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FILE NAME: Owens Illinois Library (OWL) DATE: 1955 DOC#: OWL042 DOCUMENT DESCRIPTION: Archives of Industrial Health - Pulmonary Disease in Asbestos Workers & Evaluating Disability in Compensation for Pneumoconiosis Volume 12 1955 PUBLISHERS AMERICAN MEDICAL ASSOCIATION CHICAGO 10, ILL. SUBJECT INDEX TO VOLUME 12 The following Index contains an alphabetical list of significant subjects presented in tinvolume. Abstracts are indexed by category under the heading "A bstracts." Books reviewed an listed alphabetically by title under the heading "Books." Obituaries and deatli notices an indexed under the heading "D eaths." Occupational health news compiled by the United States Health Service is indexed separate! -, under the heading "Occupational H ealth N ews." A Abrin: lethal jewelry, 468 Absenteeism : sickness, S92 A bstracts accidents and their preven tion ; protective equipment, 456, 562, 671 determination of air-borne contaminants, 454, 559,665 environmental conditions, 453, 558 general, 543 industrial toxicology, 450, 552, 660 legal medicine, 671 medicine and surgery, 451, 557 occupational diseases and hazards, 545, 657 radioactive substances and x-ray, 456, 672 ventilating, air conditioning, and engineering control, 455, 561, 667 Air pollution (editorial), 583 in Florida, 567 Public Health Service com munity program, 462 Air sampling: photomicrogra phy of air-borne particles, 584 Aluminum demonstration in animal tis sues, 218 in silicosis control: in cer amics industry, 247; ex perimental, 229; in foun dry, 221; in gold mining, 250 Ammonia: in air, determina tion of, 511 Asbestos: pulmonary disability in workers, 198 Books--Continued Halogenated Hydrocarbons : Toxicity and Potential Dangers (von Oettingenl. 369 B Barium sulfate: radioactive dust, pulmonary effects, 268 Battery workers: edathamil calcium-disodium for lead poisoning in, 528 Handbook of Emergency Toxicology (Kaye), 566 Handbook of Medical Treat ment, Ed. 4 (Chatton am! others, eds.), 459 Human Element in Indutrial Accident Prevention (Larson and others), 370 Bauxite industry: health sur vey in British Guiana community, 539 Beryllium beryllium dust, 675 disability from, 174 Blood vessels: pathology in chest diseases, 7 Books Legal Medicine, Pathology and Toxicology, Ed. 2 (Gonzalez and others), 227 Lehrbuch der Arbeitshygiene : Band I. Allgemeine Physiologie und Hygiene der Arbeit, Ed. 3 tKoelsch), 108 Mortality and Morbidity During London Fog of December, 1952, 564 Airborne Contagion and Air Hygiene (W ells), 564 Pneumokoniosen (Worth and Schiller), 459 Dust Is Dangerous (Da vies), 227 Electroplating Engineering Handbook (Graham and Pinkerton, eds.), 369 Factors Affecting Costs of Hospital Care (Hayes, ed.), 566 Skin (Allen), 458 Staublungenerkrankungen : Band II (Jotten and others, eds.), 227 Textbook of Healthful Liv ing, Ed. 5 (Diehl), 458 Workmen's Compensation (Somers and Somers), 227 Financing Hospital Care in the United States: Vol. II. Prepayment and the Com munity; Vol. III. For Nonwage and Low-In come Groups (Becker, ed.), 228 C Calcium silicate dust, hydrous : effect on animal tissues, 348 Carbon monoxide from pas senger car engines, 678 SUBJECT XDE.X Carbon tetrachloride: disease from, 522 Ceramics industry: control in, 247 Chest diseases: Sec Lungs; diseases by injurious agents by Mclntyre-Saranac c ence on, 1: papers n 1 ff., 109 ff,, 229 ft Chlorine trifluoride: inh; toxicology, 515 Cholinesterase: activity in normal subjects, - Chromium: reaction of pounds with body ti 258 Coal mining: pulmonar; ability from, 204 Cobalt effect on animal lungoxide, biological actio; particulate metal, bio!action, 127 Compensation, disability for pneumoconiosis, l.: Wisconsin Act, phys: and, 427 Correction, editorial: es tion of loss of visual ency, 527 D Deafness, occupational, 6- D eaths: Peterson, Carl 371 Dust: See also substance volved air-borne, particle c< weight, shape, and 361 control in metal mines, differential susceptibilit animals to, 288 diseases in Great Britaii radioactive, clearance : lutig, 99 E Earths, rare: See Rare ea Edathamil calcium-disodi for lead poisoning, 52 Jpu tm on ary o & i a lifity in ^lbeto 'lAJorher KENNETH W. SMITH, M.D., New York Asbestosis has been described in detail in numerous published articles and texts. W hile it is true that cases of far-advanced asbestosis ina}- have severe pulmonary disability, rela tively few of the people exposed to the fiber develop the disease. Therefore, it is the intent in this paper to mention asbestosis only briefly and then to outline various other pulmonary disabilities seen among asbestos workers. 'I'he word "asbe.