis.... .; 38? : WSson__....,,..,,..J Ba. Benaal_-- ; sa Pelcre & BfiO/sm&R&J. BiixyUteUsg tassfe. no. Amm'b assists tiy1 i8fe iteha................... \ emenc m&tst, few no. XsSaaptaierpm^eSSstss*)*.--- *"*-;| 3852 \Wait Srayih& ; N&adsinuses, Saryax, 0, i HBg. Oh&sal^s3e--inof$ssxies Amaio................... SS22 pwfe........ ...... ..: Do. 3SB7 UaiiMos........ .... MfiiSleSnaL 39,16 Saart!_______ Laos;........ ....... . Otxjapatissnal. A8S*tos.................. im ItySili &SffiHii....... .,,...8ft......... ......... Bo, OHramaOs...._....... cm FfeS.................. .J ... ______ ___ _ Do. Kittel.,..................... imz OraofoSi......._.... NiSBat i&aity and at- : Bases, long. \ X>0, Bhysicsa agone;: Ulfcavielei raisfetioa..... tm Ussm.,................ * g ............ ...... Do. Knotroniaontal. Ur*ngceaa!t..<.,_ 3802 Srit'bs......_...... OacapatitsasS, 1&S& WySS..--------...... __'Mi. .......... : Msdiciaai. mt VotiBsgfe,Sciiwares& BB(il4Y:fUgOiesKiS,; OsSBpatSonsl. von Sfcfesara<&, im Beak,....... Boas.................. j Moftlftsml, B&dteastiva sufestaae^.. tm Slaerttoga Hiss?..... Bsitsg................ . ; OrfitsTirAtonat. M.PBsb, WstB ariti SiriK.................... ; Bo. wars. VM __ .,,.v tlssoes.i V>'>. mi ..... ........ Bess.................... 5 I>i>v However, an isdiscriinia&te acceptance of those figures as reflecting the actual scope of ike occupational cancer hazards would seriously be misleading for the following reasons. The presence of occupational cancer hasards baa so far been established for only a few worker groups having contact with one or several of the carcinogenic agents listed. While, for instance, it is generally known th a t workers em ployed in gas works &od coal tar distilleries or engaged in the cleaning of petroleum stills and having skin and respiratory contact with coal and petroleum pitch and tar show an excessive liability to cancer of the skin, and apparently also, of the lung, there does not exist any official record of similar cancerous complications among electrode workem.in..ainminnm..pro.duction..pl&ua..whem.an..p.osum..to..iuBifia. OCTOBHIt S-'-MORSTIfeviJ SHS8XO&' of a mixture of coal ter, pitch, and jjefaafeum coke exists, M a b l c information, however, is on hand th a t those workers suffer from cancers of the akin a m i p m u U j ' X J o respiratory tract. The extent of this exposure W a r d may he Z tZ * iU b approximutely two4hmds of a pound of ofeetiode carbon is consumed for each pound of metallic S u n b u rn V!Ch 80a?0G *hort ^ w w " * k the United W * mfr one rm m h i <. < not thM * * * which have boon reported to &xmi^ workers of an industry of ^o kave the same effect upon the workers of S Z p tr f &mt Gr C m m y ! lf lhs a v a ik b k data would fu n tefm 1 r ^ ^ SiaCB Ciirdn ^ bdiava in their m m m itm d disease-producing properties like pathogenic micro- ^ a m s m s , there is no sound reason to assume that carciLgens make o i i T i / 1" f t?t ty r for any national r. mI j 11 f an bft abown th at such scientifically mcom- prekm aA k discrepancies are mainly due to local differences of report ing of occupational cancer cases, i nn m wT 2 l , Ti, T ia"ooe"r Tof thre hu* has0bf e*en* rlwepuo"rte"dtofrrotm" J4apa1n, t e t t a th f L"f a"i1, bu` not from " ? * * w * r <ipito the to n s are identical. 1lie occurrence of an appreciable number' of i c cancers of the skin among German u L of a ^ n l S im ?ould ^ Z P fa m l a r<K:0rd d u rk g receiit y ^ rs . If full credence q, f j b ffiVo to rrporte on arsenic cancers observed in the United w lr l? 3 ne WO' ik b k d i0 bo5iov6 ih a t arsoiucals la our part of the a S T i T T f ^ f r 1 r!WSt 6Xclysiv^ y tnediemai reasons. w L f * m10 * * **** would make such dis- tactions^ A similar situation seems to exist eoneemin* the ear- parts of the world. Although there were placed on record by English dUnagJ eCT **"** scver&l cases of skin can- xt;! d m to owmpatemal contact w ith lubricating oils nrschVatto noth,, . o8W .ll? known ,, U, the exL," t { i , S to b06? CMOBekantt tm^tli Tattrihbutin"g fb*ore"tfhe Eln"gl*ishAlolbas"e*rv-ations t*o*t"he ^ m o g e m e action of shale oils, the l a ^ c l c Z *m <o T ^ i ^l t d^S^ k a hf eca1n92c0e?rS?c"as*co i Wobsoerrveed *am* o*ng suhmefrs eebames, engineers and other workers having had exclusive com m et with lubricating and cooling oils of petroleum derivation. ' U U M E E T IN G O F XAIABC I t is worth noting In this connection th a t during' the last 20 years, there has been an almost complete lack of published additions to the list of occupational coal taf, pitch and creosote oil cancers of the skin from the United States, although such cancers have bees 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 cutout of from 100 to 250 eases 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 eases, ah occurring among employees of one com pany. During the intervening 15 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, soma consideration must bo given to the fact th a t the general population has varying degrees of contact with some of the carcinogenic agents through them presence in industrial wastes released into the environmental air and bodies of w ater, and entering subsequently the soil and the fauna and flora living in such a polluted environment and used in part for nutritional purposes. In the past, claims as to the oecerronee of so-called "neighborhood" eases of cancer have rarely been made. The well established former occurrence of arsenic cancers among inhabitants of a German region in which the drinking water supply waa 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 tion with carcinogenic aromatic amines was responsible for the production of bladder cancers among parsons living in the vicinity of this plant, While the actual existence of such conditions was denied at th a t time by other investigators, the recent demonstration of "neighborhood cases" of berylliosis makes such claims appear as not unreasonable possibilities since a highly potent carcinogen, such as bet.a-naphthylamtne, 