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FILE NAME: AT&T and other Phone Companies (ATT) DATE: 1954 DOC#: ATT053 DOCUMENT DESCRIPTION: Conference Proceedings - Workmen's Comp Problems - Company Reps pgs. 232, 235 & 236 PRO C EED IN G S-- 4 lh A n im a l C o n ven tio n o f th e Jm terfm U m al A sso cia tio n o f In d u s tr ia l A c c id e n t B oards a n d C om m issions?, Quebec? Canada? O c to b e r 3TM7? 1934 Workmen's Compensation Problems 1054 BULLETIN 186 U N ITED STA TES D EPA RTM EN T O F LABOR JAm-ea P M itch ell* Seerel& 'y BUREAU O F LABO R STANDARDS F sm l E* im ke? D ire e sw fm m m i Tm& No. ISO, mtkUrn fcke proeeedkgs l fh& AQth mzxw m m tx t o n of ike Xotem&tiensl &m&imx of fndnstr&l eddent- Boards and Corn- mkskms, whieh was M d in Quebec, Canada, October 3-7, W M . m em m gs of the. convention have been preparad for puMo&iion by the st&ff o ib Boreao of Labor Standards. J*j mm 11111 lilil:: N':": '. : OCTOBER 8--MORNING B1BSIOK 127 75 year w ith the discovery of the relation between. the occurrence of skis cancer and an occupational exposure to coal ta r {%. 1). The data given in the following tables (1 and la) briefly summarize the salient additions to the information on occupational cancer hazards made since th at time- They list the various chemical and physical agents so far recognized or strongly suspected as causes of cancer in m m . They show, moreover, the different organs and tissues representing the target organa of these agents and the number of occupational cancer cases placed m record or known to have been recognised as caused by them. T asi>s5 1.---Oceiipaiional Cancers Recorded in the United Stdies and Foreign C m n trm up to 08% A.pM Nhitr o{: Nsasbero? Sites nt*r ttnwrS,As,eskisJvatenrtodpe)s Tet Amnio_____ :__ ......... Coal t&r. pitch....... *,..................... . Petroleum___ . . . . . . . . . . . ____ . . . . Shale oils.___ .. . . . . ....................... iJgvt ar d prain>. ..................... Creosote oil__ ___. . . . . . . . . . . . . . . . . nthr&ceie ...,, ______________ _ Scot-carbon b la c k ......__ :--...------- Aromatic amfates. . . . . . . _. . . . . . . . . Eoentgeii- und radim-r&diatk___ Arsenic______. . . . . . . . . . . . . . . . . . . . . A sbestos.......................... Chromates________ _________ . . . . . Nickel.. . . . . . . . . . ... . . . . . . . . . . . , . . . . . , Coal tar, pitch............... .. Petroleum____ ________ . . . . . . . . . . Bengal___ ____________ _____ . . . . ;-:V'::A ' ^.... Isopropyl____ _________. . . . . . . . . . . . . Radio&etiye chemicals..,. ..... . 7 . . . d o . . . . . . . 110 ] .... lo....... . . . 70 ! 7 : ...d o ....... . . . l e . . . . . . .. i . . . d o . . ........ . . . . ___ d o .. . . . . . . i Bladder.... WO-408 '.T> 1Leafeeada. . M) V.vi.y...y-.v.y-.. buog. . .. . .. -- ch.-- . . . M > >> { ,do........ 0 i .NS9-& 1 V0 i Nssal sums. ->>* L&gv. .. .....de....... 7 L'u&emia,... If j Lang..... ,,. ,, 1 1Larynx___ _ 4 iNasal sinos. 6 *Bes_____ 9 1Nasal sinus. 3 25 3,158 29 5.000 14 40 20 198 .1, 200 (?) 13 650 10 83 85 84 ...... 51 58 S3 8i 0 0 0 0 I - Total__________ . . . . . . __ _ 750 7, mo ! Apprsimst. 32 % 280 99 1, 987 14 41 28 191 1, 800 (?) 29 m 23 SS 148 84 51 53 40 42 1 4 8 9 3 8,'108 isSO ^ O 5 P* ^1 % 7? & *A*$*u*^-'3** *.WwO.o** I?si:K*rx**- g B > e> >r* g- 2 s KC&t> >P*y*':F^cT;.:'>**g: : <|>~+;;$;*I >**> :i'r~~*%xr*> c x> ^ 2L 2* 3?w et> I ^ * ,s*_s p _ ?p?& S' {^"f s C9 r a sa. ^ I 3 - 1 ? ' v?: .PR.-...S|..3.x. ^ . * 8 '' g fi " "g : ^- O^ yW" p ss | O *y " "* g' g g w- \ jyT* w $ * ~. g ^ fo"*:a*.y. : aco . Cft- i*S3 fK^f. ciP^-: " P ! P* g * ECS ***, v*" ^ o 'o~`x ewS-* w;%**3'- >*$ & **v "6V~'i"' Cvi sp fi S M* 0 r* <i iz a I O5 :5ts5* ' g 1* pw: >XJ.?'"-' >* w* I%' ICi '*o WS 8w5 v r- ^ |g> :ni~-s'\ H :*^*:<:. ;-f`: #35<:^. WQ : j:?o-j: : i#<c^vK>y.i:;->:,p. i t*r!j A>*< '<*.* S ** S !a s STCPS & tv O P :935: fiK **::: fc:^: * Ijf Pp 56 s& jg m* ^eri?- S9i . : ft & i wga >>a->-< aw. a> o`- s aa ^ s" g *** 'r' i&: O7=^- W_W2. Ep .<^&:; lr:- Uwt^ i 3 a *T t+4sA.wrti-. ! "P O i:3o::>::*2/>r.*.fc. o !-a:sr TM< c* s^ST "* ;i?:::/^~t-' 3 1y?+^r* fe:' .%r?** >S -"3S W p i ^ 5 o 5 3 ** <-> 2 E'< I p .... v::;j*i '& % < * O C3 E a f ;::sft; 'P g 3 (&2 &a. g <c< 3 * 1 pSS 3 & ff S 2vi..... g p a % s Xi Jci a : p %> ZL < g :o>:' sp aa> ct> o ? :p P .S -: :r;:: t i ;*> *. :Hx OC3- ^ XPo5 L Vr~*nxf E &i o JPjgC'-< Oi""~ .I:PCS3 g 3 g Zv S; 2t S P?.*, % % << 1 i r a S--*P< R io os V tu ! & &s .: mmbc il M CCS I Ss : % cr^ i ! f H O r-i,:<5> . Ws>*'J!:::: . Q 1 i54 OCTOBER --MOIiNING SESSION from the electrodes misting of a mixture of coal tar, pitch, and petroleum coke exists. Reliable information, however, is on hand th a t these workers stiffer from cancers of the skin and, possibly, also the respiratory tract. The extent; of this exposure hazard m ay he estimated by the fact that approximately two-thirds of a pound of electrode carbon is consumed for each pound of metallic aluminum, produced, of which 801,000 short- tons were consumed in the United States in 1945. I t m equally significant th a t agents which have been reported to have caused occupational cancers among workers of an industry of cue country, do not seem to have the same effect upon rite workers of an identical industry of another country, if the available data would he accepted a t their face value. Since carcinogens behave in their fundamental disease-producing properties like pathogenic microorganisms, there is no sound reason to assume th a t carcinogens make any distinctions in their activity or effectiveness for any national reasons. In fact, it can be shown that such scientifically incom prehensible discrepancies are mainly due to local differences of report* ing of occupational cancer cases. The existence of an excessive liability of gas house retort and coke oven workers to cancer of the lung has been reported from Japan, Canada, and England, hut not from any other country despite the fact th a t the exposure conditions for workers employed in such opera tions are identical. The occurrence of an appreciable number of arsenic cancers of the skin among German users of arsenical in sect!cides was placed on record during recent years. If lull credence would be given to reports on arsenic cancers observed in the United States, one would he led to believe th a t arsemrals in our part of the world are carcinogenic for almost exclusively medicinal reasons. Again, it is hard to assume th at arsenical would make such dis tinctions, A similar situation seems to exist concerning the car cinogenicity 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 eases of skin can cers due to occupational contact w ith lubricating oils, practically nothing is officially known as to the existence of such industrial diseases from the countries on this side of the Atlantic. One seems to he content with attributing here the English observations to the carcinogenic action of shale oils, th e large-scale industrial use of which was discontinued discing the 1928's, and therefore cannot account for the more recent English cancer oases observed among spinners, mechanics, engineers and other workers having had exclusive con tact with lubricating and cooling oils of petroleum derivation. ISM MEETING OF UIABC I t is worth noting m this copn.eetio.rs th a t 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 th at the annual reports of the Chief Inspector of Factories of England and. Wales have regularly listed notifications of such lesions to the extent of from IDO to 250 cases per year. One m ay also reflect on the fact th a t the last published figures on occupational cancers in American dve workers appeared in 1938 and listed less than 100 cases, all occurring among employees of one com pany. During the intervening 13 years, the total number of such cases has risen several fold and no official data have become available from any of tire other companies producing and handling carcinogenic aromatic amines used in the production of dyes and rubber antioxidants. 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. Mu ally, some consideration m ust be given to the fact th at the general population has varyingdegreos of contact with soma of the carcinogenic gents 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 in such a polluted environment and used in p art for nutritional purposes. In the past, claims as to the occurrence of so-called "neighborhood" cases of cancer have rarely been made. The well established former occurrence of arsenic cancers among inhabitants of a German region in which the drinking water supply was polluted with arsenic from mine slag heaps represents the first occurrence of this type. Following the discovery of bladder e&neer hasards among German dye workers, it was assorted th at air environmental plant centammatkm 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 rime 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 m beta-naphthylaminc, is involved which might have produced such results if the waste disposal and housekeeping methods of the plant were inadequate. I t is probable th a t the future occurrence of cancers of the hmg and bone among individuals who lived near berylliump m d ^ n ^ h r'p r o s e s s ii# p irfts m ight fnrmrix^cdditional evidence of OCA0 B&B 8-- S K I M SESSION cancer hazards related to environmental plant pollution if beryllium and its compounds are not only carcinogenic for rats and rabbits but also lor man. Similar conditions of industrial atmospheric pollution exist around arsenic smelters, chromate producing plan 1% carbon black factories and oil refineries, as well as uranium ore milk. 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 cancel's from industry-related sources, such as exposure to carcinogens contained in the exhaust' fumes from diesel and gasoline engines, or present as additives and contaminants in foodstuffs. I t appears from these considerations that there can be no-doubt that the actual number of occupational cancers is considerably higher than the number of eases placed on record. I t is of some interest, moreover, that the number of eases 3'ecorded in medical journals is appreciably higher Ivan the number of occupational cancers which during the last 20 years have come for decision before compensation, boards be cause compensation claims in many such cases have been settled out of court. W ith a few exceptions, such as the incidence of lung cancer among American chromate manufacturers and among German and Cxeehoslovaki&n radioactive ore minora, of nasal sums, larynx and lung tumors among American isopropyl alcohol manufacturers, and of skin cancer among English coal ta r manufacturers and processer, no reliable information is available on the incidence rate of occupational cancers of the various types among different occupational population groups. B* Spechil Aspect# o f Q cgupatim m t Ca&eerg fair and competent adjudication of compensation claims for cancers allegedly caused by occupational agents or conditions requires art 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 non-oecup&tionai environmental (mediornai, dietary, cosmetic, habitual) as writ as !'spontaneous" cancers. A Definition aj the Term (iOccupational Cancer'>.--The term ''oc cupational cancori' is applied to malignant tumors originating in individuals during the course, and/or as the result of the regular ami 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 spedile agents or oriologicaily related to well defined occupational conditions which form an integral part of the ordinary working environment. They differ through those aspects from the'&cddenta! occupational cancers which result from or follow upon some extraor 154 MEETING OF IM A M dinary, unforeseen, accidental injury sustained at work and being of a nonspecific nature. $. Types m d Nature- of Occupational Oarcinogms TMOceup ation&I agents which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to thorn are largely chemicals. Some of these chemicals &re well defined, others consist, of variable mixtures of a large number of chemical conspounds, a few of which possess carcinogenic properties. A second group of occupational carcinogens is composed of agents characterised by their ionizing or nonionizing radiation. A third group is repre sented by environmental agents and conditions which sometimes have an -occupational association, and which may 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). T abcb 2.-- Occupational Oatcinugms---TSieir Monte of Exposure and Their Target Ci6Sir&i typo Spto&i <,ypt> Raul ? 'P&rget organ earemogsas; j Orgaaic chea;:- \ Scasici... cels--nistic, l Cutaneaes, respire- j Bie-ffi-fcrshieg o r g a n s my. | deeSems, lyrophcsaf- eeraa, myeioeasp r-iceyeFe B^lveapiahylamirtt:-, beasi- Respiratory, eutocie- 5 Urogences orgaes (fci&d- tiSr.e, -t-afsmerfiRiii'aj'ifear- raiaa, nsagetsta?) itv!as*n. Cosi is?, pitek, s&et, espa-dt, cas, alimenter. Catfsaepsg....... i &>f, aretes-, kidney}. Ski, i&t eif, creosote i; eelim- PcspirateW-.... tuag, cene oli t e g black, iigaite tar sad psaeifia ail. SyaibeWs ewt 3 aa;l pa Cutaacoas........ Skin. SSewias). SbsieeS bad paraffin ail...___ ....do.... ........ : Respiratory'_... Da. tnrysw. Fatolept ine; aU, diesel ad, OuiaivNRis.. .1 ... lubriiaiiag oil arid areas, Rsjn;torx........ Skirt. laiog. euUiRs: ail, arts.; Black, | asphalt, tar, clse eresia j paraffin oil. Alliiteivle.. . . . . . . J rsojtfopj-j ilv... . . . t o - - . , . ....... Vasai UBiiS. Isryat, Seag. iaafgaic ahead-1 Afsosle..____ ...........____ dabtoto feptow'.y Sria. seals. I ntotocy.v.. ... ... peas. ; Nickel.._______________ .... .. ...do ............. . Nasal sVity, sisesUrlsies ; Chrondano.. ___. . . ___ i Asbestos.......................... . ,,.do.... ..... da...... Sun', tong. a. Ftrsls&I e&ebtasms: \ X-sdUiio... . . . . . . . . . . . . . __ Caieeeeas iWissesla Skirt, C*aeetive tissue, feesa, HadiactWirp3isUoatopS>a-, i tivfrmm. ......i beta, stati esaffim-sadUti!}. I Titokatewfim itlood-iVfvciag otgsns. Skin. Ceanectlye tissue, Pimi? ffiresins organs. frmtMwmxeHsmxS.r.!SsBstowaavSifefttaiae'fss : UtrsiU'e.......... : VUaiW......... Nasa! siaos l-nog. ; WtrtStov m m m m . --u a m m a session In addition to these established occupational carcinogens there are a number of potential human carcinogens which have been shown to elicit careers in experimental animals and to which workers become exposed during their regular occupational activities. Those po tential agents which also m ost he considered in the adjudication of are listed in tables % and 4, Tabcs &--Potential Enpitantnetti&l Humsn Caresmgens Agii Site of tataor Type c-i axpfiSUTO %<:::* : Types? Ssk& wads ------------ ----------- -- -- -- ---------- -- ------------ --1 Xtre>ges.,,........... ..... Natural................. Synthetic,,,,,.,, Carfesa Tittacfalorids.. Breust............... Hys&ph sods.... Vtonus..... ........ Hypophysis...... Biver....... ........ tltvtv'!!!";' ' : C&Sroiprss......... ........,,,.. BT (&,a-Bss<p-eh!o- .W fophisnyl-i.Li-tri' e&lorpqtSfR!. Vsnuie add..., .. ...... tid------s...s... Thiosren 6S dwiva- - --A............. tires. prFi^tyafea (flui tcHw. ds!!. nietiirk U0..,._. Blsil-fe?.. Methylated aphthacr.ei. Brgius eoai 68s aad tar> SWtt........ ... ----.do...... ....... Subcutaneous tissu?. : FHher-TrepSvh eoal Hiver.............., &. ta, wares, ! h -s:___ _ Moids___ J MSlisetafS (ks&m#........ Jwd-, 'iisit'-y additive, .irai,..... ........... iahait : CsswwoSagfftiteaa _S.__ _ iilaoe p!?....i W.*v.>. Maase .....: fnduMdal aolreat. f>sgri!xing agsat. O-y'Skonijf' estait, XtaWvBga&Bfcg agoni, 53af>B?8W.rt>. l-'rodtiH. cf ireop. Grain fcffilyoai- 'iiitiiXiv.-.A*.. ExlfSotiee of oils. Mairrifeetorti, aSiStlitUa i Soivept slf88ttv6 of tills, reUss, rubber, vfXxs, fedtet aOiloids. . ' tfigrifitna <>i iaequif, 8*w l-otsb, Uessjrtg itaid. Otai-- . . . _____ 0r5uik>n of artificial ailS, piasti. K&t..... ,.,,,,1i Msnsfaetore. i ftsseetlcide. Feed e*sfaxss&sf. esfiAiaaxi.,,,....,, Ingredient of foodsiafSs :" ' iffaits, u-lno, scieo, m i t&j. MgdieSnU TannSfig agent. Ot:___S.l.,..vs,! .......&.....vl \ Oiffus Suit pres-vaCiv. dodteirj: assist. .,, .v d o ....... [ Masuiseliir y..... .......... y, Sweetening agent, y.v,..j Astifreete, ntermdi^e is expolVs oftfiufetsr. SdftWif <>t Sacquer is&s, x?od stsitts, gSnt-, extite, humr.tsst Ubiwoo>. .OitiO.&pfS?-,, ,, ,, P tiPafs':.... . .i Vehicle of iasoitieides. 0ihUiav,,.mi ,,,!j Masuf&etsre. : I <htsiJi>sSv, , , , . ; B A , J Fsel. i Oubreasts. HadUe giroducUos, j <?88dV8a..v...,' PMestfnOuf:eieefii;rxe.i. rilflgliiU : Vue?. J!'t.?<dunh<rfxsSisiriaf..s>sn<.................. I f M MEETING Of! A m Tabx.8 S.- Piftenlit-Mm^rnrnrnM-Mumm CarHu&gm*--Cantino! A' SSr.ei ternir J 1 Apostes j Types fit huios. eontsets Biglt grsa S1 bui- Ifejst bio BOB isst gsmx tCf, Butter ......... 8?jbKt&a*es Starnam i.,.,... CSSift. j Ijw---- . . . . . . J Onsi..........__ i&isfesae, polstbi. aas, psiyaBd (ay- le', MkeSte teen, SiSyjasyi xaatfcac. rySrte. Serryfites.____ _ -- .......... i ....... SaheuteBsous. / r&rsetet,___, i ..... Boa.. . . . . . . . . . J BtsasKsiv.... \ S e e t a s n ..,,....... bter. teysoid...; Oral..... .. .. .. . C>C03li,y....*..W..'... Sabctil&isseag ; rateaMtei && ..>,/...J, Tcrtedyss. ?ood safi ossisstto <3yea. ttet.........i rood dj' (orient's. Gasoli 4y,, Fiar osier. ? t a . fiber, plssiie-tedusteijsi BSBufftctufem Uses. Wr&ppisig snatsrS-t. Medloiiwd a?eh. Bat... .. , .. ... . e i . ,. .- . a.vJa Matei Biy, Xrap tabe. phosphor assnufaater. Birastors' vessels. Atoroto ergs' proue.Scra. Soil t&rr.te&a. dsfcriag steer at graffiics, paet, rubbr. Melai sioys. Rubber scofllraw, BbotoeWtric pjtetetus neeolwferf. Fir*pteo8g SgSfife Msiebm agit. Matai alk-ys aeri patbrg. '&$&}#$ initiier gfi&xf eerssk, iiftlat. rabia*. Metehs&l ligaatl T a & 4.-- Carcinogenic Chemisais Eliminated e Environmental Human Mem Sita?86sr Typpoasaosfas- ;j $a^* ;i Steaei toso Sty-ryl t e . ....... .IS u b s u is a e o u s Ms&tetai,..w......w ?A*e.--<.>,j Tiy3s8ys<Ss>?yA, ; tiSiD . -A < *t^*ssu -ftsw M iss. I S o 3 u * * a * d a * i (issus. | .......,.:v| ; Blsdder........... .. -.-.V. . . . . . . . . . . . . . J Op.......,..,.j I X ra r....____ \ Brain, J FvVvv/vvJ 1 Thyroid, i A rm stic duet, f Bm tst. ; Irticm, Kimy. : : VI b. .Brnhuit^n of Evidence,--For th establishment of causal rela tions between au exposure to these agenta and the subsequent develop* nsent of a cancer of an occupational genesis and therefore compensable nature, the following prerequisites m ust be fulfilled: OCTOBER -- MORNING SESSION" (a) Definite evidence m ust be available indicating th a t toe ell bad 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 he available on this point. Single exposures may be considered to be effective if the casual agent consists of external leaking radiation or the exposure mechanism favors the production of a carcinogenic depot in. the tissues from which a prolonged exposure of the host organism may ensue. (b) The route of exposure to or introduction of the carcinogenic agent in addition to its spcifi chemical properties and metabolic peculiarities determine the site of the organ or tissues in which a cancer is elicited. Therefore, not any cancer, bu t only cancers of specific sites are related to any particular carcinogenic agent. (c) The type of exposure does not need to he continuous or extend up to the time of appearance of the cancer, hut may he 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, bu t also by workers entering such operations on a transitory basis, such as supervisors, maintenance personnel, repairmen, truckers, loaders, yardmen, and workers employed in rooms and btdkngs near the hazardous opera tions, 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 sub sequently appearing cancers, it Is of distinct value to analyse the medical history of the affected persons for functional or anatomic disease manifestations characteristic of a pathogenic action of the particular carcinogen allegedly involved. Such nonc&neerous and often preparatory or procancerons symptoms of tiologie specificity act as stigm ata or biologie finger prints supporting not only the actuality of a previously sustained specific exposure, hu t also its causal .relationship to the cancer present. Symptomatic manifesta tions possessing such a significance are, for instance, chronic radiodermatitis, chronic ta r dermatitis, arsenic dermatosis, chronic solar dermatitis, chronic radiation periostitis, asbestosls of the lung, arid leukeuioid 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, chmummy ..nickel,. radioactive substances, and benzol. m 1954 MEETING OF IAIABO It k important, however, to note th at both these procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any etioiogically characteristic symptoms, in fact, they may not elicit any preliminary toxic or other disease phenomena despite a persistent and prolonged carcinogenic exposure. Thus, cappers of the bladder in dye and rubber workers m ay develop in the absence of any preliminary local or general warning symptoms after more than one or two decades of continuous, interm ittent, or dis continued exposure to certain carcinogenic aromatic amines. There also does not exist any parallelism between the toxic and/or irritative properties of any chemical and its potential carcinogenic qualities, nor, is there a relationship between th e degree of toxicity of any particular carcinogen and its relative carcinogenic potency. (e) Extensive experience with occupational -cancel, indicates th at 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). f t is for this reason most unlikely that occupational cancers become manifest within the first year following the inception of contact with &carcinogenic agent. In fact, all cancers which snake their appearance during the first three years of occupation in a carcinogenic environment should he subjected to severe scrutiny for a more probable isoxioccupational origin before they may ho considered from any occupational viewpoint. Tabu; 5,--Latent Periods of Qcmpaiiarial Cancers Organ 3ttd agent AveriajagrfSt obdicst- Range of latent period Skin Ansndc: Medicinal.......... ....... ................................... ............... Occupational------------- ------------------. ----------- Tar...................._...................... ............ ........................... Creosote oil...________________________ __________ _ Mineral oil__ ___________. . . . . . ....... .......................... Crude paraiSn oh________________________________ Solar radiation______ _____________________ ______ X-radiation...._____ __..........._______________________ Years 18 25 20-24 25 50-54 15-18 20-80 7 Years 3-40 4-46 1-50 15-40 4-75 3-35 15-40 1-12 Lung Asbestos..._________ _______________ ______ ____ _ Chromates__ __ ________ ________________ ____ _ Shekel carbonyl.... ........................................................... Tar fumes___ __ ___ ____ ______ ______. . . . . _____ Ios&ing radiation__-......-- -------------------------------------- 18 15 22 15 25-35 15-21 5-4" 6-30 9-23, 7-50 Bladder Aromatic amines..___________________ ____________ 11-15 2-40 if::::::':1:*:':::'::: OCTOBEB 6-- MORNING SESSION 137 (j) A sa w s sla ! production of cancers in experimental animals fey die adminisiratlen el any particular chemical or/occupational agent supplies weighty support to a claim th at such a .factor rnav have an identical effect upon man, especially if the route of exposures the physioehsuHoal status of the agent during contact, arid the cancer produced in experimental animals are identical with the corresponding aspects in human experience. However, because of the pronounced species specificity of axogenous eatcmogenlc 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. (?/) Pathologic and histologic evidence is in general of only limited importance in the establishment of the occupational causation of cancers, since neither the clinical behavior nor the gross appearance and histologic structure of cancers are etiology specific. Ho a ever, in some occupational cancers histologically or histoehemicaHy demon strable manifestations are present which give conclusive or suggestive evidence as to their particular etiology. The presence of asbestos bodies and asbestosis in n lung affected b y cancer provides practical and scientific proof a? to the sheet! ic origin of snob a pulm oiiary carcinoma. Of similar causal significance would he the demonstration of chromite dust by histochenrical methods and by incineratlnn of sections of the lung of an individual with pulmonary carcinoma. The hiafuclusmical demonstration nf arsenic in the shin affected by a carcinoma represents another illustration of the value of histologic studios in the determination of the etiology of a cancer, Likewise the presence of extensive endaflm lio changes in a fibrosed subcuta neous tissue containing a carcinoma or sarcoma would arouse the sus picion th at X-rays or radioactive energy was causally responsible for the malignant lesion. I t appears from these considerations that a competent and. critical evaluation of the entire evidence related to 1ho exposure of the individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, some histologic or histochonuoai characteristics anti the existence of corresponding ob servations on cancer production in experimental animals aside from pertinent epidemiologic data represents the scientific basis essential for medicolegal decisions in litigations of alleged occupational cancers. C, Compensation, Lows Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types- of oc cupational carcinogenic agents, industrial operations with carcinogenic 138 1854 M SETIN# OF IAIABC hazards, and occupational eaueers c o w e d . As of October 1, 1854, full coverage laws applying to all Mnds of occupational diseases in cluding saucers bad been passed ia 26 States of tb s United States and the District of Columbia; schedule coverage laws n o t always covering occupational cancers, or all types, were m force in 20 States and no occupational disease laws had been enacted at. that- time in 2 States (Mississippi ami 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 obsolete, in an era of a rapidly changing and in creasing occupational disease panorama. Snob static laws reflect a legal and soeiologic state of mind which is maladjusted to the dynamic state of modem 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 st atute of limita tions which is inadequate for providing fair protection, under certain and n o t too unusual circumstances met- with in occupation a! cancer. Since occupational cancers may become 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 tional cancers which may appear after a longer period. It is advisable for this reason to adjust all existing laws in such a w ay th a t 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 arid are increasingly be coming occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilizers, ant sprouting agents, hormonal fattening agents of livestock, lubricants and fuel of farm machinery, residual oils for smudge pots, soil 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 e--"MOKNING SESSION 138 B< fj&h&r Codes e n d Sfonderds Any attem pt toward achieving an adequate compensation by finan cial means for a cancerous condition acquired flnough contact with occupational agents not only presents considerable economic diffieldtics b u t is also of questionable humane merit. While such & procedure is evidently the best that can be done after an occupational cancer has become art accomplished fact, the wiser, snore rational, and in the long run, more economical approach to a reasonable com tro! 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 haa&rds exist} so th a t 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 dancer 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 familiarising managers of such opera tions with the potential carcinogenic properties of the substances and devices used in their establishments and with the methods and pro cedures hy which they might he controlled or avoided. The relative effectiveness of any medical, sanitary and technologic control measures to be adopted can best be determined by ascertaining the changes in the occupational cancer incidence among the total population a t risk occurring during some iQ to 30 years alter their introduction- It is therefore desirable th at provisions he made for routinely recording all cancer cases occurring among worker groups exposed to occupational carcinogens. All precancsrous and cancerous lesions observed among members of such groups should for this reason be made notifiable with the State health agency. All persons having knowledge of these cancers should be held responsible for such report ing, The adoption of such meimirm represents an im portant step from a public health viewpoint, because there is a growing urgency to determine the environmental causes responsible for significantchanges in the incidence rates of several can cam. A great deal of circumstantial and direct- evidence incriminates recent changes in the industry-related environmental factors for the startling and progressive increase in the lung cancer frequency observed 140 1854 MEETING 0? I.A1ABC in all indtistriaimed countries during the past 50 years (graph 1). A similar, while n o t as marked, rise hi m ortality 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 1844. 