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FILE NAME BF Goodrich BFG DATE 1954 Oct DOC BFG058 DOCUMENT DESCRIPTION Proceedings of IAIABC Conference Workmen's Compensation Problems Pg 263 - Goodrich Rep - Charles F. Nutter PROCEEDINGS Annual Convention of the International Association of Industrial Accident Boards and Commissions Quebec Canada October 3-7 1954 BULLETIN 180 UNITED STATES DEPARTMENT OF LABOR James P. Mitchell Secretary BUREAU OF LABOR STANDARDS Paul E. Curake Director SMIN M Foreword THIS BULLETIN No. 180 contains the proceedings of the 40th annual convention of the International Association of Industrial Accident Boards and Com- missions which was held in Quebec Canada October 3-7 1954 Proceedings of the convention have been prepared for publication by the staff of the Bureau of Labor Standards 195 128 1854 MEETING OF LALANC Occupational Cancer Hazards Institute U. S. Public Health Service Washington D. C. A. Scape Occupational cancer hazards have plagued mankind for thousands of years Undun exposure to agents of our natural environment such as solar radiation or infections with the worm Schistosoma hamRtobium have doubtlessly been responsible for the occurrence of cancers of the exposed skin among outdoor workers and of cancer of the bladder among farmers of the Nile valley even during prehistoric times However it was not until the advent of modern industrialisu some 150 years ago that occupational and industry agents have attained a preeminent position in the human cancur problem Not only are occupational carcinogane the only well defined known causes of human cancers but their number and variety have steadily increased since Pett in 1775 first related the occurrence of scrotal cancer among chimney sweeps to their exposure to soot Our real knowledge and appreciation of occupational cancer pro- ducing agents as phenomens of modern industrialism dates back some FLOORE 1 OCTOBER MORNING SESSION 127 75 years with the discovery of the relation between the occurrence of skin cancer and an occupational exposure to coal tar fig ) The data given in the following tables 1 and 1a briefly summarize the salient additions to the information on occupational cancer hazards made since that time They list the various chemical and physical agents so far recognized or strongly suspected as causes of cancer in man They show moreover the different organs and tissues representing the target organs of these agents and the number of occupational cancer cases placed on record or known to have been recognized as caused by them TABLK .-- Occupational Cancers Recorded in the United States and Foreign Countries up to 1068 Agest y Rites of cancer Number Number of of canta canr tar cades | cases In USA fbx Errupa | Tobal Arsenic Coal tar eee eee eee nee ce ee Skin pitch 000 cee ee eh eee do .... vee 7 110 Petroleum. cn. n ueewee rene ra en Shale oils ee eee eee ee eee ee ih coe ne Lignite tar and paraffin 0 eee 701 7 eae eel Creosote oil eee eee ee ene eat Eitan ae ae Anthracene . pee Gove ee en nenen : carbon blac ee ee ek e eed 01 a ae ae 1 Aromatic amines ---- ern arnt ecenser Bladker 350-100 , 88. 140 29 1,900 5 1q 40 20 | 190 1,200 2 32 3,260 3,260 99 1,907 1,907 14 41 20 191 1,600 1,600 Roentgen- and radiatio.n. Lenkemis wt 3) i 13 i Arsenic . ee. e ee ene eee Lang oo. oan 18 Asbestos Asbestos ea 3 Oe Of + 83 , Chr0o 2 m ee eea ee t eee e s .do in 65 i Nickel Nickel nn *** \ enrererereernenenenen Nasal 3 cay- Aa Yi } Coal tar pit 0.coh e eee ened Petroleum Benzol . . nee eee 2.2.2w 2 ea . ve oe ee a ee en eee eee Lang ee. we 30 .... anne laukemia ..! Lung Isopropyl ... w ene ne nena e ness Larynx oS ( Nasal sinus Radioactive chemicals 2.0.00. Bones___ sinus anna, Total ..-- | 3 0 ^' 11 4; 6 3 } $ | i 53 38 3 $i 3 Oo; 0 FY 0 1350 | 1350 7,650 5 Approximate 29 28 85 140 * 59 40 13 i 4 8 ; 6 400 128 1954 MEWTING OF LALABC TABLE Time Table of Discoveries of Occupational Convers AAAAAAAAAAA Se M oe cree Name of agant : fate | . TReowvares + Oats stfected Zaff exposur nen WANA Chemimis 3 ; 1 Boot ..... ... ... ... Dignite ane! Coal tar Dignite . Coal tas bituminous vad Colfer Colfer eathracite Coal tar faces Creciate all Anthracene all af Puen shais ol .! Petroleum still coke i Petroleum parafin Petroleum lubricsting of 5 Sha olubricating of Bentat..... rere ve dre | Aromatic aminos Intermediates Isopropri ofl .. j 1778 1578 BSE 1914 Volkmann povecns Polt ........ enenns 1) 1 eter Butlin cevnconeveeens Skin neutra 4... Occupational MBM see we ee eee DX ceastOenarcscarvene Do. Fb Zweig MS oe eee? Do BE 1920 1908 288 1830 3015 1938 1810 1828 1898 1852 Kampket~ TEES erarsee ae ynees Do. ' moov .... .. .... ee .... .... g QUver reece emcee siss vaca v | ... ... caer eersescend D9 Do. No. and | , Dervilla Quer- ol.) Do MOUNTER ; ; | asra enceeehs sk oo, : Da | ... Heller BB ee ... | | ...- ... 3 Beaecatht cee ce nae | | Before & Bosgomana Sademer tiaga 23 Ba 1 | | Izhm aevnevevenewave, Bladder ureter kid Tio BrF : | Well Smyth & Nale ; Nasal sinuses larynx { Do. . ^ sog Chamicals Areni cavnneonssorenee! > ) BEL 1883 YOR Ashrstus ot . 4 < Chromateeese cee, H Nickel nemme sar | : 1953 1035 1992 Physical agents Vinaviolet radiation 1893 Roeusmonta^ la 3802 eS 1 3081 : > Radioactive substances MAG 3829 39% > 1920 , 1935 FPA eres ciee eee Skin ... arene f 13o 7 Fatskken . Medicinet 7 Saupe . nee oven? Lung * Occupation & Smith oe eee Lynch i PRO eee cere .AG rece wo$ f al- Brenki .. Nozal cavity and Do. Da Do. muses lung linna neenee F Friedem pease ee | FR neB cae ene i ee GP nat eaee ene i Bo 4 i Environmentn og Occupations W SS OO; ' Medicinal Von Jagle Schwart&s! frming tis Occupatilomst : von Sisteuroes + Bous | 8pe | e e r sane Tassik ee . Kser& tBienwg | Mayes Word and~flFUXXU1 , TEKS ~fl Medicinal pokonaad Do. Le wee. | Martland of forming tissues wel Bons veceeemsceend ! Ul Dn | 150 ere Malet However an indiscriminate accaptance of these figures as reflecting the actual scope of the occupational cancer hazards would seriously be misleading for the following reasons The presence of occupational cancer hazards has so far boen established for only a few worker groups having contact with one or several of the carcinogenie agonta listel While for instance it is generally known that workers employed in gas works and coal tar distilleries or engaged in the cleaning of petroleum stills and having skin and respiratory contact with coal and petroleum pitch and tar show an excessive liability to cancer of the skin and apparently also of the lung there does not exist any official record of similar cancerous complications among electroda workers in aluminum production plants where an exposure to fumes OCTOBER MORNING SESSION 129 e+ from the electrodes consisting of a mixture of coal tar pitch and petroleum coke exists Reliable information however is on hand R that these workers suffer from cancers of the skin and possibly also the respiratory tract The extent of this exposure hazard may be estimated by the fact that approximately thirds of a pound of electrode carbon is consumed for each pound of metallic aluminum produced of which 800,000 short tons were consumed in the United States in 1945 It is equally significant that agents which have been reported to have caused occupational cancers among workers of an industry of one country do not seem to have the same effect upon the workers of an identical industry of another country if the available data would be accepted at their face value Since carcinogeus bohave in their fundamental producing properties like pathogenic microorganisms there is no sound reason to assume that carcinogens niako any distinctions in their activity or effectiveness for any national reasons In fact it can be shown that such scientifically incomprehensible discrepancies are mainly due to local differences of report- ing of occupational cancer cases The existence of an excessive lisbility of gas house retort and coke oven workers to cancer of the lung has been reported from Japan Canada and England but not from any other country despite the fact that the exposure conditions for workers employed in such operations are identical The occurrence of an appreciable