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PLAINTIFF'S EXHIBIT isrsc-7 - CHICAGO OCTOBER 10-14a < 1933 v ' NATIONAL SAFETY COUNCIL, ,NC 193i, Nlio<tl Sflv Courcil. Ine. Print'd in 0i U. S. A. 1 ^reword THE Transactions of the Silver Jubilce Congress and Ex position of the National Safety Council, October 10-14, are published in two volumes. Volume I contains the . Hernial and subject sessions and the sessions of tbc various ` Industrial Sections. Volume 11 contains the Street and Highway Traffic, the Conunercial Vehicle, the Transit, the Child Education. and the Monte Safely sessions. Volume 1 is distributed automatically So all industrial mem* , hers of the Council. Volume II is sent to members who are believed to be interested chiclly in the sessions it contains. However, other Council members may obtain Volume If U(>on request. Many members have found it of benefit to distribute copies of the Transactions volumes to both executives, foremen and supervisors, who have used the practical information they Contain in safety programs and tor general reference pur- po.ses. lixtra copies of the Transactions may be obtained as follows: One to 10 copies of Vol. I, at $2 each; 11 or more Copies, $1.75 each. Extra copies of Vol. II cost 75 cents each. , . THE Transactions are a condensed record of the pro ceedings of the Silver Jubilee Congress. The papers and . addresses have been edited to delete extraneous matter, ab breviate the less important portions, and emphasize what may he of particular usefulness and value in promoting ef fective safely organization and other accident prevention measures. These volumes, therefore, are a somewhat abridged version, compact, practical and of particular value to the student and executive interested in achieving more thorough accident prevention success. The original manu scripts are available for additional reference, if desired, in the tiles of the National Safety Council. , rPllE National Safely Council, at its Congresses, seeks to X diminau- from discussion matters which are not pertinent I to the ainiN of the Cimgivs- or which may he contrary to the 1 Council's policies. It cannot accept ropntisihilily, Imnevci, for all views expressed cither in the papers which have been blue od or m the discussion^ base I upon these papers. NATIONAL SAFETY COUNClLJnc. 20 North Wacher Drive Chicago Contents Council Officers and Directors................................... 4 ^ Council Purposes and Policies.................................... 9 . Annual Meeting of Members....... 1..................... 11 Annual Banquet........................................................... 31 Special Subj'ect Sessions-- ' A/DtgugrsirCticsU,uUFl-tUuulmrMae*ls,SwG-ua-naf-e.s-te-y-js--a-....-.n....Jd.......V......a.....p.....o.....r...s......................................_..._...._...._.... 443553 Falls of Workers.......... V.................................... 59 Fire Prevention................................................... 53 - Governmental Officials ....................................... 85 . Health Service in Industry...................................101 Industrial Accident Investigations.................T..11S Industrial Explosion Hazards................... 125 Industrial Nursing..............................................139 Industrial Safety Lectures...................................163 Maintaining Interest in Safety....... ........ 185 Midwestern Rehabilitation Meeting..... ..............201 Occupational Disease........................................... 211 Off-the-Job Accidents......................................... 229 Safety Fundamentals........................................... 249 Safe Use of Electricity........... ..............................257 Sate Use of Petroleum Products..........................269 Aeronautical Section .................................................. 281 " A. S. S. E.--Engineering Section............................... 295 Automotive and Machine Shop Section...................... 301 Cement and Quarry Section......... i.......................... .313 Chemical Section......................................................... 339 Construction Section.................................................. 373 Food Section .............................................................. 385 Marine Section.............................................................407 Meat Packing, Tanning and Leather Industries Section ..................................................................... 455 Metals Section.............................................................473 Mining Section ...........................................................521 Paper and Pulp-Section............................................... 555 Petroleum Section....................................................... 613 Power Press Section................................................ 665 Public Utilities Section...............................................671 Refrigeiation Section........................................ 691 Rubber Section.............................................................703 Steam Railroad...........................................................733 Textile Scct*or*-...........................................................753 Wood Products Section...............................................775 Safety Exposition--List of Exhibitors...................... 799 Indcx ............................................'..................... 805 national afety Council, Inc. HONORARY MEMBERS . ,\"imiu.N or luu.v wo Sim. Kxiunitrs Runt kt \V. Cami'iu i.i. I. 1 W Iv. PaIMI.K * OFFICERS (1938-1939) I*. It. l-l.SMi.i., I'rc-idml C W. Dimi'ksv, Vice-President fur l-iiiancc and Treasurer I-hwk H. Harrison, Vice-President fur industrial Safely tin. Miliar McClistuck. Vice-President for Public Safety Wai.uk S. Paint., Vice-President for Engineering A. \' kuiiuiiii k, Vice-President for Safety Councils R. T. Sm.KNsTK.v, Vice-President for Mcmbcrstiip A. \V. Wiiitxkv, Vice-President lor Education U. 11. Camtkox. Secretary and Managing Director . EXECUTIVE COMMITTEE (1938-1939) II. .1. Ai.hkICII, Spencer Kellogg & Sons, Inc. J. I. It wash, Pa-l President C. \\. Iti.kiayi isT, PaM President II. W. Itooi.r.ss, Sinclair Prairie Oil Company l . II. ItiifiKr, Wi-ciiU'in Public Service Corpuraliuu Kmniii W. C.vuimt.i.. Past President <l.VM.fiS,','N*atiunal'Saieiy Council; Ini.'. . ........................ .. I.. C. CAMfin;i.i.. Mining Section k dicrl I. C.vn.tx. Aetna Casualty Sb Surety Company .............. I. r.wis A. Di.lti.uis. Past President C. \V. I )i Ml'l.sv, The l.itiuid Carbonic Corporation ........ . . Iv. la. Donovan. ASSE-Enginecring Section '' . M a net's A. Dow, Past President Waiiir A. Evckson, Lehigh Valley Safety Council Kami. Iv Ckou.k. Safely ('uuneil of llie Columbus Oiamljcr of Com- inerci D. 11.. l-'l.NXIlI., Cuii-nlling Engineer H.vurv tipiuiLKT, Tbe Pultinan Company Prank II. IIakkisoS, lutcruatioiial Harvester Company IImioiii ti. I lot 1 u vx. I'ueinployineut C<>mpeiisation Commission, .Yen Jeiey S It. ltonnl.ll, pond Seeliou . , II. II. Ivt.un, liilcr-l;i,le Cuumieree Commission 4 J OFFICERS AND DIRECTORS, Continued Wai.ikk ti. Kin;:, Past President Wm. ti. Kniiiik, Milwaukee Safety Commission Ions Iv Lost;, Past President Tuns. II. M.vcltoNAUi, U. S. Department of Agriculture Arthur W. Maui.k, Commissioner uf Motor Vehicles, New Jersey Die. Miii.kr McCt intim'k, Yale University R. S. Mtuum, Public Utilities Section I. \V. Mii i ahi), fndustria! Oloyes Company IIakiii.d I.. XIixkk, K. I. dn Pont de Nemours & Company Ei.tor .Vr.ss. Director of Public Safety. Cleveland E.'J. O'lluitx, Jk., Louisville Safety Couneil Wai.it.k S. I'ainK, Aetna Life & Altiliated Companies I.kw R. Pai.mcr, Past President ' C. E. Pcttumink, Past President It. O. Picksun, Marine Section 1 Auii.kt S. Rki'.ula, Industrial Relations Counselors, Inc. l.T. Cot.. Hcnuv A. Ki.nincl.r, Past President E. A. knitCKTS, Textile Section A. V. UomviDtK, Dulutli, Missabe & Iron Range Railway Company Gloria: E. Santoro, General Electric Company f. CitAKLi:s U. Scott, Past President , Prank T. Siikets, Porllaml Cement Association (ii:x. John* H. Shckiiuknk, Massachusetts Safely Council C. W. Smith, Standard Oil Company (Indiana) Wai.ti'.m Dknt Smith, Delaware Safety Council \V. A. Skow, Const ruction Scctiili ' U, T. Sui.i.xsiKN, Elliott Service Company Lksi.ii: J. SoMKXsiiN. City Trallic Engineer, Chicago , , . ., Cot.. Jons StiiavIlIa., Consolidated Edison Company of X. Y., Inc. I.. iCoP.-.TiM.M.W, jl'^st J^gjiileut, . ..........................I o `, I,.U.roKoc (ji. TraUk. Greater Qiicago Safely Council, Inc. ,. Dr. It. L. VostiUROH, General Electric Company , ' . Dr. C. H. Watson, Past President , ' A, W. Wtin.Ncv, National Coiiscrvaliou Bureau I). A. llvHKi.r, Caruegie-Illiuois Steel Coiii|iany Arthur H. YntiNfi, Past President .. . . DIRECTORS (1938-1939) II. J. Ai.iiKii.ll, Spencer Kellogg & Sons, llie. A. L. Arvisthoni:, Eastman Kodak Company J. I. llwvsit, Past President C\ri. Uahkih, St. Louis Safety Council 'A l.io II. Hi.aui.vC, ltlaeksioiie Valley Safety Couneil W. A. Iliciml, Aiilnmolive Jfc Macliiiie Simp Section ^KNCsr W. ili.cK, United Slatei Rubber Pindticls. Inc. . S i II ''ICERS AND DIRECTORS, Continued C. W. Bkhcquist, Pail President K. I". Blank, Jones & Laiighlin Sleet Cor|iuralion It. W. Ilmxi.ss, Sinclair Prairie Oil Company , II. li. Hoi.t, Sonili Bend Civic Safety Council ` C. II. liouii.r, Wisconsin PtiMic Service Corporaliun F. S. liiiow.v, Standard Accident Insurance Company J. 11. Brown, Petroleum Section ' V. \ A. Brown, Safety Dept., Nashville Chamber of Commerce U. A. But ! ock, Rubber Section W. II. Cameron, National Safety Council, Inc. I. , C. Camprell, Minins Section IvOiiutT W. Cami-iiei.L, Past [`resident R vvmosu A. C.vkLV, Evanston Safety Council Uw Carney, Kenoilta Safely Council Uom.Kr I. Catlin, Aetna Casualty & Surety Company Maumee Cuaii.t.i.r, Railway Safety Council L. O. Ciieevkk, Employees' Puhlicalion Section \Vi. M. Clark, St. Joseph (Mo.) Safely Council Kenneth B. Coi.wan, Scalilu Trailic & Safety Council J. E. CuM-l.N'CV, Bethlehem Steel Company Frank J. Dcan, Kansas City Safety Council . Liams A. DeBi.ois, Past President C. W. Demi-esy, The Liquid Carbonic Corporation R. E. Donovan, ASSE-Engiucering Section ' Jauis Li. Douglas, The Philadelphia Gas Works Company Marcus A. Dotv, Past President Dk. Louis I. Duui.in, Metropolitan Life Insurance Company O. M. Cowards, Jr., Safety Div., Syracuse Chamber of Commerce W. A. Evcrson, Lehigh Valley Safety Council D. D. Fennell, Consulting Engineer . .. . Dunai.u A. Finkueiser, Toledo Safety Council Dr. Hart E. Fisiikk, Chicago Rapid Transit Company Chester C. Fisk, Berkeley Traffic Safety Commission Howaru B. Fosn.v, Burroughs Wellcome S: Co. (U.S.A.) Inc. Arthur C. Frcv, Worcester Safely Council John II. Giuson, Western Electric Company Lvee H. Gut, Peoria Association of Commerce Safely Council Huwakii F. Gii.uekt, Elizabeth Safely Cmmcil Ei*;.ir II. Gursucii, Grand Rapids Safety Council W. A, Griffin*, American Telephone & Telegraph Company EaklE. Grover, Safely Council of the Columbus Chamber of Com merce Harry Guiliiikt, The Pullman Company C. If. Hari-cr, Refrigeration Section D. T. 11 irkingtON, United Stales Bureau of Mines 1 . ' . Frank li. Harrison, dntcriuliuual Harvester Company 6 OFFICERS AND DIRECTORS, Continued Cues, K. Hil t, New Yoik Central Lines i(vitoid (i. Hoffman, Unemployment Compensation Commission, New Jersey Everett IIuru, Madison County-Safely Council S. It. I Iohri.1.1., Fond Section Fred 15. Hunt, Cement & Quarry Section \VI. F. J asses, I'hiladelphia Safety Coimci! T. U. Johnson, Commercial Vehicle Section Thomas I*. Kearns, Industrial Commission of Ohio H. II. Kei.i.v, Interstate Commerce Commission Walter G. Kino, Past President W.M. C. Knoei.k, Milwaukee Safely Commission , ' Wji. S. Knudsen, Detroit Industrial Safety Council Otto C. Kuiirt, Greater Springfield Safely Council ' C. L. LaFountaine, Great Northern Railway Company J. H. Lee, Wood Products Section Mili.ako C. Lefi.er, Child Education Sectiuu John E. Lonc, Past President Tuns. H. MacOonai.o, United States Department of Agriculture Uoiicrt A. McArthur, Transit Section Dr. Miller McCi.intock, Yale University Annum W. Magee, Commissioner of Motor Vehicles, New Jersey F. W. Matson, Minnesota Safety Council R. S. Metzger, Public Utilities Section I. W. Mili.ard, Industrial Gloves Company - Harold L. Miner, E, l. du Pont de Nemours & Company R. B. Moki.ev, Industrial Accident Prevention Associations Prof. Roger L. Morrison, Street & Highway Traffic Seciiuu Ernest Murphy, Albany Safety Council C. L. Mukrav, Mason City-Ccrro Gordo County Safety Council ' Ei.iot Ness, Director of Public Safely, Cleveland . E. J. O'Brien, Jr., Louisville Safety Council George. C. A. Oi-t*, The Detroit Edison Company Walter S. Paine, Aetna Life & Affiliated Companies Lew R. Palmer, Past President David A. Patton, Newark Safety Council C. K. Peacock, Chattanooga Safety Council Charles W. Penduck, Safety Division, Milwaukee Association of Commerce C. E. Pettiboke, Past President li. 0. Pickard, Marine Section Ai.ukrt S. Recula, Industrial Relations Counselors, Inc. Dr. A. R. Reinke, Contra Costa County Safety I'-mncil Lt. ( ui,, Henry A. Klnincer, Past President ..Piiiiiii- C. Rhoads, Meat Packing, Tanning Jfc Leather Industrie.