Document mBOpb6Qk0GmXMJb3rezLoOjzB

FILE NAME: Exxon (EXX) DATE: 1954 Oct DOC#: EXX062 DOCUMENT DESCRIPTION: Convention Proceedings - Workmen1 Compensation Problems 1954; Humble Rep on pg. 237 PROCEEDINGS-- th Annual Convention c f the Interrmmml AmecmUen of Industrial Accident Boards and CommissUms, Quebec, Canada^ O ctober 8~7, 29S4 Workmen's Problems 1954 BULLETIN ISO UNITED STATES DEPARTMENT OF LABOR P* MltefeelL Secretary BUREAU OF LABOR STANDARDS Paid Es Gwsslse, Pis'!? pum i 8 B iff m IBM MgKXXWO m u xm v CteexxfMlfcBual C b m v H assaedg W* IX fesaM* M. I >,9Mfs Ekm m m m M fcmum' $^Mm^ m m r Imit&i U. g,, PMm Bmkk Sesmos* Wmhffigpm* Ih . I* &mp@ OwMpPm em m s hmms h&m plsgua mmkm fot iXoussms 4$ f&?%y adua xpessea1 gge&W o w B&tw& mrmmm&o mivh m ass? mdfc&ni r kmtmm wilb m w om ; chhkmm& hmm~ tfow&t h&m im blm y hmn rmp&mihk ios tk& Qeemrme& o emettm o tks mposm sMa mmog m zrn workrns m o ommr o tks bker mxmg f&m,em o ho M e T&llsy m m oo# prtkktark times. H a ? , ifcw&s so t uafH ih& odmnt o xmsm mdaeirfkm mm ISO y* %g& tha e^sptiak, m m m try-rekta ageat i^YS atteiasd & pmmmn, pmxm k the human omwr probleai, Wt m y mu sseap&tka&i omekmgm m <mlj wl sfiasd kimw& ommm o brasas cm m n t bt tkms mmbor m Y&iiety km ste&dllj I&ereased sisea Poli ia 1775 mi ral&ted ihe- ommzmm ef mmh om mr momg chimmy %wmp i kt sqwure k* mt> Oot t&l k&mdsdge m e p p a e k tk a o oceap&ikxml canee? produekg gesta as pk.mm'smm o sxmlmn ixidmtrklkm dates hmk gome Wmom i , OGTOBLB -- MOSSflNG SESSION 127 75 years milx the discovery of the relation between the occurrence of skm cancer and an occupational exposure to coal ta r {%, 1). The d ata given in the following tables (1 and la ) briefly summarize the salient additions to the information on occupational cancer hazards made since that time. They list the various chemical and physical agents so far recognized or strongly suspected as causes of cancer in man. They show, moreover, the different organa and tissues representing the target organs of these agents sad the number of occupational, cancer eases placed on record or known to have been recognised as caused by them. Table 1,--Occupational Cancers Recorded in &e United States and foreign Countries up to tm% Sites e( wnm Ntittshw of. Kasaher o ! ; mam mm.mnm mses: Vefei : in ?XAA, j te ElSj-OJ ': Arsenic.,________ . . . ________. _______ Bkm.. . . , : 7 : Coal tar, pitch......... ...... . ................. . . . d o . . . . . . . no! P etroleum .. _________ _________ . . . . . . .... d o . . . . . . . . . 70 i Shale o i i s . . . . . . . ............ . . . . d o . - . - . ... 7 j Lignite tar arid paraffin..... ................ . . . d o . . . . . . . Creosote o i l . . . . . . ____________________________ __ . . . d o . . . . . . . 1 j Anthracene oO... ...d o ........ * M * M A Soot-carbon black---------------i . . . . . . . . . ... . d o . . . . . . . I 1 Aromatic amines.. . . , ___. . . . . . . . . . . . B lad d er.... ObtM-00 i p d o . . . ........ Boenigen- and radium-radiation------- j Leukemia.~ cr:> ! m | i L n o g . . . . . ... V ,, > o V {. v Ss Arsenic.-------------------------. . . . . . . . . . . . . |;ang--------- , Asbestos.,_____. . . . . . . . . . . . . ___ __ n { Chromates__________ _______ ______________ 7$ | C .d o .... . . . 0 1 Niekfil... . . . . . . . . . . . . . . . . . . . . . . . . , | Nasal eav~ \ By, l>vssai sfesus. ii ^ i Coal t&r, pitch................. ..................... L u n g . . . . . . 0 Petroleum..................... . ...d o ....... 1 1 Beosel. . . ______________________________________________ Loose,mla ... 11 1 1 I s o p r o p y l . . . . . . . . . . . . . . . . . . . . . ...... ;1Larynx... 4. 1 (.STaa&l sinus. 8 ! Badioactsye ehemfcais... . . . . . . . . . . . . . . j Bones_____ 0 1 1Nasal sinus. 3 j Total.... . . . . . . . . . . . . . . . . . . . 1 780 | 25 i 3, ISO j 29 | 1, 909 j 14 | 40 1 20 } 190 j 1, 200 1 (?) i 13 1 6S0 ; 18 ; 83 ; 85 j 84 j j U | j 58 1 38 I 81 l 0 < 0 ; 0 i e j ! 7,850 l 32 3,260 99 1,907 14 41 20 161 1,800 (?) 29 650 28 m 140 84 SI SB 40 42 1 4 6 9 8 8,-100 ^ W A V M V M * W A W /^ ViW,V ,v^>VW,l ` Aspraximste. ir>4 w$mw& o f ia u b c Tabs. Ia.--fsr/o: Table of Diswomu of Occupational Canmrs Ksm^ cf&s&at ;Dm j Oteeaaafer ; Oig&ss aAixstseS |t'ptuiaii exposas' OteoUftCs--OrgAiiie,' ; | 8os>i.................................1 in s ; F e ti,, . ................... &Uist {si!8S8;0------ ... Octm^i05^ ' al ie r (%iwL...... -- | !ST9 j Vdfcmsaa. . . . . . . . . . . . . . . . . . . . . . . XBj,. Cositas (Stltmir.ous).- ,,J i m i Satite.........................; Po. CbssI i&f S;St4rssciU>). -- s m o i ZV-tg.........___. . . . . . . . . . . . . . . . X>*. Ca tar (fames).. . . . . . . . i 1036 t X & v y s h s t e . , ISO. Cft!05f>tiii>U,,..___.-..--d 3026 CrOoBBiiBS.. . ........ Sida,. . . . . . . . . . . . . . . . . . Ob. Attt&ssseEs eU,,<,__*,,,*,.*$ 60S j 03tv?f. . . . . . . . . . . . . . . . J iiif ____ n. <$&3&3OU}__ \ l??g i 8e8....................... ~ d ................. . rm. ratrofeisja stiS coke------ ; tSSO 5XXfr'HSoi gftd i3ttif- f.WV.w4i>-. w.... Do. i i 33iaBfs. i Fsiyateai parat&a o a .... ? JS15 5 SaBambsifS...'.. . . . . . . 1 .....l i e ......................... Df>. W tonaai t'f&riesUraSJ I83S \ HeUe?......................... ! .... Oc, 5aSriftfcg eS....... ; 38? : WSsan___ .... . . . . . . . . i ^ ^M. ^V*-. ^ 6. Besjat__ _-- ; seas Peicre A titfsisV', OB. Amnatie ssstses {ye i 38fe S a h a .....................; n t t M a , m x - u , B.U' 3X>, iatarmeSSstss). \ i Xsapiegyl a a .. . . . . . . . . ..g 3852 Wa8, Srayit & Siate., i K&sa) siotssez. Saryax, Ob. i ismg. O h6sai^s3s-- inof$ssx\ei A m aie... . . . . . . . . . . . . . . . SS22 pwts...... ,,. .....,; X3o. 3SB7 UaicM<aa............ ..... ___ d<i,........................ XSe-iicSnsL 39,15 Saadis__ . . . . . . . . . . . . . . 3,!$;.................. OtxjBpatissaaJ, ..................... im h y a d i & Smith......... .....a a ........... ......... . Ob, Chromatis.. . . ____. . . . . ':W> Vfo,.,,.................. .....__________ ____ _ Da. K ia k sl......................... i m OrmfoSi..... . . . . . . . . . . N a m i f A t i i y and si- i >0, aasei, lisiig. \ BtsysictS agsee muavieUi raafeiaa...... 3B U asm ...... . . . . . . . . . . . SftSsx.,........................ \ 2)f>. Knyironiaeatal. arsAaigsavAUtaiBi.____ 3802 Frt&hea.. . . . . . . . . . . . . . ,, ....U n ................ ,; Qsssip&tfessS. 