number of mrsenic cancers of the skin among German users of arsonical in- secticides was placed on record during recent years If full credence would be given to reports on arsenic cancers observed in the United States one would be led to believe that arsenirals in our part of the world are carcinogenic for almost exclusively medicinal reasons Again it is hard to assume that arsenicals would make such distinctions A similar situation seems to exist concerning the carcinogenicity of lubricating oils obtained from petroleum in different parts of the world Although there were placed on record by English investigators during recent years several hundred cases of skin caneers due to occupational contact with habricating oils practically nothing is officially known as to the existence of such industrial diseases from the countries on this side of the Atlantic One seems to be content with attributing here the English observations to the carcinogenic action of ahale oils the large industrial use of which was discontinued during the 1920's and therefore cannot account for the more recent English cancer cases observed among spinners mechanics engineers and other workers having had exclusive conLaet with lubricating and cooling oils of petroleum derivation 130 1954 MERTING OP IALABO It is worth noting in this connection that during the last 20 years there has been an almost complete lack of published additions to the list of occupational coal tar pitch and creosote oil cancers of the skin from the United States although such cancers have been observed and are recorded as such in industrial records and despite the fact that the annual reports of the Chief Inspector of Factories of England and Wales have regularly listel notifications of such lesions to the extent of from 100 to 250 casos per your One may also reflect on the fact that the last published figures on occupational cancers in American dye workers appeared in 1939 and listed loss than 100 cases all occurring among employees of one company During the intervening 15 years the total number of such cases has risen several fold and no official data have become available from any of the other companies producing and handling carcinogenic aromatic amines used in the production of dyes and rubber anti- oxidants In contrast recent reports by English investigators sup- ported by the English chemical industries have supplied adequate figures on the number incidence rates and attack risks of bladder cancer among English dye and rubber workers who had been exposed to the same carcinogenic aromatic amines with which the correspond- ing worker groups in this country have occupational contact Finally some consideration must be given to the fact that the general population has varying degrees of contact with some of the carcinogenic agents through their presence in industrial wastes released into the environmental air and bodies of water and entering subsequently the soil and the fauna and flora living such polluted environment and used in part for nutritional purposes In the past claims as to the occurrence of called neighborhood cases of cancer have rarely been made The well established former occurrence of arsonic cancers among inhabitants of a German region in which the drinking water supply was polluted with arsenic from mine slag beaps represents the first occurrence of this typo Following the discovery of bladder cancer hazards among Cornut dye workers it was assorted that an environmental plant contamina- tion with carcinogenic aromatic amines was responsible for the production of bladder cancers among persons living in the vicinity of this plant While the actual existence of such conditions was denied at that time by other investigators the recent demonstration of neighborhood cases of berylliosis makes such claims appear as not unreasonable possibilities since a highly potent carcinogen such as naphthylamine is involved which might have produreil sich results if the waste disposal and housekeeping methods of the plant were inadequate It is probable that the future occurrence of cancers of the lung and bone among individuals who lived near beryllium- oo prood r u proc cei ssin ngg additfuri niso h an ddia tiol nal evidenes of OCTOBER MORNING SESSION 131 cancer hazards related to environmental plant pollution if beryllium and its compounds are not only carcinogenic for rats and rabbits but also for man Similar conditions of industrial atmospheric pollution exist around arsenic smaliers chromate producing plants carbon black factories and oil refineries as well as uranium ore mills The recent compensation claims advanced on the basis of an alleged existence between cigarette smoking and lung cancer also point to the possibility of a greater future importance of the compensation aspects connected with the occurrence of cancars from industry sources such as exposure to carcinogens contained in the exhaust fumes from diesel and gasoline engines or present as additives and contaminants in foodstuffs It appears from these considerations that there can be no doubt that the actual number of occupational cancers is considerably higher than the number of cases placed on record It is of some interest moreover that the number of cases recorded in medical journals is appreciably higher than the number of occupational cancers which during the last 20 years have come for decision before compensation boards because compensation claims in many such cases have been settled out of court With a few exceptions such as the incidence of lung cancer anong American chromate manufacturers and among German~- am~-l Czechoslovakian radioactive ore miners of nasal sinus larynx and lung tumors anong American isopropyl alcohol manufacturers and of skin cancer among English coal tar manufacturers and proressers no reliable information is available on the incidence rate of occupational caneers of the various types among different occupational population groups groups B. Special Aspects of Occupational Cancers A fair and competent adjudication of compensation claims for cancers allegedly caused by occupational agents or conditions requires an adequate knowledge of the special aspects related to the production and development of these tumors and of the criteria by which they may be distinguished from occupational environmental merficinal dietary cosmetic habitual as well as spontaneous cancers 1. Definition of the Term Occupational Cancer The term occupational cancer is applied to malignant tumors originating in individuals during the course and as the result of the regular and usually prolonged exercise of certain occupational activities entailing contact with some exogenous physical chemical or parasitic agent acting in proper intensity Occupational cancers thus are caused by spccific agents or etiologically related to well defined occupational conditions which form an integral part of the ordinary working environment They differ through these aspects from the accidental occupational cancers which result from or follow upon some extraer- 132 1954 MEETING OF LAIABC dinary unforeseen accidental injury sustained at work and being of nonspecific nature 2. Types and Nature of Occupational Carcinogens Occupational agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals Some of these chemicals are well defined others consist of variable mixtures of a large number of chemical compounds a few of which possess carcinogenic properties A second group of occupational carcinogens is composed of agents characterized by their ionizing or nonionizing radiation A third group is repre sented by environmental agents and conditions which sometimes have an occupational association and which may be related to certain infections or several specific climatic geologic dietary and nutri- tional conditions and which in part have more or less indirect relations to carcinogenesis table 2 TABLE Occupational Carcinogena Route of Exposure and Their Target Organs General type i Spwide typo . Raste of expoNUO Parpet Organ Chamfeal carcinogens " t . Organic chemi Beagle. cee cones aromatic | palycysilo but Cutaneous , : tory : respirs forming orgaAS > Houkem ~-s~-yhowar + coma myelomsi Erotyelle ; naphthylamine bencf | Respiratory stane- Urogenous orgata blad dine aminediphenylaura + ous alimentary | st ureter keiner an Wagenta tal~- -| dine ! : ' Coal tar pitch soot asphalt Outerona ; 5 7 Skin tar si creosotez creosotez unthru | Respiranctcnoenranyes Lux sene oll lamp black lignis ; ne mid paroth 4 Systhetic coak pit and : j for | Octaneous . 