-. Section , 7 OFFICERS AND DIRECTORS, Continued A. C. Rissiikkgf.r. Rochester Safety Council Marini'S Ritkk. Paterson Safety Council E. A. Roberts, Textile Section , IIestok Ruiiinson, Easthav Safety Council I'. A. Koihnsox. Paper Sr Pulp Section It. E. Rockhoff, Power Press Section Ralph l.. Ruckus, Jk., Chemical Section v> A. V. Koiiwkdkk. Duluth. Missahe & Iron Ranee Railway Company Walter RosenIiaum, Western Pennsylvania Safety Council G. E. Sanford. General Electric Company Henry G. Sciiaffnek, Eric Safety Council . Haurv A. Schultz, United States Steel Corporation of Delaware Chaklf.s It. Scott, Past President Eaiu.S. Shartzek, Utica Safety Council Frank T. Sheets, Portland Cement Association Gen. John H. Sheriiurne, Massachusetts Safety Council Mr. I,,. A. Shouoy, Bethlehem Steel Company Ehnkst L. Simonds. Xew Haven Safety Council . Judge Lr.e E. Skef.i, Cleveland Safety Council . C. W. Smith. Standard Oil Company (Indiana) ' Walter Dent Smith. Delaware Safety Council W. A. Snow, Construction Section R. T. Solkxsten. Elliott Service Company Leslie J. Sorenson, City Traffic Engineer. Chicago _ E. C. Spring, Philadelphia, Pa. George R. Stephens, Safety Bureau, Buffalo Chamlicr of Com merce C<m_ John Stilwell. Consolidated Edison Comtiany of X. Y. Inc. Arthur M. Took. Consulting Marine Engineer C. P. Tolman, Past President Mi:ll E. Trammell. Metals Section George G. Traver. Greater Chicago Safety Council, Inc. Major R. IVTrimiile, Richmond Safely Council . Frank E. Yitz, Superior and Douglas County Safely Council Dr. IV L. Yosiiurch, General Electric Company Dr. David E. Wf.cu.in, Baltimore Safety Council Dr. C. H. Watsox, Past President G. Wise 'Yescott. Safety Dept.. Auto CIuli of Rhode Island S. E. Whiting, Liberty Mutual Insurance Company . A. W. Whitney, Xatumal Conservation Bureau Charles E. Wilson, General Motors Corporation F. B. Winslow, Safety Div., Birmingham Chamber of Commerce W. E. Worth, International Harvester Company Arthur H. Young, Past President E. J. 7..U.FT, Safety Borcao, Duluth Chamber of Commerce 8 Occupational Disease THURSDAY MORNING SESSION October 13, 1938 TIu- 'essioti for the discussion of out standing problems in the field of occupa tional disease was called to order hy the Hon. I', .f. Angstcti. Chairman, the Illinois Industrial Commission, Chicago, who pre- sided. The Chairman emphasized the im portance of the selected subjects to he pre sented hy eminent s|tcakcrs. anti promptly introduced the first scheduled speaker. The Trend of Occupational Disease Legislation By HENRY D. SAYER Manager of the Casualty Department. Association of Casualty and Surety Executives I.et us consider the differences between the accidental injury and the occupational disease, h'or these distinctions are important ami must constantly he home in mind when we consider cither legislation nn^fhc sub ject of disease, or engineering methods of prevention or control. Generally speaking, accidents occur at a specific moment in point of time, and, from the standpoint of fixing liability under any policy of insurance, it is in the future; that is to say. at the moment of the acceptance .of liability under any insurance contract the accident for which liability may be as sumed has not yet happened. That fre quently is not so with the occupational dis ease. Insurance hv its very nature can only assume liabilities that have yet to arise--not those that have already accrued! Again, speaking generally, the industrial accident is something that can he seen-- even though unforeseen. It may he visual ized and described in words, setting forth specifically the time, place and manner of happening. It can then he determined, after the happening of the event, whether it was preventable or inevitable; blame, if any, can lie assessed; the worker involved, or his foreman or superintendent, can lie shown the fault, anti effective measures can be taken to guard against a like future hap pening. Hut some will say. truly, mu all accidents happen in the manner described: that not always are they held to occur only at a S|iccific moment or tinder circumstances where they can lie visualized and dcscrdietl. lty administrative and court decisions, it is true in some jurisdictions that the definition of "accident" lias liccti greatly broadened. W'c find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, ami even the specific time and place not definitely known, except.that it is shown to have probably oerttrred in the employment, being held to lie an accident. titters vs. Hull. I7S Atm. Div. ltd. !<U jf.y. * 7/5". ait anrlirax cac: Venncn v. NVw lWI l .tint, her Co., I/ t Wi*. j"G, a cum . ami oi!ur.) I'oisotting of the liody through the effects of.a deleterious or toxic substance used in the employment, the dangers of which were tmknotvii to the worker, the employer hav ing liccn negligent in safeguarding properly the use of such substance, has been held to he the result of an industrial accident. (Victory Sparkler A Specialty Co. vs. Franck*. ' 147 Maryland, 363: amt the very recent case of Black va. Creston Auto Cn., Iowa Supreme Court, August S, IMS. 7St. S.W. ISO.) And where negligence of the employer has been shown, an injury to health, even though not occurring through a happening .at a given time and place, hut hy repealed 211 . I > V ' i over month* of lime, ltA-% liccn " to Ik- nil ai-riili-nl. Vivljr t Carolina A^n'-iim Cj., jM, N'tirl!i --I-HA 5M, all A't-I'l'i'i- ca*cl -e ami oilier cases I might rile are wcpliom ami iiol tin- general rule < ulial emi-lilute* an accidental injury, ml, ur may failty assume (licit the In u( nilniiiti~tralor< of tin- taw ami i'iiiiiIn have liven itirerlly iu*piicd hy In-liel in tin- mvi-NNiiv of finding a !' tor an iiiilu.Nlrial ill lor wliieli no reiiu-ily hail liceu |iroviileil by specific :.ig of llic statute. May wc consider - a straws in I lie wind, showing a I Inn aril industrial disease liability? ay observed that the tendency of the is is to corn-true the term "accident" mure limited maimer in those states e there is specific provision in the law ittg occupational diseases. Thus, wc . dear instances ol svliat has been d "judicial legislation," that is, the - broadening the meaning ot the law -ver situations not clearly included n die terms of the law by the duly con ed legislative authorities:. ' us now consider wliat wc mean or inhy the term "oecupatinnnl disease." nc find a more difficult field--difficult . the standpoint of administration and -d interpretation; and difficult from laml|Hiint of the doctor and the cm at is disease? We think wc know, and .-I to laymen the term conjures up : minds sniuclliiiig of a rattier defiature. When we pause to consider it, irsc, infinite ipialifieations ol the term to us. and wc are confronted with conditions that fall into the zone of -such as, for example, whether her a disease. At any rate, wc say it is -normal condition, and let it go at when we come to add In tile douhtiii "di-case" llie even more imlcliniic 'imipatioii.d" or "industrial," wc find res in an area \>f 11iy;hIic;11( surt-d by a vast and increasing zone of M shading off into Frehiau liiy^lit, ihrii hall wc define Ifir term lt--u.ll dl'CA'C", I- tits ,1 mil mil III flur minds An I -I, 1.11.1,1, m 1 n|> llimi.ll \s Id l.iit no [mi iliiiiculi), iill.cl Icg- islativclv -or administratively. These include the well-known niclallic and chemical )>oisons that arc so definite and chnr.lt< tistic a part of some iiidiiNtri-.il processes.- Were the diseases arising from the use of these Mihstnnecs the only occupational di-ttases with which we need concern ourselves, the legislative difficulty would lie laigtly reiiimed, and we could safely entrust the problem to the doctor ami the engineer. ^ Hut we have seen that the legislatin' problem is lint so simple. Xr is it simple administratively. Wc find ourselves llmmdcring in a veritable morass, either because of the inherent difficulties of the situation, or because we have not or cannot agree on our objective. If all parlies would rec ognize the difficulties and the limitations on what industry ran do, or can fairly he ex pected lo do, nc could much more con fidently face the future. If wc could agree that provision fur "occupational diseases" is not synonymous with general health and life insurance for industrial workers at indus try's expense, then I am sure wc could get somewhere very definitely. Hut has there not been too imirlt loose thinking on the subject? Wc are met with a curious situation. Wc find the advocates of so-called "all-inclusive'' statutory cover age deliberately seeking indefinitene-ss. This is unlike them, for when they know wliat tlu-ir objective is, and are willing lo dis close it. they have not retrained from press ing their advantage with definite and spe cific purpose, and with exact language lo accomplish that purpose. That, at any rate, is correct legislative procedure. lint in this field, even where the liability of the employer is made inescapable, the constant suggestion is put forth that it is futile for the legislature to attempt a defi nition or delimitation of occupational dis eases, and. therefore, words of the most general character should be employed, leav ing lo the courts the interpretation of the law as they see fit. I submit that it is not the function of the courts to make up the IcgiNlativc mind; that is the function and the right and the duty of the legislature. Xor should the legislature seek to avoid ami evade responsibility by transferring to ioiuI. and comiiii->iniis the determination ol i|iic .lions of liability wliiili the legislatnic find* loo dilliciill for it to determine lor iisclf. Oil Kj'IIIHJlIUl /Sl.l.lMi' 2t- To effect coverage under the compensa tion law, lliereftiie, by any such genetal and vague language as the term "any and all nvvnpntiunal diseases," or by adding to the definition of ''accidental injury" llic plna-v "and -hall include occupational dis- ea'es," is to cn-nte an uncertain liability- line that may mpiire endless and pci haps disappointing litigation - -before the meaning of the law is established; and will nio-l eeilaiuly In- a disservice In workers ami employ cis. . Alt excellent rule--a cardinal rule--in statutory drafting, is to use words of defi nite, certain and understandable meaning, used in their common acceptance, rather than to resort to vague, uncertain and meaningless words, or words the meaning of which may have the clTcct of distorting the objective that is sought. Controversy is bred hy uncertainly of language, and controversy leads lo litigation in courts. I.iligation is expensive for all parties; it causes delay; and it frequently causes bitter disappointment. It breeds rancor. It may even lirced disrespect lor the law and (or orderly process ol government. Why then sliuiil|! there he this continuing demand for the all-inclusive coverage? W it with the vague hope that satisfaction may result in some eases of misfortune to workers who fall victims of the disease that besets us all and lurks in waiting for us in our play, in our homes, yes, and even in our sleep, as well as in our employment? l'erliapN nut--yet if that were the design, a mure simple way ol succeeding in it could nut otherwise he contrived. Are wc tu understand that imy disease of the mo-t common and ordinary risk of life may heroine an occupational disease if its source or supposed source had its origin in an incident of the employment or a con dition there present, or if claim was made that a pre-existing disease had been ag gravated hy such condition? That is a large order. It would mean that industry would become liable for any ordinary disea-e of life, provided lli.il di-ca-c could lie, with a show- of plaiiNihility, related to a condition or incident of the employment. Such diseases arc almost too numerous to enumerate. Hut wc know that (Inims have been made for tulicrculiiNis and heart disease, the two mo-t numerous diseases and the cause of more deaths than any two other diseases. Add to these pneumonia, asthma, arthritis, rluuiualiNio. and a host of others; and we discern in this the beginning of a sy-sl.