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 a t the future occurrence of cancers of the lung and h<Sm among individuals who lived near beryllium- evidence of O C P B E 'B 8-- M H N IIS f S E S S I O N |g | f f f b a s a r related to en vh m m m H l plant pollution if beryllium and its compound* are not only carcinogenic for rate and rabbits but also for man Similar conditions of industrial atmospheric pollution mat around arsenic smelters, chromate producing plants, carbon blMk faetones and oil refineries, as well as uranium ore milk. I bo recent compensation claims advanced on the basis of an alleged C r im e a between cigarette smoking and lung cancer also point to the possibility of a greater future importance of the compensation aspects connected with the occurrence of cancere from industry-related sources such as exposure to carcinogens contained in the* exhaust fumes from diesel and gasoline engines, or present as additives and contaminants in foodstuffs. I t appears from those considerations that there can be no doubt that the actas number of occupational cancers is considerably higher than the miinbor of eases placed on record. I t is of some interest, moreover, tnat tixe number of caaes recorded k medical journals is appreciably tagimr than the number of occupational cancere which during the last 20 years have come for decision before compensation boards be- cause compensation claims in many such cases have been settled out of i m n > %it-ii a exceptions>such the inekienoe o lung cancer mnong American chromate manufacturers and among German and Lsecnoslovakmn radioactive ore miners, of nasal sums, larynx and lung tumors among American isopropyl alcohol manufacturers, and of skin cancer among English coal far manufactrete and processors, no reliable information is available on the incidence rate of occupational cancers of the various types among different occupational population groups. Speckst A spects q f O c& iqm tum ci Cancers A faff and competent adjudication, of compensation claims for cancers allegedly caused by occupational agents or conditions requires an adequate knowledge of the apodal aspects related to the production and development of these tumors and of the criteria by which they may be distinguished from non.-.occupational environmental (medernab dietary, cosmetic, habitual) as well as "spontaneous" cancers. 2* &&*&*<*>* f&f T*m u(kmpaHmai Cancer",--Thu term oc- euparionai cancer 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 out-ailing contact with some exogenous, physical, chemical or parasitic agent acting m proper intensity. Occupational cancers thus are caused bv specific agents 0r etbloglcally related to well defined occupational conditions which form an integral p art of the ordinary working environment. They differ through these aspects from the accidentJ m m m m d ,..w e r e Which resullfrpm or follow upon some, extrgww- . liH 0 O F IAXAB C o f 8 o o n s p M S e " " 'l l " e'de" tal " t u n e d >. worfs m i h,,m ,, ' * * ^ t Z lX al --Occupational zs/i wtfwhtr5pesof~ i ViUimS W s in ^ k e J ^ h G h ^ ^ m h&Vmg mumd largely cbemie&k. Some of the** e , me exposed to them are ^ f ^1>^ops1c^rinn Z f e S f 3pert"8* 1 5 i0SUlar w * * * % r ^ i S T a \ v T &ch8r^ ^ Rented by e tm to m tu M ^ I f L v ^ gmu^ is pro- ^ an occupational assodaiioa am] K ^ dltlons *& sometimes m fectio^ o , several * !* * ^ to * * ijo m l onditiom, ai<^ d K * elatK>ns io cai'ciaoge^is (table 2) " ^ m r or ?ess **><W TAS" ......... ..................... Osiss.rg..j ij-pj ;, ^ ^ < * r s ^ as; f~ Orpateehotoi- ; eais~Oiaatic, ; fxsiyeysito, iiet- : ttoeynile ' C n rcin w ^lter Organs ,, ' Pm bisssife typo ' ~- KflU&i 0?<'ApO';:,iii'O -W..,, ^ V . ... >fS ^ and ThTM ??$* Tilsit <>y%ixy. 4m?}, *S' piteS>**>*> ; i Cato*** tofa&3pafsigj^>ii_ : ; wl *"a tef | Sfeaie8 as<5parsa a pp____! rfi> 8fefa. i fi! *>%8*8 0, ICxtpanfr<8yi,s:y.'..'.`...".;.;.;.:.;.;fi! r Jilx' *** *, j ; PpassrrPaabiS)i,8at,ar, cafe amda' j >; ............ 1***, ! j ' Astetos^,, ' S f t a s r P - " *.;::: 1 SM. 1 -O *tl***m ,ium . ................................. I w I..... *................... j .....I , teg.....1..... <te,,,7;;;;;;*'-'i ''** ......j; C atanaaas..^,..'.'""! S k J *' i ....... | c iva ^ ^ #p3ai-> ' i pm m I '^ = = = d g ^ ^ 1 * -> . IS S S T " -4 > g Og S S Il -s-J'| . BL * & S' * * & K' S d<r o^ g ' r I I I r a ^ g _sLr 5H?y* j* l h U 5 4 M E E T I N G - QW I A I A B C Tabs, Bmirmmmtfd Mmmn Cartdmgm#--Continued Sito of to? Tjpja8KaCtfa83i> Secies Types fj<fcumus eo.'itoeu tight grwa 8'F ix&* SGnt him FOF imt tFCF, CeHepbsae, poJysiSsi- saS) palyasnide ayia5<tofceSra teflon, poiyraaUfyl rnathse. Subeatsuwawa | Fe,rantiiti.,., ... ilasac. I .....,,.,,.,,,J Oral..... . Spbontoecas.J jPawtefi..,, ,, Kat..v.*v.*. Textile dyes. Food arid ssusUs <tysa, Food dys {tonie}. Gsaoltoss dy*. Flsre color. Film, &btt, ptee-lndustrial msnafaetes sad usss. Wrapp&g sa&iffifSid. Medieio&l agent -j i>SBi5i<!?Si.. 13W _ feau.,... Ulsy, X-ray tods, phosphor sBBsafoatara, Selenium__ Li-'?, &??<!&},,Jj Onsl... Cobalt,_______,,v SnbeiU&aeous j iViatorU,. Atoiak eaerscy prodastSen. Soil mtsmtsaat. G W y metier of ceramics, pahsf, rubber, Metei alloys. Hssfoaer aeonUraior. S PfioteefceUfcappaRitos. i Becoioriser, FStoprooSag agent. Medicinal agsai. | Metal alleys aa>3plating. I Cokoio^ moiter of aaraad, patol. rubber. Medicinal exeat. it kzmiml$ HUmmisd a Em&mmtnM Human Cttmnagem sta ><ittmtm Tyf of as- posttra timU'i tsiended im StyryHSto,,,,......,,,,.,,I Sabaatnuaans ?iivse,,.,<...>q TiypihhKsiiiiit S-Aitosdisiia>.bi'!toss,I Sabaatssaans tissue, Livst..^___* grate, Thyroid. Aeousfie duct, Breast. : iAXtemih, kidnap, Bung, OraL,.,,.,..,,,.., J>,, wd*... wwl Famti.sraL Bax........... i ................... | ..... ..,, . ,,i tfiW'i i | ; ; i j | 1'fto'iriaida, 8. Evaluation of EitiAme&.