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UNITED STATES DEPARTMENT OF LABOR
FRANCES PERKINS, Secretary
BUREAU OF LABOR STATISTICS
ISADOR LUBIN, Commissioner
BULLETIN OF THE UNITED STATES!
BUREAU OF LABOR STATISTICS]
WORKMEN'S
INSURANCE
AND
.
.
.
.
No. 602
COMPENSATION
SERIES
DISCUSSIONS OF
INDUSTRIAL ACCIDENTS AND DISEASES
AT THE 1933 MEETING OF THE
INTERNATIONAL ASSOCIATION OF
INDUSTRIAL ACCIDENT BOARDS
AND COMMISSIONS, CHICAGO, ILL.
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON : 1934
For sale by the Superintendent of Documents, Washington, D.C.
-
-
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Price 20 cents
ANNUAL MEETINGS AND OFFICERS OF THE INTERNATIONAL ASSOCIATION OF
INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
Annual meetings
President
No.
Bate
Apr. 14,15,1914____
Jan. 12, 13, 1915____
Sept. 30-0ct. 2, 1915.
Apr. 25-28, 1916.......
Aug. 21-25, 1917.......
Sept. 24-27, 1918___
Sept. 23-26, 1919___
Sept. 20-24, 1920___
Sept. 19-23, 1921___
Oct. 9-13, 1922.........
Sept. 24-26, 1923___
Aug. 26-28, 1924.......
Aug. 17-20, 1925.......
Sept. 14-17, 1926.......
Sept. 27-29, 1927.......
Sept. 11-14, 1928.......
Oct. 8-11, 1929..........
Sept. 22-26, 1930— ..
Oct. 5-8, 1931...........
Sept. 26-29, 1932.......
Sept. 11-14, 1933.......
Special meeting.
II
Secretary-treasurer
Place
Lansing, M ich ...
Chicago, 111.........
Seattle, Wash----Columbus, Ohio.
Boston, Mass..............
Madison, Wis..............
Toronto, Ontario____
San Francisco, Calif...
Chicago, 111_________
Baltimore, M d............
St. Paul, Minn...........
Halifax, Nova ScotiaSalt Lake City, Utah.
Hartford, Conn...........
Atlanta, Ga.................
Paterson, N.J..............
Buffalo, N .Y — .........
Wilmington, Del.........
Richmond, Va............
Columbus, Ohio.........
Chicago, 111..................
John E. Kinnane..
Richard L. Drake.
.......do....................
Do.
do_
Do.
/Floyd L. Daggett.........
\Wallace D. Yaple......... [•L. A. Tarrell.
Dudley M. Holman___ Royal Meeker.
F. M. Wilcox...............
Do.
George A. Kingston----Do.
Will J. F r e n c h ........... Charles H. Verrill.
Charles S. Andrus------- Ethelbert Stewart.
Robert E. Lee..............
Do.
F. A. Duxbury.............
Do.
Fred W. Armstrong___
Do.
O. F. McShane......... . .
Do.
F. M. Williams.......... Do.
H. M. S ta n le y ......... .
Do.
Andrew F. McBride.
Do.
Frances Perkins............
Do.
Dr. Walter O. S tic k ...
Do.
Do.
Parke P. Deans......... .
Wellington T. Leonard.
Do.
R. E. Wenzel..... .......... Charles E. Bald
win.
CONTENTS
MONDAY. SEPTEMBER 11— MORNING SESSION
Chairman, R. E. Wenzel, president I.A.I.A.B.C.
Page
President’s address, by R. E. Wenzel, chairman Workmen’s Compensation
Bureau of North Dakota and President I.A.I.A.B.C_________________
Business meeting___________________________________________________
' Report of the secretary_________________________________________
Report of the electrical safety code committee____________________
Report of the committee on forms_______________________________
Report of the committee on workmen’s compensation legislation___
Discussion_________________________________________________
Joseph A. Parks, of Massachusetts.
Abel Klaw, of Delaware.
Ethelbert Stewart, of Washington, D.C.
H. J. Halford, of Ontario.
Howard Keener, of Arizona.
Miss Rowena O. Harrison, of Maryland.
R. E. Wenzel, of North Dakota.
G. Clay Baker, of Kansas.
Mrs. Emma S. Tousant, of Massachusetts.
J. Dewey Dorsett, of North Carolina.
Eugene B. Patton, of New York.
Appointment of convention committees____ ______________________
1
8
8
10
11
11
13
18
MONDAY, SEPTEMBER 11— AFTERNOON SESSION
Chairman, Peter J. Angsten, chairman Industrial Commission of Illinois
What should be the obligations and rights of a minor in regard to notice
and demand, by G. (Say Baker, chairman Commission of Labor and
Industry of Kansas_______________________________________________
Workmen s compensation progress, by Joseph A. Parks, chairman Massa
chusetts Department of Industrial Accidents________________________
Discussion_____________________________________________________
Howard Keener, of Arizona.
J. Dewey Dorsett, of North Carolina.
Eugene B. Patton, of New York.
Ethelbert Stewart, of Washington, D.C.
Anton Johannsen, of Illinois.
Wellington T. Leonard, of Ohio.
Dr. Stephen B. Sweeney, of Pennsylvania.
19
22
28
TUESDAY, SEPTEMBER 12— MORNING SESSION
S e c t io n B — P r o b l e m s o p P r i v a t e I n s u r a n c e C a r r i e r S t a t e s a n d
C o m p e t i t i v e S t a t e J u r is d ic t i o n s
Chairman, Parke P. Deans, member Department of Workmen’s Compensation of Virginia
Round-table discussion______________________________________________
Advisability of using uniform forms______________________________
Parke P. Deans, of Virginia.
Sharpe Jones, of Georgia.
in
33
33
IV
CONTENTS
Page
Supplementary report of committee on forms_________________________
Discussion_____________________________________________________
Swen Kjaer, of Washington, D.C.
Hal M. Stanley, of Georgia.
J. Dewey Dorsett, of North Carolina.
Joseph A . Parks, of Massachusetts.
Parke P. Deans, of Virginia.
G. Clay Baker, of Kansas.
Ora Williams, of Iowa.
Mrs. Emma S. Tousant, of Massachusetts.
R. M. Crater, of New York.
Round-table discussion (continued)__________________________________
What kind of security shall be required of self-insurers_____________
Hal M. Stanley, of Georgia.
Mrs. Emma S. Tousant, of Massachusetts.
J. Dewey Dorsett, of North Carolina.
Joseph A. Parks, of Massachusetts.
Parke P. Deans, of Virginia.
R. M. Crater, of New York.
Ira M. Snouffer, of Indiana.
Should insurance carriers be required by law to write any risk making
application for compensation insurance_________________________
Sharpe Jones, of Georgia.
Parke P. Deans, of Virginia.
Should our association take any part in rate making for compensation
insurance__________________________________________________ _
J. Dewey Dorsett, of Georgia.
G. Clay Baker, of Kansas.
Joseph A . Parks, of Massachusetts.
Parke P. Deans, of Virginia.
Extent of loss to claimants by failure of stock and mutual companies._
Miss Ruth A. Yerion, of New York.
Parke P. Deans, of Virginia.
Mrs. Emma S. Tousant, of Massachusetts.
Should the law be interpreted strictly in industrial diseases as to
date of injury________________________________________________
Mrs. Emma S. Tousant, of Massachusetts.
Hal M. Stanley, of Georgia.
Parke P. Deans, of Virginia.
R. M. Crater, of New York.
Should wage basis for compensation benefits be calculated on full
time or actual time worked____________________________________
J. Dewey Dorsett, of North Carolina.
Joseph A. Parks, of Massachusetts.
Dr. Howard E. Bricker, of Pennsylvania.
Ethelbert Stewart, of Washington, D. C.
Presentation of evidence in contested cases, particularh' medical___
Joseph A. Parks, of Massachusetts.
J. Dewey Dorsett, of North Carolina.
Should State laws be suspended when in conflict with the N. R. A ___
Ira M. Snouffer, of Indiana.
Ethelbert Stewart, of Washington, D. C.
What can be done to harmonize Federal and State laws____________
Joseph A. Parks, of Massachusetts.
Ira M. Snouffer, of Indiana.
34
34
34
39
42
42
45
47
50
51
53
54
TUESDAY, SEPTEMBER 12—AFTERNOON SESSION
Chairman, Charles A. Nowak, vice president I.A.I.A.B.C.
The insurance principle in the practice of medicine, by R. G. Leland,
M.D., director Bureau of Medical Economics, American Medical Asso
ciation___________________________________________________________
Cooperation between workmen’s compensation commissions and State
vocational rehabilitation services, by John A. Kratz, chief United States
Vocational Rehabilitation Service__________________________________
Report of committee on safety and safety codes_______________________
Report of committee on statistics and compensation insurance costs____
56
63
68
70
CONTENTS
V
WEDNESDAY, SEPTEMBER 13—MORNING SESSION
Chairman, Samuel S. Graves, M.D., formerly medical director Industrial Commission of Illinois
Page
Physical examination of the injured back, by John D. Ellis, M.D., F.A.C.S.,
Department of Surgery, Northwestern University Medical School___
The difference between backache due to trauma and that due to disease,
by Nathan H. Davis, III, A.B., M.D., F.A.C.P., assistant professor
of medicine Northwestern University Medical School________________
Congenital anomalies and arthritis as contributing causes in injuries of
the spine, by Paul B. Magnuson, M.D., F.A.C.S., professor of surgery
Northwestern University Medical School___________________________
(1) The wedge-shaped vertebra; (2) Some distinctions between healed
fracture and healed vertebral disease, by Hollis E. Potter, M.D.,
president Chicago Roentgen Society________________________________
Discussion_____________________________________________________
H. J. Halford, of Ontario.
Dr. Hollis E. Potter, of Illinois.
Dr. Paul B. Magnuson, of Illinois.
Joseph A. Parks, of Massachusetts.
Ethelbert Stewart, of Washington, D.C.
G. Clay Baker, of Kansas.
71
81
90
96
103
WEDNESDAY SEPTEMBER 13—AFTERNOON SESSION
Chairman, Samuel S. Graves, M.D., formerly medical director Industrial Commission of Illinois.
Reduction of disability by fusion of vertebrae after back injuries, by
C. R. G. Forrester, M.D., F.A.C.S., professor of traumatic surgery
Loyola University Medical School__________________________________
Shortening the period of disability after fracture of the spine, by Philip
H. Kreuscher, M.D., F.A.C.S., medical director Industrial Commission
of Illinois________________________________________________________
Final disposition of back-injury cases, with a summary of 1,000 compen
sation accidents, by LeRoy Philip Kuhn, M.D., F.A.C.S., chief surgeon
Lumbermen’s Mutual Casualty Co_________________________________
Discussion_____________________________________________________
Ethelbert Stewart, of Washington, D.C.
Dr. LeRoy Philip Kuhn, of Illinois.
Joseph A. Parks, of Massachusetts.
Peter J. Angsten, of Illinois.
Alfred Higgin, of Saskatchewan.
R. E. Wenzel, of North Dakota.
Thomas M. Gregory, of Ohio.
Voyta Wrabetz, of Wisconsin.
H. J. Halford, of Ontario.
111
113
117
124
THURSDAY, SEPTEMBER 14—MORNING SESSION
Chairman, R. E. Wenzel, president I.A.I.A.B.C.
Report of resolutions committee_____________________________________
General review of workmen’s compensation legislation, etc., during 1933,
by Charles F. Sharkey, of the United States Bureau of Labor Statistics.
Remarks of Prudencio Rivera Martinez, commissioner Department of
Labor of Puerto Rico___________________ __________________________
J o in t
S e s s io n
of
A.G.O.I.
and
135
137
145
I.A.I.A.B.C.
Chairman, Thomas P. Kearns, superintendent Division of Safety and Hygiene, Department of Industrial
Relations of Ohio
Opening address, by Eugene B. Patton, director Division of Statistics
and Information of New York, and president A.G.O.I_______________
Status of industrial safety codes and regulations in the various States, by
Charles E. Baldwin, United States Assistant Commissioner of Labor
Statistics____________________ ____________________________________
148
151
VI
CONTENTS
Page
National safety codes progress, by P. G. Agnew, secretary American
Standards Association_____________________________________________
Discussion_____________________________________________________
W. Dean Keefer, of Illinois.
P. G. Agnew, of New York.
Morton G. Lloyd, of Washington, D.C.
Miss Ethel Johnson, of Massachusetts.
The New Deal and safety, by W. Dean Keefer, director Industrial Divi
sion, National Safety Council___________ __________________________
166
174
176
THURSDAY, SEPTEMBER 14—AFTERNOON SESSION
Second Joint Session A.G.O.I. and I.A.I.A.B.C.
Chairman, Thomas P. Kearns, superintendent Division of Safety and Hygiene, Department of Industrial Relations of Ohio
Cause analysis of accidents causing injury and near injury, by C. B.
Boulet, Public Service Corporation, Milwaukee, Wis_________________
Discussion_____________________________________________________
Ethelbert Stewart, of Washington, D.C.
Eugene B. Patton, of New York.
C. B. Boulet, of Wisconsin.
Thomas P. Kearns, of Ohio.
Swen Kjaer, of Washington, D.C.
Elmer F. Andrews, of New York.
Carl C. Beasor, of Ohio.
Standardization of codes and mechanical guarding at point of manufacture,
by Robert McA. Keown, engineer Industrial Commission of Wisconsin.
Discussion_____________________________________________________
Eugene B. Patton, of New York.
Thomas P. Kearns, of Ohio.
Morton G. Lloyd, of Washington, D.C.
Swen Kjaer, of Washington, D.C.
Elmer F. Andrews, of New York.
John B. Andrews, of New York.
Ethelbert Stewart, of Washington, D.C.
Miss Ethel Johnson, of Massachusetts.
Joint resolution re safety provisions in N.R.A. codes___________________
Appendixes:
Appendix A—Officers and members of committees for 1933-34_____
Appendix B— Constitution of the International Association of Indus
trial Accident Boards and Commissions________________________
Appendix C—List of persons who attended the twentieth annual
meeting of the I.A.I.A.B.C., held at Chicago, 111., September 11-15,
1933________________________________________________________
Index.
183
188
193
200
204
205
206
208
213
BULLETIN OF THE
U.S. BUREAU OF LABOR STATISTICS
no.
«o2
WASHINGTON
m a y w
34
PROCEEDINGS OF THE 1933 MEETING OF THE INTERNA
TIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS
AND COMMISSIONS, CHICAGO, ILL.
MONDAY, SEPTEMBER 11— MORNING SESSION
Chairman, R. E. Wenzel, president I.A.I.A.B.C.
The opening session of the twentieth annual meeting of the Inter
national Association of Industrial Accident Boards and Commissions
convened at the Congress Hotel, Chicago, III., September 11, 1933,
Mr. R. E. Wenzel, chairman of the Workmen’s Compensation Bureau
of North Dakota, president of the association, presiding.
[President Wenzel, after a few introductory remarks, appointed the
auditing committee (see p. 18).]
[The president then introduced Mr. Charles A. Nowak, formerly
chairman of the Illinois Industrial Commission and vice president of
the I.A.I.A.B.C., and after expressing appreciation of the work of
Mr. Nowak and of Mr. Peter J. Angsten, present chairman of the
Illinois Industrial Commission, in making the convention a success,
asked Mr. Nowak to preside over the meeting. Thereupon Mr.
Nowak took the chair, and after a few words of welcome to the dele
gates called for the presidents annual report.]
President’s Address
By R. E. W e n z e l , Chairman Workmen’s Compensation Bureau of North Dakota
and President I.A .I.A .B .C .
Can any good thing come out of Canaan? That question, asked
originally centuries ago, has been asked ever since, and may be asked
for many, many centuries more, playfully facetious or pointedly
serious. It has been asked, I know, concerning the State of North
Dakota. It is being asked concerning many well-known, betterknown comers of the Nation, at this very moment. Everywhere,
and nearly always, one notes that carping crispness, frequently con
demnatory, occasionally damnatory^—crispness such as one expects
to accompany bitten words with biting inferences. Seldom, indeed,
does one find even an inferential suggestion that the answer might be
in the affirmative.
May we not, therefore, endeavor to put forth a joint answer to
day—one that carries no sign of retaliatory vindictiveness; one that
may even have some soothing rather than inflammatory tendencies?
May I even be permitted to try to voice a part of it? At any rate, I
shall endeavor to do so; and I shall assume that I am speakmg to as
many who are not representatives of industrial accident boards and
commissions as I am to those who are.
1
2
1933 MEETING OF I.A .I.A .B .C .
Good things can come, do come, out of the land of the “ wild jack
asses” , just as they can come, do come, out of the land of the ambu
lance chasers, the baby snatchers, the income-tax dodgers, and the
Capone racketeers. The surface evidences of things that are ought
never to form the basis of our more premeditated conclusions concern
ing nations and peoples, or sections of nations and peoples.
Today we are most fortunately and happily situated. The Cen
tury of Progress—built, opened, and maintained amidst the most
gruelling pummelling the economic, political, and social structure of
our country ever has been given—is right at our door. That exposi
tion presents us with—it is—concrete, eloquent evidence of the ster
ling character, the abiding courage, and the astounding resourceful
ness of our people everywhere. It torrents forth, in shimmering,
shining, overwhelming brilliance—it is a message of hope. It broad
casts, it symbolizes, it exemplifies, the fundamental saneness and
soundness of our ideas and ideals. Battered, but ne ver afraid, beaten
but never conquered, defiled but seldom more than spotted, you,
Chicago and Illinois, have driven through the murky, miasmal mists
of doubt and despair, to bring leadership to America, Americans, and
the world today. You, in a most remarkable manner, and with un
failing, unerring accuracy, point the way to a new faith, a new fidelity,
a new century of progress.
We, the representatives of various provinces and commonwealths
of this western world, have come to the scene of this inspiring spec
tacle. We have come with a firm, well-founded hope that we might
be able to absorb some of the inspiration radiating from it. We have
come because we really and truly felt that we could here deal more
effectively with some of the more vexing problems that still engulf a
storm-tossed industrial and occupational world.
You who are not representatives of the boards and bureaus and
commissions, but representatives of larger groups, particularly em
ployers and employees, have doubtless come with anticipatory hopes
of a similar character. Being less weighed down with burdens of selfimposed responsibility, it is quite to be expected that you will depart
from this gathering with more appreciable dividends than we can
hope to obtain with our circumscribed, definite, prea]Tanged program.
But even we expect to make progress.
We do not expect to do more than touch some of the general
problems. We do not expect to solve many of the vexing details.
But we do expect to unravel some of the knotted skein, to straighten
out a few kinks, to cut out some of the nasty snarls; and we expect
to return to our respective jurisdictions with the ability, the power,
and the will to produce a better administrative and technical garment.
You will pardon the suggestion, I trust, that these 3 years of
unequaled adversity have brought some measure of knowledge to
those of us who have been active in this field of administration for
some time. Your facial expressions being indicative more of actual
interest than of mere curiosity at the suggestion, I follow it with a
second—an offer to have those administrators share that knowledge
with those of you who have not had that broader contact and exper
ience. Moreover, being revitalized by the brilliance and the bracing
warmth of the occasion and our surroundings, we ought, at least, to
be impelled to the effort to make some slight return for the inspira
tional values received.
PRESIDENT’S ADDRESS
3
And so, we accept your evident interest as a good omen, as an
indication that here, at least, we find that the individual citizen,
regardless of his relationship as an employer or an employee, recog
nizes that the administration of these laws is of vital concern to him,
realizes that sane, scientific, fearless administration is economically
advantageous to him, and senses that purely political tampering with
the compensation mechanism may bring on unemployment, reduce or
discontinue purchasing power, and pile up other evils and incon
veniences.
Perhaps one of the most impressive lessons learned, for example,
has been that of rediscovering the fact that the old law of “ selfpreservation” was the first law with most of our people; that it was,
and still is, the “ first law of life.” Exigencies, whether of a moment,
a month, or a year, usually lead to fear, and fear is the natural fore
runner to the domination of individual desire or need over the com
mon good. “ I help him” readily and quickly changes to “ I help me ”
(using the vernacular in which I heard it); and the ever-present pessi
mism one finds in groups of claimants easily develops into an incor
rigible “ I cannot will to work.”
There is nothing remarkable about the fact, therefore, that the
very continuance and existence of workmen’s compensation was many
times threatened during this turbulent period. Administrators of
these laws everywhere became aware of this public inoculation with a
seeming—yes, an actual—ruthlessness; and no cut, mark, or abrasion
was required to start the virus worming its way into the actions and
the thinking of our people. Human frailties were not only accentu
ated by the trials and tribulations that came upon us; they became
almost dominant for a time.
And there was a highly favorable background for this development,
if such it may be called. Knowledge concerning this technical
business of workmen's compensation was confined to a comparatively
small group. During ordinary times the process of increasing the
field of knowledge found difficulties innumerable, and speed impos
sible; but the period of the depression increased the already innumer
able difficulties, reduced speed below a snail’s pace, and virtually
barricaded all avenues to a sane, sensible, sound approach to the
problems of this technical business.
It should be easily recognized, but is not, that the compensation
law, the beneficiaries under it, and the people who pay the premiums,
have nothing to fear from efficient, fearless, honest administration.
The menace to each of them lies in the abuses that insidiously work
their way into administration1—abuses born of fraud, abuses developed
upon bases of sympathy and economic need, abuses sanctioned by the
ground-scraping abilities of political ears. The reserves of carriers,
whether public or private, are trust funds. They cannot be “ milked”
indefinitely, from within or from without. The day of reckoning must
come. And you and I, Mr. Average Citizen—purchasers of pickles
and payers of taxes—are the ones with whom that final reckoning is
done. Hence, I repeat a part of what I said last year, namely: Of
what use is the finest and best compensation law, the highest schedule
of benefits imaginable, the wisest and most humane administration,
with an insufficient number of employers operating to supply work
men with employment at which they may be hurt? This is one
budget that must be balanced; but it ought not to be balanced at the
risk of running men out of business; for running men out of business
4
1933 MEETING OF I.A .I.A .B .C .
means throwing workers out of employment; and that, again, means
the creation of breadlines and soup kitchens.
That abstract entity we call the “ public” is a great complainer at
any time, and of late it has been particularly vociferous. “ Cut
taxes!” “ Eliminate waste!” “ Get rid of bureaus!” “ Get back
to fundamentals!” it shouts. But who insisted on having all these
bureaus? Who demanded dabbling in private business? Who
wants special favors? Why, the public. And who, pray, is the
public? Why, it’s your fraternity brother. It's your personal
friend. It’s your political friend. It’s I. It’s you.
The public insists that a law be passed. It is passed. But the law
is not self-executing. It requires a department to do the executing.
When execution starts, the public feels the pinch. The law was,
evidently, aimed at the public. Horrors! Why, the public intended
to enact something that was aimed at and affected somebody else.
So, the public “ gets busy.”
The bureau, or the commissioner, or the superintendent, or the
chairman, is “ approached.” He must be properly “ advised.” If
that does not succeed, appeal is made to the governor or the attorney
general, or a “ protective association” is organized. The enforce
ment official must be made to “ understand” his duties.
Oh, yes, the public wants ability in public service. The public
wants efficiency in public service. The public wants honesty in
public service. But the public does not always get ability, or effi
ciency—or even honesty—sometimes. And the main reason is that
the public’s record is an open book. That book discloses that it
prefers the handshaker, the baby kisser, and the man ready to post
script official missives with an underscored “ I don’t mean it.” It
discloses, further, that it has not grasped, fully, the importance and
significance of these laws, refuses to recognize the administrative bodies
as something more than opportunities for clerical, political positions,
and, therefore, “ approaches” or “ attempts to approach” , through
political, social, or fraternal “ seek-easies” , and, when these fail,
reverts to the world-old method of throwing out of office.
If this association does nothing else this year, it should engage in an
educational program. It should impress upon the minds and memo
ries of all classes of people the one important fact that the administra
tion of workmen’s compensation acts, even in States where no socalled State fund is involved, is not a mere clerical function, to be
performed by any free, male white, whose pigeonholed qualifications
disclose no affirmative evidence of insanity. This, of course, is a
general observation, and no reflection upon the men and women who
have recently assumed places of authority in our midst. The virility
of the phraseology is intended solely to impress the fact that this is a
real job anywhere, even where brain-wracking, technical, actuarial
analyses are not part of the everyday work ana worry; that ordinary
knowledge of affairs is not sufficient qualification; that there must be
expert, trained guidance, continuity, and security of service, with
reasonable remuneration attached.
Wisely have those States acted where staggered terms of office
prevail. Too few, however, have displayed that wisdom. Yet how
often have we heard that the 2-year term of office is an abomination
in any relationship? As applied to this important, particular,
technical business, it is sheer absurdity, and rash extravagance.
It prevents nearly all constructive effort, prohibits deliberative
PRESIDENT’S ADDRESS
5
decisions of policy, throws process and procedure into the maelstrom
of political plunder and “ parasitis” , and paves the way to periodical
“ joy-rides” of passion and prejudice. Let the present trend ex
hibited in some quarters progress just a little further, and we shall
be ringing the funeral chimes for a goose that once laid a golden egg.
Let the lawmakers about face, however, and make provision for the
selection of the right men (under civil service, perhaps), make their
terms of office fairly long, their positions secure and independent,
their remuneration reasonable, and then destroy the opportunity
for momentary obliterations of personnel, and our children’s children
will be singing the praises of those who had the vision and the fore
sight to surround this beneficent legislation with the required safe
guards.
Another lesson learned—at least, I think it is a lesson, and that
we have learned it—is that compensation laws, though in existence
for some years, are still very, very imperfect, and in their practical
application disclose some pronounced inequities.
Aside from the well-known discrepancies, which permit a maxi
mum payment of some $5,000 for the loss of an arm in some States
(North Dakota was $6,300, is now $4,680), while others provide for
a maximum death benefit that is about 40 percent less (New Hamp
shire, $3,000; South Dakota, $3,000; Rhode Island, $3,000; Vermont,
$3,500; Wyoming, $2,000 lump sum), examples of inequities may be
found in nearly all parts of the country—many of those inequities
not making themselves particularly noticeable until the depression.
One or two concrete illustrations will suffice:
1. A ditch digger was the beneficiary of an award for the loss of
an arm; so, also, was an expert linotype operator. The award to
the former was quite a bit larger than that to the latter, the reason,
of course, being that the former chose the heights of prosperity for
his accident, while the latter’s fate carried him through without
mishap until we were in the dumps of the depression; but the normal
result, under normal conditions, is seldom equitable as between
skilled and unskilled labor.
2. Over a period of 5 or 6 years premiums were paid on a yearly
wage of $3,300 for the coverage of the same man. The depression
came and, gradually, wages were reduced until they reached a level
of $1,200 per year. Some months after this man reached the lowwage level indicated, he sustained a serious injury, and received
compensation. With the limitation to $20 per week, he could
never have drawn benefits exceeding $85 per month. As it was, he
received $67 per month. Under normal conditions, he would have
received 31 percent of his wage earnings. As the matter was properly
adjusted, he received his allotted 66% percent of his wages. Yet,
on the other hand, insurance premium income (on the same basic
rate) was reduced 63 percent, whereas compensation payment was
reduced only 21 percent.
But whether conditions are normal or abnormal, there are many
other situations that will bear consideration and possible adjustment.
Let us consider just a few examples:
1.
A mother, totally dependent for support on her son, is entitled
to a maximum award of $7.50 per week, based on wage earnings of
$30 per week by the son (North Dakota law). But if the son was
married, insteaa of single, his widow would receive a maximum of
$10.50 per week (on the same wage basis), even if she had an inde
6
1933 MEETING OF I.A .I.A .B .C .
pendent income or was able to support herself. The mother, also,
must prove dependency. The wife, ordinarily, need not.
2. A workman sustaining an injury that results in permanent total
disability, at a time when his average earnings were $21 per week,
would receive compensation of $14 per week for life, with a maximum
payment of $15,000 (North Dakota law); but if his disability was
80 percent of total, he would be entitled to receive compensation of
$14 per week for 400 weeks, making a total of only $5,600. Thus,
10 men, each receiving a disability rating of 10 percent (or 5 men,
each with a rating of 20 percent), would be entitled to awards total
ing $7,000, while the 1 man, with a 100 percent disability rating,
would be entitled to the maximum of $15,000. And suppose these
same 10 men (or the 5 men) were earning wages of $12 per week
instead of $21, we would find their 100 percent limit reached at
$3,200, while the man with the 100 percent rating, on the same $12
per week wage basis, would still draw out his $15,000, if he lived
long enough.
3. Two men, working in different employments, are injured on
the same day, with the same results; namely, temporary disability
of 36 weeks and the loss of an arm at the shoulder. One is a coal
miner, working 8 months of the year, earning $30 per week, while
working, and a total of $1,040 for the year. The other is a garage
mechanic, working 12 months of the year, earning $20 per week,
and a total of $1,040 for the year. The coal miner receives com
pensation totaling $3,920, while the mechanic receives compensation
totaling $3,690. And there is a strong probability that the coal
miner might receive a total of $5,400, while the mechanic receives
his $3,690.
And so I return again to some of the things I said last year. I
repeat: That I believe in an arbitrary, but more uniform, fixing of
values for all types of injury, at a point that will give due considera
tion to what the traffic can bear; that compensation ought to be
fixed at, and premiums paid upon, the average weekly wage for each
type of occupation, with additional consideration for men specially
skilled; and that collection of premiums should be based on pay
rolls which represent the proper number of weeks of employment
times the weekly wage.
Now, no man, save the Son of Man Himself, ever went through
life without making a mistake. It cannot and should not be expected
that those who administer compensation legislation display the
providential attribute of infallibility. Of course, there should be a
minimum of error; but the way to a minimum of error is not through
side entrances, ear whisperings, or club baitings. Successful work,
good work, true work, is not to be achieved, even for time-measured
periods, through the medium of political poundings and manipula
tions. They are achievable, however, through the medium of
confidence and confidential support extended to men of competence
and courage.
Nor need administrators fear adherence to a courageous stand for
conscientious convictions, firmly based and predicated. Views based
upon facts that bring conviction to an open mind may safety be
relied upon; and eventually they will out-maneuver personal languishments, political leanings, and commercialized seli-aggrandizement.
Propagandized attacks usually end in rout at the impact of knowledge,
courageously applied in affirmative defense. But battles are not
PRESIDENT’S ADDRESS
7
won by throwing up one’s arms and shouting “ Kamerad.” The
big things in life are achieved because men and women are con
tinually willing and ready to “ go over the top” after them.
As administrators of these laws, therefore, we make no suppliant’s
appeal. We come not as “ squealers” , trying to reach or retain a
public trough. We come as men and women of experience, endeavor
ing to make the compensation highways a little better and safer by
marking them with signs that point the way forward and in the
right direction. “ Over the top” , then, and to the attack, against
any who would capture and control those signs for their own less
worthy purposes.
We have the opportunity. May we embrace it. Those who listen
to us will know whether we know wrhat we are talking about. If
we do, we may here lay the foundations for broad policies of con
structive improvement; we may here designate and “ earmark” the
political and other evils that retard, and sometimes prevent, suc
cessful achievement; we may here frankly and openly advise our
respective legislatures and our public, out of our experience, and
pave the way to the administration of this great public trust in an
earnest, efficient, honest, manly way. Manipulators and propa
gandists to the contrary notwithstanding, decisions can be based
upon merit and right, and lack of information, or misinformation,
alone will prevent their being recognized and acknowledged as such.
May we suggest, again, the definite, permanent need for this abso
lute divorce from politics, for staggered appointments, for longer
terms, for security of tenure? May we suggest, further, the necessity
for greater uniformity of schedules among States; for a revamping of
details in items of schedules as between different groups of bene
ficiaries; for more equitable adjustment of benefits as between skilled
craftsmen and unskilled workers; for the fixing of benefits on arbitrary
but more scientific bases; for less fluctuation and more stability; for
less of sensation and more of sound sense; for a fair, frank, full admis
sion that we are administering workmen’s compensation insurance
and not community welfare legislation? We may never come to an
agreement on the final details ourselves, but we can, and we should,
arrive at, formulate, and sponsor such definite, fundamental pro
posals as meet our approval, and thus “ set a standard to which the
wise and the just can repair. ”
If now I were to summarize and place into words that which might
be construed as a message in what I have said, it would be this: That
the workmen’s compensation law is not an inanimate, burial-marking
monument; it is a virile, living organism. It is not a “ meal ticket”
for doctors, lawyers, claimants, or administrators; it is a means for
rendering able, efficient, conscientious, progress-making service to
the people. It is not a political “ pap’’-dispensing machine; it is a
highly technical, business institution, operated for two distinctively
diverse groups, with consistently constant relationships in the same
body politic, requiring a background of training, a foreground of
experience, ability, courage, honor, integrity, and an unprejudiced
humanitarian outlook that can recognize the rights of all men and the
obligation to every man, and yet can sense the power to destroy by
abuse.
[The president’s address was referred to the committee on resolu
tions.]
[Mr. Wenzel resumed the chair.]
8
1933 MEETING OF I.A .I.A .B .C .
BUSINESS MEETING
[Mr. Charles E. Baldwin, secretary-treasurer, read the following
report:]
REPORT OF THE SECRETARY
The past year has been a critical one in the life of the association. While
there has been no change in the active membership of the association, there have
been many changes in the personnel of the boards and commissions which con
stitute our membership. Several of those who have in the past taken active
parts in the activities of our association are not now connected with compensation
administration and if absent from this meeting they will be greatly missed.
The active membership of the association remains the same as last year and
is as follows:
United States Bureau of Labor Statistics.
United States Employees, Compensation Commission.
Arizona Industrial Commission.
California Division of Industrial Accidents and Safety.
Connecticut Board of Compensation Commissioners.
Delaware Industrial Accident Board.
Georgia Department of Industrial Relations.
Illinois Industrial Commission.
Indiana Industrial Board.
Iowa Workmen’s Compensation Service.
Kansas Commission of Labor and Industry.
Maine Industrial Accident Commission.
Maryland State Industrial Accident Commission.
Massachusetts Department of Industrial Accidents.
Nevada Industrial Commission.
New Jersey Department of Labor.
New York Department of Labor.
North Carolina Industrial Commission.
North Dakota Workmen’s Compensation Bureau.
Pennsylvania Department of Labor and Industry.
Utah Industrial Commission.
Virginia Department of Workmen’s Compensation, Industrial Commission.
Washington Department of Labor and Industries.
West Virginia Workmen’s Compensation Department.
Wisconsin Industrial Commission.
Wyoming Workmen’s Compensation Department.
Department of Labor of Canada.
New Brunswick Workmen’s Compensation Board.
Nova Scotia Workmen’s Compensation Board.
Ontario Workmen’s Compensation Board.
Quebec Workmen’s Compensation Commission.
The above list includes three organizations—the United States Bureau of
Labor Statistics, the United States Employees’ Compensation Commission, and
the Department of Labor of Canada—which are given full powers of membership
by the terms of the constitution itself and are exempt from the payment of dues.
There have been two additions to the list of associate members, the National
Council on Compensation Insurance, New York, N.Y., and the American Mutual
Liability Insurance Co., Boston, Mass. The applications of these two members
were received prior to our last annual meeting, but by inadvertence were not
presented for action of the convention; therefore, I submitted them to the execu
tive committee for a letter ballot and, by majority vote of the executive committee,
they were elected to associate membership. The following is the complete list:
Walter F. Dodd, 33 N. LaSalle Street, Chicago, 111.
E. I. duPont de Nemours & Co., Inc., Wilmington, Del.
A. Gaboury, secretary general, Province of Quebec Safety League, Montreal,
I. K. Huber, The Empire Companies* Bartlesville, Okla,
REPORT OF SECRETARY
9
Industrial Accident Prevention Associations, Toronto, Ontario.
Leifur Magnusson, American representative, International Labor Office,
Washington, D.C.
Pennsylvania Self-Insurers’ Association, P.O. Box 849, Harrisburg, Pa.
National Council on Compensation Insurance, New York, N.Y.
American Mutual Liability Insurance Co., Boston, Mass.
Puerto Rico Industrial Commission.
J. F. H. Wyse, general manager, Canadian National Safety League, Toronto,
Ontario.
While the above is given as the present membership of the association, the exact
membership is uncertain, as there has been no confirmation of membership during
the year. Heretofore the test of membership has been the payment of annual
dues. At our last annual meeting it was decided to waive the payment of dues
for one year; consequently no bills were sent out; hence there has been no test of
membership.
While we have not lost any member organizations, we have sustained a severe
loss of two individual members of the association, two past presidents, who in the
past rendered valuable services in the developmsnt and promotion of the interests
of the association. On December 13, 1932, I received a telegram from Mr.
Deland S. Duxbury informing me of the death of his father, F. A. Duxbury, who
passed away that morning, after a short illness. I immediately sent to the family
a letter of sympathy on behalf of the association and telegraphed a floral tribute
to be presented on the day of the funeral. He was president in 1922-23 and
continued his active interest in the association until the date of his death.
On May 25 I received a letter from Past Prssident Fred M. Wilcox informing
me of the death of our past president, Floyd L. Daggett, which occurred on
May 12 at Spokane, Wash. I also sent a letter to Mrs. Daggett expressing the
sympathy of the members of the association Mr. Daggett was president in
1915-16, the second president of the association, and took an active part during
that formative period of the association when wise counsel and sound judgment
were most essential. The passing of these two distinguished past presidents
will be deeply lamented by all.
One year ago the association voted to suspend the payment of dues for 1 year.
As there has been no source of income except a small item of interest, it has been
necessary to use the assets of the association to defray current expenses. As the
amount of cash on deposit was not sufficient to meet the current expenses, it
became necessary to dispose of a portion of our securities. On the authority of
the president of the association I sold $700 par value of 4% percent Liberty bonds.
These were sold at a little above par, yielding a small profit above the purchase
price. I ask your approval of that action.
The assets of the association are not sufficien t to meet the probable expenses of
the coming year. Therefore, I recommend the resumption of the payment of
annual dues and that each member organization be requested to pay the same
amount as in former years.
The association has amongst its assets a $1,500 certificate of the Paterson Mort
gage & Title Guaranty Co. of New Jersey. The company defaulted in the pay
ment of interest on this certificate this year, the reason being that the company
was included in the President’s proclamation declaring a bank holiday, and that
the company cannot do business until author ized to do so by the commissioner
on banking and insurance, and up to date that authority has not been given. As
this certificate will be due and payable October 19, 1933, some action should be
taken at this meeting as to the disposition to oe made of it.
The association has continued its cooperation with the American Standards
Association in its work of drafting national safety codes.
Progress is being made in organizing the two American Standards Association
sectional committees for the safety codes on exhaust systems and work in com
10
1933 MEETING OF I.A .I.A .B .C .
pressed air, both now sponsored by the association, and meetings will be held in
the near future.
A request has been received from the American Standards Association sectional
committee on the safety code for the use, care, and protection of abrasive wheels
for the sanction of the association, as joint sponsor, to amend the code by permit
ting increased speed for coping wheels, used in cutting brick, tile, or stone. The
original request of the DeWalt Products Corporation for this change was, after
approval by the Grinding Wheel Manufacturers’ Association, submitted in April
1932 to the sectional committee, of which 26 members, including the representa
tives of this association, voted in favor of the proposition, one voted against, and
one did not vote. The request is referred to the association for official decision.
The proceedings of the Columbus convention have been published by the Bureau
of Labor Statistics as its Bulletin No. 577, and copies will be sent from the Bureau
upon request.
Respectfully submitted.
C h a s . E. B a l d w i n , Secretary-Treasurer.
[Mr. Baldwin also read the financial report of the treasurer. The
secretary’s report, together with its recommendations, was referred
to the resolutions committee, and the treasurer’s report was referred
to the auditing committee.]
[The reading of the reports of the committee on statistics and costs,
the medical committee, and the committee on safety and safety codes
was postponed until a later session. The report of the committee on
rehabilitation was dispensed with, as the subject was to be covered by
a paper to be given at a later session.]
[The report of the electrical safety code committee was read by
Mr. Baldwin, Mr. Charles H. Weeks, who submitted the report, not
being able to be present.]
REPORT OF ELECTRICAL SAFETY CODE COMMITTEE
B y C h a r le s
H.
W eek s,
Chairman
(Read by Charles E. Baldwin)
In submitting to you the brief report of the electrical committee, I wish to state
that the principal activity of this committee for the past year was the reviewing
of amendments to be presented at the 1933 annual meeting of the electrical
committee (National Fire Protection Association) held in New York City on
March 14 to 17, inclusive. This meeting was attended by Delegates Charles H.
Weeks and B. P. Foster, representing the International Association of Industrial
Accident Boards and Commissions on the following committees:
Article 30.
Article 31.
Article 34.
Article 35.
Cranes and hoists— Mr. Weeks.
Elevators— Mr. Foster.
Motion-picture studios— Mr. Weeks.
Motion-picture projectors and equipment— Mr. Weeks.
At the 1933 annual meeting of the electrical committee, which was conducted
in a very businesslike manner by Mr. A. R. Small, chairman, the revisions of the
code, after much discussion and debate, were finally adopted, and the I.A.I.A.B.C.
was ably represented at this meeting. As we now have an up-to-date code on
all electrical matters, and the association is very active in connection with this
code, I feel confident that the work of the committee is going to be very helpful
to all the members of the I.A.I.A.B.C., and I want to take this opportunity of
expressing my appreciation for the efforts and assistance rendered by my alternate,
Mr. B. P. Foster.
REPORT ON W ORKM EN’S COMPENSATION LEGISLATION
11
I am very sorry, indeed, that, due to conditions in the labor department at this
time, I am unable personally to present this report to the convention.
[The report was, on motion duly seconded and carried, ordered
received, and incorporated in the proceedings.]
[The report of the committee on forms was read by Mr. Kjaer, Mr.
Wilcox, who submitted the report, not being able to be present.]
REPORT OF THE COMMITTEE ON FORMS
By
S id n e y W . W ilc o x :,
Chairman
(Read by S. J. Kj*,er)
During the Columbus convention of the I.A.I.A.B.C. the forms committee of
the National Council on Compensation Insurance promised to contact the com
missioners of the various States in regard to adoption of the standard accident
forms approved by the convention. This work was naturally handicapped by
the administrative changes in a number of States, but your committee has been
advised of good progress in this work. It is stated that some, if not all, of the
standardized forms have been adopted, and some printed, in the following States:
Alabama
Nebraska
Connecticut
New Hampshire
Georgia
Tennessee
Iowa
Vermont
Louisiana
Virginia
It was not deemed advisable to take any action on additional forms. No
meetings were held of the joint committee during the past year. Your committee,
through its chairman, invited the forms committee of the National Council on
Compensation Insurance to present in person a report of its activities in conjunc
tion with the report of the forms committee of the I.A.I.A.B.C.
[On motion, duly seconded and carried, the report was referred to
section B of the Tuesday morning session for discussion, to be reported
back to the general meeting.]
[The report of the committee on workmen’s compensation legislation
was read by the chairman, Mr. Klaw.]
REPORT OF COMMITTEE ON WORKMEN’S COMPENSATION LEGISLATION
By
A b e l K la w ,
Chairman
At the last convention of this association ths following motion was adopted:
It is the sense of the association that the committee on workmen’s compensa
tion legislation prepare a recommendation for the use of the various jurisdictions
on the matter of an amendment to their law to procure some suitable secondinjury legislation.
In pursuance of this action, a meeting of the committee was called for December
6, 1932, in the office of Miss Frances Perkins, in New York City. The following
members of the committee were present in pergon: Miss Frances Perkins, Charles
F. Sharkey, and Abel Klaw. Communications from F. M. Wilcox and 0. F.
McShane were received and given consideration by the meeting.
The final result of this meeting was the adoption of the following provision,
which received the approval of all of the members of the committee:
Whenever a subsequent injury occurs to an employee who has previously sus
tained an accidental injury, the employer for whom such injured employee was
working at the time of such subsequent injury shall be required to pay only that
amount of compensation as would be due for such subsequent injury without
25616°—34----- 2
12
1933 MEETING OF I.A .I.A .B .C .
regard to the effect of the prior injury; and whenever such subsequent injury in
connection with a previous injury results in a permanent partial disability of
75 percent or more of total disability, the compensation which is in excess of the
amount to which the injured employee is entitled solely by the subsequent
injury shall be paid out of the second-injury fund created hereunder.
The loss of both hands, or both arms, or both feet, or both legs, or both eyes,
or any two thereof shall, in the absence of conclusive proof to the contrary,
constitute permanent total disability.
There is hereby created a special fund to be known as the “ second-injury fund.”
The employer, or if insured, his insurance carrier, shall pay into such secondinjury fund for every case of injury causing death in which there are no persons
entitled to compensation, the sum of $500. The commissioner of taxation and
finance (or the State agency which controls the finances) shall be the custodian
of this second-injury fund and the industrial commission (or the industrial
accident board or workmen’s compensation bureau) shall direct the distribution
thereof.
A copy of this provision, as well as copies of the uniform provisions adopted
at the Richmond convention covering the subjects of insurance, third-party
liability, and extraterritorial coverage, was forwarded to the chairman of the
workmen’s compensation administration board of the 40 States wherein the
legislatures were in session. Request was made that consideration be given to
these proposals and that effort be made toward having the same enacted as a
part of the workmen’s compensation law.
Copies were also sent to interested agencies in the States of South Carolina,
Arkansas, and Florida, with the suggestion that if a movement should be started
in those States to effectuate the enactment of a workmen* s compensation law,
these proposals be submitted to the proponents of the same in order that proper
consideration would be given to the advisability of incorporating these provisions
as a part of the proposed law.
Of this total of 43 States to which copies were sent, 23 have no provision for
a second-injury fund, 13 have a second-injury fund provision of some sort, 4 have
no specific second-injury fund provision, and 4 have no workmen’s compensation
law.
The legislatures of the States of Alabama, Kentucky, Louisiana, Mississippi,
and Virginia were*not scheduled to meet in 1933.
Acknowledgments were received from practically all of the States to which
communications were sent, and the general attitude was one of cooperation,
although several of the States advised that the political situation was such that
no favorable action on these subjects could be hoped for at the current session
of the legislature.
From the latest information available, it appears that in 10 of the States where
the legislatures were in session no change was made in the workmen’s compensa
tion act. In the remaining States, while your committee has been unable to
secure verified copies of all of the laws enacted amending the workmen’s compensa
tion act, a preliminary survey indicates that in 8 of the States legislation was
enacted tending to provide for the specific conditions in which the association,
through its committee on workmen’s compensation legislation, has interested
itself.
Your committee feels that our movement has been given impetus, and that
with the further cooperation of the various State commissions, favorable results
can be looked for within the immediate future. Certainly it must be realized
that complete results cannot be hoped for in matters of this sort within a short
period of time. State agencies must be educated to realize the necessity for
uniform provision and the difficulty of overcoming the prevalent feeling of selfsatisfaction must be taken into consideration.
The committee again urges that the members of this association renew their
efforts toward securing the enactment of these uniform provisions, and that they
W ORKM EN'S COMPENSATION LEOHSLATION— DISCUSSION
13
take a more active part in sponsoring the same. If favorable results are to be
accomplished, it must come about through the initiative and direction of the
members of this association. Each State commission should consider itself as
a committee of one in its own State to see to it that these proposals are intro
duced in its respective legislature. This initial step, to my mind, is of primary
importance. After that has been accomplished, the rest should be easy.
[A motion for adoption of this report was made and seconded.]
DISCUSSION
Mr. P a r k s (Massachusetts). I can see a great deal of merit to that
second-injury amendment. I wonder if Mr. Klaw’s committee con
sidered other States than those stated in the schedule. I wonder if
his proposed amendment could be drafted so that it would include
States which may have a nonschedule method of paying compensa
tion, such as we have in Massachusetts. I think the time is coming
when that has to be taken care of, because of men receiving com
pensation for the same condition time and time again. It is resulting
m discrimination against men who have some physical defect from
some prior injury. I do not know whether there are any other
States that do not pay by schedule. The only schedule we have is
for specific injuries, in addition to the payment of weekly compensa
tion for disabilities. I should like to have any suggestions Mr. Klaw
has to offer. Perhaps the committee considered that.
Mr. K l a w (Delaware). Necessarily we could not work on this job
with the idea of having it applicable to one State; we had to take in
the country as a whole. First we discussed the general subject and
the advisability of adopting one sort of provision as against another,
and then we agreed upon the general form of the section. Then, of
course, we realized that in some States there would have to be changes
in the wording here and there in order to make it applicable to the
particular State, and also as to the amount that was to be paid in
each case where there were dependents. We felt that that would
have to be left largely to the individual States; for instance, New
York probably would want to make a larger assessment than that
of some of the smaller States.
While the provision that we finally adopted may not be applicable
to Massachusetts, or to one or two of the other States, we felt that
we had set up a general idea which could be amended or supple
mented so as to make it applicable.
Mr. S t e w a r t (Washington, D.C.). It seems to me that the spe
cific gain in this report is the recommendation of a universal second
ingury fund. I do not like the proposal that in case of the death of a
person who has no dependents the employer shall pay $500 into the
second-injury fund. I think that is absurdly low. I do not care
how you start, just so you get it started. What we want is a statute
on the second-injury fund. I do not see how else this thing can be
met. We know perfectly well that a man who has but one eye is
not going to be employed in a State where the loss of the second eye
means permanent total disability, the entire expense of which falls
on the last employer. We have had all the experience with that sort
of thing we want. Employers will not employ a man with one eye
or one arm or one leg, where if he loses his other arm or other leg
14
1933 MEETING OF I.A .I.A .B .C .
they are soaked, not for the loss of one arm, but for the loss of both
arms. The only way to meet that is to have a second-injury fund
for that purpose, having it entirely separate from the ordinary sched
ule of injuries and the allocation of the injuries. We have been try
ing for 20 years to get that thing through, and if we get it adopted
by this association, even as a starter along that line, it is that much
gained.
I moved to accept the report, not because I liked its detail, but
because it is the start of a thing which we must take some action on.
We must provide some way to take care of the man whom the employer
will not employ because of this law or we are going to lose the law.
Mr. H a l f o r d (Ontario). We do not understand that employers
are very backward in taking injured workmen such as the previous
speaker has outlined. We provide for that in what we call the dis
aster fund. It is a fund we use only in case of a disaster, where
two, three, or four deaths occur. In case a man who has lost an eye
or an arm is injured again, we take the money from this disaster
fund. We have had no difficulty at all along that line. The employ
ers are quite satisfied to accept that responsibility. If the disaster
fund should happen to run a little low, we assess a quarter of 1 per
cent and in that way we keep it up to $300,000 or $400,000.
I am very much in favor of a provision being made for that double
liability. Of course, I understand that most of your acts down here
do not give you that power. We have that power and we use it
whenever it is necessary.
Mr. S t a n l e y (Georgia). In Georgia, if a man loses a second eye
the employer does not have to pay him for total disability unless he
lost his other eye in the same employment. If the man has changed
his employment, the employer simply pays for the one eye lost. A
situation has arisen down there, and we do not quite know what the
outcome will be. The courts have held that there is no maximum
and minimum applying to specific disabilities. If a man is making
$100 a week and he loses an eye he is entitled to $50 a week compen
sation. The courts have passed on that, and it looks as if it were
final. I do not know. Of course, it gives the skilled man a great
deal more compensation, but it cuts down the small or unskilled
man, because there is no minimum in it. If the man has been mak
ing only $2 or $3 or $4 a week, his compensation is nothing.
Mr. K e e n e r (Arizona). The tendency with the compensation fund
of Arizona is to consolidate all funds rather than to make them sep
arate funds. I think the idea of making some legislative provision in
connection with the second-injury proposition is all right where the
fund is used for one purpose. The compensation is paid from one
source, and the compensation for the second injury is also to be paid
from the same source. I would rather have the proposition worked
out on the basis of legislation providing for a second-injury payment
from the same source than on the setting up of a separate fund and
an increase in overhead.
In the small States, financially speaking, we are trying to reduce
our overhead as much as possible. One fund answers the purpose of
everything connected with compensation insurance. I should like to
hear some discussion on legislation on that matter rather than on
the creation of a separate fund.
W ORKM EN’S COMPENSATION LEGISLATION— DISCUSSION
15
Miss H a r r is o n (Maryland). We have that situation in Maryland.
The courts to which our orders are appealed decided that a man who
had lost one eye and then lost the other eye had a permanent total
disability. We had men coming to us saying they could not get em
ployment. Our legislation this year has corrected that by an amend
ment to the law which gives the employee the right to waive his right
to permanent total disability in the case of a second injury, and he
receives compensation only for the loss of the member sustained in
the employment of the employer for whom he was working at the
time of his last injury. When I say waiver of rights I do not mean
for all permanent disability. There are just five kinds—the loss of
a hand, an arm, a foot, a leg, or an eye.
Mr. S t e w a r t . I am afraid the net result of that sort of thing is
just a little more chiseling of the unfortunate workingman. We have
gotten this down to where the lawyer and the doctor have more
interest in the workmen’s compensation law than the workingman
has.
When a man has an eye put out he has lost one eye. When he has
his other eye put out, ms second employer says, and from his point
of view he is right, “ I will pay you only for the loss of the one eye
you lost with me.”
Compensation for two single eyes is not compensation for total
disability. In whose interest is this legislation going to be? At the
Baltimore convention a statement was made that workmen’s com
pensation laws were enacted for the workingman. In the Buffalo
convention the statement was made that workmen’s compensation
laws were not made for the workingman. That is the progress of the
century.
Compensation for two single eyes is not compensation for a blind
man, and wherever or however that man becomes totally disabled,
it is not up to the legislature to try to chisel him out of the fact that
he is totally disabled and that his power to support his family is gone.
The purpose of these laws was to find a way to keep the wives and
children, the families, of the workmen who were injured in industrial
accidents off the charity rolls—that industry should pay for its own
accidents; to charge their cost as a part of the cost of production;
and to put that cost of production on the items and let everybody
pay for them.
Are we going to forget entirely what these laws are for and simply
try to relieve the employer from responsibility? I grant you that the
second employer was not responsible for the fact that in his plant
this man was totally disabled by the loss of his second eye. I grant
you that. What we propose to do here is to meet that situation by
taking care of it with a second-injury fund, secured in other ways,
but still to protect the workingman and his family. This sort of
legislation will do it, and it cannot be done too quickly.
Some States do it this way. If a man who has no dependents is
killed, all the employer has to do is to bury him. What is the result,
gentlemen? There is no use to shut our eyes to the fact that in the
great industrial States a special effort is being made to employ the
fellow who has just gotten off the boat, who has no dependents what
ever in this country, so that if he is killed by accident the workmen’s
compensation law does not apply with full force to him.
16
1933 MEETING OF I.A .I.A .B .C .
If you are going to throw all the jobs into the hands of the young
fellow or the unmarried man without wife, children, father, or mother,
or relatives on this side of the sea, then that is all there is to it. Em
ployers are doing it mighty fast. Some of you know it, and others of
you could find it out if you looked around a little.
If the death of an employee by an industrial accident means just
as much to the employer—just as much assessment against his com
pensation insurance—whether that man has any dependents or not,
then the fellow who has no dependents has no special advantage as to
getting a job. If the employer must pay that death, penalty or total
disability penalty anyhow, and that goes into a fund to take care of
the fellow with one eye in case he loses the other eye, not only are we
protecting the family of the fellow who does become totally disabled
but we are checkmating employment of people simply because they
have no dependents, by which the employer can get out from under
the workmen’s compensation law.
Chairman W e n z e l . May I endeavor to clarify the situation a
little? To my mind this matter is purely a matter of bookkeeping
and mathematics. The man who loses 2 legs, 2 arms, or 2
eyes is permanently totally disabled. We of the State funds are in
position under our laws to charge the excess loss that occurs by reason
of the loss of the second eye to our statutory reserve, which is made
up through contributions from all classifications, and hence the second
employer for whom a man is working when he loses his second eye is
charged only for the amount of the cost of that second eye, but the
reserve is charged for the balance.
The purpose of this particular amendment is to do the same thing
in the competitive insurance States. Nobody is getting anj more.
There is no increase in overhead, as the gentleman said a while ago.
It is the same identical thing. It is simply a matter of fixing the
responsibility of that excess upon the whole group instead of upon the
individual employer. That is all there is to it. It is a matter of
bookkeeping. The fund has to be raised some way. In State-fund
States it is raised, just as it will be raised by the employer, by a
special assessment of some kind. You can limit it to $500 or make it
1 percent of the premium. You can make it anything you like. The
payment to the injured is not an additional payment. It is the pay
ment to which the injured person is entitled. What difference does
it make if a man loses 2 eyes in 1 accident or whether he loses
them in 2 accidents. He has a permanent total disability and he is
entitled to payment for that permanent total disability.
I wonder if you get that picture now. It is purely a matter of
bookkeeping and mathematics, as I see it.
Mr. B a k e r (Kansas). That may be all well and good in your
insurance-fund States, which I think are in the minority, but what
are we going to do in the private-insurance States with a man who
has lost one eye while working for one employer and subsequently
loses the other eye while working for another employer, and is thereby
in fact a totally disabled man? There is no way there, as I see it, to
assess it as excess cost to the industry in a general way. I question
if very many of such States could procure a law which would place
the excess cost on society through the creation of a special fund,
W ORKM EN’S COMPENSATION LEGISLATION— DISCUSSION
17
The problem there is quite different, I think, from that of the ma
jority of States.