-u ol lu-allli in-in.one of the most costly type a sys|, hi nun toeer that would discrim inate liilleily nguiii-l the many million' who cowl i ad such di-i.i-e- iw pel haps ac tually the same way, hut who have no tinployiiniit at all against which to alia liilily. Should not the mall win) falls lieliui to a disease of mdinaiy tile while searching for a job lie just as mill li the con cern of the stale as the man who becomes disabled from the same disease and who is so fortunate as to have a job? I.et us lie realistic about this thing called health I . Ill health is a deviation from the normal. Hut what is "normal?" Ilow great a devia tion is abnormal? Disease is of ninny and varying degrees. To what extent does tint mind affect the working status? Or wliat part in the situation is played hy "will power"? These arc not fanciful question-, they arc encountered and will obtrude themselves continually in determination of compensation for disease where uc dc'eirl from the known and characteristic occi na tional diseases. -! From these remarks perhaps sonic will say we arc opposed to coverage of occiq. i- tinnal diseases under compensation law-. Not so! The stock casualty companies represented in the Association have not op posed and do not oppose the piineiple of compensation for occupational diseases, if thereby is meant compensation lor lltu-c diseases that arise from a "trade risk," nr from conditions that arc normally and usu ally present in the particular employment, as distinguished from those oidinary hu man ills that beset all of us. Our lieu of it is that the policy of coverage under llic law is a mailer of local concern, to he de termined by local legislatures in the light of local demand and with due r ;aid In local opinion of both laluit and iiulu-U; No employer in this age can re.isim:-l.|i object to fair compensation for (list i-e arising from such occupational ri-ks, in- more than lie can object to reasonable co[m- pensation for disabilities due In aceidcii.al injuries. ' This conception of industry's olilignliou is. however, quite dilfciciil from the con ception of a |-:thlic obligation to care fm I i V II . Silver Jiihilct' Stiffly Cnnorcsx itl cmti|ivih:iU` |nr all >!v,l;iu,\' and iltalli acteristically * the obligation ijf industry, ult-r ;i I'm in of health and lilV insuiam-c. why continually insist upon the u-c'uf Ian* !ir l.ill. r nhligatinu. if il be a vuliil mir, linage which is susceptible uf misiutei pre* tin- <Ml-.11 >11 ill llir >l;tlc ami I lit- uulimi latino? He well assured, if legislatures do iml IIn- obligation nf industry alum'. not perforin their duly and lay down clear Tlu' rra'imalilr, llu* intelligent, I lie sane .iv fur industry dischaigc it-* obligation its milkers Ini' Conditions Hi' health is provide for the ^ri'Alcil reasonable re* .iriiiiciils lor industrial hygiene, ami In vide eompeilsaiinn nnly fur those I'nii*. lions llial ;iI i~e from specific named ili--cs llial are truly nvcupatinnal, characMir nl, ami piriiliar In tlie pi'in'cs<c-> in definitions of liability, industrial ho.Trils and t'omiiiissjons cannot in the presence of the widows, orphans, ami indiislri.il cripples, hi' expected to exercise greater courage than the legislatures. The law in the hands of such an administrative body will he scanned, and ( fear scanned in vain, for limiting words or language to stay the hand of industry's self-rousiituti'd almoner. it'll (lie nin ker is engaged. The legislative trend, I am happy to re Industry will. I am sure, meet tlie rlr.il*' port, in recent years has been toward the ;i- n( tin: occupational disease problem, definite, rather than the indefinite. Despite il is |iri"*riiteil miller a lave dial pre- tremendous pressure, no legislature has, in ilirs llie lialiililv ni industry in iniiler- the past three years, adopted a blind, "all-in ml.ilile lerius. Iii the early day*, the clusive" occupational disease law, except Herat rule was In include ocru|ialional New York, of which I shall speak more in cases in the cnni|iensalion law hy specify- detail presently. Michigan, Rhode Island, i the particular diseases nr (lie parlicu* Pennsylvania, Delaware, North Carolina, ciinditinns lending to diseases that arc ami Washington, among the slates most nml to he cci>|i.vtiinml and compensable. ;s we call a "schedule" law. Il is the recently enacting occupational diseases laws, j have adopted the "schedule" or specific m in which compensation fur nccupa- method of coverage. Two years ago, Ohio I.al diseases is covered in all of the amended its scheduled occupational disease mlrics of Knrupc anil of South Amcr- law hy adding dust diseases to its existing It is so simple; il is s sensible; it is .schedule. In Iwo other slates, namely, Illi easily administered, that the wonder is nois and Indiana, occupational disease laws t the acceptance of the principle is not have been enacted in gemral terms. How ICI.'.ll. ever, in identical language, these Iwo stales have undertaken lo limit and Udine occupa i we will keep ever before us the priu- tional diseases and have attempted therein le that a disca-e, to lie deemed ucctip.v to saleguard industry agains{Jialiilily tor inI, must he "characteristic of and pc- the diseases of ordinary life, a' ur to" the nrciipatiun, there should he ureal diliicully in arriving at a proper nlury setup for the coverage of all true Although doubtless fam'diar-'tit many, the difinilion in the laws of those'two slates upalinual diseases. Metallic poisonings will hear repetition, as indicating the ex characteristic of nccupalimis in which treme of dillirulty in attempting to exactly h metals are Used. The diseases charac- define an occupational disease. stic uf chemicals, ni acids, of alkalies. "See. 6. In this Act the term 'Occupa > and iiiincs, aicr characteristic of and tional Disease' means a disease arising mu iliar in llmsc occupations in uhieh the of and in the course of the cmpluyim-iit. lii.vees are so exposed. The diseases of Ordinary diseases of life to which the gen respiratory system, due to the inliala* eral public is exposed outside of the em uf dusts, arc the natural arcompani- ployment shall nut be compensable, except 1 and the characteristic effect of work where (lie said diseases follow as an in uli dusts. cident of an occupational disease as defined bln such clear and specific language is in Ibis section. able, why should we lie asked In use "A disease shall be deemed lo arise out e, broad terms, the use ni uhieli may of the cniploynicnl, only if there is apparent uiiic the giving of a blank check by to the rational mind upon consideration nf dry? If the purpose is nut to charge all the circumstances, a direct causal Con try with diseases which arc nut char ner lion luiwecu the conditions under uhieh Ocfiif'tiliontil Dixeuu'1 21; the. wink is pet funned and the. occupational disease, and whiih can lie seen to have followed as a ii.it 11 a I incident of the wmk as a residl of the exposure occasioned hy the nailin' uf the employment and whit'll can he fairly traced lo the cniploynicnl as the proximate cause, and which docs tint cruiii' from a hazard to which woikmvii would have been equally exposed outside of the employment. The disease must lie incidental to the character of the business and not independent of the relation of em ployer and employee. The disease need not to have been fovesceu or expected hut after its crnitraclioii it must appear to have had its origin in a risk connected with the em ployment and to have flowed from that source as a rational ronsciiucncc." Ibiilrr this definition no industrial man ager can, with any assurance, be informed what his obligation is to his workman, and assuredly no workman sulTering from dis ease can surely know whether he is cn- titlcd^to compensation under that law. Of course* as is lo be expected, litigation over the interpretation of this definition is al ready in progress in both of these stales. And situations will arise constantly in the future where the facts will he such llial only litigation in the courts will determine the liability of industry, or the right of the worker lo be compensated. . The claims actually filed with the In dustrial Commission o( Illinois already include uudulaut fever (a disease said to he cumnicnily communicated by milk and meat products), tularemia, rheumatic lever, arthritis, rheumatic heart, heart disease, annhic dysentery, varicose veins, Hat feel, athlete's fool, cerebral hemorrhage alleged to be due to overwork, syringomyelia, and tierce disorder. T have not mentioned the claims tor characteristic occupational dis eases, such as silicosis, carbon monoxide poisoning, and the various other toxic con ditions which clearly come under the Act. 1 have rtftrrcd to the fact that New York, alone, has in recent years enacted a law coloring occupational diseases in gen eral terms. New York was the first state, I believe, to enact an outright compensation law. for occupational diseases. It did so in 19?0. The law was a schedule type law. (It so happens that I had the privilege of being one of those wlm collaborated in the draft ing of that law.) We were dealing with a new siilijii l. We I'vamiiV d the i si'-tni : laws in oilui i inn it ries and adopt'd do foim lli.il st* nii'il best ail.iptid ;r, nor no ditiuiis, iiauuly, llie I'.ngti'h law an oivupa tional diseases. The si Iodide was, fimn time lo lime, enlarged as new iiuhi'tiial processes developed new diseases. !ly l1^1*. the schedule had been enlarged lo include every disease that was a potential 'li.a/aril to the workers in New York Slat, with the single exception of the dust i. -.ca-i-' of the lungs. In order surely and certainly to bring such conditions within lie pur view id" the law, then: was tiiai'tid an ad dilinii.d item in the schedule, reading "am and all occupational diseases." The -lin'd tile was nut repealed, and the admiuis alive provisions in the law with respect (u tinschedule were continued. One of the lii-l questions that arose under this new law was whether the new classification super seded the schedule and the limitations set forth therein, or whether it was an addi tion to the schedule and applied only to those conditions not prcvioiist.