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 fcematotoxic effects. OCTOBER 8-- MBNINO SESSION 141 I t also m ay fee of significance th a t the age-+pecifie, total and ageadjusted m ortality 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 (table 6). Whether such changes in the age distribution of skin cancers for both sexes may bave resulted from the modern habit of sun bathing nr a more intense environmental, occupational and dietary contact of the general population with arsenicale, or with products of the coal ta r and petroleum industry, remains at present a m atter of speculation. For determining the possible causal signifi cance of such factors in this development, it would fee necessary to ascertain data m occupational, dietary, environmental and habitual contacts of the affected individuals, their complexion and race, and T a s t a 6,-- A gaspedfi?! Total, and Age-adjusted Mortality Holes Per 100,000 Population ja r Shin Cancer in White Males and While Females, United Stales, 1930, m s , and 1980 mm Xm t>tem 1030 1 10 : vm Mfy-tSi Under IS ____ 15-24. 25-34............... 35--44- . - __ 45-54__ -____ 5 5 -8 4 -___ -- 05-74_______ 7 5 -8 4 -........... 85 aed over__ A9 ages............. Age adjusted 5. Under 15___ 15-24.-____ 25- 34- ......... 35--44- ' 45-54............ 35-64........ . 55-74........... 75-34___ --. 55-..... ........ AH ages....... . Age adjusted 0; ne 1 0. 03 i 12 . 11 . 46 . 75 l .85 2.5 1 2. 8.0 1 5. 3 23.7 I 16.0 c a s i 52. 3 124.2 ; 172. 4 3-3 ! 3. 2 ; 4. 7 ; 3. 6 0. 03 .31 t 4 2. 7 5. 8 12, g 32.6 77. 5 2, 0 2.3 -6 2 -f 209 + 76 4 85 420 + 11 -2 0 -38 -5 5 X A/ >AA, NAA, VAAA W'hlts tomSss ; 0.07 0.07 0.02 .08 . 13 . 31 . 28 .23 ft V yS . 83 i . 55 1.2 'h 5 : 1,0 1.8 3.8 2.0 3.8 11.4 8. 7 8. 8 44 8 26. 3 la s 182. 7 132. 7 : 68. 5 2..1 2.0 2.0 2.0 2. 1 1. 0 : --71 -4188 +213 + 118 430 +24 -2 2 --29 -4 8 V* At A. A... .V- V. -V. 1M MEETING OF IAIBC on the location of the caneara in the exposed or uaexpoeed parts of the akin (site distribution), All such data coaid readily be obtained for occupational factors if all occupational cancers would fee made notifiable. A t the same time this measure would be instrumental in ascertaining to a much greater degree than heretofore the scope of occupational cancer hazards and of the c&neers resulting therefrom. The effectiveness of this pro cedure is striking!y illustrated by a graph (graph 2) published several. CUTANEOUS CANCER IN RELATION TO OCCUPATION e tc jn w K w s cm gnqm * m M i a m m izsM w g w i i s tin t m m x x fm m je ts -a w wo.y&vg. vom m m WIWtGATiO^S sr m m m mrtmcmoHs m m o r stani a mmmt ( x j >, >Vi*mx -n ss&5?n tm m m w b rm uwmm or m m ' I ; ........................... Gbapk 2, OCTOBER 8-- MOBNXNO SESSION years ago by H enry in which Ire showed the striking w hi the nam her of cases of cutaneous carcinoma in males and females in England ,W alea and Scotland attributable to occupational exposures to coal ta r, pitch, shale oil and mineral oil after statutory notification went into effect in 1920. Conclusions 1. The rapid development of modern industrialism has been asso ciated 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 th at only a fraction of the actually existing industrial carcinogens is known and th a t here tofore unknown and new 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 indicatiti" th at only a relatively small fraction of the cancers produced through contact with occu pational carcinogens has been recognised and/or placed on record. Because of the established widespread industrial contact of large worker groups with known occupational carcinogens, the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported number of occupational cancer eases and hazardous industrial operations. 4. Medicolegal decisionsin compensation procedures of occupational cancer claims should be based on a competent and critical evaluation of the entire evidence related in the exposure conditions of the claim ant, the presence or absence and the type of any etiology, specific symptomatic manifestations observed during the latent and develop mental periods of the cancer, the length of the latent period, the site of the cancer, any specific histologic and histochermcal 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 h otarda because of the dynamic state of modern industry resulting in the constant addition of new chemicals and production methods which may entail heretofore unknown occupational cancer hazards. The statute of limitations contained in the general coverage laws represents its main defect in the fair and equitable application of this type of workmen's com pensation law to occupational cancer hazards. 6. Since the prevention of occupational cancer hazards and not financial compensation for established occupational cancers appears to luv.tim,nm re,scnsible..and.butuane .method, of oeaup&tkn&L.e&ncyr .1954 MEETING OF I'AIABC control, labor codes should be properly adjusted and enforced so as to eliminate or reasonably contain occupational cancer hazards in modern industries. 7. For ascertaining the actual scope of the occupational cancer problem and for the institution of adequate control measures, it is essential th a t occupational cancers and prec&ncerdus conditions are made notifiable with local and State health and labor authorities. 8. comprehensive study of occupational cancer hazards will provide a sound basis for an equally urgent investigation of the apparent extension, of industry-related cancer hazards to large parts of the general population, BmuoGEAPey J lBcPEK, W. <X, Oceu|>ationat Tumors and Allied Diseases, '.O, C. Thomas, Springfield, fit, 1943, p. 897. Decent Developments in Environmental Cancer, A. Hvlw. Arch, Pathol. In press. A Methodology for Baviroamental and Occupational Cancer Surveys. Pobl. Health Tech. Monograph No. L \J. 8. Public Health Service, Depar meat of Health, Education and Welfare, 1950, p. 3?. 3. Tzaskg, V. M,, Occupational Disease Reporting, . S. Department of Health, Education and Welfare, Pub!. Health Service Pohl. No. 288, 1088, p. 80. 3. Stzjsss, L. K,, Recent Tnjxida 5 Occupational Disease Legislation, Uoiv. Illinois Bull. 48; N, 09, 1931, p, 30. 4. Memora, G. G., aa DAVEaroar, S, 3>, State Corugensatory Provisions for Occupftikma! XUseasea, Bureau of Mines Information Circular 7659, U. S. Department of the Interior, 1952, p. 125. 5. W/rrKRs, Tk., Industrial Physician and Workmen's Compensation--Current Trends in Compexmatlon Legislation. J. Indust. Pyg. and Toxicol. 31: 251-25.5, 1949, 9. BuBcouMvrrms on Esosspatipsj paiNcm.zs, A HaHoe&l Approach to Air Pollution legislation. Manufacturing Chemists' Assoc., 1952, p. 23. 7. TousaSUSaP, F, , Health of Workmen: Appreciation of Disks to Which Health of Workmen Are Exposed ia Industry in Province of Quebec, Caad, M. A. J, 54: 352, 1948. T h e A c cid e n t fA evetotion sscciat.ioG s lie dev th e Q aehee W erkm eyFs C em pcB saticB Law L H k T. Cpecg, President^ -Quebec Association for dm Prevention of Industrial Accidente \ ln ike essence of Mr. {*$$> * !'s statement tens read by J . A rm ani Desrechers, vice president, Quebec Association for the Prevention of Accidents} i will outline briefly the setup of the various safety assoc!atiotis, and later, being more familiar with the organization which I represent, I shall endeavour to elaborate on a few of it major promocional .Activities,,........ . ....................................... APPENDIX O M e m l A ite m l& n e e a t tJbe F a r H e th sm iia l M e e tin g tlh.e f te ra a tie > itm l s s a c l a t i a a a.f I s s d a s t r i a ! eei cleat B aarA s aiid C am m lssiaa CAHAM Alberta . feMsiO? M, Bo E., CornrnJssionet, 'Wbrkmen'a Cojapens&iion Board, Ed* monton- B s, H. H< wMwim, CM" Medical Oter, 'Wotkmm's CBipen^fctipa Board, Ednuorttoe. C. M, Ms o m r , % 0-, Chsinm, Workmep'g Compensatio Board, Edmonton, British Cchmbia F, P, scH'8aS,&<Sceret&ry, Workraen's Compensatio Board, Yanconver. Aa,m Baja., Chmrm&v, Worknnm's Compensatio Board, Vaiieoxever. k W< Bschas, Coxamissioner, Wrkme's Compensatio Board, V&ncouver. Mamloha 3U Constar, % 0., Commtesoper, Worksnen's Compensatio Board, Wfn- P. . Bo Jossa, Assistant, fco mroSssiooer, Workmen's Compensatio Board, New Bnmemck A . A , m s m ib is , President, New Brunswick Aecident Prewmtio Association, Moncfcon, Eo <0. Jo k ssto r, Vice Chairman, Workmeo'ss Compensatio Board, Sk Job, J, o L ip te id , Claims fecr, Wsrkmesdi? Compenrntion Board, Sk Jskm Newfoundland Coassrce V. Hoco ck, Cmdsshner, WorkfO&'s Compensatio Board, St. JoixtPs, mtern Pstmx, Commissioner, Workraen's Compensatlon Board, H alite, Frank Rows, Cfe&irtan, Workmsn's Compensation Board, Halifax. Ontario J. F, Gammr, yiep Chairman, Workrnen's Compensation Board, Toronto. Max X>obs, Ontario Federation ot Iteor, Toronto. P,, Fixen*, WorkraeAs Compessa&io Board, Toronto. CJk&sos Gaseow Gkeenb, Direcior, Federal Government Efnpioyees Compensa tio Brauch, Dpart:set of Labor, Ottawa. W. J. JostnsTON, Workmen's Compensatio Board, Toronto. I B. Lars, Department- of Labor, Ottaxva. A..... .............,A .......... A................,,.,...... A A o x .... ....................... ........... APPR'NMX G 229 L. B. Lrrpa&p, Physicist, Division of industrial Hygiene, Department of Health, Toronto. Wxu& MAcmAOULAN, President, Canadian Industrial Safety Conference, Toronto. V. C. Pb e i H, Director, Canadian Branch of the I. L. O., Ottawa. G. B. Poona, Workmen's Compensation Board, Toronto. Allan Postsa, Department of Labor, Ottawa. A. Bobinson, Workmen's Compensation Board, Toronto. E, E. Srarrow, Chairman, Workmen's Compensation Board, Toronto. Wabrer W. Stearns, Claims Manager, Liberty Mutual Insurance Co., Toronto. Da, E. C. Steele, Workmen's Compensation Board, Toronto. Bs. Beoce Took*, Director, Rhabilitai!, Workmen's Compenaafeion Board, Toronto. Qti-tbee. Stephss' Babin, Safety Director, .Quebec* Iron & Titanium Corporation, Sorek , G> BallaCHET, President, Quebec Metal Mining Association, Koranda, Da. B eeteano Bellemars, Workmen s Compensation Commission, Quebec. W, L. Bennett, President, Quetsee Rulp & Paper Safety Association, Quebec. J acques Brekano, Montreal. Bn. L< , Brochu, Workmea'o Compensation Commission, Quebec. Jacques Cassbajn, Department of Labor, Quebec. . B. Coos, Secretary-Manager, Quebec Pulp & Paper Safety Association, Quebec. F. ton A. Cong, Joint Manager, Queixto Industrial Accident Prevention Associa tion, Quebec. A. H erman Cons, Safety Director, Canadian Car &, Foundry Co., Ltd,, Montreal. J. Armano BesBOCHKne, -Vice President, Quebec Association for the Prevention of Industrial Accidents, Quebec. J, A. D ccrstt, Montreal, Dsseaumps, Bhawisiga Water A Power Co., Montreal. P aul B ssiasdins, Assistant to President, Casgrais & Cbarbonneau, Montreal J. E. B son, Workmen's Compensation Commission, Quebec, J, E, R. Dsmebs, Workmen's Compensation Commission, Quebec. J. H. D elisle. Commissioner, Workmen's Compensation Commission, Quebec. J oseph B blage, Workmen's Compensation Commission, Quebec. Honorable M. L. D uplessis, Q. C., Premier of Quebec. Arthur Foster, Vice President, Workmen's Compensation Commission, Quebec. H oN onateu Osssm G agnon, Minister of Finance, Quebec. Dn, G ustavs Gingbas, Medical Director, Rehabilitation Institute, Montreal. William Gaiaacher, Montreal. S. Gresobt,, Chief Claims .Agent, Canadian -National Railways, Montreal, J ean Gahneau, Workmen's Compensation Commission, Quebec. J oachim Gbensb, Q. C., President, Workmen' Compensation Commission, Quebec. Bshnabb C. H amse, Quebec Power Co., Quebec. RonoLFHE Hamel, Vice President, Cathode Goofcrence of Labour, Asbestos. H on. Wmenso H amel, Mayor of Quebec. A, II. H onsreegsr, President, Quebec Mtal Mines Accident Prevention Associa tion, Noranda. H. H. H ough, Chief Claims Agent, Canadian Pacific Railway, Montreal, Leofolk H ubert, Safety Director, Quebec North Shore Paper Co., Bale Comeau, M< Marc Lacoste, Edifice. Cadillac, Montreal. M aurice LaeSbrisrk, Quebec Iron & Titanium Corporation, SoreL m 1954 MBBl'XNC OF LUABC Etjokne LAHQeEAS> Secretary Goneral, Quebec MW Mining Associ&txoxs, Quebec. H ost L.vaekms, Workmeri's Compeixsatio Commission, Quebec. Da. Ass-hoe LScePqq, Chief Medieai OSIeer, Workmen's Compensation Com* xnission, Quebec. Dr. I>. L'SOKa s h , Workmen's Compensation Commission, Quebec, T. E, Lrrrms, Director, Quebec Metal Mining Association, Nor&nda. W. E. 'Moktgqmb&t, Safety Director, JLsrmetk B. S, Robertson, Ltd., Montreal pHiurrE Monsttk, Q. C,, Commissioner, Workmen's Compensation Com mission, Montreal. J. Ai.iuxoNss M-obknct, Workmen's Compensation Commission, Quebec. Juan Pko&nxx, Orthopedist Technician, Montreal. Romeo Pa w *, Workmen's Compensation Commission, Quebec. Doha* Quimssk, Deputy Minister of Labor, Deps-rtmest of Labor, Quebho. G. Am-, Ropsssao, Workmen's Compensation Commission. Quebec. F. M. lioaiBLKAX?, Commissioner, Workmen's Compensation Commission, Quebec. DavsS3 Romm*, Workmen's Compensation Commission, Quebec. KvAais-rs RocuarrE. Commissioner, Workmen's -Compensation Commissioii, Quebec. I, K. Bx.Oa.h:s, 'Safety Director, Canadian Johns-Manviiie Co., Ltd., Asbestos. W. H. Boutas. Assistant to Mine Manager, Canadian Johns-M&xmfie Co., Lid., Asbestos. Dsn CamhAk Esmako, Wotkmen'a Compensation Commission, Qxtefeec, Bn. F* J. Tovxangkav, Division of industrial Hygiene, Montreal. Dr. E, A. Toncor, President, Industrial Medical Association, Montreal Qrah'< TasMSoAi', Deputy Minister of Labor. Department os" Later, Quebec. L. P. Tssssrss, Workesds Oxsropensatioxs Commission, Quebec, Jacques Vessxeaus.t, Secretary, Workmen's Compensation Commission, Quebec. A. C. Walksr, Superintendent of Safety, Crane Limited, Montreal. Da, E. E. L. Watson, Medico! Director, Craxse, Limited, Montreal St, Okorob Wm?z, Workmen's Compensation Commission, Quebec. Saskatchewan M. D. Thompson, Commissioner', Workmen's Corapexisaiiox! Board, 0 . W. YAtEHAtf, Chairman, 'Workman's Compensation Board, 'Regina. C. C. WixAtAHS, Minister of Labor, Department of Labor, Regina. Bogina. UNITED STATES Alabama Joe Is. Ogv&ma, Director, Department of Industrial Relations, Montgomery. Arkansas G. L. Grant, Attorney, United Mine Workers, Fori. Smith.. Cl W, Coombs, Commissioner, Workmen's Compensation Commission, Little Rock, Annonn B. Bikes, Commissioner, Workmen's Compensation Commission, Littie Rock. C a liforma Cini? F&AKsEn, Guarantee Insurance Co., Los Angeles. JqsPph J. Caxesohee, Manager, State Insurance Fund, Burlingame, a W, MAtebJiAtn, Chairman, H:Mai: 'Cbl*m)W*Mn, San Frateiseo, AmSNBXX <? P ax? 8 c akusatlas, Director, Department of Industrial Eeiaiione, San Frauds?. 