Mrs. T o u s a n t (Massachusetts). I might say that Massachusetts
is a competitive State in general, and we have a law which provides
for and takes care of the situation very nicely. In every case where
a person is totally and permanently injured and there are no de
pendents, the insurer pays into a fund held by the State treasurer
$100, plus $150 for the undertaker. That is, in this fund is $100 for
each injury or for each person killed, when he has no dependents.
Then when a person receives an injury and is permanently totally
disabled through the loss of eyes, legs, or arms, one half of the com
pensation is paid out of this fund and one half is paid by the carrier.
That works out very nicely. One half of it is charged to the last
employer. It works out very well, in our opinion.
Mr. D o r s e t t (North Carolina). We have a second-injury fund in
North Carolina. When a man dies in North Carolina as the result
of an accident, we do not take $100 or $500 out, but we take the
whole amount out.
I agree with Mr. Stewart’s observation that there is no sense, if
industry kills a man who happens not to leave any dependents, in
saying that the industry should not pay for that death. I represent
industry on the North Carolina commission. When an injury in
North Carolina results in a death, and the man does not leave a
father or mother, his entire compensation goes to this second-injury
fund and is administered by the North Carolina commission. #If he
leaves a mother and a father, half of it goes to the second-injury
fund and the balance goes to the father and mother. We are accumu
lating a very nice fund to take care of these second injuries, because
I think it is fundamental that when a manufacturer employs a man
with one leg and the man loses that leg while he is in that manufac
turer’s employ, the employer should not be forced to pay for the loss
of both legs. That is fundamental.
Mr. P a t t o n (New York). It hardly seems necessary to have a dis
cussion on this question. Those coming from States in which there
are second-injury funds will tell you without qualification or reser
vation that a second-injury fund is a most admirable thing. This
association has discussed it in other years. We have agreed on it.
I think I would agree with the report. While we may not all agree
with the details of the report, it is a step in the right direction; it is
a stej) to which this convention on many previous occasions has
committed itself. I do not see any necessity for taking the time of
the convention by discussing it.
If anyone wants to Imow how this thing has worked over a period
of years, he has the right to talk with the representatives of States
where it has been in operation successfully. As a matter of fact, for
some years I have been strongly in favor of the attitude of North
Carolina, as pointed out by Mr. Dorsett. There are many other
injuries besides these five which ought to be compensated for. I see
no reason, logic or otherwise, in New York’s case, when the injured
worker leaves no dependents, why the employer should not pay the
average amount paid for all death cases, so that we will have a
second-injury fund, not only for these five disabilities referred to,
but for a number of other serious disabilities.
18
1933 MEETING OF I.A .I.A .B .C .
Mr. Klaw’s recommendation is for a perfectly simple thing, which
I think it is perfectly well understood was needed for years. I should
like to vote not once or twice, but 10 times in favor of adoption of
the report.
Chairman W e n z e l . I s there any more discussion? The question
has been asked for. The motion is to adopt the report as made by
Mr. Klaw’s committee.
Mr. P a r k s . Does that include the recommendation? I f it does
not, I want to include that the recommendation be adopted.
Chairman W e n z e l . I rule that it includes acceptance of the recom
mendation when we adopt it. If there is any different opinion, some
body had better make a different motion. That is understood, that
the motion carries with it the adoption of the recommendation of the
committee.
[The motion was put to a vote and carried.]
[The chairman appointed the nominating and resolutions com
mittees, the personnel of which, and of the auditing committee ap
pointed previously, is as follows:]
Auditing committee.— Eugene B. Patton, of New York, chairman; J. Dewey
Dorsett, of North Carolina; Albert E. Brown, of Maryland; Marie Brindell, of
Kansas; and Howard Keener, of Arizona.
Nominating committee.— Parke P. Deans, of Virginia, chairman; Fred W.
Armstrong, of Nova Scotia; Thomas P. Kearns, of Ohio; Hal M. Stanley, of
Georgia; and O. E. Sharpe, of Quebec.
Resolutions committee.— Dr. Stephen B. Sweeney, of Pennsylvania, chairman;
G. Clay Baker, of Kansas; Charles F. Sharkey, of Washington, D.C.; P. Y. E.
Jones, of Manitoba; and Mrs. Emma S. Tousant, of Massachusetts.
[Meeting adjourned.]
MONDAY, SEPTEMBER 11—AFTERNOON SESSION
Chairman, Peter J. Angsten, Chairman Industrial Commission of Illinois
Chairman A n g s t e n . The first speaker will speak on What Should be
the Obligations and Rights of a Minor in Regard to Notice and
Demand? I want to present at this time Mr. G. Clay Baker, chair
man of the Commission of Labor and Industry of Kansas.
What Should be the Obligations and Rights of a Minor in
Regard to Notice and Demand?
B y G. C l a y B a k e r , Chairman Kansas Commission of Labor and Industry
In my opinion, rights of minor workmen in employments subject
to compensation acts should receive special consideration, and more
consideration should be given thereto than a perusal of the compensa
tion acts indicates has been the case. In a report of the United States
Children's Bureau on the Illegally Employed Minor and the Work
men's Compensation Law (Bui. No. 214) it is stated:
It is estimated that at least 1 in every 10 persons reported as injured in the
course of employment in the United States is under 21 years of age. Many of
these are mere children. The young worker, to an even greater extent than the
worker of mature years, it is believed, is subject to accidents in industry and is
susceptible to injury from such sources as industrial poisons, fumes, and acids.
The volume and seriousness of the accidents call for careful con
sideration of the status of minor workmen. To my mind, the most
flagrant lack of consideration is that of not taking into account the
probable future earnings as a basis for compensation.
But my subject does not extend to the question of the general
status of minor workmen employed by industries subject to compen
sation acts. Further, it is not limited to a consideration of minor
workmen. I take it my subject calls for consideration of all minors,
whether workmen or not, having rights accruing by virtue of compen
sation laws, but it is limited to the matter of “ notice and demand.”
I shall, therefore, endeavor to confine myself to the given subject; i.e.,
What should be the obligations and rights of a minor in regard to
notice and demand?
The acts of the different States vary as to the giving of notice and
demand in the case of minors. There may, for the purpose of
compensation, be said to be 3 classes of minors to consider, and
I believe that each of the 3 classes calls for separate consideration.
The acts are at variance as to the obligation and rights with reference
to these different classes I shall mention as to notice and demand.
There is (1) the minor who is illegally employed; (2) the minor legally
employed; and (3) the minor dependent upon a deceased workman.
19
20
1933 MEETING OF I.A .I.A .B .C .
The Illegally Employed Minor
The laws differ in different States in the treatment of minors em
ployed in violation of child labor laws. Some States exclude illegally
employed minors from the compensation acts, others include them
without special provisions, and still others include them and require
additional compensation for them.
Again quoting from the report above referred to:
The number of minors receiving injuries while employed contrary to law and
the proportion this group forms of the total number of injured minors is not
accurately known. Statistics relating to the minor injured while illegally em
ployed have been compiled or special studies have been made only in a few
States. Limited as the information is, however, it emphasizes the unusual serious
ness of the problem of the illegally employed injured minor. In all the States for
which comparable figures exist the proportion of injuries resulting in death or
permanent disability is greater, and the average period of disability is longer, for
those injured while employed contrary to law than for legally employed minors,
a result, of course, of the fact that so many of the injuries occur in occupations
prohibited because unusually hazardous.
An example of the wide variance in the application of compensation
acts in the case of illegally employed minors may be found in com
paring the Illinois and Missouri acts.
Illinois provides that an illegally employed minor or his legal
representatives may within 6 months after injury or death elect to
reject compensation and sue for damages, except where he has
already accepted compensation with the commission’s approval.
Missouri, on the other hand, provides that minor employees, whether
legally employed or not, are deemed of full age for all purposes of
the act.
It seems to me the Illinois act has a sound provision. One illegally
employed should, in my opinion, be considered outside the law, with
the right to elect to avail himself of the benefits thereof or to bring
suit for damages. However, I do not think that as to such an indi
vidual the time within which he should elect and give notice and
make demand should run from the date of the accident but rather
from the time of his reaching majority or the appointment of a legal
representative. In the case of the illegally employed, we are dealing
with a case of a minor not even considered by law competent to
engage in the work at which he receives his injury, and therefore a
compensation act should not provide competency and impose upon him
the duty of giving notice of accident and making claim for compensa
tion. It seems only logical and fair that in such cases the time within
which notice of accident and demand for compensation are to be
made should not begin to run until the injured has reached the age
of majority or a legal representative has been appointed, and if option
of pursuing remedies under the compensation act or suing for damages
is given, time within which such election may be made should not
commence to run until the reaching of the age of majority or the
appointment of a legal representative.
Legally Employed Minor
Many parties no doubt hold to the argument that a minor, though
legally employed, should as to competency be regarded the same by
compensation acts as he is generally regarded by law; i.e., that he is
an incompetent, and time as to notice of injury and demand for Qom
RIGHTS OF MINORS RE NOTICE AND DEMAND
21
pensation should not begin to run against him until he has reached the
age of majority or a guardian has been appointed. It may be said,
Why should there be any exception in the application of a compensa
tion law? By many of the acts a minor is deemed sui juris. It seems
to me that if the State has deemed one of sufficient age to engage in a
given work it is only fair that the obligations imposed by any system
of remuneration for injuries resulting from that work should be
incumbent upon such an individual.
My understanding of the purpose of compensation acts is that, for
the benefit of both employer and employee, there be an early deter
mination of rights and liabilities, and therefore there should be
avoidance of any technicalities and impediments standing in the way
of speedy ascertainment of rights and liabilities.
Certainly, if the State recognizes that one is competent, though a
minor, to engage himself as a workman with a given industry, he
should then be considered as legally competent, so as to bind him to
the obligations of that contract of employment and the rights and
duties that go with such contract of employment.
It would seem inconsistent to me for the State to regard one as
competent to engage in a given work and, on the other hand, incom
petent as regards the legal regulations as to that work. I feel that
it is not only fair, but also that no injustice is done in placing a
legally employed minor on the same footing as an adult worker as
regards notice of injury and demand for compensation.
The legislature can fix the age at which one may be employed in
hazardous industries, and it has power to fix the age at which dis
abilities of infancy shall be removed. When the legislature says one
is of sufficient age to engage in a given occupation—in other words
to enter into a contract of employment—why, then, should it not
likewise say that such party shall himself be bound by that contract
of employment and all the obligations thereof, including the compen
sation act and the requirement thereof as to notice and demand?
Minor Dependents
Certainly no compensation act should seek to impose upon a minor
dependent the obligation of giving notice of accident and making
demand for compensation, for to do so would be obviously unjust.
It would be imposing knowledge and duty upon an incompetent, in
the eyes of the law, which would be utter unfairness. I do not think
any argument need be made that time for giving notice and making
demand should not run against a minor dependent until reaching the
age of majority or the appointment of a guardian. Otherwise, how
ever, I see no occasion for a difference in the time limit from that of an
adult dependent.
Conclusion
To summarize, it is my opinion that there should be no exception
as to minors in the matter of requiring notice of accident and claim
for compensation, except that in the case of illegally employed minors
and minor dependents the time should not commence to run until
such minors reach the age of majority or the appointment of legal
representatives.
22
1933 MEETING OF I.A .I.A .B .C .
Chairman A n g s t e n . The next speaker deserves a great deal of
credit and commendation from the officers of this convention. Your
officers selected for the afternoon program a gentleman who was known
and loved by all of us, the Honorable Fred Wilcox, formerly of the Wis
consin board. Mr. Wilcox intended to be here and would have been
but for a strike situation that keeps him in the East. When we ap
proached the next speaker whom I am to present, he said, “ Why,
certainly I will be glad to fill in any place you can use me.”
The subject this afternoon I am going to nave the speaker announce
himself. We did not ask him until about three quarters of an hour
ago, and we told him to name the subject he would talk on. I have
the great honor to present at this time Mr. Joseph A. Parks, chairman
of the Massachusetts Department of Industrial Accidents.
Workmen’s Compensation Progress
By
Joseph
A.
P arks,
Chairman Massachusetts Department of Industrial Accidents
The subject Workmen’s Compensation Progress should be discussed
by someone, I suppose, who has been associated with the work from
the beginning. I know that many of the new commissioners do not
like to be told what the beginning of this work was. They prefer
their own ideas of what it is now. When you start to tell them what
we used to do 20 years ago, they say, “ Well, that might have been all
right 20 years ago, but it doesn’t go now.” Gentlemen, it does go
now. In order to administer the workmen’s compensation act today,
in this year of our Lord 1933, we have to remember why this act was
placed on the statute books.
I listened with a great deal of attention and pride to the president’s
address. He told many truths. He told what the compensation act
was for. Mr. Stewart added a little more to it; he said the workmen’s
compensation act was for the workman, no one else. The Buffalo
convention (I was not there, but if I had been, whoever said it would
not have said it without my taking issue with him) said that it was
not for the benefit of the workman. # The workmen’s compensation
act was passed 100 percent for the injured workmen of the United
States, not 99 percent, 98 percent, or 97 percent. It is not for the
benefit of the lawyers or the doctors or the hospitals. They come in
for the consideration due them, but the primary consideration, first,
last, and all the time, is the injured workman.
I began to be interested in workmen’s compensation in my heart,
not as a legal proposition, when I was a little chap working in a cotton
mill in England. I was about 12 years old at the time, and I had
been in the mill for some time then. I was a weaver. One day I was
out in the mill yard and I saw two or three people around what they
called the watchhouse—the office we call it here. I saw a man sitting
in a chair in the office. He was holding his wrist like this [indicating].
His hand was hanging on by a piece of skin. No one was taking any
notice of him; they weren’t even giving him a look. I inquired, in
my boyish way, “ What happened? Why don’t they do something
for him? Why don’t they get a doctor and bandage him up or do
something? Why aren’t they doing something for mm?”
They said, “ Oh, there will be a wagon here any time now. He will
be taken to the infirmary.”
W ORKM EN’S COMPENSATION PROGRESS
23
As I stood there I saw a wagon come up to the door—there were no
automobiles in those days. They put him in a spring wagon and he
was taken away to the infirmary. A little while later I inquired about
it. I said, “ What will they do about that?”
“ Oh, nothing. That is happening all the time. They won't do
anything about it. They will put someone in his place.”
“ What will they do for his family?”
“ Nothing.”
They hadn’t come to that yet; no one had thought of it. Of course,
later on the workmen’s compensation act was passed in England,
Germany, and other European countries.
When I came to this country I became somewhat of a labor agitator.
I became president of my union when I was about 21 years old, and
I became interested in these labor problems. Immediately I began
thinking about workmen’s compensation—what we could do about
the sort of fellow I had seen over in the old country.
I had the good fortune to be elected to the Massachusetts Legisla
ture in 1904, and in 1905 I presented a workmen’s compensation law
to the legislature. I kept presenting it and presenting it, until in
1910 a commission to draft a workmen’s compensation act was author
ized by an act of the legislature, and I was appointed on that com
mission. In 1911 an act was presented to the legislature and passed,
to go into effect July 1, 1912. It has been in effect ever since, and it is
with its progress that we are concerned.
There has always been some argument and some little controversy
as to which State was the first to pass such an act. We are not here
to discuss that. About that time acts began to be passed, until today
we have, with the exception of 3 or 4 States, a workmen’s compensa
tion act in every State in the United States and every Province in
Canada.
We have made progress, naturally. We are having difficulties now.
We had difficulties in the beginning, but when I look back at the prog
ress we have made, I wonder whether this is the little compensation
act that we squeezed by the Massachusetts Legislature. I think about
the act when we got it through. We paid at that time, as I remember
it, 50 percent of the average weekly wages of the injured workman,
not to exceed $10 a week. We paid $10 a week for death, not to
exceed $3,000. That was the limit. We went merrily along for a
while. I remember attending a convention in Philadelphia of the
industrial accident boards and commissions. One of the subjects I
was given to discuss at that time was, What Should be the Percentage
of Compensation to be Paid to Injured Workmen? I forget just what
year that was—it was a good many years ago. I recall very distinctly
that no State was paying over 50 percent of the average weekly wages
for compensation at that time. I advocated there, as a standard, two
thirds of the average weekly wage. I know what a sensation it caused.
They said, “ You are far ahead of yourself, Joe. Forget it. It is bad
enough paying 50 percent, not to mention two thirds.”
Now some of our States are paying big amounts. I do not like to
mention them, but there is New York. North Dakota, I think, is
one of the big-payment States. There are a good many others that
are paying almost the full wages, and a good many States are paying
during life.
24
1933 MEETING OF I.A .I.A .B .C .
That is progress. In Massachusetts we have gone from not to
exceed $10 a week to not to exceed $18 a week, and from a total of
$3,000 for the injured workman who is disabled to $4,500, plus a
certain amount for specific compensation. The widow and the chil
dren are being considered. In Massachusetts the widow is getting $2
additional for each of her children, the total amount not to exceed
$6,400. While I think that is miserably small, still it is twice as much
as the widow got in 1912. That is progress, of course.
Medical attention then was given for not more than 2 weeks. When
I look back, I think of how silly that was, but we had to make a start.
Also, we had to make it look as though it would not be too expensive.
They were talking about that, I remember, when we were agitating
for it in Massachusetts. Some of the employers threw up their
hands in horror, saying “ My God, we are all going into bankruptcy.”
I remember meeting a paper hanger in Boston, where I lived. He
said, “ Parks, that will make me bankrupt in no time.”
“ WiU it?”
“ Yes.”
I thought that perhaps I could throw a little light on that because
of his lack of information on the compensation act and of my knowl
edge of it. I said to him, “ How many men did you have injured last
year, for the whole 12 months of the year?”
“ I don’t remember.”
“ You had so few you don’t remember them, do you?”
“ Yes. I remember now. I had one man injured.”
“ How long was he disabled?”
“ Oh, about 3 weeks.”
I figured up the compensation and said, “ Well, with the 2 weeks
waiting period, he would get only 1 week. That would have cost you
$10 for last year. If your business is poor and on the verge of bank
ruptcy, of course the loss of that $10 bill, plus medical expenses,
would put you into bankruptcy.”
“ I didn’t know it was as easy as that.”
That is the way it looked to them at that time. I think that is
why a good many of them let us get it by.
We progressed along the line of medical aid, until now in a good
many States there is unlimited medical service. In Massachusetts,
the law provides for medical attention for the first 2 weeks after the
injury, and in unusual cases or cases requiring surgical or specialized
care for a longer period at the discretion of the industrial accident
board. That can be interpreted to mean full medical attention. The
supreme court interpreted the word “ unusual” very strictly, and we
had to amend the law by putting in those words, “ surgical or special
ized care.” You can readily see, with a broad interpretation of those
words, that a man gets medical attention practically during his entire
need of it.
Ours is an insurance State, and personally I have no apology to
offer for being in an insurance company State. We get along very
well with the insurance companies. If they do not toe the line, we
see that they do, but they generally do. They have seen the light.
In the beginning of the administration of this act they would stop
giving a man medical attention a minute before the 14 days were up.
At that time they could not see that leaving a man with a gaping
wound on the fourteenth day was a hazard, that he might die of blood
W ORKM EN’S COMPENSATION PROGRESS
25
poisoning and they would have a fatal case on their hands. Finally
they came to realize that giving full medical attention was to their
benefit as a business proposition, apart from the humanitarian end
of it, and of course that is progress. I think that medical attention,
properly supervised, is the best feature of the workmen's compensa
tion act, next, of course, to safety and prevention of accidents. After
the man is hurt the next thing is to make him well. It is easy to give
compensation but it is not always easy to make the man well. I hope
we can make more progress in making men well. I am sorry that we
have not made the progress in that respect that we should have made
in 21 years.
I will illustrate what I mean by this: I presided at a hearing on a
case in one of our cities in Massachusetts. A doctor who conducted
a sanitarium had been treating a back injury for 5 years. The man
was on compensation all the time. When the man testified I asked
him, “Are you any better now than you were the first day you went to
Dr. So-and-so?" He said, “ No; in fact, I feel a little worse."
Then the doctor testified. I said to him: “ I suppose you have been
treating this man for a back injury with all the things that your
medical education gave you, all the experience of the years of study
and of practice?"
“ Yes; I gave him everything I had. I am still giving it to him."
“Aren't you disappointed, Doctor, that after 5 years you find him
worse than he was when you started with him?"
“ No."
He said he was going to continue to treat the man as long as he
would come to him. I do not like that. That is an extreme case but
it is a fact. I think the medical profession owes the compensation
act a little more than that. I do not think that a man who gets a
sprained back should be treated for it for 5 years without results. If
a plumber came to fix your faucet, and after coming every day for
5 years it still leaked, and you were paying him all that time, you
would want to know where he got his education as a plumber. Of
course you would. While that may be a very poor comparison, still
there is something in it.
The medical profession is one of the professions that have advanced.
Some marvelous things are being done by doctors, but they owe
more to the compensation act than just using it to collect bills. We
want to know what they did, what the results of their attention have
been, what they have done for that crippled hand, why they have not
gotten it in shape so that it can be used. That should be a labor of
love as well as a labor of business. We are looking for results. I
think a doctor who deliberately prolongs a case for the purpose of
collecting more and increasing his bill is the vilest creature we could
describe, and yet we have some who will do that very thing.
We have some splendid doctors in our State, as you have in all your
States. I dislike to talk about the exceptional doctor. I am saying
this only so that we can bring the fine type of doctor forward and
eliminate those chaps who do not give the service to which the injured
workman is entitled under the compensation act.
We have arrived at the stage in the administration of the workmen's
compensation act, particularly in these last 3 or 4 years, when we
sometimes wonder whether it is going to survive, but of course it is.
The workmen's compensation act is so big and so hinnan and so full
26
1933 MEETING OF I.A .I.A .B .C .
of good things for the workmen of the United States that it simply has
to go on. It cannot break down. But we have to be on our guard,
we have to watch it.
A good many workmen are taking advantage of this great piece of
humane legislation, to their own detriment, because after all it is our
act—it is your business, it is my business. You are paying the bill.
When these men take advantage of the workmen’s compensation act
they are taking advantage of every man they see on the street, of
their friends, their neighbors, and their children, and they are impair
ing the compensation act which was designed for their benefit. Un
fortunately, they get help. The legal profession helps them, not
knowingly sometimes, but sometimes I think it does know it. The
doctors help them, sometimes not knowingly, but; I will swear that
sometimes they do know it.
A doctor testified before me under oath that a man’s fingers were so
injured that he could not flex them, that the tendons were destroyed.
Then the doctor left. I was sorry he did. The hearing went on.
The man testified, after which he went out and sat in a room where
fortunately I could see him. He was a nervous chap and he began
to move ms fingers. Those fingers that the doctor had testified the
man could not flex because the tendons were gone were flexing just
as well as mine are now. I called his lawyer and pointed to where
this man was sitting and said, “ Harry, look at your client’s hand.”
He said, “ I will tell him now.”
“ No; you don’t need to; I have seen enough. ^ Tell that doctor of
yours what I saw, and tell him for me that he didn’t tell the truth.”
That is the kind of thing I mean. That doctor did not tell the
truth. The board is entitled to have the doctor who performs
medical service for an injured man come before it and tell the truth
about the injury. Thank God, those doctors are in the majority
who look you squarely in the eye and tell you the truth. I know
there may be honest differences of opinion. The opinions of the
doctors may be different and yet they may all be telling the truth.
I am talking about the doctor who deliberately falsifies to get a few
dollars out of a case or to curry favor with the family of the man, and
so forth. That is not progress at all. We have to be on our guard
for that.
The new commissioners (and I am addressing my remarks prin
cipally to them) have not had the experience. I say that advisedly.
I do not say that because I have been in this work for 10 or 15 years
I know it all, but I have learned from experience, and I have come to
know character a little more. When you have such experience you
are not so gullible. I hear cases today that back in the year 1912 I
would have given compensation on because I would have believed
them then. I do not believe so easily now; 21 years have taught me
to be on my guard. When a man was brought in between two
members of his family and he groaned as he hobbled to the chair,
my old heart used to go pitter-patter. The case was decided before
I had heard the evidence. What more did I want to hear? Now, I
do not blink an eye when such men are brought in, even if they are
brought in on a stretcher; I do not even give the case a glance.
What is the reason for his being in that condition? What is it
that makes him so helpless? I want the medical profession to tell
me that. That is where the doctor comes in. The doctor has an
W O RK M EN’S COMPENSATION PROGRESS
27
important function—to show you that the man can walk better than
you can yourself and that he is deliberately putting it over. If the
doctors would only say truthfully, “ There is not a thing wrong with
him. He can get up and walk out if he wants to”—if we could get
them to tell us the truth about that, what a blessing it would be.
In Massachusetts we are making progress in that respect. The
Massachusetts Medical Society, as it is at present constituted, has
promised to give us every possible aid in that respect. It is going to
cooperate with our board in suggesting to the next legislature various
amendments that will be helpful in medical matters. That is what
we want. We want the assistance of these medical societies of the
United States. Perhaps I am talking to representatives of some
States that have the same kind of act we have. I know ours is a
continuing thing. We have no schedule except that when a man loses
his arm, for instance, he gets 75 weeks at $10 a week, in addition to
his disability compensation. His disability compensation is fixed
but only so far as he continues to be disabled. It is a matter of com
petent evidence as the case progresses. The insurance company can
challenge the question of disability at any time, and we have to have
a hearing to decide whether the man is still disabled. Of course,
most of the States say, “ We give him 75 weeks and we are through
with it.” I am not criticizing that idea; as I said before, I think it
has a lot of good points in it. We continue the man on compensation,
and we have the doctors come in and testify frequently.
There are a good many things that we ought to be thinking about
as to the future of the workmen’s compensation act. I can afford,
perhaps, to talk about another thing Mr. Wenzel talked about, as
I have just been reappointed for another 5-year term, and the way
my hair is whitening perhaps that may be the last one. It takes
5 or 6 years to get onto the ropes as a member of an industrial accident
board, to get to know what your duties are, and if men are willing to
put their time into the work and make it their life work, they should
be permitted to do so. I am the only member of the Massachusetts
commission who started in 1912. Of course, the others have not all
been replaced—we have had some deaths.
I wish we could do something here more than to hope about the
tenure of office. I do not know what system you have in your States.
In Massachusetts we appoint judges for life. When I was a young
fellow, before I went on the industrial accident board, I did not quite
approve of that, but now I do, and I can talk about it without any
feeling that I am trying to perpetuate myself. I am good for 5 years
more anyway, so I do not have to be begging for a job. I think mem
bers of the industrial accident boards should be covered in the same
way, because the members are just as real judges as there are in any
court. The idea, of course, is to make them independent of politics,
to make their minds free, so that if one of them while sitting there
looks out in front and perhaps sees the chairman of the party com
mittee to whom he is beholden for his job, he need not be prejudiced
in his favor because he happens to owe him something. A man in
such a position should be free of everything. I feel that I have
always been free, but I want everybody else to feel that way. I have
been free in Massachusetts to do just as I liked without anyone
dictating to me. I have been appointed by three Republican gov
ernors and by two Democratic governors.
25616°—34----- 3
28
1933 MEETING OF I.A .I.A .B .C .
The thing I want to bring about has been brought about in my case.
I think it should be agitated. I do not think this convention would
be accused of doing something that may sound like politics or some
thing improper. I think we should have some resolution in this
regard, either deploring the tendency of the times to have States and
governors changing commissioners of industrial accident boards,
something like that, or endorsing the principle of keeping them in
office for a longer period of time. But certainly not to have anything
like they have in North Dakota, or was it Arizona, where the governor
was given power to remove a man without cause Imagine such an
outrageous thing as that—remove a man without cause. A man may
be trying conscientiously to do his duty day after day, but how can he
do it? How can any man take up this work with the knowledge that
after his 5-year term, or within 5 years, he has to leave it? He has to
have one finger in his other business and one finger in this work. He
says, “ I will have to go back to it. I owe it to my family/’ Best of
all, of course, is the principle that a man is free to render his decisions
without fear or favor to anybody, to decide his cases in accordance
with his conscience. That is the way they ought all to be decided.
In closing, I think we ought to remember one of the things that Mr.
Stewart and Mr. Wenzel talked about. It is that this is first, last, and
all the time a workmen’s compensation act, for the benefit of the
workman. All the rest is subsidiary to that. That is what we are all
interested in. Every citizen, every noncitizen, every laboring man,
every nonlaboring man, no matter what his religion is, is paying for
the workmen’s compensation act. For that reason, because we have
to pay for it, we should be interested in it.
DISCUSSION
Mr. K e e n e r (Arizona). I should like to make a statement as to
Arizona’s standing on the removal of commissioners. The governor
of the State appoints the commissioners; he cannot remove them
without cause. In fact, the removal of those commissioners who
were removed at the beginning of this year was for cause, a very good
cause.
Mr. D o r s e t t (North Carolina). I offer this observation about
something that stands in the way of progress of workmen’s compen
sation legislation. Some of you probably have had the same experi
ence we have had in the past two sessions of our general assembly.
We found there lobbyists employed by the insurance companies, advo
cating taking away from the industrial commissioners their right to
be the judges of the facts. Mr. Stewart could probably talk for
hours on that subject. There must be some reason why the insurance
carriers advocated it in North Carolina for 5 months, with no less
than half a dozen separate and identical bills to take away from the
industrial commissioners the right to be the judges of the facts. We
find the facts and in my State the courts cannot alter our findings on
the facts, any more than a judge can tell a jury that it has found the
wrong facts. With the bitter fight we have had in North Carolina
against the compensation law itself, we are proud of the fact that not
one man has ever intimated that there has been anything wrong with
the administration of that act. But for some reason the insurance
companies were there, 2 years ago and in the past year, advocating
taking away from the commissioners the right to be the sole judges
of the facts. I think that is a thing we ought to be on guard against,
W O RK M EN ’ S COMPENSATION PROGRESS— DISCUSSION
29
as that, in my judgment, will hinder progress in workmen’s compen
sation legislation.
Mr. P a t t o n (New York). I presume the reason they did that was
because of the riding in New York, which was upheld by the Supreme
Court of the United States, that the department was the final judge
of facts. That was in the case of Dahlstrom Metallic Door (Jo. v.
Industrial Board oj New York, 284 U.S. 594. The employers took
the case to the United States Supreme Court, covering nothing else
but the right of the department to be the sole judge of the facts.
The Supreme Court manifestly upheld the statute. The only way
to get around it was to get the statute repealed. The employers
would like to have in any jurisdiction the right of court review as to
facts, and the only way they can do it is to have the statute repealed.
Mr. S t e w a r t (Washington, D.C.).. On the subject of being on
your guard, the manufacturers accepted the workmen’s compensation
law because in general it was a guaranty and protection to them such
as they had never had before. Under the old liability law, a man
could have a single accident in his factory with 2 or 3 people killed.
If their representatives went to court and got $30,000 or $40,000 or
$50,000 apiece, as was entirely possible with a sympathetic jury, that
man went out of business then and there. He wasn’t crippled, he
wasn’t taxed; he was killed, his business was crushed.
The workmen’s compensation law prevented the entire ruination of
men here and there, a thing which all manufacturers and employers,
particularly those working on a narrow margin, greatly needed. Such
a fellow could go on pretty well until something happened whereby
he had to pay a widow $10,000 or $20,000. If that was all he had in
the business, it was his ruination. The manufacturers were perfectly
willing to make a jackpot of it all and to pay the insurance premium
and charge it to their cost of production, including it in the price of
their goods. While the act was of assistance to the workmen of the
community because it relieved public charity from the support of the
widow and children of the injured man, it was also in that indirect
way a great blessing to the manufacturer and particularly to the
smaller manufacturer. Then along comes another element, the insur
ance carrier which takes this man’s risk for a fee, based on an insurance
premium rate. He hasn’t that interest in the law that the smaller
manufacturer has—that it is something established to protect his
business. He has but one principal interest in the thing.
Mr. J o h a n n s e n (Illinois). I am a new member of the industrial
commission here in Illinois; I have served only 3 months. It seems to
me that the progress of compensation depends largely upon the atti
tude held by the community. It is j ust like everything else. It seems
to me that one of the important things in progress, in making com
pensation laws and their administration more effective and more capa
ble of doing the things they are supposed to do, is to see to it, as far
as possible, that the average man or woman in our communities gets
as much information as possible, in a simplified fashion, as to what the
law is and how to proceed thereunder. Having that in mind, the
legislature in this State at its last session amended the law, making it
mandatory upon the industrial commission to have the rules of pro
cedure prmted, not because the commissioners or the insurance ad
justers or the lawyers needed that information, but that injured men
and women in this State might have access thereto, so far as possible,
and in consequence need less help to enforce their claims.
30
1933 MEETING OF I.A .I.A .B .C .
What does that mean? It means that after all, while it is important
to have good laws, it is still more important or equally important to
have an administration of those laws that not only is understanding
and intelligent but also has in mind their function, namely, to see
that injured people get what belongs to them under the law and with
the least possible delay. Of course, while in many respects the insur
ance companies may appear bad or selfish or inclined to minimize, the
fact remains that, on the whole, I would much rather deal with
insurance companies than with the average employer without insur
ance. That has been my experience as a representative of a large
group of workmen prior to being on the commission. I have found
in my experience that whenever I was dealing with a contractor or an
employer who had no insurance, I found difficulty in collection. In
that connection the insurance carriers were more easy to deal with
than employers who had no insurance.
We must not be unmindful of the fact that workmen are just as
human as the rest of us. They are inclined to exaggerate the misery
and sometimes the trouble that happens to them. When something
happens to them, not only do they feel that they should get what
belongs to them, but they demand something on the basis of what
they think the law ought to be. So it is not so easy.
I believe the industrial commission in our State or in any other
State should be the judge of the facts. It is just as important how
the law is administered as it is what the law is.
It seems to me that no matter which way you look at it, it always
comes back to the one point. The administration of justice in com
pensation or any other field depends largely upon the average intelli
gence of the community in which you live. If you can help that
intelligence and understanding, then you will get better enforcement
and a better citizenship. It seems to me that the industrial boards
of all the States should exercise what influence they may have to the
end that the average person will understand our laws and will know
how to proceed under them—will know what the law provides and
will have a reasonable understanding of what to expect. If you do
that, then there will be less exploitation, and eventually, if the law
is not what it should be, that same channel of information and under
standing will make the law better from time to time.
On the whole, it was reasoned out years ago—before my time,
of course—that the workman reasons on the law of averages. He
knows that if he loses an arm in an accident, under the common law
he may hire a lawyer and bring suit. He might get $20,000 for the
loss of his arm or he might get $25,000, or he might even get $50,000—
and he may get nothing.
When this proposition of a compensation law came along, it did
what? It proposed certain specific amounts for specific temporary
losses, for death, and so on. It also proposed something else. It
proposed to take away from the employer his former right or defense
under common law for the assumed risk. Formerly if an average
workman on a dangerous machine was injured badly, he came into
court. If the court found out that he knew that machine was dan
gerous and yet worked on it, he was told that because he worked on
that machine the employer would not assume the risk; he would get
nothing. Out of that experience came the compensation law. Every
body realizes that the compensation law not only is a step in the prog
W O RKM EN’S COMPENSATION PROGRESS— DISCUSSION
31
ress toward protecting injured men, but also that it influences to a
great degree the progress of safety in dangerous occupations.
It seems to me that no matter where we may travel, we find that
what we must hope for as commissioners of industrial commissions,
as State officers, as local officers of city, community, or whatever it
may be, is to do our small part in informing and enlightening the
average man, so that the standard generally will become higher.
When it is higher we will find that the politician does not lead; he will
follow. In other words, the Government in our time or any other
time has an opportunity to crystalize the public mind in any given
direction for social legislation. This act, in its highest sense, it seems
to me, is social legislation. It is not to be against labor or for labor;
it is not to be for the employer or against the employer; but it pro
poses to see to it that industry as such will pay for its cripples and
its injured and its dead. That is the purpose of it, and in its admin
istration the commission, it seems to me, should always be the judge
of the facts. Of course if it does not apply the law properly, there
are certain courts to which to appeal on error.
In my experience I find that very few cases go to the supreme court.
The average State commission is influenced, not by a desire to serve
labor or to serve the employer, but by a desire to help to keep in bal
ance the whole situation so that industry pays its reasonable pro
portion for the maiming and crippling of men and women in industry.
No matter where you go, I think you will find that the average man
or woman you talk to recognizes that the workmen’s compensation
law is one of the most important, one of the most needed, and one of
the most elementary laws passed by any State in the Union. It is
one that reaches indirectly nearly everybody in every important
city, especially the industrial cities in this country.
Mr. L e o n a r d (Ohio). I was very much interested in the remarks
of Mr. Johannsen, especially on the matter of different kinds of
coverage. I think the big proposition is to see that whatever the
coverage is, it protects the workman. That, after all, is the purpose
of workmen’s compensation.
A year ago in Ohio Dr. Donohue, of Connecticut, asked me on the
floor what would happen if the Ohio fund had to sell its securities.
The Ohio State fund securities are entirely in Ohio municipal bonds.
I replied to him that possibly, if a crisis came and we had to sell our
securities, we would be in the same position as anyone else, we would
have to take a loss. I said, “ The time isn’t here when we have to
take a loss. ”
A short time after that we sold some securities at a profit of $20,000
to the State above what we paid for them. I had occasion to think
of his remarks a good many times after that. On the first of March
we should have had about $2,500,000 in the State fund. The bank
holiday came along and we had probably $200,000. We had money
due from public employers in Cleveland; I think we had a quarter of a
million due the fund, from all over Ohio, and the money was tied up.
The proposition came up, “ Well, how about the payments to the
injured workers?”
Another question was: “ Can we go out on the market today and
sell our securities?” We said we could not do it without taking a
big loss.
32
1933 MEETING OF I.A .I.A .B .C .
The State of Ohio enacted a law authorizing the Industrial Com
mission of Ohio to issue scrip. The bill went through and we went
to the officials and said, “ We will possibly have to issue scrip for a
little while. ” They said, “ Things are shaping up around the State
now so that the State doesn’t have to issue scrip. How about the
industrial commission?”
Then we got a bill through authorizing the industrial commission
to borrow up to $10,000,000 on its securities in the banks. We went
to see the bankers of Columbus. One man offered to loan us $400,000.
We thought we would put it up to the clearing house. The banks had
a meeting and decided that they would charge us 5 percent. We said,
“ The State of Ohio gives you its inactive funds at I percent interest.
Why should we pay 5?” We did not pay 5 percent. The upshot of
it was that one man offered to loan us $400,000 at 4 percent. Things
opened up. We got our money from Cleveland.
We saw that we would never be able to go to the banks and ask
them to loan money to us in any considerable amount unless we paid
the price. We called up the Federal Reserve in Cleveland and were
told, “ You fellows are not under the Federal Reserve. The private
insurance companies are. You fellows can’t do it.”
We thought the time was ripe to get busy down at Washington, so
Senator Bulkley of Ohio introduced a bill under the banking act
giving us the same rights to borrow money that the insurance com
panies had. Mr. Edmondson and I went down to Washington.
The bill was passed by the Senate and lodged in the House of Repre
sentatives Banking Committee. We had considerable talking to do.
Of course, it was a new thing for the Government to do, to allow
anything but private business to come under the R.F.C. We said
to them, “ We want only the same opportunity as the private insur
ance companies have to put up our bonds. We are not asking for
charity. We are not asking for something for nothing. ” They said,
“ Well, that is fair enough. ”
The bill was passed. The Ohio fund can go before the R.F.C. and
put up its securities for a loan. The same thing applies to any
State fund in the United States. We have to satisfy the R.F.C.
that our securities are good in repaying the loan. That is a mighty
important thing today in workmen’s compensation in the United
States of America.
I may say, for the Ohio Industrial Commission, that our funds
commenced to come in. We did not have to borrow any great sum,
even the $400,000. As a matter of good faith, we borrowed $100,000,
and we did not really need that. That bank was decent enough to
offer it, and we thought we would take a little bit of that $400,000.
That money was paid back, or it will be paid back within a week or so.
Dr. S w e e n e y (Pennsylvania). I was interested in the remarks on
the importance of educating the worker as to his rights. I imagine
that is not so important in some other States. In Pennsylvania we
have found that it is very helpful to send out what we call our workers ’
rights letter whenever we receive a report of an accident. That has
been going out for about a year and a half. I believe that we could
trace an increasing number of agreements, and probably an increasing
number of petitions to the board on contested cases, to the workers’
rights letter going out in the case of every accident whether it is
indicated that the accident is compensable or not.
[Meeting adjourned.]
TUESDAY, SEPTEMBER 12—MORNING SESSION
S e c tio n
B.1— Problems of Private Insurance Carrier States and Competitive
State Jurisdictions
Chairman, Parke P. Deans, member Department of Workmen’s Compensation of Virginia
ROUND-TABLE DISCUSSION
Chairman D e a n s . I think I have a sufficient number of questions
for us to consider, questions which are important to every one of us.
The first question we are going to take up this morning is one that
was referred to us by the joint conference yesterday morning on:
“ The advisability of using uniform forms and their use by our com
missioners.”
Our association has endorsed at least five blanks or uniform reports
that should be made. If I am correct, about nine States have adopted
them. Mr. Jones, from Georgia, smiles at me as much as to tell me
that six of them are from the South. Am I correct?
Mr. J o n e s (Georgia). I think so.
Chairman D e a n s . Why is it that the other commissions cannot
adopt these uniform blanks? I feel that it is due to the fact that you
have not taken time to consider the proposition. The uniform blank
has been recommended by this association and by the committee of
underwriters. It is practically in accord with the report blanks used
by our individual States. If there is any way in which we can get all
the States to use these blanks, it seems to me that is a very important
move for us to make.
I find in hearings held in the northern part of my State that many
of the insurance adjusters have numerous different forms from two
other States. This worries me in my hearings because possibly they
have not covered exactly what the people to the south of me consider
as essential parts of a report. If all of us could get together on the
same basis it would mean much to the employees. For instance, a
few weeks ago I had a case in which I had to rely on the employer’s
first report of the accident. It was a case which was going to our
supreme court. I had occasion to look at the blanks of other States,
some of which do not require as much as Virginia does and some
require a great deal more. I felt that it was essential for the employer
to give definitely this information, and I was gratified to find that the
uniform blank took care of the difficulties as I had seen them.
First, I want to urge upon the other States to adopt the uniform
blanks; second, because of the interest you have in this general
question we feel you should at least try to coordinate your interest
with ours.
One objection that has been made to these reports, I find, is due to
the fact that our commissions have accumulated quite a number of
blanks that were printed at different times. In Virginia we wait to
1No stenographic report of the proceedings of section A of this session was made.
33
34
1933 MEETING OF I.A .I A .B .C .
put the different blanks into effect until our accumulated forms have
disappeared. In that way we can go ahead and use the new uniform
blanks without putting ourselves to any unnecessary expense. Will
you now take up this subject?
[Mr. Kjaer read a telegram from H. F. Richardson, in which he
suggested communicating to the convention the results of the resolu
tion last year endorsing standard compensation claim forms as out
lined in Mr. Bartlett’s letter and advising the convention that con
tinued efforts are being made to have forms universally adopted.
The letter of Mr. Thomas N. Bartlett which was supplementary to
the report given yesterday, is as follows:]
SUPPLEMENTARY REPORT OF THE COMMITTEE ON FORMS
You are correct in that no meetings of the joint committees have been held, but
there were several meetings of the national bureau’s committee because of the
plan which was adopted in just selecting a few of the States and concentrating
on them rather than to spread the proposition out over a large territory. We
have not as yet approached all of the States by any means, and the States which I
mentioned to you in my letter of the fifth * * * are not the result of a
country-wide canvass. There has been much effort and a great deal of time
spent in this concentration on a few States at a time and it naturally makes the
work a little slow, in addition to the other reasons which I pointed out in my
letter to you of the fifth.
Some members of the national council's committee have taken special trips to
various points to confer with subcommittees and the industrial accident boards
and commissions, just as you and I did in Washington, and as I did with the
local committee of Richmond.
Commissioner Deans of Virginia and Commissioner Stanley of Georgia, both
members of the forms committee, have done excellent work voluntarily by com
municating with other boards and commissions, etc., and talcing it all in all, there
has been a large amount of preliminary and so-called groundwork done which
may not be gone into in detail, but I just thought it advisable to mention to you
in passing so that you could be prepared in answering any questions which might
arise and not let any false impressions be gained as to the results thus far.
I think you and I and all other members of the joint committee should be grati
fied at the results thus far accomplished and the favorable reception we have
received; also the favorable comments which have: been made as to the forms by
the various boards and commissions as we have contacted them. This all augurs
well and I feel confident that just as soon as the fall starts and we renew our
active work on the forms we shall have every reason to feel even more encouraged
than we have up to this point. I for one feel that the results are highly gratifying.
DISCUSSION
Mr. K j a e r (Washington, D.C.). I went with Mr. Richardson and
Mr. Bartlett to the United States Compensation Commission. As
there was a change pending in administration, the commission could
not be contacted. The secretary, however, was favorably impressed
with the progress in having these forms adopted by the States, so that
they could be applied to the longshoremen and the harbor workers,
which would simplify the work considerably in that respect.
Mr. S t a n l e y (Georgia). I cannot understand why any State hesi
tates to adopt these forms. They are better than any we have ever
had before. We adopted the forms in our State, and although there
BOUND-TABLE DISCUSSION
35
are a number of questions on the blanks that do not apply to us, I do
not see why we should object to these questions being there when they
do apply to some other States. If the various States will examine
those forms carefully it seems to me that they must conclude that
they are good forms. Certainly as their old forms give out they can
put these new forms into effect, as we did. We notified all the insur
ance carriers to continue to use our old forms until they were gone,
and then to use the new forms.
Mr. D o r s e t t (North Carolina). Where did the idea to have uni
form forms originate? In whose mind did such an idea originate?
I should like to have that answered.
Mr. K j a e r . The idea originated in the forms committee of the
I.A.I.A.B.C.
Mr. D o r s e t t . May I ask why the forms committee thought that
the adoption of uniform forms by every State would aid anybody in
the successful administration of the workmen’s compensation law in
a particular State?
Mr. K j a e r . There is considerable use of forms from other States
in neighboring States, due to extraterritorial conditions, and uniform
forms are useful for that purpose. They will save a great deal of
expense in printing costs and a considerable expense for insurance
companies.
Mr. D o r s e t t . That’s the point. What part has the insurance
carrier played in fostering and sponsoring the adoption of uniform
forms for every State?
Mr. K j a e r . Considerable, because it means reduction of expense
and reduction of premiums. Insurance will be cheaper than it would
be if they have to spend so much for printing entirely different forms
for the different States. In a good many places the insurance com
panies instead of the States supply the forms. There is considerably
less expense and less premium to be paid.
Mr. D o r s e t t . North Carolina is one of our Southern States that
has not adopted these forms, and it appears, in spite of our high re
gard for Messrs. Deans and Stanley, that we will not adopt these
forms. We think it is important to get the full picture. I have had
adjusters from both Virginia and Georgia come in and protest because
we required the full picture. They tell us what each of you require,
and it is my opinion that when you get your record you do not have
the full picture. We have elected in North Carolina, for reasons
satisfactory to ourselves, to get the full picture in every respect. We
get it because we want to find out if that man who has been injured
receives the proper medical treatment immediately after his injury.
We want that doctor, on a particular form, to say when he saw that
man. If an infection sets in we want to know when it sets in. We do
that to find out whether or not that doctor is going to treat that man
485 times, as in the case Brother Stewart referred to last night.
Another thing is wages. We want that manufacturer’s full report.
We want to know what that man’s wages were, how long he has been
employed, and whether he is a skilled or an unskilled laborer. And
then we want the full report from the insurance company.
In my State the brunt of preventing an increase in insurance rates
every time the man changes employment has fallen upon the indus
trial commission. We are suspicious that the insurance carriers desire
36
1933 MEETING OF I .A .I A .B .C .
the adoption of the uniform forms because they can evade furnishing
North Carolina all of the information that its insurance commissioners,
its industrial board, and its rehabilitation department ought to have.
As soon as we are convinced that these forms will give us a clear pic
ture I do not think that we will have any objection to adopting them.
The insurance adjusters and the insurance companies can cry from
now on, so far as we are concerned, about the number of forms that
we have, but until we are convinced that we are getting too much
information (and I do not think you ever can have too much informa
tion on these cases) we are going to continue to require them to fur
nish the information that we now require them to furnish. We be
lieve it is well for both the injured man and the man who pays the bill
that this information be received.
Mr. P a r k s (Massachusetts). I notice the chairman said nine States.
Do you know which States those are? Do you have Massachusetts
among them?
Chairman D e a n s . N o , sir.
Mr. P a r k s . Massachusetts adopted the uniform blanks. Cer
tainly we have no apologies to offer for having adopted them. I see
no reason why we should object to something uniform so that
each State with practically the same problem can be getting somewhat
the same information. I have noticed in these discussions every year
the intense feeling there seems to be toward insurance companies. I
hold no brief for the insurance companies, but Massachusetts is an
insurance State and we deal with representatives of insurance compan
ies all the time. I have a feeling that they are playing the game
squarely with us. The fact that they have suggested or helped to
prepare these forms should not mean that the proposition is loaded.
They are engaged in the same work we are engaged in. As was said
last night by an insurance representative, there should be closer co
operation, and I agree with that. We should sit down and talk with
them and not be looking for the dagger they might have concealed.
They are human beings, just as we are. Personally, I enjoy working
with the representatives of these companies; most of them are square
shooters. I have never seen them come in without putting the cards
on the table and scrapping it out. I do not find that on the claim
ant’s side, nor on the side of the attorneys. They are generally the
ones who are trying to put something over.
In discussing this matter of forms, I think we should not be looking
upon some part with suspicion, feeling that somebody is trying to hide
something or to keep some information away from us. I looked over
those forms, and like anyone else, I can think of something that could
be added or of something that should not be in the forms. You can
never get all of the States of the United States to agree upon one kind
of form. There may be a clause to be added or withdrawn.
I think in the interest of uniformity we ought all to adopt these.
If any State feels that it cannot, that is its business. I have not heard
any valid reasons why these forms should not be adopted, even by the
gentleman from North Carolina.
Mr. D o r s e t t . We have been going along here with our own par
ticular forms. What good reason is there to change except to save
something for the insurance companies? I have no brief for insurance
companies, either.
ROUND-TABLE DISCUSSION
37
Chairman D e a n s . The only reason, Mr. Dorsett, is as I explained
to Major Allen, chairman of your board. He suggested to us that
we adopt the North Carolina plan, which was based on Pennsylvania’s
plan. He agrees on the principle that we should have a uniformity
of blanks, but it is a question whether we should adopt the North
Carolina blanks or the blanks adopted by the group of industrial
commissions.
Mr. P a r k s . There are some blanks in that group that do not fit our
State at all. For instance, instead of an agreement to continue com
pensation we have what we call a discontinuance plan. Of course,
that is not uniform. I can tell you that it ought to be one of the
uniform forms, but it would not fit the rest of the States. We continue
using that form and are using the rest of these uniform blanks which
are applicable to Massachusetts.
Something has been said about the insurance companies saving
money. Of course, they can save money if they can have this uniform
blank and send it out broadcast to every State instead of having 44
different kinds of forms printed for the different States. That is
expensive.
I have in mind the State fund advocates. We have them in Massa
chusetts. There is a running fight going on in the State, and before a
commission of which I happen to be a member. The State fund is
advocated for the curtailment of compensation work cost. One of the
big things in it is that the insurance companies receive so much
money—so much for overhead, so much to run their end of it. One of
the expenses, of course, is for printing. If we can lower that expense
and have uniformity along with it, I cannot see what valid objection
there is to it. I rather like the phraseology of some of those forms;
they are very carefully worked out. If we could get a substantial
number of States to adopt them, I think it would be a step in the right
direction.
Mr. K j a e r . Mr. Parks asked what States use them. I find that
10 are on the list, and Massachusetts, I am glad to say, makes 11.
They are Alabama, Connecticut, Georgia, Iowa, Louisiana, Nebraska,
New Hampshire, Tennessee, Virginia, Vermont, and Massachusetts.
Chairman D e a n s . One gentleman asks for the privilege of discuss
ing this without being on record. If nobody objects, I am going to
permit it to be done.
[The discussion by Mr. R. M. Crater, of New York, which followed
is omitted as requested by him.]
Chairman D e a n s . What shall we do with this question which was
referred to this group this morning, to be reported on at the full
convention? I should like to have a motion from somebody. Would it
not be well for someone to move that we endorse the uniform system
and that we urge our fellow commissioners to adopt this plan?
Mr. P a r k s . I make a motion that this body go on record as favoring
the uniform forms and recommend to the general body their general
adoption.
Mr. B a k e r (Kansas). I second that motion. In doing so I imagine
there is some desire to know the willingness of the various States to
cooperate in this work. Personally, I have always had the opinion
that if there was any creditable work that this organization could do
it would be that of bringing about uniformity, as much as possible,
38
1933 MEETING OF I.A .I.A .B .C .
in these reports and forms. Kansas is not listed as among those
which have adopted these uniform forms. The only reason for that is
that we are having a special session sometime this fall. We thought
we would have it earlier than this, and have tarried on the proposition
for fear there might be some change in our law that might have some
effect upon the proposition we are fighting for.
There are one or two little things that make it impossible for us to
use one of those forms in our State. We have discussed that matter,
and in order to facilitate the use of the uniform forms in our State, we
provide a stamp to go across the bottom of the uniform form to
answer a question winch is peculiar to our own State’s method. It
is the only State in the Union with that peculiar proposition, which I
will not bother to explain now. I do not think there is anything,
outside of our coming together as we do here to educate ourselves and
to exchange our views, that will really accomplish something worth
while so much as continually to stress uniformity, in our laws as well
as in these forms.
On the matter of expense of printing, which has been referred to,
I imagine that probably is a small item compared with the facility
with which these forms can be handled through the various adjusting
offices. Our border States have sets of forms entirely different from
ours, and yet they go through the same adjusting offices, which
does cause some confusion and no doubt some expense.
Mr. W il l ia m s (Iowa). On behalf of Iowa, which was listed as
having adopted the forms (which is perhaps not strictly true), I will
say that as secretary of the Iowa Industrial Board I would not have
come here except for this very question, for I am deeply interested in
it. When our commission was organized some 20 years ago I helped
to prepare the forms. All those forms had to be thrown away because
of our experience. At the beginning of any State’s activity, you
want almost everything you can think of. As you go along you find
out that the more questions you have the less information you get.
Mr. P a r k s . Absolutely.
Mr. W i l l ia m s . A simplification of this thing is the best thing that
you can possibly get. Six years ago I commenced actively to revise
all the old blanks. I have remodeled or thrown away every one in
that time, all the while seeking simplicity and getting better results.
I should be glad at least for this first accident report, because it is,
as adopted, so like the one I have been using for years that you could
hardly tell the difference. I prepared it and had our printer line it
up for the typewriter, shortening it from a blank that was 37 inches
long to one of letter size. That was 4 years ago. While we have not
formally adopted it because the commissioner has been ill for some
time, I know we are going to use it.
Mrs. T o u s a n t (Massachusetts). I want to be recorded as agreeing
heartily with what the last speaker has said. Whether it is used by
the employer or by the employee, the easier and the quicker you get
down to the real meat of the situation the easier it is for the commis
sion to adjust and decide on the real facts. I wish the I.A.I.A.B.C.
would go even farther and recommend uniform average weekly
wage laws. I do not think there is any part of the report that causes
so much trouble and heartache as the average weekly wage question.
It is different in every single State. It is not so much the amount of
ROUND-TABLE DISCUSSION
39
compensation payable as it is how you are to figure the average
wage. Now that so many States and especially Massachusetts
have extraterritorial jurisdiction, we find ourselves attempting to
figure the average wage in other States. Some neighboring State
gives an employee an opportunity to receive compensation in one
State and then come back into Massachusetts because he will get a
little more, and we have to credit him with the amount he received in
the previous State.
With all those complications, I think the quicker we get down to
the real meat of these things the better results we will have and the
less work we will make for ourselves and for everybody else.
Mr. C r a t e r (New York). I think uniformity of legislation is
probably the most desirable thing that can be worked for at this
time. This question of the average weekly wage is one of the most
troublesome things the employer has to contend with where he has
employees crossing State lines. We have now the N.R.A.
Chairman D e a n s . I have those subjects here to be discussed, Mr.
Crater.
Mr. C r a t e r . I am not going to discuss that because that is one
subject that I am frank to admit I know nothing about. I have no
answer on that. If any of you have an answer on that I should like
to hear it. But please remember, the employer is now back of the
N.R.A., and he has been for a good many years back of the compensa
tion laws. You have to make those two things check, and you can
do it, it seems to me, by uniform legislation or by uniform applica
tion of certain rules that may be formulated by this group, and then
referred to the various commissions and adopted by those commis
sions as they are given.
Chairman D e a n s . It does my heart good to hear you people dis
cuss the question of uniformity of legislation. Some of you were
with me in Richmond when I made my annual address in which I
pleaded for uniformity of legislation. Two or three months later I
found criticisms in the insurance journals, saying it was an impossible
thing to get. I am glad to find that some people here think as I have
thought for several years.
If there is no further discussion, I will put the motion of Mr.
Parks.
[The motion was carried. Mr. Dorsett asked that the record
show that he voted “ No,” for the reason that North Carolina does
not believe that the forms advocated will furnish the information
it desires, and with no desire not to cooperate with the leaders of
this association.]
Chairman D e a n s . I am going to ask Mr. Kjaer to make a report
to the general meeting on that subject. The next question we have
for discussion is: “ What kind of security shall be required of selfinsurers?” In other words, the question involved is this: Our selfinsurers make application to us to let them carry their own insurance
in our State, and they then ask us what kind of bond we are going
to require of them. Some of our larger companies feel as if they are
larger than surety companies, larger than government, and that it
is not necessary to put up those bonds. What is the practice in your
particular States?