1&& ^VySS,. . . . . . . . . . . . . . . . .................................... ; Medlcinai. m t Voft Bsgfe, Sahwartz & ; OaiilpatScsiB!, v<m SfctsaaraOe, im Raauvia.'tive Su&aUae&S,. i m Beak,. B o a s....... . . . . . . . . . . . j M*diUs3, Kswtfag A HSSb....... Csasg........................ OWispaUsaai. r m MpXisi, Ward asirf ................... 1 Do. wars. VM ...... Bid4N*stejg tissoes. j Oa. m i Atftfthliiil................ . Beaa...... .......... ........ i I>i>. However, an mdiscrimiaat-e aoeeptanos of these figures m reflecting the aetti&l scope of ike occupational cancer hazards would seriously be misleading for the following reasons. The presence of occupational cancer kasards baa so far been established h r only a few worker groups having contact with one or several of the carcinogeuie agonta listed. While, for instance, it is generally known th a t workers em ployed in gas works and 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 m y official record of similar cancerous complications among electrode wnrkem.in..ainminnnr..pro.dnction..pl&na..wkere.an.-axp.osnre...tn.iumm. front the rioctrudes consisting of a mixture of coal tar, pitch, and petroleum coke exists. Eeliahlo information, however, k on hand th a t these workers suffer from cancers of the skin a m i possibly , also the respiratory tract. The extent of this exposure hazard may he estimated by the fact that approximately two-thirds of a pound of electrode carbon Is consumed for each pound of metallic aluminum produced, of which 80(1000 short tons were consumed in the United States in 1945. I t is equally significant th at agents which have been reported to have caused occupational cancers among workers of an industry of one country, do not seem to have the same effect upon the workers of an identical industry of another country, if the available data would he accepted a t then' face value. Since carcinogens behave in their fundamental disease-producing properties like pathogenic micro organisms, there is no sound reason to assume th a t carcinogens make any distinctions in their activity or effectiveness for any national reasons. In fact, it can ho shown that such scientifically incom prehensible discrepancies arc mainly due to local differences of report ing of occupational cancer cases. The existence of an excessive liability of gas house retort and coke oven workers to cancer of the lung has been reported from Japan, Canada, and England, but not from m y other country despite the fact th a t the exposure conditions for workers employed in such opera tions are identical. The occurrence of an appreciable numbe?: of arsenic cancers of the skin among Gorman users of arsenical in secticides was placed on record during recent years. If M l credence would be given to reports on arsenic cancers observed in the United States, one would he led to believe th a t arsonir-als in our part of the world am carcinogenic for almost exclusively medicinal reasons. Again, it is hard to assume th at arsenical would make such tilsM otions, A similar situation seems to exist concerning the car cinogenicity of lubricating oils obtained from petroleum in different parts of the world. Although there wore placed on record by English investigators tinting recent years, several hundred cases of skin can cers due to occupational contact with lubricating oils, practically nothing is officially known as to the existence of such industrial diseases from the countries on this side of the Atlantic. One seems to he content with attributing hem the English observations to the carcinogenic action of shale oils, the large-scale industrial use of winch was discontinued during the 1920's, and therefore cannot account for the more recent English cancer cases observed among spinners, mechanics, engineers and other workers having bad exclusive con ta ct with lubricating and cooling oils of petroleum derivation. U U MEETING OF 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 suds cancers have been observed and are recorded as such in industrial records, and despite the fact th at the annual reports of the Chief Inspector of Factories of England and Wales have regularly listed notifications of such lesions to the m i-m i 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 cases, all occurring among- employees of one com pany. During the in tm m m g 15 years, the total number of such cases has risen several fold and no official data have become available from any of lha other companies producing and handling carcinogenic aromatic arniaes 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 be 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 w aste 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 occurrence of so-called "neighborhood" cases of cancer have rarely been made. The well established former occurrence of arsenic cancers among inhabitants of a Gorman region in which the drinking 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-naphthylamino, is involved which might have produced such results if the waste disposal and housekeeping methods of the plant were inadequate. I t is probable th a t the future occurrence of cancers of the lung and bone among individuals who lived near beryllium- evidence of OCJOBE'H 6-- MOIiKMr SESSION 181 > career hadars related to em koim onH l plant pollution if beryllium and Its compounds are nut only carcinogenic for rate and rabbits but ; also for man. Similar conditions of industrial atmospheric pollution exist around arsenic smelters, chromate producing plants, carbon I black factories and oil refineries, as well as nramura ore milk. . The recent compensation claims advanced on the basis of an allegad existence between cigarette smoking and lung cancer also point to the possibility of a greater future importance of the compensation aspects I connected with the occurrence of cancers from industry-related sources, such as exposure to carcinogens contained in the exhaust fumes from diesel and gasoline engines* or present as additives and contaminants in foodstuffs. I I t appears from these considerations that there can be no doubt that I the actual number of occupational cancers is considerably higher than ; the number of cases placed on record, f t is of some interest, moreover, th at the number of oases recorded in medical journals is appreciably higher than the number of occupational cancers 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 court. W ith a few exceptions, such as the incidence of lung cancer among American chromate manufacturers and among German and Chechoslovakian radioactive ore miners, of nasal sinus, larynx and lung tumors among American isopropyl alcohol manufacturers, and of skin cancer among English coal far manufacturers and profiteers, no reliable information is available on the incidence rate of occupational cancers of tre various types among different occupational population groups. B- Special Aspects o f Occupational Cancers faff and competent adjudication, of compensation claims for cancers allegedly caused by occupational agents or conditions requires an adequate knowledge of the special aspects related to the production and development of these tumors and of the criteria by which they may he distinguished from aon-occupational environmental (medi cinal, dietary, cosmetic, habitual) as well as "'spontaneous" cancers. 