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FILE NAME: General Electric (GE) DATE: 1938 DOC#: GE024 DOCUMENT DESCRIPTION: Transactions of the National Safety Council ar e w o r d T ill-'. Transactions of the Silver Jubilee Congress and E x position of the National Safely Council, October 10-14, 193.S, are published in two volumes. Volume I contains the genera! and subject sessions and the sessions of the various Industrial Sections. Volume 11 contains the Street and Highway Traffic, the Commercial Vehicle, the Transit, the Child I'ldncation, and the Home Safely sessions. Volume I is distributed automatically to all industrial mem bers of the Council. Volume 11 is sent to members who are believed to be interested chiefly in the sessions it contains. However, oilier Council members may obtain Volume If i upon 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 coniain in safety programs and for general reference pur- ti |dises. Extra copies of the Transactions may lie obtained as follows: One to 10 copies of Vo!. I, at $2 each; 11 or more i< copies. $1.75 each, Extra copies of Vol. If cost 75 cents l each. i Ii T I i l l -. Transactions are a condensed record of the pro I 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 wlial i may be of particular usefulness and value in promoting ef fective safety organization and oilier accident prevention measures. These volumes, therefore, are a somewhat i * 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 arc available for additional reference, if desired, in the files of the National Safely Council. T HE National Safely Council, at its Congresses, seeks to eliminate from discussion matters which are not pertinent to the aims of the Cong res- or which may lie contrary to the f Council's policies. It cannot accept responsibility, however, for all views expressed ciliter in the papers which have been delivered or in the discussions based upon these papers. N A T IO N A L SAFETY CO UN CIL,lnc. 2 0 North Wacker Drive ? Chicago I Council Officers and Directors. Council Purposes and Policies. Annual Meeting of Members---- Annual Banquet . ........................ Special Subject Sessions-- Agricultural Safety ........... Dusts, Fumes, Gases and Va Falls of Workers........... Fire Prevention.................. Governmental Officials . . . . Health Service in Industry. Industrial Accident Investig Industrial,Explosion Hazard Industrial N ursing............. Industrial Safety Lectures. Maintaining Interest in Safi Midwestern Rehabilitation W Occupational D isease........... bff-the-Job A ccidents......... Safety Fundamentals........... Safe Use of Electricity......... Safe Use of Petroleum Prodr Aeronautical Section .................. A. S. S. E.--Engineering Section Automotive and Machine Shop Se Cement and Quarry Section....... Chemical Section......................... Construction Section.................. Food Section .............................. Marine Section............................. Meat Packing, Tanning and Leath Section ....................................... Metals Section .............................. Mining Section ............................. Paper and Pulp-Section................ Petroleum Section......................... Power Press Section...................... Public Utilities Section................ Refrigeration Section.................... Rubber Section............................. Steam Railroad............................... Textile Section-............................. Wood Products Section................ Safety Exposition--List of Exhibi Index .............................................. uiion'al afety Council, Inc HONORARY MEMBERS \ " n i i.viiiin in- Ikon a m i Isoiiikt W . Camitski.i. I. kw R. P ai.mkii S tki.i. K xoinkkus OFFICERS (1938-1939) I >. 1*. I'lNM.I.I., I 'll'.delll C. \ \ . IJi mi'Ksv, Vice-President for Pinam-e and Treasurer hu\x K H. H akuison, Vice-President for Industrial Safety I >u. Mu.11 it Mi*( t.intih'K, Vice-President fo r Public Safely W u . n . u S. I'aink. Vice-President for lfnvtinccrin.i; A. \ Uoiiwi.m.K, Vice-President for S afely Councils R. T. Soi.knsit.x, Vice-President for Membership A. W. W'lilTXi-.Y, Vice-President for Ifducation \V. (I. Camkkon, Secretary am! Mana;;in;; Director EXECUTIVE COMMITTEE (1938-1939) If. J. Al.nmcil, Spencer Kellogg & Sons, lne. J. I. I'.anasM, Past President C. \V. lii iiiaji isr, Past President H. \ \ . oiaa.ss. Sinclair Prairie Oil Company ( . I. IIiht.kt, Wisconsin I'ulilie Service Corporation k'.H!n:i W. I 'ammii.i.i.. I'asl President W. II. Camkkon, National Safety Council, lne. I. . C. Camitiki.i, Mininer Section Isoliert I. Catkin, Aetna Casually X- Surely Company I. r.wis ,\. 1>i.li.ins. Past President (.. W . Dkmi'KSY, The l.iipiid Carbonic Corporation Is. If. Donovan, ASSlf-Ifn"ineerini; Section M .\m r s A, Dow, Past President \ \ ai.ti.u A, Kvkksox, Lehigh \'allcy Safety Council If Ain. If. Gihiykii. Safety (Council of the Columbus Chamber of Com merce D. I). Pknmi.i.. Coiisultino Ifneiueer I I ahky G iti.iii-.ht, The Pullman Company I-'kaxk II. H ahkinoN, International H arvester Company I I aiioi.o Ci. IlniTMAN, Cuemploymcut Compensation Commission, New Jei-ey S. H. IloituLl.l, P o o d S e c tio n II. II. Kki.i.y, Interstate Commerce Commission 4 OFFICERS AND DIRECTORS, Continued W ai.tkk C. Kin;, P ast Pres W m. C. Ixnoki.ic, Milwaukee J ohn If. I.ONC, Past Presiile Tims. II. MacDonakd, U. S. Aimiiuk \V. M.m;kk, Commis? Du. Mii.i.ku McCiintock, Y: R. S. M ktzuik, Public Gtilil I. \Y. Mu.i.Aiti), Industrial G I Iakoi.d I., Minkk, If. I. du P Ki.iiit N i'.ss. Director of Pul If. I. O 'I'hikn, Jit., Louisville W ai.tkh S. P aint., Aetna Li I I.iavcR. P ai.mkk, Past Presi C. If. Pi:rrmoNK, Past Presi 1!. O. Pli'KAiui, Marine Sect Ai.m.iir S. Rkoiji.a, Industria I.t. Coi.. I I knhy A. R knincki If. A. UoiiKHTS, Textile Seel A. V. Ron win ii:k, Duluth, Mi Gkokih-: If. S antoku, General Ciiaki.ks If. Scott, Past P r i I'kank T. S iikkts, Portland Gkx. J ohn H. S ui:hih;hnt:, M C. W. Smith, Standard Oil < W ai.tkh I )knt S mith, 1Jelaw W. A. S now, Construction R. T. Soi.knstkn, Elliott Se I. i.si.ir. J. S oiiknson, City T r Coi.. J ohn S tii.wki.k, Consoli C. P. T okmaN, Past Presidi G i.ohc.i-: G. T ii.wkh. G reater Dh. 1!. I.. VoSHiMdai, (ienera I )n. C. 11. W atson, Past Pt A. W. W iiitnky, National I D. A. Hmuu.t, Carnenie-Illit Aicmtm II. Ydunc, Past Pi DIRECTORS (1938-1S II. .1. A i.uhii.ti, Spencer Kell A. I.. A hmstuonc., Ifastman I. I. Hanasii, Past Preside: Cahi. I'akki u, St, Louis Sa I.m II. K.UT.AC. Klaekstoiii W. A. IlKCIin.l, Automotive P untisi W. Kuck, United St I il V / 1CERS AND DIRECTORS, Continued 1 . W. Itr.NGoiiisr, Pa-d President !'. F. Biank, Junes & Laughlm Steel Corporation i t . \V. P.ocoess, Sinclair l'rairiu Oil Company If. I-.. Bolt, South lleiid Civic Safety Cotmril t - It. Iloimr, Wisconsin Public Service Corporation I1'. S. Brown, Staiulanl Accident liiMirauce Company J. II. Brown, P etroleum Section U . A. Brown, Safety Dept., Nashville Chamlier of Commerce 1C A. Bullock, Kulihcr Section W. If. Cameron, National Safety Council, Inc. I. . C. Camitiki.i., Mining Section Robert W. Camimiii.l, Past President R aymond A. Carey, Evanston Safety Council R ay C arnf.y, Kenosha Safely Council Roman' I. Cati.in, Aetna Casualty & Surety Company Maurice C haillet, Rahway Safety Council L. O. Cmeever, Employees' Publication Section W m. M. Clark, St. Joseph (Mo.) Safety Council K enneth 13. Coi.ma.v, Seattle Traffic Ov Safety Council J. E. C ui.uney, Bethlehem Steel Company F rank J. D ean, Kansas City Safety Council *I.e\vis A. De13i.ois, Past President C. \V. De.mih.sv, The Liquid Carhouic Corporation R. E. Donovan, ASSE-Engiucering Section J ames 13. D ouglas, Tlic Philadelphia Gas Works Company M arcus A. Dow, Past President D r. Louis I. D ublin, Xfetropolitan Lite Insurance Company 0 . M. E dwakos, J r., Safety Div., Syracuse Chamber of Commerce \V. A. E verson, Lehigh Valley Safely Conned D. D. Fenneli., Consulting Engineer Donald A. F inkueiner, Toledo Safety Council D r. H art E. Fisher, Chicago Rapid Transit Company Chester C. F isk, Berkeley Traffic Safety Commission H oward 13. Fonda, I3urroughs Wellcome & Co. (U.S.A.) Inc. Arthur C. F rkv, Worcester Safety Couneil J ohn 13. Giiiso.v, Western Electric Company Lyle H. Gift, Peoria Association of Commerce Safety Council H oward F. Gii.iiekt, Elizabeth Safety Council E dgar H. Gorsuch, Grand Rapids Safety Council W. A. Griffin, American Telephone & Telegraph Company E arl E. Grover, Safety Council of the Columbus Chamber of Com merce H arry G uilhert, The Pullman Company C. II. H arper, Refrigeration Section D. T. H arrington, United Slates Bureau of Mines F rank If. H arrison, International Harvester Company 6 OFFICERS AND DIRECTORS, Contini * ;y.