3853 | Bergius Shule ull and puraf~ o^ : Petroleum fuel oil deset od : .. E Do. RespirRespiaratorty ooe rsmeyof Zaryas Zaryas Cutaneous 6. 6. Bkin lubricating oil and greas | Besys hinck cutting oil warten | asphalt tas coke muda t paraffin all : rutory Lang j t Aliphatic Largante aks 2.0) chumi | Isopropyl ol ee ae IR ae aes Armvol of n BRECAtEee,. 1 reg^>ster reg^>ster KAZANAIA Nickel ewer een ene een erate MG are cae Chromium . . ee ene entevsaw ten ves sareve f cae rat Westgmus Westgmus lens lens lung kin Lung ?cavi nemt i siy tus lung Lung Physics casetangens Innising radiation Asbestsa da ene Lung Do. } radius eei no reowu eof Castanums Skin 1 TrassentauxxIS TrassentauxxIS .. a, Connective tiagun bone t turning vryane Hedboactive alpha , | >> oe Skin aus blond + beta and radiatiro Tranumru Oe Connective . i beming organs H 1 Respire Respire vaav Kusal ons i + + tank i Pot saramogaus ) AARP RMR ene Weg eeee aeeeeeee Ing oT en hornatshea Prranesga v2. Bone Binider og OCTOBER & -MORNING SESSION 133 In addition to these established occupational carcinogens there are a number of potential human carcinogens which have been shown to alicit cancers in experimental animals and to which workers become exposed during their regular occupational activities These potential agents which also must be considered in the adjudication of compensation claims are listed in tables 3 and 4 Agcsi TABLE Potential Environmental Human Carcinagens Amper , Amper FAnhamsnenien 1 naere - Me rE Te HAIL Type | Alte of tumor 1 ptx | Types of humas wutable Estrogens Netistal 4 fi vasa 0. ... ^ ychelle $ Carbon Tetrackloride i i Broast peed Paychex 5 ... Iraph nodes futament 0.00 UteruUtesrus ..1 Wak dt Hypophaycs a si esrs enawe nen os Liver vv, OL. wt : Mouse 0.) } kat Wakit 7 uinea pig Mar } , t + Manuscture Dietary additive Cametis ingredient Industrial scirent Degreasing oghat chaning ngent extinguising agent Marnfacture Production of kreon : Orain fumigent i Extractive of Bits Chloroform ... ee caeeaes weet eae a cee. 2 Mowe 333t 3te e ' .. Panutotal 7 2) Asthetic j Solvent sat Extractive of oils resins rubber warks lodine alkaloids | Ingredient of lacquer door polish desning Auld } Perfuction of artificial al DDT hlo- ) to rsphanyl rsphanyl 1,1,1 tri * seve et Oral .. vweveas Bat plast sessed Manufacturo 2 Insecticide chloroethane : Tanssic acid oe car RE eve earn ng Furrebral : oo. do : + Food contamiani ee) ingredient of foodstuffs iteks wine selfs and tea } Medlemnal agent i ' Tanning agenr Thiourea and derive tives Pheastplure Du sin fk 3188 3188 Qa heed ee oe ... _et Lise areeese Lie 2. flfl tees eyes oO cue) , : 4 us fruit preservativo Medicinal spent Manufacture Sweetening agent Diethylue glysol Kubky RR at Antifrere Intermediate in exposi ; ; : _ viekututure . i i Softener sf lacquer inks Methylated apothecin tenex Bergius oo olls and tee. i H 4 apothecin apothecin ol. i SP fabu : 7 de 1M es eRe } i Subcutaneous ( 5 tissue : i i * Mous ., 5 Blousy Rat | i wond stains glur textile humectant bobacco Vehicle of insecticides Manufacture Fu el Lutrients Plastle production CHINXS se Sice Fisher Tropsch i onis eR, i * Petrochemical woai | Livre CHINXS Sicce ua} waxes | : Fumutryni oo . can een Manufacture Fuel Branses, i . Labeant i A : 1 Dexeerlneaeet 134 1954 MEETING OF IALABO IALABO wapaann TABLE Putential Environmental wens A Human Carcinogene 3 Agat ; Site wwNOT | Typof eex- He | of Types kainan contacts ! Light gresa F br^...- Subcutaneous : | that blow FCF fast 19.9130 Farontstal ** FOF : Nat ...., 4 Textile dyes Food and crematiz Ayca ; Butter yellow Liver 2 Calliphane poiyetby - Subovtanecas ana palyamide jaz- ' | len bakelite te^-on ; polymethyl metha^ rylate t Berryllum BOO... Oral we XRUK * Kat : ^ l ajedALL Osso lius dya * Flere color wenwytut wenwytut a ates cn do F um At^,rplastic industrial manufacture AN^ USES Wrapping materia : Medicinal agent Pazomeral ... 3873433 . Metal alloy Xxay tubo Hospicedary Kadnn ene phosphor manufacture , Refractory vessels . : 3 Atom energy production ; Belenium reese ee Laser kyrod Oral ak Mo ... Roll contaminant ve Cakring matter of glass ceramics paint fabfer Metal Metal Blloys Rubber accelerator Photosl^strirappemtus ; Deculariser Cobait ... ren Subcutsasova l'amnisai tine Fireproofing agent Madletual agent Mirt alalloys and plat ing Calceing matter of glas ceramies pain rubber Afedicinal upeat " - annaoane Anan eR ate TABLE -Carcinogenic Chemicals Pliminated as Environmental Carcinogens Human Sent 3 Site of gettY Type of as- Type SSppeceiecsies Intended use i Styryl 120 .. + : Amtglamiun Amtglamiun Andens > | 2 * { i Subcutaneana Elsie Psrenber tha roaes MANol Bubsutsaques Ocal ... weft a cose) tissue Parenteral X24 | Blad Parenteral d Pare enter ral ROceR see. ant Liv e ... ...r ... ...bivstrsasaeeceeest Ful SS Bratz ' Thyroki : Assoustic duct $ Mycast H Lolikemik Txyjaswida~ WIN25K agrot Kidney } Lung > $ Fo ee oe rere ete at at PPPPPPPPPP 3. Evaluation of Evidence For the establishment of causal rela- tions between an exposure to these agents and the subsequent development of a cancer of an occupational genesis and therefore compensable nature the following prerequisites must be fulfilled OCTOBER -MORNING -MORNING SESSION 135 a Definite evidence must be available indicating that the claimant had occupational contact with any one of the various agents listed that this contact was either of prolonged nature extending as a rule over periods of at least 6 months and was of adequate intensity for eliciting a cancerous response according to any previous experience which might be available on this point Single exposures may be considered to be effective if the casual agent consists of external ionizing radiation or the exposure mechanism favors the production of a carcinogenie depot in the tissues from which a prolonged exposure of the host organism may ensus 6 The route of exposure to or introduction of the carcinogenic agent in addition to its specific chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cancer is elicited Therefore not any cancer but only cancers of specific sites are related to any particular carcinogenic agent c The type of exposure does not need to be continuous or extend up to the time of appearance of the cancer but may be intermittent In fact any contact with the occupational carcinogenic agent may have ceased many months to years or occasionally even decades before the cancer becomes manifest Effective carcinogenic exposures may be sustained not only by the ordinary operators employed in operations with occupational carcinogenic hazards but also by workers entering such operations ou a transitory basis such as supervisors maintenance personnel repairmen truckers loaders yardmen und workers employed in rooms and buildings near the hazardous operations if housekeeping and exhaust disposal methods are inadequate and environmental contaminations result d Occupational Medical Stigmata.For the establishment of causal relations between occupational exposures to carcinogens and subsoquently appearing cancers it is of distinct value to analyze the medical history of the affected persons for functional or anatomic disease manifestations clinracteristic of a pathogenic action of the particular carcinogen allegedly involved Such noncancerous and often preparatory or precancerous symptoms of etiologic specificity act as stigmata or biologie finger prints supporting not only tha actuality of a previously sustained specific exposure but also its causal relationship to the cancer present Symptomatic manifestations possessing such a significance are for instance chronic radiodermatitis chronic tar dermatitis arsenic dermatosis chronic solar dermatitis chronic radiation periostitis asbestosis of the lung and leukamoid reactions after exposure to benzol and ionizing radiation Chemical