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FILE NAME Keene KNE DATE 1935 Apr DOC KNE065 DOCUMENT DESCRIPTION Published Article from The Bulletin - Silicosis - contention pares THE VOL XIX BULLETIN APRIL 1935 No. 12 mente SILICOSIS <r edie *** EE Pa o By Oliver G. Browne Assistant General Claims Attorney New York Central Lines There are reams of literature all more or less technical in terms as well as diffi- cult to absorb on the general subject of silicosis I will attempt to set forth in simple language the nature of the disease and the serious problems now confront- ing industry in relation thereto Silicosis is said to be a fibrotic condi tion of the lungs caused by the continued inhalation of the dust of silica It may or Seutres may not cause disability When in the Ads disabling state it is of a permanent nature and there is probably no known cure <a or treatment other than to arrest the progress of the diseases incidental to it When wots not disabling the danger is in the continuance of exposure for by such does the disabling stage arrive The fault of ex- posure is that the dust inhaled gradually bate lessens the lung capacity making the subjest less able to resist and throw off tuber- Wer culosis germs and lowering the resistance to other diseases Silicosis seems unprogressive when exposure ceases It is un- like the known diseases which given a start progress to a crisis unless respond ing to under ceases treatment It however progresses exposure and although exposure the damage done becomes perma- debra nent although not necessarily disabling nthe It is doubtful if there have been any cases + of disability due solely to silicosis Those ate charged as disability are where the fibrotic mest condition had developed to the stage of CW active tuberculosis or to that of another Ne disabling disease coupled with called silicosis The best authorities indicate that of those who die as a result of sili- 1 cosis approximately 75 of them are ac- tively tubercular 93 pneumoconiosis the generaly name given respiratory affections where Ven the predisposing factor dust inhalatio-n silicosis is the name given where the dust inhaled over a sufficient period of time contains silicon dioxide in sufficient con- centration said to be ten million particles per cubic foot of air to affect the health of the worker The danger is in the fine dust It is asserted that particles greater than ten microns in diameter can pass through the finer bronchiales and are prac- tically harmless There affections medicinstiter medicinstiter definition Silicosis is usually described as falling into one of two stages the first where defi- nite physical signs of damage to the lungs is found without impairment of the capacity for work and the second where the specific signs of lung damage are shown accompanied by incapacity for work This latter stage may be classified as light or se rious and temporary or permanent Here again there is the question whether temporary means other than incapacity to re- main in any dusty occupation although permanent must mean incapacity from any work A temporary stage relates neces- sarily to ability to work for the lung affection however slight is generally regarded as permanent There are therefore countless numbers of exposed and slightly affected persons in dusty occupations who are not and probably never will be sufferers from the exposure Yet they are po- tential hazards and with the uncertainty of diagnosis their total disability or death from any cause may be attributed with some plausibility to the silicotic exposure and this will lead to serious results for em- ployers Diagnosis and prognosis yet in an uncertain state of silicosis is Microscopical 281 ow PRA Entiff's Entiff's contention 282 THE BULLETIN APRIL 1935 and ray examinations may be made but seldom do they reveal with sufficient clar- ity so that we can get a unanimity of opinion The symptoms of the ordinary cough where there has been an exposure to the dust hazard are such as to create a sus it picion of silicotic affection or progress Given such a basis is unlikely that the fairest of medical testimony with experi- - ence can give assurance of segregation of causes Where complicated with a ten- dency to tuberculosis the experts are in a turmoil especially when trying to determine if it be silicosis bringing on tuberculosis or a existing tuberculosis de- veloping or progressing because of silico- we sis In death cases when an autopsy is had usually the fibrotic changes produced by silicosis are fairly indicated It is the lack of definiteness of diagnostic findings in the disability or claimed disability cases that makes industry the easy prey of unscrupu lous claimants To determine hazard nee study essary to the industrial appropriate dust counts determine amount character the dust breathed end have a check the ceptibility dioxide . is commonly found in our food air and water but unless is not a hazard in injurious quantity it The industrial process . may produce organic dusts which may tend to injure workers by causing temporary af, fections but it remains for the inorganic dusts to cause permanent effect There are so many processes creating silica dust that many industries now resting smugly in the assurance that no hazard exists may be rudely awakened to their problem should regulatory and compensatory laws be established Any process having a small quantity of silicon dioxide dust may be ex- posed to this unless such laws carefully prescribe the method of determining not only that there is the injurious exposure but also that it caused the result on which the complaint is based Nor can one be assured that because silicon dioxide is not used or produced in the process he is im- mune from the hazard The real test is whether the worker is exposed to it from any cause even where the dust from an outside agency may pollute the air breath- ed uncertainty Prevention or avoidability of the haz ard is in such a state of at progress present as to be of doubtful value Im provement in devices to prevent