1 Definition of the Tetm uO&mpatwtml Cancer'',--The term ^oc cupational 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 entailing contact with some exogenous* physical, chemical or parasitic agent acting in proper intensity. Occupational cancers thus are caused by specific agents or euofeglcally related to well defined occupational conditions which form an integral part of the ordinary working environment. They differ through these aspects from the accidental .......... occupational cancers which result from or follow upqq .some extrpr- .. 1$M MEWL'INQ OF IABC dinary, unforeseen, accidental injury sustained at work and being of a nonspecific nature. $, Types and Nature 0/ (kcupaiim al Cardm gem ,--Occupational agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals. Some of these chemicals are well defined, others consist of variable mixtures of a large number of chemical com pounds, a few of which possess carcinogenic properties, A second group of occupational carcinogens is composed of agents characterised by their ionizing or nonionizing radiation, A third group is repre sented by environmental agents and conditions which sometimes have an occupational association, and which may bo related to certain infections or several specific climatic, geologic, dietary, and nutri tional conditions, and which in part have mors; or loss indirect relations to carcinogenesis (table 2). T able 2.-- Oecap&iional Carcinsgem-- Their Mouis &f Ssp&mre rind 'Their Target General type CBetcisss) sarSRgitiS; O rfali ehftBaU cais--aromatic, i$reye!e> BettroeyeSie iypt> y i W A M W `" V A ' U w Bt'Viici. B>.:ia-nap!tS',yUaiiiic% burntdie, 4aiaodipispfffHaars, sii, Eaagssta?) <<vtai~ dm?). Csa! m , pes, Soot asymt. Vit 8, mmAt s, aita cene oil iatap biaefc, Kmite ta? so) parais eli. Sysaheiit; <mi a 3tt ter KtlVife at CKpOSlire Target Organ Clte13iii3S respira. . BleoiMorwicg argaas tory. j Unikeif! i:. ymphosar* eoaa, aiyelcoea}, Kespirtary, euiae- j Orogenoas oraa (fead eus, aHrjt&ry, i ter, arsier, ksiiney.i. OiitAtOfsiS................ i Skia, Stsspiratocy............. -I Oug. Oataaeoas,. : SkB, Mf&mic Shaie8:mpsraSVaU--- . . ,, A l ........ | Respiratory. reteoUn.'i faU ail, iUeaei S, ' Cutaneous, ,, ubricaUag o w ecrmy Respiratory. Oo. .j li&vyLvs.* .j Skin, .i Bong, euftina: 8, earh Uttu&> asobs.'i, ter, coke, Grade psralftn il soptepy5oi! efeesBi A n m ie- v ............. I NicfeaL,.......... * A. J .Vasai siflsjsU&fyssPusg, Cibw<b*, tsym-tre ,1 Skia. n<<Si!t'aS(>f;<, , , , , , , , , J La. ...... ........................... J KiMsoiosfityiBasisisnis, t O'Rrofsfevan.., , ____ ____, il... ,,rte------.. j ................. .......... ............ <&,......... ....... Vbjsk5 Garteagafi?; | X-tatetea....... ...................J Ckianows.. ...... kmisin?radtotes, j ; Vtiooiifiaeo,.- j Sa8!oacOsfirv8Ooa<sip3ia-, [ ........ ; beta, sacl siaasa-rsisli'BS). >VmkS&88i*k I '[ I * ............ -j WigOs. J Skia, CorsreotSve tissu, boss, ? W{xi-foaiag ergaas Skia. ,, ! CiOseeUv Os?, bta- ; forsBasergaaS, ,J Ksw<!sinua ; tr)g. , Boa, ...'i'BIssMw'. s ? g Pu P* I C V ft" f? ^g fyt ft # 3v5T 2 w f i 3 11 s*>- $2. ft 3' ft ft ; $ w f is g %3 "'--v < 1 wP fwi?' ' g s S .J |S "3 "5| 1S3" .?S.3' ^a f=t ft f0 3-- fe Soa. Hi* S ^ fcjft ft & & ft. 5fe -* O S3 I: u 1" 1&1r ? I f 'i ; ! f ! s; ; B I P* E- {P-'i'P 5 ^ gfc li , o l^ jr*- 3* t U 5 4 MUETIUK* QW IAIBC Taaaa ,~~P(it<ftU{ii Bmirmmmtfd Mmmn Carmgm#--Coatioed Site al to? TyppOsSKaCtfSss- Species Typesotfcamasmaimix tight gres 8'F dia stoli him F0F fast iFCF, OeHepbane, polyethyl ene, paipasside {tijios), toktote teflon, pofyraethyi mathae- Subeat&asoua | Fio-estei!, , .,. ilasac. I ....,,.,,.,,,J Ond....__ \ SoboutoBeoHs.,]Bam&fuL.,, BsirySliam ..,,.,.___ S.e*iSs*toy.. M !S C .,.,,. listo....... ...M O...... Babble, feto..,. Textile dyes. FixxS arid ossxastts Sy. Fooddys iV;Hnt). Ossoiiass dye. Flare colas', F3s. fiber, stele-industrial jnsnafactui- sod asss. Wr&pp&g s&iffifiid. Medicinal agent siisy, X-ray tube, phosphor ssnafeetars. Selenioai._ Cobalt.,. . . . . . ___ layer, Sbytold,,..* Oral..... Ssboiitaasoas \'iVwssttsiik. .....tot. Atcsaia essere production. Sail JisontsmtRaat. CoPiring matter of ramies. paint, rubber, Metal alloys. Bssbbor accelerator. I Piiotoefcetrteappamtos. i Boeoioriser, FlreprooSag agent Medicinal sgstti. | Melai alleys aa>3plating. I ilrkri.rr matter of eraases, palai, rubber. Msltesml sgotto T abi, 4.--~'izrcmt>gmie k*m%ml$ Mlmimted a Emdr^mmM Cttmnagem w w w MW i et eastor Type of eaposnre Upeeles Ssfaadsd use &iyry; Sto.,,,,..... Sabeotaueans ; ttoextotot,, frisisito., <...,<.) Sei gest, { tissue. ; S-AiixsdA;iir>'ili'!-essJ Sobaotasaans ! Ossi____... ,.*<*......I fetototoit f tissue. ; Faresterei,.. , . J Bat............. s ; Bladder.....__ i<,. . . . . . i L iv e r ............. t ....... .j t f i w t _____________,,i ; Bruto, ; Thyroid. j :. Aeoustie duct, | i \ \ f i > j BresSi, ; i UsuF&mia, i \ Sidney. j I! Uuag. 1 1 | s i i \ ; i| l \ 8. E m hiatim of EAAmc&.