-tos" is generally used to describe several fibrous magnesium silicates which are different in their chemical compo sition and physical properties. The most important types of nhers are chrysotile, amosite, crocidolite, amhophyllite, actinolite, and tremolite. Total world production of all fibers last year amounted to slightly more than 1,500,000 tons. Approximately 95% of the fibers produced were of the chrysotile variety, 3% crocidolite, and 2% amosite. Deposits of various types of this mineral are found in many countries, but the largest mines are located in Canada and .Africa. Asbestos fibers are highly resistant to heat and acids. They h a w great tensile strength and large surface areas. Because of these properties as well a- their filamented struc ture, industrial use of these fibers through out the world is in creasin g . T h e te x tile in dustry has used them for many years to produce blankets, clothing, threads, ropes, tapes, braided tubing, and filters. In recent years, however, there has l)een an increasing use of asbestos in the insulation, building, and friction-material trades. In addition, the Recorded far publication April 7, 1955. fibers can be found in paper, wallboard, shingles, pipe covering, floor tiles, brake linings and brake blocks, cements, putties, and plastics. It should be noted that the facts presented here apply to those persons who have been exposed only to asbestos fibers and to no other dusts. As previously indicated, industry today is finding many new uses for the fibers when they are mixed with other dusts. It is an established fact that when asbestos libers are mixed with silica, diatomaceous earth, or other potentially toxic dusts, the pulmonary changes resulting from the inha lation of these mixtures are not typical of asbestosis. The x-ray pattern may be differ ent, the clinical course changed, or the sus ceptibility to intercurrent infection increased or decreased. Thus, in making a diagnosis of occupational pulmonary disease, it is highly important to obtain a detailed occupa tional history, so that asbestosis, silicosis, or mixed pneumoconioses can be differentiated. The statements and observations reported here concern several thousand men and women employed in the asbestos industry in Canada and the United States. In this industry the various mining, milling, and manufacturing operations create some dust containing asbestos fibers. If the fibers up to 50// in length are inhaled continually in sufficient quantities over a period of several years, a typical pulmonary f ib r o s is w ill develop. It has been demonstrated that this fibrosis is lue not to the chemical but rather to the mechanical action of the fibers.1 The asbestos fibers are deposited in the terminal bronchioles, initiating a tissue response which coats the fiber and eventually produces what is known as the asbestos body. This appears to be a defense mechanism of the lime. Ntt- sputum of and spora' persons ar< blc signs < fore, it sei term "asb< tosis" boo fibers but If incre. continually gresses, ai gradually a of the lung fibrosis wii tually causi finally card The pui prolonged produce a i first-stage, shows a iii lion throui | should be i 1 lateral, that ' and that the of other pin r ,rr t i n t <!<<i ii i>/ww:/v.) sputum of persons who have had only short and sporadic exposure to the dust. These persons arc healthy and have no demonstra ble signs or symptoms of asbestosis. There fore, it seems more appropriate to use the >rker3 term "asliestos" bodies rather than "asbes tosis'' Ixxlies, signifying exposure to the fibers but not necessarily indicating disease. per, wallltoard, r tiles, brake merits, putties, If increasing quantities of the fibers are continually inhaled, the tissue reaction pro gresses, and a generalized, diffuse fibrosis 'acts presented who liave been rs and to no gradually appears throughout the lower lobes of the lungs. With additional exposure, this oated, industry s for the fibers ther dusts. It when asbestos diatomaceous xic dusts, the from the inhanot typical of may be diit'erd, or the sus- Fig. 2.--Moderately advanced asbestosis. ated with this disease, which may account for the "ground glass" pattern which has been used to describe the typical x-ray picture. tion increased g a diagnosis disease, it is tailed occtipa- In moderately advanced, or second-stage, asbestosis (Fig. 2 ), the infiltration has in creased but still is confined to the lower lung fields. The "ground glass" pattern is s, silicosis, or differentiated, Fig. 3.--Far-advanced asbestosis. ions reported id men and stos industry Fig. 1.--Early asbestosis. tates. In this milling, and te some dust e fibers up to mtimially in od of several fibrosis will spread to the other lobes, even tually causing respiratory embarrassment and finally cardiac failure. The pulmonary fibrosis resulting from prolonged inhalation of asbestos fibers will fibrosis will itcd that this a! but rather fibers.1 The the terminal spouse which reduces what 'Phis appears lie htnsr. Mu- produce a typical x-ray pattern. In early, or first-stage, asbestosis (Fig. 1), the x-ray shows a fine, diffuse, homogeneous infiltra tion throughout both lower lung fields. It j should be noted that this infiltration is bi j lateral, that it is generalized at both bases, I and that the nodular conglomerate patterns I of other pneumoconioses, such as silicosis, ' n r r Tint in nlvctiw c rn>r-f. V- A. AI. A. ARCHIVES OF INDUSTRIAL HEALTH more apparent, and the heart borders are becoming indistinct or shaggy. There