analyses of tissues for the incriminated chemical also may sometimes be of assistance in establishing previous contact with any specific occupational carcinogens such as arsenic chromium nickel radioactive substances and benzol 136 1954 MEETING OF LAIABC It is important however to note that both these procedures are not applicable for all occupational cancers Some of the carcinogens do not produce any etiologically characteristic symptoms in fact they may not elicit any preliminary toxic or other disease phenomena despite a persistent and prolonged carcinogenic exposure Thus cancers of the bladder in dye and rubber workers may develop in the absence of any preliminary local or general warning symptons after more than one or two decades of continuous intermittent or discontinued exposure to certain carcinogenic aromatic amines There also does not exist any parallelism between the toxic and irritative properties of any chemical and its potential carcinogenic qualities nor is there a relationship between the degree of toxicity of any particular carcinogen and its relative carcinogenic potency e Extensive experience with occupational cancers indicates that there usually elapses a latent period of years if not decades between the onset of exposures to a carcinogenic agent and the appearance of the resulting cancer table 5 It is for this reason most unlikely that occupational caucers become manifest within the first year following the inception of contact with a carcinogenic agent In fact all cancers which make their appearance during the first three years of occupation in a carcinogenic environment should be subjected to severe scrutiny for a more probable nonoccupational origin before they may be considered from any occupational viewpoint TABLO Latent Periods of Occupational Cancers Arnica 1 Years Medicinal oo. nee ee ee en ee ee nee t Occupational ese en ne eee e ee we een i Ta eer e enna en pa neturacannacenes of Creosote all. eee ce ee ee eee eee i Mineral oil 22 aee eee eee c en eee nee cee ene | Crude paraffin oil- peewee eee eee wee eee en ween ; Solar radiacion ^^ ewe ae ne ne ewan awauavacauavnnnee : radiation oe. ene eee ce nee eee eee eee ; 18 wa | 20-21 20-21 26 50-51 50-51 | 15-18 20-30 ? Years 3--30 4-46 1-30 35-40 4175 3-35 15-81 1-12 Lung Asbestos ... eee ne nen cn ee ene e meron neuen Chromates 0. eo - eae nee een ene nnen cn ie omen Nickel carbonyl -- -- ner reat een en eee Tar furdes ae en ne eve ee eee neat eee! Ionizing radiation recnennarernenancnaere Bladder i Aromatic amines .___ ee ene eee ee .. 18 15 22 10 5 85-35 11-18 13-21 5-17 6-30 9-23 7-50 10 OCTOBER MORNING BESSION 187 f A successful production of cancers in experimental animals by the administration of any particular chemical or occupational agent supplies weighty support to a claim that such a factor may have an identical effect upon man especially if the route of exposure the physiochemical status of the agent during contact and the cancer produced in experimental animals are identical with the corresponding aspects in hunian experience However because of the pronounced species specificity of axogenous carcinogenic agents even positive experimental evidence provides merely strongly suggestive but not entirely conclusive evidence as to the existence of carcinogenic proper ties of such agents for man Only human experience gives a definite and irrefutable answer in such matters g Pathologic and histologic evidence is in general of only limited importance in the establishment of the occupational causation of cancers since neither the clinical behavior nor the gross appearance and histologie structure of cancers are etiology specific However in some occupational canerys histologically or histoelu demonstrable manifestations are present which give conclusive or suggestive evidence as to their particular etiology The presence of asbestos bodies and asbestosis in a lung affected by cancer provides practical and scientific proof as to the asbestotic origin of such a pulmonary carcinoma Of similar causal significaney would be the demonstration demonstration of chromite dust by histochemical methods and by incineration of sections of the hang of an individual with pulmonary carcinoma The histochemical demonstration of arsenic in the skin affected by a carcinoma represents another illustration of the value of histologic studies in the determination of the etiology of a cancer Likewise the presence of extensive endarteritie changes in a fibrosed subcutaneous tissue containing a carcinoma or sarcoma would arouse the suspicion that rays or radioactive energy was causally responsible for the malignant lesion It appears from these considerations that a competent and critical evaluation of the entire evidence related to the exposure of the individ- ual the symptomatic manifestations of the preparatory period the tength of the latent period the site of the cancer some histologic or histochemical characteristics and the existence of corresponding observations on cancer production in experimental animals aside from pertinent epidemiologic data represents the scientific basis essential for medicolegal decisions in litigations of alleged occupational caucers C. Compensation Laws Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types of occupational carcinogenic agents industrial operations with carcinogenic 330388-539330388-533 0398 -539 138 1964 MBOTING OF IAIABC hazards and occupational cancers covered As of October 1 1954 full coverage laws applying to all kinds of occupational diseases including cancers had been passed in 26 States of the United States and the District of Columbia schedule coverage laws not always covering occupational cancers or all types were ^finforce ^fin20 States and no occupational disease laws had been enacted at that time in 2 States Mississippi and Wyoming While workmen's compensation laws based on the principle of schedule coverage may provide some degree of compensation against disability and injuries resulting from occupational cancer hazards such legal provisions designed for the protection of workers are totally inadequate if not absolete in an era of a rapidly changing and increasing occupational disease panorama Such static laws reflect a legal and sociologic state of mind which is maladjusted to the dynamic state of modern industry However even the blanket or general coverage compensation law which is sufficiently flexible to include not only the present but also any future occupational cancer hazards usually has a statute of limit~ tions which is inadequate for providing fair protection under certain and not too unusual circumstances met with in occupational cancer Since occupational rancers may hecome manifest many years after cessation of exposure to occupational carcinogenic agents a statutory time clause of from 6 months to 6 years may be too short for occupa- tinnal cancers which may appear after a longer period It is advisable for this reason to adjust all axisting laws in such a way that such eventualities are properly covered In the workmen's compensation laws existing in most States certain groups of workers or employees such as especially farm labor and domestic servants are excluded from coverage by the law Since farming as well as housework have become and are increasingly becoming occupations having extensive contact with industrial products pesticides herbicidos synthetic fertilizers antisprouting agents hormonal fattening agents of livestock lubricants and fuel of farm machinery residual oils for smudge pots snil improvers antibiotics detergents waxes polishes dry cleaning agents there is no sound scientific reason for excluding members of such occupations from coverage by the workmen's compensation laws and from adequate protection against cancers arising from exposure to potential and actual occupational carcinogenic agents OCTOBER MORNING SESSION 139 D. Labor Codes and Standards Any attempt toward achieving an adequate compensation by financial means for a cancerous condition acquired through contact with occupational agents not only presents considerable economic dif ficulties but is also of questionable humane morit While such a procedure is