-- Fox the est&foBshraeni of causal rslalions 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 fuIMed: OCTOBER fr~ MGBNING SESSION {a) Definite evidence m ust be available indicating th a t the claimant had 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 the carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cancer is elicited. Therefore, not any cancer, but 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 bo sustained not only by the ordinary operators employed in operations with occupational carcinogenic hazards, but 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 arc 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 noncancerous and often preparatory or precanoorous symptoms of etiologic specificity act as stigm ata or biologic finger prints supporting not only the, actuality of a previously sustained specific exposure, but also its causal relationship to the cancer present. Symptomatic manifesta tions possessing such a significance arc, for instance, chronic m liodormatitis, chronic ta r dermatitis, arsenic dermatosis, chronic solar dermatitis, chronic radiation periostitis, asbestosis of the lung, and leukemoid 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 radioactive substances, and benzol. * - - - ' 1954 MEETING OS' IAIASC I t is important, however, to note that both these procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any eiioiogically 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 ant! 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}. ft 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 nonooc-upational origin before they may b considered from any occupational viewpoint, Tabj,5,--Latent Period? of Occupational Cancers Orgaa and agent AverfaugsHeod j laBtm&tngpgeraitvd Stin Mmimi Mcdkuo&L...................-- ~~-- ------ ------------- Occupational-.. . . . . . ----------------------- Tar..... ................. _.............................................. . Creosote oiL._____________________ _ Mineral ail________________________ ______ ... Crude paraSm ail------------------------------- ---- ---- Solar radiation..,...,,_______ _______ . . . -----------X~r&dSat)Oif ------------------ . . . .......................... i Years ; 18 85 | 20-24 25 50-54 ! 15-18 i 20-80 i t : Years 3-40 4-46 1-50 15-40 4--75 $~*S3 15-4i) 1-12 Lung Asbestos--,..,,..,...----. . . . ------------- -------. . . . . . . . C h r o m a t e s . . ..... .................................... Hfeksl earboayl........................... ........................ . . Tar fumes___ _--............................ ............... ...... Ionising radiation__ ....---- ...............------------------- Bladder Aromatic atnines._________________ _ --. 18 j 15 22 IS 25-85 \: 11-15 15-21 5-47 0-30 o~2a 7-50 2-40 OCfOBUE -- MOKNIMS SESSION 1ST (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 phyainehemkal status of the agent during contact, and the cancer produced in ixvperimcntal 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 hut 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 bistologically or lurioehemie&lly 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 as to the asbestosie origin of such a pulmonary carcinoma. Of similar causal significance would be the demonstration of chromite dust by histochemical methods and by incineration of sections of the lung of an individual with pulmonary carcinoma. The hinfoehemical demonstration of arsenic in the skin affected by a carcinoma represents another illustration of the value of histologic studies in the determination of the etiology of a cancer, Likewise the presence of extensive endartoririo 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 the individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, some histologic or histoehemieal characteristics and the existence of corresponding ob servations on cancer production in experimental animals aside from pertinent epidemiologic data represent the scientific basis essential for medicolegal decisions in litigations of alleged occupational cancers. C, C om pensation Laws Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types of oc cupational carcinogenic agents, industrial operations with carcinogenic ......... asiri'&s-- ............................................................... ......................... 138 1954 m m t m o f u i a b c hazards, and occupational oaucem covered. As of October i, 1954, foil coverage laws applying to all kinds o f occupations-,! diseases in cluding eaneem had been passed in 26 States of the United States and the District of Columbia; schedule coverage laws not always covering occupational cancers, or all types, were in, force in 20 States and no occupational disease laws had been enacted at th a t time in 2 States (Mississippi ami Wyoming). While workmen^ 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. Sneh static laws reflect a legal and sodologio state of mind which is maladjusted to the dynamic state of modern industry. However, even the blanket or general coverage compensation law which is sufficiently flexible to include not only the present hut 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 may he too short for occupa tional cancers which may appear after a longer period. It is advisable for this reason to adjust all existing laws in snub 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 forming as well as housework, have become and are increasingly hecoming occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilizers, antisprouting agents, hormonal fattening agents of livestock, lubricants and fuel of farm machinery, residual oils for smudge pots, soil improvers, antibiotics, detergents, waxes, polishes, d ry cleaning agents), there is no sound scientific reason for excluding members of such occupations from coverage by the workmen's compensation laws and from adequate protection against cancers arising from exposure to potential and actual occupational carcinogenic agents. OCTOBB1 -- MOBNING 8SB B 0N m I). Mbar C&ea Stamfords 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 merit. While such & procedure is evidently the best that can he 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 earn be achieved to a large degree by the enforcement of proper work conditions in operations in. which cancer hazards exist, 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 hasards, it 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 technologie 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. All prccancerous 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 measures represents an important step from a publie health viewpoint, because them is a growing 'urgency iu determine the environmental causes responsible for significant changes in the incidence rates of several cancers, A great deal of circumstantial and direct evidence incriminates recent changes in the industry-related environmental factors for the startling and progressive increase in the lung cancer frequency