-. a Cuts. E. Him., New Voi ll\ROI.H t I. HUFFMAN, I New Jersey I'.vi.ri it I limn, Madison S. 1!. I Iorki.i.i., Fond Sei F red It. H unt, (a m im i ft W m. F. J a.mes, Philadelpl T. II. J ohnson, Collimerei T homas P. K earns, IikIus IL IL K ki.i.y, Interstate C W alter G. K ing, Past IV Wsi. C. K noki.k, Milwatik' Wm. S. K nudsen, Detroit Orro C. K uhrt, Greater S C. L. L aFountaine, Great J. If. L ee, Wood Product: M i u -aud C. L efi.er, Child J ohn E. L onc, Past Presit Tuns. H. M.scDonai.d, Un. Uoiiekt A. McA rthur, Tr; D h. M i u .eu McC untock, ' A rthur VV. M agee, Commi 1'. W. Matson, Minnesota R. S. M etzger, Public Utili I. W. M illard, Industrial C H arold L. M iner, E. 1. du R. 13. Moki.ey, Industrial A P rof. Roger L. M orrison, i E rnest M urphy, Albany S: C. L. Murray, Mason City-i E liot Mess, Director o f Pul E. J. O 'Brien, J r., Louisville George C. A. O pp, The Dctr W alter S. P aine, Aetna Li L ew R. P almer, Past Presi D avid A. P atton, Newark I C. K. P eacock, Chattanooga C harles W. P endock, Safe Commerce C. E. P ettidone, P a s t Presi' II. O. P ickard, Marine Secti A lbert S. R egula, Industrial Dig A. R. R einke, Contra Co Lt. i ii.. H enry A. R knincer, P iiii lip C. R hoads, Meat P Section OFFICERS AND DIRECTORS, Continued A. C. Kissiieuuek, Rochester Safely Council Makings Riteu, P aterson Safety Council E. A. Rokekts, T extile Section , Bestow Rownson. Easlhay Safety Council I'. A. Koiunsok, Payer & Pulp Section 1?. K. Kockiioef, Pow er Press Section Rai.imi l.. Roueks, I k., Chemical Section A. V. Roiiwepek. Duluth. Missahc & Iron Range Railway Company W ai.tek Rosknu.u .'m, Western Pennsylvania Safety Council (i. E. S aneouij, General Electric Company H enry G. S ciiakknkk, Eric Safety Council Makky A. Schui.tz, United States Steel Corporation of Delaware Cutahi.es 15. S cott, Past President E aui. S. S iiautzkk, Utica Safety Council F rank T. S heets, Portland Cement Association Gen. J ohn H. S iieuiuihne. Massachusetts Safety Council I )it. L. A. S houdv, iiethlelieni Steel Company E rnest I.. S imonos. Xcw Haven Safety Council Jutter Lee E. S kt.ki., Cleveland Safety Council C. W. S mith, S tandard Oil Company (Indiana) W ai.tek Dent S mith. Delaware Safety Couneil t \ \ . A. S now , Construction Section :y iR. T. Sui-ensten, Elliott Service Company v L eseie J. S orenson, City Traffic Engineer, Chicago E. C. StTitNf., Philadelphia, Pa. G kouc.e R. Stephens, Safety Bureau, Buffalo Chamber of C om merce Cm.. J ohn S tii.u'ei.e, Consolidated Edison Company of X. Y. Inc. A htiiuh M. T ook, Consulting Marine Engineer C. I'. Tot.man, Past President Mi.t.t. E. T uammei.i.. Metals Section liEoura: G. T kavek, G reater Chicago Safety Couneil, Inc. Majok R- D. T uimiii.e, Richmond Safety Council Ekank E. Y itz. Superior atul Douglas County Safety Council Du. li. L. Yosiunuai, tieneral Electric Coinjiaity Du. David E. W ec.i.kin, Baltimore Safety Council Du. C. H. W atson, Past President G. Wist: W esuott, Safety Dept.. Auto Cluh of Rhode Island S. E. W iutinu, l.ilierty Mutual Insuvanee Company A. W. W hitney, National Conservation Bureau C h.mu.es E. W ii.son, tieneral Motors Corporation F. 15. W in.si.ow, S afety Div., Birmingham Chamhcr o f Commerce W. E. W orth, International H arvester Company AttTHUtt II. Young, P ast President E. J. X.At.TT, Safety Bureau, Duluth Chamhcr of Commerce 8 s have lo lie a dual agencies and nays ng opportunities ior >r the physically dis-t be summed up by o equal quantities of .pplicant's ability and add an unlimited perseverance. interest, work and success will Occupational Disease THURSDAY MORNING SESSION October 13, 1938 The session for the discussion of out standing problems in the field of occupa tional disease was called lo order by the lion. J\ J. Augstcn, Chairman, the Illinois Industrial Commission, Chicago, who pre- sided. The Chairman emphasized the im portance of the selected subjects to be pre sented by eminent speakers, and 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 Let us consider the differences between the accidental injury and the occupational disease. I'or these distinctions are important and must'constantly he home in mind when we consider cither legislation on^tlic sub ject of disease, or engineering methods of prevention or control. Cicncrnllyn>))eaking, accidents occur at a specific mnment in poinf'mi 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 he as sumed has not yet happened. That fre quently is not so with the occupational dis ease. Insurance by its very nature can only assume liabilities dial have yet lo arise--not those that have already accrued. Again, speaking generally, the industrial accident is something that can he seen-- even though unforeseen. It may be visual ized and described in words, setting forth specifically the time, place and manner of happening. It can then be determined, alter the happening of the event, whether it was preventable or inevitable; blame, if any, can be assessed; the worker involved, or bis foreman or superintendent, can be shown the fault, and effective measures can he taken to guard against a like future hap pening. But some will say, truly, not all accidents happen in the manner described; that not always are they held to occur only at a specific moment or under circumstances where they can he visualized and described, llv administrative and court decisions, it is true in sonic jurisdictions that the definition of "accident" has been greatly broadened. We find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, and even the specific time and place not definitely known, except that it is shown to have probably occurred in the employment, being held to be an accident. illiers vs. Hull, 178 App. Iliv. SSH. 1<U N.Y. 767. an anthrax e.w; W'lincn vs, Ww Iell l.mn* her Co., IM Wis. 370, a typhoid ca.-r; ami others.) Poisoning of the body through the effects of. a deleterious or toxic substance used in the employment, the dangers of which were unknown to the worker, the employer hav ing been negligent in safeguarding properly the use of such substance, lias been held to be the result of an industrial accident. (Victory Sparkler & Specialty Co. v*. Franck. 147 Maryland, 363; ami the very recent case of Black vs. Crclrm Amo Co.. Iowa Supreme Court, August 5, 193?, 281, N.\V\ 189.) And where negligence of the employer lias been shown, an injury to health, even though not occurring through a happening at a given time and place, hut by repeated 211 .wires over months n{ time, lias Iicen t<> lie an accident. . \r,-ly V'*. l:,r..Un:i AilieOiis Co., .'Of,, Nonli -..limt 'M, :iu .t. c:i.*.) ie<e ami oilier eases I cite are exceptions ami not the general role i ulial constitute- an aeeiilciital injury, link we. may fairly assume that the is of admiui.-lrulors of the law and courts have heen directly inspired hy belief in the mees-ily of finding a ly for an industrial ill for which no remedy had Iicen provided by specific t.ige of the statute. May we consider a< straws in the wind, showing a I toward industrial disease liability? ay observed that tiic tendency of the :s is to roiltrue the term "accident'' more limited manner in those states e there is specific provision in the law ini; occupational diseases. Thus, we clear instances of what lias been d "judicial legislation," that is, the s broadening the meaning of the law over situations not clearly included n the terms o ftlie law by the duly con ed legislative authorities. ; us now consider what xvc mean or in ky the term "occupational disease." we find a more difficult field--difficult the standpoint of administration and al interpretation; and difficult from tandpoint of the doctor and the co at is disease? We think we know, and ;'l to" laymen the term conjures up minds something of a rather defiature. When we pause to consider if, arse, infinite i|u:difications of the term 10 us. and we are confronted with conditions that fall into the /one of -such as, for example, whether licra disease. At any rale, we say it is normal condition, and let it go at when we come to add to the doubt m "disease" the even more indefinite occupational" or "industrial." we find res in an area 'of highlight surd by a vast and increasing /one of t s.tading off into Erchian night, ow then shall we define the term itional disease" ? diseases stand out in our minds as and definitely occupational. As to e have no great difficulty, either leg islatively or administratively. These include the well-known metallic and chemical poi sons that are so definite and charaep ristie a part of some industrial processes. Were the diseases arising from the use of these .substances the only occupational diseases with which we need concent ourselves, the legislative difficulty would he largely re moved, and we could safely entrust the problem to the doctor and the engineer. I?ut we have seen that the legislative problem is not so simple. Xor is it simple administratively. We find ourselves floun dering in a veritable morass, either hceau-e of the inherent difficulties of the situation, or because we have not or cannot agree on our objective. If all parties would rec ognize the difficulties and llu: limitations on what industry can do, or can fairly lie ex pected to do, we could much more con fidently face the future. If we could agree that provision for "occupational diseases" is not synonymous with general health and life insurance for industrial workers at indus try's expense, then I am sure we could get somewhere very definitely. IInt has there not been too much loose thinking on the subject? Wc are met with a curious situation. We find the advocates of so-called "all-inclusive" statutory cover age deliberately Seeking indefmitencss. This is unlike them, for when they know what their objective is, and arc willing to dis close it. they have not retrained from pre-s ing their advantage with definite and spe cific purpose, and with exact language to accomplish that purpose. That, at ativ rate, is correct legislative procedure. lint in this field, even where the liability of the. employer is made inescapable, the constant suggestion is pill forth that it is futile for the legislature to attempL a defi nition or delimitation of occupational (lis t-uses, and. therefore, words of the most general character should lie employed, leav ing to 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 legislative mind; that is the function and the right and the duty of the legislature. Xor should the legislature seek to avoid and evade responsibility by transferring to courts and commissions tlie determination of que.-tions of liability which the legisla ture finds too difficult for it to determine for itself. d U C i -`'ill To effect coverage under the compcns; lion law. therefore, by any such gcucr; and vague language as the term "any an all occupational di-eases," ur by adding I tin: definition of "accidental injury" th plira-e "am! shall include occupational dis ea-t.