'Bsv Ber? S. T homas, Bsparunent <*TEtriploymest, Sacramento. H. M. Wiiaos, Department of Employment, Sacramento. a?orado Eat H. BSAXXASfASi, Chairman, Industrial Commission of Colorado, Dsnvsf, H abop C . TpOsmox, D ireci nr o f Claims, State CompenSatS) Ihsprance Fund, Denver, C 'm m efieut B 12. Copshiux, Hartford Accident A Indemnity fin,, Hartford, A. H, Ushsss, President, Toll Gate House, Ivoryknvn. W. S. McOprss!ck, The Aetna Casualty & Surety ,, Hartford. D doim ro A s z t K lavs, Special Counsel, E, I, du Pont tie Me-oars & Co., Wilmington. p r. L J< MacCo&pm, Member, Industrial Accident Board, Wyoming. Jamba A, MrtLis, P-a5doat, Iadnstrial Accident Board, Wilmington. Foe '.N, Wasmsestos, Member, Imdustriai Accident Board, Laurel, Thair id o f Columbia &S&&SW ,L Member, National Legislative Committee, American Federation of Labor. Frakk Fans mor, Assoelaic Director of Eskse&tion & Research, Congress of ludoetml Organ!atIons Bruce A. G&ebxb, IT. 8. Department of Labor, Pam, E, Cr&sKE, Secret&ry-TregSEre?, IAIA8C, U. S. Department of Labor, Dr. W* C. ile e im , Chief, Environmental Cancer Section, G m m i Institute, Department- of Health, Education and Welfare, Bethesda, Md, Hem AMM*M Laimoa, Under Secretary of Labor, Jouti E. Lawyer* Chairman, Employees Coxnpensat.fi Appeal Board, IT. 8, Department of Labor. M acsk V, Imams amm,, Olffcsv of the SbeYeiary-Trfcssurer, I ATAEG, U. 8, Depart snoot of Labor, Wiusam MeCsursr, Director, Bureau of Employee Compensation, U, 8. Department of Labor, Fitaxx MoEonor, U. 8, Dcpartosect of Labor. F a ancsss C. SMrtA, U. S, Department of Xetbor, Ro&mcr Vat; H rx m o , United Mine Workers Welfare and Retireroont Food. Florida Man Casts., Member, Industrial Commission, Tallahassee. B, T. CoLsssan, General Counsel, Industrial Commission, Tidsanassos, Rosmbv Do erasen, Director, Workmens Compensation Division, Industrial CofORiissioo, Tallalissseti. joaarss A. Parks, Orlando, J ames T. Voeeu.E, Chairs, industrial CiMxoasasibh, Tallahassee. Georgia HiCMAso W. Best, Seeretary-Treasurer, Board of Workmen* Oorapesssat-ks, College Park. W. E. Books, Member, Board of Workmen's Ccmspcosatio, Atlanta. m >i % m m m & o f iaxabc CumffiB J, HonArns, President, National Association of Sell insurers, Lewiston. Illinois B an Asms, National Safely Council, Chicago. Hkn&t Bumman, Superintendent, Compensation Claims Department, iSurfefv General Accident <&Liability Insurance Co., Ltd,, Chicago. Essra M. Cantes, Commissioner, Industrial Commission, Chicago. Foot B, PkATSSSh Director, Industrial Division, National Association of Mutual Casualty Companies, Chicago. Mrs. Majwosj* W. Gmeaox, Connell os XadustofaS Health, A, M. A,, Chi. S, J. ItQjL&sma, Chairman, Industrial Coaimlsslon, Chicago. R osser S. Rows, Lumbermen's Mutual Casualty Co., Chicago. D. W< Jtffinaton, Commissioner, Industrial Commission, Chicago. Dr. Mjx/iok H, EsoNatiBSga, Medical Services Manager, Caterpillar Tractor Co,, Peoria, Si. Gas Mstorm, National Safety Council, Chicago. John Mobun, Commissioner, industrial Commission, Chicago. Dr. . T. Oases, Chairman, Commission o& Workmen* Compensation, Indus- trial Medical .Association, Chicago. d. A. F asaisanoa, liimois Department of Labor, Chisago. 8. J. grayns, Western Electric Go., Chicago. Pam, S, Wb j;, American Mutual Alliance, Chicago. Indiana Howasm T. Baska, General Manager and Counsel, Lynch Coal Operators Reciprocal Association, Terre Haute. Dr, A. K. Haaeonat, Indianapolis. Essanobo P. Mucosa, Hearing Member, Industrial Beard, Indianapolis. dnsKPH Pi Mssajbk, Chairman, Industrial Board, Indianapolis, Iowa G. H. OasBuasy, Deputy Commissioner, Workmen Compensation Service, Bes Mofaes. Kansas Eowa&u Cuapy, Commissioner, Office of Workmen's Compensation Commis sioner, Topeka. Anssar M. Boas, Examiner, Office of Workmen's Compensation Commissioner, Kansas City, lisara J. Taomsra, Examiner, Office of Workmen's Compensation Commissioner, Hntehinsoa. Swson Webs, Examiner, Office of Workmen's Compensation Commissioner, Pittsburg. Kentucky Parffi Con as, Acting Commissioner, .Department of Industrial Relations, Frankfort. H. WmuAMs, Attorney General, Department of Labor, Frankfort. iSKSSs wmiiwiMZ l l l l i :I;f flkiil .. v Ai A APPENDIX G 288 Mat fut Jomk W. B*tu>v, lawyer, Bangor. Mrs. Masew ne Baekasb, Industrial Accident Commission, Augusta, Cram M, Jour Member, Industrial Accident Commission, Waterville. James E, MwcHTmt, l&wyar, Bangor. F, E, RroHABnsok, Portland, Maryland MEavm L. Pks, Chairman, Industrial Accident Commission, Baltimore. D r, Jaws V, H os'E NS, Baltimore. W. Annnisrr MgwcHXKXS, Commissioner, Industrial Accident Commission, Balti- mors. Faun Sbmsss. Jr., Manager, Compensation Department, Maryland Casualty Co., Baltimore. Hekee B. Btbe, N ow Amateriiam Casualty Co., Baltimore. Massachusetts Da. 5,exansb P. ArtEEn, Chairman, Subcommittee on Industrial Relations, American College of Surgeons, Brookline, AiP&omz S. Bachohowskt, Attorney, Salem. B av D, Bakes, Employers Groups Insurance, Boston, Thomas W. Boam, Member, Division of Industrial Accidents, Boston, R. B. Coorsa, Director of Medical Relations, American Mutual Liability Is* aurance Co., Boston. Eoseke H, CPnouk, Chairman, Division of Industrial Accidents, Boston. Fhakk E, Ooorsucr, Directs of Self-Insurance, Division of Industrial Accidents, Boston. Stakwoou L. H anson, Assistant Vice President, Liberty Mutual Insurance Co., Boston. CL8. Haslan, Vico President, American Mutual Liability Insurance Co., Boston. J ames G. H aek ey, Attorney, Massachusetts Bonding and Insurance Co., Boston. Mahceu,a J. Ureas, Boston, M aey F, H soas, M ember, Division of Ind u strial Accidents, Boston. Eeaas J. Kof.oaos.tAS, Member, Division of Industrial Accidents. Boston. Eswaso J, Mepst, Attorney, Boston. Maey A. N oonan, Boston. Ashuet 8v, Ou;, Counsel, Liberty Mutual Insurance Co., Boston. Joseph A. Suluvan, Chief Examiner, Liberty Mutual Insurance Co., Boston. Mss. E mma 8 . T ousakt, Fast President, IAIABC, Quincy. Michigan W. C. Biao.or, Manager, State Accident Fund, Lansing. Habey F. Barsos, Bopcriutefideot of Claims, State Accident Fund, Lansing. WmoxAM E. B ocmanan, Chrysler Corp., Detroit. C. E. Caeotkees, Ford Motor Co., Detroit. J ohn C. CHri&EEa, Lincoln Mercury Division, General Motors, Detroit. H. A, Compeau, Attorney, State Accident Fund, Lansing, Wjuuah J, Devsbs, Chrysler Corporation, Detroit. Cteos E. Dosro, Chrysler Corporation, Detroit. James L, Hai>, Supervisory Attorney, WorMaeh'e Compensation Section, Ford Motor Co., Detroit. .................................................................................................... 284 I84 MSBTXSSii OP 1A.IA.BG W* 0 , Hotsssks, Compeneation Srsixirviso?, Ohrysicr Corporation, Detroit. Oaeud E, JortHsati, Manager, Employee Bailees Dop&rioient, Ford Motor Co., De&rhom. Wsm&u J. m m , Lacey, Jones & Doeiic. Detroit. F* A. hxfx, Staff Attorney, Workmens Compensation Section, Ford Motor Co., Detroit. Was H, MoCstss, Jib, Member, Workmen's Compensation Commission, Lansing. W, E< MacGasoos. Vice President, Michigan Mutual Liability Co., Detroit. B'sm Aum Makcus, SepreAexsting B, Horevits. Muskegon. Rsosaso E. Nossis, Chrysler Corporation, Detroit. lioessr h. O'CiiSJvsiis., Rothe, Marston, Bohn & Mazoy, Detroit. Tmsoooms P. E ta*, Chairman, Workmen's Compensation Commission, Bimon- date. RroBABn L. SeHMi?, International Representative, Compensation Department, 0 AW-CIO, Detroit, A. A, Soumitt, Vies President In Charge of Claim?, Corporal. Service, in., Detroit. Pass 8. Wabper, Attorney, Auto Owners Insnr&nee Co., Lansing. Minnesota Rosairr E. Fap.iov, Condhiaaionsr, Industrial Commission, St. Paul * M ississip pi Saw 8. ftuatzo, Commissioner, Workmen's Compensation Commission^ Jaskson. Joks? A, Csaso, Chairman. Workmesds CorftpsnS&Uon Commlsskm, Jaekson. Aftssonn WiuJ.m G. Boa a, Superintendent, Workmen' Compensation, AmericanAssoes&tad Insurance Companies, St, Louis. Csa&lss E. Catss, Member, Industrial Commission, Jefferson City. Ea s F. Chest, AaAiHfcaot Professor, St. Louis University, St. Lous?. E. EdShy Do, Attorney, Kansas City, W, E. FassLajm, Member, Industrial Coxnmlasion, Jefferaoxi City, Bess sea H. Gtvsss, Director, Division of Workmen's Competisiitioxi, Jeffers City. Sysiusrsn <1. Msxmsrr, Chairman, industrial Commission, Jefferson City. M eitiana W* W. Case, Secretary, Industrial Aoeident Board, Helena. New Jersey VDusron B ta mx, Chubb & Sons, Managers, Federal Insurance Co., Short Hills, D a, H. E. B ssckbr, Ken' Lisbon. Caea, HcmosmuAU, Commissioner, Department ol Labor A Industry, Trenton. Daman A. Si'AHi, Director, Division of Workmen' Compensation, Department of Labor & Industry, Trenton. New Mexico Ess* Jossa, Assistant Commissioner, Labor and Industrial Commission. Santa Fo. APPKNBXX C Nevi York Evks E. Manager, QI&ts & Bafety Department, fkje5?"as5jm Oil Co.. lue., New York. Loots &ssrr, Actuary, Woodward & FondiUer, Now York. H, DtmpKx Bjsuup, Director, Compensation &Safety, Bffida Locomotive Oo>, Schenectady. Miss GssfrsBS Cavarauob, Workmen's Conipeimiioa Board, Albany, U m O n i > CaveM-t, lis e President, Fidelity Casualty Co. Mew York. Otit'SS T, Cpastom, New York. M!S8a3>x. Dawson, Past Seereifsry-Yreasnrer, IMBC, New York. J. A. Darr&scKSESj Seoret&ry-ComptJroiler, Mation&i Council on Canrpensation inaurane, New York. Bessaijs XBssrtf, State Insurance Fond, New York. Miss Mary Botrt-os, Chairman. Workmen's Comjxms&f.ion Board, New York. J. Ras,- X>raas, United Sta* Casualty Co>, New York. ,Tosto?tt Dbas E oxvaeus. Attorney, New York. BtpftSa Fo'atU.EK, Woodward & Fondider, New- York. G. Ear.e .Fox, Secretary, Casuali v Hivision, Glens Fails Insurance Co. Glens mm Ds, L&oras J. Gounv vessa, National Chairman, CardiaadR-ilndastry Coi' msttee, American Heart Assodai ion, New York, Wfw,sa G. Gotmnr, C. E.. Dimeter. Instil iste for ike Crippled m Disabled, New York Mas BAUBMf* Hakcok, Assodate fkisooniist, Workmen's Compensation Board, Nett- York. Appssp Hemxx, United Steelworkers of America, Beffalo. Thkiioss B STStuas, Jm. Attorney, National AssoeMimi of Mutual Casualty Cos., New York. P, H. B uva-muss, A. C. F. Industries, New York. il M. J aoksjk, Manager. Industrial Health' Program, Johns Matsville Corp., New York. Akorew Kaomykow, New York. Enwiii D. Kyle, Conosci, New York Compensation Insurance Rating Board, Now York. M. L. LasrOwski, Western. Etectric Co., Iocs., New York. Josttr M, AIoDosal. Dirsi-ior, Workmen's Compensation, Assoeiated loduatries of New York Stato, Inc., Albany. Books'? E. M ajssham, Administrative Deputy, Workmen's Compensation Board, New York- 'Gm&m & Mv m a m , Manager, Workmen's Compensa; ion & Disshlisty CMtoe Division, Ameriesi: Sorely Co., New York. M?kas. I. Mwrpky, General Manager, AasoemtiOii of New York -State Mutual Casualty Cos., New York. Rat J. Oakley, Stato Insnranee Fund, Now York. Miss Marios Polascov, Secretary, United Steelworkers of America, Buffalo. Miss Mahv Poi.orov, Buffrdn.. J asiss J. E koao, Secretary, The BelMnstirers Association, New York. E. Y. Bva.%Fidelity Casualty Co. of Mew York, New York, Hsnsk D. Sayko, General Mimager, New York Compensation losaraaee Rating Board, New York. , M, Schkbt, Insaranse Manager, National Cmmcli of giste Ssif-Irumrers Association, New York. ism is s r a i mum m Jambs &, Shirros, Attorney American Telephone <k Telegraph Co., New York. Ctsus F. Smtthr, Claims Attorney, New York Telephone Co., New York. Wkrsam H. Ssraonrra, Assodate Attorney, State Insyrane Fumi, New York. J. Masut TjeknaN, Attorney, United Steelworkers of America, Buffalo. Wanan C. T ucker, Counsel, Utica Mutual Insurance Co., Utica. Gao, B. Wells, Western Electric Co., Inc., New York. N. M a m m Woods, Association of Casualty & Surety Cos., New York. Da. M. Wsluam &OCSSS, Director of Studies, Commerce Industry Association of New York, New York, North Carolina J. W. Beam, Commissioner, industrial Coruss1ou, Baleigh, North Dakota Orm Errant, Chairman, Workmen's Compensation Bureau, Bismarck. B. M , E van, Member, Workmen's Compensation Bureau, Bismarck. Ohio EL D. Banobbt, Emile E. Watson, Columbus. Jacob Clavmak, Secretary-Treasurer, Ohio CIO Council, Columbus, J, Maswaku Dxckbrson, Vice Chairman, Industrial Commission, Columbus. B< O. CorrEMOSLthB, Superintendent of Claims, Farm Bureau Mutual Auto Insurance Co., Columbus. W. C . K astman, Attorney, Squire, Sanders & Dempsey, Cleveland. M, H olrano Katsu, Director, Workmen's Compensation. Frigidaire Division, General Motors, Dayton. John Komw, United Bufeber Workers, Akron. Eicuaeo W. Mosse, Chairman, Industrial Commission, Columbus. Charles F. N uttes, B. F. Goodrich Co., Akron, Thomas M> Harman, Jones, Day, Coekiey & Beavi, Cleveland. Oklahoma Fun Ajlskht, Industrial Commission, Oklahoma City, Marx ChxU>rrs, Industrial Commission, Oklahoma City, J ustus Albert C. H unt, Industrial Commission, Okiahoiua City. T om G, M astsn, Commissioner, State Insurance Fund. Oklahoma City, Most E. Powsnu, Chief Attorney, State Insurance Fund, Oklahoma City. . J. Sthebrano, Industrial Commission, Oklahoma City. Oregon L, O. Arens, Member, industrial Accident Commission, Salem. Wxllxam A, Caj^ abam, Chairman, Industrial Accident Gommisskm, Salens. Pennsylvania W. E- Barnako, Manager, Compensation and Safety, Bethlehem Steel Co., Bethlehem. Frane K. Boar, Deputy Secretary, Department of Labor and Industry, Harris burg, A. C. Cast&TKAK, Chief Supervisor, Indemnity Insurance Co. of North America, Philadelphia, W. B. Coaxley, Secretary, Fire Association Of Philadelphia, Philadelphia, E. Gwmaaam, Manager, State Workmen's Insurance Fund, Harrisburg. E. M, E astman, Assistant Manager. Compensation and Safety, Bethlehem Steel PFfeliMX 28? RoeST C. Hbeo, Bopermtendnt, Compensation Classa Department, Americar. Casualty Co., Heading. Russel C. Ksisbb, Assistant Manager, State Workmen's Insuthoe Fund, H&rrisburg. Witss Lms, Secretary-Treasurer, National Council of State Belf-lnaum-a Association, Philadelphia, J ohn L< Navlok, Director, Bureau of Workmen's Compensation, Harrisburg. F, fmrcsA&o, Chief Safety Inspector, State Workmen's laaui'aaee P h ^ Harris burg. A. Scarno, Generai Attorney, Pennsylvania Railroad Co,, Philadelphia. Davib M. WansusE, Secretary, Department of Labor 4kIndustry, Harrisburg. Puerto Rico Mtm Rauusl Ngaousons, Member, Industrial Commission, Sad Joan. Eotrseoo A, Santiago, Actuary, State Insurance Fund, San Juan. Rhode Island Antonio Dr Fnto, Esecutive Assistant Curativa Center, Department of Labor, Providence. Db. J ohn . Dcnhby, dedicai Director, Curative Center, Department of Labor, Providence. South Carolina Miss Faith Coatton, Commissioner, Industrial Commission, Columbia. Jsassa J, Earn, Vice Chairman, Industriai Commission, Columbia. Mas. H, S. Tam, Columbia. Tennessee W. H, Pa&ham, Commissioner, Department of Labor, Nashville. Pago A. Paiu., Safety Enginenr, Department of Labor, Nashville. Dbwbv WHims, Director,, Division of Workmen's Compensation, Department of Labor, Nasinoile. De, V. O. Bam, Chief Physician, Humbie Oil A; Refining Co., Houston. R. L. Ecsaan, Vice President, Petroleum Casualty Co., Houston. L. H, Fasa-EU.EN, Chairman, Industria' Accident Board, Aixstin. Wkusx , Raymbb, President, Petroleum Casualty Co.,- Houston. Virginia Mm. C. B, Hitch, Richmond. W. H. Nickels, is ., Chairman, Department of Workmen's Compensation, Richmond Washington Elmeb H. Kennsov, Supervisor, Rehabilitation Center, Department of Labor mid Industries, Olympia. West Virgnia Da, John P. Barca:, Chairman, Occupational Discus; Medical Board, Charleston. Fsanhshn W. Kekx, Executive Secretary;, Workmen's Compensation Fund, Charleston. RuDonea J. MtianNSSur, largai Assistant, Workmen's Compensation Fund, Charleston. Gboboe W. Stokes, Oommiasitoner, Workmen's Compensation Fuad, Charleston. m mm fflmsmm mum Wismsi av^'Xiwx;^ v # B ;H Ksmm&i T m P^dfest Eaf&$t MytsMs, Waaa&u, Wm,im-&Lsmvjm, mMzat M ia tm j Gtmm&l, Mmiistm, I: M>l&tsftfe Mias Caaum- EmyBy<m MMu&ls, W m m i. BL&b b t 4 . N s& SSi, D s c ta ? , 'Wvrkrxi&z's C o m p sas& tlo , Irsd aalri& l Yrnttmn,. _ f Ws&'S'g,, f e a s Jaa*tl esassSsto, M&dte?, C nysm nm km , Wyoming Wm&m. F, S'f&j M aster, Werksjssa'g Kapejm-tks mmissios, Ubsys.