observed m 1M 4 MEETING OF SATABC m all induatmimed countries during the past 50 years (graph 1). A similar, while not as marked, rise in mortality rates has been observed during the last two decades lor cancers of the blood forming tissues, especially leukemias, for which the crude mortality rate increased from 1.0 per 100,000 of the population in 1000 to 4.3 per 100,000 in 1044. This development coincides with a marked increased use of mowing radiation as well as with a widespread industrial and medicinal employment of chemicals having distinct hernato toxic effects. OCTOBER 8-- MORNINQ SESSION I t also may be of significance th a t 4 c age-specific total and ageadjusted m ortality rates per 100,000 population for akin cancer In white males and whits females in the United States have shown between 1030 and 1950 a marked shift in favor of the younger age groups (table 6). W hether such changes in the age distribution of skin cancers for both sexes may have resulted from the modern habit of sun bathing or a more intense environmental, occupational and dietary contact of the general population with arsenical, or with products of the eosl ta r and petroleum industry, remains at present a m atter of speculation. For determining the possible causal signifi cance of such factors 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 T aVls Age-specific., Total, and Age-adjusted Mortality Ram Per 168,000 Population far Shin Cancer in White Males and White Females, United States, m o, m s, md i m Fader 15. 15-24 . . . . . . . . . . . . . 25--34..--------------- 85-44...___. . . . . . 4 5 -5 4 ............. 55-84........................ 85-74............... . 75-84...................... 85 and over_______ Ail ages.. . . . . . . . . . . Age adjusted J____ 1S30 is Ba'? &6&a$ifcs 54 VAaaa\w / M W * M V O.Of? 0.08 . 12 . 11 .22 .46 75 . 85 2.5 ; 2. 1 8.6 a 3 23- 7 16,0 88.2 82. 3 104.2 172. 4 3.3 3,2 4. 7 3.6 0. 03 ,34 .81 1. 4 2.7 5. 0 12. g 32.6 77,5 2,0 2.0 --82 +208 + 76 +65 +28 + 11 -20 --38 -55 Under 15 15-24___ 25-84___ 35-44___ 45-54.... 55-54___ 65--74___ 75-84___ 854-......... All ages.. Wstti femsiUs .A W A W ,,A...AM W W Z A N W V ^ > A W . W W 0.07 0.07 .88 > . IS .23 | .23 : . 83 l . 5o 1.5 ! 1, 0 3.8 | 2.0 11.4 | 8.7 44 8 26, 3 182. 7 132. 7 % l } 2.0 | 2.0 | 2*1 -&>s-k&k ..... 0.02 .31 v 1, 2 1.8 3.6 0.8 ms 68. 3 2.0 1. 0 -71 + 123 +213 +118 : +80 : +24 -22 -20 -48 .*-V -v v .> y. ------- - 142 1&S4 MEBTXNG OF IAXABC on ills location of the cancers in the exposed or uncxposed parts of the skin, (site distribution) AM such d ata could readily be obtained for occupational factors if all occupational cancers would be made notifiable. A t the same time this measure would be instrumental in ascertaining to a much greater degree than heretofore the scope of occupational cancer hazards and of the cancers resulting therefrom. The effectiveness of this pro cedure is strikingly illustrated by &graph (graph 2) published several CUTANEOUS CANCER IN RELATION TO OCCUPATION m m i s m m m r m m m r n n o f cast s m cutaneous c & m w m m m m & t ^ t y m m m m mm&wt Gaaru 2 GTOBSB 8 --MOENIKG SESSION years ago by H enry in which 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 eosl tar, pitch, shale cdl and mineral oil after statutory notification wont into effect 1, The rapid development of modern industrialism has been asso ciated with the appearance of many new occupational health hazards of which those causing cancel's occupy an important position, 2, The increasing rate at winch occupational carcinogens have been discovered during recent decades suggests that only a fraction of the actually existing industrial carcinogens is known and th a t here tofore nnlaiown 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 great 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 histochemicai 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 chemicals and 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 cancer hazards, 6. Since the prevention of occupational cancer hazards and not. financial compensation for established occupational cancers appears to he the mertt.Mnaibk .and humane mat bod of occupational cancer. 144 1954 MBBT1K6 OF IAIABC control, labor codes should be properly adjusted and enforced so as to elimnate or reasonably contain occupational cancer hazards In mod em industries, ?. For ascertaining the actual scope of the occupational cancer problem and for the institution of adequate control measures, it is essential that occupational cancers and pracancerons conditions arc made notifiable, with local and State health and labor authorities. 8. comprehensive study of occupational cancer hazards will provide a sound basis Cor an equally urgent investigation of the apparent extension of industry-related cancer hazards to large parts of the general population, BlBUOGBAPKY t> Keopus, W. ., OeciupatJonal Tumors and Allied Diseases, G. C. Thomas, Bpringdekl, lit, 1942, p, 887. Hemst Developments in Environmental Canecr, A. Review, Arch. Pafchol. Is presa. Methodology- for Environmental and Occupations; Cancer Surveys. Pubs. Health Tech, Monograph to. 1. IL S. Public Health Service, Depart meat of Health, Education and Welfare, 1980, p, 37. 2. Teasko, V. M,, Occupational Disease Reporting, i t 8. Department; of Health, Education and Welfare, Pabl. Health Serv;; Puhi. Xu. 288, 195$, p, 80. 3< Srmh-an, L. K., Itee&nt Trends m Occupational Disease Eegsl&foo. Uiv. Illinois Bull, 48; No, 89, 1951, p, 30. 4. Moscsa, G. G., ami DaviSNva'r, S, J>, State Compensatory Provisions for Occupational Diseases. Burean of Mines luforfuatiou Circular 7650, IL S. Department of the laterior, 1952, p. 125. 8, Watuks, I s, Industrial Physician and Workmen's Comixms&tion---Correat Trends in Compensado Legislation. J. Indust. Pyg, and Toxicol. 81; 251-255, 1948, 8. Sr.mcousnrrEB ok LsossiatOx PumencAs, A Ratio! Approach to Air Pontbn Legislation. Manufacturing Chemists' Assoc., 1982, p, 23. 