evidently the best that can be done after an occupational cancer has become an accomplished fact the wiser more rational and in the long run more economical approach to a reasonable control of occupational cancer hazards lies obviously in their prevention wherever this is possible This goal can be achieved to a large degree by the enforcement of proper work conditions in operations in which cancer hazards exist so that either any contact of workers with such agents is eliminated or reduced to an ineffective level As to the fundamental step for accomplishing such a control of occupational cancer hazards it would be advisable to have all factories workshops laboratories and other establishments producing handling or using known or suspected carcinogenic materials to register with State public health and labor agencies This information would provide the basis for establishing the supervision of plants by health and labor agencies and would create the proper machinery for familiarizing managers of such operations with the potential carcinogenic properties of the substances and devices used in their establishments and with the methods and pro- cedures by which they might be controlled or avoided The relative effectiveness of any medical sanitary and technologic control measures to be adopted can best be determined by ascertaining the changes in the occupational cancer incidence among the total population at risk occurring during some 10 to 30 years atter their introduction It is therefore desirable that provisions be made for routinely recording all cancer cases occurring among worker groups exposed to occupational carcinogens All precancerous and cancerous lesions observed among members of such groups should for this reason be made notifiable with the State health agency All persons having knowledge of those cancers should be held responsible for such reporting The adoption of such measures represents an important step from a public health viewpoint because there is a growing urgency to determine the environmental causes responsible for significant changes in the incidence rates of several cancers A great deal of circumstantial and direct evidence incriminates recent changes in the industry environmental factors for the startling and progressive increase in the lung cancer frequency observed 140 1054 MEETING OF LATABC in all industrialized countries during the past 50 years graph ) A similar while not as marked rise in mortality rates has been observed during the last two decades for cancers of the blood forming tissues especially leukemias for which the crude mortality rate increased from 1.0 per 100,000 of the population in 1900 to 4.3 per 100,000 in 1944. This development coincides with a marked increased use of ionizing radiation as well as with a widespread industrial and medicinal employment of chemicals having distinct hematotoxic effects ENGLAND ENGLAND & WALES oe MALES 200 iy a / COMPARATIVE TRENDS IN , RESPIRATORY CANCER 8 MORTALITY 1924-1950 j WALES | / 3! veo jt i i Se A t f i the a you Hh Gow spits from you w 3 ve cs " og Fine at oa ye 4, ENGLANDENGLAND WALES TEMA 1924 28 32 36 40 GRAPH 1 4& 1952 OCTOBER MORNING SESSION 141 It also may be of significance that the specific total and ageadjusted mortality rates per 100,000 population for skin cancer in white males and white females in the United States have shown between 1930 and 1950 a marked shift in favor of the younger age groups teble 6 Whether such changes in the age distribution of skin cancers for both sexes may have resulted from the modern habit of sun bathing or a more intense environmental occupational and dietary contact of the general population with arsenicals or with products of the coal tar and petroleum industry remains at present a matter of speculation For determining the possible causal significance of such factors in this development it would be necessary to ascertain data on occupational dietary environmental and habitual contacts of the affected individuals their complexion and race and TABLE specifir Tatal and adjusted Mortality Koles Per 100.000 Population f^,rSkin Cancer in White Males and Whale Pemales United States 1930 1945 and 1960 White naukris + tweens 320 ; " , : Changes 1010 e g Under 15 cee ee eee ee ee - 15-84 ene ener eee, 3 0.00 12 25-31 . 27 35-44 45-34 eee view rinenee es - 2. , 0.08 11 .46 83 2. 5 0.03 -82 34 7-208 81 +76 1. 1-65 2 420 55-64 oe eee ee nee neon nw ewan, 0 ( 65-74 . enerene ce aenenen 2.7 75-84 . 88. and over- over- 104.2 All ages .. er neccenaencsmaenere: Age adjusted . 22. eee ee cee ee eee 3. 47 3. 9 16 | ; 2.3 | 172 | 3.2 8 | 5. 12.8 32. 5 11 20 -88 77.5 BR 2. ee 29 AAA WWAN White males Under 15 cee eeacueeeenenunenwnenee 15-24 . i 0.07 .06 0.07 13 23-24 eee eevee! 2 / Oe 45-54 peanweenwavacnanyesnnevernrens 55-64 oeee ee nnene eeenveey 65-74 es woven 75-84 av ann en ceenneenne geecerneseave 854 enn ne ern eee eewetnnan All ages c ee 0202 eee ewe Age adjusted ` ee : . 38! 23 i 63 885 1.6 . 11. 44 182.7 7 1,0 | 29 | 8.7 1 | 26 | 132.7 4 2.1 | 29 2Q 2. -- 0.02 .31 43 1. 1. 3.6 8. 198 8. 2.0 1. -71 +188 +213 2118 -1-80 +22 -32 29 -48 ee 142 1984 MEETING OF LAIABC on the location of the cancers in the exposed or unexposed parts of the skin site distribution All such data could readily be obtained for occupational factors if all occupational cancers would be made notifiable At the same time this measure would be instrumental in ascertaining to a much greater degree than heretofore the scope of occupational cancer hazards and of the cancers resulting therefrom The effectiveness of this procedure is strikingly illustrated by a graph graph 2 published several CUTANEOUS CANCER IN RELATION TO OCCUPATION FROM 1949 GRAPH8SE HOGWIINNG EGEIGINN NUMBER ENGLANDOWFALCEASSE&S SCOTLAND CUTANEOUSNONRED CARONINOMMAA L SCO NTOLNAR NE DD ANNIALLYANNIALLY 1911 fe- 2404] TARY NOPRICATION STAToUrTORY KA 4826suff annnnnted OL MINERAL ONLY OF Oe GRAPH B.  /-bu -bu------ OCTOBEK 6 MORNING SESSION 143 oA years ago by Henry in which he showed the striking rise in the number of cases of cutaneous carcinoma in males and females in England Wales and Scotland attributable to occupational exposures to coal tar pitch shale oil and mineral oil after statutory notification went into effect in 1920 Conclusions 1. The rapid development of modern industrialism has been associated with the appearance of many new occupational health hazards of which those causing cancers occupy an important position 2. The increasing rate at which occupational carcinogens have been discovered during recent decades suggests that only a fraction of the setually existing industrial carcinogens is known and that heretoforo unknown and now occupational carcinogens may be added to the present industrial environment through the development and use of new chemicals and production methods 3. There is a great deal of evidence indicating that only a relatively small fraction of the cancers produced through contact with occupational carcinogens has been recognized and placed on record Because of the established widespread industrial contact of large worker groups with known occupational carcinogens the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported number of occupational cancer cases and hazardous industrial operations 4. Medicolegal decisions in compensation procedures of occupational cancer claims should be based on a competent and critical evaluation of the entire evidence related to the exposure conditions of the claim- ant the presence or absence and the type of any atiology specific symptomatic manifestations observed during the latent and developmental periods of the cancer the length of the latent period the site of the cancer any specific histologic and histochemical characteristics the production of corresponding cancers in experimental animals by the incriminated agent and pertinent epidemiologic data 5. Schedule coverage laws are inadequate for providing proper protection against occupational cancer hazards because of the dynamic state of modern industry resulting in the constant addition of new chemicals and production methods which may entail heretofore unknown occupational cancer hazards The statute