-- Fax the establishment of causal rela t i o n between an exposure to these agents and the subsequent develop m m i of a cancer of an occupational genesis and therefore compensable nature, the following prerequisites m ost foe fulfilled: O C T O B E R 6-- M Q B N X N G S E S S IO N (*) Definite evidence m ust be available indicating th a t the claimant bad occupational contact with any one of the various agents listed, that this contact was either of prolonged nature extending as a rule over periods of at least 6 months^ and was of adequate intensity for eliciting a cancerous response, according to any previous experience which might bo available on this point. Single 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 tbs carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cncer is elicited. Therefore, not any cancer, bu t only cancers of specific sites are related to any particular carcinogenic agent. {c} The type of exposure does not need to he continuous or extend up to the time of appearance of the cancer, but may be intermittent. In fact, any contact with the occupational carcinogenic agent may have ceased many months to years or, occasionally, even decades before the cancer becomes manifest. Effective carcinogenic exposures may be sustained not only by the ordinary operators employed in operations with occupational carcinogenic hazards, hut also by workers entering such operations on & 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 characteristic of a pathogenic action of the particular carcinogen allegedly involved, Such noncaneerous and often preparatory or procanoerons symptoms of etiologic specificity act as stigm ata or biologic finger prints supporting not only tbs actuality of a previously sustained specific exposure, but also its causal relationship to the cancer present. Symptomatic manifesta tions possessing such a significance are, for instance, chrome rsdksdormatitis, chronic ta r dermatitis, arsenic dermatosis, chronic solar dermatitis, chronic radiation periostitis, asbestosis of the lung, and kmkemoid reactions after exposure to benzol and Ionizing radiation. Chemical analyses of tissues for the incriminated chemical also may sometimes be of assistance in establishing previous contact with any apccific,occupational caremogam, such, as arsenic., chr.Q.mismp.xdckoiri radioactive substances, and benzol. 1954 M E E T IN G O f I IA B C I t is important, however, to note th at both these procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any etiologiceily characteristic symptoms, in fact, they m ay not elicit any 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, interm ittent, or dis continued exposure to certain carcinogenic aromatic amines. There also does not exist any parallelism between the toxic and/or irritative properties of any chemical and its potential carcinogenic qualities, nor, is there a relationship between the degree of toxicity of any particular carcinogen and its relative carcinogenic potency. (a) Extensive experience w ith 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)* f t is 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 be subjected to severe scrutiny for a more probable nonoccupational origin before they may ba considered from any occupational viewpoint. Tabj.5.--Latent Periods of Occupational Cancers Orgaa and agent Skin cmik'i Medicm&L ___ _____ ______________ Occupational-.. . . . . . . . . . . . . ______ .._________ Tar........................................................................................ Creosote o iL ._______________________ ____ _ Mineral ail________________________ _____ ________ Crude paraiKn oil________ ______ ____ ____ _________ Solar radiation......___________________ . . . ________ X-r&diatioif __________ ________ __ Lung A sbestos.............___ ______________________. . . . . . C h r o m a t e s .................................. ........................ Hiekcl carbonyl__. . . . . . . . . . . . ___ ________________ Tar fumes____ . . . . . . . . . . . . . . __ .____ . . . . _______ Ionising radatios___. . . . . . . . . . __ . . . . . . ___________ Averts ito Rang of p&tiA iotis petit# ! Yearn 18 25 | 20-24 25 50-54 | 15-18 i 20-80 i *tr IJ \ Years 3-40 4-46 1-30 15-40 4--75 3-35 ci--40 1-12 38 | 15 22 1 IS \ 25-35 | 15-21 5-47 0-30 0-23 7-50 Bladder Aromatic am ines..... 11-15 | 4-40 O C f O B U E -- M O K N I M S S E S S I O N 1S T (f) A successful production of cancers in experimental animals by the administration of any particular chemical or occupational agent supplies weighty support to a claim th at such a factor may have an Identical effect upon man, especially if the route of exposure, the physheheraieal status of the agent during contact, and the cancer produced in os|?erimentai animals are identical with the corresponding aspects in human experience. However, because of the pronounced species specificity of axogenous carcinogenic agents, even positive experimental evidence provides merely strongly suggestive but not entirely conclusive evidence as to the existence of carcinogenic proper ties of such agents for man. Only human experience gives a definite and irrefutable answer in such matters. (f/3 Pathologic and histologic evidence is in general of only limited 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. However, in some occupational cancers histologically or lustoeharme&Hy 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 scientific proof sis to the asbestosie origin of such a prdrncnary carcinoma. Of similar causal significance would be the demonstration of chromite dust hv bis Sort'read methods and by incineration of sections of the lung of an individual with pulmonary carcinoma. The hintodunnica! demonstration of arsenic in the skin affected by & carcinoma represents another Illustration of the value of histologic studies in the determination of the etiology of a cancer, Likewise the presence of extensive end&rtoriiie 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. It appears from these considerations that a competent and critical evaluation of the entire evidence related to the exposure of (he individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, seme histologic or histoehomica! characteristics and the existence of corresponding ob servations on cancer production in experimental animals aside from pertinent epidemiologic data represents the scientific basts essential for medicolegal decisions in litigations of alleged occupational cancers. C, C om pensation Laws Workmen's compensation laws enacted in various countries anti states reveal a remarkable lack of uniformity as to the types of oc cupational carcinogenic agents, industrial operations with carcinogenic .......... 