7. Tocsahosao, P. J., Health of Workmen; Appreciation of Risks to Which Health of Workmen Are Exposed in Industry in Province of Quebec. Caad. Al. A. J. 54; 352, 1948. Tibe Acdete1 PreyeYioii Asscei&fcjkms Under th e Q uebec W orkm ea5C om p em ation Law L* H. T. Clecu President* Quebec Association, jar the Prevention of Industrial Accidents Un ike absence of Mr. Clegg, Ms statement was read by J. Arm&nd Derrchese, vice president, Quebec Association /or ike Prevention of Accidents] I will ondina briey the setup of the various safety associat ions, and later, being more familiar with the organization which I represent, I shall endeavour to elaborate on a few of it major promocional ..MmMi............, ................... ......................................................... ............. APPWDIX O U esal Attend* a t th e F ortieth A r a ii l Meeiimg f th e Snteraaticraa! A sseeiatiea In du strial Aedw d e n t Boards and Com m issions CANADA Alberta A. ite m n e , M, B, B.t Commissioner, Workman* Compensation Board, Ed monton. J3s, H, H< SteBe&R, Chief Medical Odirer, Workmen's Compensation Board, Edmonton. 0 . M, Ma-W od, Q. C., Chaims, Workmen's Compensation Board, Edmonksn. British Columbia f< A Akcssbaod, Seeretery, Workmens Compensation Bo&rd, Vancouver. Aam B to , Chairman, Workmen's Compensation Board, Vancouver. C. W, P^mmas, Commissioner, Workmen's Compensation Board, Vancouver. Mnm'ieh Qy lx. C o a sts', Q. C,, Commissioner, Workmen's Compensation Board, Win nipeg, P. V. B, Aonm, Assistant to Commissioner, Workmen's Compensation Board, Winnipeg, N m Brurnmeh A. A, Cmspote, President, Haw Brunswick Accident Prevention Association, Moncton, IL G. jOHSSTO, Vise Chairman, Workmen's Ccsmpens&tion Bo&rd, St. Mot, J. A, Lk$ lm:c, Claims Officer, Workmen's Compms&tioo Bo&rd, S t John, Newfoundland CnAsXNca V, Hancock, Commieskmer, Workmen's Compensation Board, St. John's. Nom Beotia Awmoa P&mrp, Commissioner, Workmen's Compensation Board* H alite, P&akk Row's, Chairman, Workmen's Compensation Board, Halifax, Ontario J. P, Cahi.ev, Vice Citerman, Workmen's Compensation Board, Toronto. Max Bonos, O stein Federate of Labor, Toronto. F, Frxonas, Workmen's Compensation Board, Toronto. G&o&on Gassow Gksbk'E, Director, Federal Government Employees Compensa tion Branch, Department of Labor, Ottawa. W. J. JoKxsroN, Workmen's Compensation Board, Toronto. J. B. Lars, Department of Labor, Ottawa. ................................................................................ ......................................... .Ill S -iSJj if tSf ,, SS SI S 5 ^ o g I e! I S. a sg ^1 ^ $ `S ,>>O3 <&&^^ ! f l -g ;5 a " H SS r| s- ^ < O S"Q ssfic *$>? 3 : tt t a * 1 , g g 2 O g lg srs< > g # B fi :>-3 **4 :s %S| ! s, *. 8. a ok K'S m {303 K < S3 J3 1954 OB U.BC Eticsfs Lasockmb, Secretary General, Quebec Metal Mining Association, Quebec. Nan Lakochs, Workmen's Compensation Commission, Quebec. B s. ssestra Lecoebo, Chief Medical Offices, Workmen's Compensation Com mission, Quebec. Ds. D. Lbokab, Workmen's Compeus&tlon Commission, Quebec. T. I, Lrrxas, Director, Quebec Metal Mining Association, Nor&nda, MG E, Mokgomekt, Safety Director, Kenneth B, S, Robertson, Ltd.! Montreal, Bausa?? Mokrt, Q, C, Commissioner, Workmen's Compensation Com mission, Montreal. J AtmoMSK Morence, Workmen's Compensation Commission, Quebec-. Jban Ynm ix, Orthopedist Technician, Montreal. Roamo Paotjut, Workmen's Compensation Commission, Quebec. Dnax Quimpek, Depot;,- Minister of Labor, Department of Labor, Quebec, G. Ant, Rousseau, Workmen's Compensation Commission. Quebec, F. M,, EocirsneAe, Commissioner, Workmen's Compensation Commission, Quebec. D vo Roirn.uA, Workmen's Compensation Commission, Quebec. E yaujste; Rochutxe, Commissioner, W orkmen's Compensation Commision, Quebec. L H> Sx.osroe, gofety Director, Canadian Johns-Manviiie o,, Ltd., Asbestos, W. H. Sooxak. Assistant to Mine Manager, Canadian Jolms-ManviUe Co., Ltd., Asbestos. Dr, Camu,jn Bmako, Workman's Compensation Commission, Quebec, Bn. F, L T ouranseau, Division of industrial Hygiene, Montreal, Da. B, . Tuanox. President, Industrial Medical Association, Montreal. Qkharts Trsmbaay, Deputy Minister of Labor, Department of Labor, Quebec. L. P,, Tessnoip Workmen's Compensation Commission, Quebec. Jacqoss Vmoieauw , Secretary, Workmen's Compensation Commission, Quebec. , C. Waaksr, Superintendant of Safety, Crane Limited, Montreal. Dm R, E, L. Watson, Medical Director, Crane, Limited, Montreal. Sr, CnoReu Wums, Workmen's Compensation Commission, Quebec, 8&skal$hewan M , D, T hompson, Commissioner, Workmen's Compensation Board, 0 . W. Vau-kao, Chairman, Workmen's Compensation Board, Regina. C. C. Whaams, Minister of Labor, Department of Labor, Regina. Nogina, iabarim Jos L. CotKMAN, Director, Department of Industrial Restions, Montgomery, ArMm&s G. L. Gsu*, Attorney, United Mine Workers, Fort Smith. Q, W, Hoomks, Commissioner, Workmen's Compensation Commisssioa, Lido Rock, SNOn B. Smsss, Commissioner, Workmen's Compensation Commission, Little Rock, California C bsst F ua k k , Guarantee Insurance, Co., Los Angeles. J o seph J, G aXAAg beb, Manager, State Insor&uee Fund, Burlingame, ...BL'W-l 'FykiMoxALnL'Oiairiuaffi Industrial Aeeidenf 'CdVehMW'oh, 'Mm'lMMdiacb!' APPENDIX c Paxk, SsHAminr&mth Birootor, Department of IsdsMri&i Relation, 8 m Frmsdseo. Dr. Bab?- B. Thomas, Departnot of Bmpioy'iaent, B&cmmmiu. H, M- Wnia?;, Department of Employment, S&ermsmdo, Vtthrado Bat li, BsAJiKASSASif Ckim&n, Industrial Commission at Colorado Beaver. Haeol C, Tkospsos, Hiredsr of Qahos, State Compensate Imor&nm Fund, Denver, CennacHcBS B* B. CooaHUic, Hartford Accident & Xndenmiiy Co,, Hartford, A. H, Osnse, President, Toll Vs&to House, lYorytoxyn, W. B. MoConmox, The Aetna Casualty & Surety 0,, Hartford, 1'kia'tmre Abel Klaxv, Special CoxioaeS, E, I, du Foot tie Nttmeors A Co,, WHisimgtoa. Dr. I, J< MAeou,tvM, Member, Industrial Aeddont Board, Wyoming, Jams. A. Mtittss, President, Industrial Aeeidmxt Boned, Wibaisgton. Posm N,, Waajsnsoros, Member, Indxtstml Accident Board, Laurel, Dulrici of Columbia Assaw J, BssMittsa, Meibar, National Legislative Committee, American Federal km of Labor, FsAtta Fsasaaos, Associate Director of Bdueatloa A Bese&reh, Congress of ladostrial Crg&mrartons. Bsocb A* Cesses, IT. 8, Department of Labor, Pavl E, Op.sass, Saeretsry-T':asi'iW, IAIABC, U. S, Department of Labor, Dr. W. C. lie s see, Chief, .Environmental Cancer Section, Caneer Xostiftste, Department of Health, Education and Welfare, Befkeada, Md, Hon. Astkus iLftssos, Under Secretary of Labor, Jobs E. Lawy&s , Chairman, Employee Coxopunsatfoo Appeal Board, u, S. Department of Labor. Masuk V, Laef'iSiiWT.!,},, Clbee of the Secretary-Treasurer, XAfABG, U. 8, Department of Labor, Wim&M McCaui-st, Director, Bureau af Employees' Compensation, Xs. S> Department of Labor, Fkasxx McEoboy, Lt. 8. Department of Labor, FsATcas C, SsirrH, U. 