of limitations contained in the general coverage laws represents its main defect in the fair and equitable application of this type of workmen's com pensation law to occupational cancer hazards 6. Since the prevention of occupational cancer hazards and not financial compensation for established occupational cancers appears so be the more garaible and humane method of occupational cancer 144 1954 MEPTING OF IAIABC control labor codes should be properly adjusted and enforced so as to eliminate or reasonably contain occupational cancer hazards in mod- ern industries 7. For ascertaining the actual scope of the occupational cancer problem and for the institution of adequate control measures it is essential that occupational cancers and precancerous conditious are made notifiable with local and State health and labor authorities 8. A comprehensive study of occupational cancer hazards will provide a sound basis for an equally urgent investigation of the apparent extension of industry cancer bazarvis to large parts of the general population BIBLIOGRAPHY 1. HORPER W. C. Occupational Tumors and Allied Discuses C. C. Thomas Springfield T. 1942 p 897 Recent Developments in Environmental Cancer A. Review Arch Pathol In press A Methodology for Environmental and Occupational Cancer Surveys._ Publ Health Tech Monograph No. U. S. Public Health Service Depari- ment of Health Education and Welfare 1050 p 37 2. TR--sko V. M. Occupational Disease Reporting U. S. Department of Health Education and Welfare Publ Health Service Publ No. 248 1958 p 80 3. STEINER L. K. Recent Trends in Occupational Disease Legislation Law Illinois Bull 48 v 69 1951 p 4. Moners G. G. and DAVENPORT S. J. State Compensatory Provisions for Occupational Diseases Bureau of Mines Information Circular 7650 1. S. Department of the Interior 1952 p 125 5. WATERS TH Industrial Physician and Workmen's Compensation Trends in Compensation Legislation J. Indust Pyg and Toxicol 31 251-255 251-255 1949 6. SuecoMMITTEE ON LEGISLATION PRINCIPLES A Rational Approach to Air Pollution Legistation Manufacturing Chemists Assoc 1982 p 23 7. TOURANGEAU F. J. Health of Workmen Appreciation of Risks to which Health of Workmen Are Exposed in Industry in Province of Quebec Canad M. A. J. 54 352 1946 The Accident Prevention Associations Under the Quebec Workmen's Compensation Law L. H. T. CLxco President Quebre Association for the Prevention of Industrial Accidents In the absence of Mr. Clegg hiu statement was read by J. Armand Desrochers vice president Quebec Association for the Prevention of Accidents I will outline briefly the setup of the various safety assoriations and later being more familiar with the organization which I represent I shall endeavour to claborate on a few of its major promotional activities APPENDIX C Official Attendance at the Fortieth Annual Meeting of the International Association of Industrial Acci dent Boards and Commissions CANADA Alberta A. FARMILO M. B. E. Commissioner Workmen's Compensation Board Ed- monto8 DR H. H. Hapon Chief Medical Officer Workmen's Compensation Board Edmonton C. M. MACLEOD Q. C. Chairman Workmen's Compensation Board Edmonton British Columbin F. ARCHIBALD Secretary Workmen's Compensation Board Vancouver ADAM BELL Chairman Workmen's Compensation Board Vancouver C. W. PHITCHARD Commissioner Workmen's Compensation Board Vancouver Manitoba G. L. Coustar Q. C. Commissioner Workinen's Compensation Board Win- nipeg V. E. Jonse Assistant to Commissioner Workmen's Compensation Board Winnipeg New Brunswick A. A. Chismos President New Brunswick Accident Prevention Association Moncton R. G. JOHNSTON Vice Chairman Workmen's Compensation Board St. Joh J. A. LEBLANC Claims Officer Workmen's Compensation Board St. John Newfoundland CLARENCE V. HANCOCE Commissioner Workmen's Compensation Board St. John's Nova Scotia Aarnum Pernis Commissioner Workmen's Compensation Board Halifax FRANK Rowe Chairman Workmen's Compensation Board Halifax Ontario J. F. Camby Vice Chairman Workmen's Compensation Board Toronto MAX Donne Ontario Federation of Labor Toronto F. FINCHAN Workmen's Compensation Board Toronto GEORGE GARROW GREENE Director Federal Government Employees Compenos- tion Branch Department of Labor Ottawa W. J. JOHNSTON Workmen's Compensation Board Toronts J. B. LANE Department of Labor Ottawa OK APPENDIX C 229 L. B. LEPPARD Toronto Physicist Division of Industrial Hygiene Department of Health WILLS MACLACHLAN President Canadian Industrial Safety Conferenus Toronto- V. C. Puelar Director Canadian Branch of the I. L. O. Ottawa G. R. POOLE Workmen's Compensation Board Toronto ALLAN PORTER Department of Labor Ottawa A. ROBINSON Workmen's Compensation Board Toronto E. B. SPARROW Chairman Workmen's Compensation Board Toronto WARREN W. STEARNS Claims Manager Liberty Mutual Insurance Co. Toronto Da E. BrBBLE Workmen's Compensation Board Toronto Dr. Bruce Young Director Rehabilitation Workmen's Compensation Board Toronto Quebec STEPMEN BABIN Safety Director Quebec Iron & Titanium Corporation Sorel A. G. BALLACHKY President Quebec Metal Mining Association Noranda DZ BERTRAND BELLEWARE Workmen's Compensation Commission Quebec W. BENNETT President Quebec Pulp & Paper Safety Association Quebec JACQUES BERNARD Montreal Dr. L. A. Brocau Workmen's Compensation Commission Quebec JACQUES CASORAIN Department of Labor Quebec A. S. COOK Secretary Quebec Pulp & Paper Safety Association Quebec Paul A. Cooke Joint Manager Quebec Industrial Accident Prevention Associa tion Quebec A. HERMAN COLE Safety Director Canadian Car & Foundry Co. Ltd. Montreal J. Armand Desrochera Vice President Quebec Association for the Prevention of Industrial Accidents Quebec J. A. DUCKETT Montreal Jean DessayLLES Chawinigan Water& Power Co. Montreal PAUL DESJARDINS Assistant to President Casgrain & Charbonneau Montreal J. E. DION Workmen's Compensation Commission Quebec J. E. R. DEMERS Workmen's Compensation Commission Quebec J. H. Dacias Commissioner Workmen's Compensation Commission Quebec JOSEPH DELAGE Workmen's Compensation Commission Quebec HONORABLE M. L. DUPLESSIS Q. C. Premier of Quebec ARTHUR FOSTER Vice President Workmen's Compensation Commission Quebec HONORABLE ONESIME GAGNON Minister of Finance Quebec DR GUSTAVE GINGRAB Medical Director Rehabilitation Institute Montreal WILLIAM GALLAGHER Montreal S. Gazcoax Chief Claims Agent Canadian National Railways Montreal JEAN GARNEAU Workmen's Compensation Commission Quebec JOACHIM GRENIER Q. C. President Workmen's Compensation Commission Quebec BERNARD C. Hamel Quebec Power Co. Quebec RUDOLPHE HAMEL Vice President Catholic Conference of Labour Asbestos HON WILFRED HAMEL Mayor of Quebec A. H. HONSBERGan President Quebec Metal Mines Accident Prevention Aasocia- tion Noranda H. H. Hovas Chief Claims Agent Canadian Pacific Railway Montreal LEOPOLD HUSET Safety Director Quebec North Shore Paper Co. Baie Comeau M. Marc LACOB7 Edifice Cadillac Montreal MAURICE LAperasiens Quebec Iron & Titanium Corporation Soral 230 1964 MERTING OF IAIABC EUGENE LAROCHELLE Secretary General Quebec Metal Mining Association Quebec Now LAROCHE Workmen's Compensation Commission Quebec Dr. Arruca Leczone Chief Medical Officer Workmen's Compensation Com- mission Quebec DR D. LEONARD Workmen's Compensation Commission Quebec T. E. LITTLE Director Quebec Metal Mining Association Noranda W. E. MONTGOMERY Safety Director Kenneth B. S. Hobertson Ltd. Montreal PHILIPPE MONET Q C. Commisioner Workmen's Compensation Con mission Montreal J. Alruonse Moazncy Workmen's Compensation Commission Quebec JBAN PHENIX Orthopedist Technician Montreal Romeo PAQUET Workmen's Compensation Commission Quebec DONAT QUIMPER Deputy Minister of Labor Department of Labor Quebec G. ANT ROUSSEAU Workmen's Compensation Commission Quebec F. M. ROCHELBAU Commissioner Workmen's Compensation Commission Quebec DAVID ROBBLAnd Workmen's Compensation Commission Quebec EVABISTE ROCHETTE Commissioner Workinen's Compensation Commission Quetoc I. H. SLOANE Safety Director Canadian Manville Co. Ltd. Ashestoz W. H. Souman Assistant to Mine Manager Canadian Johns Manville Co. Ltd. Asbestos DR CAMILLE SIMARD Workmen's Compensation nission Quebec DB F. J. Tourangeau Division