'm m -- ......................................................................................... . \ y.i: : . 13 8 1954 3 0 M B rm & O F IM A B C hazards, and occupational ameers covered. As of October i, 1954, foil coverage laws applying to all kinds of occupational diseases in eluding cancers had been passed in 26 Stales 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 ami Wyoming). While workmen's compensation laws based on the principle of schedule coverage may provide some degree of compensation against disability and injuries resulting from occupational cancer hazards, such legal provisions designed for the protection of workers are totally inadequate, if not obsolete, in an ora of a rapidly changing and in creasing occupational disease panorama. Such static laws reflect a legal and sodologio state of mind which k 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 cancer hazards, usually has a statute of limita tions which is inadequate for providing fair protection under certain and not too unusual circumstances mot with in occupational cancer. Since occupational cancers may become manifest, many years alter cessation of exposure to occupational carcinogenic agents, a statutory time clause of from 6 months to 6 years m ay ho too "short for occupa tional cancers which mav appear after a longer period. 11 is advisable for this reason to adjust all existing laws in such a way th a t such eventualities are properly covered. l a the workmen's compensation laws existing inm ost States, certain groups of workers or employees, such as especially farm labor and domestic servants, are excluded from coverage by the law. Since farming as well as housework h&va become and are increasingly heeomi?>g occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilizers, antisprouting agents,, hormonal fattening agents of livestock, lubricants and rise! o f f arm machinery, residual oils for smudge pots, soil improvers, antibiotics, detergents, waxes, polishes, d ry cleaning agents), there is no sound scientific mason 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. O C T O B B 1 6-- M O B N IN G S B B S IO M 1S 0 &* &&&%andStandards Any attem pt toward achieving an adequate compensation by finan cial means for a cancerous condition acquired through contact with occupational agents no t only presents considerable economic dif ficulties but is also of questionable humane m e rit While such & procedure is evidently the best th a t can ho done after an occupational cancer has become an accomplished fact, the wiser, more rational, and in the long run, more economical approach to a reasonable con trol of occupational cancer hazards lies obviously in their prevention wherever this is possible. This goal c m be achieved to a large degree by the enforcement of proper work conditions in operations in. which cancer hazards assist, so that either any contact of workers with such agents is eliminated or reduced to an ineffective level. As to the fundamental step for accomplishing such a control of occupational cancer hazards, if would be ailvis able to have all factories, workshops, laboratories and other establishments producing, handling or using known or suspected carcinogenic materials to register with State public health and labor agencies. This information would provide the basis for establishing the supervision of plants by health 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 cedures hy which they might he controlled or avoided, The relative effectiveness of any medical, sanitary and technologic control measures to he adopted can best be determined hy ascertaining the changes in the occupational cancer incidence among the total population at risk occurring during some 10 to 80 years alter their introduction. It is therefore desirable th a t provisions bo made for routinely recording all cancer cases occurring among worker groups exposed to occupational carcinogens. AH precancerous and cancerous lesions observed among members of such 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 messum-s represents an im portant stop 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 indostry-relat&d environmental factors for the startling and progressive increase in the lung cancer frequency observed m i m M E E T IN G O F IA IA B C m all industmimed countries during the past 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 erode mortality rate increased from 1.0 per 100,000 of the population in 1000 to 4.3 per 100,000 in 1044. This development' coincide with a marked increased use of ionising radiation as well as with a widespread industrial and medicinal employment of chemicals having distinct hematotoxic effects. O C T O B E R 8-- M O R N I N Q S E S S I O N U also may be of significance th a t the age-specific, total and ageadjusted m ortality rates per 100,000 population for skis e&neer In white males and w hits females in the United States have shown between 1030 and 1050 a marked shift in fa ror of the younger age groups (table 6). Whether such changes in the age distribution of skin cancers for both sexes may have resulted from the modern habit of sun bathing or a mors intense environmental, occupational and dietary contact of the general population with arsemoak, or with products of the eosl tar and petroleum industry, remains at present a m atter of speculation. For determining the possible a n s i signifi cance of such factos-s in this development, it would be necessary to ascertain data on occupational, dietary, environmental and habitual contacts of the affected Individuals, their complexion and race, and TaVls .