-s," i- to create an uncertain liability-- one that may require endless and perliap disappointing litigation-before the mcaniii; of the law is established; and will most certainly he a di-service to workers am, cnip love is. Ail 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 nn-aniiiglc-.-y. wWds, or words tlie meaning of which'hiTay have the effect of distorting the objective that is sought. Controversy is bred hy uncertainty of language, and controversy leads to litigation in courts. Litigation is expensive for all parlies; it causes delay; and it frequently causes bitter disappointment. It breeds rancor. It may even breed disrespect for the law and for orderly process of government. Why then shotihl there he this continuing demand for the all-inclusive coverage? Is it with the vague hope that satisfaction may result in some cases of misfortune to workers who fall victims of the disease that Insets us all and lurks in waiting for ns in our play, in our homes, yes, and even in our sleep, as well as in onr employment? Tcrliap- not--yet if that were the design, a more simple way of succeeding in it could not otherwi-e he contrived. Arc we to under-land that any disease of the liio-l common and ordinary risk of life may become an occupational disease if its source or suppn-cd 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 dis ease of life, provided that disease could be, with a show of plausibility, related to a condition or incident of the employment. Such diseases are almost too muncrims to enumerate. lint we know that claims have been made for tiibcrculo.-is and heart disease, the two most numerous diseases and the cause of more deaths than any two other diseases. r' u Silz'cr Jithilee Safety Congress id compensate fu r all sickness anil death nlt-r :t for m <i liealtli ami1 life insurance. liv 1 III, if it In: a valid otic, the ol tin- Malt: and the nation IC.it the iihliwalitm id indti strv :idone. The the iulellligent,, the sane ay |'|ir iniiii'.rry h i iliM'li.'irm* nhligai ithi its in > i*i U't of health i? pr. nitir for llnr I'lMSiunable re- .ircnunls fo r nnlti-li ini hygiene, ami to vide ci>iii|ii-H':itiim mily lo r those yon-, lion? (lint art.?-: from specific named 1i- - -cs llmt nr: truly occupational, charac- i-ti' cii, mnl i-t'iiliar tu tin: processes in licit tlic w o rk e r is- engaged. udtisiry will. 1 am sure. meet llie chal- >gv of (lie ocTupalional disease problem, it is presented nmler .a law t/iat pre dict the liability of industry in nntlermlable term s. In the early lays, the neral rule w as to include ocrtipational -ea-.es in the rrHUpeiisation law by speeity- r the particular diseases or the pnrticu conditions leading to diseases that are tiled to he occupational anil compensable, i- we call a `schedule" law. It is the in in which compensation for occupanal ili-eases is eoecred in all of the mtries ol Kurd]: ami of South Amer- It is so sintplc; it is so sensible; it is easily administered. that the wonder is t tin- -acceptance of the principle is not versa!. f we will keep ever be lore us the priuie that a disease, to lie deemed occupatfi', must he ``cltaractcrislic of and pcutr to" the occupation, there should be great difficulty in arriving at a proper mtory setup for tlte coverage of all true itpational diseases. Metallic poisonings characteristic o f occupations in which It metals are used. The diseases cliaracstic of chemicals, of acids, of alkalies, i-s and fumes, arc characteristic of ami tliar to those occupations in which the ihiyecs are so exposed. The diseases of respiratory system, due to the inhala nt dusts, are the natural accompanii and the characteristic effect of work id] dii.?ts. hen such clear and specific language is able, why should we he asked to use e. broad terms, the use of which may itute the giving of a blank check by dry? If the purpose is not to charge Irv with diseases which arc not char- <7 aeteristically the obligation Qt industry, why continually insist upon the use of lan guage which is susceptible of misinterpre tation? He well assured, if legislatures do not perform their duty and lay down dear definitions of liability, industrial hoards and conuuissions cannot in tile presence of the widows, orphans, ami industrial cripples, he- expected tu exercise greater courage than the legislatures. The law in the hands of sueli ail administrative body will he .scanned, and 1 fear scanned in vain, tor limiting words or language to stay the hand of industry's self-constituted almoner. The legislative trend, I am happy to re port, in recent years has been toward the definite, rather than the indefinite. Despite tremendous pressure, no legislature has, in the past three years, adopted a blind, "all-in clusive" occupational disease law, except New York, of which I shall speak more in detail presently. Michigan, Rhode Island. Pennsylvania, Delaware, North Carolina, and Washington, among the slates most recently enacting occupational diseases laws, have adopted the "schedule" or specific method of coverage. Two years ago, Ohio amended its scheduled occupational disease law by adding dust diseases to its existing schedule. In two other states, namely, Illi nois and Indiana, occupational disease laws have been enacted in gem ral terms. How ever, in identical language, these two stales have undertaken to limit and define occupa tional diseases and have attempted therein to safeguard industry against liability for the diseases of ordinary life. Although doubtless familiar to many, the definition in the laws of those two states will hear repetition, as indicating the ex treme of difficulty in attempting to exactly define an occupational disease. "See. 6. In this Act the term 'Occupa tional Disease' means a disease arising out of and in the course of the employment. Ordinary diseases of life to which (he gen eral public is exposed outside of the em ployment shall not be compensable, except where the said diseases follow as an in cident of an occupational disease as defined in this section. "A disease shall he deemed to arise out of the employment, only if there is apparent to the rational mind upon consideration of all the circumstances, a direct causal con nection between the conditions under which Oca. tile work is performed and the occupai disease, and which can be seen to followed as a natural incident of the as a result of the exposure occasione the nature of the employment and v can he fairly traced tn the employuiei the proximate cause, and which does conic from a ha/arii to which work would have been cipially exposed out of the employment. The disease mils incidental to the character of the bnsi and not independent of the relation of ployer and employee. The disease need to have liven foreseen or expected hut a its contraction it must appear to have its origin in a risk connected with the < ployment and to have flowed from t source as a rational consequence." Under this definition no industrial m; ager fan, with any assurance, be intorn what his obligation is to his workman, a assuredly no workman suffering from d case can surely know whether lie is c tilled^to compensation under that law. < course, as is to he expected, litigation ov the interpretation of this definition is l ready in progress in both of these state And situations will arise constantly in tl future where the facts will he such tit: only litigation in the courts will dctcrinir the liability of industry, or the right (. the worker to he compensated. The claims actually filed with the In dnstrial Commission of Illinois alread. include undnlaiit fever (a disease said ti be commonly communicated by milk am meat products), tularemia, rheumatic fever arthritis, rheumatic heart, heart disease amebic dysentery, varicose veins, flat feet, athlete's foot, cerebral hemorrhage alleged to be due to overwork, syringomyelia, and nerve disorder. I have not mentioned the claims for characteristic occupational dis eases, such as silicosis, carbon monoxide poisoning, and the various other toxic con ditions which clearly come under the Act. I have referred to the fact that New York, alone, has in recent years enacted a law covering 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?fl. The law- was a schedule type law, (It so happens that I had the privilege of being one of those who collaborated in the draft ing of that law.) We were dealing with a i- noth. Stic contracted what stic ilcscritn.il blotches o r :i rash on her legs. The .oldies or ra>h she claimed were due to he alternate heating and cliillinjf ol tier gs when she switched on or off vhc heater, .`hey ilid not tuiMilitlc a disability. Iioweer, on romplainl to tier employer, she was >ld to sec tier doctor. While on her way see* tier ikwtur, on her own time, she 'ipped on the sidewalk and fell, fracturing n ankle. Although the day was cold and c testified there was iee and snow on the loualk, the claimant alleged that she fell lelv due to> weakness resulting from .so blotches,, ami the Industrial Board i found; amt louml that the eausc of die alt was an occupational disease, character-1in of and |.er;h.u' |o In i employment. The ("ouit ot Appeals, in an opinion that ristles with lifejic and sound sense, struek is free-for-all system from the language the Xew Yurk Aet. They unanimously fu.