Document wg6xrZYJ4qmMdyEKMoK575D2E

FILE NAME: Keene (KNE) DATE: 1935 Apr DOC#: KNE065 DOCUMENT DESCRIPTION: Published Article from The Bulletin - Silicosis THE VOL. XIX BULLETIN APRIL, 1935 No. 12 SILIC O SIS By O liver G. Browne S A ssistant G eneral Claim s A ttorney, N ew Y ork C entral Lines T here are reams o f literature, all more or less technical in term s, as well as diffi cult to absorb, on the general subject of silicosis. I will attem p t to set fo rth in sim ple language the nature of the disease a n d _the serious p ro b lem s now c o n fro n t ing industry in relation thereto. . Silicosis is said to be a h b ro y c co n d i tion of the lungs caused by the continued inhalation of the dust of silica. I t may or m ay n ot cause disability. W hen in the disabling state it is o f a perm anent n a tu re an d th e re is p ro b ab ly n o know n cure or treatm ent other than to arrest the prog ress of the diseases incidental to it. W hen n o t disabling, the d an g er is in th e contin uance of exposure, for by such does the disabling stage arrive. T h e fau lt of ex p o su re is th a t th e d u s t in h a le d g ra d u a lly lessens the lung capacity, m aking the sub jest less able to resist an d throw off tu b er culosis germ s and low ering the resistance to other diseases. Silicosis seems u n p ro gressive w hen exposure ceases. I t is u n like th e know n diseases which, given a start, progress to a crisis unless respond ing to treatm ent. It, however, progresses under exposure and- although exposure ceases, the dam age done becomes perm a nent although not necessarily disabling. I t is d o u b tfu l if th e re h av e been an y cases o f disability due solely to silicosis. T hose charged as disability are w here the fibrotic condition h ad developed to the stage of active tuberculosis or to th a t of another disabling disease coupled with so-called silicosis. T h e best authorities indicate th at of those who die as a result of sili cosis, approxim ately 75% o f them are ac tively tubercular. W h ile ^ p n e u 'm bconio sis 'jis th e g en e ral^ nam e given to-respiratory affections where the predisposing fa c to r iff;dust inhalation'll silicosis is th e n am e g iven w h ere th e d u st, in haled over a sufficient period o f tim e, contains silicon dioxide in sufficient con centration, said to be ten m illion particles per cubic foot of air, to affect the health o f th e w orker. T h e d an g er is in the fine d u st. I t is asserted th a t p articles g reater th an ten m icrons in diam eter can pass th ro u g h the finer bronchiales and are prac- Silicosis is usu ally d escrib ed as fallin g into one o f two stages, th e first w here defi nite physical signs of dam age to the lungs is fo u n d w ithout im p airm en t o f th e cap a city fo r work, and the second w here the specific signs of lung dam age are show n accom panied by incapacity for work. T his latter stage may be classified as light or se rious and tem porary or perm anent. H ere ag ain th e re is th e question w h eth er te m porary m eans other than incapacity to re m ain in any dusty occupation, although perm anent m ust m ean incapacity from any work. A tem porary stage relates neces sarily to ability to work, fo r the lung af fection, how ever slight, is gen erally re garded as perm anent. T here are therefore countless num bers of exposed and slightly affected persons in dusty occupations who a re not, an d probably never will be, su f ferers from the exposure. Y et they are po tential hazards and with the uncertainty o f diagnosis their total disability or death from any cause m ay be attributed with som e plausibility to the silicotic exposure an d this will lead to serious results fo r em ployers. D iag n o sis a n d p ro g n o sis o f silicosis is yet in an uncertain state. M icroscopical 281 J n b B U LLET IN ______________ ( A P R I L ^ m . an j x' ray exam inations may be m ade but seldom do they reveal with sufficient clar ity so th at we can get a unanim ity o f opin ion. T h e sym ptom s of the ordinary cough, where there has been an exposure to the d u st hazard, are such as to create a sus picion o f silicotic affection or progress. G iven such a basis, it is unlikely th a t the faTrest of m edical testim ony, with experi - en^ e> can g 've assu ran ce o f se g re g atio n o f causes. W here com plicated with a ten dency to tuberculosis the experts are in a turm oil, especially when trying to deter m ine if it be silicosis bringing on tuber culosis or a pre-existing tuberculosis d e . veloping or progressing because of silico sis. I n d eath cases w hen an autopsy is h a d usually the fibrotic changes produced by silicosis are fairly indicated? I t is th e lack o f definiteness of diagnostic findings in the disability or claim ed disability cases that makes industry the easy prey of unscrupu lous claim ants. determ ine-*-silicosishazardut-isineee^ a ry to s tu d y th e m dustriafprocess,w ith a p p ro p ria te d u s t, c o u n ts to -1d eterm in e ..th e_ , a m o u n t a n d .