^ I 'il? gf|f%g'il>: g?:f;I:C" l || 11:i: .;C,s>.astt . CTmmM inm i m m m W m n m ,: i f y ttfi:i^i:*h-:*i'iii I P R O E E B IN G S ~ ~ ~ 4 0 ih A n m m C o n v e n tio n q f th e In te r n a t io n a l A s s o c ia tio n o f In d u s t r ia l A c c id e n t B o a rd s a n d C o m m is s io n s ? Q u e b e c^ C a n a d a O ctober $~79 1934 Workmen's Compensation Problems 1054 BULLETIN ISO UNITE STATES DEPARTMENT OF LABOR Jam es P MltefeelR S ecretary m A U OP LABOE STAND EES Paul B Gusske Dimstur fill : ! M S i i | ' ,1 < of the 40th saxosa! eosTeattou of the lotera&tkm&I m k m m ^ which w&s M d m Quebec, O&u&de, osmaikoi have bees ms of the Bureau \.-:'Kiee t^'i! !J llp i$ ? f Cf:|f;ill !e m mu wmmm- of ummc C fe tijM tib a a l. 5!= W & zm s W,, I).. i&uimm M. IX, Ckipj* Bmdrmmmrn mmr S&cAm, Ctmmr im'&M, Uo ; PuMkt Mmkh Samoa, Wmimgim* h , A* Scope Occupational eases? kanards have plagued m&Mkkxd for thousands n i jm m , Undue exposure to agents 0! m r natural environment aunts t solar radiation. or iideeiltme with the werng Schistosoma hemsiobiung have doubtlessly bees responsible for the oeeurronee of cancers of the exposed skin among ontdm r workers and of causer of t i e bladder among farmers of tbe Mile Talley m m during prehistoric tones. However, it was not mats! the advent of modem m d o stm tk m pome 150 years age th a t aeetipsfional and industry-related agents iliape attained a preeminent position in %m human e&ncer problem, N o t only are oeeugaiioual e&rsiaogans tbe only well defined known causes of human cancers* bu t their number and variety have steadily increased smee P o tt m 1775 & sf reiated ilia oeeurrenea of sorefal eaooer among chimney sweeps to their exposure to soot, O ar r e d imowfedge and appreciation of occupational saucer pro ducing agents as phenomena of modern m dostm lism dates bank some Fionas I, 75 years will* the discovery of the relation between the occurrence of akin cancer and m occupational exposure to coal ta r {%. 1). The data given m the foiowing tables (1 and la) briefly summarize the- salient additions to the information on occupational cancer hazards made since that time. They list the various chemical and physical agents so far recognized or strongly suspected as causes of cancer in man. They show, moreover, the different 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 recognised as caused by them. Tables 1.--Ocewp&tiondl Citnceri Becorded in ihe United States and Farzigii Qmntries up to 795M assist > ! Sites : Nuxalw af Hxuafesroi tielraioIePyS,A. to ma8p#*s Totoi Coal ter, pifcoh. Petroleum____ LigiUte fear arid p&raiOe.... Soot-carbon black... Aromatic . Arsenic..-. Asbestos... Ciiro5r.iE.tes. Nickel... . . . . . Coal tar, pitch.. Petroleum. Isopropyl.. Total..... ` Ai>proxirssie. 7 25 32 --d o ....-- 110 3. 150 3, 200 V. . flti* * / -V A 70 29 0 7 h 900 h 007 ... d o ..____ ^ ,.w V A - A. .S* 14 14 1. 40 41 ..i f e . . . . . . : . . V A M A M-A .M. A 20 20 .. ..dO.;. . . . . . . . . . . 1 b lad der.... m - too rod?*.__________. . Leofeeada. . (n m ISO s 200 ( ?) 13 131 % 600 (?) 29 >y . y .y . X; -y -y v 650 650 18 28 ..d o ....... m : : 83 S5 w 05 140 b ..do. . . ...... 0 84 84 Mmm o&v- \t top.: 10 51 55. b'ss&l sinus. f a., v . y , a, v. 0 S3 S3 7 88 1.0 it 81 : 42 T u n g ...___ 1 0 1 Lii.ryrx..,,.. 4 0 4 Nasal sinus. 6 0 6 Bonus________ . . . 9: 0 9 r Nasal sinus . A V-A. v ~ y . . . v .^ . y- iy 3 0 i 750 F T 050 3 B, 400 128 1954 MEETING OF 1AXABC T a b is I s --- Tim e Table of Discoveries of Oempaii&nal Cancers Kate nfagitai Otite j OSacovet' ; Organs affected WM&ppl exposure : \ Oiieisefts'-Orssni: &t. ,.....__ . .. .. tris <f e n . . .........................| Sfeiit __ .... ; Occupations). C sslU f Qnpatei..-........ i m i VsMtisaft. . . . . . t & k ............: Be, Coaitas (atiuirinoas;...^ sen 5 Batti............... ......... ( Vo. Cow tar (anthracite)....... Wio ? Zweig... . . . . . . . . . . . . . . ) Bit. Casi issi (fears)............. 1030 U s ti ..... . . . . . . . . . . . . . Ito. CrP&tSl* 0&.................. ... l 0 'DottvsB..**..**..**..$ Do. ABliaaeaa o il..___ . . . . ',m 1 ORvef.................... ......N, v. ..... Du. Bittaffitn r>15ishsla oil)..... t ;< S ilt.............. ...------- ,/ /v, .,A #.,,:>-,;>>.->v.;/w.:/v. X>0. fewnJcMK stai coke....... iSSO i BefOiic cU Ouer- t ..................... . 13. \ xrxffxftffc?.* Bsfcmfcuia parai&s ci!** m o i SciabjIbss----- -. . . . . . i .... J ........ ,..,.... ........ no. Patraiftxaj lifeiestingaS. I8SS | Bci-er..................... t. 4 X>0. Silfi) lubricating c U . . . imo i Wsison........ .... ...i .......4............. . Bo. ..... ............... 5S2 1 Peler 3t Bosgunrsao. ; On. Aroffiiaic asotfies tiys 38S. 1 t e h s . . . .......... .... .... J Mttkier, wetif. Ski' T>o> isstaratetiistes). re,r. tsses>riss3yi oii.......... 822 i Siu^ aI ^ .; Kasai sirtiises, iaryttg, 1>0. king. Oi!aa':iaiS" iiuifsnia: Afsec&s___...________ 5SS2 Sirin............................ IBS? j . ... j Me-SSeSrtsS. roc- \ Saure........................ ............ -............ Oeepe.i!areV. Astssias....................... i m X>c. C htcsastas...,____ . . . . t m : v m ............................ Do. Niakci........................... JS82 i Ctrm&SS..____ .......... Nasal css-tty and at- os. i uses, Seng. feyska! agartts: XHiraifiok-i rai-tstica__ 2MH l Usism.......................... Shift........... i So. BiivirsMneritsS. %ix-xngfi(^!&C<i'AtUm........ J802 1 Friebers__ . . . . . . . . . . . . .......<io........... ........ . Oeeejjaticms!. 5308 ; Wsess.,......................, Midicina;. 580 : Vt>Cl h's^iy Bf'hwSCtX & Bawd-ferittirts tiw M . Oe\i.ptte<w\. ; eoe SkisaarecA. i82S i Beck..,.....,,....... . Basioseiva subsists. 5878 ; ITserttag -4 Hftsse..,^.. Baa*....... ............... . Oe'.fjatSartftS. 2823 McNr!, V s; t: swxi Sfeiii.......................... I>0. ! wxiiis. !83 : ___ .... Bitxttl-fartnia.ir tissues. Vo. SS3! ; MorUanfl___........... Bona........................... Da. However, an iadiserimirs.* acceptance of these figures as reflecting the actual scope of the occupational cancer liasards would seriously :be misleading for the following reasons. The presence of occupational cancer hasards has so far been established for only a few worker groups having contact with one or several of the carcinogenic agonia listed. While, for instance, it is generally known th a t workers em ployed hi gav works and coal ta r 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 electrode .workers in alntninuBi. production..plants..where an exposure to fumes from tlie oknfmdps consisting of a mixture of co&l tar, pitch, and petroleum oka Mists. Reliable information, however, is out hand th a t these workers suffer from cancers of the skin and. possibly , also tb s respiratory tract. The extent of this exposure hazard m ay he estimated by the fact that approximately two-thirds of a pound of electrode carbon is consumed for each pound of metallic aluminum produced, of which 800,000 short tons were consumed in the United States hi 1945. I t is equally significant th at agents which have been reported to have caused occupational cancers among workers of an industry of ono country, do n ot seem to have the same effect upon the workers of an identical industry of another country, if the available data would he accepted a t their face value. Since carcinogens behave in their fundamentaldisease-producing properties like pathogenic micro organisms, there is no sound reason to assume th a t carcinogens make any distinctions in their activity or effectiveness for any national reasons. In feet, it can be shown th at such scientifically incom prehensible discrepancies are mainly due to local differences of report ing of occupational cancer casus. The existence of an excessive liability of gas house retort and coke oven workers to cancer of the lung: has been reported from Japan, Canada, and England, bu t n o t from any other country despite the fact th a t the exposure conditions for workers employed In such opera tions arc identical. The occurrence of an appreciable number of arsenic cancers of the skin among German users of arsenical 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 he led to believe th a t arsenical in our part of the world are carcinogenic for almost exclusively medicinal reasons. Again, it is herd to assume th a t arsenicak would make such dis tinctions. A similar situation seems to exist concerning the car cinogenicity 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 eases of skin can cers due to occupational contact w ith hibrieating oils, practically nothing is officially known as to the existence of such industrial diseases from the countries on this side of the Atlantic. One seems to he content with attributing here the English observations to the carcinogenic action of shale oik, the large-scale industrial use of which was discontinued during the 1920k, and therefore cannot account for the more recent English cancer casca observed among spinners, mechanics, engineers and other workers having had exclusive con tact with lubricating and cooling oils of petroleum derivation. 1854 OF XAIABC I t is worth noting in tin, connection th a t during the last. 20 years, there has been an almost complete lack of published additions to the list of occupational coal 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 th at the annual reports of the Chief Inspector of Factories of England and Wales have regularly listed notifications of such lesions to the extent of from 100 to 250 cases per year. One m ay also reflect on the fact th a t the last published figures on occupational Cancers in American dye workers appeared in 1908 and listed less than 100 cases, &|] occurring among employees of one com pany. During the intervening IS 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 dvos and rubber anti oxidants. In contrast, recent, reports by English investigators sup ported by the English chemical industries have supplied adequate figures oh the number, incidence rates, and attack risks of bladder cancer among English dye and rubber workers who had been exposed to the same carcmogenic aromatic amines with which the correspond ing worker groups in this country have occupational contact. Mnulfy, some consideration must ha given to the fact th at the general population has varying degrees of contact with some of tbs 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 in such a polluted environment and used in part for nutritional purposes. In the nasi, claims as to the occurrence of so-called "neighborhood" cases of cancer have rarely been made. The Well established former occurrence of arsenic cancers among inhabitants of & German region in which the drinking water supply was polluted with arsenic from mine slag heaps represents the first occurrence of this type. Follo wing the discovery of bladder cancer hazards among German dye workers, if was asserted 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 eases" of berylliosis makes such claims appear as not unreasonable possibilities since a highly potent carcinogen, such as bef-a-naphthylarn'no. is involved which might, have produced such results if the waste disposal and housekeeping methods of the plant were Inadequate. I t is probable th a t the future occurrence of cancers of the lung and bone among individuals who lived near beryilinm- p ro d o c ia g m p r^ ^ f a ^ T ? h g m r 7 n ig h t fa m is h e v id e n c e o f- OCSBB 6-- MOKNNO SESSION csm er hasards related to environmental plant pollution if beryllium sad Its compounds are not only carcinogenic for rats and rabbits but also for m m . Similar conditions of industrial atmospheric pollution exist around arsenic smelters, chromate producing plants, carbon Mack factories and oil refineries, as well as uranium ore milk. The recant 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 e&neers from industry-related sources, such as exposure to carcinogens contained in the exhaust fumes from diesel and gasoline engines, or present as additives and cont aminants in foodstuffs. I t appears from those considerations th a t there can be no doubt th a t the actual number of occupational cancers is considerably higher than the number of eases placed on record. If is of some interest, moreover, th a t 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 be cause compensation Maims in many such cases have been settled ont of court, W ith a few exceptions, such as the incidence of lung cancer among American chromate manufacturers and among German and Cseehoslov aid an radioactive ore miners, of nasal sinus, larynx and lung tumors among American isopropyl alcohol manufacturers, and of skin cancer among English mal ta r manufacturers and processors, no reliableinformation is available on the incidence rate of occupational Cancers of the various types among different occupational population groups. B. Special Aspects q f 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 non-occupatkmal environmental (medi cinal, dietary, cosmetic, habitual) as well as "spontaneous" cancers. 2. Drjmitiqn / the Term uOemp&twnal Cancer'1.---The term "oc cupational cancer" is applied to malignant tumors originating in individuals during the course, and/or as the result of the regular and usually prolonged exercise of certain occupational activities entailing contact with some exogenous, physical, chemical or parasitic agent acting in proper intensity. Occupational cancers thus arc caused by specific agents or tiologie ally 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.wMeh result 1mm or follow' upon acme extraor W M M m m s of u u b c dinary. unforeseen, accidental injury sustained at work and feeing of a nonspecific nature. $. Types, and Nature oj Qs&tip&limal (Mrcinogen#,--Occupational agent which are known or strongly suspected as having caused cancers of various organs in workers who became exposed to them are largely chemicals. Some of these chemicals are well defined, others consist of variable mixtures of a large number of chemical com pounds, a few of which possess carcinogenic properties. A second group of occupational carcinogens is composed of agents characterized fey 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 he 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). T abbb 2.