~~Ago-spedJk, Tidal, and Age-adjusted Mortality Rates Per 100,000 Population Sor Skin Cancer in White Males and White Females, United States, fm o, m o , and M 0 TJader 18 1$*24............................................................._ .......................................................................... ^5--34 _____________ 88-4 4 ,,. ___ ________ _ 45- 84. .................................................... 55-84................................................................ 85- 74. . . ,, ..................................................... 75-84.......................................................... .. 85 as over__________ ____________ . . . Al! a g e s._________________________________________. . . . . . . . . . . . Age adjusted J___ ______ ______________ xm | t ; itm i : timstnt ma-S) 6.60 . n .22 .75 2. 5 &6 28- 7 88.2 164.2 8.8 4. 7 i 0.0d i i .11 : .46 \ ! . 85 ; 2. 1 j 5.8 1 ; 16,0 i i 82.3 j ; 172. 4 > a si i 3.6 i ! i ji 0. 03 ,34 .81 l 4 2. 7 5. 9 12. g 32.6 77.5 2.2 2. 6 --82 H-20& + 76 +65 + 28 -OH -2 0 -3 8 -5 5 WSti&feiaas&ss "*WWWWWM'WMV,WM-v w w w w w /w O fcOa U nder 15,___. . . . . . . . . . . . . . . ____ ________________ 1 5 - 2 4 ................................................................................................................................... 2 5 - 8 4 .. ............................................................................................................................................... 3 3 -4 4 ........................................................................... 4 5 -8 4 ... 5 5 - 5 4 _____________________________________________________________ 65--7 4 ___________________________________________________________________________ 7 5 - 8 4 ........................................................................................ ......................................................... 5 5 4 -............................................................................. A H ages. A ge adj u sted 1_____________________________. . . _____________________ .............................................!.. . -- t Adiastea fe? < posaaSaassa &ftke naiM m 0.07 .8 8 .2 8 . 88 1.8 2 .8 11.4 44 8 182. 7 % 1 2 .9 j 0.07 i .13 i .23 i l 56 i 1,0 | 2.6 i a? 26, 8 I 132. 7 i } 2.8 ? I S- 1 i . 81 .7 3 1, 2 1.8 3. 6 8. 8 ms 68. 5 2 .0 1. 9 -7 1 + 138 +213 +118 + 80 +24 -2 2 -2 8 -4 8 X., ---- 142 1&S4 M EB T X N G O F IA IA B C on ills location of the cancers in the exposed or unexposed parts of the skin, (site distribution) > AM such d a ta 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 mo eh 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 m a M tm m em m orn m m m * a scm iA m m m m i#is - mm m am vs.. Ossara 2 G TO B S B 8 --M O E N IK G S ES S IO N years ago by H enry in winch lie showed the striking rise in the number of oases of cutaneous carcinoma m males and females in England, Wales and Scotland attributable to occupational exposures to coal tar, pitch, shale cdl and mineral oil after statutory notification want into effect 1, The rapid development of modem industrialism has been asso ciated with the appearance of many new occupational health hazards of which those causing cancel's occupy an im portant position, 2, The increasing rate at which occupational carcinogens have been discovered during recent decades suggests that only a fraction of the actually existing kid ustrial carcinogens is known and th a t here tofore unlaiown and new occupational carcinogens may be added to the present industrial environment through the development and use of new chemicals and production methods, S, 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, the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported number of occupational cancer eases and hazardous industrial operations. 4. Medicolegal decisions in compensation procedures of occupational cancer claims should he 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 hbiochemical characteristics, the production of corresponding cancers in experimental animals by the incriminated agent and pertinent epidemiologic data. 5. 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 cbamicals ami production methods which 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 eancer hazards, 6. Since the prevention of occupational cancer hazards and not financial compensation for established occupational cancers appears ...l-o he the mori:L.tansib!c and humane ntebhM of occupational oaitoer.. 144 1954 M B E T 1 K 6 O F IA X A B C control, labor codes should be properly adjusted and enforced so as to eliminate or reasonably contain occupational cancer 'hazards in mod em industries, ?. For aseerladuag the actual scope of the occupational cancer problem and for the institution of adequate control measures, it is essential th a t occupational cancers and, precancerous conditions arc made notifiable with local and State health and labor authorities. B< A comprehensive study of occupational cancer hazards will provide a sound basis for an equally urgent investigation of the apparent extension of Industry-related cancer hazards to large parts of the general population, BIBLIOGRAPHY t> Hvapsjs, W. ., Occupational Tumors and Allied Diseases, C, C. Thomas, Springfield, TIL, 1942, p, 887. H w o t Developments in Environmental Caneer, A. Review, Arch. Pathol. In press. A Methodology fo? Bavirosmentftl And Oeeup&fckmsd Cancer Surveys. Pubs. Health Tech, Monograph Ido. 1, fl. S. Public Health Service, Depart meat of Health, Education and Welfare, 1950, p, 37. 2, Teasko, V. M<, Occupational Disease Reporting. U. 8. Department; of Health, Education and Welfare, PuhL Health Service Robl. No. 288, 1958, p, 80. ` 3, Brmaai?, L. K., Recant Trends in Occupational Disease Legislation, Uuiv. Bilnoh Bull 43; No. 89, 195?, p, 30. ' 4, Mourns, G. G., ami D.o/ iSncoot, S, <1,, State Compensatory Provisions for Occupational Diseases. Bureau of Mines Information Circular 7850, U. S. Department of the Interior, 1952, p. 125. & WATUas, I s . , Indissfcdsl Physician and Workmen's Compensafcion--Curmit Trends in Corrjpensat.ioa Legislation. 