of Industrial Hygiene Montreal Dr. B. Tuncor President Industrial Medical Association Montreal GERARD TREMBLAY Deputy Minister of Labor Department of Labor Quebec L. P. Tessier Workmen's Compensation Commission Quebec JACQUES VERREAULT Secretary Workmen's Compensation Comunission Quebec A. C. WALKER Superintendent of Safety Crane Limited Montreal Dr. R. L. Warson Medical Director Crane Limited Montreal ST GEORGE WHITE Workmen's Compensation Commission Quebec Saskatchewan M. D. THOMPSON Commissioner Workmen's Compensation Board Q. W. VALLSAD Chairman Workmen's Compensation Board Regina C. C. Wullis Minister of Labor Department of Labor Regina Itegins UNITED STATES Alabama JOE L. COLEMAN Director Department of Industrial Relations Montgomery Arkansas G. 1. GRANT Attorney United Mine Workers Fort Smith 0. W. HoGMs Commissioner Workmen's Compensation Commission Little Rock ARNOLD B. Sixes Commissioner Workmen's Compensation Commission Little Rock California CHET FRAZIER Guarantee Insurance Co. Los Angeles JOSEPH J. GALLAGHER Manager State Insurance Fund Burlingame | 8. W. >> harma luduricial l^>^ ~Co m ma^-^N -nPr^nac AFFENDIX C 231 PAUL SCHAERE Director Department of Industrial Francisco Dr. BERT S. THOMAS Department of Employment seramento H. M. WILses Department of Employment Sacramento Relations San Colorado HAY HI BRANNAMAN Chairman Industrial Commission of Colorado Denver HAROLD C. THOMPSON Director of asos State Compensation Insurance Fund Denver Connecticut D. E. COUGHLIN Hartford Accident & Indemnity Co. Hartford A. H. Genas President Toll Gate House Ivorytown W. S. McConex The Aetna Casualty & Surety Co. Hartford Delaware ABEL KLaw Spreial Counsel E. I du Pont de Nemours & Co. Wilmington Dr. J. McComum Member Industrial Accident Board Wyoming JAMES A. MILLIN President Industrial Accident Board Wilmington FORD N. WAN/isurosMember Industrial Accident Beard Laurel District of Columbia ANDREW J. Bia Member National Legislative Committee American Federal of Labar FRANK *** Associale Director of & Education Research Congress of Industrial Organizatinus BRUCE A. GREExe U. Department of Labor PAUL M. GYRSKE Treasurer IAIABC U. B. Department of Labor Dr. W. C. Hoares Chief Environmental Cancer Section Cancer Institute Department of Health Education and Welfare Bethesda Md Hon ARTUR LARSON Under Secretary of Labor JOHN E. LAWYER Chairman Employees Compensation Appeal Board U. S. Department of Labor MARIE V. Ler Office of the Treasurer IAIABO C. S. Department of Labor WILLIAM MCCAULEY Director Bureau of Employees Compensation U. S. Department of Labor FRANK McExeox U. & Department of Labor Frances C. Surrn U. Department of Labor ROBERT VAN THING United Mine Workers Welfare and Ketirement Fund Florida JAMED CAMSBon Member Industrial Commision Tallahassen B. COLEMAN General Counsel Industrial Commission Tallahassee RODNEY DURRANCE Director Workmen's Corapensation Division Industrial Commission Tallahassee Joeken A. PARKS Orlando JAMES T. VOCELLE Chairman Industrial Commission Tallahassee Georgia RICHARD W. BEST Treasurer Board of Workmen's Compensation College Park W. E. BuckNex Member Board of Workmen's Compensation Atlanta 232 1964 MBETING OF IAJASC Idako CLIFFORD J. Hormiss Freutdent National Association of Self Insurers Lewiston B. W. OPPENBS Chairman Industrial Accident Board Boise Illinois DAN ADAIR National Safety Council Chicago HONEY BUCHMAN Superintendent Compensation Claims Department Zurich General Accident & Liability Insurance Co. Ltd. Chicago EMIL M. CALIENDO Commissioner Industrial Commission Chicago FLOTO E. FRAZIZA Director Industrial Division National Association of Mutual Casualty Companies Chicago Mrs. MARJORIE W. GRIGSBY Council on Industrial Health A. M. A. Chicago S. J. HOLDERMAN Chairman Industrial Commission Chicago ROBERT S. HOWE Lumbermen's Mutual Casualty Co. Chicago D. W. Johnston Commissioner Industrial Commission Chicago Dr. Maros H. KRONENBERG Medical Services Manager Caterpillar Tractor Co. Peoria H. Gene Milles National Safety Council Chicago JOHN MOULIN Commissioner Industrial Commission Chicago Dr. C. T. Olson Chairman Commission on Workmen's Compensation Industrial Medical Association Chicago J. A. PARKIEWIck Illinois Department of Labor Chicago S. J. STEVENS Western Electric Co. Chicago PAUL 8. Wish American Mutual Alliance Chicago Indiana HOWARD T. BATMAN General Manager and Counsel Lynch Coal Operators Reciprocal Association Terre Haute Dr. K. Harcourt Indianapolis EMANUEL F. Muen Hearing Member Industrial Board Indianapolis Josers P. MILK Chairman Industrial Board Indianapolis Iowa C. H. GBZENLEY Deputy Commissioner Workmen's Compensation Service Des Moinca Kaneas EDWARD CORBY Commissioner Office of Workmen's Compensation Commis sioner Topeka ALBERT M. Ross Examiner Office of Workmen's Compensation Commissioner Kansas City RALPH J. THORNB Examiner Office of Workmen's Compensation Commissioner Hutchinson SIMEON WEBA Examiner Office of Workmen's Compensation Commissioner Pittsburg Kentucky PAUL COMBS Acting Commissioner Department of Industrial Frankfort H. WILLIAMS Attorney General Department of Labor Frankfort Relations APPENDIX C 233 Maine Maine JOHN W. BALLOS Lawyer Bangor Mrs. MADELINE Baanand Industrial Accident Commission Augusta Cran M. JOLT Member Industrial Accident Commission Waterville JAMES E. MITCHELL Lawyer Bangor F. E. RICKANDson Portland Maryland MELVIN L. FINE Chairman Industrial Accident Commission Baltimore Dr. Joan V. Horzina Baltimore W. ALBERT MENCHINE Commissioner Industrial Accident Commission Balti- more PAUL SIEMENS Jr. Manager Compensation Department Maryland Casualty Co. Baltimore Hon/YB. Suz/New Amsterdam Casualty Co. Baltimore Massachusells DE ALEXANDER P. ATTEIN Chairman Subcommittee on Industrial Relations American College of Surgeons Brooklice Alphonse S. Bachorowser Attorney Salem DAVID D. BANKA Employers Groups Insurance Boston THOMAR W. BOwn Member Division of Industrial Accidenta Boston R. B. Coores Director of Medical Relations American Mutual Liability In- surance Co. Boston EUGENE H. Giroux Chairman Division of Industrial Accidents Boston FRANK E. GODFREY Director of Insurance Division of Industrial Accidenta Boston STANWOOD L. HANSON Assistant Vice President Liberty Mutual Insurance Co. Boston Q. 8. HARLAN Vice President American Mutual Liability Insurance Co. Boston JAMES G. HARNEDY Attorney Massachusetts Bonding and Insurance Co. Boston MARCELLA J. HICKS Boston MABY F. HICKs Member Division of Industrial Accidents Bosten ELIAS J. KOLOPOLIAS Member Division of Industrial Accidents Boston EDWARD J. MURPHY Attorney Boston MARY A. NOONAN Boston ASHLEY 81. Claim Counsel Liberty Mutual Insurance Co. Boston JOSEPH A. SULLIVAN Chief Examiner Liberty Mutual Insurance Co. Boston Mas EMMA S. TouSANT Past President IAIABC Quinsy Michigan W. C. Bisnor Manager State Accident Fund Lansing HARRY F. BRIGGS Superintendent of Claims State Accident Fund Lansing WILLIAM E. BUCHANAN Chrysler Corp. Detroit C. E. CAROTHERS Ford Motor Co. Detroit JOHN C. CHELDERS Lincoln Mercury Division General Motors Detroit H. A. COMPRAU Attorney State Accident Fund Lansing WILLIAM J. DEvana Chrysler Corporation Detroit Craus E. Dusso Chrysler Corporation Detroit JAMES L. HILL Supervisory Attorney Workmen's Compensation Section Ford Motor Co. Detroit 38058 38058858n5n 18 234 1964 MEETING OP LAIABC W. G. Horouxes Compensation Supervisor Chrysler Corporation Detroit Geomas E. Jonson Manager Employee Services Department Ford Motor Co. Daarbom WILLIAM J. JONES Lacey Jones & Doelle Detroit F. A. Lux Staff Attorney Workmen's Compensation Section Ford Motor Co. Detroit WADE H. McCuez JR Member Workmen's Compensation Commission Lansing W. R. MacGascon Vice President Michigan Mutual Liability Co. Detroit BENJAMIN MARCUS Representing Samuel B. Horovits Muskegon RICHARD R. No Chrysler Corporation Detroit Rosser L. O'Cove Rothe Maraton Bohn & Mazey Detroit Taxobuas P. RYAN Chairman Workmen's Compensation Commission Dimon- dalo Richano L. ScHsu International Representative Compensation Department UAW Detroit A. A. Sexy Vive President in Charge of Claims Corporate Service Inc. Detroit FRED S. WARNER Attorney Auto Owners Insurance Co. Lausing