40
1933 MEETING OF I.A .I.A .B .C .
Mr. S t a n l e y . S o far as we are concerned, it is more important
that we all get together on this question than it is on these forms.
We have been greatly embarrassed down there. We have one very
strong, large manufacturing plant that has branches in five States
of the Union. It applied for self-insurance and we said it was all
right for the plant to give us a $5,000 bond. It went to Minnesota
and applied for self-insurance in that State.
“ Why, certainly, that is all right” , they said.
“ What about the bond?”
“ You don’t have to put up a bond.”
Here we were, requiring a Georgia concern to give a bond with us,
while in Minnesota they say that concern is amply able to pay all
premiums and no bond is required. I think if we can all get together
on some kind of uniform system covering this matter it would save
us all time.
Mrs. T o u s a n t . In the State of Massachusetts that whole business
is controlled by the insurance commissioner, and the industrial accident
board has no authority.
Mr. D o r s e t t . We have no self-insurance, but there is a surety.
Mrs. T o u s a n t . There is a surety for so-called self-insurance. The
concerns band together for that purpose. Those securities are con
trolled by the insurance commissioner.
Mr. D o r s e t t . By vote of the other members of the commission, as
a representative of the employers’ group on the commission I attend
to that end of the business in our commission. We require from every
company doing business in our State, regardless of its financial status,
a minimum bond of $10,000, and that bond must be secured by United
States Government bonds, State of North Carolina bonds, or bonds
of a surety company. We have had some 11 insurance companies
cease paying compensation claims during this depression we have been
going through, and not a single one of our self-insurers has defaulted
for one 7-day period. We are proud of our record as compared with
the record of the casualty companies doing business in our State.
Mr. P a r k s . Do you know how many States have legalized selfinsurance?
Chairman D e a n s . I was under the impression that practically every
State in the Union had it.
Mr. C r a t e r . I can answer that in a way. For instance, Massa
chusetts, Connecticut, Washington, and Wyoming have none, also
South Dakota and one or two of the southwestern States. Texas, for
instance, has no self-insurance. There are very few of the States
which now prohibit self-insurance. There are several of the States
that do not do a public-insurance business; that is, you either have
the option, as for instance in Ohio, of self-insurance or the State fund.
Chairman D e a n s . I should like to ask Mr. Dorsett this question:
Do you permit any insurance surety companies on these bonds?
Mr. D o r s e t t . Yes; we take
1 1 1 We ask that self
insurers deposit the minimum
prevent the little
man from saying that we have discriminated against him. We had
this up with one of our employers the other day, who did not want to
post any bond.
ROUND-TABLE DISCUSSION
41
Chairman D e a n s . He does it in Virginia, I promise you. Is there
any other State?
Mr. S n o u f f e r (Indiana). In Indiana there is a statutory provision
whereby the chairman of the Indiana Industrial Board may use his
judgment in granting permission for self-insurance. He does that,
and as the gentleman over there said, many times he finds that he
gets better results than he could with the insurance companies. The
gentleman said 11 had failed in his State (North Carolina). I
believe we could treble that, without exaggeration, in Indiana. We
have had but three or four self-carriers in the past 6 months or a year
who have failed to pay their compensation when it was due. We
have peculiar laws in Indiana, both for insurance companies doing
business in the State and for Indiana corporations and foreign corpora
tions. The foreign company that comes into our State may get per
mission, such as the gentleman said his company was granted in
Minnesota, but first it must comply with the laws regarding the admis
sion of foreign corporations to do business in the State of Indiana.
Then it must furnish to the industrial commission a certified copy of
the certificate that is issued to it by the secretary of state of Indiana.
If that is satisfactory, then Indiana will, on the judgment of the chair
man of the industrial board, grant any foreign or domestic corporation
the privilege of carrying its own compensation insurance in the State
of Indiana.
Chairman D e a n s . What is required in your States as to a bond to
be deposited by insurance companies? Let us have your experience
first, Mr. Stanley.
Mr. S t a n l e y . Georgia now requires a bond of $50,000. Unfortu
nately, that law does not go into effect until next year. The insurance
commissioner, by order, put it into effect immediately, feeling, how
ever, that if the insurance company objected he could not enforce it.
One or two of the larger insurance companies put up the $50,000 bond.
Then the depression came along and the rest have not done so. Most
of them, however, have given the $50,000 bond, and the other com
panies are putting up cash or rather liquid securities. We have lost
a great deal of money by not having a bond. Five or six insurance
companies, as you know, failed only recently. There has been quite
a loss in one company, which, of course, went back on the employer.
We call upon the employers to pay the compensation where insurance
companies have failed, but in many instances the employer has also
failed, so it is a complete loss to the poor fellows who were hurt.
What we are most proud of down in Georgia is the fact that we got
a law through which provides that if an insurance carrier writes a risk
on any person, if the employer pays the premium, he must pay the
compensation.
Mr. D o r s e t t . In North Carolina, we formerly permitted insurance
carriers to come in and write $6,000,000 worth of insurance and did
not require anything from them. Now, by act of the last legislature,
we require a minimum bond of $50,000. To date that law has made
23 companies withdraw from the State, which we think was a good
riddance.
Mr. S t a n l e y . This bond is required only of insurance companies,
not of self-insurers. With us our very large employers are selfinsurers and they have given us absolutely no trouble at all. Of
42
1933 MEETING OF I.A .I.A .B .C .
course we have had the $100 medical limit in the act. One large selfinsurer paid out in medical costs more than $20,000, when it was
required to pay only $100. I also want to state that Mr. Crater’s
company paid out $9,000 in one case. Our self-insurers give us no
trouble; we move along nicely with them.
Chairman D e a n s . Here is another question giv€in to me. “ Should
insurance carriers be required by law to write any risk making appli
cation for compensation insurance?” This is a very important
question.
Mr. J o n e s . That has been quite a problem in Georgia for some
time. We have one particular class of risk which is more or less
typical in the South, and we have had a good deal of trouble with it.
I understand that the coal miners in other States with the same kind
of risk give a good deal of trouble. We have a voluntary agreement
on the part of these insurance carriers now that where a risk is turned
down the company will be assigned to it. It works rather slowly
and not particularly satisfactory, but it is better than nothing. I
should like to know what some of the other States have done about
that.
C hairm an D
d o n ’ t y ou ?
eans.
Y
ou
w ork th a t through y ou r ratin g bureau,
Mr. J o n e s . Yes.
Chairman D e a n s . That is the system we work under in Virginia.
We will take up the next question: “ Should our association take
any part in rate making for compensation insurance?”
Mr. D o r s e t t . That is my question. We are fighting this in North
Carolina, and have been for 4 years. The only things that have gone
up in price in North Carolina have been insurance rates and postage
stamps; everything else has gone down. The insurance carriers have
come into our State on three different occasions and said, “ We want
those rates boosted.” The Governor of our State for some reason,
and the large employers throughout our State, came to the members
of the industrial commission (although we have no jurisdiction over
insurance rates at all) and said, “ We have confidence in you.” They
asked us to fight off a 27 percent increase in compensation insurance
rates when the record clearly showed that the insurance carriers were
not entitled to one nickel. We have the record of one of the witnesses
in the public hearing, who was sent down by one of the big mutuals.
This man lives in Chicago, and represents all the mutuals. We took
a long shot and put him on the witness stand and asked him: “ D o
the mutuals request an increase in rates in North Carolina?” He
was honest enough to say no, and that the carriers were making
money. Yet those stock companies (and the mutuals joined them)
wanted to tax industry in my State 27 percent in order to make up
for losses they had sustained in playing the stock market or buying
bonds or doing something that insurance companies should not have
been doing.
That is the reason that subject is so close to my heart. These in
surance companies wanted to put a tax of more than three quarters
of a million dollars on industry in my State when the records showed
beyond any dispute that they were not entitled to a nickel. We made
it uncomfortable, threatening to go to the highest court, and held off
ROUND-TABLE DISCUSSION
43
that increase for more than 12 months. We were suspicious that
things were being held in abeyance until our legislature could adjourn,
so we had a friend of the commission introduce a resolution to force
the issue. Our insurance commissioner, instead of allowing them 27
percent, said, “ I will allow you 7.2” , and that is all they were
entitled to.
I think it is as much the duty of the industrial commission to watch
insurance rates as it is to watch the cost of the doctor. Permit them
to continue to raise the rates and, as Brother Stewart said many times,
the undertow is going to get you, and it ought to get you. ^I hope I
am making myself understood. I have no brief for the insurance
companies; I am not fighting them because I have an ax to grind,
but because I want them to put their cards on the table face up. If
they are entitled to an increase I will be the first man to advocate it,
but I want all the cards on the table. We required certain figures.
Ours agreed so nearly and so closely with the figures of the rating
bureau that they stopped furnishing us with that information. Can
you blame us for being suspicious when they said, “ We will withhold
certain information from you as we don’t think you have any business
having it.”
The workmen’s compensation law is a humanitarian piece of legis
lation; it ought to be encouraged; it should never be allowed to go
backward in the least; and we think that the industrial commissioners
throughout the country should do what our casualty companies are
doing. We ought to organize to prevent increases in rates when
they are not justified. I have heard of no insurance companies re
ducing their rates; they always go up. If we let them continue to
go u]3, industry in my State will rebel, and I think it will be justified
in doing so%
Mr. B a k e r . I should like to ask a question, and I do so because I
do not profess to know anything at all about the insurance proposi
tion. We do not have jurisdiction over insurance companies in our
State on matters of rate making, but only in the administration of
the compensation law. In the remarks by the gentleman, he has
seemingly made a difference between the mutual and the stock com
panies m the request for an increase in rates. I wondered if there is
any fair comparison between the mutuals, generally speaking, and
the stock companies.
Mr. D o r s e t t . In what respect?
Mr. B a k e r . In the matter of rates. You stated that the mutual
companies’ record showed that they were not entitled to an increase
in rates. Is it or is it not a fact that the mutuals concentrate on the
selected risks?
Mr. D o r s e t t . Of course, under the law, employers must pay the
same rate to either the stock company or the mutual. The mutuals,
however, return part of the premium. I do not want to be misunder
stood about the mutual and stock company question—I have no choice
between those companies. There is no difference in the risk between
mutual and stock companies; no comparison or discrimination is
shown under our laws. We merely asked this man because we figured
he was shooting square with us. We wanted to find out why the
mutuals were asking for an increase when the record showed they were
really not entitled to it. He said they were making money on it.
44
1933 MEETING OF I.A .I.A .B .C .
Mr. B a k e r . The question is raised as to whether there is a fair
comparison between the two types.
Mr. D o r s e t t . Yes; for this reason. We have some provisions in
the law requiring that, if the insurance company says it will not take
a certain risk, the employer goes to the insurance commissioner, who
assigns some company to write it.
Mr. B a k e r . The mutuals cannot discard the lemons?
Mr. D o r s e t t . They must take the lemons as well as the oranges.
Mr. P a r k s . I think the gentleman from North Carolina has the
same system that we have in Massachusetts. The industrial accident
board does not fix the rate. The rate-making bureau is in the office
of the insurance commissioner. It is being agitated now, and is
before the commission that is considering the question, that the
industrial accident board should fix the rates. I am not sure whether
it should or not. I can see a difficulty in doing that. It is the indus
trial accident board that makes the award and decides the case and
then asks our insurance companies to pay out the money. It could
be extra liberal in its awards, so much so that either the insurance
companies or the employers might criticize it. They could use that
as an argument to the industrial accident board if it should have the
fixing of rates. They could say, “ You have been pretty liberal this
past year. Mr. So-and-so was given an award in a case where there
shouldn’t have been a nickel awarded. Mr. So-and-so did this and
that. The awards have generally been pretty liberal. Of course
we have no objection to that so long as you fix the rate so that we can
pay these liberal claims which you are continually allowing. ”
I am wondering if that is the best situation to have. Personally I
feel that it is nice to be able to say, when the employer kicks about
the rates, “ Well, we are sorry but we have nothing to d6 with that;
that is done by the rating bureau. All we have to do is to judge the
facts in the case and make out our award. ”
I think that rather keeps one apart from the other, and it cannot
be used against us. My mind is open on that; but I think that the
other system, while it may be open to criticism, is better than the
industrial accident board itself fixing the rates.
Mr. D o r s e t t . I do not want to be misunderstood. I do not
think that the industrial commission in North Carolina should make
the rates. I think that we should be able to protect industry in our
State against excessive rates; but we have to keep sufficient records
to enable us to advise industry in that State, as well as the insurance
companies, that we think the rates are unjustified when they are
unjustified.
Chairman D e a n s . Mr. Dorsett, your answer is on the very thing
I am after. Why should you not fix the rates, or why should you not
have that authority?
Mr. D o r s e t t . I agree with Mr. Parks. I think there would be a
situation that would not be altogether wholesome if you pass upon
the claim and issue judgment, and then make the rate. I would
not advocate in our legislature that it give us rate-making authority.
Chairman D e a n s . Why should you not have control of compensa
tion insurance in all of its phases?
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45
Mr. D o r s e t t . The industrial commission should not make the
rates. The National Council in New York can make them. I think
an independent body, the commission regulating utilities, should make
the rates.
Chairman D e a n s . Y ou feel that those bodies should use you in an
advisory capacity for the purpose of informing them about rates?
Mr. D o r s e t t . I think we should be ready to furnish industry with
information in order to prevent excessive rates. That is the position
I take.
Chairman D e a n s . Here is another question: “ Extent of loss to
claimants by failure of stock and mutual companies? ”
Miss Y e r io n (New York). I asked that. I wanted information.
I represent the Commonwealth Fund of New York City, which has
been investigating the workmen’s compensation problem for 3 or 4
years and is very much interested in determining the extent of loss to
claimants by failure of stock, private, and mutual companies in this
country. It seems to me that the last 3 years have furnished the acid
test for the insurance system in this country. I am here in the midst
of experts. Where stock and mutual companies compete for business,
I should like to know how many of them have failed, and I should
also like to know if you have any information on the extent of such
losses to claimants. I know the gentleman from North Carolina
said that 11 insurance companies failed in his jurisdiction. The
gentleman from Georgia said there were 5 or 6 in his. If anyone
else has such information I should be very happy to get it.
Chairman D e a n s . I judge that information is available. You can
get it from every State. The place to get it from really is the bureaus
in New York City, by maldng your inquiry there. I thought your
question covered the question of what would be the final outcome of
the claimant’s claim for compensation should one of these companies
fail. You didn’t intend it to cover that at all?
Miss Y e r io n . N o .
Chairman D e a n s . Your idea was to find out to what extent the
companies have failed?
Miss Y e r io n . Yes.
Chairman D e a n s . I think you can get that information.
Miss Y e r io n . We do have some difficulty, m making inquiries, in
getting that information from several organizations. Occasionally
we find reference to failure of companies in certain States. For
instance, in the State of Kansas the last annual report referred to the
failure of 3 or 4 companies, but writing to the State of Kansas elicited
no information. That is a question I should like to have answered
from the States.
Mrs. T o u s a n t . In Massachusetts we have had a number of com
panies, probably 11 or 12, either withdraw from business or fail.
According to our laws, the commissioner of insurance requires a
deposit to be made at the time they fail, which covers the liability
then as well as the potential liability—all liabilities to be incurred.
That means that our board, at the time the company either withdraws
from business or fails, figures out what the liability already is and
what the liability to be incurred is; in other words, we put an estimate
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1933 MEETING OF I.A .I.A .B .C .
on every case. It has been our practice to assign those cases to a
commissioner who takes full charge of all cases where a company has
either withdrawn or failed. That commissioner must send out
notices on every injury ever reported. A notice is sent to come in
and, if the injured man has a claim, to present it. Otherwise, we shall
take it to mean an admission that the disability has ended and there
is no further disability. The amount of money wliich we figure is
deposited in a trust fund in a bank and is to be withdrawn upon our
order. We order the bank each week to pay the open cases. As
the cases are heard and disposed of we continue to give such orders
until all of the cases are closed. We still have money in the trust
fund that has not been returned and we are holding it for a period to
decide whether or not there are any more claims which might arise
that we knew nothing about. That money eventually will be turned
back to the insurer. These claims act as preferred claims over all
other claims.
The one situation which we are confronted with now is that of the
Union Indemnity Co., which took over the New York Indemnity.
The New York Indemnity as well as the Union did business in Mas
sachusetts for a number of years. I personally have had 900 hearings,
if you want to call them hearings, on Union Indemnity cases so far.
We have deposited in the State treasurer’s office $150,000 in Louisiana
bonds, and if there is a representative from Louisiana here I can
assure him that he can get a good deal if he will confer with Com
missioner Parks or myself. We have not as yet sold the Louisiana
bonds. There has been no payment under the Union Indemnity
policy in the Union Indemnity cases. Just what our situation is I
do not know, and I do not believe Mr. Parks or anyone else knows.
Possibly the N.R.A. is going to help us out. We hope Louisiana will
come back. We are in no position to say that anyone has lost 1 cent
yet. In all other cases we have been able to require a deposit suffi
cient to meet all liabilities.
Mr. Parks suggested I explain the procedure. When the company
goes into the receiver’s hands or withdraws from business, we figure
the estimated liability, as I have said, and make a demand, one fourth
of which has to be paid within 5 days and the balance within 30 days.
If not, we bring suit. All of the companies, with one or two excep
tions, have made the payments. We haven’t had much trouble in
getting that done. Those companies already have a bond filed with
the commissioner of insurance, which is another security. In dealing
with the foreign insurance companies we have to make that demand.
As I said, the Union Indemnity Co. had a bond deposited with the
insurance commission. We have nothing to say about the deposit
of a bond at the time the license is given. The Union Indemnity
had deposited with the insurance commissioner this $150,000 in
Louisiana bonds. When we made our demand upon the Union
Indemnity it had no funds. Therefore we took this $150,000 in
Louisiana bonds as our next grab, so to speak, the only security we
had. In all other cases they have met the demand and deposited
their bonds as required.
Mr. H o r n e r (Pennsylvania). I am the Harrisburg representative
of the Pennsylvania Self-Insuring Association, and it may be of inter
est to the members of this association to know that during the year
1932 there was not a single default in compensation payments on the
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47
part of self-insurers in Pennsylvania. Every employer who cooper
ated with the Self-Insuring Association during 1932 made application
for renewal during the year 1933. There were during the year 1933
a number of insurance companies that failed in Pennsylvania, and of
course there was defaulting in compensation. The State of Penn
sylvania is trying to work that out now.
Chairman D e a n s . Here are two questions: “ Should the law be
interpreted strictly in industrial diseases as to the date of the injury? ”
The other one brings up the question of occupational diseases and
the date of injury in such cases. Two of you have the same question
up. Will anyone claim one of those?
Mrs. T o u s a n t . I asked the question. We have in Massachusetts
no law allowing compensation for an industrial disease, but as a good
many of you know, we get around that by finding, as in pneumo
coniosis and silicosis, that the infiltration of stone dust into the lungs
causes an injury to the lungs and this injury results in pneumoconiosis.
Upon that basis we can give compensation and the supreme court
has upheld us. The supreme court has said that we must find that
the injury under those circumstances occurred at the time the em
ployee was obliged to give up work. That is all well and good. Last
night I think Brother Stewart said that it was practically an indus
trial disease if they had it and it was fatal. The question that is in
my mind is on these cases where an employee has worked for 10 or
15 years in an industrial occupation. He continues to work as best
he can. The shop closes down, or the employer might have an
examination of all the employees and this man is found to have a
certain amount of dust in his lungs and he is laid off, or else he is on
a vacation and finds that he is unable to go back to work. # As a
matter of fact, he has never given up work. He does not pick up
his tools and go home and say, “ I am unable to work." He is either
laid off or is unable to go back when there is work far him. There is
no question but that he has dust in his lungs.
We find ourselves with extraterritorial jurisdiction so that a man
may claim an injury in our State or in some other State, wherever
the accident may have happened. I should like to have an expres
sion of some of the other members, providing they have industrial
diseases under the law as we have in Massachusetts.
Mr. S t a n l e y . Our law does not cover occupational diseases. The
insurance carriers, however, recently made an application to the
insurance commissioner to permit them to insure employers in Geor
gia against occupational diseases. He granted the request with the
proviso that they should make no possible effort to require the em
ployers to accept that coverage; that the business should be kept
separate from their general business and reported separately. They
immediately prepared forms for bringing occupational diseases under
the Georgia workmen’s compensation law in cases where the employers
wanted it. Of course, we had to approve the forms, and we saw no
possible objection to approving them after the insurance commissioner
had permitted them to come under that. They presented another
form that included occupational diseases. We took the position that
occupational diseases, not coming under the act, should not be in
cluded in the form, that their inclusion of them was foolish, and we
declined to approve that form. The insurance commissioner said
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1933 MEETING OF I.A .I.A .B .C .
we were right about it. It looked to us as if it were possibly a little
bit in the form of coercion. They might say, “ All light, if you won’t
let us cover your occupational diseases we will get the form to include
them and you may have a lawsuit on your hands.”
That is the situation with us. I do not know how it is going to
work out. We do not have very many such cases. Where a man has
an occupational disease and has an injury which aggravates it, we give
him compensation on that injury. That is the only time he could get
compensation under that situation.
Mrs. T o u s a n t . The situation in Massachusetts is really so serious
that the legislature appointed a special commission. The chairman
of our board is a member of that commission. We had a rather
interesting discussion. A stove concern there proceeded to have
another coverage. They had an examination and quite a group of
men were laid off because they had silicosis. The question is whether
or not they have an injury. They have never quit work—they were
simply laid off because of that condition. I think Mr. Parks might
give us some interesting information on that point.
Mr. P a r k s . Occupational disease is a very, very serious problem in
Massachusetts. In addition to this foundry situation in Camden, the
granite-cutting industry in Massachusetts, with the exception of 1 or 2
employers, is without insurance. It is because Massachusetts is an
insurance State. These employers can come under the compensation
act only by insuring in a recognized stock or mutual company; there
is no legalized self-insurance. The insurance companies have refused
to insure the granite cutters on account of the numerous applications
for compensation for pneumoconiosis. That is the way it works out.
During the depression, which struck Massachusetts as well as every
other State in the United States (we are getting along fairly well now,
as well as anybody can expect), men were laid off because of lack of
work. Immediately they would see the lawyer, who referred them to
a doctor, an expert on tuberculosis. He had them X-rayed and found
dust in their lungs. The claim was made, and most of the time they
received compensation. That became so expensive that the regular
insurance companies dropped them, and then another company
thought it would take a chance, but it had to get from under because
it was pretty near broke as the result of the claims. Now, with the
exception of just a few (I do not think there are more than 2 or 3), the
granite cutters in Massachusetts are without insurance. Of course,
that is serious. We are confronted with the problem of 42 who have
made claims for compensation on account of being discharged.
Three representatives of those 42 appeared before the commission
that Mrs. Tousant has spoken about. I spoke to one after the other.
I personally asked one man, “ How tall are you?”
“ Six feet one inch.”
“ How heavy are you?”
“ One hundred and eighty-five pounds.”
I do not know anyone here who is more healthy looking than that
fellow. The particular man I referred to was the chairman of the
delegation. He had been told that he had silicosis. He was very
emphatic in denying that anything was wrong with him. He wanted
to go back to work. Those fellows were discharged; and they cannot
get work in that city. That is where their homes are, that is where
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49
their wives and children are, and they are branded. It is a very
serious situation. It has been brought about by these avalanches of
silicosis claims and the fear of possible silicosis claims. What to do
about it is a problem. The legislature thought it should be referred to
this special commission. We are having hearings on it now, the next
one to be held about October 1.
If there is anyone here who has a situation like that in his State, I
wish he would let us know. With all due respect to Mr. Stewart, it
is not just as represented or what he thinks it is. Just because a man
has dust in his lungs it is not necessarily fatal. It is not. I recall one
case in the city of Worcester, a fatal case. The claim made for the
man was that he had a fractured skull. He fell down and hurt his
head, and was receiving compensation on the allegation that he had
a fractured skull. He died while receiving compensation. I heard
his widow’s case. An autopsy was performed, at which time the
examining doctor found pneumoconiosis. His lungs were full of dust.
He was a man 66 years of age. Up to the time of ms death, outside of
the injury to his head, he was in perfect health, and nobody ever heard
of his having pneumoconiosis. It was there only incidentally. No
body claimed that he died of pneumoconiosis. He died from natural
causes—his heart, arteriosclerosis, or something. Incidentally, they
found out that he had never had a fractured skull.
My own feeling about having dust in the lungs per se is that it does
not mean that the man is disabled nor that he received an injury. . It
has to be an accumulation of dust in the lungs which prevents him
from working and which finally causes his death. It may be that you
do not have that situation in any other State, but, as Mrs. Tousant
well said, it is a five subject in our State, and if we can get help on it
we should like to have it.
Chairman D e a n s . Are there any States that include occupational
diseases and can throw any light on this subject?
Mr. C r a t e r . I feel that the subject that is now before this group is
another example of the reason for uniformity of legislation. I think
this group could be a very potent factor in stimulating interest of the
legislatures along the lines which would provide compensation to a
man who may be injured while in his occupation, in the way Mr. Parks
has pointed out. However, this occupational-disease question is much
broader than the question of silicosis. I am wondering if that is not
just one of the outcomesof the depression. We have had a good many
of them.
While I have followed compensation cases for a great many years, it
is only recently that silicosis has been at all prominent in our compen
sation. We have been running through a cycle of occupational dis
eases. We have all kinds of deformities caused by disease. If indus
try is to pay compensation for such diseases as that (and I think they
are diseases rather than accidental injuries, in the broad general
classification), there should be some uniformity in legislation and some
policy adopted which will at least require the employer to compensate
uniformly. We handle many of those cases as sickness. In our busi
ness we are trying to get the employee back to work. That is what
we want to do. If a man becomes sick in our employment he is
handled as a sickness case, because it makes little difference to us
whether the condition is treated as being due to an injury or simply to
50
1933 MEETING OF I.A .I.A .B .C .
the development of a condition which has accumulated over a period
of years.
Silicosis is not a chronic disease, as I understand it. In other
words, it does not have many progressive conditions as I understand
a chronic disease does. Consequently, if you attempt to say that a
person who, over a period of years in tins employment, has accumulated
sufficient dust in his lungs to incapacitate him, is entitled to compensa
tion on the date he leaves the employment, it seems to me that you
are stretching the occupational-disease provision or at least the per
manent injury by reason of the accident provision of the compensation
law to the extreme. I do not know just where you can draw the line.
I wonder where we are going to stop with that type of interpretation.
Very frankly, I am not arguing the question as to whether industry
should or should not compensate for a particular type of disability or
disability due to that particular injury. It is an injury, but whether
that is an injury for which the last employer should be required to
compensate when, because of the depression, he is required to lay off
the employee, is a very serious question in my mind.
Chairman D e a n s . There are two more questions. “ Should wage
basis for compensation benefits be calculated on full time or actual
time worked?” The next one merely states, “ Average weekly
wage.” I presume that the one asking the last question is practically
asking the same thing the first questioner did. Will somebody tell
us *what you are doing as to the basis of your compensation in your
State under these conditions?
Mr. D o r s e t t . What we do is base the compensation on actual
earnings. That is only fair to the insurance company; we do not see
how we can do otherwise. The insurance company collects the
premium based upon the earnings that the manufacturer pays the
man. Our law says you must go over a period of 12 months, clearing
out the lost days—7 consecutive days. If he has not worked that
long, if he has worked only 2 months, and the pay roll that goes to the
insurance company is based upon $10 a week, we do not believe that
under our law we can award compensation except on 60 percent of
what he actually earned during that period of time. Certainly
it would not be fair for us to ask the insurance company carrying
the risk to pay compensation on a larger wage than the man actually
received from the employer, or upon which his premium has been
based.
Mr. P a r k s . D o I understand you to say that you do not count lost
time unless he has lost 7 consecutive days?
Mr. D o r s e t t . That is correct. In other words, if he works a
week, then loses a week, and then goes back, he is given credit for the
week he lays off or a week of lost time.
Mr. P a r k s . Suppose he loses 3 days. That would not be lost,
would it?
Mr. D o r s e t t . No.
Dr. B r ic k e r (Pennsylvania). I suppose those from Pennsylvania
know more about this than I do. At any rate in Pennsylvania it
is quite a controversial point, especially in the rapid-transit district.
For the last several years the men have been working a little less than
3 days a week. Computing the compensation paid those men, they
ROUND-TABLE DISCUSSION
51
were invariably, when injured, receiving more money than they
received while at work under those conditions. Recently the
Supreme Court of Pennsylvania handed down a decision. We are
now working under the system of paying them for the actual time
employed. There are many industries in Pennsylvania that are
staggering their employment. Instead of a man working a full 6
days a week, he works 3, and some other unfortunate fellow is allowed
to work 3 so he can receive some wages. It is decidedly unfair
to pay any injured employee on the supposition that if he had not
been mjured he would have been able to work 6 days a week. They
take the 3 days over a period. He may work a full week at any
time over the 6-month period, and he gets the advantage of that.
Mr. P a r k s . And you do not call that 3 days lost time?
Mr. S t e w a r t (Washington, D.C.). Was it a judge’s decision or a
supreme court decision?
Dr. B r ic k e r . I am sorry. I said that was the supreme court.
They are supposed to take it there. The lower courts have decided
that the man should be paid compensation on his time worked, not on
the days that he could have worked if there had been work there.
Mr. S t e w a r t . Is that judge paid for his cases or for bis days when
the court is not in session?
Dr. B r ic k e r . I do not know. That has been the decision in Penn
sylvania. We are working on that plan at present, awaiting some
further decision.
Mr. P a r k s . We have that staggered system in Massachusetts.
The men work for 3 days and lay off 3 days. They go along for 6
months or perhaps longer than that. If a man is working at $3 a
day we call this 3 days’ lay-off lost time. If he is working 6 days a
week it would be $18, and he would get two thirds of $18, which
would be $12. He is getting only $9 for working, so he gets $12 for
loafing. That is the way it works out. One of the last decisions ren
dered was rendered not by a judge but by myself. I had a case the
day before I left the statehouse in Boston. A State employee was
working just that way, 3 days a week. I calculated his wages at $9
a week. I could quote no law except a rule of the board, which had
decided to adopt some sort of rule on staggered employment. We
might get some law. We either have to do that or give him $18 a
week, which would have entitled him to $12 a week. As a matter of
fact, he was getting only $9 a week when he worked. The depression
brought about some difficult problems. I think the question of
average wage in a time like this has to be decided as a question of
expedience rather than law.
Chairman D e a n s . We have three more questions here: “ Presen
tation of evidence in contested cases, particularly medical.” Wasn’t
that your question, Mr. Parks?
Mr. P a r k s . Yes. On the question of presentation of medical evi
dence in contested cases, again I find that we may have a little different
system in our State from that which you have over here. On contested
cases we have a hearing; the witnesses are sworn, and a single commis
sioner sits on the case. We may have 14 or 15 witnesses. We may
have 4 doctors on one side and 4 on the other, all honest men,
presumably. They come in and go through for their respective sides.
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1933 MEETING OF I.A .I.A .B .C .
1 say they “ go through" advisedly. The attorneys have brought
them there for that purpose. The lawyer does not bring a man in
unless he knows that he is going to testify for his side. There is a good
lawyer generally on the insurance side anyhow. We are finding that
there are pretty good lawyers on the employee’s side now and then.
They proceed to cross-examine and re-cross-examine these various
witnesses, and sometimes the case goes on for 4 or 5 days. It takes
a tremendous lot of time to hear these witnesses.
I had a case that I should like to talk about. It is the case that I
rendered the decision on as to the average weekly wage. That was
one of the questions. The parties came in and agreed upon a state
ment of facts. The assistant attorney general represented the
Commonwealth in this case. The employee’s attorn ey presented
various letters from doctors—the opinions of doctors in writing—
2 or 3. The insurance company and the State also presented 2 or 3.
They agreed to do that. They also agreed that I might, if I was
puzzled after the presentation of medical evidence in that way, have
an impartial examination. They would allow that to go into the
evidence without any further hearing. The whole proceeding of that
case did not take more than 15 minutes—I do not think it took that
long. I had plenty of evidence. I took those records—the medical
evidence of those doctors in writing—without being confused with
cross-examinations, and it was comparatively easy for me to decide
that case on the question of disability because I was not mixed up
by the attorneys on both sides arguing. You know how it is. The
doctor comes in and testifies. You think, “ Well, I know what he is
saying anyway.’’ Then another lawyer goes at him and makes him
take it all back again. Then the first fellow comes back again. Thus
they go back and forth, and when they are all through you have the
man saying yes and no. I do not know what they have said. We
should have some simplification of that procedure.
I have suggested that plan to our Massachusetts Medical Society
and it has agreed to it. Outside of some who have become compen
sation doctors and who like to come and testify because they get a
good fee for it, doctors are unwilling to take up so much of their time.
The bigger men in the profession want to help the board decide these
cases, but they say, “ It takes up such a large amount of our time
that we have avoided treating outside cases because we are asked to
come in and testify afterward if the case is contested. It takes up
too much of our time. AH you give us is $10 or $15 for coming in,
and it doesn’t pay. If you would only let us file a statement of what
we consider the case to be, and have it in affidavit form if you wish,
and let us present that to you, we would be delighted to treat these
cases.’’
If you could simplify that procedure you could save a lot of work
and a lot of time of the commissioners in hearing cases, and you could
get doctors to treat the man when he is injured and give him proper
medical attention in the first instance. Then they would know that
they would not be called upon to come back and spend a whole day
in a crowded hearing for a small stipend. I want to pass that sugges
tion along. Maybe some other States have that system.
Mr. D o r s e t t . The only thing that impresses me in Mr. Parks’
statement was his reference to the doctors waiting a whole day.
That used to be the custom in my State under the old common law.
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d is c u s s io n
53
The hearings used to last for days or a week, but today compensation
hearings in my State do not last even a day. I leave for the western
section of the State, which is a 2-weeks trip, with 90 cases, and I
hear them in 12 days. When the man comes in there we do not ask
him where he lives, how many babies he has, how many times he has
been married, and so on, because we do not think it has anything to
do with how he got hurt in the course of his employment. We make
him admit all those things and then get down to the meat of the coco
nut. About the doctors, we do not have any doctors in North Caro
lina dodging compensation cases. We find that they are glad to get
them. The very best in our medical profession are delighted when we
refer cases to them. If there is a division of opinion, which we find
in almost every case, if the commissioner is at a loss to know just
what the truth is we have our medical department go over the evi
dence with us. Then, if we are not satisfied, we go to some disinter
ested, able man and talk with him and make our decision. Then if
a cross-examination is desired, we give that opportunity.
M r. P a r k s . D o yo u follow the rules of evidence a t all?
Mr. D o r s e t t . N o, sir; we do not. We do not ask a lot of foolish
questions. We do not allow a lot of technicalities to prevent us from
finding out the truth. We do not follow, strictly speaking, the tech
nical rules of evidence. I do not know that we would ever learn the
truth if we did. Our supreme court has supported us in that. It
allows us to have competent evidence upon winch to base our decision.
M r. P a r k s . D o yo u allow lette rs from doctors to be ad m itted in
evidence?
Mr. D o r s e t t . If counsel on each side are agreed on it, we do.
Mr. P a r k s . We allow that.
Mr. D o r s e t t . The feeling in our State is that the compensation
board is representing the injured man too well if he does not have a
lawyer. We permit an agreed statement of facts from the doctors,
if the statement is clear enough for us to see what they are driving at.
If it is not, we issue a subpena and bring the fellow in. Since our
able chairman put one in jail we have no trouble in getting them to
come in.
Mr. P a r k s . We have the same system. I do not think it is any
different from yours.
Chairman D e a n s . Here is another question: “ Should State laws
be suspended when in conflict with the N.R.A.?” Who asked that
question? Let’s have an answer from him first.
Mr. S n o u f f e r . I asked that. In Indiana the industrial board has
control over hours of service. We are not confined to industrial board
hearings alone. Factory inspection, boiler inspection, women’s and
children’s work all come under the industrial board. I happen to
be chairman of the industrial board, and I find that in many instances
our employers are asking us to suspend our State laws because the
N.R.A. has made different provisions. Since I wrote that question,
after hearing the discussion, I understand that many States do not
have control over the hours of service of the employees. We have
a law in our State that prohibits the employment of females after the
hour of 10 o’clock at night and before the hour of 6 o’clock in the
morning. The N.R.A. comes in and advocates (and the employers
54
1933 MEETING OF I.A .I.A .B .C .
have tried to follow it) putting on 3 and sometimes 4 shifts of
employees. The employers write to us and want us to give them
permission to work these girls and women from 10 to 12 o’clock.
If they are working four shifts, they cannot work the women on the
last shift that late, and they want us to give them permission to
do so; but we are not strong enough to suspend the laws of the
legislature.
My way of doing it is to refer them to the attorney general. If he
wants to suspend that law, all well and good. I do not believe that
I have the authority to do it myself. I thought that might apply in
some other States and I wanted to get an idea about what they are
doing on it. I find that very few States have as complicated a system
under the industrial board as we have in Indiana.
Mr. S t e w a r t . The problem seems to be confined, from this gentle
man’s statement, to a question of hours. His problem is presented to
other States in a different form. There is the problem of the minimum
wage. New York, for instance, has just finished an investigation of
the laundry business. It established a minimum wage. No matter
what it is—let’s say it is $30 a week, the N.R.A. says it should be $31.
Or, put it the other way, the State says it is $31 and the N.R.A. says
it is $30.
Can the State of New York enforce a law which is in contradiction
to a Federal law? That question is going to arise in quite a number
of States, and not only on the question of hours. You have presented
particularly the question of hours of labor for women. This move
ment to prevent women from working on a night shift, which has
gone over the country and is in effect in a number of States, is going
to run up very seriously against the N.R.A. with its 3 and 4 shifts.
After all, it is a question of what the specific motive behind the move
ment against night labor for women was. For instance, in the city
of Chicago, women working in such places as way out here on the
West Side after 10 o’clock at night, or even earlier than that, come
out of those places and go home at all hours of the night. It was not
a question so much of the hours of labor as it was the safety of those
women and girls on the street.
Chairman D e a n s . We might take up that question in line with
the second question: “ What can be done to harmonize Federal and
State laws?” Does anyone wish to discuss those two questions?
Mr. P a r k s . I think one of the things that these representatives are
looking for is some light from other States that might have the same
situation. I think the gentleman from Indiana is seeking that light.
I do not believe he is looking for the merits or demerits of the thing.
Has any other State done anything about it?
In Massachusetts, something has been done along this line. We
had what we called an overtime bill. Women and minors in the
textile factories were not permitted to work between the hours of
6 p.m. in the evening and 6 a.m. in the morning. When I was a
labor agitator and a member of the legislature I was very strongly in
favor of that bill. It was one of the political footballs in our State.
Then the N.R.A. came along. It was argued that this law, being
already on the books, interfered with the proper application of the
N.R.A. So organized labor—a branch of the American Federation
of Labor—joined hands with the employers of labor and with the
ROUND-TABLE DISCUSSION
55
Governor of the Commonwealth. The Governor sent a special
message advocating the suspension of that law. With the approval
of all the contending parties, the bill was adopted, and the overtime
bill in Massachusetts has been suspended in deference to the N.R.A.
Mr. S n o u f f e r . That is what I wanted to get, just an idea as to
what others are doing. The question has been decided by our
attorney general because we did not want to take the responsibility
for it.
Chairman D e a n s . One of our members made the suggestion that
a resolution should be drawn calling for the appointment of a com
mittee to prepare a uniform average weekly wage law. I would
suggest to that member that he take that question up with the com
mittee dealing with the uniformity of laws- of which Mr. Abel Klaw
is chairman.
[Meeting adjourned.]
TUESDAY, SEPTEMBER 12— AFTERNOON SESSION
Chairman, Charles A. Nowak, Tice president I.A.I.A.B.C.
[Telegrams of greetings and good wishes from R. B. Morley, gen
eral manager of the Industrial Accident Prevention Associations in
Toronto, and Will J. French, member of the Industrial Accident
Commission of California, were read by Secretary-Treasurer Baldwin.]
Chairman N o w a k . This afternoon’s discussion appears to me to be
of a good deal of moment, particularly since I have talked to Dr.
Leland, who is going to talk on the first subject: The Insurance
Principle in the Practice of Medicine. The Doctor will discuss this
matter from an entirely new angle, and for that reason I think it will
be of special interest to all of us. Dr. Leland is the representative of
the American Medical Association and its Bureau of Medical Eco
nomics.
The Insurance Principle in the Practice of Medicine
By R. G.
L e la n d ,
M.D., Director Bureau of Medical Economics, American
Medical Association
During the past year, in widely separated sections of the United
States, more than 40 schemes have been proposed to provide for the
periodic prepayment purchase of medical and hospital care. Never
before during a similar length of time has there developed such a
striking change in the method of offering medical and hospital service.
These schemes are largely put forth by commercial propagandists and
promoters who see in the sale of medical services an opportunity to
make substantial profit. The promoters have given little or no con
sideration to the relations which should be maintained between patient
and physician; they have, in many instances, failed to limit the pro
visions of their schemes to the low-income group, and for the most
part have neglected to safeguard their schemes against an ultimate
inclusion of medical services with hospital care. On the contrary,
some of the promoters are frank to admit that they intend to add
medical care to the hospital service as soon as the schemes become
financially secure. The contracts for medical service offered by these
promoters are therefore, in most instances, entirely one-sided; and the
provisions of the contracts are drawn largely in favor of the promoters.
This type of medical practice is not a new development; it began
as an essential feature of many pioneering projects in mining, railroad
construction, and lumbering; but even before the steady march of
commerce and industry toward the western fields oi natural resources
many of the large southern plantations were utilizing this principle to
provide medical care for agricultural workers.
It is undeniable that in many of these pioneering projects the only
practical, available method of providing medical services to the iso
lated groups of workmen was by means of contract with physicians.
Work camps were usually far removed from adequate and competent
56
INSURANCE PRINCIPLE IN PRACTICE OF MEDICINE
57
medical facilities; the inconstant size of the groups, the shifting bases
of operation, and the uncertainty of the permanence of the project did
not warrant physicians in assuming the uncertainty of a reasonable
income without" some guaranty by the promotors of the project.
There are at present some communities or projects which must guar
antee a minimum income to physicians if medical services are to be
easily available. Under such conditions contracts for medical care
may be necessary, and these contracts can be made both legitimate and
ethical.
The precedent of such plans, developed by the exigency of the situa
tion, the enactment of State workmen’s compensation laws, and the
popular lay discussion about the costs of medical care are now offered
as justification for new systems of contract practice.
Should the present movement continue without check or guidance,
it is improbable that the services provided by the schemes for hospital
care will be confined to hospital service alone. When medical service
is added to hospital care, the medical profession will have become in
volved in a combination which will influence unfavorably the quality
of medical service and may disrupt medical organization. Such a
combination of medical and hospital services will constitute a healthinsurance evil in many ways similar to the unsatisfactory European
systems.
From a study of the contract provisions and the reports of 34 of
these schemes, it is possible to draw actual illustrations of excessive
commercialization, bitter conflicts between hospitals, and between
medical organizations and hospital managements, invasion of private
practice by hospitals, impossible financial plans that involve inferior
service, and exaggerated promises of services that cannot be fulfilled.
If this same unrestrained and undirected expansion continues,
and experience with similar developments in other countries predicts
such a course, the results may be expected to be the same as they have
been elsewhere—the degradation of the medical profession to the
position of employees of #commercially minded lay organizations,
with hurried mass diagnosis and treatment of patients. So far from
being an imaginary prediction, thi3 is a description of the actual
outcome of an evolution with similar origins in many foreign nations.
Moreover, these developments can be shown to be the direct result of
a lack of foresight at the beginning of the^process.
This excessive expansion and especially its most harmful forms have
been largely due to the entrance of two factors: A “ third party”
between patient and physician, and the introduction of commercial
motives. The two are closely connected. The third party may be
a promoter, an insurance organization, or lay management of any sort,
governed by customary business, rather than professional, ethics.
The demand for expansion of such schemes seldom comes from the
proposed beneficiaries of medical service, or from the physicians who
must give it, but from lay third parties who derive personal profit or
prestige from such expansion and from the development of impersonal,
mass methods of giving and controlling medical service.
If schemes for medical care or hospitalization through periodic
payments are established under lay management of any phase of
medical practice, all the elements essential to these undesirable
developments are present. Not the least significant of these elements
is the tendency to follow commercial lines of evolution in which
58
1933 MEETING OF I.A .I.A .B .C .
motives other than those of providing a high grade of medical care are
predominant.
For these reasons it is of the greatest importance that the first
steps in any changes in the organization of medical practice be
surrounded with every possible safeguard against the introduction of
forces and tendencies that may appear of little significance at the
beginning, but which experience has shown tend to dominate the
course of evolution of such institutions, to the great injury of the
entire system of medical care.
All the contract plans now operating are essentially forms of sick
ness insurance. A recent study of health-insurance systems shows
how clear is the trend in the field of contract practice toward sickness
insurance:
Workmen’s compensation legislation has been an almost invariable forerunner
of general sickness insurance. In 1910 no State had such legislation. Today
all but four have more or less elaborate systems of protection in this field. There
is no agitation for their repeal, and little opposition to their continual extension.
That extension has already made “ occupational disease” compensable in
several States and more are added annually. The tendency is clearly described
in a recent report of the Industrial Commission of South Dakota:
“ The original idea of the workmen’s compensation law was that of helping the
injured worker to bridge over his troubles until he was again able to resume his
ordinary labor. But by actions of legislatures, courts, and commissions it is
beginning to approach that of a general plan of health and accident insurance.”
About 17,000,000 workers are paid more than $150,000,000 annually under
these laws at present, an amount fully comparable to that; expended by many
European countries' on complete systems of compulsory health insurance.
This legislation gains greatly in significance when it is considered as the founda
tion and framework of future and vastly more extensive systems of insurance,
for it now contains nearly all the features of the more extensive European systems
to which physicians and dentists most strenuously object. There is little “ free
choice of practitioner,” professional confidence is not respected, there is a mass
of lay interference, the tendency to reduce fees to a minimum is already apparent,
and charges of undue influence on professional testimony by employers or insur
ance companies on one side and by malingering employees upon the other are
already common.
It is difficult to advance a convincing argument against the theory
of health insurance. It is known that between 2 and 3 percent of
the population is sick at any given time. Considerable time, effort,
and money have been spent to demonstrate a fact that has always
been known, viz, that prolonged illness, either with or without
hospitalization, is frequently a crushing financial burden to the lowincome groups of the population. Theoretically, this burden might
easily be lifted^ from the individual if, in some way, the costs of
medical care might be spread over the entire low-income group by
small regular payments. Yet# health-insurance systems now in
operation in this country and in Europe have provided abundant
evidence of the difficulties^ and undesirable features which accom
pany the practical application of the insurance principle.
Since the entire argument for and against health insurance cannot
be presented briefly, only a few of the features considered essential
in any system of medical practice will be discussed.
The argument for health insurance is based, in this country, almost
entirely upon the reported results of researches conducted by the
Committee on the Costs of Medical Care, and any criticisms of con
clusions as to the necessity of such insurance must consider the
validity of the reports of these investigations. The basic assumptions
of these reports, and especially No. 26, The Incidence of Illness, are
INSURANCE PRINCIPLE IN PRACTICE OF MEDICINE
59
that a large section of the population is suffering from a lack of
medical care and that this suffering can best be relieved^ by a redis
tribution of the financial burden of medical care through insurance.
If not examined too closely the report seems to prove these assump
tions. Examination raises many doubts. The subject matter of the
report is “ illness” which is defined as follows (p. 8):
For the purpose of this study an illness is defined as any disorder which wholly
or partially disables an individual for one or more days or as any experience for
which medical service of any kind is received. Any condition, symptom, or dis
order for which drugs costing 50 cents or more are purchased is considered an
illness.
Plainly this is a definition of an economic, not a pathologic, phe
nomenon, and we look in vain for any correlation tables to show a
relation between these economic and assumed pathological conditions.
On the contrary, this correlation is taken for granted and made the
basis of all the succeeding argument that illness and its treatment
are almost wholly economic phenomena.
When, therefore, we find (p. 92 of the above-mentioned report),
the statement that only 82 percent of those with incomes of less than
$1,200 annually received the attention of a physician when suffering
this sort of “ illness” , while 96 percent of those with an income of
$10,000 and over annually had such attention, the conclusion which
is drawn, and upon which so much subsequent argument is based,
that at least 14 percent of the lower-income class were in need of
medical care, which was denied them because of inability to pay, is
certainly not proven. What is proven is that the rich pay more for
medical care than the poor—a fact scarcely requiring so expensive an
investigation to demonstrate.
Nowhere in the report is any attempt made to show how many
sick persons sought and were denied medical service because of
poverty; yet this is the whole question at issue.
F rom this insecure factual basis the leap is m ade to the conclusion
that insurance is the best method of supplying this medical care to
those who the proponents of health insurance claim are now being
denied it. Singularly, while almost every possible form of health in
surance is now in existence in some country, one looks in vain over the
long list of studies made by the committee for one on those systems.
Again, workmen's compensation in the United States offers an example
of such a system in 44 States, which illustrates the working of almost
every phase of health insurance, but the committee did not study this.
This careful avoidance of any discussion of the medical care given
under existing systems here and abroad is characteristic of nearly all
proponents of health insurance.
There is always an indefiniteness among those who urge health
insurance as to its objectives. This confusion, carried into the opera
tion of the scheme, is further confounded to the ultimate failure
of nearly all the objectives. It is, like all other social insurance,
primarily poverty insurance.
The combination of medical and cash benefits under the same
system or administrative body has given rise to much confusion and
dissatisfaction. The purposes of the two types of relief are very
different. Medical benefits are for the prevention and cure of dis
ease; the administration of such benefits is the special province of the
medical profession. Cash benefits are for the relief of poverty; this is
25616°—34----- 5
60
1933 MEETING OF I.A .I.A .B .C .
the special problem of the economist, sociologist, social-service expert,
political scientist, and industrialist. There are m an y points at which
the two groups must cooperate, and coordinate their efforts for the
benefit of individuals, families, or society generally. However, it
should be clear that there is a fundamental separation of functions
of these two groups. The medical profession should determine the
amount and character of medical care but not that of cash relief,
and those who are responsible for or administer financial relief should
not dominate the professional relations between patient and physician.
The question is now being sharply raised whether such deductions
from an inadequate income for health insurance may not lead to such
deficiencies in food, housing, and other necessities as to be a greater
cause of physical deterioration than the calamities against which the
worker is insured. In this connection it is worth emphasizing that
the absence of these other necessities, due to low income, may be a
greater cause of illness than the lack of medical care.
Few of those who are advocating health insurance in the United
States are stressing cash benefits, but it is these benefits which are
most eagerly desired by the insured under existing systems. It is
significant that in no country has there ever been any extensive
demand for health insurance on the part of those for whose benefit it
is ostensibly designed. The demand has always come from philan
thropists and politicians, both of whom discovered in it means of
furthering their own objectives.
An essential feature of good medical care, which is often denied
the patient under the health-insurance systems, is the freedom of
choice of a physician. For centuries the medical profession has held
that any enforced choice of physicians by lay interests destroys the
very foundation of those relations between patient and practitioner
which are essential to the best treatment. This is not simply a
tradition but is based on sound reason. Patients, not diseases, are
the objects of medical treatment and the patient is a unit continuous
through a lifetime. Relations are established between patients and
physicians, and not between diseases and institutions.
Each step in these relations depends largely upon mutual confidence.
Proper diagnosis is not possible if the patient suspeots that the attend
ing physician may be even in the slightest degree under the influence
of interests that the patient considers as hostile to his own. Such a
patient will consciously or unconsciously describe his symptoms with
the view to meeting the suspected antagonism on other points.
Modem psychiatry but confirms traditional knowledge and common
sense in the position that the success of healing rests largely upon a
similar confidence. Laboratory technique will not replace the
necessity of this confidence in diagnosis, and elaborate equipment
will not make it unnecessary in treatment.
Anything which influences the choice of the patient for commercial
reasons has the same effect as solicitation and advertising by the
physician. The evil effects of such solicitation have been abundantly
proved. Yet some forms of compulsory selection are accompanied
directly or indirectly by some sort of solicitation, thus reversing the
tested relations of patients and physicians and making the verdict of
the former upon the latter depend upon coercion.
All schemes modifying free choice by the patient substitute com
pulsory choice for the patient by some agency not itself compelled to
INSURANCE PRINCIPLE IN PRACTICE OF MEDICINE
61
accept the treatment selected. The third party that does the choosing
is an impersonal corporation legally required to give first consideration
to the profits of its stockholders. This impersonal body, usually
controlled primarily by economic and commercial motives, makes the
selection for an intensely personal service from which it has always
been a first essential that the economic motive should, as far as possi
ble, be excluded.
Again, this choice by a third impersonal party is not made for the
individual but for a group. Such a method of group selection and
mass treatment is being urged upon the medical profession just at a
time when all other fields of analogous social efforts are rejecting mass
treatment. A generation ago crime and insanity were treated almost
exclusively by mass confinement in prisons and asylums. Mass edu
cation was glorified and a mass treatment of poverty by alms and poorhouses was generally approved. In recent years there has come an
almost universal recognition of the superiority of individual, personal
“ case work” over mass action in the fields of criminology, psychiatry,
education, and other forms of social work.
Any change in the organization of medical service which destroys
the right of the patient to choose his own physician and disturbs the
confidential continuous personal relations between patient and physi
cian destroys social values which it has taken ages to establish. Those
countries that did disturb these relations in medical service have
since been involved in bitter controversies caused by the efforts to
restore such relations. Certainly we should not enter upon a road
which will inevitably compel us to pass through similar controversies
and endure similar evils in order to learn the lessons the experience
of these countries could now teach us.
A third objective of health insurance schemes which is also seldom
announced in the beginning, but which soon becomes a major purpose,
is the subjection of the medical profession to lay control. Sir Henry
Maine has told us that one of the principal characteristics of the
evolution of industrialism from feudalism was the substitution of
“ contract” for “ status” in human relations. The professions have
always resisted this tendency and maintained that such a change
destroys the most valuable characteristics of professional services.
The administrators of health insurance in European systems make no
secret of their determination to force medicine into industrial patterns.
They declare that physicians must pass from the stage of “ small
entrepreneurs,” based on a professional status, into the contract
relation of employees in great medical organizations. This program
is stated in almost these very words in the report on Methods of Con
trolling the Medical Service in Sickness Insurance of the French
General Assembly of National Unions of Mutual Societies and Sick
ness Insurance Societies, held at Dresden, October 19-22, 1930.
The desirability of any social changes depends upon whether the
social values destroyed by the change are greater or less than the new
values introduced. It is of special importance to consider whether
change demands the destruction of long-established social values.
There should be, at least, the most careful study to determine
whether changes in the form of payment for medical service neces
sarily involves such changes in the methods of giving that service as
to reduce its social value. That powerful financial and industrial
interests might profit by controlling such a service and altering its
62
1933 MEETING OF I.A .I.A .B .C .
character in the name of efficiency is not sufficient reason for even
considering a change. The only object that should influence pro
visions for medical care is the health of those cared for.
The fourth objective of health insurance is supposed to be an
improvement in the health and a reduction in the morbidity of the
insured. The failure here is most complete. A Btudy of the mor
bidity rates under sickness insurance would give the impression that
health insurance is some sort of deadly infection, for in every system
of insurance there is a steady, rapid increase in the amount of recorded
illness. To be sure, the “ illness” which is measured is to some
extent of the same character as that studied by the Committee on the
Costs of Medical Care, and is probably no accurate measure of
pathologic conditions. Fifty years of health insurance in Germany
have seen the number of days lost from labor through sickness in the
insured population increase nearly threefold. Twenty years in
England doubled the original rate. This is not due to increasing age,
because the rise is equally great among those in the prime of life. It
is not wholly due to the anxiety to obtain out-of-work benefits,
although this is a major cause, since there has been an almost equal
increase in “ illness” among dependents when these receive medical
benefits, although they are never eligible for cash benefits.
That this is peculiarly an insurance phenomenon is shown by the
fact that the insured in Germany show an “ illness” rate 10 times
that of the uninsured.
This increased “ morbidity” is directly caused by insurance.
After a few years the insured, who have been making continuous
sacrifices from their scanty wages, become filled with a desire to “ get
som ething back.” They get cash benefits if they can, but failing this,
they are determined to receive medical attention and drugs. German
physicians estimate that from 50 to 75 percent of all the “ illnesses”
treated by insurance physicians are either imaginary or of such minor
character that medical care is not needed. They are to some extent
the sufferers from the “ minor respiratory diseases’ of the Committee
on the Costs of Medical Care study and other equally minor diseases—
the “ bagatelle cases” that are so much discussed by writers on the
German system. The same condition exists in ill other systems.
English physicians complain that insurance is creating a race of
“ bottle addicts,” because, if the physician does not give them a
prescription he loses his patients, who feel that tfcey have not “ got
their rights ” out of the insurance to which they have contributed.