3 . Indust. Pyg. and Toxicol. 31; 251- 25.5, 1948, 8. sSimmvMirszz o s LsosatAtj&s? PitmensAs, A Rational Appro&dt to Air Pollution Legssiatio. Manufacturing Chemists' Assoc., 1952, p. 23. 7. TooK.aKUEAi;, P. J,, Health of Workmen; Appreciation of Risks to Which Health of Workmen Are Exposed in Industry in Province of Quebec, Canad. M. A. 3, 54; 352, 1946. Tib A c c i d e n t P r e v e n t io n A s s o c ia t io n s U n d e ? t h e Q u eb ec W o rk m en ^ C n o ip eo sa tio n L aw b> H, T. Cusci'L President, Quebec Association- for dm Prevention of Industrial Accidents f/a the absence of Mr. Clegg, his xioiemsni was trad by J. Armand i)exn>cher$} rice president, Quebec Association far ike Prevention of Amdeaisj I will outline briefly the setup of the various safety associations, and. l&ter, being more familiar with the organization which I represent, I shall endeavour to elaborate on a few of it m ajor promotional ......... ,.................... ............................................................. APPENDIX OUesal Atteadaace at the Fortieth Ah i I Meeiimg f th e Snteraatioirm! Asseeiatlea Industrial Aedsden t Boards and Commissions CHB Alberta . Fasmsaw M, B, B., Commissioner, Workmen's Compensation Board, Ed- moaton- J3s, H, H< Hisrayarf, Chief Medical Oflieer, Workmen's! Compensation Board, Edmonton* 0 , M, Ma-Ossob, Q. C., Chairman, Workmen's Compensation Board, Edmonton. British G am bia f< A kkba-o, Secretary, Workmen's Compensation Bimrd, Vancouver. Aam Bku<, Chairman, Workmen' CompetmiJon Board, Vancouver. C, W, ParrcHas, Commissioner, Workmen's Compensation Board, Vancouver. Mvnilria Gy lx- Coosas', $. Gr, Commissioner, Workmen's Compensation Board, Win nipeg- P, Y. E, J m m , Assistant to Commissioner, Workmen's Compensation Board, Winnipeg, N m Btumirisk A. A, Cmsiaot-ss, President, Hew Brunswick /dcident, Prevention Association, Moncton, IL G Johsstok, Vies Chairman, Workmen's Compensation Board, St. Mm, J. A, Lk$ lm:c, Claims Officer, Workmen's Compmsatioo Board, S t John, Newfoundland Cs-Atmites . H ancock, Commissioner, Workmen's Compensation Board, St. Joints. Nom ikotia arsoa Parai, Commissioner, Workmen's Compensation Board, H alite, P&aka Row's, Chairman, Workmen's Compensation Board, Halifax. Ontario J. P, Cass-ot, Vice Chairman, Workmen's Compensation Board, Toronto. Max Bonoa, Ontario Federation of Labor, Toronto. F- Fmcn.tu, Workmen's Compensation Board, Toronto. G eouok Gannow G k ssn k , Dime tor. Federal Government Employees Compensa tion Branch, Department of Labor, Ottawa- W,, J. Jon.vsroN, Workmen's Compensation Board, Toronto. J. B. Lars, Department of Labor, Ottawa. - ........ S&k........................................................ ..................................... 1954 O B U .B C EtJG&fs Lasgckmr, Secretary General, Quebec Metal Micing Association, Quebec, N obi. Lakochs, Workmen's Compensation Commission, Quebec. D r. Arthur Lkcprro, Chief Medical OSsee, Workmen's Compensation Com mission, Quebec. Dis. D. Lbokab, Workmen's C om petition Commission, Quebec. T. IS, Lmx.s, Director, Quebec Metal Mining Association, Nor&nda, MG E, MaKiGOMB&y, Safety Director, Kenneth B, S, lobertso, Ltd, Montreal, Emnmr-a Monsrr, Q, C<, Commissioner, Workmen's Compensation Com mission, Montreal. J. Au 'Rokss Mo-renct, Workmen's Compensation Commission, Quebec. Jban Pur. nia, Orthopedist Technicit, Montreal Romeo Faotjrt, Workmen's Compensation. Commission, Quebec. D onat Quimper, Depot;,- Minister of Labor, Department of Labor, Quebec, G. Ant, Ropsskap, Workmen's Compensation Commission, Quebec. F. M,, Eocirei-SAO, Commissioner, Workmen's Compensation Commission, Quebec. D asun RomuaB, Workmen's Compensation Commission, Quebec. EvaataTB R ocitve. Commissioner, Workmen's Compensation Commision, Quebec. L JL Sx.osroe, Safety Director, Canadian Johns-Manville o,, Ltd., Asbestos. W. H. Souxak. Assistant to Mine Manager, Canadian Jolms-ManviUe Co., Ltd., Asbestos. Da. Gam u,& &mard, Workmen's Compensation Commission, Quebec, Bn. F, L Tourangeau., Divisioxs of industrial Hygiene, Montreal, Da. B, . T urcot, President, Industrial Medical Association, Montreal Cskarxs T rsmbaay, Deputy Minister of ,abors Department of Labor, Quebec. L. P, Txs&rsKy Workmen's Compensation Commission, Quebec. Jacques VzsxgAxruv, Secretary, Workmen's Compensation Commission, Quebec. , 0 . Waukbr, Superintendent of Safety, Crane Limited, Montreal. Bn. R. E. L. Watson, Medicts! Director, Crane, Limited, Montreal. Sr, Gbprou Wums, Workmen's Compensation Commission, Quebec, 8 &skal$hewan M, D> T hompson, Commissioner, Workmen's Compensation Board, 0 . W. VAU.r.Atf, Chairman, Workmen's Compensation Board, Regina. C. C. Wxaams, Minister of Labor, Department of Labor, Regina. Regina, iabaaia J o s L. Coikman, Director, Department of Industrial Relations, Montgomery. ArMm&s G. L. Grant, Attorney, United Mine Workers, Fort Smith. Q, W. HoejMks, Commissioner, Workmen's Compensation Rock. &5OAP B, Srs.ES, Commissioner, Workmen's Compensation Reek, California CommxsioR, Commission, Little Little C&ss? Framer, Guarantee Insurance Co., Los Angeles. Joseph J. Gaixaoher, Manager, State Insurance Band, Burlingame. ...SLAW BLkinoALnL'Oiaifuan, Industrial AaoMnf Cdnixhwa>h, Slin'WrarKiiscb!'' APPENDIX c Pak, SvHAmiza&mth Bfreotor, Department of Isdustriai Relations, San Frmmco. Dr. "Bzm S. Taossas, Department of Employment, Sacramento, H, M. Wma?;, Department of Employment, Sacramento, tthrado Bt li, B&akx5s?( Chairman, himi&i Commission o Colorado* Beaver. Ha&o, C, TiHmum:-;, Diced or f Claims, State Compensation loeor&oeo Fml, Denver, Vmmcticvt B* E, Oooohux, Hartford Accident & Indemnify Co,, Hartford. . H, O sase, President, 'ToM date Ifoose, v'oryto'ivn, W. & MeCoisex, The Aetna Casualty & Surety Go,, Hartford, Delaware Abel K oatv, Spe-oial Coursas?!, E, I, d u Pos s to Isfon-oors . Co,, W ihim gio. Br. J, J< MacCoatty*, Member, Industrial Aeeidont Board, Wyoming, Jassa. . Mt.mus, President, Industrial eeidfc Board, Wib&iagton. Pos K. 