is some irregularity of the diaphragmatic outlines and beginning obliteration of both the cardiophrenic and the costophrenic angles. In far-advanced, or third-stage, asbestosis (Fig. 3 ), the infiltration still is homogeneous and bilateral, has spread to the middle and possibly the upper portion of the lung fields, but the apices remain clear. The cardiac out line is almost completely obliterated, as are the domes of the diaphragm and the costo phrenic sulci. With this picture in mind, it is advisable to reiterate the observations of many physicians, namely, that the x-ray pic ture should never be used to estimate the presence or the extent of impaired pulmonary function or disability. Many cases with x-ray evidence of third-stage asbestosis have been known to carry on their usual work and live fairly comfortable lives for several years. On the other hand, no case of definite disa bility has been seen unless there was the typical x-ray pattern. There is no typical clinical picture for asbestosis. The disease is insidious in its onset and slowly progressive with continued inhalation of the fiber. There is a gradual increase in cough and expectoration, some anorexia and weight loss, then slowly in creasing dyspnea. Cyanosis and clubbing of the fingers are rare findings. There is evi dence that asbestosis will not progress after exposure ceases, but this seems to be true only if the worker does not develop an intercurrent pulmonary infection. It will be shown that asbestos workers are not predisposed to develop more intercurrent pulmonary infections than are found in other workers. However, when an acute pneu monitis develops in the presence of an estab lished asbestotic fibrosis, the infection is slow to heal, relapses are frequent, and the patient may be more susceptible to subse quent pulmonary infections. While it is true that the disease is slow and insidious in its onset and that people with advanced asbestosis may lead relatively normal lives, eventually the heart begins to fail, and death from cor pulmonale rapidly follows. 200 Gregoire * has reported that pulmonary function studies on asbestos workers have shown that the chief physiological problem is that of a "tight" lung. The vital and maximum breathing capacities are lowered, expansion of the lung is difficult, and arterial oxygen saturation of the blood is diminished in some cases, indicating an impairment of gas transfer through the lung. Diffuse ob structive emphysema, so commonly seen in silicosis, is not apparent in asbestosis. These pulmonary function studies are of importance in the proper diagnosis of pulmonary fibrosis and the estimation of pulmonary disability. Of more importance is the fact that these tests can often help the clinician in directing the treatment of the case. Unfortunately, there are too few persons who are properly qualified today to carry out these tests and interpret the results. An x-ray survey was made of one group of 708 employees working in an asbestos mill where the ore was dried, crushed, sep arated and graded, packed, and then shipped. Operations in this plant required the em ployees to rotate through various jobs; hence it was impossible to relate any x-ray changes to a particular job or to a specified dust concentration. At the same time it could be assumed that all members of the gr. up had been exposed to varying concentrati ms of the dust. The chest x-rays of these mployees were divided into three br .ad groups: (a) essentially normal lu i.s; (b) marked linear exaggeration (P-2) mt no typical pattern of asbestosis, and (c) Ainite asbestosis. Table 1 shows that of the 708 employ es studied 649, or 91%, had normal x-r -s. This is of interest because 204 employees or 29% of the total group, had 10 or more yv rs of service, and 2 men actually had wor ed more than 40 years in the dust. Table 2 indicates that 52 of the 708 em ployees showed a marked increase of all peri bronchial markings, although none had d:fi- * Gregoire, F. : Pulmonary Function Studie! in Men Exposed for Ten or More Years to Inhalation of Asbestos Fibers, read before the Seventh Sara nac Symposium, 1952 (unpublished)'. fVIMONARY DISABILIT Te gxpoture, yr.... jtjBploy, do. gjte asbestosis. Inasmuch these men had essential early in their employ assumed that most of th g markings were assoc ibsequent dust exposures, jft of the length of expos clop x-ray changes is fed that 69% of this g ire years of exposure, able 3 shows that of tl bad developed definite x stosis. These men e iges of pulmonary invo e working steadily at tbs with no signs of di: iterest to note that non t-ray evidence of aisbestos years of exposure. Frequently it has been si nn 5 to 10 years of exp ibestosis. The survey re med mill employees. It ier operations might ha\ ires with other disease e> hich might influence this < ily--the length of exposu: Tration of dust in the air m a t there is probably an i lability to the developme ' 'ibrosis. ; Medical literature has ittention to occupational p *uut very little has been re urrence of nonoccupation >e among those emplo OF IN D U STR IA L H EALTH