- included therein. The legislature, having evaded the duly of defining the term "occupational disease," the Industrial Hoard, which administers the law, adopted a definition. That definition is well worth repealing: that the Hoard deems a disease to be occupational only when it is "characteristic of and peculiar to the trade, employment, or occupation" in which a worker was engaged. This defi nition was adopted almost verbatim in the Rlioilc Island and Michigan l.nws. The Appellate Division of the Supreme Oonit. however, declined to follow it. and hi a vote 01 three lo two, held that unv tliiea-c that arises out of a condition incidental lo the employment must lie deemed to he an occupational disease. (llislu|i vs. Comer tv Poll.,, V, Ji| ,',|.t., || ,i, ............ -W-; l iill.ll'Vl e Vs. oil .M.its) Cll(|-.t .1 lion, g5l Appill.ilc llivinon, 9l)l ) The Goldberg case was appealed to the Court of Appeals--the court of last resort in New York. So completely do the facts in the Goldberg ease bear out what I bate said about indefinite liabilities under an allinclusive law, that they will bear icpctilioiiSbiclcy Goldberg was employed to sell tickets in a moving picture theater. Her booth was on the sidewalk. It was kept healed, in cold weather, by a small clntiic lli alcr, Opel itl .1 fri.in , . . I ' - ./ > >ili. Stic coutt acted what she <lcacriln.il .* I>l.>trlit't or a rash on licr legs. The Hitches or rash she claimcJ crc- line to. ic alternate healing ami chilling of tier . gs winn she switched on or oil the healer, lu-y tliil not constitute a disability. I low - eer, on complaint to her employer, she was ild to see her doctor. While on her way t see her doctor, on her own time, she. ability follows immediately, and in which prompt report lo (he employer is made. This is uni far dilferent from'.fhc ride in regard to hernia as an accident. Hut in New York, during the past yc>r( it lias become somewhat the fashion 10 regard almost every hernia as either an accident or an occupational disease. lipped on the sidewalk and (ell, fracturing n ankle. Although the day was crdil and This followed on a decision of the Coinl of Appeals, sustaining an award for hernia e testified there was iee and sunn on the as an occupational di-casc whcrcid the In letealk, the claimant alleged that she fell hly dm: to weakness ic-nlling from dustrial Hoard specifically Initinl that no accident had occurred. In the ease pre ;--e hhilehes, and llie. Industrial lloaid sented, the worker was required, in the iiiiunl; and loiiiiil that llie cause ni the ill ua> an oeenpali.iiial disease, chaiatpi- course of his employment, at (ruptuil intervals, to rotate his Iindy on the hips. lie of and pemhar to Ini employment. This man was employed in a glass factory, The Coml ot Appeals, in an opinion that .idles with logic am! sound sense, struck is I'rcc-l'or-all .system from the language : the N'eiv Vork Ad. They unanimously lie gathered molten glass on the end of a plumy, uliielt he, in tout, swling aluil ami placed in a mold. The weight was lint excessive, living only a matter of a lew tii-eil to roueede that this was an oeeutlioual disease. To make every disease puimds. In affirming this award, the Court of Appeals said: , it arose out of and in the course o( cm- "The finding, supported by evidence, is oyniviit compensable as an occupational that (he continuous gathering and lifting of iscaso, they said, ivould he to make llie glass from a furnace involved a constant -mpcm-alion tare "the equivalent of life twisting and straining of the body. This id health insurance." The court further process, from gradual stretching, resulted id that to he "occupational," the disease in a hernia which is a disease (Matter of . list l<e one uliicli "results front the iia< Alpcii vs. I`divers 22J N. Y. 97, 101.) There re of the employment": and that hy na- is medical testimony that claimant's occu -re of the-employment is meant--conditions pation would produce this disease and there uliielt all employccs of a class arc subject are judicial decisions in oilier jurisdictions :d uliielt attach to the occupation--"a holding that hernia is an occupational dis /aril uliielt distinguishes it from the usual ease (Marathon Taper Mills Co. vs. hid. >i of occupations, and is in excess of the Comm. 203 Wis. 17; Travelers Ins. Co. rard attending employment in general." vs. Lorkc 50 1-cd. (2nd) HJ, 343)." *:.,li|l,tfri: < s. Os4 Marcy Corporation, dcciitot ...... ary II. 19 IS, ami rcjHSrlcii in 276, X. V, tl'n'icr vs. Citlcnili-r Itroltirrs Inc., 27S X. V. its 16 X. E. 2ml SCO.) * || ^ It 12 X.K. 2nd. ill.) Perhaps the most controversial question Thus, alter more than tuo years of involved in occupational disease legislation it uncertainty ns to the meaning of (lie e. (he Court of Appeals has eliminated mt the New York Statute the diseases ordinary life which arc only incidental spcculaliiely related to the occupation is the treatment oi liabilitiejijlpr dust dis eases of the lungs. In no. class of cases is the marked difference bct-d-vcn accidents arising at a given time and place and occitpational diseases more pronounced. In this I list a wind al.ml hernia as an oceupana| disease. Never hereloforc regarded an oceupalional slisi-asc. hut quite gendly rccogni/id under certain circumnecs as an accidental injurs--the Occnionnl Disra-c Law of Michigan, enacted l .'car, specifically inehided hernia in schedule of diseases. Not all hcruiac. 'v'vgr. arc so included, hut only iho-e irli of recent origin, as to uliielt dis category of cases, wo. find silicosis, anthracosilieosis, and ashestosis, all of them (..ms of pncunuHiocmiioM-'. While these diseases in some of their forms arc among the most ancient, their ravages having been rec ognized generations ago, little has been known until recent years of their causation, of their pathology, and of their complica tions with other diseases. A vast fund of know ledge of these diseases lias been gath ered in the past leu years, amt intensive ) i 'fi ll) uIiohc- i ':si . studies of their etiology ami patlmlogy are still going forward. One lari stands out clearly, and that is, that these diseases do not progress lo the point of disability until after many ycars of exposure to dust. The length of lime, varying from five to twenty-five or mure years, is dependent in large measure upon the concentration of dust, the com position of the du-t, the time actually ex posed dining winking hours, aod the in dividual Misccptihilily nr liesislancc of the worker. Another fact tli.-ft stands out is licit the fibrosis id the lungs, once ac quired, is permanent ami iiicurahte, ami, in iini'nniplicali.'d cases is mil susceptible to medical liealmeiil. Matty thousands of workers today, under no law lull the rommon law, have been employed in employments exposing them to mure or less heavy concentrations of dust for many years. In the event of the enact ment o( an occupational disease law in cluding those diseases, industry w-ill find itself, at the stroke of a pen, liable for conditions already acquired through long years of employment, and which may be come dnsahtiiig at any moment. In this sit uation, the best'guaranty against disable ment is continuous and steady employment. Many a man, actually able lo work amt earn good wages, while lie has a job, will he able to demonstrate hy x-ray and clin ical examination the presence of a marked degree of silicosis, when his job slops because of depression or otherwise. Hence arises the question of the so-called "accrued liabilities)'' This term which has come into commnii use is perhaps not an exact term, ill that "liability" docs not occur until disablement, and the liability is only "accrued" at that lime. What we have in mind when we discuss accrued liabilities is the condition of fibrosis of the lungs which has accrued and has been acquired over a period of years. This condition, living permanent, remains with the worker, whatever and wherever may he his employment. Perhaps a more exact expression would lie "potential liabilities,'' ami yet they are more than potential; the condition giving rise lo them is actually existent. Industry tells us quite truly that it can not now pay lull compensation out of cur rent income to all of the men employed in industry who may base in the past t'*currcd some degree of fibrosis of the huq?'. Put if industry cannot assume these liabil ities, how much less justification is ll|l-'rc to call upon iii-iirancc. out of the |ircmiiu>ts of next year, to pay for disablements ac quired over (lie past fifteen years, and for which it received no premium? In this difficult situation, it has been found necessary in many slates, if em ploy incut is to he roiiliiiiious mid imiiih r rupltd, and if men are eventually in I" compensated for the fibrosis acquired due to future exposures, lo absolve, to a :[.i'':il e-Mciil, industry ft uni the ohligalioii of Com pensation for p:is| evjiosiui s, and to ha . eoiiqieii'alioii iqiou (he extent of expo-nnafter the enact unlit of nil oivup.ilioii.il disease law. Thus, there has conic into acceptance in several stales the principle of graduated compensation benefits for dust diseases, limited lo (iitiire exposures, ami eliminating in large measure the ex posures of the past. Under this system compensation for dis ability or death occurring during (lie first month under the new law would be only a nominal amount (it lias been set as low as $51X1 lo start with). A pci .sou disabled during llie second or third mo.ntli alter the enactment 'of an occupational disease law will Ii.kc been exposed, lo a small extent at least, under that law.''flic ex posure is perhaps in itself iiisuliicicnt to actually result in any harm Hut the ntnximimi benefits will lie increased, iiioutli be month hy small increments, until in tincourse of two or three years the full limit chargeable lo industry in the parliml.ir stale will have been readied. This sy-lcm is lint so complicated as it might sc in. The effect of it is rather to postp. me tin going into edict of :r dust disease aw tor a matter of two or three years, and experi ence .... . this law has demons trap that few claims aric where the compim-nthm benefits arc so limited, the umlan. p;e (erring to stay at work as long a- ib. . can. It may be said that it works liar-lily in the ease of llie pcrsmi who hccnuiercally totally disabled in the vaily ni.milis of law. When measured by the liability with which the employer may faille b< charged, it does not. in fact, work a hard ship, and when cuinpatcd. wilh the exist ing system in stales not mm under oven-  III! i-alimixl ilisvace laws, il not only is not .1 liaril-hip lint is. in fact, a great Imon. The |>ritwi|>lc of limited and graduated liability of the cn|dnycr for <1un| (li-ca-es lias lieeu recognized liy etiaclmciits in New Voile, Michigan. Pennsylvania ami Oliio. \u iiunsiial luotision lias lieeu :iilo|>ted in tic slate of Wa-hiuglmi, providim; under tlieir seliedide form of law lltal live cost of eoiii|i`ii-.iiinu lor on ii|ialioiial ili-va-c-t hall lie divided vi|ii.dly lielneeil tin' ini' :>liner and Ids Winkers, and dedm linns dull ( made ft mil the employees* uaees as eoiiliiliiuiuns ton aid llte in-<ui:mee preoiinnis inenliid. lercsA must he given lo industrial health. The care for the health of the norkrr must not he confined to thg guarding against those conditions that arc mentioned specifically in the law. The engineer's re sponsibility is a broader responsibility than is the legal liability for coinpensalimi. Theic can lie nu ihmhl that the eimmeratiim in the taw of specific conditions for uliiih liability is absolute u-ill he of great ad vantage hi the industrial engiiieir* in seek ing hi enforce pinpt-r liealllt standards. Il is far easier fur him tu obtain approval of Ids rcvumiiiciulalinus, if he eau pi'ini out hi management that the use of hen/ol or Uni ulial. you \uuy say, lias all lliis lo some licn/id dciivuliw is specifically men- In with litv s.ifcry i-ngim cr? li<'mil. and point lo the specific paragraph Il lias iiuii li, The safely engined' an no longer Ivganl liini'elf as lining Ids inh if lie steles only ways ami means It) lioiinale llte industrial aeiideiil The in- in the law that cite-, the liability of tincniphncr for that eotidilion. No argument is needed to eonvinei: management of its obligation in such a case. In-trial logicm-l tiiiisl hecome the rollengue The same is true with rcgatil to all of I tin* inihi'trial engineer. Medical seittiee the metallic poisonings and all of the other imisl give intensive thought anil simly to wide range ol chemical exposures. INyrlin- It Ivriididng tin: elietls U|on the litituaii logically tilers' is great power in tin; printed '>'lem oi various imlitstiial piocvsscs, ami word, ami even the most backward manage t .vpostirc to various innicrinls Iheiein. All ment may he made to rcs|>ud ulieii the siuisiires eaiinot lie eliminated atul still clear mandate is set forth in the law. Not hate industry per tot in its functions. Most so easy will it lie, tinder a general, vague, important, theiefurc. is the medical deter- and all-inclusivc occupational disease sialute, idiiatioii of what arc safe limits in cv- to convince management that it has specific po.