'Wshhtotos, Member, Indxtstrai Accident Board, Laurel, Dlrci of Columbia R&gw J. B i m u x k , Member, National Legislative Committed, Americas Federation o Labor, Fa?4k. F sssbaok., Associate Direstor o Edneathm A Research, Congress of ludnsim l Drg&r.h&Giom, B&ocm A. Gkssxs, U. B, Department o Labor. Papa 12, Oo.astcs, l&orot&Fy-Treasure?( LAI ABO, U, S, Department of Labor. Dr. W. 0 . Hemran, Chief, Environmental Cancer Section, Cancer lusfifufo, Department of Health, Education sod Welfare, Befhesda, Md, Ho, Aktkuk Laicos, Under Secretary of Labor, Jobs E. Ls'y&b, Chaim as, Employes Compensation Appeal Board, IL S. Department of Labor. Mason V, LenriKee'T.i,},, Olflee of ibe Beerei&ryD'rcasurer, A IA B C , U. 8 . Department of Labor, Wrusam McCauekt, Director, Bureau of Employee' Compensation, U, S, Department o Labor, Ftu ax McKnnor, LT. B, Department of Labor. FAAAcm C, Smyth, U. 8, Department of Infoor. lQ&mr Vau IYSttms United Mise Workers Welfare rmd Retirement Fuad. Fl&rida <amk&Cattsaos, Member, ledutriai Commission, Tallahassee, B, T. Comtus', Caserai Counsel, Industrial Commserton, T&ii&hxsane, Boonmv DuariAHca, Director, Workotords Compensation Division, Industrial Commission, 'Bailbanse, dosis A. Pa&Xs, Ori&odo, Jamsb T. Yoest&s, Chairman, Industrial Commission, Tallahassee. Georgia R icuesn W. Best, Secrefary-Treaaur?, Board of WorkmatCs CfompeoxafioK, College Park. W, E, Bocxnoss, Member, Board of Workmen's Compensation, Aplasia. fHpiVrV,:;" c c C . A; :pi .t.; I: > v'-ei. 'yxsppx-Ki.% '-t&Wl p la w v w is s 3; sao^ y ^ssrvrraj^ "3$ yt0j:pmj; fw?so;pw| jo 'iiXinxx'^-iQ youojBssmitJiQ to ^ y `m:myj *my& 8%9nW9% & & p I l '| F tjB S ss s gr 1 sa *M>i 3 O m 8 a 1C5 PT n*3* e&8 5$* bT 90 B 1 oS3 9 S Bg I s Pi oI, I I 5g $K oe !0 1 5B3. Ci 3i &K ^0 w mo ^ i I p Pm?'Ig 'I jg ^ & t, ^ g K w > S5 U fi J a ls DETOT 0 DHH/Eg n u appendix g 233 Mcme J a m W, Ballou, lawyer, Barsgor, Mrs. Ma&!iIH Baekabk, Industrial Accident Commission, Augusta. Grati. M, Jolt, Member, Industriai Accident Commission, Waterville, Jabm M, MffdmUi, Lawyer, Bangor. F. E, BruuABOSOK, Portland. M&ryhni M m vm L. Pmn, Ofc&irm&u, Industrial Accident Commission, Baltimore. Dr, Jon s V, HorasKs, Baltimore. W. ALooser Msrohks, Commissioner, Industrial Accident Commission, Baiti* mom Path. Ssbkebs, Jr., Manager, Compensation Department, Maryland Casualty Go., Baltimore. Hnnav B, Borea, New Amsterdam Casualty Co., Baltimore, M&mwwsUii Ba. Albxakop P, A n m iii Ch$irmm, Subcommittee on Industrial Eolations, American College of Surgeons, Brookline, AnraoEsn S. Bachosowsk, Attorney, Salem. B ava B , Basxa, Employers Groups Insurance, Boston, Thomas W. Bows, Member, Division of Industrial Accidents, Boston. E . B. Cooras, Dbaotor of Medical Eelations, American Mutual Liability Is* anranes Go., Boston, B do&kk H< Cimeox, Chairman, Division of Industriai Accidents, Boston. P&A&m E, Goormer, Director of Self-Insurance, Division of Industrie Accidents, Boston. Svaswoo L. H ausos, Assistant Aloe President, Liberty Mutual Insurance Co., Boston. G> 8 . Hahuah, Flee President, American Mutual Liability Insurance Co., Boston. James G. BDas&nr, Attorney, Massacbusette Bonding and Insurance Co., Boston, Mahck&a J. Hicks, Boston. M sar F. Hrcue, Member, Division of Industrial Accidents, Boston. Elias J. KotorowAS, Member, Division of Industrial Accidents, Boston, Eowaug J. Mu&rsrsr, Attorney, Boston. Many A, Hooka, Boston, srn.Kr St, ClAi, Counsel, Liberty Mutual Insurance Co., Boston. Joseph A, Suuavak, Chief Examiner, Liberty Mutual Insurance Co., BostonM ss. Emma 8. Tonsanr, Past President, XAXABC, Quincy. Michigan W, C. Bruitoa, Manager, State Accident Fund, Lansing, H abkt F. Bernes, Superintendent of Claims, Stato Accident Fund, Lancing. Wkuaam B. B ocuanak, Chrysler Oorp., Detroit, . E. Caso?hkns, Ford Motor Go., Detroit. John C. Osamaas, Lincoln Mercury Division, General Motors, Detroit. H. A. CompUau, Attorney, State Accident Fund, Lansing, WiSMAas J. Dxvese, Cbrysler Corporation, Detroit, Crams E, Boaro, Cforysisr Corporation, Detroit. I amzs L, Hmn, Supervisory Attorney, Workmen's Goiapensafion Section, Ford Motor Co,, Detroit. ...... ...................................................................................................................... 234 H R H M E E T I N G O F LA .B C W. L Hm'onxms, Compensation Supervisor, Chrysler Corporation, Detroit. B m m & S. J m m a x , Manager, Employee Services Department, Ford Motor Co,, Dearborn. WisAiAM h Jos'as, Lacey, Joses & Boelle.. Detroit. F. A. Lux, Staff Attorney, Workman's CDrop&ns&tion Section, Ford Motor Co,, Dtroit. Wads H, MsGxsa, Je., Memher, Workmen's Compensation Commission, Lansing. W. E, McGs &cox. Vice President, Michigan Mutual Liability Co., Detroit. Bar.aasm Etas c ok, teprasestiag Sinnu! B, HoravGs. Muskegon. S sechasis E. Noams, Chrysler Corporation, Detroit, Roes-mr L. O'Cox.vsu., Eothe, Mraton, Rohn & M&aoy, Detroit, T 4x0005: P. Et&s , Chairman, W'orkmen's Compensation Commission, Dimon dale. Rrmm.m !,. Bonmu, Iniem&tional Representative, :o:?xmsMkm Department, CJAW-CIG, Detroit-* , . Sosaoxx Fine IPresideS: in Charg Claims, Corporate Servies, too., Detroit. Fan B, Waknes;, Attorney, Auto Owners Insurance Co,, Lansing. Mmmseia Rosaa? B. Farscv, Commissioner, Industrial Commission, St, Paul. Miggimippi San S. AujiSOf Commissioner, Workman's- Compensation Commission, Jackson. Io n s A, Crag, Chairman. Workmen's Cornp&iss&fioo Conunisslon, J&eksos. M&mti WiMJA Q. Hvhvu, Rupertnteudsiit, Workmen's Contpimsaikm, AmermatsAssociated Insurmsce Companies, St, Louis, CnnSims F, C-tras, Member, Industrial Commission, Jefferson City, Eawl F. Cssferr, Assistant Professor, St. 