-ed to concede that this lias an orcu- iiional disease. To make every disease nit aro-e out of ami in the course of cmioynietit compensable as an occupational isease. they said, would he to make the mpensatioii law `'the "equivalent of life id health iiisiiranee." The court further id that to he "occupational," the disease list he one wEtich "results from the na1 :rc of the employment" ; and that he naire of the employment is nieaul--conditions >which all employees of a class are subject id which attach to the occupation--"a ./ard whieh distinguishes it from the usual m of occupations, ami is in excess of the i/.aril attending employment in general." ability follows immediately, and in which prompt report to the employer is made. This is not far different from the rule in regard to hernia as an accident. But in New York, during the past yeyr, it has become sumewhat the fashion to regard almost every hernia as cither an accident or an occupational disease. This followed on a decision of the Conn of Appeals, sustaining an award for hernia as an occupational disease wherein the' In dustrial Board specifically found that no accident had occurred. In the case pre sented, the worker was required, in tincourse of his employment, at frr<|itenl intervals, lo roate his body mi the hips. This man was employed in a glass factory, lie gathered molten glass on the end of a pumiy, which he, in turn, swung about ami placed in a mold. The weight was not excessive, being only a matter of a few pounds. In affirming this award, the Court of Appeals said: "The finding, supported by evidence, is that the continuous gathering and lifting of glass from a furnace involved a constant twisting and straining of the body. This process, from gradual stretching, resulted ill a hernia which is a disease (Matter of Alpevi vs. Powers 223 N. Y'. 97, 101.) There is medical testimony that claimant's occu pation would produce this disease and there are judicial decisions in other jurisdictions holding that hernia is an occupational dis ease (Marathon Paper Mills Co. vs. 1ml. Comm. 20.1 Wis. 17; Travelers Ins. Co. vs. Lorke 56 l ed. (2nd) -Ml, 4-14)." (l-'ii.srrr vs. Cilli-mlvr Itro lliers Inc., 27S X. V. *itoltllicrif is. 95+ 3Iarc>* C o rp o ratiu n . cleciilcil J tS 16 X. E. 2ii.l 260.) J.ifid.trv I t , I9.is', an,I rc p o rlo i in 2 /6 , .V. V. i l l 12 X.K. 2nJ. . i l l .) Perhaps the most controversial question Thus, after mure than two years of cat uncertainty as to the meaning of the .c, the Court o f Appeals has eliminated nu tltc Xew York Statute the diseases ordinary life which are only incidental speculatively related to the occupation, lust a word ah,ut hernia as an oceupanal disease. X'ever heretofore regarded an occupational disease, hut unite gendly recognized under certain eirciminecs as an accidental injury--the Occuional Disease Law of Michigan, m ailed l year, specifically included hernia in schedule of diseases. X'ot all hemiae. sever, are so included, hut uulv those rlv.jo recent origin, as to which dis- involved in occupational disease legislation is the treatment of liabilities for dust dis eases of the lungs. In no class of cases is the marked difference between accidents arising at a given time and place and occu pational diseases more pronounced. In this category of cases, we find silicosis, anlhrncnsilicosi.-, and ashc.stosi.s, all of them forms of pncunionocnuiosi. 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 knowledge of these diseases Jias been gath ered in the past Mi years, and intensive t < i i'iij c studies of their etiology ami patlioh are still going forward. One act stands out clearly, and tl is, that these di-vases do not progress the point of disability until after ma years of exposure to dust. The length lime, varying from five to twenty-five more years, is dependent in large mcasi upon the concentration of dust, the co position of tlic du-t, the time actually t posed during winking hours, and the i dividual susceptibility or ijesislance of t worker. Another fact licit stands out that the fibrosis of the lungs, once : quiied, is permanent and incurable, at in uncomplicated eases is not susceptible medical liealmentr Many1-"thousands of wankers today, ttml no law hut the common law, have he employed in employments exposing them more or less heavy concentrations of ill for many years. In the event of the ettat meiiirof an occupational disease law i eluding those diseases, industry will fu itself, at the stroke of a pen, liable fi conditions already acquired through lot years ot employment, and which may b conic disabling at any moment. In this si uation, the best `guaranty against disnbl ment is continuous and steady employmet Many a man, actually able to work ai earn good wages, while he has a job, wi he able to demonstrate by x-ray anil clii ical examination the presence of a marks degree of silicosis, when his job sii>| because of depression or otherwise. Hence arises the question of the so-callc "accrued liabilities/' This term which hr come into common use is perhaps not a exact term, in that "liability" does nr. occur until disablement, and the liabilit is only "accrued" at that time. What w have in mind when we discuss accrue liabilities is the condition of fibrosis o the lungs which has accrued and has bee acquired over a period of years. Till condition, being permanent, remains wit the worker, whatever and wherever may b his employment. Perhaps a more exar expression would he "potential liabilities, and yet they are more than potential; th condition giving rise to them is actuall; existent. Industry tells us quite truly that it can not now pay full compensation out of cur rent income to all of the men employed ii rv in. . ' m j . ' i y L d u - j i t'.V. j>;itioti.-il disease laws, it not only is not a liardship Imt is. in fact, a great boon. The principle of limited and graduated liability of the employer for dust diseases has been recognized by enactments in Xew York, Michigan, Pennsylvania and Ohio. An unusual provision has been adopted it the state of Washington, providing under their schedule form of law that the cost of compensation lor occupational diseases 'hall be divided equally between the em ployer and his workers, and deductions diall he made from the employees' wages as contributions toward the insurance premiums involved. I'm what, you may say, has all this to do with the safely engineer? It has much. The safety engineer can no longer regard liimscl f as doing his job if lie seeks only ways and means to eliminate the industrial accident. The in dustrial hygienist must become the colleague >f the industrial engineer. Medical science must give intensive thought ami study to determining the effects upon the human system of various industrial processes, and exposure to various materials therein. All exposures cannot he eliminated and still bale imluslrj perform its functions. Most important, therefore, is the medical deter mination of what are safe limits in ex posures--the so-called "threshold limits." The engineer cries aloud today for expert medical guidance on this subject. Armed with such medical opinion and advice, the :ask of the engineer lh.cn is to devise pract ical ways and means for attaining condi:imis where such threshold limits apply. Every industry presents a problem or erics of problems in itself. No two inhistrics are exactly alike. What is tolerdile in one may be intolerable in another. A'hat is good practice in one industry nay be totally inapplicable for practical easons in another. The task of the cnliiiccr then is to find how right principles nay he made applicable. Industry today, ?inorc than at any time n its history, mtist bear the burden of esponsibility for tiic health as well as for he safety of the industrial worker, and if -is health and his safety are adequately afeguarded his happiness and the happiness if those about him will be increased. Thercorc, it is of prime importance in the field if-safety that intensive and increasing in terest must be given to industrial health. The care for the health of the worker must not be confined to the 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 compensation. There can be no doubt that the enumeration in the law of specific conditions for which liability is absolute will he of great ad vantage to the industrial engineer in seek ing to enforce proper health standards. It is far easier for him to obtain approval of his recommendations, if he can point out to management that the use of benzol or sonic benzol derivative is specifically men tioned, and point to the specific paragraph in the law that cites the liability of the employer for that condition. No argument is needed to convince management of its obligation in such a case. The same is true with regard to all of the metallic poisonings and all of the other \yide range of chemical exposures. Psycho logically there is great power in the printed yword, and even the most backward manage ment may be made to respond when the clear mandate is set forth in the law. Nrot so easy will it he, under a general, vague, and all-inclusive occupational disease statute, to convince management that it has specific duties with regard to the elimination of health hazards. Thus, we see there is an other and potent argument for the schedule law, rather than the all-inclusive law. There is perhaps yet another and even more compelling reason for applying the rule of sanity and common justice to leg islative mandate in the complex field of occupational disease. Shall employment he limited to those who are physically per fect? All humans are not examples of physical perfection, nor can we by legisla tive fiat reverse the laws of nature which immutably decree that wc shall grow older with the passing years. We have seen and discussed the dangers inherent in the all-inclusive theory of stretching the law to cover every sort and condition of disease, and to try to make them employment-related. When that stretching is complete, when administrators of the law find it easy and possible to burden industry with the responsibility of health insurance under the guise of an occupational disease statute what of tho.-e who, wanting employment or seeking to tain it, arc not physically perfect yet laiuly arc not disabled? Much is heard today of the dread fo year-line for employment. Whatever facts may he as to that, is it not possib if not probable--that industry, in desp lion and against its desire, will be foi eventually to accept only those am whom the health hazards arc least 1111 tain--the physically perfect, the young the strong? \Vc way well pause to 1 / Handicaps in the Diag By CA REi i'% D< It is a popular medical belief that <>eci tional diseases arc far more difficult to ognize and precisely to class as such nnv'iothcr type of disease state. So fn is this idea rooted in the minds of s physicians that they argue that occ tional diseases never should he made c pensable because of extraordinary <J no.