8, Department of Labor. Eosest Yak Htsssc, United Mine Workers Welfare ?md Rotiremauf Fund. Flwida aties Castssos, Member, Industrial Coriaslot Tallahassee, B, T, Cotasssav, Car,era! Counsel, Industrial Commission, Tsdi&hassee, Boosbt Dua&Attca, Birootor, Workmords Oompe&satkm Division, Industrial Commission, Tallahassee. Josaris A. Pakxb, Orlando, James T, Yocells, Ch&lnnaa, I sdustri&i Commission, Tallahassee. Georgia BiCUAsn W. Best, Sesretary-Treosuror, Board of Workr&orLs Compensation, College Park. W< E, Bucxnxa, Mesaber, Board os Workmen's Compensate, Atlanta, m m > i m eeting o f m & m Ms&o Correa ). B opjuss, President,, National Association of Self Insurers, Lewiston. B. W. OrneuBnsM, Chairman, Industrial Accident Board, Boise. Illinois B ah Aoask, National Safety Courses!, CMeago. Hem Bpc'b&ak, Superintendent, Compensation Claims Department, 2?ieh General Accident A. Liability Instm&nee Co-, Ltd., CMeago. Earn, M, Caj..j o, Commissioner, Industrial Commission, Chicago, fm r s i E, Fasstpa, D ie te r , Industrial Division, Nations! Association of Mutual Casualty Companies, Chicago. Mrs, Msafoma W, Grouser, CouseH os Industrial Health, A, M, A., Chicago, B. J. HoannwaK, Chairman, Indnatmi Commission, Chicago. Rtssswr 8. Hows, Lumbermen'a Mutual Casualty Cm, Chicago. I>, W, Johnston, Commissioner, Industrial Oonmrissioo, Chisago. 3D?. Mivmu H, XsoH nsasss, Medical Sendees Manager, Caterpillar Tractor Co., Peoria, H. Ona MibbXM, National Safety Gounod, Chicago. Johs Moousn, Commissioner. Industrial Commission, Chicago. Dr. C. T. Onto, Chairman, Commission on Workmen^ Compensation, 1nds~ trial Medieal Assoeiatsoo, Chicago. J. A. PASgxsws, Illinois Department of Labor, Chicago. S. J. Brayus, Western Eleetrk Co., Chicago. Paoh S, Wmr>, American Mutual Alliance, Chicago. Indiana Howasn T. General Manager and Conosel, Lynch Goa? Operators Redproaal Association, Terre Haute. Dr, A. K, HsacoonT, Indianapolis. EtiAHonL F. Msan&a, Hearing Member, Industrial Board, ladianapolis. JeasFg P, Mrixaa, Chairman, Industrial Board, Indianapolis, Itmtt C, H. Cans?,?, Deputy Commissioner, Workmen's Compensation Service, Bps Moines, Eoasns Eowasb osm , Commissioner, Office of Workrnea's Compensation Commis sioner, Topeka. Atmanr M. Boss, Esaminer, Office of Workmens Compensation Commissioner, Eanras City, li&xmi J. Thoensk, Examiner, Office of Workmen* Compensation Commissioner, HoteMaso. Sm'SiOM Wnsa, Examiner, Office of Workmen's Compensation CnmsnissSoncr, Pittsburg. Kentucky Paw, Combs, Acting Commissioner, Department of Industrial Rel&iloxss, Frankfort. H. Wimasss, Attorney General, Department of Labor, Frankfort. a ppen d ix g 233 Meme j a m W, Basaoo, lawyer, B&rsgor, Mrs. Ma&!iih BAnnaae, Industrial cddeat Commission, Augusta. Gram M, Jomr, Member, Industrial Accident Commission, Waterville, Jmm, S, Mwcmm, Lawyer, Bangor. F. E, ErcKAansou, Portland. ' M&ryhni M mvm L. Pmn, Ofc&irmau, Industrial Accident Commission, Baltimore. Br, Jamsx V. Hopxhs, Baltimore. W. A<8bkt Msrohks, Commissioner, Industrial Accident Commission, Balti more. Fato. Shmess, Jr., Manager, Compensation Department, Maryland Casualty Co,, Baltimore. Mmimr B, Seven., New Amsterdam Casualty Co,3 Baltimore, M&,nmhmtitc Ds. P, A n m n s Ch&im&n, Subcommittee on Industrial Eolations, American Collge of Songeons, Brookline, nraoasn S. Baohosowski, Attorney, Salem. Bav B, Basas, Employers Croups Insurance, Boston, Thomas W. Bows, Member, Division of Industrial Accidents, Boston. B. B, Coo?a, Director of Medical Betatrons, American Mutual Liability Is* snranes Co., Boston, Ebermr H< Qmoux, Chairman, Division of Industrial Accidents, Boston, P&Afc'mE, Conroer, Director of Self-Insurance, Division of Industrial Accidente, Boston. Staswoo l), Hajssok, Assistant Aloe President, Liberty Mutual Insurance Co., Boston. G. 8. Hasuah, Flee President, American Mntual Liability insurance Co., Boston. I amhs O. Haa&mey, Attorney, Massachusetts Bonding and Insurance Co., Boston, Mahckuoa J. Hrcan, Boston. Manx F. Hrcua, Member, Division of Industrial Accidents, Boston, Emas J. Kos-orowAS, Member, Division of Industrial Accidents, Boston, Ebwako S, Munrav, Attorney, Boston. Many A, Hookas, Boston. Ashs.kt St, CoAi, Counsel, Liberty Mutual Insurance Co., Boston. .logera A, Buuavas, Chief Examiner, Liberty Mutual Insur&neo Co., Boston- Mas. Emma 8. Tonsanr, Past President, IIABC, Quloey. Michigan, W, C. Brsuor, Manager, State Accident Fund, Lancing, Haaot P. Bksoos, Superintendent of Claims, State Accident Fund, Lansing. WmorAM B. Bockanan, Chrysler Cerp,, Detroit, . E, CAnorCTUs, Ford Motor Go., Detroit. Jos C. Chouas, Lincoln Mercury Division, Oeneml Motors, Detroit. H. A. Comp&ao, Attorney, State Accident Fund, Lansing, Wouam I, Dsvoss, Chrysler Corporation, Detroit, Crans E, Dunro, Chrysler Corporation, Detroit. jA&mg L. Hmn, Supervisory Attorney, Workmen's Compensation Section, Ford Motor Co., Detroit. .................................................................................................................................... 234 Hl54 MEETING OF l A lABC W, L Hm'Oimms, Ceenpensatlon Supervisor, Chrysler Corporation, Detroit. fm m n E. Jo, Manager, Employee Services .Department, Ford Motor Co., Duarbom. Wisliam J* JoS'as. Lacey, Joses & Doelle, Detroit. F. A. Lux, St&lf Attorney* Workmen's Coropsxs&tson Section, Ford Motor Co,, Detroit. Wads H, MoCkke, Jw, Member, Workmen's Compensation CommimAn, Irnmng. W. R, McGskcok. Vice President, Mi&htg&u Mut oat Liability Do., Detroit. Bxxit? Marcus, Roprasentiag Saran! B, HoravGs. Muskegon. 