There is not one health insurance, but many. Each type has
many features, some good and some bad. Understanding of the
multiplicity of problems which health-insuranee systems have
introduced into the practice of medicine can come only after careful
and prolonged study. In many of these systems no convincing
proof has been advanced to show that the costs of medical care have
been reduced or that the public welfare is thereby more adequately
or universally protected. Certainly the history of health-insurance
systems abroad may well serve to indicate the dangers which such
methods introduce in medical practice. Moreover, most of the
insurance systems abroad and by far the greater number of contract
practice and pseudo-insurance schemes in the United States have
failed to preserve those features of medical practice most conducive
COMPENSATION AND REHABILITATION SERVICES
63
to the best interests of the public welfare and the independence and
advancement of the medical profession.
From the foregoing brief discussion of the application of insurance
to the practice of medicine it is apparent that in most instances pro
fessional relationships between patient and physician are disturbed
by denial of free choice of physician; there is an almost universal
tendency to impose lay control on the medical profession; the inci
dence of illness has not only not been reduced, but there has been a
steady increase in the morbidity rates among the insured.
The public deserves good medical care. The type of medical
practice which best serves the public needs is the type which should
be followed, but the medical profession is the best judge of the
adequacy and competency of the service. The medical profession
has no desire to obstruct reasonable and honest efforts to provide good
medical care. While here and there adjustments may be necessary to
correct a few obvious inconsistencies in certain phases of present
medical practice, thus far no convincing arguments have been
advanced to warrant a complete revolution in the methods which have
stood the test of centuries. If there are groups of the population
unable to meet medical costs, some of the excuses for the lack of pur
chasing ability are sure to be found outside the realm of the present
costs and methods of administering medical service.
Chairman N o w a k . I think, perhaps, the doctor’s discussion was a
little more general and covered a wider field than any covered by this
session, and yet some of the items in his paper cover some of the things
we are interested in. If there are no remarks nor any questions to
be asked Dr. Leland, we will proceed to the second paper on the
afternoon’s program, Cooperation Between Workmen’s Compensa
tion Commissions and State Vocational Rehabilitation Services.
This paper is supposed to cover the report of the committee on reha
bilitation, which as you know was passed at the meeting yesterday
morning. Mr. Kratz, who was to read this paper and to lead the
discussion, is unable to be here, but he has sent a very eminent and
well-equipped lieutenant, Miss Tracy Copp, member of the Voca
tional Rehabilitation Service staff, who will read Mr. Kratz’s paper.
Cooperation Between Workmen’s Compensation Commis
sions and State Vocational Rehabilitation Services
By
John
A.
K ratz,
Chief United States Vocational Rehabilitation Service
(Read by Miss Tracy Copp)
A few months ago I was in the office of a State supervisor of voca
tional rehabilitation when a man about 35 years of age came walking
in on a pair of crutches. Three months before, this man had been
injured m an employment accident and his leg was still in a plaster
cast. He presented to the supervisor a letter from the chairman of
the State workmen’s compensation commission. This letter sets forth
so clearly the points I wish to emphasize to you, that I wish to read it
to you and take it as my point of departure in this brief discussion of
the cooperation which should exist between compensation commis
sions and State rehabilitation departments.
64
1933 MEETING OF I.A .I.A .B .C ,
Re
F r e e m a n , L o u is
E,
No. 105118.
M r.----------------,
Supervisor of Vocational Rehabilitation,
State Office Building, City.
D e a r M r . ----------------: I am sending the above-named to you in the hope
that you can give his case immediate consideration. A copy of the medical report
was forwarded to you yesterday. The examiner who has handled the case advises
me that the employer for whom Mr. Freeman was working at the time of his
injury will be glad to reemploy him upon his recovery. He will not be able, how
ever, to return to the job he was holding at the time of his injury. In view of his
apparent good intelligence, the fact that he has rather heavy family responsibilities,
and his expressed desire to enter at once upon a program looking to his return to
employment, this appears to be a case in which the commission has an unusual
opportunity to cooperate with your office in rendering a constructive service. I
am therefore authorized by the commission to offer you every facility at our dis
posal in working out Mr. Freeman’s rehabilitation. For the present, Mr. Free
man will be rated as temporary total disability, but this fact should not prevent
his immediate entry upon his preparation for an occupation within the physical
limitations and prognosis indicated in the medical report.
After you have worked out his program of rehabilitation, I should appreciate it if
you will advise me from time to time on his progress. In the meanwhile, let me
assure you of our desire to cooperate with you at all times
Sincerely yours,
Chairman.
When the supervisor had completed his interview with this man,
I secured this information: (1) As a matter of routine in every case of
major injury and in every case where the injury is of such a nature as
to handicap the injured person in returning to his old job, a carbon
copy of the medical report is sent to the rehabilitation office; (2) In
every such case it is a part of the job of the investigator to ascertain
from the employer whether the injured worker will be reemployed
upon recovery; (3) In every such case, where a lump-sum settlement
is contemplated by the commission, the recommendations of the
rehabilitation department are secured and given full consideration;
(4) When the rehabilitation department recommends commutations,
extensions, or readjustments of compensation for rehabilitation pur
poses the commission cooperates to the fullest extent of its authority.
On the part of the supervisor, I learned that he promptly investi
gates all cases reported by the commission and reports to the com
mission the action taken on each case. If the case is found to be
eligible and feasible of rehabilitation, this report includes a state
ment of the proposed plan of rehabilitation with recommendations for
such aid and assistance as may be needed from the conmiission in
carrying out the plan. The supervisor attends the hearings of the
commission when the rehabilitation of an individual case is involved.
He supervises the training, places in employment, and follows up
every case for a time sufficient to be reasonably sure that the injured
worker has been restored to a status that is in keeping with his mental,
physical, and vocational capacities.
Now, I wish to read to you the response of the supervisor to the
letter from the chairman of the compensation commission:
COMPENSATION AND REHABILITATION SERVICES
Re
F r e e m a n , L o u is
No. 105118.
65
E.
Hon. --------------------------------- ,
Chairman, Workmen’s Compensation Commission
State Office Building, City.
D e a r S ir : In compliance with your letter referring Mr. Freeman to this office
for rehabilitation, I am pleased to advise you that the following has been agreed
upon:
1. Mr. Freeman will be enrolled on Monday, May 8, at the __________
Institute of Business for a 10-month course in elementary accounting.
2. Upon completion of the course, th e ----------------Co., employer at the time
of injury, will take Mr. Freeman into the office as assistant to the cost accountant
for a period of 1 month at half pay.
3. At the end of 1 month, he will be employed at full pay as clerk in charge of
stock records and accounts.
4. A report of his progress will be sent to your office at the end of each 3-month
period.
(Signed)-------------------- ,
Supervisor of Rehabilitation.
I have cited this instance because it epitomizes the relationship
which should exist between compensation and rehabilitation depart
ments.
There are a number of conceptions one might have of the purpose
of workmen’s compensation and the functions of a compensation
commission: (1) The compensation law might be considered as a
kind of blanket insurance policy under which a workman is paid a
sum of money in the event of injury. Under that concept the com
mission would function simply as an agency to determine the extent
of disability and to authorize the payment of the money as provided
by law. (2) It might be conceived as representing a differential
between earning power before and after injury for a given period of
time, in which case it would be the function of the commission to
establish and maintain the differential over the period specified.
These are obviously narrow and socially inefficient conceptions.
The broader, more constructive, socially sound conception is that
compensation represents a provision by society for sharing with the
worker the consequences of injury or disease and for hastening and
assuring his restoration, in every possible case, to active participation
in the life of his community. Under such a conception, the function
of the commission goes beyond the mere determination of the extent
of injury, reduced earning capacity, and the amount of the com
pensation award. It takes into consideration the future as well as
the present of the individual and makes a conscious effort to secure
his restoration to his former status of social and economic independ
ence. The vocational rehabilitation act which has now been adopted
in 44 of the States of the Union grew out of this conception. Even
before the national act providing for the establishment of rehabilita
tion services in cooperation with the States had been passed, a number
of compensation commissions had already established rehabilitation
services under their own auspices in order to put this conception of
compensation into practice. And, when the national act was written,
its proponents saw to it that a special provision was made in the act
for cooperation between compensation commissions and the rehabilita
tion departments in the States which accepted it. Thus, there is
indicated a specific intention, an implied obligation, and a legal basis
for cooperation between these agencies. This cooperation has been
established and is working effectively in a number of the States.
66
1933 MEETING OF I.A .I.A .B .C .
To be effective, cooperation must be definitely organized. There
fore, I wish to point out the principles upon which the plan of coopera
tion should be based and the methods by which it can be made to
work effectively. (1) There must be a clear understanding as to
what the commission will do and what the rehabilitation department
will do, each for the other, toward the rehabilitation of compensation
cases; (2) An individual must be designated, in each organization,
who is to be responsible for cariying out the respective tasks agreed
upon; (3) There must be established a definite routine by which the
tasks are to be accomplished. To illustrate the methods by which
these principles can be put into operation, let us suppose that among
other things the commission agrees to report all cases of major injuries
to the. rehabilitation department. Responsibility for doing this may
be placed upon the clerk who types the medical reports. This clerk
by simply making extra carbon copies of these reports and mailing
them daily or weekly to the rehabilitation office carries out this
part of the agreement admirably. Or, on the other hand, suppose
the rehabilitation department agrees to investigate, and make recom
mendations on all applicants for lump-sum settlements in which a
program of rehabilitation for the individual is involved. The super
visor, by assuming the responsibility himself or by assigning an agent
to this task, would thus carry out that part of the agreement. If
cooperation is organized on the basis of these principles and a definite
routine of procedure is established, the cooperative arrangement will
work almost automatically.
In preparation for this occasion, I made a study of 12 States in which
cooperation between commissions and rehabilitation departments has
been a well-established policy over a period of years. I wish to quote
some of the facts I found in this study.
In 9 of the 12 States, the commission assumes responsibility for
reporting to the rehabilitation office, either daily or weekly, all cases
of major injury and all cases where the nature of the disability will
probably result in the inability of the worker to return to his old job.
In three instances, the rehabilitation office has assigned one of its
staff to the task of securing reports of such cases from the records of
the commission. In 7 States, a clerk in the commission has been
designated as the person to be responsible for selecting and reporting
the cases. Examiners make the reports in only one instance. Last
year the commissions of these 12 States made a total of 827 commuta
tions, extensions, and readjustments of compensation for rehabilitation
purposes. In addition to this splendid cooperation, they provided
special medical benefits, artificial appliances, and maintenance for
cases undergoing rehabilitation in 201 instances.
On the part of the rehabilitation departments in these 12 States,
my study shows that 6 of the departments report the action taken on
cases reported to them by the commission, and 4 States make periodic
reports on the progress of compensation cases toward rehabilitation.
Last year, 842 compensation cases were rehabilitated, this number
being almost the same number as that in which the commissions
cooperated by making special compensation adjustments for rehabili
tation purposes. The 847 cases which were rehabilitated represent
an average of 28.8 percent of the number of cases reported by the
commissions to the rehabilitation departments, the percentage ranging
from less than 2 percent in one State to as high as 52 percent in
COMPENSATION AND REHABILITATION SERVICES
67
another. In the country as a whole, approximately 33% percent of
the 5,593 cases rehabilitated last year were accident cases. As you
know, the cases eligible for rehabilitation service are not limited to
accident cases. Persons disabled by disease and also those suffering
from congenital and birth injuries are eligible for rehabilitation
service.
I have quoted these figures in order to show you the interdependence
of compensation commissions and rehabilitation departments in doing
a complete, socially sound job for those whom they serve. They are,
in fact, complementary services, each to the other. While their
specific functions are somewhat different, their general objective
should be the same, viz: To remove the hazard of maladjustment for
those who are so unfortunate as to suffer accident or disease in our
industrial establishments. They can accomplish this general objec
tive only by working together. Therefore, in conclusion, my plea to
you and to the rehabilitation workers of this co*untry is that if you
have not already established a functioning working relationship in your
respective States that you get together and work out a plan by which
you may cooperate in solving the individual problems of those whom
it is your mutual responsibility to serve.
Chairman N o w a k . If there are no questions or remarks on this
subject, that will terminate the program for this session; but I should
like to call your attention to the program for tomorrow. In arranging
this program your committee, particularly the medical part of it, felt
that perhaps the session might be of greater service to the members
of the various commissions if the discussion were limited to one
subject.
In Illinois one of the perplexing problems the commission has to
deal with is a subject that is very wide, one which takes in probably
more complications than any other phase of injuries. That subject is
back injuries. We have never known whether we were doing the
right thing on certain of those cases. When the program committee
met last spring in Chicago, after a discussion as to what subject would
be of greatest benefit to this association, it decided that the problem
of back injuries was probably the most confusing to all of the com
missions. For that reason we have tried to cover every phase of back
injuries, as you will note in your program. The men who are to read
the papers and lead the discussion are experts in their lines, and you
will have the best available information in the country.
Mr. P a t t o n . I am surprised to see the meeting adjourn without
any discussion of Dr. Leland's paper. I think it is a most excellent
paper, and I am surprised that it did not evoke some criticism on the
part of the members here. For one thing, I was very much impressed
with the fact that it was the most intelligent criticism I have heard
of the report of the Committee on the Costs of Medical Care, although
I am not saying that I agree wholly with the criticism. For the most
part, the report of that committee seems to be accepted as gospel faith.
I think Mr. Leland has pointed out a number of things in connection
with this whole matter of choice of physician that we can very well
ponder.
[Mr. Kjaer reported to the session on the deliberations and dis
cussions of section B of the morning session on the report of the
committee on forms (see pp. 33 to 39). A motion to refer the report
68
1933 MEETING OF I.A .I.A .B .C .
to the resolutions committee, with the recommendation that it prepare
a resolution asking the commissioners of the various States to adopt
the forms if convenient, was seconded and carried.]
Chairman N o w a k . Mr. Patton, I think some of those who usually
start discussion of these matters are missing here today. If they
were here we would probably have a discussion of both these papers.
I regret very much that there has been this lack of comment. I agree
with Mr. Patton that both of these papers are certainly worthy of
comment.
[The report of the committee on safety and safety codes was read at
this time.]
REPORT OF COMMITTEE ON SAFETY AND SAFETY CODES
By
T hom as
P.
K earn s,
Chairman
There is not much to report on the activities of your committee on safety codes
that is not already briefly covered in Secretary Baldwin’s report.
The two codes for which the I.A.I.A.B.C. is sole sponsor, namely, the Code on
Exhaust Systems, covering standards for installation and operation of apparatus
for removing dust, fumes, and gases by means of blower or suction and properly
arranged hoods, and the Code on Work in Compressed Air, covering tunnels,
caissons, or wherever workers are subjected to air under pressure greater than
atmospheric pressure, have not been completed but, as Mr. Baldwin states, some
progress has been made in organizing the American Standards Association sec
tional committee, and it is hoped that meetings can be held in the near future.
The proposed revisions to the Abrasive Wheel Code, permitting increased speed
for coping wheels for grinding brick and stone, has been approved by the sec
tional committee and is referred to this association for official approval.
In this connection I might say that members of the association have been active
and rendered valuable assistance in connection with the code work of the American
Standards Association and in the various States, but in view of the fact that at
the joint session of the I.A.I.A.B.C. and the Association of Governmental Officials
in Industry on Thursday, Mr. Baldwin is scheduled to make a report on the
Status of Industrial Safety Codes and Regulations in the various States, and
Mr. Agnew, secretary of the American Standards Association, will report on the
Progress of National Safety Codes, and since these reports will be made a part
of the proceedings of this convention I do not think it either necessary or advisable
to burden you at this time with any detailed report on these, subjects.
There is a great deal that could be said, however, on the subject of safety.
We do not wish to burden you with a long discussion of the subject, but we would
like to leave with you one or two thoughts. While the records available show
that a much greater interest is being manifested in safety work throughout the
country, not only as it pertains to industry but also as it relates to public and
home accidents, and while much has been accomplished along this line, the toll
of life and limb that is still being taken through accidents is the best indication
that there is still a big job ahead before we can lay any claim to having even
approached the desired goal in accident-prevention work.
Many of the States and Provinces are carrying on this work through their fac
tory inspection departments or special bureaus set up for the purpose, and some
remarkably good work has been done in this way, but we feel that the time has
arrived when accident boards and commissions and others charged with the
responsibility of administering workmen's compensation laws will have to give a
great deal more serious thought to the question of accident prevention, not only
REPORT OF COMMITTEE ON SAFETY
69
because of the humanitarian aspects but because it is essential, yes necessary,
in working out a solution of many of your compensation problems, and particu
larly your compensation costs, since the best and surest way to reduce these costs
and incidentally to keep down premium rates is to prevent the accidents.
This seems to be a most opportune time to give this question serious considera
tion, as we are at present face to face with one of those infrequent cycles when
accident exposure is likely to increase by leaps and bounds and which find many
unprepared properly to cope with the additional hazards to workers, and such
hazards abound in our industries today. Chief among them are the loss of skill
and stamina due to long periods of idleness and the consequent danger which
faces the worker until these conditions are readjusted by time and experience.
The mental hazards of the average job are greatly accentuated as a result of the
worries of idleness, reduced incomes, and pressing financial responsibilities, and
the readjustment of these attitudes is dependent upon the possibilities of steady
employment.
We think it will be conceded that it is a serious mistake for any industrial estab
lishment to slacken its vigilance against accidents in the haste to bring production
back to normal, as such a policy is not only inimical to the welfare of employees
but is also economically unsound. This is a fact generally recognized by those
who give to safety equal weight with production in plant policy, and should need
no sustaining argument. Yet there is the ever-present danger that eagerness to
meet and profit by new conditions after a depression without precedent in the
history of industry may result in failure of both employer and employee to give
safety the place its importance warrants.
Intensive safety effort in industry is imperative, not only because it is the
human thing to do but from the standpoint of economy and protection of the
workmen’s compensation funds, and we would therefore urge every member of
the association to give serious thought and consideration to these problems and
to go back to their respective jurisdictions with a firm determination to do every
thing in their power to stimulate a greater interest in industrial safety and to
promote organized systematic and cooperative accident-prevention work in the
industries of their State.
[A motion that the report of the committee on safety and safety
codes be accepted and made a part of the proceedings was seconded
and after some discussion amended to refer the report to the resolu
tions committee. The amended motion was seconded, and Mr. Kjaer
made the following remarks:]
Mr. K j a e r . In connection with that, I should like to give a few
figures which I have compiled to show that safety measures pay.
The figures pertain to the industrial accidents of one fairly large firm
from 1930. It had a pay roll of a little over $391,000,000. It paid
out for accident prevention $1,164,409, and made compensation and
medical payments to the extent of $4,561,425. This firm happened
to be a self-insurer, as naturally, being that large, it found that cheaper
than if it had to pay insurance premiums. If it had paid insurance
premiums on its pay roll they would have amounted to $15,641,555.
Consequently it saved over $10,000,000 in comparison with what
other firms of the same class had to pay in insurance premiums, and
it was because this firm had extraordinary safety measures.
The amended motion was put to a vote and carried.]
[Secretaiy Baldwin read a telegram from L. W. Hatch, chairman of
the committee on statistics and compensation insurance costs, and
asked that the telegram be received as the report of that committee.
70
1933 MEETING OF I.A .I.A .B .C .
A motion to accept the telegram as the report of that committee and
to make it a part of the record of the convention was made, seconded,
and carried. Besides expressing regret because of inability to be
present, and best wishes for a successful convention, the telegram which
was made the report of the committee was as follows:]
REPORT OF COMMITTEE ON STATISTICS AND COMPENSATION INSURANCE
COSTS
By L. W.
H atch,
Chairman
(Read by Charles E. Baldwin)
There is no report at this time of committee on statistics for past year, as com
mittee has not met nor taken any action. Several members of it have continued,
however, on sectional committee on standard accident statistics of American
Standards Association, and during past year substantial progress has been made
in work of this committee by completion of revised cause code by a subcom
mittee. A meeting of this sectional committee has been called for September 28
in Chicago to consider cause code and remaining points concerning accident rates
on which there are still serious differences of view. Efforts to arrange earlier
meeting have failed owing to impossibility of securing adequate attendance
because of economies imposed by business conditions. It is hoped at meeting
on 28th work of sectional committee may be advanced to final report.
[Meeting adjourned.]
WEDNESDAY, SEPTEMBER 13— MORNING SESSION
Chairman, Samuel S. Graves, M.D., formerly medical director Industrial Commission of Illinois
Chairman G r a v e s . The first speaker on our program this morning
is Dr. John D. Ellis, who will tell us about how to estimate disability
of the back.
Physical Examination of the Injured Back
By John
D.
E l l is ,
M.D., F.A.C.S., Department of Surgery, Northwestern Uni
versity Medical School
The precise diagnosis of the nature of back disability, the estima
tion of its actual time of termination, and the decision as to the proper
treatment which is indicated, have become some of the most perplex
ing problems which are presented to the compensation commissioner,
as well as the surgeon responsible for the management of the case.
The frank fractures or dislocations offer less trying problems than the
so-called minor injuries which come to the surgeon of trauma in vari
ous stages of development or resolution. It is the latter class of in
juries which particularly concern us in this paper.
The development of more adequate roentgenograms, especially clear
and diagnostic laterals, has been in some measure a deterrent in actual
diagnosis, since even competent radiograms cannot visualize or dis
tinguish a minor joint injury, or indicate whether it is arthritic and
whether located in joint cartilage or capsule. Likewise, the X-ray
cannot help us in distinguishing between joint lesions and the accom
panying protective reaction of the overlying muscles and ligaments
which help to immobilize this tender joint. Likewise, myositis and
muscle sprains, and strains without underlying joint lesions, cannot
be visualized or diagnosed by radiographic examination.
Furthermore, in workingmen of middle age and later, roentgeno
grams are prone to display varying degrees of calcium salt deposits
about joint edges, ligament, tendon, and muscle attachments, but give
little information as to the chronicity or recency of such deposits, or
the degree in which they are the result of a single mechanical trauma,
inflammation, disturbance of calcium metabolism, or long-continued,
heavy labor.
The amount of loss of function in the injured back can no more be
assayed by X-ray examination than can this type of examination be
relied upon to diagnose the commonest type of serious traumatic knee
disability, injury of the internal semilunar cartilage, or the frequent
cause of intractably painful shoulder which results from rupture of
the supraspinatus tendon.
The actual diagnosis in the case of the injured back must, then, be
arrived at by history of the occurrence of the trauma, general exam
ination, and specific examination of the back itself, including X-ray
examination. The present paper is limited to the criteria for arriving
at a diagnosis which may be obtained by a routine and systematic
71
72
1933 MEETING OF I.A .I.A .B .C .
examination of the back itself. The importance of a carefully arrived
at diagnosis is, that upon the diagnosis depends the decision (1) as
to whether any actual physical disability exists in objective findings
which may, if necessary, be made clear to a board of laymen or a
jury; (2) as to what really constitutes the nature of the disability;
e.g., a lumbosacral, sacroiliac, or intervertebral strain; a nontraumatic arthritis; merely a muscle or ligamentous injury; or a myositis.
The second consideration is important, because on the actual diag
nosis depends the type of management which the case deserves.
I cannot condemn too strongly the unfortunate habit of routine
daily application of lights or heat to the injured back, with no further
attempt at diagnosis or therapeusis, and calling this “ physiotherapy. ”
The examination of the injured back is made tremendously more
difficult by the fact that, with the exception of the objective evidence
elicited by expert manipulation (expert passive motion for diagnostic
purposes), the data that we find are those produced by spasm, con
traction, and rigidity of the muscles moving the joints, rather than
signs produced by the painful joints themselves. But it is these
problems of differentiation we must attack.
An analysis of the mechanics of spine motion could be divided into:
(1) The status of the average normal spine; (2) that with anatomic
abnormalities and anomalies of development; (3) the spine present
ing nontraumatic pathological changes. The two latter groups may
predispose to prolonged disability after trivial mechanical trauma or
aggravation of slight disability of function out of all proportion to
the severity of the trauma.
Normally, each vertebra bears its superimposed weight on three
points of support—one the body and two the articular processes. The
vertebral bodies are particularly adapted for weight-bearing by the
interposition of the elastic and resilient intervertebral disks. Lordosis
of the lumbar spine is a late development in the phylogeny of man.
In excessive lordosis of the lumbar spine, that portion of the weight
normally borne on the front half of the vertebral body is transferred
to the posterior half and its associated articular processes. The more
the degree of lordosis, the more weight is borne on the articular facets,
and these are not provided with shock-absorbing intervertebral disks,
as are the bodies. At its junction with the fifth lumbar segment, the
sharp backward deviation of the sacral segment necessitates that the
entire weight-bearing rest upon the articular facets. This arrange
ment is a penalty man pays for his erect posture. Backache is an
ailment peculiar to the human animal.
In the “ normal average” spine, motion is not uniformly distribu
ted in the different levels. The cervical spine is the most mobile
division. As nearly as this can be determined, however, 75 percent
of the antero posterior motion of the neck is confined to the articula
tion between the occiput and the first segment of the spine, and 75
percent of the rotary motion occurs between the first and second seg
ments. The lumbar spine is less mobile than the cervical, and the
thoracic spine less mobile than the lumbar. In workingmen, exam
ination often reveals practically no mobility in the upper half of the
thoracic region.
When the lumbar muscles—in particular, the erector spinae group,
which is one large muscle belly on either side comprised by the spinalis
lumborum, longissimus dorsi, and iliocostalis lumborum, named in
PHYSICAL EXAM INATION OF INJURED BACK
73
order as one travels out from the midline—are examined manually,
the three components can rarely be distinguished. In one chronic
arthritis, involving most of the spine, I was sure I could palpate
separately the stringy, fibrous, and contracted longissimus. Rarely,
in these patients, can a contracted or spastic, shelf-like lateral border
of the quadratus lumborum be distinguished. The short muscles
running vertically between the transverse processes and the obliquely
situated rotators cannot be identified.
The criteria which one expects to discover from examination of the
loin muscles are the changes of the muscle system moving any joint,
which characterize pathology in the joint, whether it be spine, shoul
der, hip, or other articulation. These are criteria of:
1. Acuity: (a) Spasm of erector spinae muscles causing lateral devi
ation, lordosis, or immobility at one point; (b) Tenderness of a defini
tive muscle group; (c) increased muscle consistency, due to extravasa
tion or infiltration of products of inflammation; (d) defense reaction
(like Hartman’s defense in the abdominal wall).
2. Chronicity: (a) Permanent contracture, not spasm; (b) tender
ness, not acute or sharply defined; (c) increased consistency, due to
fibrosis; (d) no Hartman’s defense; (e) changes in opposing muscles
and synergists.
3. Later chronicity: (a) Contracture without spasm; (b) tenderness,
not great or local; may be absent; (c) muscle wasting; (d) a definite,
limited range of passive motion without actual pain; (e) signs of adhe
sions of old arthritic joints on (1) jarring of spine with heel of hand,
or (2) percussion of head.
Technique of Examination
I am indebted for much of the rationale of this routine examination
to the inspiration received from Dr. James Mennell, whom I saw
perform many similar examinations in St. Thomas Hospital, London,
m 1930. This routine is not offered as being superior to any other, but
merely as being immensely superior to no routine method at all. As
industrial consultant, I have examined many backs of patients who
had been treated for weeks or months with no examination except
cursory palpation, instruction to try bending forward, and, sometimes,
roentgenography.
The patient is first stripped and walks about the room. The shoe
heels are examined to ascertain whether there is more wearing of
one than the other. A tendency to walk on the ball of one foot, to
keep one knee slightly flexed in walking, or to hold one side of pelvis
higher, is noted.
General examination in sitting position.—This position is chosen
because when sitting there is less limitation of motion in sacroiliac
lesions than in standing, whereas in lumbosacral lesions there is no
difference in limitation in the two positions. A stool is used high
enough to allow the feet to rest on the floor with knees at right-angle
flexion and without a back. By inspection, it is noted whether the
patient bears weight in equal amount on the two ischial tuberosities.
If more weight is borne on one than the other, an investigation by
trial postures must be made to ascertain whether this is deliberate,
habitual, or accidental. If the choice is found to be deliberate, the
chances are that the sacroiliac or lumbosacral joint on the side that is
being spared is tender.
74
1933 MEETING OF I.A .I.A .B .C .
Inspection is now made for:
1. Scoliosis, as to whether lateral, the so-called “ sciatic” , without
compensatory curve in dorsal region and, therefore, more likely acute
and protective, rather than rotatory, and with compensatory curves
probably little likely to be the result of injured or inflamed joints,
muscles, or ligaments.
2. Erector spinae muscles, their relative prominence or state of
contraction on the two sides. I do not find a contra-lateral scoliosis
opposite in direction to the side of the inflammat ory or traumatic
lesion, such as Putti and others describe, common, nor am I able to
find alternating scoliosis occurring after injuries.
3. The degree of loss of the normal lordosis seen on standing; that
is, whether the lumbar region flattens out completely on sitting down
or retains most of the standing degree of lordosis because of spastic
or fibrous erector spinae muscles.
4. The relative height, not only of the posterior iliac spines to each
other, but also of each to its anterior superior fellow. A discrepancy
on one side indicates a twist in one side of the pelvis on the sacroiliac
joint—in my experience always an anomaly, but possibly, as Mennell
finds, rarely traumatic. #This can be diagnosed before the radiogram
is taken. The sacral hair and dimple of the spina bifida occulta may
be seen.
On palpation, the spasm, permanently increased tone, or defense
reaction in lumbar muscles may be discovered, but palpation yields
more definite findings in the prone position. Localized points of
tenderness must be marked to see how they correspond to tender
points in the prone position. The head and spine must be percussed;
complaints of definite pressure pain on percussion is noted.
Active and passive movements in the sitting position.—The patient
is asked to bend forward; The normal spine should then show an
approximately perfect curve. In men past middle age, varying
degrees of loss of flexion, of course, exists in the upper dorsal to lower
cervical region. Local deviation to right or left, or tendency to bend
the whole spine a little sidewise in flexion, is noted. The latter, of
course, corroborates lateral scoliosis caused by a unilaterally con
tracted or spastic erector spinae group. The actual degree of flexion
forward of the whole spine is less important than local and lateral
discrepancies of mobility. The change in rhythm of the spine in
resuming the upright position often reveals more pathology than
flexion. There may be a lagging of one section, a resumption by
coming up, at first, slightly sidewise. One part—often the lumbo
sacral—may show no motion until complete extension has occurred
in the rest of the spine, and then quite suddenly jump into extension.
This is strongly suggestive of lumbosacral trouble. Finally, upright
ness may be attained by a wriggling, snakelike motion, practically
characteristic of intervertebral arthritis.
Lateral motion and voluntary rotation should next be performed
and noted. Passive rotation, however, produces more reliable data,
and passive lateral motion in the supine position is more reliable than
in sitting, as the examiner has, in the former, a better control of the
patient’s torso.
The examiner must rotate the torso on the sitting hips in three posi
tions—hyperextension, erect position, and flexion. If rotation elicits
more expression of pain in one lower lumbar region, there may be a
PHYSICAL EXAM INATION OF INJURED BACK
75
lumbosacral strain, an articulated fifth transverse process, or a uni
lateral sacralization of the fifth. Whether these latter conditions are
actually likely to be more sensitive than the normally arranged fifth
is sub judice to my mind. The careful work of Bertolotti and others
of the Italian school of orthopedics indicates that an especially painful
syndrome results at the sacralized side after slight injury.
There may be little impediment to rotation in a case of lumbosacral
strain if the condition be unilateral; however, rotation toward the
side of the sprain can be passively performed to a greater degree than
away from it, which latter manipulation finally reaches a point where
the contracted lumbar muscles are put on a stretch. It should be
remembered that comparatively little rotation actually occurs in the
normal lumbar spine, except that which takes place between the fifth
lumbar and the sacrum. Hence, passive rotation tests are the impor
tant criteria for painful motion in these joints particularly.
The amount of freedom of motion between the fifth and the sacrum
depends to a large extent upon the direction of the articulations at
this level. If these are in the coronal or frontal plane, lateral and
rotary motions are much freer, while if, on one side or both they are
in the sagittal plane, both rotation and lateral bending are much
restricted. Putti estimated that more than 20 percent are sagittally
directed, an anomaly responsible for a fair degree of stiffness here
without injury or disease at this level. X-ray checks one’s suspicion
of this anomalous arrangement.
In sacroiliac conditions, the patient is more sensitive to twisting
of the trunk on the pelvis while sitting than while standing, because,
while standing, if the sacroiliacs are sensitive, the rotation of the
body is unavoidably taken up by the hip joints. The actual range
of painless passive motion may vary if performed with the patient
leaning forward, erect, or leaning backward. If it is found that the
range of painless movement is greater when the trunk is flexed, the
diagnosis of an abnormally long transverse process impinging against
an iliac wing (which may later be found in the X-ray) is strongly
suggested.
Examination in standing position.—In this position, every point
observed in the sitting position must be checked and compared.
Inspection of the degree of lordosis is first made. The normal degree
of “ hollowness” of the lumbar region varies notably with body type,
pendulous abdomen, flat chest, and general posture, which cannot
be detailed here. Both unusually flat back and the pronounced
“ sway back” may be regarded as potential causes of backache, since
both represent abnormal adjustments of muscle balance, making the
maintenance of the erect position more easily disturbed than in a
normally balanced back. The accentuated degree of lordosis limited
to the upper lumbar is frequently seen in the arthritic backs of short,
stout, flat-backed individuals. Lateral deviation should be compared
with the degree of lateral scoliosis in sitting, the length of the two legs
being measured if notable discrepancy exists in this deviation. The
rhythm of the back in flexion and return is not so notably changed
after joint injuries as in the sitting position. Most of the flexion may
be performed by the hips with the back held more nearly motionless
than during the same movements in sitting. Active hyperextension
gives a more notable difference in motion in sacroiliac than in lumbo
sacral conditions. In the former, the movement can be seen to be
25616°—34----- 6
76
1933 MEETING OF I.A .I.A .B .C .
performed in the lower spine, while in the latter, where this movement
is from its inception painful, hyperextension is accompanied by imme
diately beginning to move on the hip joints.
Examination in supine position.—This is principally conducted by
passive motion, and the findings are of the greatest value in the
diagnosis of the cause and determination of the exact lesion causing
lumbar and low back pain.
It is important, first, to notice how the patient climbs onto the
examining table. The examiner has an opportunity of observing the
foot selected for the first step up, also the movement or lag in the
movement which travels up the joints of the back in ascending the
table. The patient with an involved hip or sacroiliac joint will never
voluntarily use the leg on the affected side to rise up onto the stool
in mounting the table. This is true also if the ligaments between the
tuberosity or spine of the ischium and the coccyx or sacrum are sore
on one side only. The patient with low lumbar intervertebral sore
ness or lumbosacral soreness will often raise the leg on the painful
side with the knee flexed, and may raise this leg with the aid of his
hands. General lumbar involvement with bilateral spasm of lumbar
muscles may cause the patient to lie face downward on the couch and
then roll over, thus avoiding the necessity of flexing the lumbar spine.
The natural position on lying supine must be noted. If the lumbar
muscles are actually in spasm, almost the same degree of lordosis will
persist as found on standing. If one side is spastic, the iliac crest can
be seen to be notably higher. If this condition is due to acute muscle
spasm and not to chronic fibrosis, the affected side of the pelvis can
generally be brought down to the symmetrical position by a continued
gentle traction on the thigh, but will promptly recur when the pull
is released. With sacroiliac pain, the patient may keep one knee and
hip slightly flexed, often with no lordosis. If a unilateral lumbar
muscle spasm is pronounced, the patient may prefer or insist on lying
on the sound side and not supine, or, if both sides are spastic, as in
general soreness of the lumbar vertebral joints, he may refuse to
assume the supine position and lie face down.
Passive motions should begin by the elevation of both thighs with
the knees extended. The degree of motion necessary to elicit pain is
almost pathognomic of the level of the spine at which the soreness
exists. The first 45° of flexion can be taken up by the hip joints;
thereafter the pull of the hamstrings puts a torsion strain on the
sacroiliacs. At approximately 90° flexion, the torsion is trans
mitted to the lumbosacral level, and motion further than this flexes
the intervertebral joints of the lumbar spine progressively at higher
levels as the motion is continued.
An interesting test is the flexion of both thighs with the pelvis held
firmly fixed on the table by an assistant, coiSining: all torsion stress
to the sacroiliacs until the arc of motion which involves the lumbo
sacral region is reached, then suddenly releasing the fixed pelvis.
The flexion is suddenly transmitted to the junction of the fifth and
sacrum, and if the soreness is localized there, a sharp expression of
pain is elicited. On raising the legs separately, both sacroiliac and
lumbosacral pains are elicited at a smaller arc of motion than when
both are raised.
PHYSICAL EXAM INATION OF INJURED BACK
77
Special tests of importance are:
1. Forcible compression and separation of the iliac crests, response
in one or both of which is a distinctive indication of sacroiliac sprain,
while these maneuvers have no effect upon the lumbosacral articula
tion.
2. The Gaenslen's sacroiliac sign puts forward torsion on a suspected
sacroiliac by first flexing the thigh of the suspected side, then hyper
extending the thigh of the sound side. Pain appears in the suspected
side.
Lateral motions of pelvis on spine can be adequately performed if
the examiner passes his forearm under the flexed knees and swings the
pelvis to either side. This motion can be thought of as “ opening up”
or pressing together the lumbar articulations as the right or left
swing occurs. Unless sacroiliac strain is excessively acute, the strain
on this joint is negligible, and the level in the lumbar spine which is
painful can easily be determined. It is easy to produce a palpable
or audible “ snapping” , which can often be localized in the affected
joint or joints and indicates, to my mind, evidence of a low-grade
local arthritis. This maneuver may temporarily relieve painful lum
bar joints and relax protective muscle spasm so that the examined
patient thinks he has received a beneficial treatment, or, in the terms
of the chiropractic, an “ adjustment.” Rotation cm also be studied
by a similar manipulation, and its limitations or limits of painless
motion can be recorded to compare later with manipulation in the
sitting position. A greater range of painless motion can be elicited in
the supine position on rotation and side flexion than in the sitting
position, which latter position increases the muscle spasm and adds
weight-bearing to the painful motions of the affected joints.
Examination in the side-lying position is merely confirmatory of
previous findings and adds only one advantage, which is that of mak
ing anterior rotatory torsion possible in a questionable sacroiliac
joint by hyperextension of the thigh.
Examination in the prone position.—Again anterior rotatory torsion
can be applied to the sacroiliac joint, and by holding the pelvis fixed
on the table, these motions can be excluded from the lumbosacral and
interlumbar joints. The prone position is the ideal position for palpa
tion of the lumbar muscle bellies and quadratus and their attach
ments to the sacrum and pelvis. Tender points found in the sitting
position can be verified and false statements as to their location
checked. Local or general muscle spasm and Hartman’s defense can
be studied. The sacrum and iliac crests must be carefully and sys
tematically palpated for the telltale nodes and sensitive areas of
“ myofascitis” or chronic myositis. The sciatic nerve, iliolumbar and
sacrospinous ligament, lumbosacral and sacroiliac joints, can be
palpated directly for tender pressure points.
Exaggeration and malingering.—The data obtained from the above
examination furnish comprehensive evidence when associated and
tabulated for objective proof of discrepancy between the symptoms
complained of and the actual anatomic and clinical findings, to prove
or disprove the patient’s claim. A careful mechanical and clinical
analysis of lumbar and low back pain findings will sufficiently un
mask unjustified complaints and aid in the detection of malingerers
without special tests for malingering. If necessary, one can point out
on the witness stand the discrepancy between subjective symptoms
78
1933 MEETING OF I.A .I.A .B .C .
and actual demonstrable loss of range of motion, failure of definitive
tendencies, and pain on motion to correspond with the alleged disabil
ity. Certain objective features of low back strain of various types
cannot be feigned. Voluntary rigidity from muscle contraction is,
for instance, always bilateral. No patient can remember to keep the
proper muscles contracted and complain of motion at the proper
point in its excursion, which one finds in veritable strain or arthritis.
F ig u r e
1 —Showing hand holds of examiner for rotating lumbar spine in erect sitting position.
should also be performed in semiflexion and hyperextersion.
Rotation
Figure 2 —Demonstrating lateral motion of pelvis on lumbar spine by the examiner with patient supine.
PHYSICAL EXAM INATION OF INJURED BACK
F ig u re 3.—Demonstrating lateral passive motion of pelvis to right to deter
F ig u r e
F
ig u r e
79
ine lumbosacral lesion.
4.—Showing elevation of a single limb putting stress first on hip joint, then on sacroiliac, and
finally on lumbosacral as elevation is increased.
5.—Demonstrating method of confining torsion stress to sacroiliac joint excluding lumbosacral as
long as pelvis is pinned to table, to distinguish sacroiliac from lumbosacral lesions.
80
1933 MEETING OP I.A .I.A .B .C .
F ig u r e
F ig u r e
6.—Hand holds to test for pain on passive rotation of pelvis to right on lumbar spine.
7.—Passive forward torsion of left ilium on sacroiliac joint. The torsion is confined to sacroiliac
excluding lumbosacral joint as long as pelvis is fixed on table by examiner’s left hand.
Chairman G r a v e s . I think Dr. Ellis, in presenting his paper, has
tried to bear in mind that all of us who are here are not doctors. It
is quite common in the experience of any doctor, when examining a
patient, for the patient to think, and sometimes to say, “ Well, how
do you know this.” He has tried to make it clear to you who are
not doctors that through careful study and much experience we know
a lot of these things, which, of course, cannot be expected from people
who are not trained in this line of work. All of the papers for this
convention are printed and so far as possible arranged in a way to
make the matter as clear as possible to people untrained in our par
ticular profession.
Another thing we encounter a great deal in industrial work is the
question of whether a man’s complaint is due to an injury or whether
it is due to some disease or natural process due to old age. In these
cases, those of us who are doctors are confining our work more and
more closely within very narrow limits. Some of us are surgeons
and some of us are internists or men practicing internal medicine.
Oftentimes I have found it very difficult to decide definitely whether
the complaint was actually due to an injury or whether it was due to
disease or advancing years. In order to bring these things out quite
clearly, Dr. N. S. Davis, assistant professor of medicine, North
western University, has kindly consented to give us a paper covering
those points particularly.
1933 MEETING OF I.A .I.A .B .C .
81
The Difference Between Backache Due to Trauma and That
Due to Disease
By
N a th a n
S.
III, A.B., M .D ., F.A.C.P., Assistant Professor of Medicine,
Northwestern University Medical School
D a v is
“ It appears to me a most excellent thing for the physician to culti
vate prognosis; for by foreseeing and foretelling, the presence of the
sick, the present, the past, and the future, and explaining the omissions
which patients have been guilty of, he will be more readily believed
to be acquainted with the circumstances of the sick; and he will
manage the cure best who has foreseen what is to happen from the
present state of matters.” (Hippocrates, The Book of Prognostics,
as translated by F. Adams.)
This quotation from the “ father of medicine” , Hippocrates, seems
to be most apt in opening a symposium on the subject of back pain and
its causes before the International Association of Industrial Accident
Boards and Commissions.
Backache is a symptom that Lambright (Annals of Internal Medi
cine, February 1929, p. 807) found in one tenth of the patients studied
for chronic disease. It is also a not uncommon symptom of acute
infectious diseases. It is a subjective symptom and so cannot be
directly measured, as can such symptoms as fever and blood pressure.
This multiplicity of causes, this inability to measure accurately its
severity and the indefiniteness of its localization make backache a
symptom that is most difficult for the internist properly to evaluate
even when the complication of trauma does not exist. It is no won
der, then, that it is so commonly the chief complaint of those claiming
disability as a result of injury.
Back pain is not a single entity but varies from slight discomfort to
the severe stabbing pain of renal colic. In some cases it is more severe
in the morning, in others in the evening; in some it is aggravated by
exertion, in others improved; its location may vary from the tip of the
coccyx to the base of the skull, though the laity more commonly
consider backache as some sort of pain in the lumbar or sacral regions.
Sir James Mackenzie attempted to classify symptoms into three
groups, namely: (1) A structural group, shown by a physical sign
the result of a structural change in the tissues; (2) a functional group,
due to disturbances of function; (3) a reflex group, arising from the
stimulation of the central nervous system.
He further stated that there were two ways in which symptoms may
be produced: (1) When a person falls ill every organ of the body may
be disturbed, as from the toxins of an infection; (2) when an organ
is diseased, its impaired function reacting on the other organs of the
body produces another series of symptoms. He believed that the
vast majority of the symptoms of disease were disturbances of the
normal reflexes. (Reports of the St. Andrews Institute for Clinical
Research, vol. I, Oxford Medical Publications.)
Backache is certainly a symptom arising from disturbances of the
normal reflexes which may be on a structural, a functional, or a reflex
basis. To make an accurate diagnosis in patients who complain
chiefly of backache it is necessary to have (1) a thorough understand
ing of the reflex mechanisms that may be involved and (2) of the
pathological conditions that may cause disturbances in these reflexes.
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1933 MEETING OF I.A .I.A .B .C .
The anatomical unit of the nervous system is the neurone, a nerve
cell with its processes, dendrites, and axis cylinder. Chains of such
cells make up the nervous system; these cells do not blend with one
another anatomically. At the synapse, where one such unit is in
contact with another, there is a limiting membrane endowed with
distinct and highly important properties. With few exceptions, at
least two neurones, with an intervening synapse, appear to be neces
sary to make a functional unit. One of these cells must be an afferent
one that transmits impulses excited in it by the stimulation of special
ized end-organs or “ receptors.” The other must be an efferent neu
rone that conducts the impulses to some tissue or organ, which re
sponds by whatever action characterizes it. But in man few reflexes
are as simple as this, for most neurones have synapses with more than
one other neurone—have synapses with neurones that conduct the
impulses to higher and lower segments of the visceral and central
nervous systems. The spinal cord, the medulla, pons, and the gray
matter of the aqueduct of Sylvius, the lower or first level of Hughlings
Jackson are, according to the work of Sherington, capable of reflex
action only if cut off from higher levels. These are the “ uncondi
tioned” reflexes that take place in a definite predictable form that is
dependent only upon the nature and the site of the stimulus applied
at the periphery. Conditions that exist when the higher levels are
not cut off are much more complex, for then we have to deal not only
with reflexes but also with various forms of sensation and with volun
tary action, the “ conditioned” reflexes of Pavlov
Furthermore, there are synapses between the** neurones of the
cerebrospinal nervous system and those of the visceral nervous sys
tem, the sympathetic and bulbosacral systems, which may give rise
to either “ conditioned” or to “ unconditioned” reflexes. The visceral
nervous system is connected with cerebrospinal systems on a seg
mental basis to give rise to some of the “ unconditioned” reflexes,
but also with afferent neurones that carry the impulses to areas of
the brain in which they are translated into consciousness and give
rise to sensations. These sensations may be referred to the tissue or
organ in which the receptor is located or to tissues or organs innervated
by neurones arising from corresponding segments of the spinal cord.
Thus painful sensations arising from altered visceral reflexes are com
monly referred to other tissues. The production of sensation further
more depends not only on the anatomical pathways the nerve impulse
takes and the character of the impulse, but also upon the receptivity
of that part of the brain which is concerned in translating them into
terms of consciousness. As the afferent paths utilized in the produc
tion of sensation are, in part at least, the same as those which are
used in the afferent side of the “ conditioned reflex” , a sensation or a
reflex, or both a sensation and a reflex may result from the same
afferent impulse. In states of excitement or mental stress such as
are seen following trauma, a stimulus, even one arising from the
visceral nervous system, may set into activity the reflex mechanisms
that are usually activated only by much stronger stimuli; that is, the
emotional condition of the patient affects not only the neural activity
underlying sensations but also the “ conditioned” and even the
“ unconditioned” reflexes.
The relation of the visceral nervous system to the segments of the
cerebrospinal nervous system are shown in figure 1, and the effects
BACKACHE
DUE
TO
TRAUMA
AND
TO
DISEASE
F i g u r e 1.—Diagram
of the sympathetic and bulbosacral nervous system. (After Meyer and Gottlieb.) The sympathetic innervation is indicated by the
continuous black line and the light dotted lines arising from the sympathetic segments (horizontal etching). The bulbosacral autonomic is indicated by
the heavy dotted lines arising from bulbosacral segments (verticle etching).
84
1933 MEETING OF I.A .I.A .B .C .
of stimulation of the visceral nervous system are shown in table 1.
In figure 1, the efferent pathways are indicated. While the afferent
pathways are not identical with the efferent, they parallel them
quite closely. In figure 2 is shown the segmental or radicular inner
vation of the skin. From a study of these figures and tables it
appears that afferent impulses arising in the colon, for example, may
give rise to sensations and other disturbed reflexes in the areas
receiving innervation from the sixth to twelfth thoracic, first to
fourth lumbar, and first sacral segments. Usually sensation arising
F i g u r e 2.— Segmental
innervation of
th e
skin.
(After Hewlett.)
from impulses set up in the colon is referred to the abdominal wall,
but not infrequently it is associated with lumbar pain and may even
give rise to some spasm in the lumbar muscles. Similarly, impulses
arising in the pericardium, pleura, peritoneum, liver and bile passages,
esophagus, stomach, small intestine, pancreas, heart and aorta,
kidneys, ureters, bladder, prostate, seminal vesicles, uterus and
adnexa, and other organs or tissues of the chest and abdominal
cavities, and the diaphragm may give rise to sensations of pain in
the back, the location of which is dependent on the level from which
the organ in which the “ receptor” is located derives its enervation.
BACKACHE DUE TO TRAUMA AND TO DISEASE
T able
1.— The visceral effects of stimulation of the sympathetic and craniosacral
systems (after A. W. Hewlett)
Organ
|P“
85
}lndis..................
M . ciliaris.......... ...........................
M . orbitalis (Mueller’s)...............
Salivary glands.............................
Cerebral blood vessels................. .
Oral blood vessels....... —.......... .
Cutaneous blood vessels of head..
Coronary blood vessels-------------Intestinal blood vessels------------Genital blood vessels... ...............
Sweat glands__________________
Mm. arrectores pilorum (
Heart muscle_________
Esophagus......... ..........
Cardia...........................
Tonus of stomach_____
Peristalsis of stomach...
Secretion of stomach___
Motility of intestine----Colon............................
M . sphincter ani........ .
Gall bladder____ ____ _
Pancreas secretion_____
Bronchial musculature..
M . sphincter vesicae___
M . detrusor vesicae____
Uterus (pregnancy)____
Uterus (gravid)............
M . retractor penis-------Sugar tonus------ ---------Heat tonus-----------------Pigment cells_________
Effect of sympathetic stimulation
Stimulates (Th. I and I I).
Stimulates (Th. I-III).
Constricts (Th. II-IV)..
-----do_______________
Constricts (Th. II-IV) „
Constricts (Th. II-L. IV ).
Constricts (L. I-IV).
Stimulates (Th. II-L. IV )..
Stimulates (Th. IV-VII)__
Stimulates (Th. I-V)______
Relaxes (Th. II-IV )______
Paralyzes (Th. II-L. IV ).._
Diminishes (Th. II-L. IV ).
Paralyzes (Th. II-L. I V )...
Diminishes (F )_____ _____
Inhibits (Th. II-L. IV )___
Relaxes (L. I-IV )................
___ do--------------------- ------ Relaxes (Th. II-L. IV )____
Inhibits (?)......... ................
Contracts (L. I-IV ).
Relaxes (L. I -I V )...
Contracts (L. I-IV )____ ________
Increases (Piqure of Cl. Bernard).
Increases (Piqure vermis)_______
Contracts................. ....................
Effect of craniosacral auton
omic stimulation
Stimulates (N. III).
Do.
Stimulates chorda tympani.
Dilates (N. X ).
Constricts (N. IX ).
Dilates (N. pelvicus).
Inhibits (N. X ).
Excites (N. X ).
Do.
Increases (N. X ).
Do.
Do.
Excites (N. X ).
Excites (N. pelvicus).
Cramps (N. pelvicus).
Contracts (N. vagus).
Excites (N. X ).
Do.
Inhibits (N. pelvicus).
Contracts (N. pelvicus).
Relaxes (N. pelvicus).
P. T. Herring (Reports of the St. Andrews Institute, vol. II, Oxford
Medical Publication) states that he is of the opinion that pain in
muscle, whether voluntary, cardiac, or involuntary, is always asso
ciated with contraction of the muscle, but that some other factor or
factors are necessary, of which deficient blood supply is one of the
most important. Backache as a rule is described as a deep pain
rather than a superficial one. If there is tenderness associated with
it, it is deep rather than superficial tenderness. This is true whether
the backache is a symptom directly ascribable to recent trauma—
that is, contusion, strain, sprain, or fracture; to visceral disease; or to
toxins of an infection. That is, commonly backache seems to be due
to muscular pain. Figure 3 illustrates the somatic connections be
tween the sympathetic ganglia, the arteries, arterioles, and the
viscera and the central nervous system. Thus it is possible to have
afferent impulses from a viscus reflexly stimulate the involuntary
muscles of a viscus, cause vasoconstriction of arteries and arterioles
and even voluntary muscles. The diminished blood supply so pro
duced may so affect the viscus as to increase the afferent impulses
from it and may also cause a relative ischemia in the voluntary
muscles of the back whose arteries and arterioles are innervated
through the sympathetic from the same segment of the cord. This
ischemia of the voluntary muscles gives rise to another set of afferent
impulses which in the central nervous system may be converted into
sensations of pain, and since visceral afferent impulses usually do not
affect consciousness directly, the backache is frequently the only sub
jective symptom. Arteriosclerosis and hypertensive vascular disease
00
o*
/S o m a tic afferen t fiber 1 -n
7
,
d l ^ i s c e r a l afferent fiber/Dot3 511001
Sweat'glanck
Afentral ramus
co m m u n ic a te ;
'^/-Sym pathetic
A rtery -
ganglion
Postganglionic fib e r-—
F ig u r e
Postganglionic fib e r
3.—Diagram, right, presenting a section through the spinal cord, a sympathetic ganglion, and a spinal nerve to illustrate the chief functional types of peripheral
nerve fibers, and, left, the distribution of postganglionic efferent sympathetic nerve fibers. (After S. W. Hanson.)
I.A .I.A .B .C
Sm ooth musctle
o f hair follicle
OF
Ramus
Arteriole-
MEETING
Dorsal ram us
1933
dSpinal'^an^lion
BACKACHE DUE TO TRAUMA AND TO DISEASE
87
may also give rise to an ischemia of the back muscles that may
stimulate reflexes that result in backache and muscle spasm. It is
evident that disease in a viscus may give rise reflexly to alterations
in the physiology of the muscles of the back that are almost identical
to those produced by pathological lesions involving those muscles or
their attachments or the ligaments associated therewith.
Capps and Coleman have shown that irritation of the parietal
pleura and peritoneum causes pain to be referred to areas correspond
ing to the point irritated. They found the pericardium insensitive to
pain. Irritation of the diaphragm on both its peritoneal and pleural
surfaces caused referred pain. When the central position of the
diaphragm innervated by the phrenic nerve was irritated the pain
was referred to the neck to the region supplied by the third and fourth
cervical nerves. The peripheral portion of the diaphragm is supplied
by the lower six intercostal nerves, and irritation of this portion
gives rise to pain referred over the lower thorax, epigastrium, and even
down over the whole abdomen. With the pain is associated hyper
esthesia and hyperalgesia of the skin and superficial tissues, and
somtimes muscular rigidity. (Capps and Coleman. A Clinical
Study of Pain. New York, The Macmillan Co., 1932.)
It has been shown by J. E. Goldthwait that visceoptosis, which
usually involves both the thoracic and abdominal viscera and is
associated with a low diaphragm and incorrect posture, may give rise
to afferent impulses that ultimately result in backache. (Journal of
Bone and Joint Surgery, April 1933, p. 279.) These impulses can
readily produce changes similar to those already described for a viscus
and for the pleura and peritoneum.
It is then evident that on an anatomical, physiological, and neuro
logical basis, backache may be a symptom of pathological conditions
in the abdominal and thoracic cavities as Well as of changes in the
spinal column and the voluntary muscles of the back. Pathological
changes in the central nervous system, both functional and organic,
may also give rise to backache. Steindler includes in this group
tabes, meningitis, syringomyelia, lateral sclerosis, tumors of the cord,
hemorrhage into the meninges or substance of the cord, and neuritis.
Fatigue is a common cause of both headache and backache. In
some individuals, the headache is more common and in others back
ache. This type of backache is purely functional and no anatomical
or physiological changes are found associated with it, though it may
be accompanied by some hyperesthesia, hyperalgesia, and increased
muscle tone if not by actual muscle spasm.
The title of this paper is The Difference Between Backache Due to
Trauma and That Due to Disease. So far all that has been said makes
it appear that there are no differences. The question of congenital
anomalies and of arthritis has not been discussed, as that subject is
to be taken up later in the symposium. Toxins from infection have
been but briefly mentioned for two reasons—because of the relation
of such toxins to arthritis and chronic rheumatic disease, and because
in acute infections such as typhoid, paratyphoid, undulant fever,
dengue fever, secondary syphilis, malaria, etc., the acute illness of
the patient and his other symptoms make it evident, even in the
presence of an injury, that the injury has little, if anything, to do with
the backache. Lesions of the spine causing backache have also not
been mentioned as they are to be considered by others.
88
1933 MEETING OF I.A .I.A .B .C .
What, then, are the differences between backache due to trauma
and backache due to disease?
The backache may have the same location, the same intensity,
the same character whether due to trauma or to disease. Hyper
algesia, hyperesthesia, increased muscle tone, and muscle spasm may
be present in either case. It is therefore necessary to look elsewhere
if we are to make such a differentiation. That a differential diagnosis
may be made, it is necessary to take a careful history, a history that
is not only complete since the time of the injury but also prior thereto.