-tic dilliculties. l.atcly, I\clterin(5 has said, "The doc tell us there are certain diseases that incurable. Do you know what an incur disease is? It is one that the doctors 1 know anything about. The disease ha: objection to being cured at all." This may he paraphrased by say There are no ltfuliagnosable ocenpati diseases. The only ones that appear ink nosahlc are the ones the physicians I not learned how to diagnose. No occ tional disease has ever offered any r tauee of its own to being diagnosed, disease is perfectly willing to be diagiu At least one-half of all occupations seases are almost self-diagnosing, par larly when arising in groups; the remai half present no greater difficulties attend the diagnosis of some other ci: of diseases. To maintain that occupat: diseases are beyond the diagnostic ski the physician is pure defeatism. With c propriety, it might he suggested tha neurology he abandoned because the jority of conditions arising in this may not he diagnosed with ease. While it may he said that there ar iJ/ / \ i .*# i y%'a,v Definition and Terminology Much confusion is caused by lack of miformiiy and clarity in definition Scarcely uy two slates in their statutes accept the ..line tliTniitioii of an occii|iatioiial disease, a a few states, hernia is by law specified - an occupational disease. However, in the' Majority of states it is, when related to inlustre as a cause, classed as a traumatic ujury. In a few states, the definition of if occupational disease provided by statute such that certain items later appearin'; on .liednles themselves do not conform to definition furnished. Well meaning legislators might enact a uv declaring that two and two make seven, ut the mathematical facts still might reiain iither wNc. So with legislation in-, 'living occupational disease diagnosis, there 'ay he demands for legal acceptance of Main conditions as occupational diseases, lien elementary medical facts point ether ise. One group of physicians may reserve 10 term "injury" for exclusive use in cone>tiou with trauma, while another with ropricty may assert that occupational disr ,'s of many natures represent "injury" the same extent implied by the term r mmntism." l.ct ns consider, for example, the oceurnre of an accidental injury or the one nid and a clear-cut occurrence of an ocipatinnnl disease on the other, both caused .mi one ami the same substance. Imt under licrent circumstances. It might come .nit in a given factory that a workman ..red a tank car, lately emptied of ben- and in the absence of suitable protcc"c and precautionary nicasnres might, thin ten minutes, become asphyxiated as result of breathing benzol vapors. Mnn- 'tly, such an occurrence as this would accepted as an accidental injury and no mpensation hoard would ever raise a es.ion that such was not the case. 011 the other hand, this same benzol, cci. from this tank car, might he utilized this same factory in some productive .ration, giving rise'to benzol vapors. Day day, another workman might inhale some these vapors. In due course, this work insure might produce the usual and raoteristic features of that occupational .-asc known as benzol poisoning. Here in it is most unlikely that any physician compensation hoard would entertain any uncertainty (hat this condition represents a characteristic occupational disease. P.etwecn these extremes, there is some point at which difficulties would arise in distinguishing occupational diseases from accidental injuries. This same situation ap plies to many other substances and many other occupational diseases. There is per haps no warrant for any attempt at a hard and fast demarcation in terms of time, in dicating where an accidental injury expo sure leaves olT and an occupational disease exposure begins. However, there may be some justification for the practice of many' physicians, who hold that if the exposure leading to damage is less than one work period, the ensuing injury should he recognized as an accident. Conversely, if the exposure period extends for more than one work period, then the resulting damage may with propriety' be ac cepted as an occupational disease. In gen eral, it may he 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. Fallacious Medical Histories .<e .As a result of careful training, every physician is disposed to attach significance to the history statements given by a pa tient or members of his family with re gard to any disease. The less a physician may know about the possible ctiologic facts in any situation, the more consideration he is likely to gicc to history statements. It is human nature to associate all of our ills with some particular happening or series of happenings. A cold may he associated with a particular period of sitting in a draft. A gastrointestinal upset is prone to he associated with some particular alco holic bout or food engorgement. in the case of industrial workers, there is an especial proneness to associate any bodily ailment with sonic aspect of work. Inasmuch as almost every workman hopes, openly or secretly, that any and all dis eases from which lie may suffer may he laid at the door of his employer, lie is most likely to stress and emphasize the high probability' that this condition unfailingly was produced by the chemicals, gases, va pors, dusts, etc. that at lend his work oper 'll Uii ations. This does not necessarily sent dishonesty or cupidity on the p: the patient and only may involve tho: tnati frailties shared by all of us. No less, flu: history statement ma duly iiilliivncc the physician in his rio-is, may lead to misdiagnosing, may the way tor unwarranted claims or law without any evil intent on the part o physician. It is most unfortunate tlia physician is all too often unable to npi the worth of/Wurk history statements vided by a patient. Let us, for the mo: assume that a specialist in car diseas visited by a patient on account of deal In connection with the history, the p cian .may .record- that this patient is a forge;-'Operator. The physician may ahead and make many careful examinat looking for the cause o the deafness, l infection, from syphilis, from heredity, If, however, he had obtained a com work history, and was in position to e\ ate this work history, he might conic at to know that this drop forge operate perhaps exposed to as much noise and cussion as ever arises in ordinary im tr ia / work and that the deafness pre clearly is an occupational disease, resul from sustained noise exposure. It may be asserted that well meat physicians, without any evil intent, thro their misunderstanding of patients' desc I lions of work operations have become I sponsible for a high percentage of large number of unwarranted suits t have flooded the country in recent ye: In short, one of* the handicaps to the pro diagnosis of occupational diseases is to found in the attaching of undue significai to the patient's statements as to work ci dilions, when the physician himself is t able to appraise their reliability and me Some physicians need to make themscb more remote to tbe fallacy that just becat a workman is employed in a daugerc trade, inevitably any ailment must neci sarity be the result of work exposu There still may be a few persons who m believe that lead poisoning may arise fre work in making lead pencils. Time as a Handicap in Diagnosis Too often the physician well qualified the field of occupational diseases, does it. sec the patient or claimant whose comlitic r\ SiU'cr Jubinc ."yajciy Gonyrcss itcs toward an inferior physician, less conrmil wiili the lack of qualification1;. The :Icjit to which lack of qualifications in ocipatiunal disease work may go is reflected the fact that recently a duly licensed fiv-ician in the State of Michigan reported, i.n-slinal peristalsis" as a diagnosis of an ccupational tliscasc. While the unwillingness of a physician to vept responsibility for pathologic slates nil which he is not conversant is coinendahle, there still remains a duty to di et hi> patient into channels wherein adeuate services may he procured. Industrial Terminology One of tlie most annoying handicaps in -.tablisliing the exact etiology of a possible ccupntional disease resides in the wideiread practice of industry in using code . itdiols in the designation of its substances, ii inquiry, the patient may state to his ysieian that his work consists of filling mtainers with "11-72." But, inquires the uysician, "What is 11-72?" The patient utilities. "B-72 is a mixture of M-20 with '-40 and I.