8s chahs R. Noams, Chrysisr Corporation, Detroit. Roeusw L, O'Cos.vsu,, Roth, Maratcm, Bdha & Masoy, Detroit, TutoriOU: P. Ryss . Chairman, Workmen's Compensation Commission, Bimon date. Rcbb L, Schah?, lateniatiauM t&proseni&iH'e, Fkunpensabon FJepa W-CIO, Detroit-, , . Soeourr, VsOfe PrestiicaI: in Charge et Claims, Corporate Service, too., Detroit. Paso B, Wahkek, Attorney, Auto Owners Insurance Co., Lansing. Mirmvmltt Roaswr IL Farscv, Cosnndssionor, lodu&trmi Commission, Bt. Paul. Mississippi Saa S. Ausoso. Consmissdoaer, Workmen's Compensation Commission, Jackson. Jous A, Cbah, Chairman, Workmen's Cimpens&fion Commission, Jaeksom Missmiri Witbi.m G. Bro, Superintendent, Workmen's Compensats-org meHean Associated Insurasee Companies, St, Louis. Chartas E. CUves. Member, Industrial Commission, Jefferson City. Eawl F. Caferr, AsW-dsmt Professor, St. Loose University, Bt. Loom R, Rossa* C am , Attorney, Kansas City, W, E. FansuAitti, Member, Industrial Commission, Jefferson City. Spbeesu K. Grrssa, Director, Division of Workmen's Ccsnsiieuaatiou, Jefferson City. Srsmrm J, Msxmsrr, Chairman, lodnetmi Commission, Jefferson City. Mariana W,, W. GABt'Sm, Secretary, Industrial Accident Board, Helena. Nsm Jsrsity Wmfison Beaks. Chahh & Sons, Managers, Federal Tnssmnee Co., Bkort HsSN. Da. H. E. Bsfoaek. New Lisbon. Caro Hrorrmah, Commissioner, Department of Labor & Industry, Trenton, Ba rnm, A. 8vasa, Director, Division of Workmen's Compensation, Department of Labor & Industry, Trimton. New Msxim EKHUsaau Joses, Assistant Commissioner, Labor and Industrial Cenrasson. Santa F&. AFFEND NYork Evset? Ev Ai.ss, Managen 0 keines & Safety Department, Soeony-Yaeuum 051 o,. Ine., New York. Louis SBErr, Actuary, Woodward & Fondilier, New York, S . D sout Enmutj, Director, Compensation A Safety, AMeriDm Locomotive Co., Schenectady. Miss GPutsuns OavAUAuan, Workmen'* Comy-esmtiosi Board, Albany. &ATOOK& A, CATKHtT, Vied Piesidord, Fidelity A Casualty Co., New York, uvs s T, Cbavtoa, New York, Massham. Dawsok, IV.t Seeretary-Troaeoref. IAIABC. Hew York, D A> Dnaasoasita, Seerotary-Compfroilor, National Council on Compensation Insurance, Ne w York, Brrass&is Disam, State Insurance Fuad, New York. Mi&g Maas B Oteroa, Chair.ns.",. IVorkmoa's ComjxosiiafkKs Board, New YorkJ. liAhm B rass, Dotted States Casualty Co,, Hew* York. Jssen Dkax Euwakus, Attorney, Now York. Ri-COASo Finranssir, Woodward & Pondhiey, New York, O. Eabmr Fox, Secretary, Casualty .Divisioth Gicm Fails lnaam>@e Co., Glens mu Du. L&okauu J. Oopow-Araa, National Chairman, CV-diaeAnrlndnstry Com- raifctse, American Heart Association, New York, Wra*js C. Ootmre, C. E-, Dfreetor, ImAltnio for f ho Crippled and Dla&bfed, Now York, M iss JAakstte H a s s o n , Associate Economist, WorkincnV Compensation Board, New York, Aspskd Hesitate, United Steelworker of America, Buffalo. TMsonoAS Hsivasjm, Jm. Attorney, National Assodatiou of Mutual Castudty Cos,, Net? York, P. H- II oiSi-fiSMS,, A, 0. F. Iadueiries, New York. IL M, Jacsao#, Manager. Industrial Health Program, Johns M&siwllle Corp.. New York. Akokkw Kaluyuow, New York. Eowrst D, Krus, Counsel, Now York Comi&maatiors Insurance Hating Board, New York, M. L, Lasscowsax, Western lileetrlc Co,, Ine., New York, Jouk M. MeDo&Ats, Director, Work!** CompensaHo, Assomt.od Industries of New York State, Inc,, Albany, Bosaar E, MAasA?m, Admieisirafteo Deputy. Workmen's Compensation Board. New* York, Citehue B. MuiteioAte, Managen Workmen' Compensation A Disability Claims Division, America Surety Co., New York, MreoABi, J. Mxm'PUY, fkmorsl Mariager, Association of Hmv York State Moinai Casualty Cos., New York. Bay J. AKAEY, State Inseranee Fetid, New York. Miss Maukvm Boraxor, Serratary, Dnifcitd Steelworkers of Ameriea, Buffalo. Mrss Maar Rnoaov, Buffalo. Janas d. Es;as, Secretary, The BelfHhsurers Association, New York. B. Y. Rvas, Fidelity & Casualty Co. of Hew York, New York, Hskjav D. 8arasp General Manager, Now York Compensatio Insar&aee Rating Board, Now York. A, M, Sea st, insurance Manager, National Cmmdl of State Self-Insurers Asaoeiation, New York. m 1854 MEETING OF IAXARC Lames E, Shxsm , Attorney, Americas Telephone & Telegraph Co., New York. Ct&ub F. SMSsm, Claims Attorney, New York Telephone Co., New York. Wumau H, Srmotrra, Associate Attorney! State Insurance Fuad, New York, J. Maeht Turswar, Attorney, United Steelworkers of America, Buffalo. Warm s , Tocasm, Counsel, Utica Mutual Insurance Co,, Utica. Gm , D, W ells, Western Electric Co., Inc., New York. N. M m m Woods, Association of Casualty & Surety Cos., New York Qu. M. WrmA&t S o c sss, Director of Studies, Commerce & Industry Association of Now York New York. Norik Carolina Jf. W. Bear, Commissioner, Industrial Commission, Raleigh, North Dakota Orra Barant, Chairman, Workmen's Compensation Bureau, Bismarck 8. M. Evan, Member, Workmen's Compensation Bureau, Bismarck. Ohio H. D. Banokrt, Emile E. Wataon, Columbus. Jacob Caabmak, Secrotary-Tre&aurer, Ohio CIO Council, Columbus, J, Mafkasu Dxckss&son, Vice Chairman, Industrial Commission, Columbus. B, G. G o S u p e r i n t e n d e n t of Claims, Farm Bureau Mutual Auto Insurance Co,, Columbus. W, 0 , Hardman, Attorney, Squire, Sanders Dempsey, Cleveland. M. Hoe&ano Karen, Director, Workmen's Compensation, Frigidaire Division, General Motors, Dayton, John Kumfox, Doited Rubber Workers, Akron. Exguard W, M ossa, Chairman, Industrial Commission, Columbus. Charles F. N w a , B- F, Goodrich Co., Akron. Thomas M> Harman, Jones, Day, Coekiey & Be&vis, Cleveland. Oklahoma Pua Ansanr, Industrial Commission, Oklahoma City. Mark Okiyssaa, Industrial Commission, Oklahoma City. Junsa anssr C. Hunt, Industrial Commission, Oklahoma City. Tom G, Marsw, Commissioner, State Insurance Fund, Oklahoma City, Mot; Ik F b w to, Chief Attorney, State Insurance Fund, Oklahoma City. B. J. Sbthbbxa.no, Industrial Commission, Oklahoma City. Oregon, L, 0 . Abmms, Member, Industrial Accident Commission, Salem. WttuiAM A, CauoaSan, Chairman, Industrial Accident Commission, Salem. Pennsylvania F. E. Baesaa, Manager, Compensation and Safety, Bethlehem Steel Co, Bethlehem. Fra.sk El BoaUj Deputy Secretary, Department of Labor and industry, Harris* burg. A. G. CamsTMAR, Chief Supervisor, Indemnity Insurance Co. of North America, Philadelphia. W, D . Coaxlbk, Secretary, Fire Association of Philadelphia, Philadelphia. E. Gwaaam, Manager, Stats Workmen's Insurance Fund, Harrisburg. E. M. Hartman, Assistant Manager, Compensation and Safety, Bethlehem Steel Co., BibMssss. 1 -V 18 affm m % c Da, V G, Rats, Chief Paysieift, Humble & Bemag So.r Ha R, L. ScsiMA.s, Vice Ptesfdsat, Fetrdeum Casualty Gof Houston. L, H, FhSwzu.ZH, Chairman, lad striai Accident Board, Austi, FSiua A, IlA-iUKn, President, Petroleum Casualty Co., Houston, Qm m x, W, 8&r8?Commissioner,' Wcrkmca^,(fom yen^io Fasti, iCh&rlestoa_ s I ** , s? *3 #* *<>S <y< 1& iS i S3 a Z h  m i m S OF l&BC W immm F> iaa'008} Attorney, MMwmkm. B'/M> Km^srn, Vm Fxmm% Empktym; MuUik, Waaaaa. M & M m & a k W A rm im i Uiym&p Qmsm, Mmimn, ' I: M, lMm^.% Claims iJ&mrni; MateFs, W&mm, &&m % L, j&fegK, Bsete?, W om fs Oompassiio, XxsasM&i Commman, Mmh _ <2h&8m&&f Isasfeml Ooxamissk, Mt>i. Wymm$ f S M * F, Psa-air, M&s&ger, WeakaaaFs s&p&nmtfan C&nxmksmn h tijm m . ,...... ....s.-.s s s ***.tm w fr . m m - w