-nres--the so-ealled "threshold limits." duties with regard to the elimination of The engineer cries aloud today fur expert lu-alth hazards. Thus, we sec there is an medical guidance on this subject. Armed other and potent argument for the schedule with siicli iiivdical opinion and advice, the law. rather than the all-inclusive law. ta-k ol the engineer then is to devise prac tical nays and means for attaining condi tions where such threshold limits apply. There is perhaps yet another and even nunc compelling reason for applying the livery industry presents a problem or rule of sanity ami couumlji. justice to leg islative mandate in the complex field of erics of problems in itself. No lun in occupational disease. Shall employment he dustries arc exactly alike. What is lolcr- limited to those who are^jiliysically per ihlc in one may he intolerable in another. What is good practice in one indu-try fect? All humans arc not examples of physical perfection, nor ean-'.wc by legisla may be totally inapplicable for practical tive fiat reverse the laws of nature which reasons in another. The task of the en- immutably decree that we shall grow older .iuccr then is to find liotv right principles with the passing years. nay he made applicable. We have Seim mid discus-ed the danger- Industry today,'more than at any time inherent in the all-mcln-ivc tlieoiy of in its history, intist hear the burden of stretching the law to cover every sort responsibility for the health as well as for and condition of disease, and lo try tu the safety of the industrial worker, and if make them employment-related. When that : is health and lii safety are ailei|uately stretching is complete, when administrators safeguarded his happiness and the happiness of the law find it easy and possible lo I.those about him will he increased. Thcrc- burden industry with the responsibility of furc._ it is of prime importance in the field health insurance under the guise of an oi safely that intensive and increasing in- occupational disease statute, tvhat of those who, wauling employment or seeking to re tain it, arc not physically perfect yet cer tainly are not disabled? Much is heard hulas of the diead fortyyear-line for employment. Whatever the facts may he us lo that, is it not possible- if iml probable--that industry, in despeialion and against its tlc-iie, will he foieed vvciilunllt hi areept only those among whom the health h.i/ards are least uiieertain- tin* phisieally perfect, the yuiing and the strong? \}'c may well pause to eon sidyr the devastation such a sii-ialinti "'ml produce. In the interest of all workers, the ynin ami the old. the perfect and llit. impvrfcihi us not 'embark upon Icgi-kilite polieii that eau h ad only to enlarging tin' fii I of iim-inpliiymint, and lo closing the dmof imhisiiinl opportunity to iho-c skill, ami faithful uni hers uho, hating |'n -s, I In* uuiidinu of life, aie -aihjt 11 h< tlio u.ilmnl inlii inilics and ill, of the. l|e-li 1 which all nu n, in lime, most l-.u. > Handicaps in the Diagnosis of Occupational Diseases f By CAKKY I*. McCOKI). M.D. Detroit, Midi. It In a popular medical belief that occupa uiidiaunosddt: orrup.iimti.d di . U nm tional diseases aie far more to ire- hr rrcogiii/rd that many nin;.iu ondi.i oy.ni/v ;im! precisely tu class as such than IiomiI, or mmv o|lIrn misdi.igr.o'ifl. *11 any tillin' type disease Mate. So lirutly prime for, this i> tlial the Hvii is thi* idea rooted in the minds of some physician -*w mils muuII innnbi.*!* ai physicians that they arum- that occupa- our type il occupational disease. I *iKi lional diseases never should he made com Ohio as a t>picul imhMiial Mali. ihr (oj pensable because of extraordinary diag number of occupational diseases, oinpm nostic diliicuHics. ' able :*! otherwise. rcpmicd lo ..*<: Sl- l.aUdy, Kcluiing has said, "The doctors tell us (here are certain diseases that are , incurable. Do you know what an incurable dis<*a<c is? It is one that the doctors don't know anything about. The disease has no Ihpaiitmui of Health duiit..: the ycai l'1 was !,</<). On the other hand, these .nr this state <1200 physician^. Thu-, only >.' occupatiouat disease arose for every doctors in the slate. objection to being cured at all.11 Hue then is the foremost handicap *rhis may be paraphrased by say in*: There arc no tuidiagimsaldc occupational diseases. 'I he only ones (bat appear uudiaguosable arc the ones the physicians have not teamed how to diagnose. No occupa tional disease has ever offered any resis tance of its own to being diagnosed. The disease is perfectly willing to he diagnosed. ( At (east one-half of a)t occupational di seases are almost self-diagnosing, particu(arfy when arising in groups; the remaining half present no greater difficulties than attend the diagnosis of some other classes of diseases. To maintain that occupational <lisea>cs arc beyond the diagnostic skill of tb<* rccoeoi/hm and diamonds of n* i nj tioual diseases and at the same tiun back handed compliment to indiMiv. I thiMry. because of its inevcution n hit \ imnt, )i;> >o limited the mtinhcr of Ciipationat di-cascs that day by day P pliysiciau is ordinarily not .-purred to \ pn-Mhility that any* worker who m ck I profc*"i'u.il guivhnice may ha\c a di-i a-c occupational origin. Here, too, is the fun* menial reason why more medical 'dm do not develop trainmec departments in t lieUt or organize special hospital *cr\i for the care of occu}ialioiial du.-a-c tients. the physician is pure defeatism. With equal While Ihci c aic leasons for rejoicing i propriety, it might be suggested that all there arc comparatively so leu occup-tli. neurology be abandoned because the ma diseases, wc should rccoguizc lb *t th jority of conditions arising in this Reid are fjccific situations which iutrodm e dt may not he diagnosed will) ease. noslic diflicullics. A number of jlicsg While It may be said that there arc no now presented, as separate entities. . . . .1/ . I V l ..I Definition and Terminology iinccilaiiity that this condition represents a Much riiiifii'inn is caused lv lark of characteristic occupational disease. :-iiforinitv ami rlarily in (Icfinition Scarcely rielwccn these extremes, thirc is some :i\ tun stairs in tlicir statutes accept tlic line dvfiuilinii uf an occupational disease, i a few stales, hernia is hy lae specified an nerupalion.d disease. I ion ever, in the ajnrily of slates it is, when related to in In-try as a cause, cla-scd as a traumatic limy. In a few states, the definition of u occupational disease pinvided hv statute -m il that eeit.iiu items later appearing on hedidcs themselves do not conlorm to a- definition furnished. Well meaning legislators might enact a t.e declaring that t\rn ami two make seven, ut the mathematical facts still might re tain ntherui-e. So uilli legislation in-, oiling occupational disease diagnosis, there ay lie demands for legal acceptance of Main conditions as occupational diseases, lieu elementary medical facts point othcri-e. One group of physicians may reserve e term "injury" for exclusive ti-c in conctioii uilli Irpmna, while another with ropricty may assert that occupational disiscs of many natures represent "injury'' the same extent implied by the term raunsali-iii." point at si hit'll difficulties would arise in di-lingui-hiug occupational diseases from accidental injuries. This same situation ap plies to many other ifnh-lnnrc* and many other occupational diseases. There is per haps no warrant for any attempt at a hard and fast demarcation in terms of lime, in dicating where an nrcidcnlal injury expo sure leaves olT and an orrujialional disease ex|i-urc begins. However, there may be some justification for tlic practice of many physicians, who hold that if the exposure leading to damage is less than one work period, the ensiling injury should he recognized as an accident. Conversely, if the exposure period extends fur more than one work period, then the resulting damage may with propriety be ac cepted as an occupational disease. In gen eral, it may be claimed that-one of the disturbing handicaps to uniformity, clarity, and precision in connection with occupa tional disease diagnoses stands in relation to awkward legal situations, inadequate defi nitions, unsuited classifications and such. I.rt us consider, tor example, the occur- Fallacious Medical Histories in'C of an accidental injury on the one As a result of careful training, every uwl and a clear-cut occurrence of an nr- physician is disposed to attach significance palioital disease on the other, Imtli caused to the history statements given hy a pa mi one and the same substance, hut under tient or members of his family with re tie-rent circumstances. It might come gard to any disease. The less a phy-ivian nit in a given factory that a workman may know about the possible ctiologic farts :vrcd a tank car, lately emptied of hen- in any situation, tlic more consideration lie I, and in the absence of suitable protcc- is likely to giic to hislorjdjfjlatcmcnts. (t c and precautionary measures might, is human nature to assoriale all of our thin ten minutes, heroine asphyxiated as ills with some partiridar happening or series result of breathing benzol vapors. Man- of happenings. A cold iiiay'^he associated -lly, <ucli an nrcurrcncc as this would with a particular period of sitting in a niTeptcd as an accidental injury and no (h a ft. A gasiro iiitcstiii.il up-'et is prune to Mipensation hoard would ever raise a he associated with some particular alco- clion that such was not the ease. .liolic bout or food engorgement. 'hi the other hand, this same benzol. ;cu from this tank car, might be utilized this same factory in some produrliie .ration, giving rise to benzol vapors. Day day, another workman might inhale some these vapors. In due course, this work -lire might produce the usual and raclcri-tic features of that occupational i-.i-c known as benzol poisoning. Here mi- it is most unlikely that any physician compensation hoard would entertain any In the ease of industrial workers, there is an especial pronencss to associate any bodily ailment with some aspect of work. Inasmuch as almost every workman hopes, openly or secretly, that any and all dis eases from which lie may snffer may he laid at tlic door of his employer, lie is most likely to stress and emphasize the Itigli probability that this condition unfailingly was produced by the chemicals, gases, va pors, dusts, etc. that attend his work oper- ) lAi Ilf'Ull III// t-h.i.