-07." Completely the physician left in the dark, hut if the truth were :own it might he shown that this patient as engaged in the filling of cans with a irnisli remover, which consists of a mixire of wood alcohol, benzol and a syn d ic wax. Snell situations may heroine so coiifusg that it may he almost impossible for c physician to obtain proper information to work exposures. Medical, safety, so ul service or insurance departments all ay have difficulty iu oblainiug full inrntatinn as to actual chemicals and mixres of chemicals designated in production *vations only by code numbers. The Absence of Records The majority of industrial plants fail maintain sufficient medical and work cords to serve the physician properly in mieetiou with occupational disease work. a given instance an afflicted workman ty give as his .occupation some innocus job as "elevator operator." He may rcmber that the job before that was as "truck driver." There his memory may 1. His work record may show no items ta transfer within the factory of his t employment and no record of any pretis employments. Although the x-ray of the chest of this workman may strongly suggest the possibility of silicosis, nowhere on the work record may it be 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 be em phasized that one of the many handicaps to the physician in making an accurate diagnosis is to be found in the widespread practice of hospitals, of clinics, insurance records, etc., in merely naming the trade of a workman rather than describing his exact occupation. It is quite insufficient for med ical purposes for a record merely to show, lor example, that the patient was employed as an "automobile worker." I'nder tliis heading, there are perhaps not less than 200 different and dissimilar types of em ployment leading to different exposures: such for example as to silica in the foundry, cyanide in the heat treating room, chromium in the plating department, lead in body fin ishing, and on and on. Lack of Library Facilities . ! With some temerity the statement is made that regardless of many hook publi cations in the field of industrial hygiene and occupational diseases, special maga zines, and articles appearing in general medical magazine publications, there is, at this time, no condensed, informative ma terial on occupational diseases well suited to file needs of till; laniily practitioner. ft is of course impossible ami undesirable that any attempt should be made to reduce all of the lore of occupational diseases to sonic thin book to which the practitioner may refer and with certainty obtain ail the guidance needed in the treatment and man agement of occupational diseases. Granting all this, there still is occasion to assert that a real need now exists for a book publica tion on occupational diseases designed for services to the neighborhood physician who in the aggregate sees far more occupational disease cases than the small number of specialists in this field. Attitude Tow ard Industrial Medicine In times long ago, when mine workings, sawmills, and-railroad construction camps were established in remote sections of the country, far removed from the usual sources of medical services, it became necessary that the management bring into these iso- m . 'Vu' latcd work places a physician who m carry out all manner of medical serv These physicians set the broken arm: injured miners; delivered the babies of miners' wives; treated the miners' chili for measles and mumps and otherwise tempted to meet the medical needs of tl detached communities. Usually the c panics contributed to the income of tl physicians and every family and e\ single man was taxed a stipulated sum c month tn-s-order to cover the phvsici: salary. Thus arose the term "Conti Physician." This perhaps did not alw represent the best of medicine and not all instances were these contract phvsici of the highest type. Later...some of these communities lieca larger` towns, or cities, and other pin cians sought to gain a livelihood, only find that the contract physician was in saddle. This gave rise to complaint ; out of this "Pandora's box" have come numerable evils that even to this day tend the highest type of industrial medi supervision under the most ethical a commendable circumstances. It lias 1 conic a tradition on the part of many the medical profession to blame almost a manner of their eormoinic dfficullies up industrial physicians. So real is this d affection that some organized medit groups have sought to legislate against : most any form of industrial medical pra lice and in some instances to deny mei bership in medical societies to industri physirans. As a result, industrial pliy: cians in some respects have been branch with a scarlet letter. This queer situation, strange to sa may serve as a handicap in the diagnos of occupational diseases, since some of tl best physicians, and particularly the moi timid ones, fear lest they may become bi smirched hv cooperating in this type c medical endeavor and to some extent shu any close affiliation that might lead to liftc eyebrows by those regarded as the leader of the profession. Now that the American Medical Asso ciation is somewhat alert to this situatioi and has organized a Council on Industria Health, including some members with in dnstrial medical experience, it is to In hoped that after all the industrial pliysi cian may become respectable. 224 .Si/cv/- Jubilee S a f e l y Congress. spurious claims predicated upon improper medical advices. The usual trial of an oc cupational disease case is a travesty. The liumhaslic statements of some physicians, unattended hy any iota of fact, bring into disrepute the entire medical profession and take away its lime honored traditions of integrity and skill. A furl lier significance in the misdiagnosis of occupational diseases on the part of pliisicians is to he found in uinvarrantci hardships imposed upon employers. Re ecnily a physician made a diagnosis o silicosis in two workmen in a given depart ment. As a result, widespread npprenhen sious arose among the remaining workers strikes were threatened, talk developed a-, to demands for high wages because of un usual exposures and the expectancy or a short work life. The employer was com pelled to spend some SS5.000 in the installa tion of an elaborate dust control system. badly needed under postgraduate auspices. (b) In every industrial community, at least in every industrial state, there should be available for cooperation with the general medical profession a number of much experienced and highly skilled occu pational disease consultants, who, through limiting tlieir^profcssional activities to this one aspect of medicine, may become highly proficient in the solution of occupational disease enigmas. (c) In every state and in some of the larger industrial cities, there should he maintained public institutions devoted to industrial hygiene and occupational dis eases whose technical services may he avail able to the physician in charge of patients who may be suffering from occupational diseases, and these public bureaus should serve as fact finding bodies, equally inter ested in the worker and his employer. As a matter of fact, these two workmen did not suffer 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 expensive installation made and cunlrariwise other departments did present practical exposures for 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 effort to obtain precise work histories, both present and past, and may seek to gain an adequate understanding'as to the work en vironment, its materials, machinery and possible exposures. might have been spent to better advantage (e) Controversies should be eliminated in procurement of needed protection. in the largest possible measure from occu The Road to Betterm ent pational disease work. Many abler physi cians eschew all connections with this type This entire discussion would be without of medical practice because of the sad exany value it present day practices and sit pencncc that nearly every case may be so uations only were condemned. More ac involved in controversy, litigation, disaf curate diagnoses as to occupational diseases arc badly needed. These better diagnoses fection, until the good physician may feel that he may be degraded. will coinc in proportion to the extent tiiat the changes now listed arc brought to ac tuality. (f) A need exists for greater disclosure to physicians of the chemical nature of work materials to the harmful nature of (a) The general level of knowledge of which employees may be subjected. In occupational diseases on the part of the dustry may have excellent reasons for hid medical profession should be increased ing the nature of some of its chemical ma through the introduction into medical col terials under code terms, but more often lege training of a practical amount of in these code terms are designed only for struction on industrial hygiene and occu convenience and not for secret formulae pational diseases furnished by men who purposes. A greater degree of cooperation have had first band experience in this field on the part of the manufacturer will even and arc not wholly dependent upon textbook tuate in die belter health protection of his 'ore. However, it is emphasized that in workers through the more intelligent min undergraduate medical training this form istrations of the patient's physician. Gjf instruction necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is (g) Lastly, it may be pointed out that belter diagnoses of occupational diseases will come when the general medical pro or | ; j j ] j ! > i | : m G fession, through its organizatio alter its attitude toward industri cine, shall recognize this type of just the antithesis of the undesi peels of state medicine, and may realize that industry, under the of aide medical directors, is the mi source of numerous cases to he Necessity for ' In the In By MLLTC Cljief, Envision of Industrial You are all aware of the value dent statistics. You know that will quency and severity rates there v no solution of the safety problem would he groping in the dark. U they are available, we know when live measures are needed and this us an opportunity to correctly jt value of one method of prevent! another. Today, the %rip of statistical is closing down upon industri-, 1 public health and safety. Vital ` however imperfect, are one of tl means now available for measuring longevity and the progress of services in the battle against diseas So well recognized is this futu principle that the effectiveness ol or stale health department is judg large measure, by the accuracy ai pletcness of its morbidity and r reports and records. The same principle obviously sho true for the groups of workers e in a factory, mine, quarry, public i: department store. These records are of value not : to indicate what has been done, : this is important enough in dcnioi to management the value of certa and, therefore, the advisability of uitig it, as they are to chart future Insufficient data have thus far pi the recognition of some health p peculiar to wage-earners ami there i evidence to indicate that morbid mortality rates are higher for some n, Silver Jubilee Safety Congress ()'<uptititu t D eath R ates by Occupation .1// C u tt ie s T u b en u lo sis o f the Lunas i Cuiiivr <ind Tumori I'nitVi.'ioiial mm 670 5 26.2 .18.8 70. J Skilled worker 8221.9 72.1 59.7 85.4 Semiskilled w >tk*r 10(19..1 102.1 71.6 90.8 Unskilled worker 14 17 7 184.9 1.15.9 106 6 I R a t o i-.