As the history is usually the most important single item in the making
of a diagnosis, it should be taken by the attending physician and
not by a relatively inexperienced assistant. Then there must be a
most careful physical examination including a thorough neurological
examination and observation of posture, habitus, etc. During the
taking of the history and the making of the physical examination, the
physician should endeavor to estimate the intellectual capacity and
the emotional condition of the patient. After such an examination,
the physician should have a definite idea as to the presence or absence
of acute or chronic infections, of the results of malnutrition or disease
in childhood or at any time prior to the injury; of defective posture
and its results; of disease of the central nervous system, the respiratory
system, the cardiovascular system, the gastro-mtestinal system, the
genito-urinary system, of diseases of metabolism, of diseases of the
bones and joints. It is advisable at this stage to record a tentative
diagnosis. Then such laboratory tests should be ordered as are
needed (1) to confirm the presence of visceral disease, disease due to
toxins or preexisting disease of the bones and joints, and (2) to rule
out fractures, dislocations, and other lesions that might be the direct
results of trauma.
The differences between backache due to trauma and that due to
disease consist, then, in the presence, in backache due to disease, of
symptoms and findings that are characteristic of disease of the central
nervous system, of the viscera of the thorax and abdomen, of acute
or chronic infections, of diseases of metabolism, and of changes due to
faulty habitus or congenital anomalies and the absence of findings
characteristic only of injury.
Trauma may, however, affect backache that is really due to nervous
or visceral disease. As stated before, the afferent impulses in their
passage upwards may excite reflexes at various levels, and may or
may not give rise to sensations. The impulses arising in a diseased
viscus may be such that under ordinary circumstances they give rise
only to “ unconditioned” or at most to “ conditioned” reflexes but
not to sensations. Trauma, direct or indirect, to the back increases
the receptivity of those portions of the brain that are concerned with
the translation of afferent impulses into terms of consciousness; as a
result the injured individual acquires a new symptom, backache.
The backache may be added to the previous symptoms or may be sub
stituted for them. Hyperalgesia, hyperesthesia, and muscle spasm
may develop because of similar increases in receptivity in the synapses
having to do with “ conditioned” and “ unconditioned” reflexes.
Under these circumstances is the backache due to disease or to
trauma or to both? Has the trauma caused an aggravation of the
disease or just an aggravation or alteration of the symptoms?
BACKACHE DUE TO TRAUMA AND TO DISEASE
89
The patient has a pain where he had none before or a nondisabling
distress has become a disabling pain. Without doubt, the backache
is in such a case due to the trauma, at least insofar as it is more dis
abling than it was before the injury. But should a patient with back
ache due to visceral disease but aggravated or precipitated by trauma
be entitled to the same compensation as an individual who is equally
incapacitated by backache which is not associated with visceral dis
ease, but is due directly to an injury? It would appear that a less
severe trauma would be required to cause disability in the man who
had a visceral disease that might at any time have caused the back
ache even if he had not sustained an injury, than would be required
to cause such disability in one not suffering from visceral disease. A
slight injury with resulting backache that is really disabling should
cause one to suspect preexisting visceral, osseus, or articular disease
or malingering. Evidence of the presence of preexisting visceral,
neurological, osseus, or articular pathology should make one think a
long time before making a diagnosis of malingering. It would be
most unfair to make a diagnosis of malingering m an individual who,
because of a disturbance of the normal reflexes arising as a result of
an injury, really had incurred a subjective aggravation of a preexisting
pathological condition. It does seem, however, that one with dis
ability due to a subjective aggravation of a preexisting pathological
condition should not receive as much compensation as should the
individual with equal disability for which the trauma was the only
cause found.
It is evident, then, that insofar as the condition under consideration,
backache, is concerned, sensation and reflex action are closely bound
up together. Sensation may be induced by visceral reflexes, so back
ache may be due to pleuritis, meningitis, peritonitis, heart and arte
rial disease, gastro-intestinal disease, etc. While it is impossible to
state definitely what is physical and what is mental insofar as back
ache is concerned, it. does seem that this problem will eventually be
solved. As T. W. Salmon has stated: “ The discovery of regulating
mechanisms—chiefly in the central nervous system—that enable
whole systems of organs to act in sympathy with other systems show
us that the minute study of a single organ is inadequate to explain
even all of its own functions, much less the part it plays in the life of
the organism as a whole. Thus the way is rapidly being cleared for
the concept of man as an organism acting, even in his most circum
scribed mental or physical activities, as a whole.”
So in the differential diagnosis of backache, whether it be cervical,
dorsal, lumbar or sacral, whether constant or intermittent, severe, or
mild, whether associated with hyperesthesia, hyperalgesia or muscle
spasm, we must consider these factors for what they are worth, but
must not neglect to examine the man as a whole, if a correct diagnosis
is to be made and the recovery of the patient hastened.
“ Life is short, and the art long; the occasion fleeting; experience
fallacious, and judgment difficult. The physician must not only be
prepared to do what is right himself, but also to make the patient,
the attendants, and the externals cooperate.” (The first aphorism of
Hippocrates.)
Chairman G r a v e s . Our next paper is by Dr. Magnuson, whom
a good many of the Chicago men and some of the out-of-town men
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1933 MEETING OF I.A .I.A .B .C .
will remember as the first medical director of the Industrial Commis
sion of Illinois. Dr. Magnuson established our medical department
and largely our medical reputation in the industrial commission; and
his work has had a great deal of influence on the formation of medical
departments of industrial boards of other States. Dr. Magnuson is
to give a paper on Congenital Anomalies and Artliritis as Contribut
ing Causes in Injuries of the Spine.
When a great many of these cases come up for decision and the
severity of injury has been taken into consideration, almost invariably
the question arises, “ What was the condition of this man’s back
prior to the injury?” In examining a good many thousands of
X-ray plates surgeons have found that there are relatively few backs
which come before the industrial commissions by reason of accident
that have not had something the matter with them prior to the acci
dent. One of the important questions is to separate those two con
ditions and to decide how much is due to one and how much is due to
the other—how much the accident aggravated tho injury. I do not
know of anyone more competent to enlighten ub upon that subject
than Dr. Magnuson.
Congenital Anomalies and Arthritis as Contributing Causes
in Injuries of the Spine
By
Paul
B.
M agn u son ,
F.A.C.S., Professor of Surgery, Northwestern
University Medical School
M .D .,
The normal spine is a complicated mechanism composed of small
segments of bone held together by ligaments of considerable elasticity,
and supported by joints which overlap, each vertebra overlapping the
one below and allowing a small amount of motion This mechanism
supports the trunk and head and also encloses the central nervous
system which controls all motion and sensation below the skull.
Over the anterior surface of the spine there is a fine plexus of nerves,
which control the autonomic functions, namely, the sympathetic
nervous system. So we can see that an injury to the spine and the
structures which immediately surround it can affect motor and sen
sory nerves, and may have an effect on the purely automatic control
of the functions of the body. Because of the complicated anatomy
and the strains put upon it, and because of the heavy layer of poste
rior muscles, examination of the spine is difficult, and the highest
degree of analytic ability, differentiation, and power of elimination
by exclusion is required in making such examination with a view to
diagnosis of existing conditions.
Back injuries, therefore, have been looked upon with suspicion for
many years. Varying opinions may be obtained as to the degree and
character of disability in a given spine, and this has resulted in a feeling
that injuries to the spine, and, as a matter of fact, all conditions causing
pain in and about the spine, are vague, and are many times claimed
by a patient without corroborative evidence. The interpretation of
the degree of importance of certain findings in the X-ray of a spine is
probably the cause of more dispute among attorneys than any other
evidence. This is doubtless due to the fact that the plaintiff’s attor
ney grasps at anything that he feels may be made into objective evi
dence of what he believes may be the result of an injury. Because
ARTHRITIS AS CAUSE IN SPINE INJURIES
91
of his insistence, medical men have many times allowed themselves
to be involved in argument as to whether a condition was or was not
due to bony injury. Injury to the spine is like injury to any other
group of structures in the body, and in forming an opinion there should
be taken into consideration not only the bones, which show in the
X-ray, but all the other tissues that go to make up the support of the
trunk, namely, ligaments, tendons, muscles, fascia, the capsules of
joints and the joints themselves, and the nervous system which they
so closely surround. An injury or an inflammatory condition, as
well as growths pressing upon the spine, can all cause symptoms
which are referable to interference with the function of the nervous
mechanism.
It has been interesting to me for more than 20 years to note that the
largest number of back injuries—as a matter of fact in my experience
over 80 percent—occur in individuals past 40 years of age. Practically
all the cases that came before me while medical director of the Illinois
Industrial Commission, in which there was dispute as to occurrence
of injury, its seriousness, or its influence upon the alleged disability,
were in patients whose tissues showed the results of degeneration
caused by the wear and tear of life. If you will think back over cases
which you have seen, I am sure that you will be able to recall very
few of men in early life where injury to the spine resulted from com
paratively slight trauma, who were not restored to perfect health and
usefulness; on the other hand, you will be able to recall many cases of
older men, who, though only slightly injured, never returned to their
former occupation. In many of these cases you have been told that
the patient had arthritis, and X-ray evidence was offered in proof
thereof. X-ray evidence of arthritis is always ancient evidence, be
cause arthritis is not apparent in the X-ray until the cause of the
arthritis has existed for many months and probably years.
Then there arises the question as to whether the arthritis or the
injury is causing the disability. The same conditions which produce
arthritis produce changes in the ligaments, which cannot be demon
strated by the X-ray. The ligaments, instead of being elastic and
strong, become inelastic and more or less brittle, and it is possible to
injure them with comparatively slight trauma. One point which has
not been impressed sufficiently upon the minds of the medical profes
sion or of those laymen who deal with injuries is that an injury does
not change location; the point of pain from an injury does not v a ry
from day to day. If there is tenderness one day, the tenderness is
in the same place the next day and the day following, and a patient
who cannot locate accurately the point of pain from one day to
another should immediately be cataloged as one who does not have
an injury. If a ligament is torn or overstretched, the pain remains
in the same place constantly from the time the injury occurs until it
is well; it does not shift. The same is true of an injury to a bone or
joint, or the detachment of a muscle or tendon. On the other hand,
pain which is due to a mild inflammatory condition is frequently more
generalized, some days worse in one position, some days in another,
it varies from day to day in intensity and frequently in location. It
is perfectly true that tenderness occurs in constantly the same spot
from inflammation due to tumors or abscesses, but these give other
symptoms, both on physical examination and in the X-ray. In an
injury to the tissues making up the spine, the same motions that cause
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1933 MEETING OF I.A .I.A .B .C .
pain one day will be found to cause pain on the next day if the exam
ination is repeated. # Therefore, in cases where there is suspicion re
garding the probability of injury and the diagnosis, careful record
should be made on first examination, and checked within 24 or 48
hours to see whether the symptoms remain the same. If on the sec
ond examination they are found to vary, they should be checked a
third time, and if they vary again from the first two examinations,
there can be grave doubt as to whether there is any real injury. In
any injury or disease of the spine the nerve symptoms due to exten
sion of inflammation, and pressure due to swelling, frequently come
on some time after the injury or the onset of disease, and develop as
a result of the extension of an inflammatory process or pressure, so
that these symptoms may increase in seventy in the course of days
or weeks. But if they are due to local pathology they constantly
involve the same group of nerves, and the area can be traced, if one
has knowledge of the routes of the nerves, as easily as railroad men
trace a certain car on a given area of switch tracks. Sometimes the
pressure on nerves will cause pain referred to the terminal of a sen
sory nerve whose trunk is involved in an inflammatory process. This
explains the development of so-called sciatica in low back injuries,
so-called neuritis of the arm in neck injuries, and referred pain around
the chest and abdomen in injuries along the dorsal and lumbar spine.
The first examination of a patient who complains of injury to the
back should be most thorough and complete. As a matter of fact,
this holds true in every case of injury or disease. A patient may
have a pain in his back due to something entirely foreign to injury,
but if it is not so diagnosed early in the case, and if the doctor has
not come to a definite conclusion as to its cause, the patient may be
perfectly honest in his conviction that he has injured his back, and
may have this conviction firmly fixed in his mind at a later date if
the cause for the pain has not been found. There is little logic in
coming before an industrial commission or a court and testifying that
a man is a malingerer, or that his pain and disability are due to some
disease, after he has been treated for months by heat, diathermy,
massage, and other therapeutic agents before the doctor reached tins
conclusion. In my opinion, most of the cases of malingering and
neurosis seen in industrial practice are the direct result of improper
diagnosis and poor treatment, and it is the responsibility of the med
ical profession to detect the malingerer at once and to prevent the
development of neurosis by finding the cause of pain, whether it be
due to injury or to disease.
A careful examination means not only keen analysis on the part of
the examiner, but also the expenditure of much time; and the doctor
who is pressed for time constantly, and usually underpaid for his
services, is always handicapped. He has a one-man job, with only
one head and one pair of hands to do his work; there are a limited
number of hours in the day in which to work, usually none to play,
and sometimes few to sleep. Without a clear head and time to use
it, many cases of so-called injury to the spine may be allowed to slip
by without diagnosis of the cause of the pain in the back. My own
feeling in the matter is that most patients who complain of pain in
the back have pain in the back, but it is also my opinion that at least
50 percent of them have pain in the back due to something besides
injury, or the pain is only precipitated by some happening at the time
ARTHRITIS AS CAUSE IN SPINE INJURIES
93
the patient is working. A thorough examination at the first com
plaint of injury, with the privilege of spending a little money for
blood chemistry, blood counts, X-rays of teeth, examination of the
throat and sinuses, would result in a large saving in money and time
and would eliminate the necessity for many aggravating adjustments.
If there is any doubt in my mind upon first examination as to whether
a man has or has not been injured, he is sent to a hospital where he
can be kept at rest and under observation and where a diagnosis can
be made. If the ligaments of the spine are injured and there is
evidence of arthritis in the X-ray, it can be fairly assumed that this
patient is going to make a comparatively slow recovery. It is impos
sible to give complete rest to the spine and its supporting ligaments
except by putting the patient to bed. Braces help, heat helps, but
the factor that caused the arthritis must be eliminated before the
condition can be completely remedied, and until that factor is elim
inated in all probability the patient will continue to have pain in
the back.
Two of the greatest causes of arthritis are low-grade infections and
toxemia. By toxemia is meant poor intestinal elimination, putrefac
tion of various kinds in the intestinal tract, or an incompetency on
the part of the general organism to handle certain kinds of food or a
considerable quantity of one kind of food. The average workman
has a comparatively limited diet, and he may have an intolerance or
partial intolerance for certain foods which he had been taking month
after month. These foods leave a residue, because they are not
handled as they should be, and this residue is in the form of an irritat
ing poison. The poisons are deposited in the ligaments, in the attach
ments of muscles around the edges of joints, and at the attachment of
joint capsules, because these tissues are low in blood supply and con
sequently low in resistance. When these chemicals are deposited
they act as irritants to the covering of the bone at the attachment of
the tendons and ligaments, and roughenings develop which are ap
parent in the X-ray. We all carry large factors of immunity in our
various organs which prevent their breakdown for a long time, but
finally these factors are overcome by the constant feeding in of small
amounts of poison, and it is during the last 20 years of life that they
begin to show the effects most positively. If a man is injured, if he
continues to carry these toxins in his blood, with the constant de
position in the attachments of muscles and throughout the ligaments,
we cannot expect to have the^ already damaged ligaments heal and
again support the weight to which they have been accustomed. Lowgrade infections cause the same sort of damage, but are usually much
more apparent in the physical examination.
For these reasons it seems to me that medical men and laymen
interested in industrial practice should insist on the thorough examina
tion of a patient from every standpoint at the time he first comes
under observation; that no stone should be left unturned to find out
the cause of the pain and disability, not with the idea of proving that
it is not due to an injury, but with the idea that should always be
uppermost in the minds of those who handle such cases, of ascertain
ing the cause of disability and then instituting proper procedures to
relieve it.
Anomalies of the bones of the spine are frequent, especially in the
lower lumbar and upper sacral regions. The objective evidence here
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1933 MEETING OF I.A .I.A .B .C .
is plain, inasmuch as the spine is not normal, or rather, is not within
normal limits as shown by the X-ray. Dr. Potter will tell you about
wedged-shaped vertebrae, and I am sorry that he will not have time
to tell you about many other anomalies, the interpretation of which
leads to much diversity of opinion. There are certain anomalies of
the spine which weaken its mechanical structure, probably the most
frequent being those which occur between the fifth lumbar vertebra
and the sacral articulation. As mentioned at the beginning of this
paper, each vertebra has a bony process which fits over a bony process
extending upward from the next below it. If it were not for these
processes in the normal spine, all the strain of holding the vertebrae
together would come directly upon the ligaments. At the junction
of the lumbar spine with the sacrum, the fifth lumbar vertebra fits
on top of the first sacral at an angle of about 45° to 60°, depending
upon the amount of curve that an individual has in the spine. This,
from a mechanical standpoint, is a weak arrangement, because the
fifth lumbar vertebra has a constant tendency, due to the weight of
the body above, to slip forward and downward, being prevented from
doing so by the bony projection of the articular processes of the verte
bra which fit over the first sacral, locking it in place, plus the liga
ments and muscles which support the back. There are many varia
tions at this particular point in the spine, consisting of changes in the
angle of articulation, so that the fifth lumbar is sometimes not firmly
locked over the first sacral vertebra. These processes vary so much
in their ability to support the spine that it frequently becomes con
fusing to say what is normal and what is an anatomical anomaly. We
have seen the joints vary in their angle on the two sides, one side
being, perpendicular and the other side approaching the horizontal.
Sometimes both sides approach the horizontal, and in some cases
there is a complete failure to unite between the anterior and posterior
part of the fifth lumbar vertebra. Not infrequently we find six lum
bar vertebrae instead of five. In some cases the wings of the hip
bones, called the ilia, come up high on each side of the fourth and
fifth lumbar vertebrae, and at other times we find the fifth lumbar
vertebra set high on top of the sacrum, with the wings of the ilia
barely level with the top of the first sacral vertebra.
It becomes necessary, therefore, to define what is t>,strong back and
what is a weak back. In general, we may say that the short, heavy,
thickset back, with properly overlapping processes, is the strong back.
The long thin back, with considerable space between the lower ribs
and the top of the hip bones or pelvis, is the weak back, and to put
a man with a long thin back to doing heavy lifting is to court disaster.
If it were possible to X-ray the lower back of each man who applies
for work at heavy labor, and to eliminate the structurally weak backs
from that type of work, there would be fewer back injuries, because
the leverage on a long back is much greater, while the muscles which
control the motions of that back are no stronger and frequently not
so strong as those which control the shorter back, which has less
leverage from the weight.
There are also anomalies in the lateral processes in this region,
which have caused much discussion. The lower back is still going
through a period of evolution, and Dr. Theodore Willis of Cleveland
has shown that in more than 700 anatomical specimens which passed
through the laboratory at Western Reserve University, 3.5 percent
ARTHRITIS AS CAUSE IN SPINE INJURIES
95
had anomalies of the lower spine. We do not know, of course, how
many of these people had suffered from pain in the lower back, but
when X-rays of patients who did complain of pain in the lower back
were examined, it was found that the percentage of anatomical anom
alies shown in the X-rays was much higher than in the supposedly
normal individuals. This would indicate that anatomical anomalies
of the lower spine do cause weakness in a certain percentage of cases,
and yet quite frequently such anomalies are found when the spine is
X-rayed for other causes than pain in the lower back, and when such
patients are questioned as to whether they have had any trouble in
the back many of them reply that they have never known they had
a back. There is one anomaly, however, of which we have spoken,
which undoubtedly is responsible for slipping of the fifth lumbar
vertebra on the sacrum, and that is a lack of bony support between
the fifth lumbar and the sacrum, caused by a failure of the vertebra
to unite properly in all its parts, or by serious changes in the angle of
this articulation so that the fifth lumbar does not properly lock over
the sacrum*
We fit animals into their proper niches in life; we breed bird dogs
for finding game because a good nose is required; we do not hitch
them to carts, because they are not built for it. We breed heavy
horses for hauling heavy loads, horses that have thick stocky backs
and large muscles; we breed other horses for speed, long-legged animals
with agile muscles. But with men we do not differentiate between
the man who is fitted for labor and the man who is fitted for speed.
Various efforts along this line on the part of large corporations in the
last few years have been considerably hampered by the rules of the
unions, and in these socialistic days, when it seems that a great many
people feel that they are entitled to a living whether they work or
not, even when there is plenty of work, it is increasingly difficult to
fit a man into his right niche. But from the standpoint of anatomy
this should be done, and when it is done there will be fewer back
injuries.
It must be emphasized in conclusion that X-ray evidence in the
case of arthritis or mildly traumatic injuries to the spine is worth very
little, because it shows only the bones, and the bones are a com
paratively small part of the mechanism which goes to make up the
back and its support. Careful examination, with a thoughtful
analysis of the findings, will show that the large majority of injuries
to the back are due to other causes primarily and that the trauma is
the thing that precipitates the pain. The pain would not be caused
were it not for the underlying degeneration of the tissues. Therefore
let us give thought and attention to the diagnosis of the cause of pain
in the back, rather than to the pain itself. The pain is only the red
flag which calls attention to the fact that there is something wrong.
Chairman G r a v e s . Dr. Magnuson has made it plain how it is that
sometimes when we have complaints as to backs we are at a loss to
attribute the complaint the man makes to the particular accident
that he had. While of course, as doctors, we all know that the X-ray
does not show everything, I think it is reasonable to say that
it is probably the most important single factor that we have in
determining actual injuries to bone, to say nothing of some of the
other uses to which X-rays are put. In Chicago we are fortunate in
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1933 MEETING OF I.A .I.A .B .C .
having one of the most experienced X-ray artists in this country,
Dr. Hollis E. Potter, and he has kindly consented to give us a paper
this morning on certain conditions in the spine which we will all find
very interesting. We are looking forward to a rather general dis
cussion of all of these papers by everyone—not the doctors alone—
because, so far as possible, the papers have been arranged so that they
will be easily understood by people who do not have medical training.
They are the ones who we particularly hope will discuss liberally what
the doctors have told us.
(1) The Wedge-Shaped Vertebra; (2) Some Distinctions
Between Healed Fracture And Healed Vertebral Disease
By
H o llis
E.
P o tte r ,
M.D., President, Chicago Roentgen Society
The Wedge-Shaped Vertebra
Although every man connected with the health of industrial workers
is constantly brought into touch with injuries and disabilities refer
able to the spine, and although most of us are in some way or another
led to look at and judge from the appearances shown on X-ray films
made from these painful backs, it is probably true that the X-ray
method, and particularly the finer technic which brings out details
in the spine, is not so old but that there are points of confusion still
remaining in the minds of many. It may not be amiss, then, to call
attention to two or three general rules regarding the interpretation of
changes in the spine, for if we have in mind a few good general rules
the number of cases in which there might sti]l be confusion will
become less.
It is well known to all of us that in sections of the spine below the
neck the most common type of fracture is that produced by bending
of the spine forward. A person is doubled up like a jackknife, and at
the point of greatest pressure certain vertebral bodies may become
compressed or impacted so that when X-rays are obtained they show
a narrowing at the anterior edge, with perhaps no narrowing posterior.
In other words, the bone substance in the forward part of the vertebra
has been squeezed down so as to produce a more or less wedge-shaped
vertebra. While this can usually be suspected on the anterior views,
it can be very much more surely made out and measured on the lateral
views of the spine. Often, indeed, the same mechanism produces the
same type of fracture in the neck, but inasmuch as this region is very
much more movable and the injury may take place when the neck is
twisted at one angle or another, fractures in the neck may be quite
variable.
The wedge-shaped vertebra is such a common consequence, there
fore, in fractures of the middle and lower spine that doctors and
arbitrators alike have too often jumped at the conclusion that when
ever a wedge-shaped vertebra is demonstrated this constitutes a
sufficient proof of a fracture in connection with any given injury.
I would like to bring out certain X-ray features which are almost
constantly present when the wedge-shaped vertebra means com
pression fracture, and certain features in those cases where the wedgeshaped vertebra did not result from fracture but is merely found
incidentally.
WEDGE-SHAPED VERTEBRA AND HEALED FRACTURE
97
In the first place, it is not generally known among doctors and
arbitrators that when a compression fracture occurs in the middle or
lower spine the compression almost invariably takes place at the
upper and anterior portion of the body and hardly ever at the lower
anterior aspect. For some reason we have seen this occur time and
again but have not come to appreciate the constancy of the defect
at the upper side. A short time ago I took the trouble to count more
than a hundred fractures at the dorsolumbar spine and found that the
lateral views showed uniform evidence of compression in the upper
part of the vertebra rather than in the lower part. I took the matter
up with roentgenologists in three other cities and through their
courtesy 500 compression fractures in all were reviewed, and in only
one case below the upper dorsal region did the lateral X-ray films
appear to show that the compression was in the lower part of the
vertebral body. When the compression is relatively slight and
recent this point is easy to recognize. When the compression has
been carried farther so that the front of the vertebra is not more than
half as wide as the back, then, particularly in the old healed cases, it
may be necessary to judge from the outlines of the whole vertebra
as to where the breakdown occurred. I will show on lantern slides
that in these cases the inferior line of the vertebral body lies at a
right angle to the posterior line, whereas the superior line is at acute
angles to the posterior line. This in itself demonstrates that the
deformity was produced by a condensation or impaction of the upper
anterior portion without affecting the lower part. Now this general
rule can be used to distinguish compression fractures from deformities
of vertebrae produced by causes other than fracture. It so happens
that in these other conditions the changes are quite as frequently at
the lower anterior part or involve both upper and lower portions
alike. We will later emphasize one or two common causes of wedgeshaped vertebrae that were produced by influences other than
fracture.
It is also true that in the fractured^ wedge-shaped vertebra one is
usually able to make out not only the impaction at the upper part of
the vertebra but also some outline changes at the anterior profile such
as are produced by comminution of fragments. Also one may see
changes of internal structure in the vertebral body even though no
distinct lines of fracture are evident after recent injury. In a frac
ture which has become largely healed the irregularities at the anterior
profile tend to smooth off a good deal but still may show a slight
overhang or projection at the impacted area just below the articular
edge. Internal structures show a new network of bone which some
what approaches the normal, but the condensation of bony impaction
may persist for a very long time. When, therefore, the lateral view
of the vertebral body shows it to be narrow in front by reason of
impaction or condensation of the upper anterior portion, and when
in addition some local outline irregularity or change in internal
structure is present a diagnosis of compression fracture is fairly
certain.
Now it is a fact which has been too much overlooked that wedgeshaped vertebrae are not very uncommon as a result of some changes
peculiar to the growing age between 13 and 16 years. Much has been
learned in recent years concerning a condition called osteochondritis,
which by many has been viewed as a noninfective inflammation of
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1933 MEETING OF I.A .I.A .B .C .
the incompletely ossified components of the vertebra probably
brought on by some violent movements or actual slight injuries. It
has been explained by many as an injury mainly to the blood supply
affecting the centers of ossification in the forward part of the verte
bra. It does not usually produce a very sore back but is usually the
cause of some pain and spasm. It is often incorrectly diagnosed
as tuberculosis.
The old-fashioned expression “ growing pains” is probably ex
plained by some measure of osteochondritis of tliis sort. The facts
are, however, that a single one or several adjacent vertebrae show at
this stage on lateral films an irregularity in the small bony centers
which are incompletely developed at the upper and lower anterior
part of each vertebral body. The condition runs along until the bones
have obtained their final ossification, after which an observation
shows that they are more or less wedge-shaped. In these cases the
narrowing at the forward margin of the body is not caused by any
apparent condensation or impaction of bone, and the narrowing is
as much from faulty development on lower side as on upper.
In later life such wedge-shaped vertebrae, if multiple and extreme,
may cause a slight stoop or kyphosis. They also show greater tend
ency to develop osteoarthritis than other portions of the spine. So
now with its arthritis this spine is more vulnerable to injury than the
normal spine, and if the X-ray findings are not properly interpreted
a diagnosis of compression fracture is wrongly made. If seen long
after injury and accompanied by the spurs of arthritis how easy it is
to interpret wrongly the arthritic spurs as callus.
Wedge-shaped vertebrae may also be present as a congenital varia
tion in architecture and thus accidentally found in X-rays following
spinal injury. Another type of wedge-shaped vertebra may also
be seen as the result of infective disease, which often destroys more of
the front than the back of the vertebral body. Such infective dis
ease in active stages may be distinguished from fracture by the signs
of spongy bone dissolution and by the fact that the disease tends to
invade the adjacent intervertebral joint rather early in the disease.
This presents on lateral X-ray films a picture of decreased joint
space and ragged joint margins, especially on the side first affected.
An abscess may be recognized in outline or may be assumed to exist
when small irregular bony fragments are cast off, and lie at the side
or in front of the vertebrae.
Such infective breakdown may or may not result in a vertebral
body of wedge form in tuberculosis and less frequently in typhoid,
pneumonia, and simple pus infections.
Some Distinctions Between Healed Fracture and Healed Vertebral
Disease
The X-ray is sometimes called upon to distinguish between a very
old fracture and old healed disease such as tuberculosis of the spine.
In certain cases this may be difficult, but there are some fundamental
differences in the X-ray appearances which may be most valuable in
reading a short series of spine films made at various angles.
In the first place, it is a well-known fact that in vertebral fractures
the intervertebral cartilage is more resistant to injury than the
bone composing vertebral bodies. Even in severe impactions the
WEDGE-SHAPED VERTEBRA AND HEALED FRACTURE
99
cartilaginous interspace tends to retain its normal width as the
bone is crunched down. Usually the lower margin of the vertebra
above retains its normal crisp uninterrupted line. The impacted
vertebra may show some irregularity at its upper margin because of
the irregular collapse of fragments.
In vertebral disease the contrary is most often true. There is a
strong tendency for disease to invade the joint at an early period,
and this disease rapidly destroys the fibrocartUage and by extension
invades the vertebral body adjacent. This gives a collapse in which
the interspace is reduced in size and the joint margins are ragged and
irregular. While the disease is active there is not likely to be real
confusion in diagnosis.
When, however, the disease becomes healed, the bone regains its
density and much new bone may be formed between the boaies and
surrounding the interspace in such a manner that it might be confused
with the callous formation about a severe fracture. Neither the
disease nor the fracture may call forth a great amount of new bone,
or either may do so. When the new bone formation is exuberant,
then must one apply his rules regarding preservation of interspace.
At some angle or other the X-rays in fracture will show the original
crisp articular margin of the vertebra above and more or less com
pletely the intact margin of vertebra below an interspace. In healed
disease no angle can be found where this is true. The vertebrae may
be partly or completely fused together, with permanent reduction or
entire loss of cartilaginous space. The new bone surrounding the
outside may be quite similar in healed fracture and disease. The
key finding is the preservation of the cartilaginous space after
fracture, and this may only be visible in an oblique or lateral view.
I will now try to show by a series of lantern slides a number of
illustrations as to the character of the deformity in the wedge-shaped
vertebra produced by fracture and in further lantern slides the
distinction between old fracture and old vertebral disease.
ioo
1933 MEETING OP I.A .I.A .B .C .
1.—Slight compression fracture in body
of an upper lumbar vertebra. The compres
sion is entirely at upper anterior portion.
Using the posterior margin as a base line the
degree of compression is about 7 percent.
F ig u r e
lower. The angle of upper surface to pos
terior margin has been dropped from 90
degrees to 80 degrees and 78 degrees.
WEDGE-SHAPED VERTEBRA AND HEALED FRACTURE
101
/
3.—Tracing from lateral view through
midthoracic region. Here in a case of osteo
chondritis a wedge-shaped vertebra shows
lowered angle of 8 degrees at its inferior surface
and 5 degrees at its superior surface with
respect to its posterior base line,
F ig u r e
F i g u r e 4 — Another
osteochondritis in lower
dorsal region showing tendency of wedge
form to be caused by deficiency at lower an
terior as well as at upper anterior surface.
The outline form aids in differentiating
from fracture in later life.
102
F i g u r e 5.—Tracing
1933 MEETING OF I.A .I.A .B .C .
from healed disease in lum
bar region. Here the cartilaginous interspace
is nearly gone and a firm bony fusion has taken
place at right side. In healed fracture the inter
space is preserved. The disease was typhoid
infection.
6.—Healed tuberculous disease in midlumbar region. The cartilaginous space again
is nearly gone. Bony union is taking place.
F ig u r e
BACK INJURIES
103
DISCUSSION
Mr. H a l f o r d (Ontario). I should like to ask the doctor who was
showing the vertebrae a question or two in regard to some of the
things he said. Like everyone else who is administering compensa
tion on boards, I was quite interested in some of those things. A
great many of those fractures have come to our notice. The first
question is this:
After the intervertebral space is cleared away and there is no ob
struction whatever and no ragged edges, should there be much, if any,
disability?
Dr. P o t t e r . That is not an X-ray question but a question on
disability. It is not actually an X-ray question whether a person is
disabled or not, clinically. However, the question might be put this
way: In the average case, if the clearing that you speak of does occur,
is it favorable to lessened disability? Is that more like it?
Mr. H a l f o r d . Yes.
Dr. P o t t e r . The clearing you mention is what? I suppose you
mean if the spaces between the fracture are preserved. That is a
difficult thing unless you differentiate them from disease which de
stroys the inner space.
Mr. H a l f o r d . Another question: When a fracture is healed per
fectly, as you outlined there, and there was just a slight fracture and
no spinal-cord injury, should there be any disability? I am speaking
of the slight fracture that is perfectly healed.
Dr. P o t t e r . That is another question of disability. Year after
year we find people who have had a slight injury and a slight fracture
and did not know it, because it was not disabling at the time. They
go along through life, and it may be discovered accidentally some 15
or 20 years afterward. In my opinion, fractures are not as disabling,
many times, as are strains and sprains without fracture.
Mr. H a l f o r d . We have had a number of cases where the workman
has had a spine fracture and really did not know it. He was never
told about it and he went on with his work. There is one more
question, Doctor. I have never heard of a spine being affected
through typhoid. That is new to me. We have the tuberculous
spine, and I was wondering if there would be very much disability
after that condition has been cured by bone graft or anything else.
Should there be very much disability in a case of that kind, par
ticularly in tuberculosis?
Dr. P o t t e r . That is a very broad question and it is again a ques
tion of disability. Many cases of tuberculosis and typhoid go
through a course and heal up so that they are fused. You have done
practically what you wished to do by operation, which is to fuse them.
Mr. H a l f o r d . I have one more question. One thing we are all
interested in is osteoarthritis. Does a fracture naturally increase the
osteoarthritis in a spine, particularly where the fracture is, and in the
spine in general?
Dr. P o t t e r . Yes, I think it does in the course of months, many
months. When a fresh fracture occurs in the vertebral body, you
see some measure of osteoarthritis in the immediate neighborhood.
After 6 or 9 months the picture shows that the osteoarthritis im
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1933 MEETING OF I.A .I.A .B .C .
mediately around the region of the fracture has increased; the amount
of bone laid down has increased. You see some laying down in 3 to
6 months, but you see it more matured in 9 or 12 months.
Mr. H a l f o r d . Does it tend to initiate* osteoartliritis other than
where the fracture is or in the vicinity of the fracture?
Dr. P o t t e r . Y ou are practically asking whether trauma has an
influence in the formation of osteoarthritis. There are two aspects
to that. One is a severe injury like that which produces a fracture,
and the other is a large number of small repeated traumas. The in
fluence of trauma, broadly speaking, in the formation of osteo
arthritis is admitted by all writers. There was a very good article
in a recent journal. A man who has examined 2 or 3 thousand cases
said, “ I can tell whether the man was right-handed or left-handed by
seeing the evidence of his spine.”
So small traumas have an influence in the formation of osteo
arthritis as we see it in life, but osteoarthritis as we see it in the
X-rays is the effect of influences that have gone on tlirough the man’s
life and have left their hyperthrophic marks, and there is no measure
of good support for it.
Dr. M a g n u s o n . I should like to say, in answer to the question as
to how much disability a fracture may give, that there is no reason
why a fracture of the spine should occasion a permanent disability.
What occasions a permanent disability in fracture of the spine, in
my opinion, depends upon two things. Of course, in a fracture dis
location where there is injury to the nerve supply, that more or less
results in a permanent disability, providing the nerves have been
pressed upon or injured sufficiently to put them out of business to a
greater or lesser extent. I think what we are talking about more
particularly is compression fractures; that is, where the bodies of
vertebrae are compressed anteriorly, as Dr. Potter has shown. He
has shown the differentiation between those things and the other
things that may be confused with them.
The disability in a compression fracture of the spine depends upon
this, as I see it. If you will notice the X-rays Dr. Potter showed
us, some of those spines have an acute angle in them; and if you
draw a line from the neck down to the top of the fractured vertebra
and then meet it with a line coming up through the middle of the
lower vertebrae, you will see that they vary in angles.
No man can stand with his back permanently bent over in this
position [demonstrating] for any great length of time without having
pain, but many times that pain is not in the fracture, because those
fractured bones heal. That pain is caused by the constant cross
strain and overstrain put on the muscles and ligaments of that man’s
spine because he has a permanent angle in his spine and cannot
take it out. If you want to find out how that feels, just put the front
of your leg up against a fender of an automobile and stoop over and
look at the engine for 20 minutes without straightening up. Then
you will know just what happens in a compression fracture of the
spine where there is a permanent deformity which throws a man
over the line.
There are ways of correcting that. One is hyperextension at the
time of injury sufficient to reduce that disability and put the man
in an upright position again. If that is impossible, and in some
BACK INJURIES— DISCUSSION
105
cases it is, another way is by means of a compensatory curve above and
below. By compensatory curve I mean tins: If we have an angle in
the spine like that [indicating on blackboard], by tilting this part
of the spine forward you partly straighten it, and if you put another
curve in front of that, so far as the upright position is concerned, you
have restored it.
If that bone heals and there are compensatory curves developed
above and below, then that patient is reestablished in the upright
position and strain is taken off the ligaments md muscles. There
are two things to do:
Reestablish the normal outline of the bone by actually breaking
up that impaction that has resulted from the fracture. Nature will
fill in that bone so that a year later Dr. Potter cannot tell that there
is a fracture there. Nature has filled in that bone and the edges are
square.
Or else develop a compensatory curve above and below that fracture
to compensate for the angulation that is put in that spine. Relieve
the muscles of the leg and back. Many of these cases of fracture
of the spine which have that angle do not have pain at the point of
fracture but have pain in the lower lumbar and sacroiliac region,
where the great muscles which are responsible for the upright position
of the back are attached.
Those are the things that govern the amount of disability as the
result of fracture, not the fracture itself. The bone heals just as
true as any other bone heals.
Mr. P a r k s (Massachusetts). As good as it was before?
Dr. M a g n u s o n . The bone is as good as ever. When you maintain
a man in that stooped position his muscles cannot stand the strain;
when you relieve the strain he is as good as ever.
Mr. P a r k s . Does the fracture have anything to do with that?
Dr. M a g n u s o n . It has, because that is the cause of throwing him
out of plumb. The end result is the same, but the fracture itself
heals.
Mr. P a r k s . You have to treat the stooping?
Dr. M a g n u s o n . You have to reestablish the upright position of
that individual so that he can stand without a constant overstrain
on his muscles and ligaments.
Mr. H a l f o r d . In cases where there is a fracture, do you think it
is wise to bone graft or heal or reestablish, as you call it, soon after
the accident or later on? . What period do you think is advisable?
I have heard doctors say that the reestablishing of the spine should
be undertaken quite early instead of waiting for 5 or 6 months or a
year, for the simple reason that it is more easily reestablished then,
and should be done so as to prevent further disability.
Dr. M a g n u s o n . A fracture of the spine which causes injury to the
nerves should always be operated on as soon as it is seen and can be
taken to a hospital where it can be done properly, because any pres
sure on the nerves or nerve cells for any great length of time produces
a degeneration in those cells, even if it has not killed them or com
pressed them very badly right at the time of injury. The thickening
and induration helps the pressure and there is serious disability.
That does not mean that all cases of injury of the spine and cord are
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1933 MEETING OF I.A .I.A .B .C .
relieved by operation, because they are not, but every fracture of the
spine with injury to the cord where there is a block—where there is
sufficient pressure on the cord so that the spinal fluid cannot circulate
freely—should be operated on immediately.
In compression fracture the thing to do is to reduce the deformity.
Here we have a wedge-shaped vertebra. This is at one angle to the
spine and that is at another. The thing to do immediately is to try
to reduce that compression; that is, the jamming in and the crushing
in of the bone cells. The spine is made of what we call cancellous
bone. It is a honeycomb sort of bone. It is like the shaft of your
long bones. By hyperextending that patient properly we can pull
that fractured space apart so that the vertebrae will stand this way,
this space being empty, and then nature will fill in that space and in
that way the spine can be reestablished. If this is not done right
away, you cannot do it at all.
If the thing has already healed sufficiently so that when you see it
you cannot do that, then the next best thing to do is to bend the
patient’s spine that way there [indicating] and that way there [indi
cating] so that the weight-bearing line is reestablished. You can do
that sometimes by hyperextension and exercising.
There is no trouble about the bone healing. It U the position in
which it heals. Suppose you have a spine like that [indicating].
The man’s head is here, his arm is here, and he is standing in a
stooped position. Suppose the fracture healed with good solid bony
callus. He comes before you and the doctor says, “ This fracture is
healed. Here is the callus. Look at it. That bone is all healed.”
He is perfectly right, but what is this man doing4> He is holding
himself up with big guy ropes of ligament which run from the spine
down here to the hips. He is holding himself at an angle and fre
quently he has no pain there at all. He has pain down here [indicat
ing].
.
Mr. P a r k s . After listening for 21 years to doctors giving testi
mony before me in contested cases, and then meeting such doctors
as we have here this morning (and we have the same type in Massa
chusetts and all over the United States), I sometimes wonder if some
of the men I have to listen to belong to the same profession.
You gentlemen here today have made it so clear. In a case of a
wedge-shaped fracture, if these doctors who tell us the unvarnished
truth about such a thing were the only ones permitted to come before
us, we would have no difficulty at all. It is the other fellow, who
comes forward. Of course he is supposed to have the requisite
qualifications, but after the insurance lawyer asks him for his quali
fications we find out sometimes that this man is still an interne. He
takes a chance, however, on asking and answering all kinds of expert
hypothetical questions and enunciating medical doctrines that no
one ever heard of before. We are all at sea then and do not know
just what to do about it.
You say, “ Why are you telling us about it?” I presume there are
a number of doctors here. I was impressed with this statement by
Dr. Magnuson: “ It is the responsibility of the medical profession to
detect the malingerer at once and to prevent the development of
neurosis by finding the cause of pain, whether it be due to injury or to
disease.”
BACK INJURIES— DISCUSSION
107
That is the whole thing—whether the man is a faker, or not. Only
a few months ago I had a man before me who was claiming for disa
bility. His compensation had been discontinued. When the at
torney called on the doctor to testify, he testified that the man’s back
injury was no better, that he was still suffering from a fracture, and
that he would continue to suffer. I looked up the record and found
that his injury was a wrist injury.
I said, “ Well, Doctor, did you know that this man never hurt his
back, that all he had was a wrist injury? Did he tell you that? ”
“ No. I didn’t know that. He didn’t tell me that. He told me
he had hurt his back.”
“ So you believed him? You have actually found that he did have
an injury to his back?”
“ Yes.”
Well, of course when the doctor finds an injury to his back when the
man never had such an injury, when he tells you that the man is un
able to work and will never go back to work, what are you going to
do with the doctor? That is an actual case and I can tell you about
many more like that.
It is the responsibility of the medical profession to clean up this
thing. The Massachusetts Medical Society is taking steps to do so.
The matter has gotten so bad (I know it has in my State and I pre
sume it has in other States) that clean, honest, respectable, God
fearing doctors who know their business will not come before the
industrial accident board and be bullyragged by these lawyers who
are making a racket out of compensation. They will not come, but
we can always find unreliable doctors who will come in and say any
thing for a fee. Whose responsibility is it? In the compensation
work in the United States we want the assistance of doctors of the
type we have heard here this morning. We want them in this work.
We want them because the workmen’s compensation.act is an honest
act, the most humane piece of legislation that has been enacted in the
United States. It is intended to take care of honest injured workmen
and the dependents of those who are killed. What has happened?
The law in practice has become burdensome on industry, it is true.
In payments we have gone from $1,000,000 to $12,000,000 a year in
our Commonwealth. A good many of those millions are being paid
to people who should not receive them. If it were not for that, we
could increase the benefits to those who are honestly entitled to them.
The medical profession has the key to the whole situation. If we
could only get the medical profession interested, through its medical
societies, in coming to the hearings to testify, that would solve the
problem. For instance, Dr. George, who is one of our impartial
expert X-ray men and has been for about 21 years, comes before our
board time and time again. When he is testifying I know I am getting
100 percent truth. I know his testimony can be relied on, and there
are a good many others like him I could mention.
In a case where a doctor had treated a man for 5 years for backache,
I asked the man, “ How are you feeling?”
“ Badly.”
“ Are you any better after this treatment?”
“ No.”
“ Do you feel any worse?”
“ Yes, I feel worse than I did in the beginning.”
26616°—34----- 8
108
1933 MEETING OF I.A .I.A .B .C .
The doctor testified that he was treating this man every week,
three times a week, with massage and diathermy. While diathermy
is a good thing, I think it is the most abused service in existence.
This doctor was running a sanitarium in that city and people were led
to believe that he was an expert.
This fellow had been on compensation for 5 years. I said to the
doctor, “ This man said he had a pain in the back and you put him on
diathermy.” He did not have a fracture, just an ordinary sprain
from bending down and lifting an object; he felt a pain in the back or
something like that. I asked the doctor if he had cured him. He
said, “ No.”
“ Are you going to continue to treat him? ”
“ Yes, as long as he comes to me.”
I could have added, “ As long as he has the money to pay.” I
cannot believe that the medical profession is so backward that it can
not cure a man of a plain, ordinary sprain in 5 years. I think it
reflects on the medical profession to have that put on the record.
I am talking about this situation because it must exist in every
State in the Union. We are going to clean it up in Massachusetts;
those fellows are not going to continue to get away with that stuff.
As the doctor well said in his paper, instead of making the correct
diagnosis in the beginning, looking to see if there is an infection, look
ing for the foci of infection and giving a thorough examination, such
a doctor says, “ Come in tomorrow and we will start you on diather
my.” He starts on diathermy and sends the bill to the insurance
company. It gets report after report and the doctor starts collect
ing his money.
The workmen’s compensation act is not a doctor’s act nor a lawyer’s
act. If we knew what the lawyers are getting, perhaps we would
find that the lawyers are getting more than the doctors. We would
not mind so much if they would give good service.
If the doctors would just tell us the truth. That is what we want.
You may disagree with each other. You may have honest differences
of opinion. I have had a dozen X-ray men all see a picture in a differ
ent way. Perhaps that is an honest difference of opinion. Some
times it is and sometimes it is not.
You members of the great and honorable profession of medicine have
the key to the welfare and the future progress of the workmen’s compen
sation act. We want it administered honestly, that is all. Come in
and tell us the truth. I do not care if you do get big fees; I want you
to be paid for your work. You have to live; you have to support
your offices, and you have to support your families. You are entitled
to decent fees. We will see that you get them, but we want you to do
something for them.
We want the big men in the profession in this work. That is my
appeal to you this morning. Come into it and do not be afraid of
the shysters that are in it. If you do that, you will be a great help
to this work, and incidentally to the great profession that is yours.
We have many problems. We want to make these injured fellows
well and strong.
Mr. S t e w a r t (Washington, D.C.). The workmen’s compensation
commissions of the United States pay to injured workmen over
$119,000,000 a year. They pay for physicians and hospitalization
BACK INJURIES— DISCUSSION
109
$112,000,000 a year. When we started out medical cost was about
5 percent of operating expense; now it is about 35 percent.
The workmen’s compensation commissioners of this country (and
I was secretary of this association for over 12 years) are a lot of buck
passers. There is no reason why they should be so terribly at the
mercy of the physicians who treat corns and consumption in the same
way.^ We have unfortunately written into our compensation laws
and into our compensation practice the doctrine that the worker
may choose his own physician. The trade unions were largely
responsible for that, for the reason that company physicians and
insurance company physicians were the first to be witnesses against
the injured worker. You could nearly always depend on their being
for no disability or for a minimum disability. They were employed by
the wrong side and they were not fair.
Very often the workers do insist on selecting their own physicians.
In a concern in Philadelphia that has a welfare department, if a man
or woman is away from work more than 1 day somebody goes to see
what is the trouble. In one case a fellow had been away for 3 days
as I remember it. The concern sent a welfare worker to see why he
had not come to work. The welfare worker came back and reported
to the establishment’s physician that the man had just been taken to
the hospital for an operation for appendicitis. Knowing where the
man worked and the conditions of the work, the physician was
suspicious. He hurried out there and found the man all tied up with
painter’s colic, and the white-clad doctors were just going to operate
for appendicitis. There is no question but that that is the penalty
the workmen pay very often for choosing their own physicians.
You can get at that in a different way, but there is no excuse for
compensation commissioners permitting the kind of physicians that
Joe Parks is talking about to practice or even to appear before them.
Very often these physicians are organized gangs of humbugs. I know
what I am talking about. New York had an epidemic of lead poison
ing. A gang of so-called physicians would inject lead into these
poor devils of workers. The workers were in the game too. I am
not saying that it was done without the consent of the fellow who was
getting enough lead shot into his system to produce an urinalysis
that would show lead.
Not only do you not have to consent to the practice of that sort
of medicine before you, but it is your duty to see that those fellows go
to the penitentiary.
In Toronto they fired 11 doctors last year because they caught
them in rather questionable practices in the matter of their reports—
nothing like what they practice here in this country. While I do
think, as Parks said, it is up to the American Medical Association
to clean it up, it is also up to the American Medical Association to
form such a contact with the members of this association as will
enable them to clean out this racket, for that is what it is. It is a
racketeer movement on the workmen’s compensation fund. It is
paying out $112,000,000 a year to doctors and hospitals. It is up
to you doctors, but it is not primarily up to you; it is up to the lazy
workmen’s compensation commissioners.
Mr. H a l f o r d . We have our troubles just as you do, but we have
some wonderfully good doctors. I do not by any means condemn
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1933 MEETING OF I.A .I.A .B .C .
them all. There are a few who are not good, and we deal with those
few in accordance with the merits of the case. It is unfortunate that
you people do not have such a law as we have in Canada. We have a
right to say whether or not we shall receive their reports. When we
find that a doctor is not acting in accordance with the principles he
should abide by, we simply notify him and call it to his attention.
If the doctor does not violate the principle again, all well and good.
If he does, he knows the consequences. We tell him that if he does
not want to practice under the rules and regulations of the board, he
does not have to. That settles it.
Mr. Stewart said that we put off 11 a short while back. That is
actually true. We are putting doctors off all the time, for various
reasons. The medical fraternity is in accord with oar practice and
is delighted to see them go because they are not very much good to
anybody in the profession. The doctors cooperate with us. If there
is trouble we are very glad to see their representatives and we deal
with them. The representatives learn the true facts of the case. I
have not seen one case where they disagreed with us. They knew
we werte absolutely right in taking such action.
Of course, there is this about some of your commissioners over
here. You do not get the experience to deal with these fellows
because they are not left on the be
question. How do you know
experience. In Canada they let us alone; we are put on the board
for a long period and, as a rule, we stay there. I have been on the
board for 12 years and I am learning things all the time.
Mr. B a k e r (Kansas). You have to become bad for them to put
you off.
Mr. H a l f o r d . Perhaps. If they had a bad one, there would be
little difficulty about that. However, they let us stay there as long
as we are right.
I really believe that if you could get an act something like ours it
would be beneficial not only to the workmen but to the community
at large. Of course, some think the act was Diade for them and
nobody else. Their bills are sometimes indicative*, of what their souls
are, but they have to take the consequences. You can generally tell
what a doctor is when he sends in his bill. We have a staff of 7 or
8 who have nothing to do but look after bills and keep track of these
fellows. When we find them deserving censure, they get it. I think
Mr. Stewart struck the nail on the head when be said the commis
sioners are (I will not say lazy) dilatory. I think you should take the
bull by the horns and try to rectify the situation.
[Meeting adjourned.]
WEDNESDAY, SEPTEMBER 13—AFTERNOON SESSION
Chairman, Samuel S. Graves, M .D ., formerly medical director Industrial Commission of Illinois
Chairman G r a v e s . The first paper that we have this afternoon is
entitled, “ Reduction of Disability by Fusion of Vertebrae after
Back Injuries” , by Dr. C. R. G . Forrester, of Chicago, who has had a
matter of 30-odd years of experience with broken backs.
Reduction of Disability by Fusion of Vertebrae After
Back Injuries
By C. R. G.
F orrester,
M.D., F.A.C.S., Professor of Traumatic Surgery, Loyola
University Medical School
I have been asked by your committee and particularly by your
chairman, Dr. S. S. Graves, to give a paper on this subject. In doing
so, I wish all the readers to keep in mind that the opinions expressed
are based solely upon my own experience over a period of 32 years,
during which time I have devoted my entire practice to industrial
surgery, read many papers before industrial societies, and have
written a book on the subject. To state how many cases of back
injuries I have handled, ranging from fractures to concussions and
simple sprains, would be impossible as it goes up into many thousands.
There is, of course, among the medical men, a marked diversity of
opinion as to the best procedure to follow. I am beginning to think,
however, after a careful observation that opinion is divided and a
rather sharply outlined difference will be found between the ortho
pedic surgeon and the traumatic surgeon, in that there is more of a
tendency on the part of the orthopedic surgeon than the traumatic
surgeon to fuse spines—a matter of opinion based on the observation
of both parties.
There is no doubt but all of us will accept certain conditions as
calling for fusion:
1. For instance, a spondylolisthesis (which is a slipping of the fifth
lumbar) of congenital origin which has become aggravated by trauma
which after conservative methods does not clear up.
2. Occasionally, an injury sufficient to produce a fracture through
the fifth lumbar vertebra, involving the pedicles and lamina, and the
fracture causing the same symptoms as that of a spondylolisthesis
and which can only be proven by X-ray in the event good lateral
views are taken from more than one angle.
3. An old tubercular spine, which has become healed, but in which
a severe trauma has definitely lighted up the old process; in other
words, produced a definite aggravation.
One of the most important factors in the handling of all back injuries
is the immediate examination, with sufficient X-rays at hand to make
an accurate, scientific diagnosis. I do not hesitate to say that in some
instances there is the occasional physician seeing these cases who is not
111
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1933 MEETING OF I.A .I.A .B .C .
sufficiently trained to conduct that examination or interpret the
X-rays. That is not a criticism of the physician, because in many
instances the accident occurs in an out-of-the-way place where proper
facilities cannot be obtained. The responsibility then rests with the
chief or consulting surgeon, who should have full authority to act. In
such instances^ where the condition is not immediately recognized, a
chronic condition may occur which in the opinion of some surgeons
calls for fusion.
As yet I have not found one that could not be cured if properly
treated by conservative methods. I have not seen a case in my
own practice, with the exception of the three conditions above men
tioned, in which it was necessary to perform a fusion operation.
I have seen some cases where a fusion operation had been performed
in which the disability was doubled, the medical costs doubled, and
the man still disabled. The operating surgeon in that instance will
say, “ Well, if this was a private case in which litigation did not enter
the field, he would be all right in the usual time.”
If that is the case the same features enter into the picture in plain
fracture of the spine not in litigation, which is very true. For
instance, in the last year I have handled three private cases of severe
fracture of the cervical vertebra. All these wore my collar brace—
one for 4 months, one for 7 months, and one for 6 months. None of
these cases lost any time away from their occupation, and continued
on with their work after removal of the brace without any complaint.
On a check up, all three at this time admit complete cure and none of
them were fused.
I am not surprised that, after hearing such cases, there may be a
terrific amount of confusion in the mind of an arbitrator or commis
sioner as to how to decide them, particularly when, in hearings before
you, one group of doctors testify to a cure and the other group testify
to a permanent total disability for life. About the only solution, as
I can see it, is that you organize a statistical board in which the ulti
mate analysis of these cases could be made. You could then deter
mine very quickly which side was correct; in fact, jour final results
would probably amaze you, particularly in regard to how soon that
man returned to work after his case was settled. Again, it is probably
very hard for the layman to understand why I am not in favor of a
fusion operation to reduce disability except as stated above, and I
will try to explain my reason in your own language.
First, in fractures of the spine the process of bone repair, which is
the throwing out of a supporting and healing callus, performs the
same function of fusion as an open operation. It does it in the same
period of time with much less risk, cost, pain, or suffering.
Some may say, “ Well, why does the pain persist and the man com
plain that he is unable to work?” There are two possible and prob
able answers: (1) He was not given sufficient immobilization by the
surgeon, or (2) his case is not settled yet.
In occasional instances some surgeons say fusion is indicated in
back pain where there is not even any evidence of fracture; for
instance, when the pain is low down in the sacroiliac region. I have
proved conclusively that attention must first be paid to a careful
examination generally for focal infections. If present, clear them
up, and then if the condition does not repair, a simple wrenching of
the back will do wonders. This was a method taught me by Sir
DISABILITY PERIOD AFTER FRACTURE OF SPINE
113
Robert Jones, of Liverpool, England. I have used it time and again
with remarkable results and I have never had to fuse a case. Some
of my associates have accused me of practicing osteopathy, which, of
course, does not interest me. It is results for the man we are after.