or reduce the exposure in this respect is in Employment and of periodic examinations workers exposed the sult The removal of hazard muse thosensusceptible thosensusceptible to disease into hazardous employments seems clearly indicated ulatory laws providing dust methods have some time Reg prevention existed but been questioned their efficiency To compensate suffering workmen for silicosis claims under the existing Work- men's Compensation Law seems cal without impracti putting a tremendous burden on industry Under the existing system every injury and death where there was exposure to dust containing silicon dioxide would be compensated unless the method of determination be carefully prescribed It would seem that any law should define the dust count formula although opinion , differs on this also the disease itself and possibly the industries covered by it If these are not prescribed vague testimony founded on supposition and opinion will be found to support awards in every case of tuberculosis pneumonia bronchitis asthma and other common respiratory diseases where there is a scintilla of that silicon dioxide prevails in evetnesmtiinmuotney employ quantities in the process or in the ment It would be for all practical poses a blanket health pur- compensation law The experience in states other than New York is not a happy one The following quotation from the Bulletin of the ciation of Asso- Casualty & Surety Executives is portentous The Employers Mutual Liability Insurance Company of Wisconsin which . writes about 50 of the workmen's com- pensation insurance in that state has re- =~ cently completed an analysis of its losses in Wisconsin on policies issued in 1932 and expiring in 1933. In that policy year the ratio of occupational disease losses to total premiums was 10.2 to total losses was 13.5 That was the average for all classifications includ ing many in which no occupational dis- ease losses occurred In those classifica tions in which occupational disease losses occurred the occupational disease loss Im avoidability of the hazhaz state of uncertainty of doubtful value reduce vices to prevent or this is respect in progress periodic examinations of to the hazard must re- val of those susceptiblesusceptible other and hazardous ns clearly indicated Reg dust oviding prevention or some time existed but has been questioned : suffering workmen for nder the existing Work ion Law seems impracti- ng a tremendous burden der the existing system death where there was containing silicon dioxide method sated unless the be carefully prescribed at any law should define rmula although opinion o the disease itself and stries covered by it If scribed vague testimony sition and opinion will ort awards in every case pneumonia bronchitis common respiratory dis- is a scintilla of testimony e prevails in even minute rocess or in the employ > for all practical pur tealth compensation law in states other than New py one The following e Bulletin of the Asso- , & Surety Executives is . ee ers Mutual Liability Iny of Wisconsin which 6 of the workmen's com- nce in that state has re- - an analysis of its losses policies issued in 1932 1933. In that policy of occupational disease remiums was -to S 13.5 That was ill classifications includ- ch no occupational disred In those classifica- cupational disease losses cupational disease loss APRIL 1935 THE BULLETIN 283 ratio was of course much higher Siff cosis was the most costloyccupational disease It accounted for of the occupational disease In iron foundries 47 of the total losses from both accidents and occupational dis- eases were due to silicosis alone in steel foundries the percentage was 88.7 and in malleable iron foundries 89.1 _ Im Ontario the experience has resulted in a recent change limiting the application of the law although information obtain- able is somewhat vague From New South Wales where there has been more experi- ence we get the following again quoting the analysis of the annual report contain- ed in the Bulletin of the Association of Casualty & Surety Executives The figures in this report indicate that the pure loss ratio under this scheme of compensation for silicosis from 1927 to 1932 averaged over % of wages In the year ending June 30 1933 which was a period of extreme de- pression the ratio to payrolls of losses paid seems to have mounted to about fit 17.8 It is implied in the Report that dae the industries affected cannot stand any on increase in their contributions and that abet increased subventions from the State are ollie necessary to finance the scheme In this Ni connection it should be noted that the scale of benefits under this scheme is not abnormal the maximum total pay ments for incapacity for illustration being limited to 750 Throughout the .. industrial states there is to be found afew communities severely pow suffering froma multiplofiscuiitstayt directed against industries failure to guard againstdust hazard Most of these suits are alleging a silicosis Many of them have been defended successfully and while many settlements have been made on a basis of prudence there have been few actual recoveries Such a suit is however very costly to defend During the present period of unemployment such suits are to be expected given the slightest basis of fact No compensa- tion law would cure this evil as to suits already brought It would and must operate as to future employment except that probably past exposure when coupled future exposure would figure in the cumulative processs of acquiring the affection Whether or not silicosis may be entirely prevented in future industrial operations is doubtful It can and must be reduced and with a genuine effort to this end the danger of suits will be minimized and in any event with proof of the employer's effort available defense should be com- paratively easy If not reduced and a workman's compensation scheme be injected into the relationship then the costs of insurance coverage must substantially increase Of the suits now pending against industries it is fair to state that