-Uj,' aliens. This docs not necessarily repre sent dishonesty or cupidity on the part of tlic patient and only may involve those Iminan frailties shared by all of us. No less, the history .statement may un duly infiiieiicc (lie physician in ids diag nosis, may lead to mi-diagnosing, may pare tile way for unwarranted claims or law suits uilliunl any evil intent on the part of the physician. It is most unfortunate that (lie physician is all lou often unable to appraise tlic wottil of ,Svork history statements pro vided by a patient. Let us, for tlic moment, assume that a specialist in car diseases is visited by a patient on account of deafness. In connection with the history, tlic physi cian,may record that this patient is a drop forge operator. Tlic physician may go ahead and make many careful examinations, looking (or the cause of tlic deafness, from infection, from syphilis, from heredity, etc. is to be appraised until long after tha1 time within which the disease might hav* Iveen di.igqoscd with precision.. Wilhoin any pm pose of condemning or finding fault the f.icl must lie faced that in nv.iiiy in stances the decision of a patient to fd.iiin his ailment on work causes was not ninth iiiIhin that period when some or ad 01 the characteristic in.mi testalinns neie Pres cut. Then, at some later time, a physician qualified in occupational disease work na. be called upon to c'xamiuc the claimant cm to reach a decision based upon the cxaiuj innlion of inadequate records of aiiolhiii physician who himself did not carry om any examinations witli particular rcfcrciin to that occupational disease for which .< claim later lias been filed. This is askin; too much of tlic diagnostic ability ot any good physician. I f, however, lie had obtained a complete ' On tlic witness, stand, the charlatan ai work history, and was in position to evalu ways makes the better impression on a ate this work history, lie might come at once jury, because lie is unhampered by tin to know that this drop forge operator is caution ami reserve that guide the up perhaps exposed to as much noise atid con right witness. Being positive is often merely cussion as ever arises in ordinary indus-: a matter of being wrong in a fond voice tria/ work and tiiat the deafness present The point is that tlic time to make a ding, clearly is an occupational disease, resulting nosis of an occupational di'ea-c ir tin' from sustained noise exposure. period duritjg which the disease exists1 It may be asserted that well meaning physicians, without any evil intent, through their misunderstanding of patients' descrip Other wise, the most accomplished physi cian may be placed in an imfortunate po sition in the reaching of his decisions. tions of work operations have become re sponsible for a high percentage of tlic Insufficient Training and Experience large number of unwarranted suits that An outstanding drawback to the pvopci have flooded the country in recent years. diagnosis of occupational disease; may be In short, one nfithc handicaps to the proper found in inadequate training in, medical diagnosis of occupational diseases is to lie schools for this aspect of medical work. found in the attaching of undue significance This is not a thrust at tlic doctor, :.or may to (lie patient's statements as to work con any complaint lie made against met -at cd ditions, nlien the physician himself is un ucatiou today. It may not he expected that able to appraise tlicir reliability and merit. medical schools will markedly enlarge an Some physicians need to make themselves already over-crowded curriculum to pro more remote to the fallacy that just because vide extensive instructions with reference a workman is employed in a dangerous to occupational diseases when die minihci trade, incvilaldy any ailment must neces of eases yearly is so smalt as In pi.nidi sarily lie the result of work exposure. only one for every five or six pin -ici.iii.- There still may be a few persons who may Rcalizing his own shortcomings in tlii. believe that lead poisoning may arise from field, a good general practitioner may hon work in making lead pencils. estly shun this type of work, bu'; this Hep Time as a Handicap in Diagnosis on his part may eventuate in c cii more undesirable situations.' Too often the physician well qualified in (lie field of occupational diseases, docs not sec tlic patient or claimant whose condition The patient, instead of being rcfcirc to a belter qualified pliy s'iei.V' in lh\ field is given no aJviccs, whereupon h gran Silver Jului, r Au/c/j- l vmjress c let toward an inferior physician, less con- of the chest of this workman may strongly moil willi the lack of qualifications. The suggest the possibility of silicoses, nowhere tout to which lack of qualifications in ocq-.ilioiial disease work may go is reflected the fact that recently a duly licensed n'ioian in (lie Stale ill Michigan reported nic-tinal peristalsis" as a diagnosis of an .ciipalional disease. W hile the unwillingness of a phisicintt to cept responsibility for pathologic Males nh which he is not conversant is com ndahle, there still remains a duty to (li st his patient into channels wherein adc- on the work record may it he Shown that for a period of seven years at some much earlier time this workman was employed a a laborer in a pottery In this same connection it should he em phasized that one of the many handicaps to the physician in making an accurate diagnosis is to be found in ibc widespread practice of hospitals, of clinics, insurance records, etc., in merely naming the trade of a workman rather than describing his exact late services may lie procured. occupation. It is quite insufficient for med . Industrial'Terminology One of the most anno) mg handicaps in lahlishing the exact etiology of a possible ,'cupational disease resides in the wide-.; road practice of industry in using code . mhnls in the designation of its substances, n inquiry, llir patient may state to his n-ioian that his work consists of filling in.liners with "lt-72." Hut, inquires the avsician, "What is H-72?" The patient miinies, "11-72 is a mixture of M-20 with ical pur|io.cs for a record merely to show, lor example, that the patient was employed as an "automobile worker." Under this heading, there are perhaps not less than 200 dilTcrcnt and dissimilar types of em ployment leading to different exposures: such for example as lo silica in the foundry, cyanide in lire heat treating rooln, chromium in the plating department, lead in body fin ishing, and on and on. Lack of Library Facilities . 10 and 1.-07." Completely llic physician With some temerity the statement is left hi the dark, hoi if the Irulh were made that regardless of man)' book publi "II it might he shown that this patient cations in the field of industrial hygiene a- engaged ill the filling of cans with a ami occupational diseases, special maga irniah remover, which consists of a mix- zines, and articles appearing in general ire of wood alcohol, benzol and a syn medical magazine publications, there is, at dic wax. tins time, no condensed, informative ma Such situations may become so s'on 1 u - - terial on occupational diseases well suited c that it may lie almost impossible for to the needs of the family practitioner. e physician to obtain proper infoimation It is of course impossible and undesirable to work exposures. Medical, safely, so that any attempt should he made to reduce il service or insurance ilcpui lim-nls all all of the lore of occupational diseases to ay have diuirtilly in obtaining [nil in- some thin lunik to which the practitioner rmaliou as to actual chemicals and mix - may refer and with certainly ohlaiit all the les of chemicals designated ill production guidance needed in the treatment ami man rations only hv code numbers. agement of occupational diseases, t hauling The Absence of Records Die majority of industrial plants fail maintain sufficient medical and work cords to serve the physician properly in -imcction with occupational disease work, i a given instance an afllicled workman iv give as his occupation some innocit"> iob as "elevator operator." He may rc- all this, there still is occasion lo asseit dial a real need now exists for a hook publica tion on occupational diseases designed for services lo the neighborhood physician who in the aggregate sees far more occupational disease eases than the small number of specialists in this field. Attitude Toward Industrial Medicine mbcf ili.it die job betorr that was as In times long ago, wlien mine workings, iimk iliorr " Tlnrc his mrmot) ml) -awmilL, and railroad construction camps i Hit m.iL i((Oid nil) 'bow no ilcms wvic established in remote sections of the In 111".(cr w I lull the fisloi) of lot (omiliy, far rrmosed from the usual sources i ci iplojincut and no itcmd ol an) pic- of medical services, it became necessary nit .employments. Although the x-ray that the management bring into these iso- ;.\c r ihiiiihil /.'/ >.-m' latcd work places a physician who might New Chemicals carry out all manner of medical services. A further deterrent to accurate d'aG- These physicians sit the broken arms of nosis of occupational diseases is linked up injured miners; delivered the babies of the miners' wives; treated the miners' children for measles anil mumps and otherwise at tempted to meet the medical needs of these detached communities. Usually the com panies contributed to the income of these physicians and every family and every single man was taxed a stipulated sum each month tn-urder to cover the physician's salary. Thus arose (lie term "Contract Physician." This perhaps did not always represent the best of medicine and not in all instances were these contract physicians of the highest type. with an almost endless flow of new rhcniicals into industry's processes. Year by )car, a far greater number of new (hemicals are introduced than the mini' cr of investigations referable to their to (icily. It is often true that nowhere in the entire literature concerned with industrial 'tox icology may any word he found aidin.- the physician in determining if a given cln'mual might he responsible for a series of objec tive and subjective symptoms in any patient. One of the most desirable changes needed in connection with woikcr health protec tion is the requirement that no new sub Later some of these communities hccanic stance lie introduced into induilry on a larger towns, or cities, and other physi production basis until it shall have been cians sought to gain a livelihood, only to established to the extent possible, through find that the contract physician was in the animal experimentation, that such a sub saddle. This gave rise to complaint and stance is without dangerous potentialities. out of this "Pandora's box" have come in numerable evils that even to tliis day at Significance of Handicaps in Diagnosis tend the highest type of industrial medical A recital of the type just presented supervision under the most ethical and might he continued almost indefinitely, hut commendable circumstances. It lias be perhaps without profit. The entire situa come a tradition on the part of many of tion may he summarized by staling that the medical profession lo blame almost any whereas occupational diseases themselves maimer of their economic dfiicultics upon are probably as diagnosable as any oilier industrial physicians. So real is this dis difficult class af diseases, just aliout every affection that some organized medical stundiling block that may be produced is groups have sought to> legislate against al laid at the door of the physician sincerilx- most any form of industrial medical prac seeking lo acquire sufficient evidence mmii tice and in some instances to deny mem which to make - exact diagnostic dcci-ii-n. bership in medical societies to industrial The greater number of these stumbling physiraus. As a result, industrial physi blocks repre-ent no willful desire to hamper cians in some respects have been branded the physician, hut instead arise from the with a scarlet letter. results uf peculiar ciiciiiii-tanccs that in This queer situation, strange to say, some mca-iiie separate indtisliiaj di-ci-es may serve as a handicap in the diagnosis from the general run of alllictioiis. of occupational diseases, since some of the best physicians, mid parliculai ly the mure timid unes, fear lest they may become hesmiiclw.ll by cooperating ill this type of medical endeavor and to some extent slum any close alliliation that might lead to lifted eyebrows by those regarded as the leaders of the profession. As a consequence, huge iminlu-i s of imw an anted diagnoses ol occupational dis eases have been made and are being inade. Scores of suits have been instituted