Minnesota ROBERT E. FARICY Commissioner Industrial Commission St. Paul Mississippi SAM S. ALLREO Commissioner Workmen's Compensation Commission Jackson JOHN A. CRAIS Chainnan Workmen's Compensation Commission Jackson Mis ouri Missouri WILLIAM G. Bueu Superintendent Workmen's Compensation AmericanAssociated Insurance Comprains St. Louis CHARLES E. Cares Member Industrial Commission Jefferson City EARL F. CHEF Assistant Professor St. Louis University St. LoniR. Rosegr an Attomey Kansas City W. E. FREELAND Member Industrial Commission Jefferson City Spences H. Givens Director Division of Workmen's Compaisation JeffermON City Sreruby J. Malerr Chairman Industrial Commission Jefferson City Moniana W. W. CASPER Necretary Industrial Accident Board Helena New Jersey WINSTON BLANN Chubbs & Bone Managers Federal Insurance n Short Hills DR H. E. BRICKER New Liskan CARL HOLDERMAN Commissioner Department of Labor & Industry Trentes Dax A. Spain Director Division of Workmen's Compensation Department of Labor & Industry Trenton New Marisa XBANKZER JONES Assistant Commissioner Labor and Industrial Commission Santa Fe PENDIX C 235 New York EVERETT R. ALDEN Manager Claims & Safety Department Oil Co. Inc. New York Loms ARBErr Actuary Woodward & Fondiller New York Varnum ~DUDLEY BIERAU Director Compensation & Safety American Locomotive Co. Schenectady Miss GERTRUDE CAVANAUGH Workmen's Compensation Board Albany RAYMOND A. CAVERLY Vice President Fidelity & Casualty Co. New York OLIVER T. CLArron New York MARSHALL Dawson Past Treasurer TALABC TALABC New York J. A. DENESCHERZ Comptroller National Council on Compensation Insurance New York BENJAMIN DISSIN State Insurance Fund New York Miss MARY DONLON Chairman Workman's Compensation Board New York J. Rap Dyxxs United States Casualty Co. New York Jos esDEAN Euwanus Attorney New York RICHARD FORD.x Woodward & Fandiller New York G. Barte Fox Secretary Casualty Division Glens Falls Insurance Co. Glens Fals DR LEONARD J. GOLDWATER National Chairman Industry Com- mittee American Heart Association New York Walas C. Gorrax C. E. Director Institute for the Urippled and Disabled New York MISS JEANETTE HANION Associate Economist Workmen's Workmen's Compensation Board New York ALFRED HEINEX United Steelworkers of America Buffal~- THEODORE HETSLEB Js Allorney National Association of Mutual Casualty Cos New York H. HUMPHRIES A. F. Industries New York II M. JACKSON Manager Industrial IIcalth Program Johns Manville Corp. New York ANDREW KALMrkow New York EDWIN D. Kn.E Counsel New York Compensation Insurance Rating Board New York M. L. Laszowaaz Western Electric Co. Inc. New York JOHN M. McDONALD Director Workmen's Compensation Amoriated Industries of New York Statz Inc. Albany Rosear C. Marshall Adininistrative Deputy Workmen's Compensation Board New Yorke GEORGE E. MULLIGAN Manager Workinen's Compensation & Disability Claims Divisiou American Surety Co. New York MICHAEL J. Monpuy Coueral Manager Association of New York State Mutual Casualty Cos New York RAY J. OAKLEY State Insurance Fund New York MISS MARION POLAKOV Secretary United Sterlworkers of America Buffalo Miss MART Pooray Buffalo JAMES J. REGAN Secretary The Inswers Association New Yark R. V. RYAN Fidelity & Casualty Co. of New York New York HENRY D. SAYER General Manager New York Compensation Insurance Rating Board New York A. M. Scr Insurance Manager National Comell of State IncureTa Association New York eee . . . 236 1954 MEETING OF JAIABC JAMES R. SHIELDs Attorney American Telephone & Telegraph Co. New York CYRUS F. SMITH Claims Attorney New York Telephone Co. New York WILLIAM H SRIZatrz Associate Attorney State Insurance Fund New York J. Harry Tiernan Attorney United Steelworkers of Americs Buffalo WARZEN C. Tyckss Counsel Utica Mutual Insurance Co. Utica Gro D. WELLS Western Electric Co. Inc. New York N. Moscan Woods Association of Casualty & Surety Cos New York DR M. WULIAM ZUCKER Director of Studies Commerce & Industry Association of New York New York North Carolina J. W. Bzan Commissioner Industrial Commission Raleigh North Dakota Oris Batant Chairman Workmen's Compensation Bureau Bismarck B. M. RYAN Member Workmen's Compensation Bureau Bismarck Ohio D. BANGER Emile E. Watson Columbus JACOB CLAYMAN Treasurer Ohio CIO Council Columbus J. MAYNARD DICKERSON Vice Chairman Industrial Commission Columbus B. G. GOTTEMOELLZE Superintendent of Claims Farm Bureau Mutual Auto Insurance Co. Columbus W. C. HARTMAN Attorney Squire Banders & Dempsey Cleveland M. HOLLAND Kaiss Director Workmen's Compensation Frigidaire Division General Motors Dayton JOHN KUMPEL United Rubber Workers Akron RICHARD W Moxes Chairman Industrial Commission Columbus CHARLES F. Norera B. F. Goodrich Co. Akron Thomas M. HARMAN Jones Day Cockley & Reavis Cleveland Oklahoma FRED ALBERT Industrial Commission Oklahoma City MARI CHILDERS Industrial Commission Oklahoma City JUDGE ALBEET C. BONT Industrial Commission Oklahoma City TOM C. MARTIN Commissioner State Insurance Fund Oklahoma City MONT R. POWELL Chief Attorney State Insurance Fund Oklahoma City E. J. BUTHSKLAND Industrial Commission Oklahoma City Oregon L. O. ABENs Member Industrial Accident Commission Salem WILLIAM A. CALlahan Chairman Industrial Accident Commission Salem Pennsylvania F. R. BARNAKo Manager Compensation and Safety Bethlehem Steel Co. Bethlehem FRANK K. BOAL Deputy Secretary Department of Labor and Industry Harris- burg A. C. CHRISTMAN Chief Supervisor Indemnity Insurance Co. of North America Philadelphis W. D. COAKLEY Secretary Fire Association of Philadelphia Philadelphia B. GWILLIAM Manager State Workmen's Insurance Fund Harrisburg R. M. HARTMAN Assistani Manager Compensation and Safety Bethlehem Steel Co. Beklehoto APPENDIX C 237 Roamer C. H^nowSuperintendent Compensation Claim Department American Casualty Co. Reading . RUSSEL C. Kersen Assistant Manager State Workmen's Insurance Fand Harrisburg WALTER LINK Treasurer National Council of State Insurers Association Philadelphis JOHN L. NAYLOR Director Bureau of Workmen's Compensation Harrisburg F. Parcano Chief Safety Inspector State Workmen's Insurance Fund Harris- burg A. SCHROEDER General Attorney Pennsylvania Railroad Co. Philadelphia DAVID M. WALKSE Secretary Department of Labor & Industry Harrisburg Puerto Rico MISS RAQUEL NIGAGLIONY Member Industrial Commission San Juan EDUARDO A SANTIAGO Actuary State Insurance Fund San Juan Rhode Island ANTONIO DI PINTO Executive Assistant Curative Center Department of Labor Providence DR JOHN E. DONLEY Medical Director Curative Center Department of Labor Providencs South Carolina MISE FAITH CLAPTON Commissioner Industrial Commission Columbia JAMES J. REIO Vice Chairman Industrial Commission Columbia Mas H. S. Tark Columbia Tanneeter W. H. PARHAM Commissioner Department of Labor Nashville PAUL A. PARLIPS Safety Engineer Department of Labor Nashville DEWEY WHITTLE Director Division of Workmen's Compensation Department of Labor Nashville Texas Dr. V. C. BAIRD Chief Physician Humble Oil & Refining Co. Houston R. L. ECKMAN Vice President Petroleum Casualty Co. Houston L. H. FLEWELLEN Chairman Industrial Accident Board Austin Fetzx A Raynez President Petroleum Casualty Co. Houston Virginia Mrs. C. B. Hrcu Nichmond W. H. NICKELS JR Chairman Department of Workmen's Compensation Richmond Washington BIMES H. KENNEDY Supervisor Rehabilitation Center Department of Labor and Industries Olympia ; West Virginia DR JOHN P. Brick Chairman Occupational Disease Medical Board Charleston FRANKLIN W. KERN Executive Secretary Workmen's Compensation Fund Charleston RUDOLPH J. MURENSET Legal Assistant Workmen's Compensation Fund Charleston GEORGE W. Stoxes Commissioner Workmen's Compensation Fand Charleston APPE LEANLARA pate 1084 MEETING OF LALABC Wisconsin STEPEN J. Huon Attorney Milwaukee BE Konous Vice President Employers Mutuals Wausau Monman LaVITAN Assistant Attorney General Madison J. B. Liberes Clain Counsel Riployers Mutuals Wauanl~- HABBY A. Neon Director Workmen's Compensation Industrial Commission Madison. Vbera Wassers Chairman Industrial Commission Madison Wyoming Wyoming Wax P. Perar Manager Workmen's Compensation Commission Cheyenne ********** ********** *** DPX GF 1858