-- Ociiptiionai Oarcinogena--- Their Ernie of Exposure end Their Target iM W W A W iW W W A W A - Ganef? typa SpeOi type Riait? et exposaite Target Oxgn Cfcamss&i csrcSnogins; Ofjfsaic ehsajicaSs--'j.romatic. mSVsrfiia hi>t* eroeyile Bvnsot. Sata-aspbOiyferainc-, teiU- dite 4.tik;in<ah('yi<aar6. avarie, Eaegeia ?) (tafeV Cixtnit, re sp ira tory. Respiratory, e a ta a eus, firaentKry. Siead-ferrsic.? a r g a a s iftntkrtot, iyiaphesar* coaa, osyeiotas'i. erogenous orsaca (fend" dit, ureter, kUaey). Cea! ter, pit?!, soot, aSfteX fer 2, creosote a, atteinsaeae oi? israp tdacfc, iigttiw fer te parsia ait. Syothetf W? U and fer OafeBpi35___.......... Respiratory.. _______ . Ouraasoas.. . . . . . . . . . . SkJn, Skis. A?iph8$e...,,.___ tQfgafi S te p s C&S. Shale all arid paraf ....... Ifefooienfe tuai 8, 8;sei 8, JBbiatiss oi at;8 grass*, CBtia? 08, sraua b te k , asp?!??., fer, coke, erada paradin ait sopfopy? o . .., fsauie____ . . ......___. . . . . . NicfeoS.. . . . . . . ------------------ . . ...*,.. . ............. ........ RSpatoy___ ...___ Ciitaaaous.. . . . . . . . . . . . Revoittory.---------- , isfetete:, Sijgsm#.:, rafer. . . . . . . . . , . . ........................ mefeegs: Ohrixjjfem__ ._..__ Asbestos....... ........... . Xraisiiari..,,*..... . ,*,,__ ..Ce....... _.<fe,........ .......... f OafemnS____ |: trmseivu&ysk ; RaSaaotlwratifstfea {Cpha-, vij .-r.;<w.; i befe, sud Sfea&-rsdiatfc<?3). lrm?BKiaa??ism. Sfeseiwsry,..-.. 1ittr-if rXti.SiVCiSIXi.... . Ce. jarasu Ski, Uuf>K. Vsaisifeia, iarjfex.Sung. Skia. tarty. Noet essit-y, sss: ilium* iung, O*. Cotiflaotfv ifssite, hase, Mood-fdsraiag gsm, SAi. CvareeUye tissus, Ma<>& fcfifa raws. Nas? ftiau .tg. Boue. $$ P f ; 1S hI ' S' 8 Il : & g ?' h. 1 sy g s g g t% " r S : F *r*t ; & <r : g /3*.?*rr3 1 te! ? & S. :K5itfr' ??'.-tJ~ '*S<. : g. m f : ;: : 8 ry :5 : mr* ? $'*'"r"" """ i >> > < > < > & $*:: . * ri 1 : >.. j:-: ;'j .>:::> ..........r "; < <X 3t X;T* *3 v* ^ It , Is g a : s c Ex, 1 1 M; ^<> *S ^ s >egt- & S o a s 55. gy.-w : ! b <* ; | a g i? I * f I f g II; g: $? S . <5 S W O <? & .>yg.' , a ^ S. (*f>< f-k. 3 ! 0 I <? ;s I > & s r**' y& wp I l f l ! $r* &$ ir* S8 : i ? &r ; ; g; '. K.s S- h> ; te : S : te \ **? 1>$r 2 # <> &rQKt Qs s> <Ic& ~ o O P 2T *& O S ig <* 3. & >. sa h5-^<>5 g, g & * g s-s* I I 1 25 ! $&s3g <W*>v % 1M4 M OE T $ OF AABC TxBfeg ,-- 'Polvtial .Bmirmtmmkd Human Carcinogen#--Continued Agai ::?JgS groas SF ferftUaf fes FC? issi grass FOB, O-Jiiofefesac, poiaifey- esa, paisasai ny- So), fesisefeto foe, ptsiymei&$ aafeao* Sfe. e su m a r | 'T^ ^ X' Snbut&ftaoas Fsaarfensd.... ipastos j Types (> fcumsin eonUots ~------ J ..-- ---------- H&. J Tsitile dyes. Food ae-3 Kj&msii 3yoa. v * r.,, .. . . . ___s Oral... fetalira.. Sabontsneoas.. ; B fersteU Z&! Fod yo ftwtont). Gsolk flyi. Fiora color. Film, feaf, plssticdadesiria! issaafsctia-e and sscs. Wrapping rasiefiul. Msdiairiai aggnt Bsrryiiam.. Sosa. J ?a:&r&5.., ! AarsissS'v* Sesniuss......,.,.......... Vtf, Sfe?iO.-J; OrsL Cobalt.,.... . . . . . . . . . . . . Safecat&asas \ Ps-sjiar,. Bafebk. Sisa....... ..fej... A y ..d fe x Matai siiay, X-ray tab, phosphor mariufectnra. Bahaatary nasse!. Atosai artorpy prodtoSon. Soft opsssiSjiaa. \ Cntofing matter of glass, ` sasales. paiat, fubbar, I MfitBt alloys, j Knfebar aeceksitfef. I Ffebiefefestrfc app&totus. > Beoolwisfef, I FftyptooSay agoni, j hedofemi agssii . { Matai alloy* ac>3 plating. I Odorisg noiitor of a!s*( oeraadto, paia". rnbbar. i Misiioinsi sgasi. T ascs 4.-~C nrcinagenic C h m v e a h E lim in a ted as E m irm m n M H u m a n gate Sito nt ftiiear |AWW|-V>A'WMM/M>/WM-MW; Siyryi *38............. Siibsaisoeans tlstoa. S'A*s'! .aao-f'totoSA. Sdhaatanaons tissa. i Xissfar_____ I rate. Thyroid. : Acodstie daet, Breast. I aifeasnia. i Kidney, I Idiag. Typa et asposara fepask-s L i iis i t o k t o i . . . . . . . ! fe to 'to ? ........ : i I <t-. ...,,,..... ~ .....,,do..........,.i Faastis&S..........i: lis t.............; . . fetos...,..... ....,,i ....... j ....,' , 3 atondsd usa A ra;;;iSaaifid dyeAl insaatiaida. $. E v d m tk n of BmAence.-- Fov the establishment of causal rela tions between an exposure to these agents and the subsequent develops m ent of a cancer of an. occupational genesis and therefore compensable nature, the following prerequisites m ust be fulfilled: O C T O B E R S-- M O R N IN G S E S S IO N 135 (a) Definite evidence must be available indicating th a t the claimant had occupational contact with, any one of the various agents listed, th at 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 he 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 carcinogenic depot in the tissues from which a prolonged exposure of the host organism may ensue. () The route of exposure to or introduction of the carcinogenic agent in addition to its spcifi chemical properties and metabolic peculiarities determine the sits of the organ or tissues in which a cancer is elicited. Therefore, not any cancer, bu t only cancers of spcifi sites aro related to any particular carcinogenic agent* (c) The type of exposure does not need to bo continuous or extend up to the time of appearance of the cancer, hut may be interm ittent, 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, bu t also by workers entering such oprations on a transitory basis, such as supervisors, maintenance personnel, repairmen, truckers, loaders, yardmen, and workers employed in rooms and buildings near the hazardous opera tions, if housekeeping and exhaust disposal methods are inadequate and environmental contaminations result. (d) Occpaiofil M edimi Stigmaia.--iBoT the establishment of causal relations between occupational exposures to carcinogens and sub sequently appearing cancers, it is of distinct value to analyze tbs medical history of the affected persons for functional or anatomic disease manifestations characteristic of a pathogenic action of the particular carcinogen allegedly involved. Such noneaneerous and often preparatory or ptec&necrotts symptoms of tiologie specificity act as stigm ata or biologic finger prints supporting not only the actuality of a previously sustained specific exposure, but also its Causal relationship to the cancer present. Symptomatic manifesta lions possessing such a significance are, for instance, chronic radiodormatitis, chronic ta r dermatitis, arsenic, dermatosis, chronic solar dermatitis, chronic radiation, periostitis, asbestesis of the lung, and ieukemoid 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 spnrifie..nctnipatioiial...cariftiaogcri:a,. such, as arsenic,. chromium,, nickel,.. radioactive substances, and benzol. 1954 MBBTING 03? IA1ABG I t is Important, however, to note th a t both those procedures are not applicable for all occupational cancers. Some of the carcinogens do not produce any etio'fogic-ally characteristic symptoms, in fact, thay 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 symptoms after more than one or two decades of continuous, intermittent* or dis continued exposure to certain carcinogenic aromatic amines. There also docs not exist any parallelism between the toxic and/or irritative properties of any chemical and its potential carcinogenic qualities, nor, is there &relationship between, the degree, of toxicity of any particular carcinogen and its relative carcinogenic potency. (e) Extensive experience with occupational cancers indicates th at there usually elapses a latent period of years, if not decades, between the onset of exposures t-o a carcinogenic agent and the appearance of the resulting cancer {table 5). I t is for this reason most unlikely that occupational cancers become manifest within the first year following the inception of contact with &carcinogenic agent. In fact, all cancers which make their appearance during the first three years of occupation in a carcinogenic environment, should he subjected to severe scrutiny for & more probable xionoocupatioual origin before they may be considered from any occupational viewpoint. Table 5.--Latent Periods of Occupational Cancers Organand agent Average fniest Rang of | period lataatiserii'ii Skin Au-xudi;: 1 Medssinsil__ Occupational. ...--------j T a r.._____ ____ Creosote oil..____ 1 Mineral oil...___ - ....-- Crude parai&n oil- Solar radiation.. ............ | X-radiation........ - i Lang | Asbestos. .. .. . .. Cbromatos_____ ----- 1 Nickel earbonyi-- _____ : Tar fumes_____ _ ............................ ............. ....... ____ 16 fhfciMhp radiation. | Aromatic nines... Bladder Years 25 50-M 20-gO *? 18 15 22 ; Years 3- 40 4- 46 1-50 15-40 4-75 8-85 t-12 15-21 5 - 47 6- 30 0-23 7- 50 2-10 OCTBKt 6-- MORNING SESSION 13? (J) A successful production of cancers la experimental animais fcy t he administration. of any particular chemical or occupational agent supplies weighty support to & claim th a t such a factor may have an identical effect upon roan, especially, if the route of exposure, the phyaiochemical status of the agent during contact, and the cancer produced in piperimental animals are identical with the corresponding aspects m human experience. However, because of the pronounced species specificity of axogenous carcinogenic agents, even positiva experimental evidence provides merely strongly suggestive hut not entirely conclusive evidence as to the existence of carcinogenic proper ties of soph agents for man. Only "human experience gives a definite and irrefutable answer in such matters. (if; Pathologic and histologic evidence is in general of only limited importance in the establishment of the occupational causation of cancers, since neither the clinical behavior nor the gross appearance and histologic structure of cancers are etiology specific. However, in some occupational cancers histologically or Mstoehenneally demon strable manifestations are present which give conclusive or suggestive evidence as to their particular etiology. The presence of asbestos bodies and asbestoses, in a lung affected b y cancer provides practical and scientific, proof as to the ashesto?ic origin of such a pvdmonary carcinoma. Of similar causal significance would lie the demonstration of chromlfe dus? hv msfochemiral methods and by incineration of sections of the lung of art individu# with pulmonary carcinoma. The hiaioehemieai demonstration of arsenic hi the skin affected by a carcinoma represents another illustration of the value of histologic studios in the determination of the et iology of a cancer, likew ise the presence of extensive endarioriue changes in a fibrosed subcuta neous tissue containing a carcinoma or sarcoma would arouse the sus picion that X-rays or radioactive energy was causally responsible for the malignant lesion. It appears from these considerations that competent- and critical evaluation of the entire evidence related to the exposure of the individ ual the symptomatic manifestations of the preparatory period, the length of the latent period, the site of the cancer, some histologie or histochomical characteristics and the existence of corresponding ob servations on cancer production in experimental animals aside from pertinent epidemiologic data represents the scientific basis essential for medicolegal decisions in litigations of alleged occupational cancers. C. xfmpen.su Zion Lutm Workmen's compensation laws enacted in various countries and states reveal a remarkable lack of uniformity as to the types of oc cupational carcinogenic agents, industrial operations with carcinogenic .......... SS85P ... .... ... .. ........... ... 13; ISM MBBTIH0 OF iEAIABC haa&rds, and occupational cancers covered, As of October i, 1954, full coverage laws applying to all kinds of occupational diseases in cluding eased* bad been passed in 26 States of tb s United States and the District of Colombia; schedule coverage laws not always 'covering occupational cancers, or all types, were in force in 20 States and no occupational disease laws had been enacted at. th a t time in 2 States (Mississippi 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 obsolete, in an era of a rapidly changing- and in creasing occupational disease panorama. Such static law's reflect a legal and soelologic 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 st atute of limita tions which is inadequate for providing fair protection under certain and not too unusual circumstances m et with in occupational cancer. Since occupational cancers may become manifest many years after cessation of exposure to occupational carcinogenic agents, a statutory time clause of from 6 months to 6 yearn may be too short for occupa tional cancers which m ay appear after a longer period. I t is advisable for this reason to adjust all existing laws in such a way th a t such eventualities arc 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, arc excluded from coverage by the law. Since farming as well as housework have become anti are increasingly be coming occupations having extensive contact with industrial products (pesticides, herbicides, synthetic fertilizers, antbprouting agents, hormonal fattening agents of livestock, lubricants and fuel of farm machinery, residual oils for smudge pots, soil 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. W iistfyiyy:i y|pIIJfyy llib ililiii yf iilgpl! yfyii|y|ii ciyiyiyiyty OCTOBER 6-- MOREi&G SKS8X0N 139 3 , J.Mbm Cade m id Standards A n y Attempt toward achioving an adequate compensation by finan eial means for & cancerous condition acquired through contact with occupational agents not only presents considerable economic dif ficulties but is also of questionable humane merit. While such & procedure is evidently the best that can be done after an occupational cancer has become an accomplished fact, the wiser, snore rational, and in the long run, more economical approach to a reasonable com troi 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 th at 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 bo 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. Tins information would provide the basis for establishing the supervision of plants by health and labor agencies and would create the proper machinery for familiarising managers of such opera tions with the potential carcinogenic properties of the substances and devices used in their establishments and with the methods and pro red ores 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 alter their introduction. It is therefore desirable th a t provisions bo made for routinely recording all cancer eases occurring among worker groups exposed to occupations! carcinogens. All precaneerous and cancerous lesions observed among members of such groups should for this reason he made notifiable with the State health agency. All persons having knowledge of those cancers should fee held responsible for such report ing. The adoption of such measures represents an im portant stop 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 groat deal of circumstantial and direct evidence incriminates recent changes in the industry-related environmental factors for the startling and progressive increase in the lung cancer frequency observed 140 1854 MEETING OF 1AIABC in all indtistri&liged countries during the past 50 years (graph 1). A similar, while pot as marked, rise in m ortality rates has been observed during the last two decades for cancers of the blood forming tissues, especially leukemias, for which the crude m ortality rate increased from 1.0 per 100,000 of the population in 1900 to 4.3 per 100,000 in 1844. 