and some have been won liv claimants whose claims possess no whit of merit, chiefly be cause well meaning physicians unlmiq-il) implanted the seed of possibility that hi' Now that the American Medical Asso disease might have been caused by work ciation is somewhat alert to this situation and that the responsibility might be laid and has organized a Council on Industrial at the door of the cmplo)cr. While the re Health, including some members with in sults may ha\e appeared to work an in dustrial medical experience, it is to he justice and monetary loss upon tlic cm hoped that after all the industrial physi ploycr, in the long rim the interests oi cian may become respectable. the worker himself are nut served by these 221 .'ulvcr JitbiLw Sajity Conyra*. v spurious claims predicated ii|>on improper badly needed under postgraduate auspices. medical advices. Tlic usual trial of an oc cupational disease case is a travesty. Tlie |iuml>astic statements of some physicians, niiatteiidcd l>y any iota o( fact, Lrininto disrepute the entire medical profession and lake away its lime honored traditions ol` intcgiiiy and skill. (b) In every industrial community, or at least in every industrial state, there should he available for cooperation with the general' medical profession- a number of much experienced and highly skilled occu pational disca-c consultants, who, through limiting thcir'profcssional activities to this A further significance in the misdiagnosis one aspect of medicine, may become highly of occupational diseases on the part of proficient in the solution' of occupational plnsieians is to he found in unwarranted disease enigmas. hardships imposed upon cmploj cri. Recciilly a physician made a diagnosis of . (c) In every state and in some of the larger industrial cities, there should be silicosis in two workmen in a given depart maintained public institutions devoted to ment. As a result, widespread apprvnlicn- sions arose among the remaining workers, strikes were threatened, talk developed as to demands tor high u-nal exposures and wages because of tinthe expectancy 01 a ' industrial hygiene and occupational dis eases whose technical services may he avail able to the physician in charge of patients who may lie suffering from occupational diseases, and these public bureaus should short work life. The employer was com pelled to spend some $S.\00Q in the installa tion of an elaborate Jn;t control s> stem. serve as fact finding bodies, equally inter ested in the worker and ,1ns employer. As a matter of fact, these two workmen did not sutler from silicosis, were not in any wise disabled, had never been exposed to silica; no silica or any other harmful dusts were created. There was no need for the expulsive installation made and contrariwise other departments did present practical exposures tor which this $S5,000 (d) Much will be gained if all physicians responsible for the health of industrial workers in any capacity may make greater clTort to obtain precise work histories, both present and past, ami may seek to gain an adequate understanding'as to the work en vironment, its materials, machinery and possible exposures. might have keen spent to heller advantage (c) Controversies should be eliminated in procurement of needed protection. The Road to Betterment in the largest possible measure from occu pational disease work. Many abler physi cians eschew all connections with this type This entire discussion would he without any value it present day practices and sit uations only were condemned. More ac curate diagnoses as to occupational diseases arc badly needed. These teller diagnoses of medical practice because of the sad ex perience that nearly every ease may he so involved in controversy, litigation, disaf fection, until the goorl physician may feel that lie may be degraded. will come in proportion to the extent that . (i) A need exists for greater disclosure the changes now listed arc brought to ac lo physicians of the chemical nature of tuality. work materials to the harmful nature of (a) The general level of knowledge of occupational diseases on the part of the medical profession should he increased through the introduction into medical col lege Iruining of a practical amotiiil of in struction on industrial hygiene and occu pational diseases furnished by men who have had first hand experience in this field and arc nut wholly dependent upon textbook lore. However, it is emphasized that in undergraduate medical training this form which employees may lie subjected. In dustry may have excellent reasons for hid ' iug the nature of some of its chemical ma terials under code terms, but more often these code terms arc designed only for convenience and not for secret formulae purposes. A greater degree of cooperation on the part of the manufacturer will even tuate in the better health protection of his workers through the more intelligent min istrations of the patient's physician. of inslrmlion necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is (g) Lastly, it may lie pointed out that belter diagnoses of occupational diseases will come when the general medical pro Oci u/'ui'<'iiu/ i <>. fession, through its organizations, shall alter its attitude toward industrial medi cine, shall recognize this type of work as just the antithesis of the undesirable as pects of state medicine, and may conic to realize that industry, under the guidance nf able medical directors, is the meritorious source of numerous cases to he referred lo almost every specialty in mcdici"v. organized medical profession ivlilcdn cclly should render its approval and sup lo the efiorts of the physicians cam. seeking to protect workers join the u dangers connected with iudustry's (Inin-, of substances and work conditions. ' Necessity for Uniform Absenteeism Record ' , In the Industrial Health Program By MILTON H. KRONENBERG, M.D. Chief, Division of Industrial Hygiene, Department of Public Health, State c Illinois, Chicago ' Yon arc all aware of the value of acci dent statistics. You know that without fre quency and severity rates there would he no solution of the safety problem and we would he groping in the dark. Hut, since they are available, we know where correc tive measures are needed and this affords us an opportunity to correctly judge the value of one method of prevention over another. Today, the grip of statistical methods is closing down upon industry, medicine, public health and safety. Vital statistics, however imperfect, arc one of the chief means now available for measuring health, longevity and the progress of medical services in the battle against diseases.. These excessive rates arc especially able for unskilled workers as sliow the accompanying table. These death rales could only bate prepared by statistical inclhod.- f a sis and, therefore, clearly point out \ one phase of our problem lies. If nothing more than this we would plenty to do trying to uncover the nn to health among the unskilled grim workers. The morbidity and morlalilt data down by uniform and adequate tcpi of cases can also scric as a ha-is fur ventiun and health education among t ers, the same as is and has i ecu dmi. accidents. ' So well recognized is this fundamental It may interest jott to know Ilia principle that the effectiveness of a city Kastman Kodak Company, EiI.mui I Ior state health department is judged, in a Illuminating Company, I loud I iM cr 1 large measure, by the accuracy and com pleteness of its morbidity and mortality reports and records. The same principle obviously should hold (rue for the groups of workers emplojcd in a factory, mine, quarry, public utility or department store. These rtcouls are of value not so much lo indicate what has been done, although this is important enough in demonstrating lo management the value of certain work and, therefore, the advisability of contin uing it, as they are to chart future action. pane, WeslingliuiisC, Mctropolit.ui Life cral Motors, and several others ha\ jeais made sickness studies wiili Hi of statistical methods. In tlii> wat were able lo evaluate the dillcunl si> problems confronting them and tlmse iug alteiiiiun, and at the same time these sickness records pmprily app and evaluated, thej were able to c their employees regal ding digc-lin eases, colds, nuciuntmi.i, tllhciculn-i ccr, skin disorders, as well as nth. ments. Insufficient data have thus far prevented the recognition of some health problems peculiar lo wage-earners and there is ample evidence to indicate that morbidity and mortality rates are higher for some groups. Furthermore, studies conducted ii eilic industrial mulcrtjkir.gs lute dm, value of statistical methods in ret the incidence of such ilisea-es aluonia, tuberculosis, and dcgcncralit 2<j Stiver Jubilee Safely Congress \ Death Rates by Occupation .1// Cuu'i-t 7 *Aff/.w*/?jjlt Itl'lAl SI-VKHil*lwi-x'liiH.,.,.n.,.1f.l.rl.ru.t.'.il.....- M67i0lt.*57... l ?l.l---- . ..... . . . . U--*n*'l*il--l'tl H-iifivt'-i lOOO.i . - - --- ....... m 7 ioj.s ... ~.. ui.v * 1- . ...... . --------..-- _ . /*H< HM'Hfftl .IM N M. -- .... 5*7 7 71 ft 1.15 V . K.t |vr 10*MMhi (H.cu|>k'il itMk*a based on I S. Cvinu* iUu in lu Kvtctliil Xt.Ura. ('miter rlN<( I'umuki 70vl Its 4 W$ 1116 * .a-es tu be Iiiylfcr Ilian the avciage for dents, the quality of bis work is of a .v entire industrial population. Tliit was ally demonstrated in a pneumonia study along steel uothers nliicli uas conducted > (lie U. S. I'nblic Health Service. lower grade, team work is disrupted, fac tory processes are dislocated, undue burdens are placed 011 other workers and tbc worker himself become- dissatisfied. If be is oc Drury, some years a;;u, was abb: In slimy cupied with weighty matters of policy and high rale n( tuberculosis aiming workers production 1 lien someone in that urgauiza- (lie ax-grinding industry, ami llie Harry, liim must assmiie the leadership and ac- ' Viiiu/iiI, siiiily revealed a high twhenu- plain! him with the problem by understand -is rale among granite workers. N'oiloubi. able and intelligent faels and' figures. llier occupational undertaking* would re* eal ilala lor prevention, control and cdualion were it possible to liavc adei|iiatr talislical records as revealed in tbc slide i-l shown you. There are progressive industrial organ izations who may and have spent large sums of money fur the improvement of working conditions and (or the care of workers who become ill, but without cur Dr. Selby of licm-ral Motors, in calling rent plant information almtil the human Meiiiioo i,, his slalislies shows lliat ahoiil factor much of this money ami Hiurl has ' u of a day per annum is lost due to nc- been spent on ''genera! principles'' or per upalional injuries and lliat includes overt- haps concentrated upon the elimination of alioiial diseases as well, whereas, eiy'bt. only one or two publicized health hazards, inc or ten days per year is the total ami only from the standpoint of existing >sf time from all illnesses. In Dr. Xcw- compensation laws, ns for example, sili ui't's report ior the American College of cosis. Hut. the extent of the health problem -nrgvons, the figures arc about tbc same, in a plant necessarily may not cud line. bis shows us that our industrial illness rnhiem is ap|irONiniately fifteen limes the izc of our accident problem. It is evident llml industry could well fiord to roiicuilratc on illnesses among ngc-earncrs, other than the occupational i.-eascs, because they arc tile ones that nusc the greatest amount of absenteeism id arc the biggest drain on industry. With the progress of industry especially on the chemical side, new health problemwill arise resulting in physiological ami pathological upsets. The effect cm health will, therefore, have to be measured and evaluated. We inu.