has reported that pulmonary lies on asbestos workers have .he chief physiological problem "tight" lung. The vital and eathing capacities are lowered, the lung is difficult, and arterial ation of the blood is diminished s, indicating an impairment off through the lung. Diffuse ob- >hysema, so commonly seen in it apparent in asbestosis. These notion studies are of importance' diagnosis of pulmonary fibrose nation of pulmonary disability, xjrtance is the fact that n help the clinician in directii t of the case. Unfortunately, few persons who are properly ty to carry out these tests andj results. " -urvey was made of one groi oyees working in an asbesft ie ore was dried, crushed, s> aded, packed, and then shi; t this plant required the rotate through various jol impossible to relate any x-i particular job or to a specifi ation. At the same time it hat all members of the osed to varying concentratii The chest x-rays of these : divided into three bri essentially normal 1 linear exaggeration (P -2 ) tern of asbestosis, and (c ) is, ows that of the 708 emplo; or 91%, had normal x-ray ;rest because 204 employ tal group, had 10 or more yi id 2 men actually had worl years in the dust, licates that 52 of the 708 d a marked increase of all kings, although none had : Pulmonary Function Studies' >r Ten or More Years to Inhalatf ers, read before the Seventh i. 1952 (unpublished}- PULMONARY DISABILITY IN ASBESTOS WORKERS Table 1.--Employees with Normal X-Rays Exposure, y r........................................................ 1-4 6-9 10-H 15-19 20-24 26-29 30-34 35-39 40-44 45-19 Employees, no.................................................. 294 151 94 40 44 16 5 3 1 1 nite asbestosis. Inasmuch as the majority oi these men had essentially normal x-ray lilms early in their employment history, it i> assumed that most of the later increased h ug markings were associated with their subsequent dust exposures. Further indica te 01 of the length of exposure necessary to d>velop x-ray changes is seen when it is n ;ed that 69% of this group had 10 or ne ne years of exposure. Fable 3 shows that of the 708 employees 7 had developed definite x-ray evidence of a.-Festosis. These men exhibited various stages of pulmonary involvement, but all iv re working steadily at their accustomed joi.i with no signs of disability. It is of imn est to note that none had developed x-ray evidence of asbestosis with less than 20 years of exposure. Frequently it has been stated that it takes fmm 5 to 10 years of exposure to develop asbestosis. The survey reported here con cerned mill employees. It is possible that other operations might have different expo sures with other disease experience. Factors which might influence this experience are not only the length of exposure or the concen tration of dust in the air but also the fact that there is probably an individual suscep tibility to the development of pulmonary fibrosis. Medical literature has given considerable attention to occupational pulmonary disease, but very little has been reported on the oc currence of nonoccupational respiratory dis ease among those employed in the dusty trades. The following survey was made in order to determine the incidence of non occupational respiratory disease in another group, of 1561 men and women, working in the asbestos industry. A review of absentee records indicated that no valid conclusions could be obtained from this source, because the reason for absence was given by the employee himself. Sickness often was used as an excuse to cover short absences for a variety of personal reasons. It then was decided to study the claims submitted for sickness and accident insur ance. All employees in the survey participated in a plan operated by an independent insur ance company. Indemnification was made only after the nature of the illness had been certified by the treating physician. The study included claims submitted over a three-year period for such illnesses as the common cold, sinusitis, pharyngitis, grippe, bronchitis, pneumonia, asthma, and pleurisy. Occupational respiratory diseases and pul monary tuberculosis were excluded in the report. Table 4 shows that of the 1561 employees in the survey group there were approxi mately equal numbers in dusty and nondusty occupations. Of all claims filed for respira tory diseases, 45% were for employees with dust exposure. Oinical observations for many years had given the impression that a dusty occupation in itself would not predispose a person to more nonoccupational respiratory disease than would a dust-free job. This survey shows that the rate of disease over Table 2.--Employees with P-2 X-Ray Readings Exposure, yr...................... .............................. 1-4 5-9 10*14 15*19 20*24 25-29 30-34 35*39 40*44 4549 Employe,, 00................... .............................. 5 11 S 10 11 4 1 1 0 1 T able 3.--Employees with Asbestosis . Exposure, yr...................... .............................. 1-4 6-9 10-14 15-19 20-24 25-29 30*34 35-39 40-44 45-49 employees, no................... ............................... 