-ch ara cte r ofc th e d u s t b re a th e d ,tQAhavc .a* .ch eck in p i-o n -.ih f fuiy^^dbihty^oisJthe.w orkersjiw Silicon dioxide is com m only fo u n d in our food, air and w a*e r b u t unless in in ju rio u s q u a n tity it is n o t a hazard. T h e industrial process . may produce organic dusts which may tend . to injure workers by causing tem porary af f. fac tio n s b u t it rem a in s fo r th e in o rg an ic 'I dusts to cause perm anent effect. T h ere are so m any processes creating silica dust th at m any industries, now resting smugly in the assurance th at no h azard exists, may be rudely awakened to their problem sh o u ld reg u lato ry an d com pensatory laws be established. A ny process having a sm all q uantity of silicon dioxide dust may be ex posed to this unless such laws carefully ' prescribe the m ethod of determ ining, not o n ly th a t th ere is th e in ju rio u s exposure but also th at it caused the result on which th e com plaint is based. N o r can one be assured th a t because silicon dioxide is n o t u sed o r p ro d u ce d in th e process h e is im m u n e fro m th e h a z a rd . T h e rea l te st is w h eth er th e w orker is exposed to it fro m any cause, even where the dust from an o u tsid e agency m ay p o llu te th e air" b r e a th ed. Prevention or avoidability of the h a r d is in su ch a sta te o f u n c e r ta in ty \* f` present as to be of doubtful value I provem ent in devices to prevent or re d u ^ th e ex p o su re in this respect is in p ro g r s ? Em ploym ent W p erio d ic workers exposed m " th e K a ^ n u f ? ^ i W suit. The rem oval nof^thosea^tt^D tB r to disease into o th er and m o n -hazardour em ploym ents seems clearly in d ic ated ^ R . ulatory laws providing dusU uprevrnr. 8 m ethods have th e ir efficiency- h a s b e e n qu estio n ed * T o com pensate suffering workmen for silicosis claim s un d er th e existing W ork m e n s C om pensation Law seems im practi cal w ithout putting a trem endous burden on industry. U n d er the existing system every injury and death, where there w exposure to dust containing silicon dioxide w ould be com pensated unless the m ethod o t determ ination be carefully prescribed I t would seem th at any law should define the dust count form ula, although opinion differs on this also, the disease itself, and p o ssib ly th e in d u strie s co v e red b y it. Tf these are not prescribed vague testim onv fo u n d e d o n supposition a n d opinion, will be found to support aw ards m every case of tuberculosis, pneum onia, bronchitis asthm a and other common respiratory d is' eases w here th e re is a scintilla o f testim ony th a t silicon dioxide prevails in even m inute quantities in the process or in the em ploy m ent. It would be, for all practical pu r poses, a blan k et h ea lth com pensation law T h e experience ,n states other than New Y ork is n o t a happy one. T h e follow ing quotation from the Bulletin of the A sso cia tio n o f C a su alty C S u re ty E x ecu tiv es is portentous: "T h e Em ployers' M utual Liability In surance Com pany o f W isconsin, which . w rites a b o u t 50% o f th e w o rk m en 's co m pensation insurance in th a t state has re cendy com pleted an analysis o f its losses in W isconsin on policies issued in 1937 an d expiring in 1933. In th a t policy year the ratio of occupational disease losses to to ta l p rem iu m s was 10 7 % __to to tal losses was 13.5% . T h was the average for all classifications, includ ing m any in which no occupational dis ease losses occurred. In those classifica tions in w hich occupational disease losses occurred the occupational disease loss A PRIL, 1935 avoidability o f th c haz T f ? f , " ncerta`nty at of doubtful value T Aces to prevent or reduce H.s re sp e c t is p r o g ress periodic exam inations of to th e hazard m ust re val o f those susceptib], ather and non-hazardous ns clearly indicated Re oviding dust prevention -r som e tim e existed but ias been questioned. : suffering workmen for nder th e existing Workion Law seems impracting a trem endous burden ' j " ihc f xisting astern d e a th , w here th e re was :ontaining silicon dioxide sated unless the method be carefully prescribed at any law should define >rmula, alth o u g h opinion o, the disease itself, and stries covered by it. If scribed vague testimony, o sitio n a n d o p in io n , will o rt aw ards in every case pneum onia, bronchitis, com m on respiratory dis is a scintilla o f testimony e prevails in even minute rocess o r in the employ- fo r all practical purle a lth co m p en sa tio n law. in states other than New >py o n e . T h e follow ing e Bulletin o f the Asso ' & S u re ty E xecutives is :rs* M u tu al L iability Injy o f W isconsin, which o f th e w o rk m en 's com nce in th a t state, has re an analysis o f its losses p olicies issued in 1932 ^933. In th a t policy of occupational disease em ium s was 10.2 % -- to s 13.5% . T h a t was dl classifications, includch no occupational dis ed. In those classifica` upational disease losses cup atio n al disease loss APRIL, 193?] THE BULLETIN 283 ratio was, o f co u rse , m u c h h ig h e r. *!SS!i? cosis was th e"^as?