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. OCTOBER 8-- MORXIEO SESSION 141 I t also m ay be of significance th a t the age-specMc, total and R e adjusted m ortality rates per 100,000 population for slrin 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 (table 6). Whether such changes in the age distribution of akin cancers for both sexes may have resulted from the modern habit of sun bathing or a more intense environmental, occupational and dietary contact of the general population with arsenical, or with products of the cos! ta r and petroleum industry, remains at present a m atter of speculation. For determining the possible causal signifi cance of such factors in this development, It would be necessary to ascertain data on occupational, dietary, environmental and habitual contacts of the affected individuals, their complexion and race, and TxfciiE 6.--Age-speeijlc, Total, and Age-adjusted Mortality lile* Per 100,009 Population jar Skin Cancer in White Males and White Fmales, United States, IQSO, m s , and 050 j 100 mm IM S 1 W SS i smbsm~mms Ifder Its______ 1e--24.... ,,_. -- 25-34__. . ___ _ 35-44,,,,___ , 45-54_____ ....... 55-84.................. 85-74....... .......... 75-84____ ____ 85 and over__ ... AMages____ __ Age adjusted 5... ............................ . J ................................ 1 . . . . . . ..................! . .._____ _________ 1 ................................. 1 ................................ i ................................ : - _ _ _ _ _ _ _ _ _ _ _ _ _ _ .! . -- ........5 .5 ________________ i .1 2 .2 2 .7 5 2 .5 8 :0 25. 7 8 8 .2 124. 2 4. 7 0. 08 I . 11 i . 46 ! 1 .8 5 1 2. 1 i 5 .3 | : 1 6 .0 I | 5 2 .3 I : 172. 4 1 3,2 ; a6 f i j 0 .0 5 j .5 4 : . 81 ! 1 .4 1 2. 7 i 5. 9 j 12. 8 ! 3 2 .6 ! 77. 5 j 2 ,9 1 2 .9 Witili fesmtes 82 m + 76 +65 + 22 + 11 --29 -58 -55 Under 1.5-----1 5 - 2 4 ._______ 25-34..._____ 55-44...............: 45-54............... s s - e - i................. 65-74___ ____ 75-54-- . . . . . 854'. --------: AMages.... . . . Age adjusted 5. . ,, .......... .... ; __________ - _ _ _ _ _ _ _ _ _ _ i i ...................................................................... __________________ ____________ -- i .............................. i ____ _ _ 3. ______ 3 -- i ............................................................ . -- -- .! ------------- . . . . . . . . ______ 1 9 .0 7 .0 6 .2 3 . fsS p 11.4 44. 6 2.9 0 07 I > . 13 j .23 i . 55 I i j v0 l * .: 22 { 8. 7 ] 1 26. 3 if | 132. 7 | i 20 1 2. i 0 02 . 31 .72 L 2 1 f 3 6 6.8 j 18.8 i 88. 5 j 2Q ; 1. 9 " 1 --7I + 138 + 213 + 118 -f-SO + 24 48 mm MEETING OF 1AXABG on tii location of the cancers in the exposed or nnexposed parts of the akin (site distribution). All such data could readily fee obtained for occupational factors if all occupational cancers would fee made notifiable. A t the same time this measure would fee instrumental in ascertaining to a much greater degree than heretofore the scope of occupational cancer hazards and of the cancers resulting therefrom. The effectiveness of this pro cedure is strikingly illustrated fey a graph (graph 2) published several CUTANEOUS CANCER IN RELATION TO OCCUPATION tAAFHSMOW&kt f m. NUMP 0? M$ Or CUMCSUS AOOnOMAM W$jm a rfMAtesw a scort&Np mows m t w w t FUOM m ~ 8949 9 C U K . vouMmnr sm nm m m n fK m m s * um& mt \ \ >V/ \ || ..... .m'n'Sf'uy>m5m*sa ?<ss VCAFS, m r m m m m m m m $ r m m -m m m .... ................... Gsa?k 2, OCTOBBE 8-- MOBNNG 8ESS0N years ago by H enry in which he showed the striking rise in the number of eases of cutaneous carcinoma In males and femalee in England, Wales and Bentland attributable to occupai ional 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 asso ciated with the appearance of many new occupational health hasards of which those causing cancers occupy an important position, 2. The Increasing rate at which Occupational carcinogens have been, discovered during recent dee&des suggests that only a fraction of the actually existing industrial carcinogens is known and th a t here tofore unknown and new occupational carcinogens m ay he added to the present industrial environment through the development and use of new chemicals and production methods, 3. There k a great deal of evidence indicating th at only ft relatively small fraction of the cancers produced: through contact with occu pational carcinogens has been recognised and/or placed on record. Because of the established widespread industrial contact of large worker groups with known occupational carcinogens, the potential scope of the occupational cancer problem evidently is much larger than apparent from the reported number of occupational cancer cases and hasardons 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 claimant, the presence or absence and the type of any etiology, specific symptomatic manifestations observed during the latent and develop mental periods of the cancer, the length of the latent period, the site of the cancer, any specific histologic and 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 hasards because.of the dynamic state of modem industry .resulting in the constant addition of new chsmicals and production methods which may entail heretofore unknown occupational cancer hasards. 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 hasards and no t financial compensation for established occupational cancers appears to he the more sensible m d humane method of oeetipational cancer 144 i 8m m m m m o f ia ia b c control, labor codes should be properly adjusted ami enforced so as to eliminate or reasonably contain occupational cancer hazards in mod em industries. 7. For ascertaining the actual, scope of the occupational cancer problem and for the institution of adequate control measures, it is essential th at occupational cancers and preeanecrons conditions 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 au equally urgent investigation, of the apparent extension of industry-related cancer hazards to large parts of the general population, BmuOGRAPHY l> Heaps:, W. C!., Occupational Tumors and AUiod Diseases, C. 0, Thomas, Springfield, Hi,. 1.942, p, 887, Recent Developments in Environmental Cancer, A. Review, Arch, Pathol. In press. A MorliodobKy for Eavirosiamutaf sad Oeeijp&rloa&i Cancer Surveys* PubL Health Tech. Monograph No. I, II. 8. Public Health Service, Depart. meet of Health, Education and Welfare, 1858, p, 37. 2. Tsasso, V. M,, Occupations! Disease Reporting. Lb S. Department of Health, Education sad Welfare, PehL Health Service Puhl, No. 288, 1858, P- 803. SrzjKsa, lx. K., Recent Trends in Occupational Disease Legislation. Untv. Illinois Bull. -18; No, 88, 1851, p, 80. 4. M okgjs. G. ft., and D a vast our, 8, State Compensatory Provisions for Occupational Diseases. Bureau of Minus lofomr&tk) Circular 7858, U. S. Department of the Interior, 1852, p. 125. 5. Waters, To.. Industrial Physioian and Workmen's Compensation---Current Trends in Compensation Lagislatioa. J. Indnet. Pyg. and Toxicol. 51: : 2S1---255, 1049, : 8. Sukoousuttes ox Legsseatios Pam arena, A Rational Approach to Air Pollution; Legislation. Mannfaetaring Chemists' Assoe., 1882, p. 83. 7. Tockakoea!, F, .L, 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, 1848. T he A ccident Prevention A ssnetalions U nder th e Qsaebee W orkm en's Com perssatio n Law L H, T. Ccecc, President, Quebec Association, for the Pretention of Industrial Accidents | In the absence of Mr, Ciegg, hut su&emem ions read by J. Armand Dcsrsckers, eke president, Quebec Association fur ike Prevention of Accidents] i will time briefly the setup of the various safety assockitoiis, and later, being more familiar with the organization which I represent, I shah endeavour to elaborate on a few of it major promotional ...ft&tivitifis......... . ..... ............................. ............................ ............. m m m x c O fficial tteass.ce a l fis B a rile tti m m ai M eetlg th e In te rn a tio n a l A ssociati a f In sio stria l d~ d e a l B ea rd s m& C aoe oe tsstasss CASABA lberi . WmnxtOf M. B. 12., Commissioner, Workmen's Compensation Board, Ed monton. Bs< H. R, 'Bmaxim* CMe Medical &Mme, Workmen's Compensation Board, Edmonton. :, G. M, Macros, 0,, Chsirm&n, Workmen's Compensati*} Boat'd, Edmonton. British Columbia F, F. KCrnsKALO, Secretary, Workmen's Compensation Board, Vancouver, A x>am Bata, Chairman, Workmen's Cnnxpensatiou Board, Vaneoivr. C. W. FsrrcHB, Commissioner. Workmen's Compensation Board, Vancouver. Mftnoha Q, B. Cpsn?, % C.f Commissioner, Workmen's Compensation Board, WIn- aipeg. P. . E. Jones, Assistant to Commissionar, Workmen's Compensation Board. Winnipeg. Mow Brunswick A, * CHisKt-a, President, Now Brunswick Accident Prevention Association, Moncton. ....... ....... ..... .............. XG C. Johnston, Vice Chairman, Workmen's Compensation Board, St, John, J. , LeBlkc, Claims Mcer, Workmen's Compensation Board, St, John, Newfoundland Cs,A&aKen V. Hancock;, Commissioner, Workmen's Compensation Board, St. John's. Mam Scotia Am s s Parma, Commissioner, Workmen's Compensation Board, H&ld&r, f a m a Rows, Chairman, Workmen's Compensation Board, Halifax. Ontario J. F< CA3.ar, Vice Cimirm&m Workmen'Compensation Board, Toronto. Man Bonos, Ontario Federation o Babor, Toronto. F. Frncnasr. Workmen's Compensation Board, Toronto. Cssosob OssfO'* Casosns, Director, Federai Government Employees Cooipenea- tion Branch, Department o Labor, Ottawa. W,, .J. Johnston, Workmen's Compensation Board, Toronto. J. B. Dans, Department ai Babor, Ott&o-s, ....... .... .... . ..... . ...........: A vm atm x c L, B. Lssppa&o, Physicist, DivBios of Industrial Hygiene, Department of Health, Toronto. W&x Macoaospak, President, Canadian industrial Safety Conference, Toronto, V. C. Pasoas, Director, Canadian Branch of the I .L 0., Ottawa. G. B. Boot, Workmen's Compensation Board, Toronto. jxak Pomma, Department of Labor, Ottawa. A. Eossmsoa, Workmen's Compensation Board, Toronto. E. , SoAnaow, Chairman. Workman? Compensation Board, Toronto. Wassmsw W. Stkaens, Claims Manager, Liberty Mutual Insurance Co., Toronto. Da. E. C. Steels, Workmen's Compensation Board, Toronto. Da. Badcs YouSto, Director, Rehabilitation, Workmen's Compensation Board, Toronto. Quebec Braresar Babj. Safety Director, Quebec Iron Titanium Corporation, Sorel, . G, BAXAACHxy, President, Quebec Metal Mining Association, Norsada. Da, BarrrsAKO Bslluma, Workmen's Compensation Commission, Quebec. W, L. Bssnstt, President, Quebec Pulp A Paper Safety Association, Quebec. Jacuues Been. t, Montreal. Dm L< A. Bsocuu, Workmen's Compensation Commission, Quebec. Jacques Casobajn,, Department of Debar, Quebec. . S, Coon, Secretary-Manager, Quebec Fuip & Paper Safety Association, Quebec. Paon A. Cooks, Joint Manager, Quebec Industrial Accident Prevention Associa' tion, Quebec. . HkemAtr Cook, Safety Director, Canadian Car A Foundry Co., Ltd,, Montreal. J. AimAd B bsbocmS&s, Vice President, Quebec Aasoeiatioa for the Prevention of Industrial Accidents, Quebec. J, A. DpoKS-rr, Montreal. Jkak XhsgsAtmusa, Shawinigan Water &. Power Co., Montreal, Path, B ksjasmns, Assistant to President, Casgrain & Qtarboaneau, Montreal. J> E, Drorr, Workmen's Compensation Commission, Quebec, J. E. E, D esssss, Workmen's Compensation Comxaisssioi:, Quebec, J, II. Deusms. Commissioner, Workmen's Compensation Commission, Quebec. Jossrn D ulao, Workmen's Compensation Commission, Quebec. ffotrosABLK M. L. Durnassis, Q. C., Premier of Quebec. Askmoa WMtsm, Vice President, Workmen's Compensation Commission, Quebec. Hwojsaauo Onjssxms; Gaoson, Minister of Finance, Quebec. Dm Gustavs Gis-obas, Medical Director, Rehabilitation Institute, Montreal. Wzlltam CAiXAOHna, Montreal. S. Gassoag, Chief ClMms Agent, Canadian National Hadways, Montreal. Jaafr Gasneau, Workmen's Compensation Commission, Quebec. Joacum Caarirsa, Q. C., President, Workmen's Compensation Commission, Quebec. Bssrak C. Hamso, Quebec Power Co,, Quebec, BunooFHE HasukO, Vice President, Cathode Conference of Labour, Asbestos, Hon. WsteaBo Hakko, Mayor of Quebec. A. H. Hoxarnsnoss, President, Quebec; Metal Muses Accident Prevention Associa tion, Noranda. H. H. Hoooh, Chief Claims Agent, Canadian Pacific Railway, Montreal. Labnotm H vnm r, Safety Director, Quebec North Shore Paper Co., Bale Comeau, M. Mane Lacoste, Edifice Cadillac, Montreal. :: Maunieu LArsnsrana, Quebec Iron & Titanium Corporation, SorsL ' V, ISM m m n m m m m c Ep<sens LKoeHEiB> Seeretary Gonoral, Quebne Matai Mining Association, QPete, Kota Lace, Workenerds Compensation Commission, Quebec. D&. Annaon LBcnnae, CMef Mediesj &ieer, Workmen' Compensation Com mission, Quebee. D&. !>. Lsokas, Workmeds Gampepsation Commission, Q ute. T. E> Lrrrps, Birector, Q ute Mtal Mining Assodstion, Monda. W. t*l Montgombrt, Safety Xteetor, Koanetk B, S. Robertson, Ltd., Montreal Fbrmrnb Monstts, Q, Coxmnmimmt, Workmerds Compensation Cosft- missios, Montreal. L AmOsss Moresct, Workmen's Compensation Commission, Q ute. Joan Fnmxxt Orthopedisi; Tachaient, Montreal R ombo P aquet, Workmerds Compensation. CbraeMssbbh, Quehee. lionaT QrK?sn, Dcputy Mimster o Labo?, Bepartment o b&bor, Qute. G. Akt. Rousseau, Workmerds Compensation Commission. Q ute. 1 . M. Bochb&sao, Cosmmssianer, Workmerds Compensation Commission, Qute. I>AVip B.