0 0 0 0 6 1 0 1 0 0 1UST RIAL HEALTH. I isability without asso-' icosis may be found in, ition of quartz particle iround terminal bron> blood vessels and of their transportation]^ C a lu a lin q K i a ii h in (C o m p e n s a tio n :ENCES t of the Commission ! ,, p .neumoconioi )ccurrence of Certain sis and Tuberculosis, At teg; Aspects e of Employment in G. 22, 1951, Govemr of South Africa. T 'ODORE C. WATERS, Boltimore : Report of the Come ing the Functioning of ' m r approach to the discussion of the au. Government PrintaEpt -ill. it which has been assigned to me, I h Africa, 1952. 1 .. -Il*>: i like to call to your attention that H. : Occupational Chesty. : A Review of Progress ^ - :inns for the compensation of pneumo- ca, A. M. A. Arch. Indu t!.' .(s have presented some of the most 1955. -- '.'"II! i ncrsial subjects in state legislation. In Silicosis Act, 1946, Act I 'retoria, Union of airs,* benefits payable for silicosis or :nis are subject to limitations which msolidate, and Extend tht Phthisis. Act 47. of lWfc.* 'retoria. Union of Soatk; I applicable to injuries resulting from a; in 15 states,f compensation is not air fur partial disability, and with respect Africa Government No inary, No. 5003, F eb .J m- statutes providing compensation for ii'Kunioses. there is extensive variation :*i i' benefits paid and in the concept of c Ash of Silicotic t. M. Res. 6:1-7, 1913 I. W , and Moir, J.jS y Refracting Particles^ of Silicotic Lungs Disclosing Siliceous Publ. South A frican' 6. Studies in Experin neumoconioses, Publ. .5:1-87, 1922. A .: Contributions to ! `ability resulting from these diseases. In ''n "pinion, the reasons for this legislative ": i::: are as follow s: 1 I lv fact that, upon enactment of the occupar-*i ei'ease compensation statutes, an employer 'w-ni: liable for the so-called "accrued" liability from the inhalation of dust prior to the b*'r :"at (lie law became effective. i'o.blems incident to the proper diagnosis of * rintials in the concept of compensable ihisis, Publ. South 1926. I i lination of disability. and Strachan, A. S .: -I n and Character of S9 ases Occurring on the ' uth AfricaiTTrist. M. "rd for publication April 7, 1955. 'ma. Arizona, Arkansas, Colorado, Floriioa, Idaho, Iowa, Maryland, Massaclnt' lean. Minnesota, New Hampshire; New S trach an , A. S,, and If th A frica: A Symposium I'atliological Anatomy ease. Proceedings of il Officer's Association, > 1'Malinina. Oregon, Pennsylvania, South ' ' \a, I'tah, Vermont, and West Virginia, ua. Colorado, Florida. Idaho, Massa ri alligali, Minnesota. New Hampshire, A. Ohio, Oklahoma. Pennsylvania, South I Adi, and Vermont. W ith respect to the first of these items, "accrued" liability is perhaps a misnomer, because what industry was faced with upon the enactment of the compensation statutes was potential liability for pulmonary changes resulting from extended exposure of em ployees to the inhalation of dust prior to the effective date of the statute. W e must bear in mind that upon the enactment of the com pensation statutes the employer became an insurer of the health of the employee as to these diseases. He was stripped of his com mon law defenses, and the continuation in employment by employees automatically im posed upon the employer responsibility for compensation. W ith respect to the diagnosis of pneu moconioses, I do not need to tell this audi ence of the limited general medical knowl edge that existed some years ago. at the time of the enactment of our compensation statutes making the diseases compensable. Industrial medicine has made great progress in this field, although there is still room for con tinuing improvement. In the trial of any given compensation case, commissions and courts follow the general administrative policy of giving to the claimant the benefit of every doubt; and if there is medical evi dence in the record to support a diagnosis and finding of the existence of the disease, our administrative agencies are inclined to hold that the disease is compensable, ir respective of the fact that reputable, com petent medical testimony will refute an af firmative diagnosis. This reason alone, caused great concern to those industries having dust hazards and to insurance carriers responsible upon such risks. W ith respect to concepts of disability, we again find material .differences in the legis lative provisions of our compensation laws. 159 '/ I X D U S T R I . I L H E A L T H * Jk mployer and to the employee . ilie, I feel that the carrying .. olicv will make the employer the health of the employee, v the employee's illness is at editions that are characteristi to his employment, find this change in concept >ose of workmen's compensa-^ we now come to the fourt! t forth, namely, the valuay in compensation for pneu^ ny privilege to participate i imber of compensation case|Sj. is for pneumoconioses, an57 obleni of greater importance' ult of solution than the at ion of disability. While the* ion has improved its tecn-Jf diagnosis of this conditioi as been made in the estai e formula for the evaluate dmittedly, the inhalation \tended period of time