^^fd y TM o cctip atio rtl disease. J t .acc6uhted% f6 r j9 l0 % " o f %Ke 1 occupational iiisiljieStdiss^ In iron . foundries 47% o f th e to tal losses, from : both accidents and occupational dis eases, w ere due to silicosis alone; in steel foundries the percentage was 88.7; and : in m alleable iron foundries, 89.1." i In" O ntario the experience has resulted in a recent change lim iting th e application of the law, alth o u g h inform ation obtain able is som ew hat vague. F ro m N ew S o u th W ales, where there has been m ore experi ence, we get the follow ing, again quoting ] the analysis o f' th annual report con tained in the Bulletin of the Association of Casualty Si S urety Executivfs: "T h e figures in this rep o rt indicate 1 th at the pure loss ratio under this schem e o f com pensation for silicosis, fro m 1927 to 1932, a v e ra g e d o v er 6 7c ' of wages. In the year ending Ju n e 30, 1933, which was a period o f extrem e d e pression, th e ratio to payrolls of losses paid seems to have m ounted to about i 17.8% . I t is im plied in th e R eport th a t | the industries affected cannot stand any i increase in their contributions and that i in c re a se d su b v e n tio n s fro m th e S tate are < necessary to finance the scheme. In this i connection it should be noted that the ! scale o f benefits u n d e r th is schem e is not abnorm al, the m axim um total pay- I ments for incapacity, for illustration, be ing lim ited to 750." T h ro u g h o u t ^the ,,in d u stria lstate s , there i is t o J je fo u ijd _a, few co m m u n ities 'severely i suffering fro n if'a m ultiplicity f ju ifs'^ a l law ^directed ag ain st in d u stries T o T T ailu re to guard against th e -d u st h azardT} M ost of these suits are alleging a silicosis. M any of them have been defended suc cessfully, and while m any settlem ents have been m ade on a basis o f prudence, there have been few actual recoveries. Such a suit is, how ever, very costly to d efen d . D uring the present period of unem ploy m ent such suits are to be expected, given the slightest basis of fact. N o compensa[ tion law w ould cure this evil as to suits already brought. It would and must oper ate as to future em ploym ent except that probably past exposure, when coupled'w ith future exposure, would figure in the cum u lative processs of acquiring the affection. W h e th e r o r n o t silicosis m ay be entirely prevented in future industrial operations is d o u b tfu l. I t can an d m ust be red u ced a n d w ith a genuine effort to this en d the" d an g er o f suits will be m inim ized and, in a n y ev e n t, w ith p r o o f o f th e e m p lo y e r's effort available, defense should be com paratively easy. I f not reduced, and a w o rk m a n 's co m p e n sa tio n sch em e be in je c t ed into th e relationship, then th e costs of insurance coverage m ust substantially in crease. O f the suits now pending against in d u stries it is fa ir to state th a t alth o u g h a com plete defense is available in a m a jo r ity o f th e m , u n d e r o u r w o rk m e n 's co m pensation scheme, substantially all would have been the subject of an award and the costs trem endous. In N ew Y ork the plan of scheduling oc cupational diseases, when recognized as such, based on the English system, has long been established and these have been com pensated as accidents. T he m ain d if ficulty in opening the same door to a res p irato ry disease is, as h as been p o in ted out, one of diagnosis. T o open th at door lets in m ost of the ordinary diseases of life and those bro u g h t on by the vices an d incorrect habits of living of m ankind, to gether with the infirm ities of age. In d o ing so th e com pensation law becom es m ore than ever a scheme for relief as distin guished from a purpose to displace the old liability system with som ething m ore equi table, the original conception of a w ork m e n 's co m p en sa tio n law. In view of the uncertainties of diagnosis o f the disease, if it be such, the difficulty of establishing th at a h azard exists, or does n o t exist, and the greatly increased cost of u n restrain ed com pensation coverage, it should be left to the industry itself to d e cide if such a coverage is necessary o r d e sirable. I f a com pulsory com pensation law is h a d it m eans th a t ex tra costs a n d care m ust be borne by m any industries not now suffering from the so-called lawsuit "rac k et" . W h ere th e coverage is elective, th e ind u stry can survey its operations, and if it decides it has the hazard it m ay, if it chooses, protect itself from suits by elect ing to be covered as