'Loues University, t> Loue E. Rossa? Cak, Attorney, Kansas City, W, E, FansLAifti, Member, Industrial Commission, J&fferaon City. S p s x s r K. CTsae, Director, Division of Workmen's Cksmiimisatioo, Jefferson City, Srsmtxx J, MJxx&rr, Chairman, Itsduetmi Commission, Jefferson City. Mtiniana W, W. CnKf-aa, Secretary, Industrial Accident Board. Helena. Nets Jersey W mmosi Soaks. Chubb & Sons, Maougars, Federal Tsmsmnee Go., Short HiSR. Da. H. E. Bsf fixas. Hen' Lisbon. Gare, Hono^aMAX, Coio.mlxaioaer. Department of Labor A Industry, Trenton. D-uss, A. Spai, Director, DMeioo of Workmen's Compensation, Department of Labor & Industry, Trenton. New Maxim EKKasensi Joses, Assistant Commissioner, Labor and Xndisstri&i Coiutaisssoo. Santa Fe. AFFEND C N m> York Ermsrnt E v Ai.ss, Managen Claims & Safety Department, Soeony-Yaeuum Oll Co,. lue., New York. Lxns A saarr, Actuary, 'Woodward & Fondisler, New York, S . D busy BmnAU> JMmciot, C m pwm tsm Safety, ttmtfm toeem otim Co., Schenectady. Miss OkwrsonB CavA&Anatf, WorkmenY Compensation Board, ih&oy. kAm<wst > Cykb&t , Ysee President, Fidelity Casualty Co. New York. {Inresa T, C&attm, New York, Makwsaw Dabwc-k, P art SeereiEry-Yreaijure?, lAiBCL New York, J* A DyrrnscitSES, Secretary-Comptroller, National Council on Compensation Insurance, New York, BiMWAas Xhssra, State Insurance Fund, New York. Msas Ma&y D ostlos, Chairman, Workmen's ofnpesation Board, New York, J. IU .p; I>y&ns, United States Casualty Co,, New* York. Jo sse n Dban E owakds, Attorney, New York. R.-Ckas lYiM&iLi.iKK, Woodward & Fendiller, New York, C, E ra ra Fox, Secretary, Casualty .Division, Gkma Fails neurasee Co., Glens Falls, De . LaosASi) J. OocewAran, National Chairman, CkndiaodnMndestry Cova- mifctse, American H eart Association, New York, Wj.sa C. Co irro r, C. E,, Director, Imlioie for the Crippled and Disabled, New York. Msas 5eascsurra H r s to s , Aasociaie Eonnonust, Work mers A Compensation Board, New* York, Aurasc Hssrnsx, United Steelworker of America, Bntfaka TMJSOiKms B s ra .ra , J m, Attorney, National Association of MsAitud Casualty Cos,, Now York, F, H, H nnriiiMs,, A. 0 , F. Indus! ries, Now York. IL Ai, J acsso, Manager. Bsdusfmi Health Program, Johns M&nwllle Corp.. New' York. Amoksw KALsarraow, New York. Eowra D, K n.x, Counsel, Now York Comisenaatiors Insurance Hating Board, New York, M. L, Labsow sat, Western Ekwtrsc Co,, I ne,, Now York, JoHK- M, M cDo&aPS, Director, Borkm en's Compensation, Associated Industries of Now York State, lue,, Albany, B os ea r E, Ma-obau,, AdsninistralWe Deputy, Workmen's Compeusaiioa Board, New* York, BOSr,E F . MiJiBoari, Manager^ WorksueuY Compensatio A Disability Claim Division, Amenrau Surety Co., New York, Mouab, J. ?v! vmrsrv, Douerai Manager, Association of Ni>w York State Mutual Casualty Cos., Now York. Bat i . akxby. State IriSnrant Bund, New Yxnk. Miss Massoou Poj.AKor, Secretary, United Steelworkers of America, Buffalo. Mrss Mart Pouskov, Butfalo. Jasks }. Bram s, Secretary, The Belf-Insurera Association, New York. H. V. R.tak, Fidelity Casualty Co. of New York, New York, Hsn st D. Satsb, General Manager, Now York Compensation lusur&aee Bating Board. New York. , M, Scasfrn'r, Insurance Manager, National Coxmoil of State Seif-Insnrera Association, New York. m 1854 MEETING OF IAXABC $&mui E, Saxw m , Attorney, Americas Telephone & Telegraph Co., New York. Cmams F. Smtteb, Claime Attorney, New York Telephone Co., New York, W w u tm M, B m a tn s , A ssocie Attorney, State Insurance Fuad, New York. J, Hahht Trssaw, Attorney, United Steelworkers of Amnes-, Buffalo, Wapsmh , Toc& as, Counsel, Utica Mutual Insurance Co,, Utica. Gao, D. W m s, Western Electric Co., Inc., New York. N. M tm m W ooes, Association of Casualty & Surety Cos., New York Qu. M. WxuAkH S o c s s s , Director of Studies, Commerce & Industry Association o f Now York New York. North Carolina, J. W. Beam, Commissioner, Industrial Commission, B&lelgk North Dakota, Gt%s B utant, Chairman, Workmen's Compensation Bureau, Bismarck. B. M, Rvah, Member, Workmen's Compensation Bureau, Bismarck. Ohio H. B . Basokst, Emile E. Wataon, Columbus. Jacob Cbatman, Secretary-Treasurer, Ohio CK> Council, Columbus, J, Matkasu Dxcess&soo", Vice Chairman, Industrial Commission, Columbus. B< 0 , Gorrmausnmra, Superintendent of Claims, Farm Bureau Mutual Auto Insurance Co,, Columbus. W, 0 , Hautman, Attorney, Squire, Sanders A Dempsey, Cleveland. M. Hot&Atro Kaisu, Director, Workmen's Compensation, Frigidaire Division, General Motors, Dayton, John K xm rm , Ousted Rubber Workers, Akron, Etchaud W, M ossa, Chairman, Industrial Commission, Columbus. CuAEuee F. N w s s , B- F. Goodrich Co., Akron. Thomas M. Hammah, Jones, D ay, Coekiey Baavis, Cleveland. Oklahoma Fus Ansanr, Industrial Commission, Oklahoma City. Mask Omiwssba, Industrial Commission, Oklahoma City. Joosb AobbstC. H unt, Industrial Commission, Oklahoma City. Tom G, Mahsw, Commissioner, State Insurance Fund, Oklahoma City, Mont If, Pow&uo, Chief Attorney, State I nsurance Fund, Oklahoma City. E, J. SursnanANo, Industrial Commission, Oklahoma City. * Oregon L. 0 . A x zm , Member, Industrial Aecident Commission, Salem, WttLiAM A, CAuaASAN, Chairman, Industrial Accident Commission, Salem. Pennsylvania F. R. Baesaxo, Manager, Compensation and Safety, Bethlehem Steel Co., Bethlehem. Feans K Boat., Deputy Secretary, Department of Labor and Industry, Harris* burg. A. C. Chbxstoan, Chief Supervisor, Indemnity Insurance Co. of North America, Philadelphia. W, D . Coaxlet, Secretary, Fire Association of Philadelphia, Philadelphia, E. Cwuaam, Manager, Stats Workman's Insurance Fund, Harrisburg. R. M . Hautmaw, Assistant Manager, Compensation and Safety, Bethlehem Steel Co., BiMefeass. rsr C, Hbkoks Sapenteden!.s Compensatio Cl&im Departraeatf Amenean E sjbou'H J, Mtmsssatr, -egal Assistant, Workmens Compeoastioa Fuad, Charleston. wamx, W. 8&r8? Commissioner, Worknmn'BCfompanagtio Fund, Chagfestoa. l U M H S OF IAM.BC W m m m mmmn A Attorney, M ite se, Bx;E. Ylaa PtotoleM, IStoptoyens M atois, Watm. Mtototo&a k W , Aatoxi Attorney CJsag?!,, Madisaa, A & Itotototo OMms ikmnmi; Bmpkxy&M MatoAs, W&as&a, A M 3 5, Btotof-a?t WoBhasaB Ctoa>passBoi Xator&l Commmtess. MSmk _ ' Waag?, <toito&8;f IsdasferM Atotossas, MMs, Wgemrng W mmm P, P a to , Masagsr, Werksma's mpmrnibn Gvinmissim, h&jmm. ................&..a. .twi.pttmtzaitt