y changes demonstrable C. ation. All of us are expose^ assume that it is correct idvancing age such chanj emonstrable. e that a given employee^ inhalation of dust, and -r that such inhalation cat ges. When does that com cabling within the con< - above referred to? V ovee subject to exposure* s employment ? When si he deprived of his privtli . work in the occupation he engaged? What metl medical science to valua ? What methods are ai science to pronounce is totally disabled? W from a diagnosis of pai hi the employee at that rim? mployment ? Should he E s and have that paymeol. FUALUATIOX OF DISABILITY effect a release of continuing liability to his employer? Should his ability to procure other employment free from dust exposure dep-ive him of any continuing benefit under the c-mipensation law? What methods are avail able to our commissions and courts to pro]. rly evaluate disability free and clear of pre judiced medical testimony that may be off< ed by the claimant ? By the employer ? (. : by the insurer ? These are the imponder ables with which we are faced in our con sideration of this subject. We still do not know all the answers to tli.-se questions, but I would like to review uii h you briefly some of the standard legis lauve provisions which have attempted to dial with these matters and to establish dii'-vtives to administrative agencies in handl in'.; claims. The principal legislative protidmis to which I would refer are as follows. !. DENIAL OK COMPENSATION FOR PARTIAL DISABILITY I-rum the medical standpoint, the evalua tion nf partial disability resulting front pneutimoinioses differs materially from scheduled miurit-s presently compensable for loss, or - of use, of other parts of the body, such m .m arm. leg, hand, etc. The Saranac I.aimratory has been a leader in medical u-'iarch attempting to find some method ff,r the evaluation of partial disability, but it' present distinguished Director, his predtrev'ors and their associates, and other 'rientists engaged in these studies have not yet timild the answer to the problem. Of '.cc'dty. the attempted evaluation of a fixed I'-rceniajr^ of disability is exceedingly comi 'la u d and unsatisfactory. Therefore, the ' --i'',ver and the insurer contend that coin- should not be paid unless the 'huh lias suffered wage loss or that comm-atii m. if any. payable for partial dis* ' "v >lnmid effect the discharge of the MT ' liability within a reasonable time " - r uination of employment. Contra, the wee lias, in fact, received some injury : du inhalation of dust and development mpit'trable disease. Perhaps legislative ''iK denying compensation for partial disability are not thoroughly satisfactory or fair to the parties concerned with the ad ministration of the laws, but unless and until the medical profession gives its ap proval to some method of evaluation of par tial disability, strong arguments may be presented for this type of legislative pro vision. 2. COMPENSATION FOR TOTAL DISABILITY Xo one can challenge the propriety of paying compensation for total disability for pneumoconioses. However, what do we mean by total disability? Under the definitions above referred to, it may mean one of several things : a. The inability to earn any wages in the employ ment where last employed. b. The inability to perform any further work in the occupation in which the employee was engaged. c. The inability to earn equal wages in other suitable employment. Under the first concept of disability, com plete loss of wage is a condition precedent to an award of compensation. Under the second concept, the employee must be unable to perform any further workin his occupation. In this class, we are faced with the administrative and court rulings that have the effect of awarding compensation in those cases where the administrative agency is of the opinion that continuing exposure is hazardous and detrimental to the claimant and, therefore, compensation for total disability should be awarded even though the claimant is able to make as much, and in some cases more, in other employ ment. In the third classification, the right to re cover compensation is dependent upon proof that the claimant has been incapacitated from earning equal wages in other suitable employment. Simply to state these phases, that enter into the determination of what is and what is not a compensable claim illustrates the problems facing our compensation commis sions in disposing of issues presented by this disease. 161 A. M A. A R C H I V E S OV I S O L ' S T R I . II. u (t* In summary, they fall into four classifica fairness to the employer and to the cnij,. tions. as follows: and to the public. I feel that tlu- car: 1. Inability of the injured employee to earn full wages in the employment in which he was last employed-t out of such a policy will make the em|. an insurer of the health of the em),.. .... whether or not the employee's illnv-- 2. Total disability rendering the employee unable to perform any further work in his then occupation or in any other trade, business, or occupation^ 3. The event of becoming incapacitated, either partially or totally, from performing his work in the last occupation in which he was exposed to the hazard of such disease.