although a complete defense is available in a majority of them under our workmen's compensation scheme substantially all would have been the subject of an award and the costs tremendous In New York the plan of scheduling occupational diseases when recognized as such based on the English system has long been established and these have been compensated as accidents The main dif- ficulty in opening the same door to a res- piratory disease is as has been pointed out one of diagnosis To open that door lets in most of the ordinary diseases of life and those brought on by the vices and incorrect habits of living of mankind together with the infirmities of age In doing so the compensation law becomes more than ever a scheme for relief as dist~-n- guished from a purpose to displace the old liability system with something more equitable the original conception of a workmen's compensation law In view of the uncertainties of diagnosis of the disease if it be such the difficulty of establishing that a hazard exists or does not exist and the greatly increased cost of unrestrained compensation coverage it should be left to the industry itself to de cide if such a coverage is necessary or de- sirable If a compulsory compensation | law is had it means that extra costs and care must be borne by many industries not now suffering from the called lawsuit racket Where the coverage is elective the industry can survey its operations and if it decides it has the hazard it may if it chooses protect itself from suits by electing to be covered as to the disease hazard by compensation and also it could take such preventive measures that are indicated The problem is not simple and is in no such state of certainty that the decision PR ty contenti intiff's contenti sevweinciaten THE BULLETIN APRIL 1935 may be easy to make Until experience both from the standpoint of prevention of the dust hazard and knowledge of the dis- ease progresses to the point of clearer in- dication it would be the part of wisdom to at this time make haste slowly If silicosis is to be loosely added to the list diseases now scheduled in compen- sation laws it would be as pointed out disastrous from the standpoint of cost It would be far better if we must have com- pulsory coverage to provide a separate act limiting the diseases to those that can to clearly be shown have been caused by the risks of the occupation embodying in such a law the determination of both the disease and the hazard by a competent political medical body Such a law must fit in with the many other problems brought about by the slow accumulation of such diseases such as the period allowed for accumulation the employer to be charged with the loss the payments to be -, made when the disability is only occupa~- tional and the degree of disability when ~.. the disease is considered in connection with other disabling or partially disabling a diseases Unless these and other protec- tive features are incorporated we may look for a further extension of industry's as. sumption of the burdens of relief While the above was written with spe- * cial reference to the situation prevailing i<n New York State other states have al- most the same problem No satisfactory < method of putting occupational diseases under compensation laws seems possible without permitting all determinations to be * made by a board of scientific men which should be in my opinion 100 medical Any studies needed by other professional aid could easily be procured No present administrative body seems fully equipped and as about 90 of the questions are es- sentially medical it takes a medically trained mind to thoroughly understand them ' A wide open coverage of occupational diseases is not to be thought of from the standpoint of industry It is true that in a few states by interpretation and under the Longshoremen's and Harbor Workers Compensation Act there is this coverage They are just beginning to learn what it means The simple meaning of the term occupational disease is a disease that oc- curs during the occupation in the sense of its being contracted in the occupation from something occurring by reason of the na ture of the occupation This opens the door wide to all manner of diseases Com- municable diseases such as smallpox scar let fever spinal meningitis etc. may be ac quired by contacts with other workers workers in the occupation Colds bronchitis pneu monia may be acquired by ordinary ex- posures or at least attributed to those exposures in such a manner that there is no per- possible way to combat it while the son affected is in the occupation All these are within the simple definition for occu pational disease now being laid down by the courts that it must be the usual and ordinary incident of the occupation The usual attempt is to define occupa tional disease The legal effect of it is to open the door to cover almost anything that occurs in the employment This does not serve as an effective limitation on the coverage It would seem that any attemp at an inclusive coverage should luni the hazard in which the disease may be incurred by making it compensable only when due to risks other than those of :. dinary life specially created by the nature of the occupation The English system established in York only enumerates also scribes the procesisn which the hazard ex ists and _is not wide open Silicosis and- other dust diseases may be described but the hazard oremployment in which the disease can be acquired and for which it is to be compensated should be carefully prescribed any compensation law 3 Sane. emi e oO yet bh Oe ' ae cain ee A A oe ie RA KR RH om et WHAT ABOUT THE BORDER CASES ti Claim By R. O. Carter Agent Missouri R. R. Co. Is nor our failure to settle more of these cases the real cause for many of the far fetched decisions about which we com- plain Run through your Reporter select at random some cases in which decisions ad- verse to the railroad were made by the courts of last resort then try to deter mine why the Claim Department failed to a et ae A eT @ er len a er ee eer Pe