>}w..ah, Workrnen's Coinpensatton Commission, Quebec. Evar-ste. Rc'PSe,- Commissioner, Wnrkmen's Compensation Commission, Q ute. L H , Bx.oamb, Bsfsy Direclor, Canadian Johns-Manville o,, Ltd., Asbestos. W. H.:So?a&, Assistant to Mise Manager, Canadian Jolms-Manvie Go., LfcsL, Asbestos. Die. Cam!.!.k Smaso, Workmen's Compensation Commission, Quebec. Dis, F, J. ToranskaP, Division ot industriel Ilygirse, Montreal Dsu B, A. Toacor, President, Industrial Medical Association, Montreal GastAK 'Fkbmbbae, Deputy Minstcr of Labor, Department ot" L&bor, Queb, L, F. TssSrsa, Workmerda Gompensation Commission, Qubec. Jacqoks VssaXAtrt/r, tereiary, Werkrnen'a Compensation Commission, Quefeec. A, C. Wa>eee, Superintendant of Safety, Crne Limited, Montreal Dm R. E. L, Wat&on, Medical Drector, Crne, Limited, Mon?.mal St, George Whb, Workmords Compensation Commission, Q ute, Seskatehets&n M, D. Thomtro, Coamaissoner, Workmen's Compensation Board, tegina, G. W. VAu.nAti, Chairroan, Workmeids Compensation Board, Rgion C. G. W&XUKS Mini.ster of Labor, Department of Labor, Regma, labma Job L. Coleman, Diredor, Department of Industrial Relations, Montgomery. Arkanz&a G. L. Cs Axr, Attorney, Cnitd Mine Workersg Fort Smitli. D* W, Hontes, CommBstoner, Workmen's Compensation Commission, l if t e Rock, ssJonn B, Se b s , Commissioner, W orkm eu'a Compensation Commission, Littfe Rock, Cktfor&ia Cinit Fmaiba, Gnaranteo lasuraoee Co., Los Angeles. Joskeh 3. G.aabaghes, Manager, State Inanrance Fond, Buriingame. Wy Ma>'onaa>, Gbairman tndbs'i'iai IresArn* C? ?i xin^rio, Ban Franoiaeo APF$MDiK C Favi- m m m x m w , Directors Department of Industrial Relations, San Francisco. Br. 3z&? S. Tmossas, Department of Employmi* S&iirasessnto H M, Wimo$, Department of KinpUeyiaent, Sacramento, Colorado Bay II. BaaxxassaA, Chatrenan Xndtsstri&i Commission i Colorado, Denver, Hakos. C. Tat&P&m, Director of Claims, State Compensarlo Insurance Fund, Denver. Vmnedicitl & B. Couminirc, Hartford Accident & Indemnity Co. Hartford. . H. Ossia, President, Tosi Oats; House, Iv-arytomn, W. 8. MeCokarox, The Aetna Casualty & Surrey Co., Hartford. Ddiixmre Anna S u w , Special Colmaci, E, L du Foot de Hrnmors & Co., Wilmington. Br. . J, Mac'Cou.um, Member, Idusiri&l Accident Board, Wyoming. Jisss A. Mruan, President, Industriai eedcnt Board, Wihaiagton. P us N . W aksots, Member, IndxsStrial Accident Board Laurei, M drid 0/ Gdntnbia Awnaaiv i. Bbisleb, Member' National Legislative Committee, American Federai ioa of Labor, Itilave. F kOv'acS, Associati? Director f Education A Research, Co.ogtcss of Industriai Organisations, Bsucb A. Gasassi, U. 8. Department ai Labor. Fas;?, E, Grassa, Beeret&ry^Treaaurer, IAIABC 0. S. Department of Labor. Dr. W. C, iio&rsn, Chief, Environmental Cancer Skitmn, Cancer institute. Department of Health Education and Welfare, Betkesda, M4> Ho. A rapa LAitsosr Under Secretary of Labor. .Joua E. L.va'TSS, Chatman, Employees Compensation Appeal Board, D 8, Department of Labor. Marik V, btsimaamitlh, ORIce of the SeeretaryTra8urer( IXABG, CI. B, Department of Labor, Wiujam McCaOBsy, Director Bureau of Employees' Compensation, U. S. Department of Labor, Fraxx McBnear, U. 8, Department of Labor, Fiascos 0. Saara U. S, Department of Labor. Hobekt Vast U rm m , United Mine Workers Welfare and Retirement Fund. Florida S-ASies Camesos, Member, Industrial Commission, Tallahassee. B. T, Commas:, Ceneri Counsel, Industrial Commission Tatiaiiasges, BpOfigy DoRSoneBj Director, Workmen's Compensation Division, Industrial Commission, Tallahassee, dosar . Passo, Orlando, Jams T, Yoeat&s, Chairman, Industrial Commission, Tallahassee. Georgia Eicbaso W. Bvst, Secrotary-Treasuror. Board of Workmen** Compensation, Collega Park. W. E. Bookas, Member, Board of Workmen's Compensation, Atlanta. o I I j fe. i? I S: ?0 p3 W 8 ? 8 f g1? , g i Pg- &fe L s F? Sa>3 g. :Q:' i? <56 &ff & t S3 & tw68s m 6 & f SS' aoI ,9 OO : OS(w3fl oS3 i B 0o B 5w Oss>s : o g <3 6S . t S3. r , tOf oo 1*3 8 *5**o^>, o 0g g o 25 t w 'Spd'Bajpaj tp'sg psujssp! `msq *st3$ %j & s?pdu2pa| `pOTog p'ssnpuj 'a^wsspf 8g|.jSh `sst^ ^ toisv^ foiisimpxtj 'oe a o s H v g -jj -y -a<j sn^j 9U& 'uoi'i'si&my [sooadjoa'g; te>ptosd0 \m(y sp^'i `pmxi puts ^Shgu^j^ psx& P^Ymyg &'mG|x *3*"8 pmA SS > g: X X f * O g HS <3 ' Sa <*>* Stt< k3r<f oK* *g as SP 3^? I_H Iv't' ~ Ck HP Ci - N >* 5*33 5 K3 O ir mO : i'i II W w >& A>*O*** o Ofi?>*** <9* a ppen d ix c 233 M&iiie J o m W. & m & v , law yer, Bangor, Mss. MAsrasxn Baskas, Industrial Accident Commission, Augusta, Cram M. Jour, Member, Industrial Accident Commission, Watoralte. J:ams E, Mrs'Ciosa., lawyer, Bangor. F. E. Ero&abssok, Portland. Maryland M m v m %, Eras, Chairman, Industrial Accident Commission, Baltimore. Dr, Jon V. lIosmsNe, Baltimore. W. Aranm? MEaein, Commissioner, Industrial Accident Commission, Balti more. Pawl Simagns, Jr., Manager, Compensation Department, Maryland Casualty Co,, Baltimore. $*K#ir B, Stirra, New Amsterdam Casualty Co., Baltimore. MassaakmxUs D s. A m x m M ft P. Anxzm, Chairman, Subcommittee on Industrial Halations, American GoSiege of Surgeons, Brookline, Arasorrsn B. Bacsosowsks, Attorney, Salem. Davx B, Ban*, Employe^ Groups Xjisurassce, Boston, Tsokas W, Borra, Member, Division of Industrial Accidents, Boston. B . B. Coorsa, Director of Medical Eolations, American Mutual Liability In surance Co,, Boston. Ebon* K< Ossosxk, ClsaiMae, Division of Industrial Accidents, Boston. Fha s E> Goosmstj Director of Self-Insurance, Division of Industrial Accidents, Boston. STAsmoon B, HAitsbtf; Atofetant Yica President, Liberty Mutual Insurance Co,, Boston. G. 8. Hahlas, Vice President American Mutual Liability Insurance Co., Boston, James <3, Habsbby, Attorney, Massaefausetts Bonding and Insurance Co,, Boston. MAacrans J. Hicks, Boston. Mas* F, Hsc&s, Member, Division of Industrial Accidents, Boston. Eatas J. Koi.oaof.ias, Member, Division of Industrial Accidents, Boston. E&wakb J, M oansr, Attorney, Bostoa. Mauv A. Noosas, Boston. Asuanr St. Cn&ra, Counsel, Liberty Mutual Insurance Co., Boston. Jose ns? A. Souavas, Chief Examiner, Liberty Mutual Insurance Co,, Boston. M ss. Emma 8. Tousakt, Past President, XAIABC, Quincy. Michigan W, C. Braaor, Manager, State Accident Fund, Lansing. H rasv F. Bazoos, Superintendent of Claims, State Accident Fund, Lansing. Wstt-XAi* B. Bucuaka, Chrysler Corp., Detroit. C. E. Cm&SB&m, Ford Motor Co., Detroit. Jos C. Camnaas, Lincoln Mercury Division, General Motors, Detroit. H. A. CostasAO, Attorney, State Acoldest Fund, Lansing. Wjamam J. D sveas, Cbrysfer Corporation, Detroit. C rass E> Doaxo, Chrysler Corporation, Detroit. Jaws L, Max, Supervisory Attorney, Workmen's Compensate Section, Ford Motor Co., Detroit. ......... ....................................................................................................................... 234 S384 BTm OF UAB W. G. Horcususe. Compensation Supervisor, Chrysler Corporation, Detroit. Q m m n li. J ohnson, Manager, Employee Services Department, Ford Motor Co>, Dearborn. Wsoiuam J. Janus, Lacey, Joaes & Doee, Detroit. F. . Lux, Staff Attorney, Workmen's Compensation Section, Ford Motor Co., Detroit. Wads FI. McCxaa, do., Mootter, Workmen's Compensation Commission, Let,slog. W. H. MacG sb o o s. Vice President, Michigan Mutual Liability Co., Detroit. Bxtmmrr M arcus, Representing Samuel B, Horovits, Muskegon. Bc Sru R. KoRsts, Chrysler Corporati??, Detroit. Homme L, O'Coxnbu. Rathe, Maratea, Bohn & Marey, Betroit, T hkoookk P. Utah. Chairman, Workmen' Compensation Comrnsssmn, Bitnon- d&le. RrcnsB I Sen m ut, nternatmxal Repressolalive, Compensation Department, UA'W-CIO, Detroit, A. A. BnUAnrr, Fino President in Charge of Claims, Corpora-'e Servire, lor., Detroit. Faso 8. W arner, Attorney, Auto Owners insurance C o, Lansing. Minnesota J Roana-! E. F aricv, Commissioner, Industrial Commission, St. Paul. M ississippi Sa S. Anuta o. Commissioner, Workmen's Compensation Commission, Jackson. J ohn A. Cba?t>, Chairman, Workore's Compensation Commission, Jackson. fisseti W'n.nrAM G. Bun, Hoperinteedmit, Worksnen's Compensation, Amerieats,Associated Insurance Companies, St, Louss. Charuss E. Gates, Member, Industrial Commission, Jedersots City, Ears, F. Courr, Assistami Professor, St. Louis University, St. Louis. R< Ronnut Cohn, Attorney, Kansas City, W, E, Frospano, Member, Industrial Commission, JeEerao Cky. Sbsnosr H, CVRS, Director, BivLdon of 'Workman's Crm-jfensatxoo, Jeifemo City. A StssuspN J. Msxa-srr, Chairman, Industrial Commission, Jefferson City. Menions W. W. Caesaa, Secretary, Industrial Accident Board, Helena. Metti Jersey Winston Brans, Chubb & Bons, Managers, Federal Insurance Go,, Short Hills. Da. f, E. Bat oxer. New Lisbon. Caro Holonrma n , Commissioner, Department of Labor & Industry, Trenton. BantRPA, Si'Aisi, .Director, Division of Workmen's Compsnsatio!, Department of Labor & Industry, Trontom Nets M exit bnnemaso Jones, Assistant Commissioner, Labor and Industrial Oonumssion. Easts Fe. M $mmm e New York Evs&srr B. Manager. Ciairxis & Bafety IMparfcmeot, ScaHyay-'V&esim Oli ,, lue., New York. Lotns sBsrP, eioary, Woodward & Fondilier, New York. H. B v m m Bm&AV) Director, Conspensatlon &Ssfeiy, M m m Locomotive Do., Seenectady. Msss Gkstsjbb Osvanacoh', Workinen's Corop-ensatsos! Board, Aits&ay. B askO?!. A, Cayk,t, Vice Preside!, Fdeiity &. Caaoalty Co., New York. O&rvss T, O&atton, New York, MaEsasa. Dawson:, Past %:ere?.sry~T?easre?. SAIABC. New York, J. A, DMEsciissa, Seeretary-Cosnptroiler. National Cotonisi on Coj&peiss&tioa li&xivsmet, New York, Bknjajkh D is&is, Siale Jsarance Fund, New York. Miss Maev Dofflos, Ckairinso. B orkmon's Compensati Board, New York. ,!. R.,:>n Dy&es, United States; Casualtv Co,, New York. Jossoh Dsan Eowaeos, tiorney, New York. Beoaso FonnriA.ee, Woodward & Pondfier, New York. G, Eaks, Fox, Secretare, Casuali v Hivi:o, Glc-.m Falla ineitFanee Co., Ulens Falla. Da. Lbonas 1. Golowtke, Natscmai Ch&nnais, Cardrao-irladnstry Coen Vmfctee. American Kaart Assodaioe, New York. Wsxjas C. Ooarn'C C. E-, Director, instiinte for 1he Grppie and Dss&blod, New York. Miss JeaKwswe Hasaos, Assodate Economist, Yorkoxen's Conpseostior! Board, New York. Anrsao Dajrrafi, United Ptelworkers o? America, Beffalo. Tmsouose B stssi.es, Jh.. Attorney, Nai ion&i A.-wodaiio <>{ M.itosi Casaalty Cos,, Nere York. P, H. Busseaasse, . C, F. Industries, New York. IL M. JAoaaoa, Manager. ItdxisdrSal Health Program, John Msorville o*p., New York. AnoRsw Kaossysow, New York. Enarra D, Erta, Cottaseli New York Cornpoiisaton Isseur&o; Est-ing Board, New York,. M. L. I.AsaowsKi, Western Electric C.x ine,, New York. io s a M, McDkas.o, Dirator, Worknth'n Gofhpdsation:, Associated Industries of New York Stato, Ine,, Aihany, Roeenr E, Maasa,( d<n.tjxistratlve Bcpaty. WorknnuxN Compensation Board, New York, Geosoe 13. Mptktdarsj Manager, WorioeenY Compensai io & Pisahxlity Clan Drvfeion, Amen; Bnrety Co., New York. MrewAiss, X fvfonroiv, Conorei Manager, Assodai loti of New York State Muitt&i Cssualty Cos., New York. Rat . Oakiev. Stat InsuFanoe Fnnd, New York. Miss Masso?. Pglaxgv, Sorretary, United Steeixvorkers o? Anwrsea, Buffalo. Miss Mansr Poporoy, BoRalo James J. E rga, Seeret&ry, The Sek'-Insus-ers Assodati;, New York. B. V. Evasi, FMestty & Casualty Co. g New tor, New York, H'sNSt Ti. Satbb Generai Manager, New York Conspesis&Mon Issnr&Kea Bating Board. New York. : A,- M, ScKSiror, Inaonanee Manager, N&tansi Coxmnil <rf Siate Ssiif-Iwasrers ssseiatsosg New York.  WM M&mma qp iaiabc J ambs R, Smmmr Atfcwey,. Amerlc&a Telephone & Telegraph Ce,, "New Yerfc CtbS F, Smbtss, ClSiins Attorney, New York Telephone Co-, New York, Waunuss M. :S3gi68, Associale Attorney, State Insurance Fanti, New York. J. Kabbt Tibbsae, Attorney, United Steelworkers of Amens, Buffalo. WAassrn C. Took*, Counsel, Utics Mutual Insurance Co., Utlca. (Sxe, B. WsuA, Western Eecirse Co., Ine., Hew York. N, Mam.m Woods, Association of Casualty & Surety Cos-, New York, Da. M, WmuAst Zocsks, Director of Studies, Commerce &Industry ASocktbn of New York, New York, North Carolina I. W. Bzaw, Commissioner, Industrial Commission, Raleigh, North Dakota &sm Bmm% Chairman, Workmen's Compensation Bureau, Bismarck, BLM, E van, Member, WoykmmvVCompefisatiori Bureau, Bismarck. Ohi H. B. Banobst, Emile E. W&fcsOn, Columbus, Jacob Cxavmab, Seeret&ry-Tre&aumr, Ohio CIO Council, Columbus. A, Matti** Di:o?mo30K, Vice Chairman, Industrial Commission, Columbus. B, . 0srsKOsmoBB, Superintendent of Claims, Farm Bureau Mutual uto Insurance Co,, Columbus. W. C. Hap?mA8, Attorney, Squire, ganders Dempsey, Cieveistnd. M> Hosbano ESB, Bisector, Workmen's Compensation, Frigidaire Division, desierai Motors, Dayton. John Kcuyssn, United Rubber Workers, Akron, Rcbabb W, Mosse, Chairman, Industriai Commission, Columbus. Cbaeabs F, Norrsa, B. F. Goodrich Co., Akron. Tko&as M. Habmas, Jones, Bay, Coeldoy <feBeavi, Cleveland. Oklahoma, Fsbb Abbbbt, Industrie Commimlon; Oklahoma City, Maes CnraoBas, Industrial Commission, Oklahoma City, Janos .BS&-? C. Hour, Industrial Commission, Qklahoura City. Tom G. Massue, Commissioner, State Insurance Fund. Oklahoma City, Mort B, Powers,, Chief Attorney, State insurance Fund, Oklahoma City, E, J. ladastrkd Commission, Oklahoma City. Oregon, L, Q. Abbes, Member, Industrial Accident Commission, Salem. WaxiAM , Cauuabae, Chairman, Industrial Accident Commission, Salem. Pennsylvania F. E. Babhaso, Manager, Compensation and Safety, Bethlehem Steel Co., Bethlehem. Fbams K. Boat, Deputy Secretary, Department of Labor and Industry, Harris burg. A. 0. CumsmAK, Chief Supervisor, Indemnity; Insurance Co. of North America, Philadelphia, W, B. Coaklbv, Secretary, Fire Association of Philadelphia, Philadelphia. K Gwrr&rass, Manager, Stats Workmen's Insurance Fund, Harrisburg. R. M. B abtmae, Assistant Manager, Compensation and Safety, Bethlehem Steel Co., BktBlsh&m. FFBNm x e 237 Roaaur C, Hsbokj, Superintendent. Compensation Claim Department, A m s Casualty Co., Reading, ... Bussar, C. Kbsuu Assistant Manager, State Worfcme&'g n8ura&e Fund, Darsisburg. WMta&x Loan, Secretary-Treasurer, National Council et State Belf-Inautare Association, Philadelphia, osa* L. Navm*s, Director, Bjxeau of Workmen's Compeasatis, Harnsfomp. F, PsrrcsA&w Chief Safety Inspector, Siate W^orkmea?s lesurapee J ^ i ^ Mania- bargA. BcstfedKR, Sanerai Attorney, Pennsylvania Railroad <s,, FMictelpMs. Davi M. WAx,eBa, Secretary, Department ai Labor & Industry, Harrisburg. Puszte> Rito Miss R auus- Ngaouon?, Member, Industria} Commission, Ban dosai, Enoaano A. SAtmaoo, Actuary, State Insurance Fund, Bau Juan. Rhode island Aaromo Dr Errer, Esecutive sslstaxit Curative Center, Department of Labor, Provides*. Da, J o s s E. Dosmsy, Medicai Dirselo?, Curative Ceste?, Department of Labor, Providence. South Carolina Mja F am i Coattos, Commissioner, Industrial Commission, Columbia. J ambs J. tan, Vice Cis&lrma, Industria? Commission, Columbia. Mas. H. B. Tara, Columbia. Tmrmsee W, H, P ashsm, Commissioner, Departroimi of Labor, Nashville, Faso A. PaiU/iaa, Safety Engineer, Department at Labor, KashysUe. D sw sr f i m a n , Director, Division of Workmen's Compeas&iiou, Department of Labor, Nashville. Texas Da V. C; Barn, Chief Physician, Humble Oil A Refmkig o., Houston. E, L. E cbmak, Vlas President, Petroleum Casualty Co., Houston, L. H, Fasa-EtaBN, Chairman, Industriai Accident Board, Ausisi. Fssux A. Uym&, President, FetroiaUto Casualty Co,, Houston. Virginia Mss. C. B. Hrrca, Richmond. W. H, Kickkss, Jb<, Chairman, Department of Workmen's Compensation. Eiehmosd. Washington Dub: H. K bbbbot, Supervisor, Rehabilitation Center, Department of Labor and Industries, Olympia. West Virginia, Dm J obs P, Bsrou, Chairman, Occupational Disease Medical Board, Charleston. FaAsiania W, K m x, Executive Secretary, Workmen's Compensation Fund, Charleston. Rudolph J. MoEBJisar, Legal Assistant, Workmen* Compensation Fund, Chrlestosv. Geohob W. Sroxr.s, Commissioner, Workmen's Compensation FumL Charleston 288 u m Moe oe a of mx&bc X H&-0t>cs rsftf, Mifomttkee. B; 15, l&smm, Vim Pm ideat* Empiatms M m M W&mm, Mvsmmm hmrzMii gm im t Urmy G&am&h Medium, ` M' M 'tksm^a, Gklms CkssMj FBa^loysis MMu , W&tsa&u. BLam^ A, Musson, Bhmi?, Wmkmm^ Csrpsasaiio, JMm&rM Ooxnvamioo, MtseJu _ W s A * ^ :6 W r a t ladusfei&I C&aslssic, Mdso, Ifpwm f P, Pssf&r, Maa&gsr, W<srks!S8K'S C om pensati Cofasaissioa, Cheygaaa ..si,ssjss*:.iss^fds*>,?**.