|| tributable to conditions that are charact.:... of and peculiar to his employment. Bearing in mind this change in cuU,.. of the basic purpose of workmen's com,,,; . tion legislation, we now come to tinreason above set forth, namely, the t \ 4. The event of becoming incapacitated from performing his work or from earning equal wages in other suitable employment.!! tion of disability in compensation fur ,i;, moconioses. It has been my privilege to participate ,. There can be no doubt that the basic con the trial of a number of compensation . cept of "disability" upon the enactment of involving claims for pneumoconiosc-. ai;; the workmen's compensation laws was to I know of no problem of greater import;::;,, provide monetary compensation for injuries and more difficult of solution than the resulting in a loss of wage-earning capacity tempted evaluation of disability. While t! resulting front the traumatic injuries or oc medical profession has improved it.- uV . cupational diseases arising out of and in the nique for the diagnosis of this couditi.,- course of employment. Unfortunately, that little progress has been made in the e-:., original concept has changed. In an effort lishment of some formula for the evaiuati,.- to liberalize the administration of the laws, of disability. Admittedly, the inhabit : , compensation has been, and is being, awarded dust over an extended period of time uj not for wage loss hut for what might be cause pulmonary changes demonstrabi, i,;. termed to he damages sustained by an em roentgen examination. All of us are e.\o,,M ployee during the course of his employment to dust, and I assume that it is curr ; i.. irrespective of wage loss. While I admit my say that with advancing age such c! -mg. - own prejudice on behalf of the employer are inevitably demonstrable. and the insurer, the fact is that our legisla tures, commissions, and courts, interpreting and administering workmen's compensation laws, are tending to award compensation for loss of earnings irrespective of cause. Per haps that result is socially desirable; I am not here to argue that point pro or con, hut in Let us assume that a given etnplte iexposed to the inhalation of dust. ;r !c us assume further that such inhalation > pulmonary changes. W hen does that . di tion become disabling within the c m ; n of that term as above referred to? in: should the employee subject to exposv U J Illinois, Indiana, Michigan, Xew York, and Rhode Island. Arizona, Colorado, Nevada, New Mexico, Utah, and Vermont. || Florida, Georgia, Idaho, Kansas, Maryland, North Carolina, South Carolina, and South Dakota: removed from his employment? When -1 aid such employee be deprived of his pri>; ? of continuing at work in the occupant--- in which he may he engaged? What met;."A are available to medical science to evak ite partial disability? W hat methods are avail UIowa. (Disability not defined in the States of Alabama, Arkansas, California, Connecticut. Dela ware, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri. Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Virginia, Washington, W est Virginia, and Wisconsin.) able to medical science to pronounce mat the employee is totally disabled? Whai sequelae result from a diagnosis of partial disability? Should the employee at that time terminate his employment? Should he he paid "X " dollars and have that payment 160 SI'AI.VATIO S OI: n iSA K effect a release of continuing employer? Should his ability ; ""employment free from dust prive hint of any continuing 1 compensation law? What met to our commissions and rly evaluate disability free at Ittdiced medical testimony th. by the claimant? By ' by the insurer? These are es with which we are face deration of this subject. 'W e still do not know all tl questions, but I would i nth you briefly some of the s ative provisions which have at with these matters and directives to administrative age; claims. The principal le ^visions to which I would refer : t. DENIAL OK COMI'EXSATI - J'AKTIAL DISABILIT ' From the medical standpoiir 1tion of partial disability resultin ^moconioses differs materially fr "injuries "presently compensable f loss of use, of other parts of tl *as an arm, leg, hand. etc. ? Laboratory has been a leader I research attempting to find s- , for the evaluation of partial d Zits present distinguished Direc ^decessors and their associates. scientists engaged in these stud ^ a s yet found the answer to the ^ necessity, the attempted evaiuati: v'percentage of disability is excet plicated and unsatisfactory. Th employer and the insurer conten f | pensation should not be paid A claimant has suffered wage loss < . X. pensation, if any. payable for M ability should effect the disch: ^ em p loyer's liability within a rea- W aiter termination of employment. W employee has. in fact, received s Y front the inhalation of dust and d X of demonstrable disease. Perhaps * provisions denying compensation Jfc 4 I N D V S T R I . If. 3. VA LCK OF M