Chronic rheumatic backs aggravated by trauma do not call for
fusion. Fusion will not cure them if you do not remove the focal
cause. To my mind even the suggestion of a fusion operation to a
patient only tends to exaggerate to him the extreme severity of his
condition. There are many instances in my practice where the
patient had a chronic back pain in which I made the suggestion to him
that he take an anesthetic and let me manipulate his back, resulting
in a very rapid cure without the anesthetic and manipulation.
Again, the layman hearing a case in which a fusion has been per
formed feels he must, in view of his lack of personal knowledge and
the apparent severity of such an operation, give the man a large
award as a matter of precaution and protection; so the company
interested, I might say, has gained nothing by this additional proble
matical expenditure.
In some instances cases are settled as based on the cost of the opera
tion plus temporary and total disability after the patient has refused
operation. The practice is vicious as it develops two factors—the
man gets his money and disappears, or the occasional case becomes a
neurotic and a dependent upon society.
In closing, I wish again to emphasize my position; this paper is
written and based upon the observation of a great number of cases
in which the end results have been carefully observed and checked.
Chairman G r a v e s . I am sure we have all enjoyed Dr. Forrester's
paper very much indeed and we will enjoy the next paper, entitled
“ Shortening the Period of Disability after Fracture of the Spine” ,
by Dr. Philip H. Kreuscher, medical director of the Industrial Com
mission of Illinois, and president of the Illinois State Medical Society.
Shortening the Period of Disability After Fracture
of the Spine
By P h i l i p H. K r e u s c h e r , M.D., F.A.C.S., Medical Director, Industrial Commis
sion of Illinois; Associate Professor of Surgery, Northwestern University Medical
School; Attending Surgeon, Passavant Memorial and Wesley Memorial Hospitals;
Attending Orthopedic Surgeon, Cook County Hospital, Chicago
The period of disability following fractures of the spine varies with
the following conditions:
1. Type of fractures—with or without dislocation, simple, com
minuted or compressed, fracture of the spinous process, laminae,
transverse process, single or combined with fracture of the body of
the vertebra.
2. Location of the fracture.
3. Presence or absence of nerve and spinal-cord injury.
4. The conditions under which the fracture is managed.
5. The lapse of time between fracture and beginning of treatment.
6. Age and general condition of the patient.
7. Injury to the blood supply of the vertebrae.
8. Methods of treatment.
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1933 MEETING OF I.A .I.A .B .C .
The vertebrae most commonly fractured are the fourth, fifth, and
sixth cervical, the twelfth dorsal, and the first lumbar. The injury
is usually caused in one of three ways: By direct blow fracturing
the lamina; by fall upon the head or the buttocks, compressing the
bodies of the vertebrae, or by forced flexion or extension of the spine
causing dislocation with or without fracture of the bodies of the
articular processes. More than one half of the fractures of the
cervical vertebrae ar.e fractures of the spinous processes. More than
two thirds of the fractures of the dorsolumbar vertebrae are fractures
of the bodies of those vertebrae. (Treatment of Fractures, Scudder.)
Type of fracture. —Simple fracture of the laminae, spinous or trans
verse processes, when there is no displacement of fragments, should
heal very promptly and without incapacity. Where the fracture is
comminuted and there is considerable compression of the vertebral
body, the length of time for restoration of function immediately
becomes very much increased. This is especially true when the com
pression is in the anterior as well as lateral portion of the body. In
the straightaway anterior compression, especially when treated early
with hyperextension of the spine, early healing may be expected, if,
however, you have a combination of compression and comminution
there is delay in the healing of the fracture.
Although the spinal cord is very well protected from injury, the
incidence of impingement, laceration, and even complete transverse
section of the cord is far greater than one would expect. Injuries to
the spinal cord in the cervical region cause the greatest disability.
In the lower lumbar region above the second lumbar vertebra the
lower extremity usually suffers, as well as the sphincters. Extensive
fracture and dislocation of the third, fourth, and fifth lumbar vertebrae
impinging the cauda, but with early restoration of function, are on
record.
In those cases where early treatment of spinal fracture is instituted
the disability is very greatly lessened. Delayed tre atment of com
pression fractures or comminuted fractures of the vertebrae gives us
the greatest amount of disability and the maximum period of incapac
ity. Fractured spines treated in a well-equipped hospital by a
surgeon who is accustomed to the treatment of fractures often heal
very promptly and without deformity of the laminae or vertebral
bodies. Hemorrhage into the spinal canal, incident to fracture, may
give temporary nerve inhibition, the extent and duration of this
inhibition depending upon the amount of hemorrhage into the spinal
canal and the complete immobilization of the fracture. In patients
of advanced age the increase of lime salts in the bone permits of
extensive comminution and compression which would not obtain in
younger individuals sustaining the same injury. Regeneration and
bone healing in patients of advanced age is delayed as it is in fractures
of any other bone.
The amount of injury to the blood supply of the vertebra is a
definite index of the bone healing. The nutrient artery of the verte
bral body passes into this body from behind and laterally and is very
well protected, and should not, as a rule, be injured unless there is
definite dislocation, fracture of the laminae near the body, or extensive
compression of the vertebra.
I stated in the beginning that the period of disability varied with
the methods of treatment instituted. The management of any frac
DISABILITY PERIOD AFTER FRACTURE OF SPINE
115
ture, whether in the long bone or in the spine, demands immediate
immobilization. This immobilization must be in a position which will
best restore the fragments to their normal relationship. We have
no control over the position of fragments in the fracture of the trans
verse processes, but we have definite control of the position of fracture
in the laminae, in the spinous processes and especially in the vertebral
bodies. Early immobilization has these very definite advantages:
(1) It relieves pain; (2) it prevents further displacement of the frag
ments; (3) it stops hemorrhage into the spinal canal and the surround
ing structures; (4) the earlier this immobilization is brought about the
less of “ pressure absorption” and the sooner the bones begin to
regenerate.
As in the extremity, the position of the patient’s body must be
varied in the cervical fractures to bring about the best apposition of
fragments. Not all compression fractures should be treated with
plain hyperextension by the Rogers frame, since in some of these
fractures the compression is not only in the anterior portion of the
body but may extend to the posterior portion of the body or laterally
into the body of the vertebra. The determination of these facts can
be made only by anteroposterior and lateral X-ray films and possibly
best by stereoscopic films of the vertebra. In compression of the
posterior portion of the body flexion of the spine is indicated for
reduction. In those of the lateral aspect of the body flexion to the
side opposite the compression is indicated. In those instances where
compression is entirely anterior some method of hyperextension must
be instituted at once.
Regeneration of a fractured spinal body depends not only upon
immobilization and proper coaptation of the fragments but also upon
the blood supply of that body. Where one has reason to believe that
the nutrient arteries have not been injured, the bone may be expected
to heal in the usual 6 to 8 weeks under proper conditions. If the injury
has been extensive a much longer period of time is necessary. There
can be no fast rule as to the length of time a spinal-fracture case will
be disabled. Fracture dislocation of the upper cervical vertebra
would require a very much longer time for healing, since injury to the
spinal cord is much more prevalent and serious in that portion and
since the immobilization is much more difficult. Therefore the period
of disability which might apply to fracture of the cervical vertebra
would not apply at all in the mid-dorsal, upper lumbar, or lower
lumbar areas. Prior to the last decade we taught our students that
following fractures of the vertebral body the patient’s spine must be
immobilized over a period from 10 to 12 months. The rationale for
this teaching has never been entirely explained. Since the war and
since our experience with fractures of the spine has increased, we
realize that healing takes place quite as early as it would in the shaft
of the femur or the humerus, provided, of course, that immobilization
and reduction are complete and that there has been no injury to the
spinal cord nor to the spinal nerves. This immobilization must be
maintained until such a time when a firm bony callus has formed.
If a patient with compression fracture of the lower dorsal or thoracic
region is permitted to assume the upright position and is permitted to
flex forward before the callus formation is complete, a compression
must of necessity again take place. If we have reason to assume that
8 weeks is the average time for a healing of the fracture of the body
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1933 MEETING OF I.A .I.A .B .C .
of the vertebra, then immobilization beyond that time is entirely
unnecessary. It must be remembered that in compression fractures
there is a compression of spongy bone substance, and that when that
compression is corrected there is still a loss of bony substance which
must be filled in. When once there has been complete bony healing
there is no reason why the patient should not assume the upright
position. There is no reason why lateral and anteroposterior motion
should not be instituted, since motion of this type improves circulation
and prevents the inevitable osteoporosis or atrophy of disuse which is
seen in these cases of over-immobilization.
The plaster of paris jacket has been the favorite method of treat
ment because it can be made by the average surgeon with a consider
able degree of accuracy to fit the patient’s body. Here again we
must remember that a plaster jacket which was put on with the
patient lying down is not a suitable one in which the patient might
best assume an erect position. I have made it a rule to make a new
plaster mold when the patient is able to assume an upright posi
tion. Such a cast will offer better protection against undue and
unwarranted movements.
It is the purpose of this paper, I believe, to attempt to outline the
period of disability following a fracture of the spine. I realize that in
so doing we will be contradicted by those who have in their practice
immobilized their spine cases from 10 to 16 months. On the other hand,
I doubt whether early mobilization of the spine case 6 to 8 weeks after
the fracture is the safe rule to follow. I believe that a compromise
should be reached in which the patient is permitted after 6 or 8 weeks
to get up and about, with either plaster molded jacket} or a brace, and
as he finds that this immobilization is no longer necessary, he may be
permitted to go about without any immobilization, at least for the
ordinary activities, being instructed, however, to wear his appliance
when he attempts unusual activity or such movements as may em
barrass the integrity of the union. I can think of no greater calamity
than a refracture of a lamina or a recurrence of compression of a
spinal vertebra. It is, therefore, my opinion that a reasonable length
of time should elapse from the time the X-ray shows good healmg
until the patient is permitted to go about without support. This
length of time may be 8 weeks or 8 months, depending upon the con
ditions set forth in the beginning of this paper.
How, then, can we shorten the period of disability following fracture
of the spine?
First, give an early accurate diagnosis. What type of fracture
have you? What portion of the body, what portion of the spinal
column, has been fractured or injured?
Second, by early institution of efficient treatment. We so often
become creatures of habit and because a man has a fracture of the
spine we put on a certain splint or cast without using our cortical cells
at all.
Third, in certain cases operating on and fixation of the spine,
spinous processes, or the lamina will greatly shorten the period of
disability.
Fourth, rehabilitation methods. Physical therapy methods will
aid greatly in bringing about a more efficient circulation, and we
might as well, as physicians, give these patients the benefit of that
FINAL DISPOSITION OF BACK-INJURY CASES
117
treatment. If we do not, the chiropractor will surely do it. We must
remember that every case is a case by itself, a rule to itself, and that
no two cases can be managed according to a set, given rule. There
again is where the use of good common sense comes in.
As in any other disease or condition, treatment of the patient must
not be forgotten in these fractures of the spine. If the patient’s
mind can be kept straight and he can be made to realize that his
spine will heal if he cooperates, that when it is completely healed he
will no longer have pain, and that when he no longer has pain he
can go back to work, you will have gone a great way toward making
a producer of a man who otherwise would be a burden to society.
Chairman G r a v e s . The next paper will, I am sure, be of much
interest to all of the commissioners and to all of the doctors. It is a
remarkable paper in that it covers a review of 1,000 cases of back
injury. I do not remember any other paper which has covered so
broad a scope. I know that Dr. Kuhn has spent a great deal of time
on this paper and has some very exhaustive information to give us.
Final Disposition of Back-Injury Cases, with a Summary of
1,000 Compensation Accidents
By L e r o y P h i l i p K u h n , M.D., F.A.C.S., Chief Surgeon, Lumbermen’s Mutual
Casualty Co., President Institute of Traumatic Surgery, surgical staffs Augustana
and Columbus Hospitals, Chicago
Compensation laws are “ buffers” or regulators to safeguard the
workman, the employer, and in fact everyone having to do with
their administration. It is quite evident from the results that the
administration of compensation accidents depends more for its success
upon the skill and honesty of physicians and surgeons. The preven
tion of accidents, it is now gradually being recognized, is dependent
more on mental and physical examination, treatment, and placement
of employees than upon mechanical safeguards, shop discipline, or
“ safety-first crusades.” #From the moment the accident occurs,
medical care is all decisive. Medical judgment decides the extent
of the injury and therefore the amount. The character of medical
administration determines to a large extent the period of temporary and
permanent disability and, finally, the method and time for rehabilita
tion. Regardless of these facts, there is only one State (Connecticut)
in which the law provides for a physician in any official administrative
capacity concerned with determining #the policy of compensation
administration. The evaluation of disabilities, not only of back
injuries, but of all others as well, therefore, depends upon an honest,
painstaking examination by a well-trained doctor who is more or less
familiar with compensation laws in general.
Anomalies
Around 10 percent of all back-injury cases have some form of
abnormality or anomaly. The administrator should have full knowl
edge of the normal back else he cannot differentiate abnormal or con
genital deformities. Occasionally we have 6 lumbar vertebrae instead
of 5, or the last dorsal vertebra may not have its twelfth-rib
attachment.
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1933 MEETING OF I.A .I.A .B .C .
Anomalies of the spinal column throughout the growing period of
life and at time of birth are subject to many influences of illness which
affect the growth of bone or the growth of muscular and tendon
material. The life and growth of the spinal column may be likened
to the growth of trees m a forest. Seldom do we go through a
forest and find all straight trees. Throughout the forest you will
see knotted, twisted, or deformed trees—queer-looking sights; like
wise, the human. Our spinal vertebrae are subjected during the grow
ing period, for example, to the sitting position we are allowed to
assume while in public schools. Much has to do with how parents
and teachers control the movements and growth of the child. # Mul
tiple factors may cause spinal curvature by upsetting equihbrium or
the motor system of the back, just the same as severe infections in
childhood may affect any of the vertebrae, thereby changing the
position of the spine or producing some rotary lateral curvature.
Malnutrition is very common among children, even with those under
relatively normal conditions. Often the results of underfeeding or
malnutrition affect the skeletal growth as well as the loss of muscle
weight and tonicity. This muscle degeneration attached to the spinal
column during the growing period of life brings about a muscle imbal
ance. You can readily see from the accompanying charts1how differ
ent muscles pulling on portions of the vertebrae upset the position of
the vertebral bodies so that they are pulled one way or the other,
bringing about unequal muscular action resulting in idiopathic scoliosis
which has a great deal to do with irregular posture of the individual,
thereby producing muscular pain wherever imbalance occurs.
Confusion of Opinion
Confusion of medical opinion on the witness stand is the root of all
evil for the industrial commissioner in back cases. The great list of
back strains or minor injuries are the disabilities where so much con
fusion exists in determining what percentage of permanent disability
the patient should have.
Too much stress among medical men is placed upon strains, pulls
and tears of muscles or ligaments. A doctor once said to me, “ How
can you tear or strain one of the large muscles of the thigh? Whoever
heard of a thigh muscle being pulled loose from its attachments? ”
The muscles of the back are broad, thick, and long. The muscles of
the thigh may be longer, but they are similar to the muscles of the
back, subject to just as much pull, strain, or tearing. None of these
employees come to us for strains of muscles of the thigh or chronic
disturbances such as lameness.
Unless X-rays reveal lipping, or chronic hypertrophic arthritic
changes, there is just as much exaggeration and overdiagnosing as
muscle pull or strain. Sacroiliac joints have been on 24-hour duty
in the medical profession for a long time. If all child-bearing women
had complaints for 3 to 5 months after birth of a baby, when these
sacroiliacs certainly have some strain, we would have back cases to
keep doctors busy indefinitely. But quite the contraiy, these mothers,
rich and poor, are up and about in a week or 10 days without any
sacroiliac joint pain.
* Charts prepared by Dr. Eben J. Carey in the department of anatomy, Marquette University School
of Medicine, Milwaukee, Wis.
FINAL DISPOSITION OF BACK-INJURY CASES
119
Compensation laws make no reservation for the employee who should
go back to work gradually, allowing the patient to become hardened
by slowly returning their muscles to usual duties. If there were some
provision made for the employee to return slowly, it would do more to
reduce malingering, restore confidence, and cut down the percentage
of permanent disability than many days of massage with further
medical attention.
With simple back strains there may be injury to soft tissue which
could be overlooked by a hurried examination. It is bad practice to
apply adhesive and return some of these patients to work. Usually
they work a few hours or a day, then stop. These cases should have
rest in bed, and then some support to the back. When they are di
rected to resume work, it should be light employment.
Injury to the lumbosacral joint is not so common except in spondylo
listhesis cases. I am fully of the opinion that back anomaly cases
should not be in heavy-labor employment unless an agreement is
entered into by the patient and the employer.
Operations
Many operations are attempted on these back cases by surgeons of
national reputation. Few, if any, operated upon will ever return to
employment, once they have a fusion of the vertebrae or any type of
major operation on the back. Industrial commissions have been
known to recommend some type of fusion operation, when it has been
demonstrated many times that it means a permanent total disability
and the patient taken out of employment. A medical authority has
statistics in 1,000 cases, of which only 5 were patients thought ad
visable for fusion. The operation is almost always done for the sub
jective symptom of pain. It requires 6 months or a year for the
patient to recover. Usually, by this time he is a chronic invalid,
mentally, physically, and morally.
Aggravation
The question under our workmen’s compensation laws, as to aggra
vation of a preexisting disease has been worked overtime. It is claimed
old chronic hypertrophic arthritic backs are the cases usually aggra
vated by some form of strain, slip, or lift. When the settlement days
are over these patients always return to work. If they have hyper
trophic arthritis up and down the spine they also have it elsewhere.
You never hear them complain about other joints.
The doctor cannot determine in these cases what disability is due
to strain or trauma and what is due to disease or malingering. Ar
thritis has been there many years. The trauma to his back is minor.
Why should this type of patient have 6 months’ temporary and a
“ horse-trader’s” deal of lump-sum settlement before the employer is
released? The patient may have many other strains about his body
and return to work in a few days with no thought of permanency. I
maintain the employee should have a liberal estimate in a case oi this
kind, but no permanent should be allowed, because if arthritis existed
before the accident so did the pain.
If these back cases are informed by the doctor, upon first examina
tion, that the injury is slight, they will be back to work in a day, a
week, or 10 days. Many of these patients will return to work even
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1933 MEETING OF I.A .I.A .B .C .
before the expiration of the period. Frequent examinations and
changing periods of disability only make a compensation neurosis
which finally ends with the gold cure. These are malignant diseases
from a mental standpoint. Excision of a part of the growth at one
time only forces us to return many times later. Set a period of dis
ability and hold to it. Sell the patient on the diagnosis.
In my opinion there is only one real back condition, and that is
lumbago. I mean, of course, taking into consideration fractures
that exist and other conditions that are diagnosed by the X-ray
examination. A prominent doctor, in a town of 40,000 population,
answering my question of how he managed back cases in a plant
employing 5 to 700 people, said: “ I usually give them 200 grains of
salicylates the first day, have them rest in bed 1 or 2 days—then, I
tell them to go back to work and forget their troubles.” This physi
cian does not have more than two or three back cases a year. He has
really solved the problem completely in this location.
Economics
The economic situation of all these back cases concerns largely the
employer or the insurance company. Many times claims adjusters
find it necessary to interview doctors and hospitals in reference to
their fees. Frequently these cases require a great deal of patience on
the part of physicians as well as time and attention in the physical
therapy department, until the doctor has finally convinced the man
that he can go back into employment with safety. Naturally, this
medical attention is expensive, and the doctor is of the opinion he
should submit a bill according to the financial standing of the insur
ance company rather than the man's ability to pay.
When it is explained to the doctor that insurance companies collect
premiums on workmen's wages, that it is unfair to charge on the basis
of the financial standing of the insurance company, but it should be
rather on the financial standing of the employee, most physicians will
readily arrange the bill to suit the type of case treated. There is no
question but that the excessive losses by insurance companies on
compensation claims undoubtedly can be traced to a great extent to
exorbitant doctor and hospital bills, as much as to the delay of the
workman to return to employment if he has the slightest pain in his
back. It would be too bad if through indifferenc e or lack of proper
understanding by the medical profession, eventually insurance com
panies would have to stop writing compensation insurance for em
ployees. Then all of this business would go over to State funds.
Naturally, the medical profession would suffer; the favored political
few would get all the medical fees, as is so common in administration of
State laws.
Many doctors believe they have a goose that lays golden eggs.
The goose may be killed and no more golden eggs will be forthcoming.
Quite frequently we find a reputable doctor charging more than the
occasion demands and this same physician frequently will show indif
ference when asked about his fee. A doctor in general practice might
send out $5,000 worth of bills at the end of the year, from which he
might obtain around $3,000 in return. He should realize that all bills
rendered insurance companies are usually paid in full and promptly.
>M.Tr^pwiy-i
H
dor$t
n. liiocosUbi dyrsi
Hsrtle! iranfversanui
Trans va rso -sp ira l group
fs s e m u p i n a l j j d o r j j
m mwilrfidus
M«rof*1of«x tuogf et breves
tt iito c o $t^|s<
(ucnbcrum
_M pJOAS m >jor
M .gju teus mAximus
F
igure
1 .— D o r
sal
a spec t
o f
o f
th e
t h e
Dynam
ic
M
u s c l .e - B o n e
Balance
Mo
del
H u m a n S p in e .
The spine has no direct solid support but is suspended in a field of bilaterally balanced tensions of steel
wire springs. The 12 dorsal and 5 lumbar vertebrae are composed of oak wood and between the ver
tebrae are placed disks of felt which represent the intervertebral disks. Dorsad to the center of the
vertebral bodies is a hole through which is threaded a wire spring one fourth inch in diameter. This
axial spring is attached above and below to the stand and permits mobilization of the vertebral bodies
in relation to one another. (About one fifth natural size.)
M .iiiocost*I'S dors*
M.t!'ap«ziuS
►M .u tijitm u s dorsi
tlm.inta'CQstalcs cxterni
H.roct'ui abdominis
M.psoat mjiottl. gtu4ammMtmui
F
igure
2.—Ve n t r a l As p e c
t
of th e
o f th e
H
Dyn
amic M uscle
uman Spin e.
-Bo n
e
Bala n ce M o d el
The spine has no direct solid support but is suspended in a back-pressure field which is a resultant of the
bilaterally balanced spring tensions. The black elastic band extending vertically over the midventral
aspect of the bodies of the vertebrae represents the middle longitudinal ligament. (About one fifth
natural size.)
h . sliocosfMis dorjri
M. frrdseiius ..... ,
f1:t».infercosUiay
i ___
M .U tisjim u S d o rji
M.inierfrhftns
vem nuy
ft. Rec+us
abdominis.
M.iliocosfaSts
iumbor-um —
ri.P*oas
majoi*
Mtf*n$Yett«*5pin*
group
H
dent
nmaihfiim '
i w eUforei imti
et brents
M. gtut-eus maxima*
F
igure
3.—lateral Aspec
t
o f th e
o f th e
dynam ic M uscle
um an S pin e.
H
-Bo
n e
balance
Mod
el
The spine has no direct solid support but is suspended in a back-pressure field produced b y the bilaterally
balanced tensions of steel wire springs. The ventral concavity in the thoracic and the ventral convexity
in the lumbar regions are produced b y differential tensions of the steel wire springs. The transverse
wooden bars represent the upper and lower limits of the thoracic cage and the pelvis, the pubis ventrad,
and the sacrum, ilium, and ischium dorsad. The ventral convexity of the lumbar region of the spine
is the result of the two muscular forces, (1) the bowstring effect of two powerful muscles, the sacrospinales
and their synergists, and (2) the ventral traction of the psoas majores. The ventral convexity of the
cervical vertebrae is likewise a result of the bowstring muscles of the back of the neck. The lumbar
and cervical compensatory curves are developed with the increase of power of the dorsal spinal extensor
musculature in maintaining the spine erect. The cervical convexity develops from 3 to 6 months after
birth when the head is flexed and maintained in the upright extended position when the child begins
to sit unaided. The lumbar curve develops from 9 to 12 months after birth with the ability of the growing
child to sit, stand, and walk with the spine vertically placed. (About one fifth natural size.)
F
igure
4.—Ven tr o
lateral a spe c t of th e Dynamic
Model of th e h u m an Spine.
M
u scle
-Bo
n e
Balance
The spine is stripped of all tensions of the steel springs and the mechanical resultant of the back pressure
of spring pull. When the superficial parallel bowstring muscles of the body were weakened or paralyzed,
the convexity of the spine was directed toward the weakened side (figs. 6, 8, and 10). If the right, external
intercostal muscles or the rectus abdominis muscle was weakened or paralyzed, those on the left side
acted as a bowstring and forced the convexity of the spine to the opposite or right side (figs. 6 and 10).
The convexity of the spine was directed to the left side when the left iliocostalis dorsi muscle was para
lyzed. (About one fifth natural size.)
F
igures
5
to
10.— d o r s a l a nd v e n t r a l
Bo n e Ba l a n c e M o d e l o f
a spec ts of t h e Dynam ic
the H uman Spin e.
M
uscle
-
The left lateral scoliosis is produced b y the release of the springs on the right side which represent the
trapezius muscle (fig. 5). The right lateral scoliosis in the dorsal region is produced b y the release of
the springs on the right side, which represent the right external intercostal muscles (fig. 6). The left
lateral scoliosis in the dorsal region is produced b y the release of the springs, which represent the right
trapezius muscle (fig. 7). The left lateral scoliosis in the dorsal region is produced b y the release of
the springs on the left side which represent the left iliocostalix dorsi ir.uscle (fig. 8). The right lateral
scoliosis in the dorsal region is produced b y the release of the springs on the left side which represent
the left trapezius muscle (fig. 9). The left lateral scoliosis in the dorsal region is produced by the release
of the springs on the left side which represent the left external intercostal muscles (fig. 10). (About
one twelfth natural size.)
121
FINAL DISPOSITION OF BACK-INJURY CASES
Analysis of 1,000 nonfatal back-injury cases
Indemnity paid
Item
Medical expense
Total paid
Num
ber of
Per
Per Aver
Per Aver
cases Amount cent Aver
age Amount cent
age Amount cent
age
of
of
of
total cost
total cost
total cost
LOCATION AND NATURE OF
INJURY
Vertebrae:
Fractures................... —
Bruises, contusions, and
abrasions------------------Stiffness and other loss of
function_____________
Dislocations...................
All other______________
Total......... ............ .
Sacrum and coccyx:
Sprains and strains.........
Bruises and contusions...
Fractures_____ ________
Stiffness and other loss of
function-------- --------Dislocations___________
Cuts, lacerations, and
punctures____________
All other..........................
Total......... ............... .
Muscles, ligaments, and
bones (other than verte
brae, sacrum, and coccyx):
Sprains and strains_____
Bruises, contusions, and
abrasions------------------Stiffness and other loss of
function-------------------Fractures_____ _____ —
Dislocations----------------Cuts, lacerations, and
punctures-----------------All other______________
15.5 $1,332
$18,036
20.6
$419
$75,296
16.4
2.5
457
2,633
3.0
132
11,777
2.6
589
19,753
613
3,805
5.4
.1
1.0
3,292
153
1,268
2,263
85
1,066
2.0
1.2
.:i
377
21
355
22,016
698
4,871
4.8
.2
1.1
3,669
175
1,624
76
90,575
24.5
1,208
24,083
27.5
321
114,658
25.1
1,529
177
11
7
52,850
891
19,462
14.3
.2
5.3
294
81
2,780
13,881
666
2,569
15.9
.8
2.9
78
61
367
66,731
1,557
22,031
14.6
.3
4.8
377
142
3,147
5
3
6,794
318
1.9
.1
1,359
106
1,220
212
1.4
.2
244
71
8,014
530
1.8
.1
1,603
177
1
1
9
2,029
9
2,029
41
289
.1
.5
.3
41
289
50
2,318
.6
50
2,318
205
82,353
22.3
402
18,878
21.1)
92
101,231
22.2
494
584
114,297
31.0
196
28,367
32. i)
49
142,664
31.2
372
85
17,418
4.7
205
6,209
7.:i
73
23,627
5.2
278
13
7
2
20,887
15,174
749
5.7
4.1
.2
1,607
2,168
375
3,582
2,155
109
4. :l
2.5
276
308
55
24,469
17,329
858
5.3
3.8
.2
1,882
2,476
429
4
5
4,450
7,695
1.2
2.1
1,113
1,539
115
1,342
1.5
. :i
29
268
4,565
9,037
1.0
2.0
1,141
1,807
43
$57,260
20
9,144
6
4
3
.:i
$1,751
Total___________ ____
700
180,670
49.0
258
41,879
47.9
59
222,549
48.7
318
All other:
Cord impingement-------Bruises, contusions, and
abrasions____________
Fractures______________
Sprains and strains-------Cuts, lacerations, and
punctures__________
9
6,485
1.8
1,081
610
.7
102
7,095
1.6
1,183
4
3
2
306
3,010
5,473
.1
.8
1.5
1
1,003
2,737
118
865
502
.: l
1.0
.6
30
288
251
424
3,875
5,975
.1
.8
1.3
106
1,292
2,988
1
200
200
500
.6
500
700
.2
700
Total________________
19
15,474
4.2
967
2,595
3.0
162
18,069
4.0
1,129
369,072 100.0
369
87,435 100.0
87
456,507 100.0
457
Grand total__________ 1,000
CAUSE OF ACCIDENT
Falls:
On level_________ ______
From elevation...............
97
147
42,549
85,817
11.6
23.2
439
584
7,472
19,155
8.6
21.9
77
130
50,021
104,972
11.0
23.0
516
714
Total......... ..................
244
128,366
34.8
526
26,627
30.5
109
154,993
34.0
635
Lifting and handling of ob
jects_____ _______________
Struck by falling objects____
All other----------------------------
515
29
212
118,850
9,602
112,254
32.2
2.6
30.4
231
331
530
30,082
2,039
28,687
34.4
2.3
32.8
58
70
135
148,932
11,641
140,941
32.6
2.5
30.9
289
401
665
369,072 100.0
369
87,435 100.0
87
456,507 100.0
457
Total................... ......... 1,000
122
1933 MEETING. OF I.A .I.A .B .C .
Analysis of l y000 nonfatal back-injury cases— Continued
Indemnity paid
Item
Medical expense
Total paid
Num
ber of
Per
Per Aver
Per Aver
cases Amount cent Aver
age Amount cent
age Amount cent
age
of
of
of
total cost
total cost
total cost
DURATION OF DISABILITY
Less than 1 week----------------1 week to 5 weeks. .................
6 to 10 weeks...........................
11 to 25 weeks........................
26 to 50 weeks.........- ..............
51 to 75 weeks------- ------------76 to 100 weeks....... ...............
101 to 150 weeks............... —
151 to 200 weeks.................... .
Over 200 weeks................... .
176
438
109
100
59
30
19
25
20
24
Total................ .......... 1,000
$1,051
16,851
13,202
30,567
38,297
30,183
26,961
48,571
63,155
100,234
0.3
4.5
3.6
8.3
10.3
8.2
7.3
13.2
17.1
27.2
$6
38
121
306
649
1,006
1,419
1,943
3,158
4,145
369,072 100.0
369
$2,821
11,338
6,415
11,046
11,877
6,078
5,510
10,314
9,288
12,748
3.2
13.0
7.3
12.6
13.6
7.0
6.3
11.8
10.6
14.6
$16
26
59
110
205
203
290
413
464
531
87,435 100.0
87
$3,872
28,189
19,617
41,613
50,174
36,261
32,471
58,885
72,443
112,982
0.8
6.2
4.3
9.1
11.0
7.9
7.1
12.9
15.9
24.8
$22
64
180
416
850
1,209
1,709
2,355
3,622
4,708
456,507 100.0
457
DEGREE OF PERMANENCY
0 percent................. - ........... —
1 to 5 percent-------- ------------6 to 10 percent--------- ----------11 to 15 percent-------- ----------16 to 20 percent-------- ----------21 to 25 percent........... ...........
26 to 30 percent................... .
36 to 40 percent____________
41 to 45 percent-------- ----------46 to 50 percent------ -----------51 to 55 percent------------------56 to 60 percent------ -----------61 to 65 percent......................
66 to 70 percent........... ...........
71 to 75 percent........... ...........
76 to 80 percent........... ...........
81 to 85 percent............. .........
86 to 90 percent-------- ----------91 to 95 percent-------- ----------96 to 100 percent------ -----------
801
50
32
22
16
15
12
6
5
10
3
1
8
5
2
4
5
1
1
1
Total......... ................... 1,000
60,887
16,229
24,181
21,515
17,912
20,054
25,001
16,245
10,629
18,498
9,004
3,565
33,315
20,133
8,313
17,292
26,519
5,000
8,145
6,635
16.5
4.4
6.6
5.8
4.9
5.4
6.8
4.4
2.9
5.0
2.4
1.0
9.0
5.4
2.3
4.7
7.2
1.3
2.2
1.8
76
324
756
943
112
1,337
2,083
2,708
2,126
1,850
3,001
3,565
4,164
4,027
4,157
4,323
5,304
5,000
8,145
6,635
369,072 100.0
369
32,495
5,752
5,955
5,353
2,734
4,990
3,441
3,591
1,253
4,462
1,578
222
5,993
1,530
188
3,361
1,920
425
1,292
900
41
37.2
6.6
115
186
6.8
243
6.1
3.1
171
333
5.7
3.9
287
4.1
599
1.4
251
5.1
446
1.8
526
222
.3
6.9
749
306
1.7
94
.2
3.9
840
384
2.2
.5
425
1.5 1,292
1.0
900
87,435 100.0
87
93,382
21,981
30,136
26,868
20,646
25,044
28,442
19,836
11,882
22,960
10,582
3,787
39,308
21,663
8,501
20,653
28,439
5,425
9,437
7,535
20.5
4.8
6.6
5.9
4.5
5.5
6.2
4.3
2.6
5.0
2.3
.8
8.6
4.7
1.9
4.5
6.2
1.3
2.1
1.7
117
440
942
1,221
1,290
1,670
2,370
3,306
2,376
2,296
3,527
3,787
4,914
4,333
4,251
5,163
5,688
5,425
9,437
7,535
456,507 100.0
457
Fixed Standards for Disability
It is not possible in back-injury cases to classify them, nor to apply to
them definite percentages of loss as we do with fingers, feet, or upper
and lower limbs. I like very much the plan given to this association
a year ago by Dr. C. W. Roberts, medical adviser Department of
Industrial Relations of Georgia. In his paper,2he states: “ A member
is composed of a supporting bony framework, broken by joints; of
surrounding muscular tissue, by the exercise of which power is applied;
of a system of nerves, both motor and sensory, through which the
energizing force flows; of a vascular system to supply nourishment
and remove wasteland of a protective covering, the skin. The brunt
of injury may occasionally fall heaviest upon one of the aforementioned
systems, but is rarely confined to it alone.”
As a working basis, we might proceed by attaching to each of these
systems some fraction, as: For bone and joints, 25 percent; muscles,
25 percent; nerves, 25 percent; vascular tissues, 10 percent; and skin,
15 percent—to compose perfect function. We must not attempt to
2U.S. Bureau of Labor Statistics Bui. No. 577, p. 163.
FINAL DISPOSITION OF BACK-INJURY CASES
123
arrive at the percentage of handicap b y deducting only the calculated
loss suffered in the single system .
# T o apply this system to back cases we would have to assign a frac
tion to each o f the back’s m ain functions— for instance, bones, 25
percent; m uscles, 25 percent; nerves, 25 percent; vascular tissues and
skin, 20 percent; m ental and em otional standing,, or inclination o f the
individual to work, 5 percent.
O f course, every case estim ation should be considered from the
standpoint o f the individual. T h ey are all back cases, bu t each is quite
different from the other. F or a commissioner to base an opinion on
purely scientific facts as set forth b y the doctor, w ithout giving full
appraisal to the human elem ent attached to the case, would be measur
ing the mechanical functions o f m an as a robot, which is n ot practical
and let us hope w ill never be done. I am heartily in favor o f adopting a
m ethod of estim ation o f disability on back cases such as W isconsin
has so nicely done b y com paring the percentage of loss o f use with
am putations. W isconsin has settled its problem of disability with
reference to shoulder, elbow , w rist, fingers, hip, knee, ankle, and
shortening of leg as follow s:
Percentage o f loss o f use as compared with amputations at involved joints
Percent
Shoulder: Limitation of action, elevation in all directions to 90°, but other
wise normal___________________________________________________________
20
Elbow:
Ankylosis of elbow joint at 45° less than full extension (radioulnar motion
destroyed, hand 45° less than fully pronated)--------------------------------- 60
Limitation of motion of elbow joint (radioulnar motion unaffected):
Remaining range, 90-135°----------------- ----------------------- ---------------- 20
Remaining range, 135-180°---------- --------------------------------------------- 35
Ankylosis of radius and ulna estimated at elbow joint (hand 45° less
than fully pronated)_______________________________________________ 20
Wrist: Ankylosis, straight position-------------- --------------------------------------------- 25
Fingers: Complete ankylosis—
Midposition:
Thumb:
Distal joint only---- -------- ----------------------------------------------------- 25
Proximal joint only_________________________________________ 15
Distal and proximal joints__________________________________
45
Distal, proximal, and carpometacarpal joints....................... ........ 85
Fingers:
Distal joint only____________________________________________ 25
Middle joint only___________________________________________ 75
Proximal joint only_________________________________________ 40
Distal and middle joints_______________________ ______ ______
85
Distal, middle, and proximal joints...............................................100
Complete extension and abduction:
Thumb:
Distal joint only___________________________________________
35
Proximal joint only_________________________________________ 20
Distal and proximal joints---------------------------------------------------- 65
Distal, proximal, and carpometacarpal___________ ______ ____ 100
Fingers:
Distal joint only____________________________________________ 35
Middle joint only___________________________________________ 85
Proximal joint only_________________________________________
50
Distal and middle joints____________________________________ 100
Distal, middle, and proximal joints.............. .............................100
25616°—34----- 9
124
1933 MEETING OF I.A .I.A .B .C .
Percentage of loss of use as compared with amputations at involved joints— Con.
Percent
Hip: Ankylosis in alinement for normal standing position________________
Knee:
Ankylosis at 170°_________________________________________________
Limitation of motion: Remaining range 135-180°___________________
Ankle: Ankylosis at right angle________________________________________
Shortening of leg (no posterior or lateral angulation, age 50 or less):
1 inch___________________________________________________________
1*4 inches________________________________________________________
2 inches__________________________________________________________
50
40
20
30
7
14
22
Mayos ’ report of 1,100 patients over 50 years of age revealed 58
percent suffering from some form of rather silent hypertrophic ar
thritis of the spine. Granting that none of us are more than 85 percent
normal, I do not think industry should be called upon to carry the 15
percent sickness load of the individual.
Summary
(1) Careful consideration of the human element.
(2) Interpretation of medical findings, i.e., X-ray and arthritic
changes, by expert roentgenologist.
(3) No back or head case should ever be decided by a commissioner
or a board of arbitration without an impartial experienced traumatic
surgeon sitting in the conference.
(4) All back cases should be returned to employment slowly, i.e.,
light work for a few days or a week; not to be given heavy lifting work
immediately, as this will discourage the employee.
(5) When fusion operations are done and the surgeon maintains a
cure has occurred, the settlement contract should not carry a percent
age of permanent disability.
(6) The time has come in compensation cases when honest doctors
should have something to say about the final rating that these back
cases should have.
(7) Weak-back individuals should never be placed by employers
in work where they will be required to carry on the duties of a “ truck
horse” , when they are by birth, education, and physical development
fitted for the duties of a “ track team.” Their muscles and ligaments
cannot stand the strain of heavy lifting without years of physical
development for this kind of employment.
DISCUSSION
Mr. S t e w a r t (Washington, D.C.). Do you mean to say there was
but one permanent total disability case?
Dr. K u h n . N o . Y o u notice that is based only on nonfatal back
injury cases.
Mr. S t e w a r t . Even so, from 96 to 100 percent you have only one
case. That means that there was only one permanent total disability
case.
Dr. K u h n . There have been a number of death cases, which, o f
course, would be permanent.
Mr. S t e w a r t . I m ean exclusive of death,
BACK INJURIES— DISCUSSION
125
Dr. K u h n . Only one. You will notice that the one disability
amounted to only $6,635, while eight cases from 61 to 65 percent
permanent total disability cost $33,315.
Mr. S t e w a r t . I am thinking of the number,
Dr. K u h n . That is according to our list.
Mr. S t e w a r t . You say less than 1 week. A great many States do
not pay anything for that time; there would be no compensation for
an injury lasting less than 1 week, so except in a very few States that
would not include any indemnities paid.
Dr. K u h n . There was a cost attached. There would be medical
and sometimes hospital expense, and X-ray, which brought this figure
on the 176 cases.
Mr. P a r k s (Massachusetts). That must be all medical, then.
Dr. K u h n . I should think so.
Mr. S t e w a r t . That does not say 1 day. It says it is less than 1
week. There are a number of States that pay after the third day.
M e m b e r . The amount paid was $1,051.
Dr. K u h n . That was $1,051 on 176 cases, which averaged $22 for
each case.
M
em ber.
I s th a t com pensation?
Dr. K u h n . The gentleman just stated that many States do not
have any compensation payments for less than 1 week, so it must be
all medical.
Mr. S t e w a r t . Your own figures show it is mostly medical.
Mr. P a r k s . These figures are for Illinois alone?
Dr. K u h n . N o , these figures were taken from Maine to California.
About half of them were from the Central States, the other half from
the New England States, and a large number from California and the
Southeastern States.
Mr. P a r k s . Dr. Kuhn said that he wished all the States had a
system like the one in Wisconsin, which puts everything on a percent
age basis. We do not have that in Massachusetts. I do not know
whether the Wisconsin system is better than ours. For instance, anky
losis of the shoulder is given a certain percentage of disability. When
the doctor says the injured man has that percentage, he is unable
to move his shoulder due to ankylosis, and he is given so much money
for that. I am wondering if that does not put a premium on the man 7s
trying to establish that he has that percentage of disability due to
ankylosis. In Massachusetts we have no schedule system except for
specific injuries. It is all based on disability—a man’s ability to work.
That is the principle on which our workmen’s compensation was
founded. It took the place of the damages system of the employer's
liability law and the common law.
The compensation law was based on whether the injury prevented
the man from working, and was to pay for his inability to work, not
the injury per se. For instance, an employee who worked on one of the
big newspapers a good many years ago lost a hand. Strange as it may
seem, the loss of the hand did not constitute disability for his job,
for not many weeks after the healing of the stump he was ready to
go back to work in the composing room and did, and he is doing that
126
1933 MEETING OF I.A .I.A .B .C .
work today. When he got all his compensation he went back to work.
We did not say to him when he lost that hand, “ We will give you
$4,000 or $5,000.” That is paying damages for his hand, which is
getting away from the first principles of the act. Compensation was
intended to bridge him over his period of disability, not to give him a
lot of money.
This Wisconsin schedule is getting back to that. At a hearing to
decide on how much restriction a man has, you decide on the medical
evidence you receive today. In the trial of a case we often have an
attorney say to the employee, “ Show the commissioner how well you
can walk.” Of course, tne man does not show the commissioner
how well he can walk; he shows the commissioner how poorly he can
walk. The attorney says, “ Take a look at him. He is demonstrat
ing how he can walk.” Many times, when we meet the man on the
street the next day, he can demonstrate a different kind of walk.
If at a hearing, with the assistance of physicians, he demonstrates
to the satisfaction of the commissioner that he has a 60 percent re
striction in his shoulders, he is handed the money on the assumption
that he has a permanent 60 percent of whatever it is in his shoulder.
He gets the money and he puts it away somewhere or blows it in.
Two or three weeks later you may find no restriction or very little.
Even if he shows that he really is not 100 percent cured, that he has
a restriction, he may have a job in a factory or workshop where it
does not constitute a disability. You are giving him money on the
basis of damages. I wonder whether our system is better than that.
I should like to have some opinion on that.
Mr. A n g s t e n (Illinois). I too am curious about the Wisconsin
tables. I should like to see the experience of Wisconsin with that
system. We are wondering if a lot of men who have gone back to
work with a slight ankylosis of some kind do not come back and put
in their claim for so much disability. I am likewise interested in the
final statement of Dr. Kuhn’s. He said he hoped the day would
come when the honest doctors would be given an opportunity to be
heard on back cases. I too hope that day is not far distant. So far
as the Illinois commission is concerned, the honest doctors on either
side will be the ones who will command the attention of the commis
sion, if I have anything to say about it.
My friend Joe Parks says he does not pay any attention to the walk
of the individual when he comes in to show how he can function. I
have in mind a certain case that I did look at. The insurance ad
juster and the family doctor and the jurymen had agreed on a settle
ment—I think it was about $800 for the percentage of loss of use of
the arm. They asked for verification and approval by the court or
by the board. A lot of questions were asked and something told me
intuitively that there was something wrong about the case. The
family doctor said, “ Commissioner, I have had the case for 2 or 3
months. Subjectively I cannot find anything wrong with that man’s
shoulder. Objectively, he complains of inability to raise it over a
certain point.”
I said to the man, an Italian, “ Tony, are you a married man?”
“ Oh, yes, I am married.”
“ Any children?”
“ I have six or seven.”
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127
I got the name of the youngest child. We went along, talking
about the children. Suddenly I came back and said to Tony, “ What
is the matter with your arin?”
“ Oh, Judge, my arm is sick.”
“ What is the matter with it?”
“ I can’t get ’im up.”
“ How far can you get that arm up?”
“ Oh, like this.”
He got his arm up to the point where the doctor said it was as far
as he could go with it.
Then I said, “ Tony, how far could you raise that hand before you
hurt it?”
“ Oh, hell, just like that.”
He shot the arm straight up like this [indicating]. That is one
case where it paid to go through those motions. I want to say that
I look at them once in a while.
Mr. H ig g in (Saskatchewan). I want to ask Dr. Kuhn a question.
He made a comment after he was through the pictures that attracted
my attention. If I gathered what he said correctly, it was that the
commissioners*of compensation boards should not attempt to adjudi
cate on the cause of permanent disability in such cases without medi
cal advice. I should like to ask the doctor this question: Assume that
you have 12 experts in a particular case where their advice is sought.
Six experts say “ This is the result of what has happened” , and six
say that it is not. The doctor said that the commissioner should
not attempt to set that permanent disability without medical ad
vice. All right. When the medical fraternity is split wide open, I
say that the commissioner must set the permanent disability on that
case. I should like to ask the doctor what he would do where 12
experts were split evenly on the amount of permanent disability.
If it should not be set by the commissioner when the medical profession
is split wide open, who is going to set it?
President W e n z e l . I do not happen to be a doctor. I am a
lawyer, as most of you know. It seems to me that the question has
been answered by the gentleman who asked it. It is just the medical
advice and those differing opinions that enable the commissioner to
formulate an opinion. You weigh the evidence presented by the
expert. I have been a commissioner for 10 years but I am not an
expert in the direct sense. I am an expert in a lay sense, yes, but
I look to the physician for expert opinion concerning the percentage
of disability.
I believe the method adopted by Wisconsin is the best method
that can be adopted. I differ from my friend Joe Parks in that
regard. I will give you a specific illustration. An engineer met
with an accident at a time when he was drawing $225 per month
salary. He had an accident to his arm which disabled that arm,
according to the best expert medical testimony we could obtain, 30
percent. There was a permanent disability to that arm—a loss of
use—of 30 percent, anatomically or whatever it may be. After the
injury and within a period of 3 months of completion of the healing
period, that man got a job in Sioux City at $275 per month, but we
entered an award for a 30 percent loss of the use of that arm. He
was entitled to it under any compensation law in the land. No one
can say whether or not with a 100 percent arm he might not have been
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1933 MEETING OF I.A .I.A .B .C .
drawing $350 or $400 a month. He suffered that loss of use, and the
compensation law says, “ When you suffer loss of use which is of a
permanent nature, we, under this law, will attempt, in part at least,
to compensate you for that loss of use.”
Nobody could pay me or you for the loss of two eyes—no com
pensation law ever enacted could—but there is an attempt, at least,
to do that very thing. In order to arrive at a proper percentage you
must have expert medical testimony, and if they differ, you do just as
a jury does. You weigh the value of each bit of evidence that comes
to you. You recognize the experience and the ranking of the man
who gives the testimony as to the percentage of disability. You
weigh one against the other, and from that evidence you arrive at a
conclusion. I think it is the only way to handle permanent disability
cases.
Mr. H i g g i n . I still maintain that the question I asked has not been
answered. I am quite capable as a commissioner of making my own
decisions. They are not always right nor are they always wrong. I
simply asked the question of the doctor because of his statement.
Canada is operating under entirely different workmen's compensation
laws from those of the United States. I refuse to be ashamed of the
act because a commissioner of workmen's compensation does not do
his duty in his position. There is a duty to perform and the com
missioner knows it. After he has made a decision he should stand by
it regardless of who says yes or no. That is the way I make mine.
The doctor having made the point that no commissioner should
settle disability questions, particularly permanent disability cases,
unless he has medical advice, I still ask the question. I ask the
doctor, when the best he can get in medical evidence is split wide open
on the disability, who is to decide. He said you should never decide
the matter of permanent disability unless you have medical advice.
If he cannot get that, who is going to do it?
Dr. K u h n . I shall be delighted to attempt to answer the gentle
man's question. I think it is a fair one for a meeting of this find to
decide. Later on this afternoon I hope some resolution will be
introduced pertaining to the very question he has asked. The State
of Connecticut, I believe, answers his question 100 percent. If a
commissioner has heard 6 doctors testifying on one side and 6 doctors
testifying on the other side (and I conclude he has a different opinion
from all of them), medical assistance on the caso at the time that
testimony was introduced would clarify the whole thing. I do feel
that the time has come when this whole question of deciding on
matters of permanent disability is one that is up to the medical
profession, and unless we get into these commissions competent
medical men we are going to have commissioners in the same position
the gentleman from Canada is in at the present time.
Mr. H i g g i n . I want to say I am in no peculiar position. I think
I know my duty. I can listen to lawyers and doctors, but I still have
a duty to perform. If I do not do that, then the quicker the work
men's compensation laws are wiped off the map the better for all
concerned.
Mr. G r e g o r y (Ohio). There has been some comment attacking
the medical profession. There has been some comment from our
very distinguished associates here in reference to the commissioners
BACK INJURIES— DISCUSSION
129
and their duties, their lacking that intestinal fortitude which was
spoken of in respect to medical questions. In Ohio we have a multi
tude of good doctors; we have a few quacks, like every other place. In
Ohio and I suppose every other State, we have to rely largely upon
doctors for advice and guidance in compensation matters. I have
been admitted to the bar, and I know many of the weaknesses of the
legal profession, but I never realized so much that the medical pro
fession had such a tremendous advantage over the legal profession.
I find in many instances that doctors, when they are mystified, simply
go off into the realm of possibility and probability, which leaves the
commissioner in the bewildered state that my friend over here
referred to.
Realizing the weakness of humanity, it is difficult to appraise all
the physical infirmities. It is more or less a guessing contest, at best,
after we have assembled all the best medical opinions and advice that
we can receive. It is only on occasions like this that I think com
missioners can get an opportunity to acquire knowledge as to how to
appraise medical opinion.
In Ohio we maintain a medical staff to advise us. After we have
obtained the best medical opinion available, we endeavor to have our
medical staff sift the various opinions and give us their advice before
we finally determine the matter.
The question has been raised in reference to the policy of Wisconsin.
While it might not be approved altogether, I feel that it has some vir
tue, in that compensation cases could be appraised early and the
extent of actual disability determined and the matter adjudicated. I
feel that in many cases it would have a great tendency to dissipate the
compensation mind that arises in many cases. The past 3 or 4 years
have brought about some realities that we did not recognize thereto
fore. We are recognizing the fact that most of us are becoming what
we might term claim-wise. We are making claims for everything.
We make claims for money, which is one of the prime objectives, of
course. We make claims for medical attention. We make claims
for charity. We are all more or less getting into that state of mind.
I feel that workmen’s compensation has to be administered in the
future so as to minimize that state of mind among injured workmen.
It is only through conferences like this that we get inspiration and
guidance. It is impossible for the various States and Provinces to
discuss the matter as a broad proposition, because they are gov
erned in each mstance by a different set of laws. I know that under
our law in Ohio we cannot work as you work in other States. You
possibly are extremely liberal in most instances. I noticed that when
Dr. Kuhn gave the cost in 1,000 cases, the average cost, as compared
to the average cost in many cases of similar character which we have,
was quite low.
The medical question is one not to be dealt with harshly. In
Ohio we have to rely so tremendously upon the physician that we
naturally have to separate the good from the bad. Every physician
is entitled to compensation for services justly rendered. Many times
I feel that if we could pay for results rather than for treatment, from
an economic standpoint and for the good of the patient, we might
make greater progress. The quarrel between the profession and the
board is primarily on the amount that should be paid for^treatment.
You rarely hear any question about what the results are. However,
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1933 MEETING OF I.A .I.A .B .C ,
I realize that it is impossible to measure legal service and especially
medical service on that basis.
In regard to doctors, I am going to relate a case which happened.
Mr. Carlin, a lawyer in Ohio, happened to appear before the commis
sion on one occasion in a death case. It looked like a rather in
volved matter, one which might take very extended investigation
and inquiry. It happened to go through much more rapidly than
anticipated. After the award was made he went to an uncle or
some other relative of the minor children in behalf of the widow and
children, and said, “ I will give half of my fee and have it set aside
in a bank or trust fund, so that it may be preserved as a contribu
tion toward the education of the minors.” I offer that only to show
that a professional man who recognizes the ethics of his profession
sizes up the particular case and is not concerned in the award alone.
I am satisfied that the medical profession largely has that spirit,
and if we can cooperate to bridle and harness those who become
obstreperous we can make progress.
Mr. W r a b e t z (Wisconsin). I suppose that the schedule which we
have adopted in Wisconsin for compensating relative injuries would
not apply in States where compensation is paid purely on the basis
of wages lost. We take the law as it is, however, and because com
pensation for certain things is paid on the basis of a schedule, we are
bound by the law. In cases other than amputations compensation
will be paid on the basis of relative degree. I am principally re
sponsible for the schedule which was finally adopted. That was
based on 7 years’ experience as an examiner, when I found myself in
the same position as the gentleman from Canada. When we had a
case of injury to an arm or hand, which was in the schedule, we would
find doctors who testified that it was all the way from 10 to 90 percent
disability on exactly the same sort of conditions. That, of course,
could not be. A fact is a fact, no matter where you find it. There
fore we thought that, as a matter of efficient administration of the
compensation law and also, Dr. Kuhn, as a matter of education to the
doctors, we would adopt the schedule for guidance in cases of that
kind. Therefore in a dozen places in the State we gathered the doctors
who had experience in industrial work, and after numerous public
hearings adopted this schedule.
It has practically eliminated from the field of argument all questions
of disability with respect to the injuries included in the schedule.
We very seldom have them. As to just how much motion a man has
left to fit into the schedule, that after all is a matter of proof. You
have a man walk in front of you and you believe him or disbelieve
him, as you please. It is only after long experience, as Mr. Parks
well understands, that you can determine whether or not the man is
faking. You have to arrive at the facts—as to whether or not he
does have an ankylosis or certain motions, or just what ails him.
In answer to the gentleman from Canada, I might say that when
such a case arises in Wisconsin this is the way we handle it. If it
is a case we are not particularly familiar with or if the medical state
ments are not clear, we appoint somebody else as an adviser. We
follow his advice absolutely, and we know on which side to join in
the argument.
On the matter of what you might call shyster doctors who come in
to testify, that again is a matter of belief. You can believe them or
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131
not. If after a few cases lawyers (and they are partly responsible
for it too) find that certain doctors are not believed, or that their
testimony does not bear much weight, those doctors are usually and
gradually but finally eliminated from the picture.
Mr. H a l f o r d (Ontario). Speaking of disability, and how you are
to judge the ankylosis, whether it is a low or high degree of motion
that the patient has left, that is a very difficult question to decide
sometimes. To take an instance, a doctor will, as our friend from
Wisconsin says, give all the way from 10 percent up to 90 percent.
You do not know whether he is right or wrong, but you have to
decide the question. From the accident, you would thmk, perhaps,
that there should be no disability at all, and wonder why that amount
of disability should exist. We have had all these problems and they
are very difficult to handle.
We decided that we would put in a therapeutic clinic and give
these cases physiotherapy. We have all the machines for testing these
fellows. We have a clinic under the supervision of a very eminent
physician who is educated in that line of work. We bring these
fellows in to him. A man may come in like this [indicating] and we
send him out like that [indicating] sometimes. Sometimes he can get
his arm up half way and sometimes all the way. We bring men
in with stiff ankles, absolutely ankylosed. With the machines we
have, we give them a great many degrees of movement of the ankle.
We have electrical attachments that we put on their feet, and on their
knees, and on their arms, and so on. We have finger-movement
machines, and machines for the wrist and back. We bring these
cases to the clinic from the outside districts, and give them that treat
ment as long as it is necessary. That has been of great assistance to
us. We use electrical treatment and the whirlpool bath, the walking
machine, the rowing machine, and the bicycle. We give them treat
ment as long as we are getting any movements from them. We test
them out pretty well to find out whether or not they are malingerers.
M r. Parks. D
o
y o u do th a t you rself?
Mr. H a l f o r d (Ontario). When I say “ we” I mean the board. I
do not mean the doctors outside.
Mr. P a r k s . The commissioners do it? You do not mean the com
missioners, do you?