to the disease hazard by com pensation, and also it could take such preventive measures th at are indicat ed. T h e pro b lem is n o t sim ple a n d is in no such state of certainty th at the decision  t i f f ' s c< 284 THE BULLETIN [A P R IL , 1933 - "J m ay be easy to make. U n til experience, both from the standpoint of prevention of th e dust hazard and know ledge of the dis ease, progresses to the point of clearer in dication it w ould be the p a rt of wisdom to at this tim e "m ake haste slowly". _ I f silicosis is to be loosely ad d e d to the lis f'o f .diseases now scheduled in com pen sation laws, it w ould be, as pointed out, disastrous from the standpoint o f cost. I t w ould be far better, if we m ust have com pulsory coverage, to provide a separate act lim iting the diseases to those that can 'clearly be show n'to have been caused by th e risks of the occupation, em bodying in such a law the d eterm in atio n of both the disease and the hazard by a com petent non-political m edical body. S uch a law m ust fit in with the m any oth er problem s b ro u g h t about by the slow accum ulation of such diseases, such as the period allowed fo r accum ulation, the em ployer to be charged with th e loss, the paym ents to be m ade w hen the disability is only occupa tional, and the deg ree of disability when th e disease is considered in connection with other disabling or partially disabling diseases. U nless these and other protec tive features are incorporated we m ay look fo r a fu rth er extension of industry's as . sum ption of the burdens of relief. W hile the above was w ritten with spe " cial reference to the situation prevailing in N ew Y ork State, other states have al m ost the same problem . N o satisfactory : m ethod of p utting occupational diseases u n d er com pensation laws seems possible w ithout perm itting all determ inations to be its being contracted in the occupation fro so m e th in g o c c u rrin g by re a so n o f th e n!T tu re o f th e occupation. T h is opens th d o o r w ide to all m anner o f diseases. Co * m unicable diseases, such as sm allpox, scar le t fe v e r, sp in a l m en in g itis, etc., m ay be ac quired by contacts with other workers the occupation. Colds, bronchitis, pnej1 m o n ia , m ay be a c q u ire d by o rd in ary ex p o su res, o r a t least a ttrib u te d to those ex p o su re s in su ch a m a n n e r th a t th e re is no possible way to com bat it, while the pcr so n a ffec ted is in th e o ccu p atio n . AH the, are w ithin the sim ple definition for ocru p atio n al disease now being laid down h\ th e courts, th a t it m ust be the usual an ordinary incident of th e occupation. T h e u su a l a tte m p t is to d e h n e occupa tio n a l disease. T h e le g al effect o f it is open the door to cover alm ost anything th a t occurs in the em ploym ent. This doc. n o t serve as an effective lim itation on the coverage. I t w ould seem th a t any attempt at an all-inclusive coverage sh o u ld limit th e h a z a rd in w hich th e disease m av be in c u rred by m aking it com pensable onlv w hen d u e to risks, o th e r th an those of otdinarv life, specially created by the nature o f th e o ccu p atio n . T he-so^iledaE nghsl, system ,, lo n g ,esta b lish ed in N e w - Y o r k ^ b t o n ly en u u x era t^ ^ h if^ iisca ses ,but~also -d*'. scribes th e process jin w hich th e hazard e \ ^ ists andjis^|iot.jw ide.,,open.^Sihcosis-and-J other d u st diseases m ay be described but the hazard or^ em ploym ent in .which thrV disease can be acq u ired an d fo r which it is to be com pensated sh o u ld be carefulIv p rescrib ed .in . an y com pensation law. 3 : m ade by a board o f scientific men which should be, in m y opinion, 100% m edical. A ny studies needed by other professional aid could easily be procured. N o present adm inistrative body seems fully equipped W H A T A B O U T T H E "BORDER-LINE" CASES? and as about 90% o f the questions are es sentially medical it takes a m edically train ed m ind to thoroughly u nderstand them. A wide open coverage of occupational By R. O . C arter Claim A gent, M issouri-Kansas-Texas R. R. Co. diseases is n o t to be th o u g h t o f fro m th e s ta n d p o in t o f in d u stry . I t is tru e th a t in a few states by interpretation and under th e L o n g sh o re m e n 's a n d H a r b o r W o rk e rs' C om pensation A ct th e re is this coverage. T h ey are ju st beginning to learn w hat it means. T h e sim ple m eaning of the term "occu p atio n al disease" is a disease th a t oc curs during the occupation in the sense of Is n o t o u r fa ilu re to settle m o re o f thcsicases the real cause for many of the "f.irfetch ed decisions a b o u t w hich we com plain? R un th ro u g h your R eporter, select ai ran d o m som e cases in w hich decisions a d verse to the railro ad were m ade by the courts of last resort, then try to deter m ine why th e C laim D ep a rtm en t failed to . -T*' k.