-r tuil.Oiiil .cue.iicil m airi, based on l '. S. Census d a ta in ir:: sclen t'd States. .:ov:> lo be higher than the average for dents, the ^quality of his work is of a c entire industrial population. This was lower grade, team work is disrupted, fac i i arly ileimmstrated in a piieiiinonia study tory processes are dislocated, undue burdens moil!; >itel workers which was conducted are placed on other workers and the worker v the U. S. Public Health Service. himself become:- dissatisfied. It he is oc Drury, some years as, was able to show cupied with weighty matters of policy and high rate o.i tuberculosis among workers production then someone in that organiza :i the ax-grinding industry, and the Harre, tion must assume the leadership and ac .'ermont, study revealed a high tubercu- quaint him with the problem by understand -is rale among granite workers. Xo doubt, able and intelligent facts and figures. titer occupational undertakings would re- There are progressive industrial organ i eal data for prevention, control and cdu- izations who may ami have spent large ation were it possible to have adequate sums of money for the improvement of latistical records as revealed in the slide working conditions and for the care of i-t shown yoh. workers who become ill, hut without cur ' ir. Selby of twiic-ral Motors, in calling rent plant information ahum the human 'leullim to bis statistics shows that about factor much of this money amt effort has u6paotifouaaldaiynjupreier sanannudmthiast loinstcludduees looccouc-- hbaepens cspoennctenotrnate"gdenueproanl pthrienceiplilmesin"aotironpeorf- ' i -alioiial diseases as well, whereas, eight, only one or two publicized health hazards, iue or ten days per year is the tolal and only from the standpoint of existing st time from all illnesses. In Dr. Xcw- compensation laws, as for example, sili uist's report for the American College of cosis. Hut the extent of the health problem 'urgeons, the figures are about the same, in a plant necessarily may nut end here. his slums us that our industrial illness With the progress of industry especially i rohlem is approximately fifteen times the on the chemical side, new health problems ize if our accident problem. will arise resulting in physiological and It, is evident that industry could well pathological upsets. The effect on health fiord lo concentrate on illnes>es among will, therefore, have to be measured and uasgcaes-cesa,rnebresc,auostehetrhetyhanarethetheoccounpeastiothnaatl efovraluoanteed.to Wjuedgemutshte heaffviecacdyatoaf imn eothroddesr I niisc the greatest amount of absenteeism employed to combat disease, so wc must nd are the biggest drain on industry. first know where health is being menaced, In the recent Xatioual Conference on the relationship of occupation to these dis lealth Conservation, it was estimated that eases ami the causative factors responsible. ne nation's bill for illness ami premature The records you keep will lie a guide to ac eet-!a.thds olalmarosunatnsnutoallya,pparnodximthaatetlyontenevIenrly tioTnhaesrewfoerlle,asIa sraeyc,ordproovf eactyioonu.r value to i verage day about four million persons in industry since many a skilled industrial e 'United States are incapacitated by 11- medical department has been limited in its C'i. Xo doubt many industrial workers budget and activities because it overlooked re in that last figure. the necessity and value of absenteeism re The industrialist of today should recog- ports and records which could bare Iren :/c that a sick worln r is pi one to acci used to enlighten manage::.cut i egardii ._. its 0 health problems. Perhaps in soi the industrial establishment may fii ficult lo undertake a complete recoi of absenteeism. T do urge you. tl make a start somewhere. It nee< too elaborate. 1 have heard it said that the I to delect illnesses which are cau: absenteeism from work is by perioi ieal examinations. I am not fully i with this type of prevention. It helpful where the illness lasts Ion a week or ten days, but somethin! be done about the frequent one, three day absences, aiid I fear that physical examinations will not h mendoitsly. This, of course, does n that industrial medical services shou don or minimize that phase of heal iee. The industrial hygiene divisions i health Departments and that of the State Public Health Service are urj employment and use of a uniform t recording and reporting alisenteeisn worker due to sickness. Forms am ods have been developed after a s some twenty years by the Public Service and also as a result of tin Xatioual Health Inventory of chro case affyeting workers. The aforemc health agencies will gladly assist ; operate with industries desirous of Sam e or r / . v A- .Vi ;> o i. OiTrt/MliOM .llif S ex Coii / J - ._ . -- -- 1 __________ -- .... 22S Silver Jubilee Safely Congress of the symptoms experienced liy the patient should he recorded. Tlic point is tliat 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 by "pain in tbe stomach" than to get ten different guesses of the disease or ail ment causing the pain. Another item of importance on the record is "by whom diagnosed," and sliould show whether the diagnosis was made by the family phys ician, plant physician, nurse or the patient himself. Under "termination" of ease; 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 if the''items listed in the slide just shown you arc 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 by departments or occupation. 3. The mortality rate. 4. The case fatality rate, expressed as the percentage of eases 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 which shows that the strength of any wheel is dependent on each and every spoke and each is dependent upon the other, otherwise vour structure is unbalanced or collapses. IDJOU RS MUST S 'e a rn Ik s ilr o a d TUESDAY AFTERNOON SESSION October 11, 1938 The first meeting of delegates to the Steam Railroad Sessions was called to order by Mr. \\\ W. Wood, Superintendent of Safety and Welfare, Baltimore & Ohio Railroad Company, Baltimore, Maryland, who presided. Chairman Wood hrielly out lined the significance t>f the programs of the two sessions planned, and then intro duced the first speaker. *9 "HiddeiTCauses" By FRED W. SARGENT President, Chicago and North Western Railway Company, Chicago We have seen the evolutionary growth steadily, the whole conception of safety of accident prevention work from its in work has progressed and evolved until to ception, as applied to the American rail day it has become a nationwide activity, roads. /Many of .ns here knew Mr. Ralph drawing to its cause the best minds and the C. Riifhards intimately, and discussed his finest characters in our social structure. hopes and ambitious with him frequently. And with this greater interest in the work I -I Though lie met from time to time with dis it has been hut natural that the whole couraging results, yct^lic never surrendered. scope, theory and conception of the under He laid the foundation for safely,,work that taking'should gradually enlarge to embrace is vastly enlarged and is rapidly ripening the wider field of accident prevention, to into collateral lines that arc of benefit not which 1 am about to refer. only to employees and managements hut to , the entire economic and social structure of the country. In recent years many, of the railroads have enlarged their conception ol this work and have come to the realization that safely In the beginning, and even until rather work involves not only safe tools, safe way 1 recent times, the greatest emphasis was laid upon working rules ami physical conditions of plant and facilities; in other words, a and structures, and safe surroundings, hut involves likewise, and with equal impor tance, the very physical and mental condi safe place t<5*work. There was every rea tion and attitude of the employee or officer son in the world why the greatest emphasis himself. With this thought in mind we shnuld he placed upon these factors, and, have changed the title of the head of our indeed, we are not yet so far along that surgical organization from that of "Chief we can alToril to lessen our efforts with Surgeon" to that of "Medical Director," f motion to these matters. because if men are to avoid accidents we In the beginning, the idea of a surgical * department was to care for men and women ? after they were injured. Gradually this j conception has been enlarging and changing 7 into a broader field and greater service, if s; a greater service is possible. This depart'V ment no longer has as its sole objective the healing of wounds and the saving of know that they must not only he sureiiumled with safe working rules and safe working conditions, hut they themselves must he physically and mentally fit; and that the so-called human element, always and ever present, must constantly he reck oned with if we are to achieve the ultimate beneficial results so earnestly desired. human lives after injuries. Gradually, And so it is that in all this work, whether I m v'eu- (oil railroad right in be permitted when feas- removed. J ing should lie given of rains by sounding the in accordance with tlie law ! regulations. of these requirement- will l'Clves stop crossing acci only an aid to a general v Responsibility s are involved in 90 per lug accidents. Since there. . automobiles ami 232,902 "tide, the opportunity tor : is apparent. The public, .1 definite responsibility in a and enforcement of such result in : section of motor vehicles i- cars will be barred from ilation of tiie licensing of those mentally and phys>i and those with a record ng will not he