Mr. H a l f o r d . The board does it. I told you that we have carried
this treatment out under the supervision of a very eminent physician,
skilled in that line of work. The same man does not do it all; he has
his assistants down there. The cost of the machines was not very
much, perhaps a matter of $4,000 or $5,000. Since last May we have
treated some 3,000 or 4,000 cases. We have had splendid results
from that treatment. In one case we had in three of the most eminent
physicians in Toronto. They wanted to operate on this fellow's back.
He had all the symptoms calling for an operation. I do not remember
whether it was spondylolisthesis or something else, but they wanted to
procure fixation with a bone graft. Our chief medical adviser said,
“ I don't think we should operate on that fellow.” That fellow came
in all stooped over. We gave him 25 treatments of physiotherapy
and he went home cured. That is an actual fact. I do not say we
cure them all that easily, but we do a good deal of such treatment,
and we lessen the disabilities.
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1933 MEETING OF I.A .I.A .B .C .
So far as arm movements are concerned, the men come in this way
[demonstrating]. We treat them a little while and they can get the
arms up to here [demonstrating]. In a few more days they can
straighten them out a little better. We get them out as far as they
can go. We have finger movements which we give in some cases.
We also have wrist movements. In that way we get wonderful results.
There may be lack of pronation or supination. When we give a
certain amount of treatment it lessens the disability and it also lessens
the payment of compensation.
Mr. A n g s t e n . Is that done only on disability cases or on all cases?
Mr. H a l f o r d . In all cases where we think it should be done.
Mr. A n g s t e n . H o w do you acquire jurisdiction for those treat
ments? Where do you get the people?
Mr. H a l f o r d . We have them come to us.
Mr. A n g s t e n . If a man is hurt he is sent to the clinic?
Mr. H a l f o r d . We bring him in if there is any doubt about the
cause at all. We have a little contrivance there—an electrical ma
chine. The fellow lies on his back. If he has knee trouble, we put it
on his foot and gradually bring back the movement. We increase
the movement as desired. It is remarkable what it does to the fellow.
Fellows come in there who can hardly walk, and we send them out
with their disabilities wonderfully lessened. We have a little walking
machine. Some of these fellows cannot walk. We put them in that
and it helps to give them balance. We can tell whether they are
able to walk a straight line.
It would be a good thing if you could get some of those things in
stalled over here. That is a privilege our boards have. I am quite
satisfied that then you would not have as many difficulties as you
have now. We do not require any lawyers to handle our business.
We have no such troubles. If the case is not properly adjusted in the
first place—if we make a mistake—we open it up again. If the fellow
is entitled to anything more we give it to him. On the other hand, if
we have given mm a pension for life and we find he is not entitled to
it, we refuse to go further. I just wanted to tell you about what we
have, to give you a little encouragement to work for legislation along
that line.
Mr. S t e w a r t . Mr. Wrabetz of Wisconsin says a fact is a fact in
workmen’s compensation, but it is nothing of the kind. You are
dealing with human beings. We have had numbers of instances
where a carpenter—just an ordinary carpenter apparently—had lost
an arm, and when it was healed he went into the contracting business
and became a rich man. He never would have been anything but a
carpenter if he had not lost his arm.
Doesn’t it always depend upon what man you are talking about as
to whether or not a fact is a fact? That is to say, as between the
great masses of workmen a fact is not always a truth. I have had
some little experience with that myself. I became a totally disabled
stammerer at the age of 7 years. I never spoke a word for 5 years;
I carried a slate around my neck to write down even what I wanted to
eat in my own home. I went to school, but I was not permitted to
recite, so I had to sit in my seat and listen to the others recite and
to what was said by them. I kept my mouth shut and learned more
BACK INJURIES— DISCUSSION
133
than all the others put together. Then, after learning to read, I
read about Demosthenes going down to the brook and breaking
himself of stammering. I said to myself, “ I can do anything that
any Greek ever did.” I started to carry paving stones under my
tongue and I made a gravel train of myself. I read that story again,
and I discovered that Demosthenes would put the stone squarely in
his mouth and then go down to the seaside and speak so he could
hear himself above the sound of the waves. I used to take a book
and read it one word at a time. I read it just as loud as I could yell.
After 4 or 5 years of that I found that my muscles down here came
across fairly well when I told them to say this or that or the other.
They were not all right but they were much improved. From what
seemed to be a permanent total disability I had a Wisconsin 25 percent.
Some men are improved by accident. The same accident that is a
permanent total disability to one carpenter makes another carpenter
a contractor, and he builds the Chicago Post Office. You have to
take the mentality into consideration. Here I want to come back
at your malingerers, Doctor. One of the doctors here this afternoon
quoted Dr. C. W. Roberts, of Georgia, but he didn’t quote him quite
far enough. Dr. Roberts said that certain injuries, certain types
of injuries, with certain types of minds, destroy the will power, and
such a man is not a malingerer in the common sense of the term;
that is, he is not willfully and deliberately refusing to work for the
purpose of getting compensation. That is what is ordinarily under
stood by malingering. If a man gets his leg cut off you put a wooden
stick under the stump and he is able to walk around. If a man gets
a back injury or a head injury, that breaks down his will power, and
is just as much a part of the accident as the fractured vertebra.
Instead of putting mental and moral props under him, you cuss him
as a malingerer and make him one.
You invented the lump-sum settlement as a premium on malinger
ing, as a bait to hang out before that man, and then you wonder
that, with his weakened will power, he does not go to work. It is not
the poor devil whose mind has been broken with his back or with
his blow on the head who is to blame for his inability to get hold oi
himself and take advantage of the opportunity he might otherwise
have to get well. It is not that poor devil’s fault. It is the fault,
first, of your lump-sum settlement, of the bait you put in your trap,
and secondly, of the unsympathetic attitude you take. You do not
see that a, back injury or a head injury hurts more than the bone.
You cannot see with the X-ray what a breakdown there has been in
that man’s moral control of himself, or in his will to do and his will
to want to do. Until you recognize that ninety-nine hundredths at
least of your so-called malingering is the fault of your lump-sum
settlement and of your idea that a back is a back, a fact is a fact, and
you can see into a man’s soul with an X-ray, you have a long way
to go.
Mr. P a r k s . I know that Mr. Stewart means what he says and
that there is a good deal in what he says. There are two things that
happen to a man when he is hurt. The man may be a big longshore
man who knows nothing but the strength of his big right arm, and
what he can do with it. That arm is crushed off his body. He not
only receives that physical injury but something snaps inside. When
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1933 MEETING OF I.A .I.A .B .C .
that wound is healed, we have to bring his morale back. Mr.
Stewart is right. That man’s will power is hurt. We have to separate
him from the deliberate faker. There are very few deliberate fakers.
When we talk about malingerers I mean that kind; I mean the kind
of man who comes in or is assisted in. He takes his crutches and
puts them in the comer and commences to talk. Then he walks out
without them. That is the type of fellow I mean. I have had one
or two like that.
Mr. S t e w a r t . In 21 years you have had one or two?
Mr. P a r k s . We have had two or three; they are the exceptions.
The average workman, I firmly believe, is honest. We have to treat
him just as he is. In talking about this, there is no difference of
opinion between Massachusetts and Wisconsin and New York and
Nova Scotia. Because of their different acts and the different ways
in which they are administered we all learn something. How much
did we learn from the gentleman from Wisconsin? He told us how
those schedules were arrived at; it is a different system from ours. It
would not fit in with our present act. We know that Ontario also
has a different system from ours. The employers pay into the depart
ment, and the commissioners have their fingers on everything in that
department. Of course, in Massachusetts, we could not do what
they do. I want to. say in passing, to my friends the doctors, look
out. Be careful that under the compensation act, in insurance States
particularly, you do not have a system of State funds. What do
they have in Ontario? A few hand-picked doctors and a beautiful
clinic, which is taking all of the business out of your hands. You
would not be troubled any more about presenting bills to insurance
companies. The work would be done nevertheless and done in the
scientific way they have of doing it in Ontario, to their credit. I am
not criticizing it; I think it is all right.
[A motion thanking the chairman for the arrangement of the day’s
program and the doctors who prepared the papers was made, seconded,
and unanimously carried.]
[Meeting adjourned.]
THURSDAY, SEPTEMBER 14— MORNING SESSION
Chairman, R. E. Wenzel, president I.AJ.A.B.C.
# President W e n ze l . We will now open the final session of the asso
ciation. There is only one report which was on the program of the
Monday session that has not been presented and that is the report of
the medical committee.
[Secretary Baldwin reported that Dr. Graves had spoken to him
about the report and stated that whatever report might be made in
that connection was covered in the prepared papers that were read,
and he felt that no separate report was needed.]
[The report of the auditing committee was presented and after
some discussion was referred back to the committee for suggested
amendment.]
[The report of the nominating committee was presented. The list
of officers will be found on p. 204. Boston, Mass., and September
10-14, 1934, were recommended as the place and time of the next
annual meeting. The report of the committee was adopted.]
President W e n ze l . The next report is that of the resolutions com
mittee. Is the committee ready to report at this time?
REPORT OF RESOLUTIONS COMMITTEE
Resolved, That the Bulletin of the United States Bureau of Labor Statistics
577, is hereby approved as the record of the nineteenth annual convention of
the association held at Columbus, Ohio, September 26 to 29, 1932.
The resolutions committee recommends that the presidents report be accepted
and spread upon the minutes as read.
Whereas Divine Providence has called from our midst Floyd L. Daggett,
president of this association from 1915 to 1916, and F. A. Duxbury, president from
1922 to 1923; be it
Resolved, That the International Association of Industrial Accident Boards
and Commissions record with much sorrow the closing of these two books of life
at a time when their experience, clear perception, ability to act with force and
precision was of such utmost value to their associates; be it
Resolved, That the service rendered during the formative period, the guidance
and wise counsel during the 20 years of our existence has enriched this association
and it is better because they lived; be it further
Resolved, That the assembly pause in silent tribute to the memory of these
distinguished gentlemen; be it further
Resolved, That a copy of these resolutions be sent to the respective families
and States represented.
The committee recommends that the special items in the report of the secre
tary, which was referred to the committee on resolutions, be approved as follows:
1. The resumption of the payment of annual dues, both of active and associate
members, such dues to be the amount which was in effect prior to the order of
suspension of same.
2. The sale of Liberty bonds (4.25 percent) of the value of $700, which was
sold upon the authority of the president to defray current expenses of the asso
ciation during the year.
135
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1933 MEETING OF I.A .I.A .B .C .
3.
The association agrees to the proposed revisions to the abrasive wheel
code permitting an increased speed for coping wheels from 6,000 surface-feet
per minute to 9,000 surface-feet per minute for cutting brick and stone.
The committee also recommends that the matter of disposal of a certificate
of $1,500 of the Paterson Mortgage & Title Guaranty Co. of New Jersey, which
becomes due and payable on October 19, 1933, be referred to the incoming
executive committee for any action which it may deem advisable.
For several years schedules have been collected by the association through
the United States Bureau of Labor Statistics to ascertain the remarriage status
of widows in the United States, for the purpose of compiling an American re
marriage table to replace the Dutch remarriage table now used in this country.
The committee recommends that the association request the United States
Bureau of Labor Statistics to compile the schedules received for an American
remarriage table.
The resolutions committee recommends that the members of the association
do everything in their power to adopt the uniform forms for use in their re
spective jurisdictions.
Resolved, That the president be authorized to appoint a committee of three to
study the situation in the various States and Provinces regarding the deter
mination of average weekly wage, with instructions to have material available
as early as possible for the use of those States having legislative sessions during
the coming year and to report to the next annual meeting, and that such com
mittee be authorized to expend not to exceed $100 in such study.
Resolved, That we express our appreciation for the many privileges and cour
tesies extended to and enjoyed by this association, the members thereof and
the families of the members thereof, at the twentieth annual meeting of the
International Association of Industrial Accident Boards and Commissions, held
at Chicago, 111., September 11-14, 1933.
Resolved further, That the thanks of the association be extended to Charles
A. Nowak, former chairman of the Industrial Commission of Illinois, for his
cooperative participation in the meetings, and to Peter J. Angsten, chairman
of the Industrial Commission of Illinois, and to the many other citizens of said
city and State who have had part in providing for our welfare, instruction, and
entertainment, and especially to the following members of the medical profes
sion who contributed outstanding papers to the literature of this association:
R. G. Leland, M.D., N. S. Davis, III, M.D., John D. Ellis, M.D., Paul B.
Magnuson, M.D., Hollis E. Potter, M.D., C. R. G. Forrester, M.D., Philip
H. Kreuscher, M.D., Leroy P. Kuhn, M.D., and to Samuel S. Graves, M.D.,
formerly medical director Industrial Commission of Illinois, for so ably guiding
the discussion of the medical questions.
Be it further resolved, That the convention places on record its approval of
the wise procedure adopted at the Wednesday meeting of dealing with one
important specific subject exclusively.
Resolved, That this association wishes for Chicago a more glorious future and
believes its contribution to the world in presenting the Century of Progress at
this time is immeasurable.
Unanimously adopted and signed by each member of the committee.
S t e p h e n B . S w e e n e y , Chairman.
G. C l a y B a k e r .
P. V. E. J o n e s .
C . F. S h a r k e y .
Mrs. E. S. T o u s a n t .
REVIEW OF COMPENSATION LEGISLATION IN 1933
137
[It was moved and seconded that the report of the resolutions com
mittee, as shown above, be adopted. A discussion followed in which
the subject of annual dues was brought up. A motion was made
and seconded that the associate membership dues be increased from
$10 to $25. After a suggestion from the floor that such dues were
fixed in the constitution and could be changed only by amendment
to the constitution in the manner prescribed therein, the report of
the committee was adopted.]
[The amended report of the auditing committee was presented and
approved.]
[A motion was made, seconded, and carried that a committee be
appointed to draft a new constitution and bylaws, to be submitted
at the session next year. The incoming president will appoint the
committee.]
[The following motion was referred to the committee for the 1934
program:]
At the meeting of Section A of Exclusive State Fund Jurisdictions on Tuesday,
September 12, 1933, the following resolution was moved by Mr. Thomas M.
Gregory, chairman of the Ohio Industrial Commission, and seconded by Mr.
Howard Keener, chairman of the Arizona board: That it is the wish of the meet
ing that in making up the program for the next annual meeting a morning and
afternoon session be allotted to them.
[A motion was made, seconded, and carried that a statement en
titled “ General Review of Workmen’s Compensation Legislation,
etc., During 1933 ” , prepared by Mr. Sharkey, be made a part of the
record and printed in the proceedings. The paper is as follows:]
General Review of Workmen’s Compensation Legislation,
etc., During 1933
B y C harles
F.
Sharkey,
of the United States Bureau of Labor Statistics
Almost a quarter of a century has elapsed since the first workmen's
compensation law was adopted in the United States. For the purpose
of bringing together the officials charged with the administration of
these laws, an association, national in scope at first but later enlarged
so as to include the Canadian administrators, was formed to discuss the
interpretation of the laws and the practical problems of the adminis
tration, and to adopt so far as possible uniform methods and prac
tices and thereby render mutual help to each other.
Twenty years after that small band of pioneer administrators met
in Lansing, Mich., we, their successors, meet in this city to continue
the work which they began.
While we cannot boast of a century of progress, yet during the last
quarter arc of the past century, workmen’s compensation in the
United States has advanced from the theoretical stage to the prac
tical. Early constitutional lawyers considered the principle of work
men’s compensation antagonistic to our basic State and Federal Con
stitutions. The common-law theory of employers’ liability has now
been supplanted bv the principle of workmen’s compensation in all of
the States of the union with the exception of four (Arkansas, Florida,
Mississippi, and South Carolina). No principle of our law fabric has
had such a far-reaching effect and change in respect to the rights of
employers and employees.
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1933 MEETING OF I.A .I.A .B .C .
Legislation—United States
Since our last meeting in Columbus, Ohio, another legislative year
has rolled around, with the result that some changes have been effected
in our basic workmen’s compensation laws.
While 40 of the 44 States in which compensation laws are in opera
tion met in regular session during this year, only 30 States amended
the law. The legislatures of Alabama, Kentucky, Louisiana, and
Virginia—^States in which compensation laws are upon the statute
books—did not meet this year in regular session. Of the 4 States
which do not have workmen’s compensation laws, three of the legis
latures met in regular session, while the fourth—Mississippi—did not
meet. A compensation bill was introduced in Arkansas, but accord
ing to a statement of the commissioner of labor, the bill “ was never
returned from the committee on labor.” Similarly in Florida such a
bill was proposed but it did not pass.
Many special sessions have been called this year. Of the States
from which legislation is available, however, none acted upon the
subject of workmen’s compensation except Arizona and New York.
In 10 States the workmen’s compensation law remains unchanged
by the 1933 legislatures. These States are Connecticut, Idaho, Kansas,
Maine, Michigan, Missouri, Rhode Island, Texas, Utah, and Vermont.
In 12 other States the net result included only 1 or 2 changes, in most
instances of a minor nature.
Arizona merely reduced the salaries of the industrial commission
from $5,000 to $4,000 per annum at the regular session and amended
six sections of the act at the special session. Delaware authorized
two municipalities to accept the act, while Nebraska extended the
coverage provisions of the act and Maryland excluded wood cutters.
Colorado investigated the administration of the workmen’s com
pensation insurance fund, and provided that payment for the rental
uarters of such agency be paid out of the fund. The Legislature of
Forth Dakota authorized the governor of that State to remove the
commissioners without cause. The effect of this law has, however,
been suspended by a referendum petition. Before a coal mine may
be operated in this State, full compensation insurance premiums
must have been paid. Ohio gave authority to the industrial commis
sion to pledge securities of the State fund for the purpose of borrowing
money for the payment of compensation. Indiana and New Hamp
shire now provide for double compensation in the case of injured
children illegally employed. New Hampshire also fixed the minimum
weekly rate of compensation at $7, and extended the period of medical
and hospital service from 14 to 30 days. Nevada merely provided
that a child under 18 years of age need no longer prove residence with
the parent in order to establish a conclusive presumption of total
dependency.
The attorney general of South Dakota is hereafter to be the indus
trial commissioner. West Virginia merely amended the provisions of
the insurance fund in the matter of investments.
Several States passed legislation securing the payment of compen
sation by insurance carriers. In Tennessee insurance companies must
furnish a bond in the sum of $50,000. In lieu of such bond a certificate
may be accepted from the commissioner of insurance of the State in
Q
RE VIEW OF COMPENSATION LEGISLATION IN 1933
139
which the insurance company is organized, or domiciled, assuring that
such company has on deposit in the State the sum of $100,000 in cash
for the protection of all of its policyholders ratably. Notice to the
insured employer of an injury is hereafter deemed notice on the part
of the insurer, and such a clause must be inserted in every policy of
insurance. #The compensation law in this State also was strengthened
by giving inquisitorial powers to county grand juries over all viola
tions of the law relating to accident reports and insurance. The
Legislature of Georgia also enacted legislation requiring every insur
ance company doing any workmen’s compensation business in the
State to furnish a bond of $50,000. An insurance company in this
State is hereafter denied the right, after accepting a compensation
remium, to plead that the employer was not subject to the act.
►etween the parties concerned the issuance of a compensation policy
is made a definite contract.
Hereafter in North Carolina if any insurance carrier withdraws
from doing business in the State while any liabilities are outstanding,
the industrial commission may cause suit to be brought on a judgment
in the State of the carrier's residence, for the benefit of the claimant.
The Wisconsin law was amended providing that no compensation
policy shall be canceled unless notice both to the commission and to
the assured shall be given. The new provision is designed to give
ample notice and opportunity to an employer to maintain continued
coverage.
Before leaving the subject of insurance, brief mention should be
made of the creation of a State insurance fund in Oklahoma to be
administered by the industrial commission. State and municipal
corporations must insure in such fund, while insurance is optional
with other employers.
In addition to the increased coverage provisions already mentioned,
such amendments were also made in California, Massachusetts, New
Mexico, and North Carolina. In California the coverage was enlarged
so as to include volunteer firemen. New Mexico added all peace
officers and the warden and guards at the State penitentiary to the
list of extrahazardous occupations covered under the act. Employees
of electric street railroads in all counties except one were extended
coverage provisions in North Carolina, but sawmills and logging
operators employing less than 15 employees are excluded.
Perhaps the largest number of changes in the basic compensation
laws during the current year was made by the Legislature of Oregon.
In this State approximately 20 acts were passed, virtually resulting
in a new compensation law. I will not enumerate the many changes
but refer only to a few of the new provisions. #Fees for legal services
hereafter must be approved by the commission; extraterritorial
effect was given to the compensation law; a volunteer fireman is
for the purposes of the act considered engaged in a nonhazardous
employment. In the future, notice must be given to the Oregon In
dustrial Accident Commission whenever a member of the employer's
family is hired. The commission was also empowered to accept the
warrants or certificates of indebtedness of municipalities in payment
of contributions due the insurance fund.
During the economic crisis of the past 4 years the subject of
coverage of relief workers has perplexed the courts and administrators
of workmen's compensation laws.
E
26616°—34---- 10
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1933 MEETING OF I.A .I.A .B .C .
In Pennsylvania the legislature attempted to solve the workmen’s
compensation problems created by the system of “ work relief.” This
State enacted a special compensation law to cover only those persons
engaged in work for any public or charitable organization by direction
of the State emergency relief board. The new law is thus limited in
scope, and does not include employment by local charitable units not
under the emergency relief act. Compensation under the plan com
mences after 26 weeks of disability, except in permanent injury or
death cases. The payments are to be made from the State work relief
compensation fund, created by an initial appropriation of $25,000 and
supplemented by a payment of 25 cents per week for each worker
used by any “ work relief” employer who elects to be relieved of
liability. The fund is to be administered, however, under the State
workmen’s compensation insurance fund.
New Jersey is another State which considered this problem. By
the provisions of chapter 81, all relief employment is declared to be
casual employment, and therefore not covered by the workmen’s
compensation act. However, the legislature, in order to take care of
this problem, authorized the State director of emergency relief to make
an award to any person injured in emergency relief work according
to the provisions of the New Jersey workmen’s compensation law.
The award in such a case is to be paid directly from the emergency
relief fund.
The law relating to third-party actions received consideration in
California, Montana, and North Carolina. The question of appeals
and procedure therefor was considered in California, Illinois, Iowa,
Maryland, Minnesota, and New York.
Massachusetts, in addition to liberalizing its law, attempted to
correct a condition in the granite and foundry industries. The legis
lature of 1933 provided for the appointment of a committee to investi
gate the problem of diseases caused by dust in the granite and foundry
mdustries. The investigative commission was empowered to devise
ways and means to protect the employees from such diseases, and for
some plan of insurance coverage. There was also a mandate for the
commission to study the problem of industrial disease compensation
in general.
An amendment to the Wisconsin law, in view of the situation in
Massachusetts, is of interest. In that State—
Because of confusion resulting following passage of a revisor’s bill in 1931, the
supreme court held that in order to recover compensation benefits it was no longer
necessary for an employee to establish causal relationship between his employ
ment and his injury or disease, but that it was sufficient to show that disability.,
regardless of cause, commenced while the relationship of employer and employee"
existed. In order to express the true and understood intent of the law, the .
legislature provided that in order to recover compensation the employee must
sustain an injury (defined by law as mental or physical harm caused by accident
or disease), and that the accident or disease causing injury must arise out of his
employment.
Previously the court had held that in case of occupational disease the date of
injury was to be taken as the date of disability. Where disability did not result
until after the relationship of employer and employee had terminated, the appli-;
cant was without remedy because of the provisions of law requiring that at the
time of injury the relationship of employer and employee must exist. The legis
lature amended the law to provide “ time of injury” , “ occurrence of injury” , “ date
of injury ” in the case of disease, as the last day of work for the last employer whose
employment caused disability. This provision extends remedy to an employee
RE VIEW OF COMPENSATION LEGISLATION IN 1933
141
who, because of exposure contracts disease which, however, does not result in
disability until after the employment has been terminated.
New York eliminated the time limit upon reclassification of a disa
bility. It gives the department of labor freedom to change the
classification of cases irrespective of lapse of time. A review of a
reclassification as permanent disability made more than 7 years after
the accident must be by the entire industrial board, and must be
decided by an affirmative vote of at least three members.
The Legislature of the State of Washington made a radical change
in the method of payments into the accident fund. Instead of being a
certain percentage of the pay roll the rates are now fixed at a certain
basic rate per workman-hour in the various classes of industry. The
basic premium rates in cents per workman-hour apply to the accident
fund as well as to the medical-aid fund. Computation of the average
weekly earnings of employees was the subject in several States. In
California the earnings hereafter are to be based on a 5-day, 30-hour,
week.
Liberalization of benefits received the attention of the legislatures
of other States in addition to those already mentioned, especially in
California, Minnesota, Montana, New Mexico, Oklahoma, and
Wisconsin. In New Mexico, while the weekly minimum compensa
tion in total disability cases was fixed at $8, the period of compensa
tion for the loss of one leg between the knee and ankle was reduced
from 110 weeks to 100 weeks.
In Illinois the powers of the industrial commission were strength
ened, and hereafter employers subject to the act must post printed
notices advising employees as to their rights.
While the workmen’s compensation legislation committee of this
association drafted early this year a uniform provision for submission
to the States to care for second-injury cases, only one State acted on
the subject. Minnesota increased the amount payable into the
second-injury fund from $200 to $300.
Four territorial legislatures also met in regular session. Alaska
and Puerto Rico made no changes, while Hawaii made two changes of
minor importance. Official information has not been received as to
whether any changes have been made or are contemplated in the
workmen’s compensation law of the Philippine Islands, the legislature
of which is now in session.
The Congress of the United States has also been in session since our
last meeting. The second session of the Seventy-second Congress
was held, and immediately following March 4 an extraordinary session
of the Seventy-third Congress convened. While legislation of a farreaching nature was passed at this session, no changes were made in
the compensation law already extended to employees of the Federal
Government, longshoremen and harbor workers, and private em
ployees in the District of Columbia.
Legislation—Canada
Of the eight Canadian Provinces having compensation laws the
1933 legislatures of Alberta, Ontario, Quebec, and Saskatchewan
acted on the subject of workmen’s compensation, while those of
British Columbia, Manitoba, New Brunswick, and Nova Scotia
did not. Alberta merely enlarged the powers of the board in the
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1933 MEETING OF I.A .I.A .B .C ,
matter of procedure. Ontario amended the act so far as merit
rating and silicosis were concerned.
The principal change in the Quebec act was the elimination from
the schedule of industrial diseases of silicosis, pneumoconiosis, and
several allied diseases. The silicosis act of 1931 was repealed. Other
changes included a reduction of the weekly minimum from $12.50 to
$10, and a change in the waiting period whereby a workman must be
disabled for 3 weeks before compensation is payable from the date of
injury.
Under the provisions of the Saskatchewan workmen’s compensa
tion law as amended, “ employers” hereafter shall include a trustee,
receiver, etc., and any person appointed by a court to carry on an
industry. Any employer failing to report an accident is made indi
vidually liable for medical aid as well as for compensation. The
powers of the Saskatchewan commission were also enlarged. The
power to remove any of the commissioners may be accomplished by
the legislature. They are, however, immune from liability for any act
done in the execution of their duties, the same as judges. Other
changes of a minor nature were also accomplished.
Occupational Diseases
It has been observed, in the review of this legislation, that many
jurisdictions have considered the problem of occupational diseases.
At this point it would seem appropriate to refer briefly to the reports
of several commissions appointed to investigate this subject. The
Pennsylvania committee submitted a report to Governor Pinchot in
March of this year. Some of the conclusions of the committee include
the following:
The commission is definitely convinced that any compensation law including
occupational diseases within the compensation system of the State of Pennsylvania
would require a separate act with a separate framework of rules and procedure for
the administration of such law, insofar as occupational disease presents a problem
different from that presented by accidents.
The commission is of the opinion that occupational disease legislation should
recognize that accidents happen at a given point of time with a particular em
ployer, that occupational diseases are frequently of slow development, clear up
and recur, and that special provisions fitted to this difference in character must
be made.
Your commission is likewise convinced that the phrase “ occupational disease”
has a distinct significance, but that it is not capable of such accurate definition
that administrative boards and courts will be able without the assistance of
scientists to determine what is or is not such a disease.
The commission is also of the opinion that in connection with a listing of diseases
there should be a general statement of the occupations within which those diseases
naturally occur.
Your commission is of the opinion that the diseases which will be of major im
portance and which will present the greatest difficulties as administrative prob
lems, are silicosis and/or miners’ asthma, and further believes that any act which
includes them as compensable diseases must contain special provisions outlining
the course of procedure to be followed in determining in a given case whether or
not a claimant is entitled to compensation, and which employer or employers shall
be held liable therefor.
The commission is of the opinion that it is impossible accurately to estimate the
additional cost which will be imposed upon industries by reason of the inclusion
of occupational diseases in a compensation system.
Pursuant to a resolution of the Illinois Senate, a report by a medical
committee on silicosis was submitted to the chairman of the industrial
commission.
R E VIEW OF COMPENSATION LEGISLATION IN 1933
143
The report particularly observed that it was essential to establish
definitely as to what physical conditions and pathological pictures
should constitute compensable silicosis. Continuing, the report
showed that—
The medical logic behind the present agitation for legislation to include “ sili
cosis” , or the effects of inhalation of silica and the silicates, and not “ pneumo
coniosis” , or the effects of the inhalation of any dust, rests upon the opinion of
many authorities that disabling fibrosis of the lungs from dust is in reality, in the
vast majority of cases, due to silicosis, while an accompanying inhalation of coal
dust or clay will actually retard the action of the silica. * * * It is extremely
important for anyone proposing legislation to cover the effects of dust inhalation,
in order to avoid endless controversy, to decide definitely whether he chooses to
propose legislation covering the effects of all dusts (pneumoconiosis) or of dusts of
silica or silicates (silicosis).
Court Decisions
A large number of workmen’s compensation cases were decided by
the courts during the past 12 months. The Supreme Court of the
United States had occasion to pass final judgment on several work
men’s compensation cases— Voehl v. Indemnity Insurance Co. oj North
America, 288 U.S. 162; Aetna Life Insurance Co. v. Moses, 287 U.S.
530; and Ohio v. Chattanooga Boiler & Tank Co., 289 U.S. 439. The
first case concerned the workmen’s compensation law in the District
of Columbia, the second the Federal longshoremen’s and harbor work
ers’ compensation act, and the third, the workmen’s compensation
law of Ohio.
An interesting case was decided by the Court of Appeals of the
District of Columbia, in which it was held that a preexisting condition
did not bar recovery of compensation. In this case an employee,
while using a hot-water hose for defrosting cans, was seized with an
epileptic fit. Because of the contraction of his muscles, he continued
to hold the hose so that the hot water ran over his body, inflicting
serious bums which caused his death. An award was denied by the
deputy commissioner, who held that the proximate cause of the injury
was the epileptic seizure, which had no relation whatever to the
employment.
From the facts in the case the court of appeals held that the employee’s death
was caused by the burns and not by the epileptic condition, and that such burns
were inflicted by means of an instrumentality in the hand of the employee which
he was using in the course of his employment. The court called attention to the
fact that a liberal interpretation in favor of an injured employee should be given,
since workmen’s compensation statutes in general are remedial.
The Supreme Judicial Court of Massachusetts had occasion to pass
on a case involving an injury to a workman on Federal property.
An employee by the name of Charles Lynch was injured while in the employ of
the N. P. Severin Co., a general contractor, engaged in the construction of a new
post-office building in Boston, Mass. At the time of the accident the employee
was at work on land owned by the United States, and while in the course of his
employment he had occasion, from time to time, to leave the Federal property.
The main contention of the insurer was that since the injury occurred on land
belonging to the United States the Federal Government had sole jurisdiction, and
that the Industrial Accident Board of Massachusetts was without jurisdiction.
In 1927 (ch. 309, par. 3) the Legislature of Massachusetts amended section 26
of the State workmen's compensation act. By the provisions of this amendment
the workmen's compensation act was given extraterritorial force. It is now no
longer considered doubtful that anyone who is employed in the State can recover
under the workmen’s compensation act for an injury which has occurred in
another State.
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1933 MEETING OP I.A .I.A .B .C .
The court based its opinion principally upon a Montana case. (honey v.
Industrial Accident Board, 87 Mont. 191.) In that case an employee was hired
in Montana to work on a road being constructed for the National Forest Service.
This road was partly in the State of Montana and partly in Glacier National Park,
the latter being a tract of land ceded to the United States by the State of Montana.
The injury in this case occurred while the employee was on that section of the road
within the boundaries of the national park. The Montana Supreme Court held
that there might be a recovery under the Montana workmen's compensation act.
The Massachusetts Supreme Court, in answering the contention that the
Federal Government has taken possession of the field of compensation, stated
that there is no Federal workmen's compensation law and since the Government
has not taken possession of that particular field there was no basis for the con
tention as raised by the insurer. The court said that the fact that the injury
occurred on land of the United States did not render inapplicable the State work
men's compensation act, and that the law as amended by the act of 1927 covers the
contract of the parties.
The decree of the lower court was therefore affirmed.
Another case decided in 1933 by the Massachusetts Supreme
Judicial Court of interest to members of this association, was that of
an employee drowned while engaged in scavenger service on a scow.
The case was especially referred^ to by Mr. Samuel B. Horowitz of
Boston at our meeting last year in Columbus, Ohio. The court was
called upon to determine whether an employee sweeping the deck of
a scow and drowned in navigable waters was engaged in maritime
employment or whether the work was a matter of local concern and
hence cognizable under the Massachusetts workmen’s compensation
law.
The high court of Massachusetts upheld the Industrial Accident
Board that the death was compensable under the State workmen’s
compensation law. (In re Herbert’s case, 186 N.E. 554.)
Other cases which may be deserving of mention are as follows:
(1) The Supreme Court of Tennessee held that a nursery employee
was a “ farm or agricultural laborer” , and therefore not entitled to
receive compensation for injuries under the workmen’s compensation
law of that State. (Ginn v. Forest Nursery (7o., 52 S.W. (2d) 141.)
(2) An employee contracting a skin disease while in the employment
of a rug company, but suffering no disability until some time after he
left the company’s employ, was not entitled to workmen’s compensa
tion according to the Wisconsin Supreme Court. (.Kimlark Rug
Corporation v. Stansfield, 246 N.W. 424.)
(3) Compensation was denied for injuries received in employment
not incidental to the office by the Supreme Court of New Jersey. In
this case the workmen’s compensation bureau awarded compensation
to a minister who was injured while removing a heavy barrel from the
cellar of the parsonage. The supreme court, however, reversed the
State bureau. The court reasoned that the claimant was performing
a household duty for his own benefit, which he would have been re
quired to perform if he lived in a house owned by himself. (Van
Devander v. West Side M.E. Church, 160 Atl. 763.)
(4) In applying the provisions of a State workmen’s compensation
statute, due consideration must be given to treaties between the
United States and foreign nations. This was held by the Supreme
Court of Appeals of West Virginia in the case of Urbus v. State Com
pensation Commissioner, 169 S.E. 164.
R E V IE W OF COMPENSATION LEGISLATION IN 1933
145
(5) Ail employer’s violation of a safety order was held by a Cali
fornia court to warrant additional compensation. (.Ethel D. Co. v.
Industrial Commission, 21 Pac. (2d) 601.)
(6) The widow of a traveling salesman, who was bitten by an in
fected wood tick, was awarded compensation for his death by the
Supreme Court of Idaho. {Roe v. Boise Grocery Co., 21 Pac. (2d)
91°.)
In an Oregon case {Banister v. State Industrial Accident Commis
sion, 19 Pac. (2d) 403) an employee who was cutting brush for the
city, and received poison-oak poisoning, was held to have received an
accident caused by external means. The State industrial commission
in the first instance disallowed the claim, but upon subsequent appeal
to the courts the decision of the commission was set aside.
The supreme court discussed the question fully, calling attention to the fact
that the commission relied on the statement that “ an idiopathic as distinguished
from a traumatic disease cannot be regarded as an injury by accident.” How
ever, the court said that an idiopathic disease is one which develops gradually or
imperceptibly, and that poisoning from poison oak was not such a disease.
(7) An alleged oral agreement by the employer to pay the injured
employee wages in lieu of compensation payments was declared by the
Superior Court of Pennsylvania to be wholly null and void. {Blair
v. Laughead, 165 Atl. 58.)
(8) In the case of Manfield & Firman Co.
Manfield (182 N.E.
539) the Appellate Court of Indiana held that in order to entitle a
stockholder, director, or officer of a corporation to compensation
under the Indiana workmen’s compensation act, “ he must be an
employee whose remuneration is popularly designated as wages,
rather than salary; * * * whose labor is manual or of a like de
gree of industrial or commercial importance as manual labor when
viewed from the standpoint of individual accomplishment.”
(9) A pertinent case of interest to administrators was that in
Arizona in which the supreme court of the State upheld the right of
the governor to remove the entire personnel of the State Industrial
Commission. {Sims v. Moeur, 119 Pac. (2d) 679.)
It may be said in closing that the courts of the nation adjudicated
perhaps the usual number of workmen’s compensation cases, and that
the legislatures of the various jurisdictions which took up the subject
of workmen’s compensation during 1933, for the most part enacted
into law amendments which were beneficial, that the scope of the acts
have been enlarged and strengthened, and that the general tendency
was toward the improvement of the compensation laws.
[President Wenzel expressed to Mr. Nowak and Mr. Angsten the
appreciation of himself and of the association for their part in assuring
the success of the convention. He then presented the incoming
president, Joseph A. Parks, who took the chair. Mr. Parks ex
pressed his appreciation of the honor conferred upon him and asked
for the cooperation of the members during the coming year. After
the presentation of the incoming vice president, Mr. Prudencio
Rivera Martinez, commissioner of the Department of Labor of
Puerto Rico, was asked to speak on the situation in Puerto Rico and
responded as follows:]
Mr. M a r t in e z (Puerto Rico). I come from a very far distant
place, about 1,400 miles from New York. I have been striving there
146
1933 MEETING OF I.A .I.A .B .C .
for years to have all social legislation enacted in the matter of this
compensation law. From 1916 to 1928 we had an exclusive State
fund. That proved a failure because of the administration and
politics, and in August 1928 there was a change to a competitive
form. It happened that in authorizing self-insurers and private
carriers to operate, the Government had to take up every bad risk.
Conditions today are worse than they were in the past. Our
country is mainly agricultural. Conditions are such that the em
ployers claim that their premiums as applied to agricultural risks are
confiscatory. They have been protesting all the time against this
insurance provision. There was enacted in special session of the
legislature new legislation which I call novel legislation, and it is now
awaiting the signature of the governor. According to law, he has 30
days after adjournment of the legislature either to approve or to veto
the legislation. We do not know at this time whether it will be
signed by him and become a law or be vetoed. We should know
about tomorrow, the 15th of September, as that is the expiration of
the time within which he has to make it a law or to veto it.1
The title of the proposed law is as follows:
An act to promote the welfare of the inhabitants of Puerto Rico as regards
accidents causing death, injuries, or diseases derived from the occupations of
workmen while engaged in their work; to establish the social service compensa
tion to workmen and employees in Puerto Rico, and to compensate their heirs
and beneficiaries, as defined; to provide ways and means for the enforcement of
these duties; to create a manager of the Workmen’s Compensation Social Service
Fund, and an Industrial Court, and to determine the powers and duties thereof;
to determine the liability of the Government of Puerto Rico and of its municipali
ties under this act; to levy a special tax and premium quotas for said services,
and to authorize the survey of the reinsurance of workmen; to repeal act No. 85
of 1928, known as the “ Workmen's Accident Compensation A ct” and all laws
in conflict herewith; to appropriate up to the sum of $25,000 out of any funds
available in the Treasury of Puerto Rico on December 31, 1933, and preferentially
out of any surplus in the fund of the Workmen’s Compensation Bureau of the
Department of Finance, and for other purposes.
That is the title of the act. The Governor of Puerto Rico refers to
the heads of the different departments any legislation affecting their
departments. They report on the legislation and either recommend
its approval or its rejection and veto. I have written in my report
to the Governor of Puerto Rico that the purpose of the law is ex
plained in section 2, by which it is declared that the Legislature of
Puerto Rico considers, as a policy of great social and human impor
tance, the need of establishing a system that shall prevent the loss of
human beings in factories, shops, and fields of production and in
work in general in the Island of Puerto Rico, through disability and
death. It is established by this section that all the inhabitants of
Puerto Rico shall contribute to this service, thus establishing a
doctrine and principles in Puerto Rico which are fundamentally differ
ent from those established up to the present and by which only the
employers were to pay the loss based on the risk of the employment.
In departure from the old system it has been the purpose of the
legislature, as explained, to make of the compensation service a
social service, the cost of which should be borne by all the com
munity instead of the employers alone,
i This legislation was pocket vetoed by the governor.
RE VIEW OF COMPENSATION LEGISLATION IN 1933
147
Then I might mention the different aspects of the law and come
to the part that provides for the premiums, but I am going to mention
that in a few minutes.
Section 28 provides that the Treasurer of Puerto Rico should levy
and collect from January 1,1934, until June 30,1935, in the same form
and manner and through the same proceedings in force for the collec
tion and levying of regular property taxes, and in addition to said
taxes, a tax of thirty hundredths of 1 percent of the assessed value of
all taxable real and personal property in Puerto Rico; and the pro
ceeds of said tax shall be converted into a special fund which shall be
known as “ Special Fund for the Workmen's Compensation Social
Service."
Section 29 provides that from January 1,1934, until June 30, 1935,
the Treasurer of Puerto Rico is likewise authorized and directed to
levy, collect, and withhold from any funds belonging to the several
municipalities of Puerto Rico, including the government of the capital,
1 percent of the total amount of the municipal budget for the payment
of salaries and wages to the municipal employees and workmen
covered by this act.
Section 30 provides that for the same period as above, the treasurer
should levy and collect annually on any funds of the insular govern
ment or of any of its dependencies, boards, or commissions, 1 percent
of the total amount of the respective budgets to be used for the pay
ment of salaries and wages of employees and workmen covered by
this act.
Section 31 provides that the same official should levy and collect
1 percent of the general budget of every public work carried out by
the Federal, insular and municipal governments and by the govern
ment of the capital, whether by administration or on call for bids,
for the compensation social service of the employees and workmen
used therein and covered by this act.
Section 32 provides that the same officer should levy and collect
from every person, partnership, or corporation, engaged in any busi
ness or industry in Puerto Rico and employing workmen or employees
covered by this act and not paying direct taxes on property located
in Puerto Rico, 1 percent of the total amount of the annual pay roll
of the workmen and employees used in his business or industry.
I was interested in reading that part about contributions and taxes,
that is all. My purpose in bringing this to you is that I believe it is
important for you. I will leave a copy of the bill with you as well as
a copy of my letter to the Governor.
[After remarks by Mr. Stewart referring to conditions in Puerto
Rico, a motion was made, seconded, and carried that this matter be
referred to the executive committee for consideration and such action
as it may see fit to take.]
[Meetmg adjourned.]
THURSDAY, SEPTEMBER 14—MORNING SESSION
Joint Session of A.G.O.I. and I.A.I.A.B.C.
Chairman, Thomas P. Kearns, superintendent Division of Safety and Hygiene, Department of
Industrial Relations of Ohio
Opening Address
By
E ugene
B.
Patton,
Director Division of Statistics and Information of New
York and President A.G.O.I.
As most of you know, there are three organizations of labor depart
ments which meet annually. The one with which we are most familiar
is what Mr. Stewart terms the alphabet society, the I.A.I.A.B.C.,
which, being interpreted, is the International Association of Indus
trial Accident Boards and Commissions. There is another organi
zation known as the A.G.O.I., or the Association of Governmental
Officials in Industry of the United States and Canada. It is the
joint session of these two bodies which is now beginning.
There is also a third organization of labor department officials
known as the International Association of Public Employment
Services, which is directly and particularly concerned with the
operation of public employment offices. There probably are other
organizations, but these are the three which I have in mind.
We have a very short time and a crowded program; therefore my
presidential address is to consist simply of a recommendation which
probably will not meet with the approval of more than a few of
you; yet it is a recommendation which personally I strongly favor
and believe to be for the best interests of all concerned.
That recommendation is that henceforth there be one annual
meeting of labor department officials. In the term “ labor depart
ment” I include various titles, such as industrial accident commis
sions, departments of industrial relations, or whatever they may be.
I mean to include that group of people in a State or Province which
is concerned with labor problems.
My recommendation is that there be one annual meeting of such
officials, at which meeting there be one section devoted particularly
to workmen’s compensation problems, one section to public employ
ment office problems, and one section to the general problems of laborlaw administration and enforcement with which the A.G.O.I. concerns
itself. In other words, it is to have something somewhat analogous
to the National Safety Council, which deals with the general problem
of safety and has separate sections to which those interested in any
particular phase of the safety problem are directed and in which they
may meet.
I realize quite well that there are reasons rooted in tradition
against this, but the present depression has taught us, I think, that
it is wellnigh impossible (in many cases it has been proved to be
so) to get anything like an adequate representation from each of the
Provinces and States for each of these separate conventions. It
148
JOINT SESSION— A .G .O .I. AND I.A .I.A .B .C .
149
takes time, money, and effort, and expense of one kind or another
is involved. In many cases the same people from a given Province
or a given department who would go to one of these meetings are
also expected to go to another. I can see no reason why it would
not be more desirable, from the standpoint of stimulation of interest,
increase in attendance, and decrease in expense, to have one com
mon, general meeting of labor department interests. I see no reason
why^ any particular interest, such as workmen's compensation,
public employment offices, administration of labor laws, and so
forth, could not be as well cared for as it is at present. I feel quite
sure that there would be a larger attendance and a greater interest
manifested bv so doing.
This I realize will require changes in the constitutions of each of
these organizations. I will take occasion to point out such steps as
I could take unofficially and without having any authority entrusted
to me in this direction. The A.G.O.I. was to have met in Buffalo
in May 1932. Because of the prevailing depression the meeting was
postponed for 1 year. We had no session in 1932 and waited until
1933. At a meeting of the executive committee in Buffalo a com
mittee was appointed to prepare for the 1933 session. I made an
effort to secure in 1933 a meeting in the same city and at approxi
mately the same time—that is to say, within the same week—of all
three of these bodies. The public employment officials were quite
eager for it and were going to meet with us, until late in the summer,
when they decided that on account of the reorganization of the
Federal Employment Service it would be essential that they meet in
Washington this year.
The I.A.I.A.B.C. went so far as to agree to this joint session
which was at first planned for only a half day; then because of the
full program, it was extended to something more than a half day.
That is my recommendation. I realize how much may be said
against it; nevertheless I am convinced of its value.
Another thing particularly concerns the A.G.O.I. only. If we do
go on as we are, I recommend a constitutional change which will
lodge the office of the secretary in the United States Bureau of Labor
Statistics, on the ground that it has the organization and the facil
ities for conducting such work and that it will provide a greater con
tinuity in the management of the program. Even if that is not done,
I recommend that some one person, either the secretary or the
president, be given full power to draft the program for the coming
year. The A.G.O.I. does not have funds for an annual meeting of
its executive committee to formulate a program, and therefore it is
necessary to correspond with the States and Provinces. I believe
that, whoever may be our secretary, if either the secretary or the pres
ident is given such power it will save time and effort, and a better
program will result, than under the present plan which involves con
ference by mail.
Mr. Kearns, superintendent of the Division of Safety and Hygiene
of Ohio,is to preside at this joint meeting onsafety, and he is responsible
for a large part of the program. The first two addresses were arranged
for by the A.G.O.I., and from then on the speakers have been secured
by Mr. Kearns, perhaps acting in conjunction with Mr. Baldwin.
Before turning the meeting over to Mr. Kearns, I wish to ask that
150
1933 MEETING OP I.A .I.A .B .C .
in your minds and in your conversation with each other you will at
least give the recommendation I have made your serious consideration.
Chairman K e a r n s . It is indeed a happy privilege to preside at
this joint session this morning, because of my past connection with
the Association of Governmental Officials in Industry and my present
connection with the I.A.I.A.B.C.
I think it a splendid idea to hold a joint session of these two asso
ciations for the purpose of discussing the subject of safety, one of the
most humanitarian problems confronting us today, and one which is
engaging the attention of the entire world because of the terrific toll
of life and limb being taken by accidents, not only in industry but
also in the home and on the public highways.
While a great deal has been accomplished in the prevention of acci
dents in recent years through the enforcement of safety laws and
regulations and the promotion of educational safety work in indus
try (and that is the phase of safety work in which both organiza
tions are primarily interested), the roster of those killed and injured
in accidents in industry is still unnecessarily large. When we think
of 15,000 being killed and 1,215,000 being seriously injured in indus
trial mishaps in 1 year in this country alone, we get some idea of the
magnitude of the job that lies ahead and of the grave responsibility
resting on the shoulders of those of us who are charged with the duty
of bringing about the enforcement of safety regulations and promot
ing industrial safety work.
This responsibility is, I think, greater today than it has ever been.
Industry is passing through the most momentous crisis in its history,
but the tide seems to be turning, and as it turns and normal condi
tions once more prevail, safety work and safety workers are almost
certain to face a crucial test. Long periods of idleness have softened
workers, slowed up the skill acquired by long practice, forced read
justments, placing men on unaccustomed jobs, impaired the effi
ciency of safety organizations, and put both employer and employee
in a frame of mind not conducive to optimism. The mental hazards
of industrial jobs have been greatly accentuated in these times, and
the readjustment of mental attitudes will be one of our biggest
problems.
The future of safety depends largely upon the success attending
our efforts to effect a transition from the reckless to the careful age,
and the degree of success attained will depend largely on the amount
of effort put into the work by those who bear the responsibility. I
am as optimistic as any man regarding the future of safety. While
the time will probably never come when there will be no industrial
accidents, I think the day will come when all preventable accidents
will be prevented, when safety consciousness will have taken such
root in the hearts and minds of employers and workers that the lax
ity which permits the occurrence of a preventable accident will be
viewed with shame, and when a man’s attitude toward safety will
have equal weight with his ability and integrity. It may mean years
of persistent effort to bring this about, but my prediction is that
this goal will ultimately be reached if we all do our part.
So I repeat that it is fitting and appropriate that these two organi
zations which have so many things in common in connection with
this great problem of safety should get together for discussion of the
topic, so that we can give each other the benefit of our views and
STATUS OF INDUSTRIAL SAFETY CODES
151
experiences and do what we can to be mutually helpful in working
out a solution of these problems.
In arranging for the program for today, we have endeavored not
only to select subjects that would be of vital interest to all safety
advocates and workers but also to select speakers who from training
and experience could speak with authority on the subject of accident
prevention. I believe that every one of the speakers will have a
real message on safety for this audience today. The first item on
the program is the “ Status of Industrial Safety Codes and Regula
tions in the Various States” , by Charles E. Baldwin, Assistant Com
missioner of Labor Statistics.
Status of Industrial Safety Codes and Regulations in the
Various States
B y C h arles
E.
B a l d w in ,
United States Assistant Commissioner of Labor Statistics
During the period of domestic and handicraft employment, before
the application of steam and electric power, workers were exposed to
few hazards, and the question of safety in industrial life was principally
a matter of individual caution. Introduction of machinery changed
conditions completely. Accident hazards were multiplied, and the
safety of the worker depended not only on his own judgment and
caution, but also on the judgment and caution of his fellow workers, as
well as on the amount of protection afforded by the employer or by
the manufacturers of the mechanical devices against the hazards
incident to machine operation.
It did, however, take considerable time before it was realized that
an accident to a worker is evidence that something has gone wrong,
and that a repetition of a particular kind of accident is evidence that
something is habitually wrong and should be corrected. The mount
ing toll of industrial accidents causing physical and mental suffering
as well as financial loss to the workers, and the increased cost of pro
duction to the employers, finally resulted in enactment of State
regulations to safeguard workers from preventable accidents.
Massachusetts took the lead in 1877 with the first American law
requiring factory safeguards, providing that all transmission machin
ery and all machinery having movable parts in factories and work
shops, or mechanical and mercantile establishments, should be securely
guarded as far as practicable, if so placed as to be dangerous to em
ployees while engaged in their ordinary duties. Factory inspectors
were appointed 10 years earlier, and a permanent bureau for the inves
tigation of labor conditions was established in 1869.
The example of Massachusetts was followed by New York, Wis
consin, and other States, many of which adopted blanket codes or
regulations of similar character. It was, however, found that under
blanket provisions the standard was very indefinite and vague, and
that the constant changes in industries and methods required specific
and detailed regulations. As a result, a number of special safety
codes, rules, or regulations for industrial activities covering either
specific important industries, certain mechanical processes, or special
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1933 MEETING OF I.A .I.A .B .C .
hazards have been developed in the leading industrial States and in
others that have considered accident prevention important.
Safety codes or regulations are adopted and enforced for the
purpose of preventing accidents. The enactment of workmen's
compensation laws and the compilation of accident statistics have
played very prominent parts in the accident-prevention movement
and have pointed out the necessity for safety regulations. Industry
was forced, through workmen's compensation acts, to pay the bills
for all accidents. Through such payments the employers began to
realize the frightful toll of indifference and, sometimes, criminal
negligence. Statistics disclosed that it was cheaper to prevent acci
dents than to pay for them, and investigation showed that a large
majority of accidents could be prevented. The experience of some
large firms, which had applied rules of their own, proved both points.
Safety regulations in some States are still statutory, with certain
agencies designated for enforcement. In other States it has been
found advisable to authorize the enforcing agency (industrial com
mission, department of labor, utilities commissions, etc.) to formulate
reasonable rules, regulations, or orders for the prevention of in
dustrial injuries. In such case the rules are sometimes promulgated
by the enforcing agency itself, but the principal industrial States
have adopted the method of forming advisory committees for as
sistance in the drafting of safety codes or orders. Such advisory
committees are composed of the various groups interested: Employ
ers; employees; and insurance, medical, legal, or technical experts
with special knowledge of the particular problems involved. In
some States public hearings are also held before the codes become
effective.
Since the previous report to this association an inquiry has been
made, through the United States Bureau of Labor Statistics, con
cerning the specific safety regulations in effect at the present time
in the individual States and the District of Columbia. Information
has been received from practically all, and is shown in the appendix,
by States. Previous information, supplemented by data obtained
through careful research, is given for the States from which definite
information was not obtained.
In some instances the safety regulations shown in the appendix
are authorized specifically by statute, while in others they are pro
mulgated under authority of the industrial commission, the depart
ment of labor, or other regulatory agency to carry out the general
provisions of law which authorize safety measures, without defi
nite specifications. Safety provisions covering mines and mining
operations are indicated under a general classification “ Mines", and
are not given in detail, as that subject is ordinarily covered by the
United States Bureau of Mines.
Two of the States, Alabama and New Mexico, have no safety regu
lations of any kind, and Florida has only regulations covering em
ployment of children under 16. Other States show considerable
variation. Some of them have safety provisions covering all dan
gerous practices, while others have regulations for a few specific
subjects only.
Some revisions and changes were made during the past year in
the existing regulations in several States and some new safety codes
STATUS OF INDUSTRIAL SAFETY CODES
153
were adopted. Notable among the latter were the laws and regula
tions for the use of nonshatterable glass in motor vehicles, adopted
by California, Massachusetts, Michigan, Nebraska, and New York.
Bills on this subject have also been introduced in the legislatures of
Illinois, New Jersey, and Ohio, and in the United States Congress.
In California a new code was adopted for work in compressed
air. In Maryland the existing list of approved safety codes was en
larged by the adoption of codes on compressed-air work; floor and
wall openings, railings, and toeboards; and protection against light
ning; making a total of 32 separate safety codes approved by that
State. In North Carolina regulations were issued covering spray
painting and quarries.
In Ohio a new code has been adopted, covering pressure piping
and mechanical-refrigeration systems and equipment, while two of
the previous codes have been completely revised, bringing regula
tions up to date for elevators and for fabricating machinery.
Appendix A. Safety Regulations for Industrial Workers, by States, 1933
Safety codes, rules, or regulations for the protection of industrial workers
have been adopted by all of the States except Alabama and New Mexico, and
by the District of Columbia. Considerable difference exists, however, in the
number of subjects covered in the various jurisdictions, partly due to differ
ences in industrial development.
A compilation is here presented of the specific subjects covered in each of the
States, either by statutory enactment or by orders of the enforcing governmen
tal agency authorized through the laws to develop and issue regulations, accord
ing to information received by September 1, 1933, from the various States and
from research of reports and laws.
The classification may not be complete, as some States have blanket regulations
covering health and safety of industrial workers in all industries located in the
jurisdiction, but it is assumed that all subjects are listed that are covered by
specific rules and practically all that are covered by the general rules. Brief
explanatory notes are included.
Alabama.— No industrial safety laws have been adopted, and no govern
mental agency has authority to formulate rules or regulations. Suggestions
furnished to industrial establishments, When requested, are usually based on
regulations advocated by the various engineering societies or the National
Safety Council.
Alaska.—Statutory regulations cover health and safety of workers in mines,
and sanitary conditions in factories, canneries, or other establishments where
labor is employed, but failure of securing appropriation for necessary expenses
has prevented enforcement of the sanitary provisions for nearly a decade.
Arizona.— Safety measures are provided to a certain extent through the
industrial commission by variation in the cost of insurance in the State com
pensation fund. Statutory provisions cover the following subjects: Abrasive
wheels, construction work, electrical installation, and power-transmission appa
ratus.
Arkansas.— Statutory provisions cover boilers, mines, public-safety corpora
tions, and industrial sanitation for female employees, and prohibit employment
of children under 16 in dangerous occupations. Some proprietors of laundries,
woodworking plants, printing plants, etc., provide safety appliances in con
formity with recommendations of companies manufacturing such appliances,
but such measures are voluntary.