-t have data ill order for one to judge tbc efficacy of methods employed to combat disease, so wc must first know where licallli is lu-iug menaced, In the recent National Conference on the relationship of occupation In tlic-c dis Icaltli Conservation, it was estimated that eases ami the causative factors responsible. ue nation's bill fur illness and premature Tbc records you keep will be a guide to ac baths amounts to approximately ten hil- tion as well as a record of action. .011 dollars annually, and that on every terage day about four million persons in c United Slates arc incapacitated by ill- < No doubt many industrial workers ie in that last figure. ' Therefore, I say, prove your value to industry since many a skilled industrial medical department has liven limited in itbudget and activities because it overlooked the necessity ami value of absenteeism re Thy indusliinlisl of today should rccog- ports and records which could ba.e l-rcn i/c -that a sick worker is prone to acci used tu enlighten manage: ,cnt icgaidii ... its .) Occupational l>iseuse health problems. Perhaps in some cases up and maintaining records of irktu-s the imlmtrial establishment may find it dif their particular plants. An an *)>'* ficult to undertake a complete record system evaluation of these reports an-i .co.ril of absenteeism. I do urge you, though, to another service otlcrciMiy them to ul.in., make a start somewhere. It need not he mini. ton elaborate. ' Hcfurc showing you a form on width I have beard it said that the lust way tu deled illnesses which are causative of absenteeism from work is hy periodic phys ical examinations. I am nut fully in accord with this type of prevention. It may he helpful where the illness lasts longer than a week or ten day's, hut something should collect )oiir absenteeism data, and which be (cimcd the ''master .sheet,'' I should I to anptaiul >ou with several impoii items that must he had for )uur rno hcfurc they can li ml themselves to anal anil evaluation. The form is self c.vpla lory except (or a few gciisiat remarks. be done about the frcrpicnt one, two or A carrl should lie made nut for each three day absences, and I (ear that periodic every cmplu)cc on the payroll, regard physical examinations will nut help tre of whether he or she gets s,ck or not. 'I mendously. This, of course, does nut mean is necessary in order to ascertain the r that industrial medical services should aban of those sick to the iiumbcr on the par don or minimize that phase, rtf hcallli serv The winkers' age, sex, color and occup.t ice. arc imporlaiit tu record since they w ill I The industrial hygiene divisions of Stale to he related to the specific exposul pi Health Departments and that of the L'niled lalioii. Slate Public Health Service arc urging the kinder "occupation" state the vvoil, employment and use of a uniform code fur which the employee was engaged whin recording anti rc|iorting absenteeism of the sickness began. The ``dale disability In--, uorkcr due to sickness, bonus ami meth should only he reemded for one full ods have been developed after a study of or longer, in the roiuum "work day- !. some twenty years hy the Public Health we refer to calendar days and thi- is n,, Service ami also as a result of the recent sary to put lost lime 011 a eon1p.11.1hh* l National Health Inventory of chronic dis for all employees. For "diagnosis" ease alfyctiug workers. The aforementioned should list the sickness or injury when il health agencies will gladly assist and eo- nitcly known; if there is any doubt nl opeiate with industries desirous of setting the correctness of the diagnosis, a slntcp 22S !> liver Jubilee Safety Congress of the >vmptums experienced liy tltc patient should be recorded. The point is that facts should be recorded and not guesses. It is more important, for example, to know that ten men in a' given occupation were dis abled hv "pain in the stomach" than to got ten different guesses of the disease or ail ment causing the pain. Another item of importance on the record is "hy whom diagnosed," and should show whether the diagnosis was made by the family phys ician. plant physician, nurse or the patient himself. L'nder "termination" of case, one should record whether the illness terminated in recovery, death, relapse or ended in a chronic condition. The following statistical information and data are. therefore, possible it lhe''items listed in the slide just shown you are care fully prepared. 1. The frequency or severity rate of any given disease for the entire plant, individual departments or occupations. . 2. The time lost due to any given dis ease or to all diseases combined in the en tire plant or hy departments, or occupation. 3. The mortality rate. 4. The case fatality rate, expressed as the percentage of cases of a given disease which terminates fatally. - The intelligent application of preventive measures, of control* of health preservation must have statistics and they will always he an integral part in the solution of any problem. That it holds true in industrial hygiene is represented in my next slide whicli shows that the strength of any wheel is dependent on each and every spoke and each is dependent upon the other, otherwise your structure is unbalanced or collapses. ADJOURNMENT Sfesam Heifliraad TUESDAY AFTERNOON SESSION October II, 1938 The first meeting; of delegates to the Steam Railroad Sessions was called to order by Mr. W. W. Wood, Snperintemlciit of Safety and Welfare, lialtimorc & Ohio Kailroad Company, lialtimorc, Maryland. who presided. Chairman Wood hriedy out lined the significance t>f the programs of the two sessions planned, and then intro duced the first speaker. * "Hidden"Causes'' By FRED W. SARGENT President, Chicago and North Western Railway Company, Chicago We have seen the evolutionary growth of accident prevention work from its in ception, as applied to the American rail road*. Afany of ns here knew Mr. Ralph C Richards intimately, and discussed his hopes and ambitions with him frequently. Though lie met from time to time with dis couraging results, vet lie never surrendered. He laid the foundation for safety work that is vastly enlarged anti is rapidly ripening into collateral lines that are of benefit not only to employees and managements but to the entire economic and social structure of the country. . In* the beginning, and even until rather recent times, the greatest emphasis was laid upon working rules and physical conditions of plant and facilities; in other words, a safe place l<5*wnrk. There was every rea son in the world why the greatest emphasis ihniild lie placed tiiioit these factors, and, . indeed, we arc nut yet so far along that ire can afford to lessen our efforts with ; relation to these matters. In the beginning, the idea of a surgical department was to care for men and women ' liter they were injured. Gradually this , conception has been enlarging amt changing [ into a broader field and greater service, if j a greater service is possible. This depart . stent no longer has as its sole objective ! the healing of wounds and the saving of i human lives after injuries. Gradually, steadily, the whole conception of safety work has progressed and evolved until to day it has heroine a nationwide activity, drawing to its cause the best minds and the finest characters in our social structure. And with this greater interest in the work it has iieen hut natural that (he whole sco|ic. theory and conception of the under taking should gradually enlarge to embrace the wider field of accident prevention, to which l am nltotit to refer. In recent years many, of the railroads have enlarged their conception of this work and have conic to the realization that safety work involves not only safe tools, safe wav anti structures, ami safe surroundings, hut involves likewise, and with equal impor tance. the very physical and mental condi tion and attitude of the employee or olliccr himself. With this thought in mind ur have changed the title of (he lieati of our surgical organization from that of "Chief Surgeon" to that of "Medical Director," because if men arc to avoid accidents we know that they must not only he sur rounded with sate working rules and safe working conditions, hut they themselves must lie physically and mentally fit; and that the so-called human element, always and ever present, must constantly lie reck oned with if we arc to achieve the ultimate beneficial results so earnestly desired. And so it is that in all this work, whether V**l Steam Railroad 'dd of informing the public ns to the number of accidents, their causes and how they may be avoided. Will* this limited application of effort, automobile accidents of all kinds have been constantly increasing. We have found in our efforts .to prevent accidents to employees that we must supplement our educational methods with rules regulating the conduct of the individual and that such rules to be effective must be enforced. It is imperative that a similar procedure bo followed if we are to curb the recklessness inherent in certain motor drivers. Ninety-five per cent of the motor drivers of this country are competent and careful, ft is to them that we appeal to aid us in the-enforcement of such rules and regula tions as are necessary to eliminate from our highways the one and one-half million drivers who arc reckless and incompetent. THURSDAY AFTERNOON SESSION October 13. 1938 . Safety and Public Relations By ROBERT S. HENRY Assistant to the President, Association of American Railroads, Washington. D. C. The safety movement, which constitutes full measure of success. How well they one of the proudest chapters of American and their successors did the job is told in industrial achievement, naturally falls into the statistics of declining accident rates, of two main divisions. Safe conditions must lives and limits saved. _ be created, in the first place, hut there must In these latter years, American industry lie also created a safe state of mind. is faced with the ttcct! for another sort of No doubt the pioneers of the safety movement encountered industrial managers willing enough to install safe equipment, understanding and cooperation on the parr not only of those employed hut of the whole public which our industry serves. but skeptical as to the need or the value In the short space of little more than a of the education and exhortation needed to century, our American scheme of enterprise instill safe ways of thinking. Every man has settled and civilized a continent. It has knows that to get hurt will cost him time made possible a standard of material plenty and money anti sutfering, these skeptics and well-being unknown before m the his .might have said, so what's the use of going tory of the world, and tmkunun elsewhere to a lot of trouble to tell him so? He'll in the world today. We are :>M that one- take care of himself! third of the people of the nation are ill-fed. Fortunately, the safety pioneers realized that safety was a matter of the minds of men just as much a# a matter of machines, and that the safes: equipment and the safest rules did not. in and of themselves, make a sate man. They fought their bat tle for safety on both fronts--safe condi tions, yes, but safe thinking as well, achieved through constant iteration and reiteration ill-honsed and ill-clad, hut it -.'.uid hbome in mind that when this American way of enterprise becan to futxti-.r a century and a half a-Jo. practically she vi'-.le pop ulation was ill-fed. ill-housed and ill-clad, according to our modern standards Mis takes have been made, perfection i> a long way olT, hut there is in the record of achievement much solid ground for pride. of simple principles. Today, as never liefore, the best opera The early leaders of the safety move ment pioneered in a field broader than their direct goal of promoting personal' safety. They pioneered in- the field of se curing and organizing the wide-spread un tion. the safe functioning, theNvry exist ence of the vast and varied organization of our economy of tree enterprise, depend upon public understanding ami appreciation of what it is, what it docs, how it works, derstanding and cooperation without which what it means to all of us. tbtir movement must have failed of its The safety movement is built upon safe