permitted to i the highways not only als at grade crossings lint msclves that the way is opting to cross the tracks. early show that the rail.is their opportunity per'V'tual progress in rcducIts. I low ever, they have 'tie motorists and they are reach in an efferiive man. it is necessary that the the cooperation of state iliic officers in policing the Tossings in connection with tics on the streets and plan of this nature--he als and the public--would i effective means of chcck.md reckless d r iv i n g over The railroads as a rule iax payers in (lie cities and aInch they operate and are --Iteration. lies in education and law 'cation is merely a method Steam Railroad 743 of informing the public as to tiic number of accidents, their causes and how they may lie avoided. With 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 oi the hidividual and that such rules to be effective must be enforced. It is imperative that a similar procedure be followed if we are to curb the recklessness inherent in certain motor drivers. Ninety-five per cent of the motor drivers of this country arc competent and careful. It is to them that w-c appeal to aid us in the enforcement of such rules and regula tions as arc 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 one of the proudest chapters of American industrial achievement, naturally falls into two main divisions. Safe conditions must be created, in the first place, hut there must he also created a sale stale oi mind. No dmiht the pioneers of the safety mnvemcntijChcounterctl industrial managers willing enough to insjall safe equipment, hut skeptical as to the need or the value of the education ami exhortation needed to instill safe ways of thinking. Every man knows that to get hurl will cost him time and money and suffering, these skeptics might have said, so what's the use of going to a lot of trouble to tell him so? He'll take care of himself! Fortunately, the safety pioneers realized that safety was a natter of the mir.ds of men just a< much as a matter of machines, ami that the safes: equipment and the safest rules did not. in and of themselves, make a safe 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 reparation oi simple principles. 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 derstanding and cooperation without which their movement must have failed of its full measure of success. How well they and their successors did the job is told in the statistics of declining accident rates, of lives and limbs saved. I11 these latter years, American industry is faced with the need for another sort of understanding and cooperation on the part not only of those employed but of the whole public which our industry serves. In the short space of little more than a century, onr American scheme of enterprise has settled and civilized a continent. It has made possible a standard of material plenty and well-being unknown before in the his tory of the world, and unknown elsewhere in the world luday. We are told that one- third of the people of the nation are ill-fe-l. ill-housed and iii-ciad, hut it -iyuld h- borne in mind that when this American way of enterprise becan to runctk:: a century and a half ago. practically the- pop ulation was ill-fed. -housed ni.d ill-clad, according to our modern standard-. Mis takes have been made-, perfection i- a long way off, but there is in the record of achievement much solid ground for pride. Today, as never before, lire hc<t opera tion. the safe functioning, th c \e iy exist ence of the vast and varied organization of onr economy of free enterprise, depend upon public understanding and appreciation of what it is, what it docs, how it works, what it means to all of us. The safety movement is built upon safe < ;l H ,.:t T,' I 1 ; ) : I I .1 > 14 , I .\vm \-jtf:n Xiim-iuil Siij i1/ y i. o iiy n s s liy an undtilj- high incidence of tubercu losis. O ther dusts and silicate compounds so tar studied produce, at most, only a mild non-progressive reaction in the 1units, provided there is no significant amount of free silica in their compo-itimi. While not serious clinically, such conditions may Rive rise to considerable litigation. Adequate statistics on morbidity and mortality from occupational disease, to serve as a basis for effectively focussing the efforts to study and control dust dis eases of the lungs, are non-existent. In concluding this section, the follow ing quotation from a court decision in Wisconsin is pertinent (Schaefer v. In dustrial Commission, 265 N. W. 390 (Supreme Court, February, 1936)): . . It -will be necessary to distin guish carefully between medical or patho logical disability and actual physical in capacity to work. The medical experts apparently ignore this distinction, and so increase the difficulty of arriving at a just result under the law." Preventive Engineering It would be needless repetition to dis cuss in a technical way the engineeringphases of dust control. All interested are referred to "Industrial Dust," by Drinker ami Hatch, which deals comprehensively with the subject; U. S. Bureau of Mines Information Circulars 68-10 and 684S, by Harrington and Davenport, a review of literature on "Prevention of Dust Dis eases-'; If. S. Public Health Service Bul letin 217, by Bloomfield and DallaVallc, on "The Determination and Control of Industrial D ust"; Keport Z9 of the Amer ican Standards Association: and to the L*. S. Bureau of M ina for a list of ap proved protective devices. It may be said that, in general, the engineering specialist can and will devise the necessary equipment to meet the con ditions specified to him. But the setting of limits of permissible dust concentra tion is not his but the physician's respon sibility. The engineer is concerned with keeping dustiness to or below the limits at present considered satisfactory. Methods of Determining Dust Some dusts (as lead) are determined by chemical methods and the ronccntra- tions in air arc recorded gravimetrically as milligrams per cubic meter. Others las silica, where sire is a factor in de termining dangerous particles), are given by count. Neither method gives the whole story, but in both cases it may be possible to secure the informal inn neces sary for the purpose. In one of the reports referred to earlier, there occurs this statement: `'There is no doubt in the mind of anyone familiar with the present dust-sampling and dustestimating methods that they will be amended and changed from time to time. At the present writing we would advise the use of the simplest possible procedures where dust control alone is in question. If one wishes to obtain values which can he compared with published data, it is generally necessary to copy with consid erable care the technic used in the origi nal case. This is another way of admit ting the annoying fact that results by one method are usually not comparable to those obtained by another method." In another place, the report says: "It is very doubtful if .any useful purpose is served by determining accurately ex tremely dense dust concentrations--the only excuse for such data is to show the skeptic that the workplace is much dustier than it should be. . . . " It is probable that any sampling pro cedure which fixes concentrations in groups 100 tier cent apart is sufficient and that the results of any attempts to come closer to the concentration at the moment of sampling are simply misleading. Tims ranges such as 0-5, 5-10. 10-20, 20-40, etc., suflice for dust control." As dust particles in the lungs are of the order of 1 micron, with rarely a particle over 10 microns, dust control for hygienic reasons should he aimed at parti cles in the size range found to have been breathed and retained. Again quoting: ". . . if oiic could avoid use of the dusts of I micron or less or exclude them from the dust which passes a 325-mesh screen, nearly all dust diseases would be elimi nated." Dust Elimination Obviously, it is better, when possible, to purchase equipment already supplied with exhaust liood, rather than to have to won y to fit one to equipment not de signed to be hooded. Thus the responsi- 'w ' i I J liility for potential efficiency is upc manufacturer. There is available comparatively information upon which to base the tific design of bonds. The T'rev Engineering Committee of Air II} Foundation includes in its recent i a table of minimum air velocities tr ture certain industrial dusts (for i granite cutting, grain elevators, spraying, sand pulverizing and cl welding). For protective equipment such a respirators, air supplied masks, sand helmets, and goggles, very comple formation is available, because of the of the U. S. Bureau of Mines, tin renu of Standards, and the Ann Standards Association in preparing issifmpF specifications to he met i equipment is to be used under cond where approval is necessary. Of course, all agree that, where hie, dust should he controlled a scfiirce, and protective equipment where this action cannot be accompl Permissible Dustiness There arc various figures that hav< and are being used as guides to per hie dustiness where free silica is pr It should be noted that many of tin were not determined as the medic Huirement, hut as being attaiual: good practice and apparently satisf; from a safety standpoint. In South Africa the figure is 1 gram per cubic meter (or 300 pai per cubic centimeter, or approximate million per cubic foot). Dr. Lanza found in 1917 in the J Mo., district that, with good engim practice, a figure of 1 milligram pc liters of air could be attained.-* The U. S. Public Health Service, study in the anthracite region of Pei vania, found that 50 million partich cubic foot with 5 per cent quartz i coarse dust and 10 million particle cubic foot with 35 per cent quartz apparently satisfactory and often attained. The figure of 10-20 million partich cubic foot for granite dust with 3 cent quartz content is often quoted the Vermont granite studies of the Public Health Service.