EDICAI. BOARDS IX THE STATE ADM INISTRATIVE AGENCY One result of the problems presented by compensation for pneumoconioses is legisla tive recognition of the value of Medical Boards to assist the administrative agency in its determination of issues presented in claims. The basic questions involved are medical, namely: ( a ) whether or not the claimant has a disease: (/>) the nature and extent of disability. Owing to the highly technical nature of the medical testimony presented on behalf of the claimant or the employer, the need for Medical Boards to evaluate that testimony is imperative. The net result is that now 17 states# have Medical Boards whose decisions are either conclu sive with respect to the medical issues in volved in the claim or advisory to the ad b. Monetary limitations of compenst). ing limited compensation for partial di>.,i,,\. escalator provisions for total disability. c. Limitation provisions barring right : dating from the termination of employa., With respect to these matters. I o , |, . to you for consideration the statu-,.-. Arkansas, Maryland, North Carolina, v, Virginia, and Wisconsin. None of tin-,. . perfect, but they have attempted t.. some method for the proper coiupvns ,; for partial disability with terminai, continuing liability of the employer. Perhaps the most grievous defect in .. statutes is found in those sections du,-,;.. with limitation provisions relating to tin- m., when claims must be filed in order i : ii... to be compensable. This is a major ]>r.>t.i, and one which presents the opportun.i:\ f. extended discussion. From the stun.n . ministrative agency. of the employer and the insurer, t!u> Y.:. In the past, too little attention has been the termination of liability within a - given to the role o f the medical examiner able period of time after employait: l,, in the administration of workmen's compen sation laws. Time does not permit an ex tended discussion of this matter, but I ex press the hope and opinion that in the future our legislatures and commissions will not only recognize the need for such Boards but accept and enforce their opinions in preference to the prejudiced opinions of ceased. From the standpoint of the en - .\, . he feels that be is entitled to compt: - :i,,; beginning at any future time when t: . ease becomes demonstrable or disabi r. respective of the date of termination hi. employment. Certainly from the star. of legislation, we do not know the t: to this problem. witnesses testifying on behalf of litigants. CONCLUSION 4. EXISTING LEGISLATIVE METHODS PROVIDING COMPENSATION FOR TYPES OF DISABILITY Time does not permit the detailed discus sion o f this phase of the subject that is merited, and I can only generalize with respect to it. However. I should like to call your attention to the following features of legislative provisions : a. Denial of compensation for partial disability (discussed above). # Arizona, Colorado, Georgia, Idaho, Iowa, Maryland, Minnesota, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Sooth Dakota, Texas, Utah, and West Virginia. The foregoing discussion has beer. csented for the purpose of directing u thoughts to those questions, medicai 1 legal, involved in the evaluation of disa' y. I have attempted to address my remar; o the legal issues presented. Our state leg itures and our commissions and courts : i not found the answers to the problem- i presented. In cooperation with our broti of the medical profession, it is to he ho; ! that greater uniformity of legislation ! administration may develop in this field ! that justice may be done to those affect..: by the administration of our compensati' .: laws. 162 We*--- % PaJon P J ,i J P f t UHCAN A. HOLADAY, B.S., M.A., Sal- a saaiiM Ba-iL': y occupational exposure of \v ctive dust and gas has only of general interest. Interest jnranium became an important ai it after mineral. This develop Ued in the employment of large 'miners, so that a problem that `apparently minor importance in has become one that demands . ^ t i s the purpose of this paper to pr< levels of radon found in uraniu nonuranium mines, to refer briefly ble biologic effects, and to make ; the careful examination of exi.-= which should help in the determin. safe working level of radon and i dation products. All uranium ores contain rad therefore the radioactive gas rado tinuouslv produced and is released atmospheres. This gas and its i daughters. RaA through RaC', are as the most important radioactive present in uranium mines from t point of their possible biologic eft question then i s : What are the ef ..duced by the inhalation of alph: ^ radioactive elements ? The result .... exposures should provide the data j;, lishing proper working levels. In f. tunately, such records are limited w y to the elements witli which we are cerned. Recorded for publication April 7. 1 ",siy Sanitary Engineering Director. C A Health Field Station. Division of Spc Services. Public Health Service, U. S. of Health, Education, and Welfare (M r ; Presented by W . Clark Cooper, M.I Director and Chief of the Division Health Services, Public Health Service.