California.— Safety orders of the industrial accident commission apply to all
places of employment in the State, and the commission has power to require
that all unsafe conditions be removed, whether that condition is or is not covered
by a special order. The safety orders cover the following subjects;
154
1933 MEETING OF I.A .I.A .B .C .
Machine tools
Abrasive wheels
Metal working
Aeronautics
Milling industry
Air-pressure tanks
Mines
Amusement parks
Automobile brakes and brake testing
Motorboats
Oil drilling
Automobile headlighting
Painting
Bakeries
Paper and pulp mills
Boilers
Brewing and bottling
Plant railways
Plate- and sheet-metal working
Canneries
Plumbing
Ceramics
Potteries
Chemicals
Colors for traffic signals
Power control, electrical
Compressed-air machinery (in part)
Power control, mechanical
Power-transmission apparatus
Compressed-air work
Printing
Construction work
Conveyors and conveying machinery Protection from fire and panic
Quarries
(in part)
Refrigeration, mechanical
Cranes, derricks, and hoists
Rubber machinery
Dredges
Drycleaning and dyeing
Safety glass
Dust explosions, prevention of
Sanitation, industrial
Scaffolds and staging
Electrical installations
Shipbuilding
Elevators and escalators
Steam shovels
Engines
Exhaust systems
Steel mills
Stevedoring operations
Explosives
Floor and wall openings, railings, and Sugar factories
Tanneries
toeboards
Textiles
Forging and hot-metal stamping
Foundries, protection of workers in
Tunnels
Ventilation
Gas installations
Walkway surfaces (in part)
Grandstands
Welding
Ladders
Laundry machinery and operation
Window washing
Lighting factories, mills, etc.
Woodworking plants
Logging and sawmill machinery
Colorado.— Safety regulations, based Dn broad statutory provisions, are now
enforced by the inspection department of the industrial commission, with the
exception of mining regulations which come under the coal-mine inspection
department or the State bureau of nsun s, respectively. The following subjects
are covered:
Lighting of school buildings
Abrasive wheels
Machine tools
Boilers
Compressed-air machinery
Mines
Construction work
Paper and pulp mills
Conveyors and conveying machinery
Plate- and sheet-metal working
Drycleaning and dyeing
Power presses, and foot and hand
Dust explosions, prevention of
presses
Rubber machinery
Elevators and escalators
Sanitation, industrial
Exists, building
Floor and wall openings, railings, and Scaffolds and staging
Spray painting
toeboards
Foundries, protection of workers in
Sugar factories
Ventilation
Ladders
Laundry machinery and operation
Walkway surfaces
Woodworking plants
Lighting factories, mills, etc.
Connecticut.— Statutory provisions co er the following subjects:
Exists, building
Automobile brakes and brake testing
Laundry machinery and operation
Automobile headlighting
Lighting factories, mills, etc.
Boilers
Construction work
Power-transmission apparatus
Sanitation, industrial
Electrical installations
Scaffolds and staging
Elevators and escalators
Ventilation
Exhaust systems
STATUS OF INDUSTRIAL SAFETY CODES
155
Delaware.—Statutory provisions cover the following subjects: Aeronautics;
automobile brakes and brake testing; automobile headlighting; boilers; can
neries; exits, building; and explosives. Local safety provisions for the city
of Wilmington cover drycleaning and dyeing, gas installations, plumbing, and
protection from fire and panic.
District of Columbia.—Safety regulations, adopted by the Commissioners of
the District under authority enacted by Congress of the United States, cover
the following subjects:
Grandstands
Air-pressure tanks
Plumbing
Automobile brakes and brake testing
Automobile headlighting
Power control, electrical
Power-transmission apparatus
Boilers
Pressure piping
Compressed-air machinery
Drycleaning and dyeing
Pressure vessels
Protection from fire and panic
Electrical installations
Refrigeration, mechanical
Elevators and escalators
Sanitation, industrial
Engines
Exits, building
Steam shovels
Florida.— The only safety regulations in the State are the statutory provi
sions of the child-labor law, which include safety and sanitary provisions for
children under 16.
Georgia.— Statutory provisions cover building exits and child labor only.
None of the governmental agencies are authorized to promulgate safety codes.
Hawaii.— Statutory provisions cover aeronautics, and explosives (under super
vision of the Territorial superintendent of public works), while sanitary regu
lations are promulgated and enforced by the Territorial board of health.
The workmen’s compensation law has no provision for safety regulations,
but the industrial accident boards cooperate with local insurance carriers and
employers to minimize industrial accidents, and ordinances of the city and
county of Honolulu regulate several industrial conditions. Including the items
mentioned previously, the subjects covered by the various regulations are:
Ladders
Aeronautics
Laundry machinery and operation
Automobile brakes and brake testing
Lighting factories, mills, etc.
Automobile headlighting
Lighting of school buildings
Construction work
Lightning, protection against
Electrical installations
Plumbing
Exits, building
Protection from fire and panic
Explosives
Floor and wall openings, railings, and Safety glass
Sanitation, industrial
toeboards
Scaffolds and staging
Grandstands
Idaho.— Safety regulations issued by the industrial accident board, which is
empowered by statute to protect workers, cover the following subjects:
Printing
Elevators and escalators
Exits, building
Protection from fire and panic
Laundry machinery and operation
Woodworking plants
Power-transmission apparatus
Illinois.— Statutory provisions, administered by the department of labor
through the division of factory inspection, cover the following subjects:
Abrasive wheels
Laundry machinery and operation
Construction work (structural iron)
Lighting factories, mills, etc.
Cranes, derricks, and hoists (limited)
Power control, electrical
Electrical installations
Power control, mechanical
Exhaust systems
Power-transmission apparatus
Exits, building
Sanitation, industrial
Floor and wall openings, railings, and Scaffolds and staging
toeboards
Spray painting
Foundries, protection of workers in
Ventilation
Gas installations
Woodworking plants
Ladders (in part)
Indiana.— Statutory provisions of the factory act, the boiler inspection act,
and items under the State safety department, cover the following subjects:
25616°—34----- 11
156
1933 MEETING OF I.A .I.A .B .C .
Laundry machinery and operation
Abrasive wheels
Lighting factories, mills, etc.
Aeronautics
Lighting of school buildings
Air-pressure tanks
Logging and sawmill machinery
Amusement parks
Machine tools
Automobile brakes and brake testing
Metal working
Automobile headlighting
Milling industry
Bakeries
Mines
Boilers
Brewing and bottling
Paper and pulp mills
Plate- and sheet-metal working
Canneries
Plumbing
Ceramics
Potteries
Chemicals
Compressed-air machinery
Power control, electrical
Compressed-air work
Power control, mechanical
Construction work
Power presses, and foot and hand
Conveyors and conveying machinery
presses
Cranes, derricks, and hoists
Power-transmission apparatus
Dredges
Quarries
Drycleaning and dyeing
Refrigeration, mechanical
Sanitation, industrial
Dust explosions, prevention of
Scaffolds and staging
Elevators and escalators
Shipbuilding
Exhaust systems
Spray painting
Exits, building
Explosives
Steam shovels
Felt-hatting industry
Steel mills
Floor and wall openings, railings, and Sugar factories
toeboards
Tanneries
Forging and hot-metal stamping
Textiles
Foundries, protection of workers in
Ventilation
Welding
Grandstands
Heads and eyes, protection of
Woodworking plants
Ladders
Iowa.— Blanket regulations, covering specified health and safety conditions in
all workshops or other industrial establishments, except mines or in agricul
tural work, authorize orders by the State bureau of labor for proper observ
ance of the law. Regulations for mine safety are under the jurisdiction of the
State bureau of mines. Special industrial subjects covered include the following:
Laundry machinery and operation
Abrasive wheels
Mines
Boilers
Dust explosions, prevention of
Paper and pulp mills
Plumbing
Electrical installations
Elevators and escalators
Power presses, and foot and hand
Exhaust systems
presses
Power-transmission apparatus
Exits, building
Printing
Forging and hot-metal stamping
Rubber machinery
Foundries, protection of workers in
Heads and eyes, protection of
Sanitation, industrial
Woodworking plants
Ladders
Kansas.— No specific codes for special subjects, but statutory blanket regu
lations for all industrial establishments authorize orders from inspectors for
necessary changes according to individual judgment. In a general way the
following subjects are covered:
Dust explosions, prevention of
Abrasive wheels
Aeronautics (in part)
Electrical installations
Amusement parks
Elevators and escalators
Automobile brakes and brake testing Exits, building
Automobile headlighting
Explosives
Bakeries
Floor and wall openings, railings, and
Boilers (in part)
toeboards
Canneries
Foundries, protection of workers in
Colors for traffic signals
Gas installations
Construction work
Gas-mask canisters, colors for
Conveyors and conveying machinery
Heads and eyes, protection of (in part)
Cranes, derricks, and hoists
Ladders
Drycleaning and dyeing
Laundry machinery and operation
STATUS OF INDUSTRIAL SAFETY CODES
157
Printing
Lighting factories, mills, etc.
Machine tools
Protection from fire and panic
Milling industry
Quarries
Refrigeration, mechanical (in part)
Mines
Oil drilling
Sanitation, industrial
Scaffolds
and staging
Power control, electrical
Sugar factories
Power control, mechanical
Power presses, and foot and hand Ventilation
Walkway surfaces
presses
Power-transmission apparatus
Woodworking plants
Kentucky.—Statutory regulations cover only industrial sanitation (under the
State board of health), fire prevention (under the State department of fire
prevention and rates), coal mines (under the State department of mines), safety
provisions for miners and dust removal for polishing or grinding machinery
(under the department of agriculture, labor, and statistics). The latter is
authorized to inspect industrial establishments and suggest corrections of hazards.
Some safety codes have been adopted by the department for the guidance of
inspectors in making recommendations.
Louisiana.—Some statutory regulations exist, but the only inspection is in
the parish of Orleans by an inspector specifically provided by the law to enforce
the child-labor act. The following subjects are covered:
Printing
Construction work
Protection from fire and panic
Elevators and escalators
Sanitation, industrial
Exhaust systems
Scaffolds and staging
Exits, building
Ladders
Maine.— No codes have been adopted. The department of labor and industry
is permitted by law to order changes in ways, works, and machinery, where same
are deemed necessary. Safety provisions cover the following subjects:
Plumbing
Automobile headlighting
Power-transmission apparatus
Boilers (in part)
Sanitation, industrial
Compressed-air work
Tunnels
Exits, building
Maryland.— American Standards Association safety codes have been adopted
by the State industrial accident commission as minimum specific requirements
for safety and have the force of law. The following subjects are covered:
Laundry machinery and operation
Abrasive wheels
Lighting factories, mills, etc.
Compressed-air machinery
Lightning, protection aganist
Dust explosions, prevention of
Logging and sawmill machinery
Electrical installations
Mines
Elevators and escalators
Paper and pulp mills
Exits, building
Floor and wall openings, railings, and Power presses, and foot and hand
presses
toeboards
Power-transmission apparatus
Forging and hot-metal stamping
Refrigeration, mechanical
Foundries, protection of workers in
Rubber machinery
Gas installations
Textiles
Gas-mask canisters, colors for
Woodworking plants
Heads and eyes, protection of
Ladders
Massachusetts.— Under authority conferred by statute the State departments
of labor and industries, of public safety, and of public works have adopted a
number of health and safety codes covering the following subjects:
Ceramics
Abrasive wheels
Compressed-air machinery
Aeronautics
Construction work
Air-pressure tanks
Conveyors and conveying machinery
Automobile brakes and brake testing
Cranes, derricks, and^ hoists
Automobile headlighting
Drycleaning and dyeing
Bakeries
Electrical installations
Boilers
Elevators and escalators
Brewing and bottling
Exhaust systems
Canneries
158
1933 MEETING OF I.A .I.A .B .C .
Exits, building
Power control, electrical
Explosives
Power control, mechanical
Felt-hatting industry
Power presses, and foot and hand
Floor and wall openings, railings, and
presses
toeboards
Power-transmission apparatus
Foundries, protection of workers in
Protection from fire and panic
Gas installations
Quarries
Heads and eyes, protection of
Refrigeration, mechanical
Ladders
Rubber machinery
Laundry machinery and operation
Safety glass
Lighting factories, mills, etc.
Sanitation, industrial
Lighting of school buildings
Scaffolds and staging
Lightning, protection against
Spray painting
Logging and sawmill machinery
Steel mills
Metal working
Sugar factories
Painting
Tanneries
Paper and pulp mills
Textiles
Ventilation
Plate- and sheet-metal working
Potteries
Woodworking plants
Michigan.— In addition to stautory legislation, the department of labor and
industry has adopted rules and regulations for safety in industrial establish
ments, some of them as a result of conferences with those interested. The laws
and regulations cover the following subjects:
Abrasive wheels
Heads and eyes, protection of
Ladders
Automobile brakes and brake testing
Automobile headlighting
Laundry machinery and operation
Lighting factories, mills, etc.
Boilers
Lighting of school buildings
Canneries
Paper and pulp mills
Colors for traffic signals
Power control, electrical
Construction work
Conveyors and conveying machinery
Power control, mechanical
Power presses, and foot and hand
Dust explosions, prevention of
Electrical installations
presses
Power-transmission apparatus
Elevators and escalators
Rubber machinery
Exhaust systems
Sanitation, industrial
Exits, building
Floor and wall openings, railings, and Spray painting
Textiles
toeboards
Ventilation
Forging and hot-metal stamping
Welding
Foundries, protection of workers in
Woodworking plants
Gas installations
Minnesota.— The statutes relating to industrial safety are very general in
their application and authorize the industrial commission to promulgate specific
rules and regulations. With the exception of regulations for plumbing, which
are under the jurisdiction of the health department, these cover the following
subjects:
Heads and eyes, protection of
Abrasive wheels
Laundry machinery and operation
Automobile brakes and brake testing
Logging and sawmill machinery
Boilers
Paper and pulp mills
Brewing and bottling
Plumbing
Canneries
Power control, mechanical
Construction work
Power presses, and foot and hand
Conveyors and conveying machinery
presses
Drycleaning and dyeing
Power-transmission apparatus
Dust explosions, prevention of
Quarries
Electrical installations
Refrigeration, mechanical
Elevators and escalators
Sanitation, industrial
Exhaust systems
Scaffolds and staging
Exits, building
Floor and wall openings, railings, and Ventilation
Window washing
toeboards
Woodworking plants
Forging and hot-metal stamping
Foundries, protection of workers in
STATUS OF INDUSTRIAL SAFETY CODES
159
Mississippi.— No special safety codes have been adopted, but statutory pro
visions cover the following subjects:
Exits, building
Lighting of school buildings
Floor and wall openings, railings, and Power transmission
Sanitation, industrial
toeboards
Ventilation
Guarding of all machinery
Lighting factories, mills, etc.
Missouri.— The labor laws of the State contain general provisions for the
protection of industrial workers, with specific reference to several subjects but
details left to the judgment of the State department of labor and industrial
inspection, and the only specific rules formulated by the department pertain to
boilers. Including this code, and the regulations for mines which are under
the jurisdiction of the State bureau of mines, the following subjects are covered:
Foundries, protection of workers in
Abrasive wheels
(in part)
Automobile headlighting
Gas installations
Bakeries
Heads and eyes, protection of
Boilers
Mines
Colors for traffic signals
Floor and wall openings, railings, and Plant railways
Power control, mechanical
toeboards
Protection from fire and panic
Construction work
Sanitation, industrial
Dust explosions, prevention of
Scaffolds and staging
Elevators and escalators
Ventilation
Exits, building
Woodworking plants
Explosives
Montana.— Statutory provisions cover boilers and steam machinery, electrical
installations, and mines.
Nebraska.— The safety codes approved by the American Standards Associa
tion have been adopted as minimum requirements for safety. The following
subjects are covered:
Laundry machinery and operation
Abrasive wheels
Metal working
Air-pressure tanks
Paper and pulp mills.
Bakeries
Boilers
Power control, electrical
Construction work
Power control, mechanical
Conveyors and conveying machinery
Power-transmission apparatus
Cranes, derricks, and hoists
Pressure vessels
Drycleaning and dyeing
Rubber machinery
Exhaust systems
Safety glass
Exits, building
Sanitation, industrial
Heads and eyes, protection of
Scaffolds and staging
Ventilation
Ladders
Floor and wall openings, railings, and Window washing
Woodworking plants
toeboards
Nevada.— Statutory provisions cover the following subjects:
Abrasive wheels
Ladders
Electrical installations
Mines
Power-transmission apparatus
Exits, building
Floor and wall openings, railings, and Tunnels
toeboards
New Hampshire.— The factory-inspection law permits the bureau of labor
to issue orders covering any condition that is dangerous to the life and limb
of workers. Regulations issued cover the following subjects:
Floor and wall openings, railings, and
Abrasive wheels
toeboards (in part)
Automobile brakes and brake testing
Foundries, protection of workers in
Automobile headlighting
Heads and eyes, protection of
Boilers
Ladders
Compressed-air machinery
Laundry machinery and operation
Elevators and escalators
Lighting factories, mills, etc.
Exhaust systems
Logging and sawmill machinery
Exits, building (in part)
160
1933 MEETING OP I.A .I.A .B .C .
Machine tools
Sanitation, industrial
Paper and pulp mills
Tanneries
Power presses, and foot and hand Textiles
presses
Ventilation
Power-transmission apparatus
Walkway surfaces
Refrigeration, mechanical
Woodworking plants
New Jersey.—Statutory provisions and safety regulations cover the following
subjects:
Abrasive wheels
Heads and eyes, protection of
Boilers
Ladders
Ceramics
Laundry machinery and operation
Chemicals
Lighting factories, mills, etc.
Construction work
Potteries
Cranes, derricks, and hoists
Power control, electrical
Dust explosions, prevention of
Power control, mechanical
Electrical installations
Power presses, and foot and hand
Elevators and escalators
presses
Exhaust systems
Printing
Exits, building
Refrigeration, mechanical
Explosives
Rubber machinery
Felt-hatting industry
Sanitation, industrial
Floor and wall openings, railings, and Scaffolds and staging
Ventilation
toeboards
Forging and hot-metal stamping
Window washing
Foundries, protection of workers in
Woodworking plants
New Mexico.— No safety regulations exist. Some safety practices have been
applied in coal mines through cooperation of inspectors and employers, but
strictly voluntary, as there are no State laws for enforcement.
New York.—The State department of labor is authorized to formulate and
adopt codes or rules which have the same force and effect as statutes enacted
by the legislature. Such codes are supplementary to the labor law, which in
some sections is specific, but in others broad and general. They are developed
with the aid of an advisory committee, and public hearings are mandatory before
final adoption. The existing codes cover the following subjects:
Machine tools
Abrasive wheels
Metal working
Bakeries
Milling industry
Boilers
Mines
Brewing and bottling
Paper and pulp mills
Canneries
Plate- and sheet-metal working
Compressed-air work
Plumbing
Construction work
Potteries
Conveyors and conveying machinery
Power control, mechanical
Cranes, derricks, and hoists
Power presses, and foot and hand
Drycleaning and dyeing
presses
Dust explosions, prevention of (in
Power-transmission apparatus
part)
Printing
Elevators and escalators
Protection from fire and panic
Engines
Quarries
Exhaust systems
Rubber machinerj'
Exits, building
Sanitation, industrial
Explosives
Floor and wall openings, railings, and Scaffolds and staging
Tanneries
toeboards
Textiles
Forging and hot-metal stamping
Tunnels
Foundries, protection of workers in
Ventilation
Hand tools
Walkway surfaces
Heads and eyes, protection of
Welding
Ladders
Window washing
Laundry machinery and operation
Woodworking plants
Lighting factories, mills, etc.
STATUS OF INDUSTRIAL SAFETY CODES
161
North Carolina.— Rules and suggestions promulgated by the State department
of labor covering the following subjects:
Abrasive wheels
Lighting, factories, mills, etc.
Automobile brakes and brake testing
Lighting of school buildings
Automobile headlighting
Lightning, protection against
Bakeries
Mines
Chemicals
Painting
Colors for traffic signals
Plant railways
Plumbing
Cranes, derricks, and hoists
Electrical installations
Power control, electrical
Elevators and escalators
Power-transmission apparatus
Exits, building
Protection from fire and panic
Explosives
Quarries
Floor and wall openings, railings, and Sanitation, industrial
toeboards
Spray painting
Hand tools
Textiles
Heads and eyes, protection of
Ventilation
Ladders
Woodworking plants
North Dakota.— Safety regulations of the State department of agriculture
and labor cover the following subjects:
Boilers
Engines
Construction work
Exits, building
Conveyors and conveying machinery
Mines
Cranes, derricks, and hoists
Scaffolds and staging
Electrical installations
Ohio.—Safety codes prepared under statutory authorization by the indus
trial commission, with the assistance of representatives of employers and em
ployees, have the force and effect of statutory regulations. The following
subjects are covered:
Abrasive wheels
Metal working
Painting
Air-pressure tanks
Plate- and sheet-metal working
Bakeries
Plumbing
Boilers
Potteries
Ceramics
Compressed-air work
Power presses, and foot and hand
Construction work
presses
Cranes, derricks, and hoists
Power-transmission apparatus
Drycleaning and dyeing
Pressure piping
Pressure vessels
Elevators and escalators
Protection from fire and panic
Exhaust systems
Exits, building
Quarries
Explosives
Refrigeration, mechanical
Floor and wall openings, railings, and Rubber machinery
toeboards
Scaffolds and staging
Forging and hot-metal stamping
Spray painting
Foundries, protection of workers in
Steel mills
Hand tools
Tunnels
Ladders
Ventilation
Welding
Laundry machinery and operation
Lighting factories, mills, etc.
Window washing
Woodworking plants
Lighting of school buildings
Machine tools
Oklahoma.—Statutory regulations, or safety provisions issued by the State
department of labor to give effect to the laws, cover the following subjects:
Abrasive wheels
Dust explosions, prevention of
Bakeries
Elevators and escalators
Boilers
Engines
Brewing and bottling
Exhaust systems
Canneries
Exits, building
Compressed-air machinery
Explosives (in part)
Construction work
Floor and wall openings, railings, and
toeboards
Conveyors and conveying machinery
Foundries, protection of workers in
Cranes, derricks, and hoists
Heads and eyes, protection of
Drycleaning and dyeing
162
1933 MEETING OF I.A .I.A .B .C .
Ladders (in part)
Laundry machinery and operation
Lighting factories, mills, etc.
Logging and sawmill machinery
Machine tools
Metal working
Milling industry
Oil drilling
Plate- and sheet-metal working
Potteries
Power control, electrical
Power control, mechanical
Power presses, and foot and hand
Power-transmission apparatus
Pressure vessels
Printing
Safety glass
Sanitation, industrial
Scaffolds and staging
Steam shovels
Steel mills
Tanneries
Textiles
Ventilation
Walkway surfaces
Woodworking plants
Oregon.— Statutory provisions, or safety standards, promulgated by the indus
trial accident commission and having the effect of legislative action, cover the
following subjects:
Abrasive wheels
Lighting factories, mills, etc.
Air-pressure tanks
Logging and sawmill machinery
Boilers
Paper and pulp mills
Plumbing
Canneries
Compressed-air machinery
Power control, electrical
Construction work
Power control, mechanical
Conveyors and conveying machinery
Power presses, and foot and hand
Cranes, derricks, and hoists
presses
Electrical installations
Power-transmission apparatus
Elevators and escalators
Pressure piping
Exhaust systems
Pressure vessels
Exits, building
Printing
Floor and wall openings, railings, and Sanitation, industrial
Scaffolds and staging
toeboards (limited)
Foundries, protection of workers in
Walkway surfaces
Ladders
Window washing
Laundry machinery and opreation
Woodworking plants
Pennsylvania.— Safety codes, developed under statutory authorization by the
State department of labor and industry, assisted by employer and employee
representatives of the respective industries, and submitted to public hearings
before adoption, cover the following subjects:
Lighting factories, mills, etc.
Abrasive wheels
Automobile brakes and brake testing
Lighting of school buildings
Automobile headlighting
Logging and sawmill machinery
Machine tools
Bakeries
Milling industry
Boilers
Brewing and bottling
Mines
Canneries
Paper and pulp mills
Plant railways
Chemicals
Compressed-air machinery
Power control, electrical
Compressed-air work
Power control, mechanical
Construction work
Power presses, and foot and hand
Drycleaning and dyeing
Electrical installations
Power-transmission apparatus
Elevators and escalators
Printing
Protection from fire and panic
Engines
Exhaust systems
Quarries
Exits, building
Safety glass
Sanitation, industrial
Explosives
Floor and wall openings, railings, and Scaffolds and staging
Spray painting
toeboards
Forging and hot-metal stamping
Tanneries (in part)
Foundries, protection of workers in
Textiles
Gas installations
Tunnels
Heads and eyes, protection of
Window washing
Woodworking plants
Ladders
Laundry machinery and operation
STATUS OP INDUSTRIAL SAFETY CODES
163
Rhode Island.— Statutory provisions of the factory-inspection law and the
boiler-inspection law cover the following subjects:
Floor and wall openings* railings, and
Abrasive wheels
toeboards
Aeronautics
Automobile brakes and brake testing
Foundries, protection of workers in
Automobile headlighting
Laundry machinery and operation
Lighting factories, mills, etc.
Bakeries
Sanitation, industrial
Boilers
Scaffolds and staging
Colors for traffic signals
Construction work (cities)
Textiles
Ventilation
Explosives
South Carolina.— Statutory regulations pertaining to industrial establish
ments prohibit children under 14 from cleaning machinery while in motion and
require seats for female employees in mercantile establishments and sanitary
drinking receptacles, the only industrial safety regulations in the State.
South Dakota.— Statutory regulations cover automobile brakes and brake
testing, automobile headlighting, boilers, lighting of school buildings, and indus
trial sanitation where women or children are employed. They also cover building
exits (under the jurisdiction of the State fire marshal), as well as mines, quarries,
and the removal of gases, fumes, or dust in smelters or reduction works (all under
the jurisdiction of the State mine inspector).
Tennessee.— Safety standards adopted by the factory-inspection division of
the State department of labor and published for the use of inspectors or the indus
tries cover the following subjects:
Metal working
Abrasive wheels
Amusement parks
Paper and pulp mills
Compressed-air machinery
Plate- and sheet-metal working
Conveyors and conveying machinery
Power control, electrical
Power control, mechanical
Cranes, derricks, and hoists
Drycleaning and dyeing
Power presses, and foot and hand
Elevators and escalators
presses
Printing
Engines
Protection from fire and panic
Exhaust systems
Exits, building
Quarries
Floor and wall openings, railings, and Refrigeration, mechanical
Sanitation, industrial
toeboards
Foundries, protection of workers in
Spray painting
Gas-mask canisters, colors for
Tanneries
Ladders
Textiles
Ventilation
Laundry machinery and operation
Lighting factories, mills, etc.
Walkway surfaces
Logging and sawmill machinery
Woodworking plants
Machine tools
Texas.— The health, comfort, and safety law, the law for female employees,
and the child-labor law permit a broad field for safety rules in factories, mills,
workshops, and mercantile establishments. Specific requirements include exits,
handrailings, and industrial sanitation, but the State bureau of labor statistics
includes the following subjects as covered:
Logging and sawmill machinery
Amusement parks
Automobile brakes and brake testing Milling industry
Automobile headlighting
Mines
Colors for traffic signals
Plant railways
Plumbing
Construction work
Dust explosions, prevention of
Power presses, and foot and hand
presses
Electrical installations (local)
Power-transmission apparatus
Elevators and escalators
Printing
Exhaust systems
Exits, building
Protection from fire and panic
Explosives
Quarries
Floor and wall openings, railings, and Sanitation, industrial
toeboards (in part)
Scaffolds and staging
Gas installations
Stevedoring operations
Hand tools
Sugar factories
Ladders
Textiles
Laundry machinery and operation
Tunnels
Ventilation
Lighting factories, mills, etc.
Lighting of school buildings
Woodworking plants
164
1933 MEETING OP I.A .I.A .B .C .
Utah.— The industrial commission is authorized to promulgate and adopt safety
codes, rules, and regulations. A number of standards have been adopted as a
result of conferences with employers and employees. The following subjects
are covered:
Lighting of school buildings
Abrasive wheels
Logging and sawmill machinery (in
Air-pressure tanks
part)
Amusement parks
Automobile brakes and brake testing Machine tools
Metal working
(in part)
Milling industry
Automobile headlighting (in part)
Mines
Bakeries
Oil drilling
Boilers
Painting
Brewing and bottling
Plant railways
Canneries
Plate- and sheet-metal working
Ceramics
Plumbing
Chemicals
Potteries
Colors for traffic signals
Power control, electrical
Compressed-air machinery
Power control, mechanical
Compressed-air work
Power presses, and foot and hand
Construction work
presses (in part)
Conveyors and conveying machinery
Power-transmission apparatus
Cranes, derricks, and hoists
Pressure piping
Drycleaning and dyeing
Pressure vessels
Dust explosions, prevention of
Printing
Electrical installations
Quarries
Elevators and escalators
Refrigeration, mechanical
Engines
Safety glass
Exhaust systems
Sanitation, industrial
Exits, building
Scaffolds and staging
Explosives
Floor and wall openings, railings, and Spray painting
Steam shovels
toeboards
Forging and hot-metal stamping
Steel mills
Foundries, protection of workers in Sugar factories
(in part)
Tanneries
Gas-mask canisters, colors for
Textiles
Tunnels
Grandstands
Ventilation
Hand tools
Heads and eyes, protection of (in Walkway surfaces
Welding
part)
Ladders (in part)
Window washing
Woodworking plants
Laundry machinery and operation
Lighting factories, mills, etc. (in part)
Vermont.— No specific safety codes have been adopted. The statutes are
indefinite but broad so far as the jurisdiction of the State commissioner of
industries is concerned and the activities of that office cover the following
subjects:
Lighting factories, mills, etc.
Abrasive wheels
Logging and sawmill machinery
Compressed-air machinery
Construction work
Paper and pulp mills
Conveyors and conveying machinery
Power-transmission apparatus
Quarries
Cranes, derricks,' and hoists
Sanitation, industrial
Elevators, and escalators
Exits, building
Scaffolds and staging
Floor and wall openings, railings, and Tanneries
toeboards
Textiles
Foundries, protection of workers in
Ventilation
Heads and eyes, protection of
Walkway surfaces
Laundry machinery and operation
Woodworking plants
Virginia.— Statutory regulations give the State department of labor dis
cretionary powers in the regulation of safety appliances and sanitary con
ditions in industrial establishments, but does not provide for the establish
ment of safety codes. In 1930 the legislature appointed a committee to study
the advisability of adopting a safety code for employers and employees. A
report of this committee has been submitted to the legislature, recommending
STATUS OF INDUSTRIAL SAFETY CODES
165
promulgation of safety codes by the industrial commission, with enforcement
in the department of labor and industry. Specific statutory provisions cover
the following subjects:
Mines
Abrasive wheels
Elevators
Power-transmission apparatus
Exits, building
Quarries
Explosives
Washington.— Under statutory regulations the State department of labor and
industries has promulgated general safety standards, adopted after conferences
with employers and employees and holding of public hearings. These stand
ards have the status of legislative action, and carry penalties for noncompliance.
Much of the safety work is covered by city ordinances, such as building exits,
elevator operation, etc., and motor-vehicle subjects are under the jursidiction of
the highway patrol. The following subjects are covered:
Abrasive wheels
Mines
Oil drilling
Amusement parks
Painting
Automobile brakes and brake testing
Automobile headlighting
Paper and pulp mills
Boilers
Plant railways
Brewing and bottling
Plate- and sheet-metal working
Plumbing
Canneries
Chemicals
Potteries
Construction work
Power control, electrical
Conveyors and conveying machinery
Power control, mechanical
Cranes, derricks, and hoists
Power presses, and foot and hand
Dredges
Dry cleaning and dyeing
Power-transmission apparatus
Electrical installations
Pressure vessels
Printing
Elevators and escalators
Engines
Quarries
Exhaust systems
Refrigeration, mechanical
Exits, building
Sanitation, industrial
Scaffolds and staging
Explosives
Floor and wall openings, railings, and Shipbuilding
Steam shovels
toeboards
Foundries, protection of workers in
Steel mills
Hand tools
Textiles
Heads and eyes, protection of
Tunnels
Ventilation
Ladders
Laundry machinery and operation
Walkway surfaces
Welding
Lighting factories, mills, etc.
Logging and sawmill machinery
Window washing
Woodworking plants
Metal working
Milling industry
West Virginia.— No special rules have been issued, but statutory provisions
cover the following subjects:
Power control, electrical
Abrasive wheels
Power control, mechanical
Boilers
Power-transmission
apparatus
Elevators and escalators
Sanitation, industrial
Exits, building
Ventilation
Laundry machinery and operation
Woodworking plants
Mines
Wisconsin.— The industrial commission is charged with the duty of fixing
standards of safety in all places of public employment, and has promulgated
a number of safety codes or general orders, with the assistance of advisory
committees, and public hearings. Including the provisions for plumbing, which
are under the jurisdiction of the State board of health, the following subjects
are covered:
Boilers
Abrasive wheels
Colors for traffic signals
Aeronautics
Compressed-air work
Automobile brakes and brake testing
Construction work
Automobile headlighting
Cranes, derricks, and hoists
Bakeries
1933 MEETING OF I.A .I.A .B .C .
166
Paper and pulp mills
Plumbing
Dry cleaning and dyeing
Electrical installations
Power control, electrical
Power control, mechanical
Elevators and escalators
Power presses, and foot and hand
Engines
presses
Exhaust systems
Power-transmission apparatus
Exits, building
Pressure vessels
Explosives
Floor and wall openings, railings, and Printing
Quarries
toeboards (in part)
Refrigeration, mechanical
Forging and hot-metal stamping
Rubber machinery (in part)
Foundries, protection of workers in
Sanitation, industrial
Flammable liquids
Scaffolds and staging
Heads and eyes, protection of
Spray painting
Ladders
Tanneries (in part)
Laundry machinery and operation
Textiles
Lighting factories, mills, etc.
Tunnels
Lighting of school buildings
Logging and sawmill machinery (in Ventilation
Window washing
part)
Woodworking plants
Machine tools
Mines
Wyoming.— Under the authority of the act creating the State department of
labor and statistics, the commissioner issues safety orders for industrial estab
lishments, while under statutory mining regulations the safety orders for mining
are issued by the coal-mine inspection department. The following subjects are
covered:
Logging and sawmill machinery
Abrasive wheels
Machine tools
Aeronautics
Automobile brakes and brake testing Mines
Paper and pulp mills
Automobile headlighting
Plate- and sheet-metal working
Colors for traffic signals
Power control, electrical
Compressed-air machinery
Power control, mechanical
Construction work
Conveyors and conveying machinery
Power presses, and foot and hand
Cranes, derricks, and hoists
Power-transmission apparatus
Dust explosions, prevention of
Refrigeration, mechanical
Elevators and escalators
Rubber machinery
Exhaust systems
Exits, building
Sanitation, industrial
Floor and wall openings, railings, and Tanneries
toeboards
Textiles
Forging and hot-metal stamping
Ventilation
Foundries, protection of workers in
Walkway surfaces
Ladders
Window washing
Laundry machinery and operation
Woodworking plants
Lighting factories, mills, etc.
Chairman K e a r n s . The next number on the program is a report
on National Safety Codes Progress, by Mr. P. G. Agnew, secre
tary of the American Standards Association.
National Safety Codes Progress
By P. G. A g n e w , Secretary American Standards Association
There have been many developments in the national safety-code
program which are of special importance to governmental agencies,
and rather than go into the details of the progress of work on all
safety-code projects, which I understand will be printed in the pro
ceedings, I will limit my discussion to some of the high spots of the
safety-code activities.
NATIONAL SAFETY CODES PROGRESS
167
First, you will be interested to know what new projects have been
undertaken. Two have been initiated during the past year, covering
work in compressed air and specifications and methods of test for
safety glass. The first-named project is under the sponsorship of the
I.A.I.A.B.C. and was initiated as the result of a request received from
that organization. At the present time the States of New York, New
Jersey, Massachusetts, and Pennsylvania have safety codes on this
subject. A code for the State of California is in the course of prepa
ration. The increased use of compressed air in tunnel, bridging, and
building construction necessitating the use of caissons has made this
group of regulations of importance. As most of this work is done by
special contractors operating throughout the entire United States, it
is important that a national group of regulations with which these
contractors are familiar should be developed and put into use. The
sectional committee for this project has been appointed and work
will be undertaken during the coming winter.
The project on safety glass was initiated following a request re
ceived from the National Bureau of Casualty and Surety Under
writers, which organization, together with the Bureau of Standards,
is sponsoring this project. The scope of the code will cover all kinds
of safety glass used in motor vehicles, airplanes, boats, bullet-proof
glass for armored cars and partitions, and safety glass for use in
goggles. The specifications, as far as goggles are concerned, will
supplement and tie in directly with the specifications now contained
in the head and eye code.
While th© number of new projects which have been undertaken is
not very large, a successful effort has been made to revive some of
the other projects which have been lying dormant for a number of
years. Of particular interest is the safety code for ventilation and
the safety code for exhaust systems. The first code is still sponsored
by the American Society of Heating and Ventilating Engineers, but
a complete new sectional committee has been appointed and work
will be started this fall. In addition to all of the material previously
collected for use by the old sectional committee, the new committee
will have available the ventilation code requirements prepared by
the sponsor organization. It is expected that the new committee
will be able to make considerable progress in a short period of time,
inasmuch as many of the conflicting points of view of different
technical organizations have been brought into closer harmony during
the past 2 or 3 years.
The safety code for exhaust systems is now being sponsored by
the I.A.I.A.B.C., and the new technical committee for this code has
been appointed and will shortly proceed with the work. The scope
for this project remains as originally approved.
The industrial sanitation code, sponsored by the United States
Public Health Service, is now being actively developed by a sectional
committee as reorganized during the past year. The committee has
held one meeting, considering a tentative draft of the code prepared
by the sponsor. Plans have been made for the development of other
codes following the completion of the standard now being prepared
on industrial sanitation in manufacturing establishments. Other
codes will be developed covering labor camps and mercantile estab
lishments.
168
1933 MEETING OF I.A .I.A .B .C .
Among the projects now under revision that are of outstanding
importance is the safety code for the protection of the heads and eyes
of industrial workers. The sponsor, the United States Bureau of
Standards, has submitted a new scope in order to permit the project
to contain specifications for respirators. This new section will be of
extreme importance to all regulatory bodies in view of the emphasis
that is being placed these days on occupational diseases resulting from
dust hazards. Any regulatory bodies having special points of view
should send their comments to the representatives of the I.A.I.A.B.C.
and the A.G.O.I. so that they will be able to present such comments
to the sectional committee. Additional comments on the experience
of regulatory bodies in applying the provisions of the national head
and eye code would also be of considerable value to the sectional
committee.
The use of the national safety codes by regulatory bodies is con
stantly increasing, and there is one point in this connection which
has been brought forward and should be emphasized at this time.
Many of the States feel that it is not possible for them to use safety
codes, inasmuch as they have not been accorded any regulatory au
thority by their respective legislatures. That such States can use
safety codes in their inspection work is exemplified by the way in
which the State of New Jersey has found it possible either to develop
its own codes or to use the national codes without having specific
authority to do so.
The factory laws administered by labor departments prescribe that
certain hazards must be eliminated without specifically stating the
methods. In such cases inspectors, when issuing orders for the
elimination of hazards and when requested for information as to the
methods which should be followed, can refer to the safety codes as
the standards which are being followed by the department and in
this way put across the proper safety-code program. Of course, the
plant manager would be in position to follow his own method of re
moving a particular hazard if he so desired, but he would have to
furnish ample evidence that his own method was the equal of that
set forth in the standards of the Department of Labor.
The A.S.A. will be very glad to go into this situation further with
any regulatory body which would like to proceed with the develop
ment of a code program and has been unable to get the necessary
legal authority from its legislature.
National Safety Codes—Progress Report
A9 {1929).— Building-exits code
A.G.O.I. representative, John Campbell, Pennsylvania Department of Labor
and Industry.
I.A.I.A.B.C. representative, James L. Gernon, New York State Department
of Labor.
At the annual meeting of the National Fire Protection Association in May
1933, the proposed report of the building-exits code committee, which includes
certain revisions harmonizing this code and the building code of the United
States Department of Commerce was approved. It is expected that the revised
tentative draft will soon be printed and circulated to the members of the com
mittee and other interested groups for comment and criticism.
A10.— American standards for safety in the construction industry
The organization meeting of this sectional committee was held in September
1930, at which time arrangements were made for the appointment of six sub
committees with individual chairmen, to carry on the work of the various sections
NATIONAL SAFETY CODES PROGRESS
169
of the code. These subcommittees are now at work on the preparation of drafts
of the various sections and it is probable that a meeting of the sectional com
mittee will be held in connection with the National Safety Congress in Chicago
in October of this year.
A ll (1980).— Code of lighting: Factories, mills, and other work places
A.G.O.I. representative, C. H. Weeks, New Jersey Department of Labor.
I.A.I.A.B.C. representative, T. C. Eipper.
The revision of this code, which gives recommended values and minimum
requirements for illumination of various classes of industrial buildings and work
places has been widely used since its approval in 1930. The code has also been
recommended in a study on the Lighting of Work Places, published by the
Women’s Bureau of the United States Department of Labor.
A12 (1982).—Safety code for floor and wall openings, railings, and toe boards
A.G.O.I. representative, E. J. Pierce, New York Department of Labor.
I.A.I.A.B.C. representatives, J. L. Gernon, New York Department of Labor;
C. H. Weeks, New Jersey Department of Labor.
This code is the result of several years’ work of a broadly representative tech
nical committee and is perhaps one of the most important of the safety codes
developed during the last 10 years. It contains definitions and regulations ap
plying to aU places where there is a hazard of persons or materials falling through
floor and wall openings, or from stairways or runways. Copies of the code
were distributed to regulatory bodies, building inspectors and other interested
groups at the time of its approval.
A H .—Safety code for the construction, caref and use of ladders
I.A.I.A.B.C. representatives, R. J. Cullen and J. L. Gernon, New York De
partment of Labor; R. Me A. Keown, Industrial Commission of Ohio; J. P.
Meade, Massachusetts Department of Labor and Industries.
On the basis of comments and criticisms received following the distribution of
the last draft of this code, a final draft is now being prepared by the chairman of
the committee, and it is expected that it will be put to letter ballot of the sec
tional committee within a few weeks and then submitted to the American
Standards Association for approval.
A17 (1981).— Safety code for elevators, dumbwaiters, and escalators
A.G.O.I. representative, J. P. Meade, Massachusetts Department of Labor
and Industries.
I.A.I.A.B.C. representatives, M. H. Christopherson, New York State Insurance
Fund; C. H. Weeks, New Jersey Department of Labor.
The technical committee in charge of this code is a permanent one and an annual
meeting is held. At the meeting held in March of this year various revisions were
given consideration which will bring the code into line with the latest engineering
practice. The handbook for inspectors which will supplement the National code
has not yet been submitted for approval, but when it is completed this standard
will be of value as a means of giving additional information concerning the
application of the provisions of the code.
A22.—Safety code for walkway surfaces
A.G.O.I. representatives, John Campbell, Pennsylvania Department of Labor
and Industry: H. E. Mackenzie, Connecticut Department of Labor.
I.A.I.A.B.C. representative, T. C. Eipper.
The code drafting committee is still making every effort to prepare a draft for
submission to the sectional committee. Following the last meeting of the code
drafting committee, held on February 14, 1933, a questionnaire was sent out to
members of the committee asking for fundamental information from the field to
determine the type of material to be included in a draft code. A report is then
to be prepared for transmission to the full sectional committee summarizing the
work of the subcommittee and requesting that the members use the question
naire as a means of obtaining further practical information from industry.
A28 (1982).— Code for lighting of school buildings
This standard was prepared under the joint sponsorship of the Illuminating
Engineering Society and the American Institute of Architects, and the last
revision was approved as an American standard in September 1932.
A89.—Safety code for window cleaning
I.A.I.A.B.C. representatives, T. C. Eipper; C. A. Pense, Illinois Department
of Labor.
The final draft of this code has been approved by the sectional committee and
by the sponsor, the National Safety Council. It is now before the executive com
170
1933 MEETING OF I.A .I.A .B .C .
mittee of the safety code correlating committee and will be submitted for formal
approval to the Standards Council within a few weeks.
B7 (1980).—Safety code for the use, care, and protection of abrasive wheels
I.A.I.A.B.C. representatives, John Campbell, Pennsylvania Department of
Labor and Industry; H. G. Ehret, Industrial Commission of Ohio; R. Me A.
Keown, Wisconsin Industrial Commission; J. P. Meade, Massachusetts Depart
ment of Labor and Industries; John Roach, New Jersey Department of Labor.
The latest revision of this code was approved in June 1930. The code is con
tinuously under revision and the committee is now considering changes in certain
provisions of the code regarding allowable speeds for coping wheels. The per
manent sectional committee also acts as a committee on interpretation of technical
questions arising in the application of the code. The code has been almost
universally adopted throughout the grinding-wheel industry and as a basis of
requirements for State regulatory bodies and insurance inspectors.
B8 (1982).—Safety code for the protection of industrial workers in foundries
A.G.O.I. representative, E. J. Pierce, New York State Department of Labor.
The revision of this code which was originally approved in 1922 was developed
under the joint sponsorship of the American Foundrymen's Association and the
National Founders’ Association. Probably the outstanding provision of the
revised code is the requirement which applies to charging buggies (new equipment
only) calling for the use of small size automatic couplers. The revised code was
approved as American standard in April 1932.
B9 (1938).—Safety code for mechanical refrigeration
A.G.O.I. representative, M. H. Christopherson, New York State Insurance
Fund.
I.A.I.A.B.C representative, J. F. Scott, New Jersey Department of Labor.
A revision of this code covering the refrigerant methyl formate was approved in
January 1933. The code is still under revision and a list of amendments to the
present requirements has been prepared by the subcommittee on interpretations
and exceptions for consideration by the entire sectional committee. These
amendments cover the small office-household type of air conditioning unit which
was not included in the original code.
B ll (1926).—Safety code for power presses and foot and hand presses
This project was originally undertaken in 1920 and approved as American
tentative standard in 1922. The work of the committee was continued and in
December 1924 the code was advanced to the status of American standard.
The last revision was approved in 1926.
B15 (1927).—Safety code for mechanical power transmission apparatus
I.A.I.A.B.C. representatives, John Campbell, Pennsylvania Department of
Labor and Industry; S. Kjaer, United States Bureau of Labor Statistics; R. Me A.
Keown, Industrial Commission of Wisconsin; J. P. Meade, Massachusetts
Department of Labor and Industries; John Roach, New Jersey Department of
Labor.
A new section to this code, on mechanical power control, has been before a
special subcommittee for some time, but no progress has been made during the
last year owing to the difficulty of securing attendance at committee meetings
under present business conditions.
B19.— Safety code for compressed-air machinery
I.A.I.A.B.C. representative, J. F. Scott, New Jersey Department of Labor.
This committee has been inactive for several years and no meetings have been
held.
B20.—Safety code for conveyors and conveying machinery
A.G.O.I. representative, J. P. Meade, Massachusetts Department of Labor
and Industries.
I.A.I.A.B.C. representatives, M. H. Christopherson, New York State Insur
ance Fund; R. Me A. Keown, Industrial Commission of Wisconsin; J. F. Scott,
New Jersey Department of Labor.
This project is being developed under the sponsorship of the American Society
of Mechanical Engineers and the National Bureau of Casualty and Surety Under
writers. The work has been divided into several sections and subcommittees are
now at work preparing drafts which will be considered at a later date by the entire
sectional committee.
B 24 (1927).— Safety code for forging and hot-metal stamping
A.G.O.I. representatives, J. P. Meade, Massachusetts Department of Labor
and Industries; John Roach, New Jersey Department of Labor.
NATIONAL SAFETY CODES PROGRESS
171
I.A.I.A.B.C. representatives, R. McA. Keown, Industrial Commission of Wis
consin; S. Kjaer, United States Bureau of Labor Statistics.
This code was initiated in 1923 and approved as American recommended
practice in April 1927. No revision has been undertaken.
B28.—Safety code for rubber machinery
A.G.O.I. representative, E. L. Sweetser, Massachusetts Department of Labor.
I.A.I.A.B.C. representatives, S. Kjaer, United States Bureau of Labor Sta
tistics; John Roach, New Jersey Department of Labor; R. E. Lee, Ohio Depart
ment of Industrial Relations.
A subproject, B28a, safety code for rubber mills and calenders, was completed
by the technical committee in charge of this code and approved as American
recommended practice in March 1927. The committee is at present inactive.
B80.—Safety code for cranesf derricks, and hoists
A.G.O.I. representative, E. B. Patton, New York Department of Labor.
I.A.I.A.B.C. representative, S. Kjaer, United States Bureau of Labor Statistics.
A completed draft of this code was submitted to the members of the sectional
committee in July 1932. Various comments and suggestions were received as the
result of the circulation of this draft, and they are still being considered by the
sectional committee.
B31.— Code for pressure piping
I.A.I.A.B.C. representative, A. L. Wilhoit, Youngstown Sheet & Tube Co.,
Youngstown, Ohio.
No drafts of this standard have been completed or submitted for final approval.
The sponsor for the project, the American Society of Mechanical Engineers
is now preparing revised drafts which have been reviewed by the editorial
committee.
C2 (1927).— National electrical safety codet parts I and I I I
I.A.I.A.B.C. representative, S. Kjaer, United States Bureau of Labor Statistics.
This project was approved in 1927 as American standard. While no revisions
have been undertaken during the past year, one of the rules of the code provides
that when new values for the ultimate fiber stresses of wood poles shall have been
formulated by the sectional committee on wood poles-05, the values given in the
national electrical safety code shall be proportionately adjusted. New values for
these fiber stresses were approved as American standard in November 1930 and
have therefore been incorporated in the electrical safety code.
D1 (1925).—Aeronautic safety code
This project was developed under the joint sponsorship of the Society of Auto
motive Engineers and the Bureau of Standards and approved as an American
tentative standard in 1925. The Bureau of Standards later resigned from its
sponsorship, leaving the Society of Automotive Engineers as sole sponsor. In
January 1933 a request was received from the American Society of Mechanical
Engineers for a revision of this code. The sponsor was notified of this request,
but the American Standards Association has not as yet been advised as to whether
or not such a revision will be undertaken. The present code is completely obso
lete, necessitating its either being revised or dropped from the status of American
standard.
D2 (1922).—Safety code for automobile headlighting—laboratory tests for approval of
electric headlighting devices for motor vehicles
This code was submitted for approval as an existing standard by the Illumi
nating Engineering Society in 1921, and was given formal approval as American
tentative standard in November 1922. The Illuminating Engineering Society
and the Society of Automotive Engineers were then designated as cosponsors to
undertake a revision of the code. Extensive research was carried on and in
January 1928 a proposed revision was issued by the Illuminating Engineering
Society for trial, comment, and criticism. In October 1932 the National Bureau
of Casualty and Surety Underwriters requested the early completion of this
revision as being of vital interest both from a humanitarian and from a commer
cial point of view. An informal conference was held composed of members of the
sponsor organizations, the National Bureau and the American Standards Asso
ciation staff. It was agreed by the meeting that a sectional committee should
immediately be formed to undertake the development of a comprehensive group
of national specifications covering not only the technical points in the construction
of headlights but also standards of service and usage.
25616°—34----- 12
172
1933 MEETING OF I.A .I.A .B .C .
D8 {1927).— Colors for traffic signals
This code was developed under the sponsorship of the American Association of
State Highway Officials, the Bureau of Standards, and the National Safety
Council, and was approved as American standard in November 1927. It repre
sents the only group of national standards which have been developed on this
subject. No revision is at present being undertaken.
D4 (1927).—Safety code for brakes and brake testing
The American Automobile Association and the Bureau of Standards acted as
joint sponsors for this project, which was approved as American tentative stand
ard in 1927. A revision has been under way for several years and considerable
research work has been done, but owing to the lack of funds it has been impossible
to complete the research work necessary. Obtaining new funds will probably
have to await improvement in business conditions.
D5.— Manual on street-traffic signs, signals, and markings
The American Engineering Council, sponsor for this project, has requested that
action by the American Standards Association be delayed, due to the formation
of a joint committee of the American Association of State Highway Officials and
the National Conference on Street and Highway Safety to bring about the coordi
nation of the codes of the organizations. The joint committee has made very
definite progress in the development of a manual following considerable research
conducted by the Bureau of Standards. It is expected that the committee will
complete its work by the end of the year.
K2 (1927).—Gas safety code
This code was developed under the sponsorship of the American Gas Associa
tion and the Bureau of Standards and was approved as an American standard in
December 1927.
K1S (1980).—Safety code for the identification of gas-mask canisters
A.G.O.I. representative, John Roach, New Jersey Department of Labor.
I.A.I.A.B.C. representative, C. A. Pense, Illinois Industrial Commission.
Under the sponsorship of the National Safety Council this code was approved
as American recommended practice in January 1930. As a result of a sugges
tion of the German national standardizing body that this code be correlated with
other national codes on the same subject, the International Standards Association
was requested to appoint a committee to consider the correlation of the work of
the several national standardizing bodies. No action has as yet been taken.
LI (1929).—Safety code for textiles
A.G.O.I. representative, John Campbell, Pennsylvania Department of Labor
and Industry.
I.A.I.A.B.C. representatives, J. P. Meade, Massachusetts Department of Labor
and Industries; H. M. Stanley, Georgia Industrial Commission.
Work on this code was undertaken in 1925 and was approved as American
tentative standard in March 1929.
01 (1930).—Safety code for woodworking plants
I.A.I.A.B.C. representatives, R. McA. Keown, Industrial Commission of
Wisconsin; S. Kjaer, United States Bureau of Labor Statistics; J. P. Meade,
Massachusetts Department of Labor and Industries.
This code became an American tentative standard in 1924 under the sponsor
ship of the National Bureau of Casualty and Surety Underwriters and the
I.A.I.A.B.C. A revision was approved as American standard in March 1930.
The sectional committee is now considering the question of dust explosions as
related to woodworking establishments, but no drafts have as yet been submitted
to the American Standards Association for approval.
02 (1924).—Logging and sawmill safety code
See p. 174.
PI (1926).—Safety code for paper and pulp mills
I.A.I.A.B.C. representatives, John Campbell, Pennsylvania Department of
Labor; J. P. Meade, Massachusetts Department of Labor; H. Schreiber, Wiscon
sin Industrial Commission.
This code was developed under the sponsorship of the National Safety Council
and approved as American tentative standard in January 1925. This code is now
under revision and several additions have been made to the personnel of the
sectional committee. A revised draft of the code was circulated to members of
the sectional committee under date of January 24, 1933, and a meeting of the
committee has been held to consider this draft.
NATIONAL SAFETY CODES PROGRESS
173
Z$ (1922).— National safety code for the protection of the heads and eyes of industrial
workers
A.G.O.I. representative, J. P. Meade, Massachusetts Department of Labor and
Industries.
I.A.I.A.B.C. representative, C. W. Roberts, M.D., Atlanta, Ga.
This project was sponsored by the Bureau of Standards and approved as
American recommended practice in 1921. It was advanced to the status of
American standard in October 1922. A revision was undertaken in 1928 and
the scope found not to be broad enough to include gas masks and respirators.
The sponsor was asked to submit a restatement of scope for approval to cover
these subjects. This statement has now been received and referred to the com
mittee on scope for recommendation. A draft was submitted to the committee
under date of May 26, 1933, and on June 8 further material was forwarded to
the committee supplementing the draft. It is probable that some reorganiza
tion of the technical committee will be undertaken to insure that all interested
groups are afforded representation.
Zlf..— Safety code for industrial sanitation
A.G.O.I. representative, T. C. Eipper.
I.A.I.A.B.C. representatives, John Campbell, Pennsylvania Department of
Labor; S. Kjaer, United States Bureau of Labor Statistics; John Roach, New
Jersey Department of Labor.
A second draft of this code was forwarded to the sectional committee under
date of June 13, and the first meeting of the reorganized committee held on
July 12. Various changes in the draft were considered by this meeting and the
proposed revisions have been circulated to the entire committee. It is expected
that another meeting will be held in the early fall for the purpose of completing
the section of the code now under consideration, the safety code for industrial
sanitation in manufacturing establishments.
Z5.—Ventilation code {proposed committee)
A.G.O.I. representative, John Vogt, New York State Department of Labor.
I.A.I.A.B.C. representative, John Vogt.
The sectional committee being formed by the sponsor, the American Society
of Heating and Ventilating Engineers is now practically completed and it is
expected that work will be begun on the project in the early fall.
Z8 {1924).—Safety code for laundry machinery and operations
This code was developed under the sponsorship of the A.G.O.I., the Laundryowners National Association, and the National Association of Mutual Casualty
Cos. It was approved as American tentative standard in June 1924.
Z9.—Safety code for exhaust systems
A.G.O.I. representative, John Roach, New Jersey Department of Labor.
I.A.I.A.B.C. representatives, John Campbell, Pennsylvania Department of
Labor and Industry; T. P. Kearns, Industrial Commission of Ohio.
The sponsorship for this project has been reassigned to the I.A.I.A.B.C. and
the sectional committee is now about completed. An organization meeting will
probably be called some time in the near future and work actively begun.
Z12.—Safety codes for the prevention of dust explosions
A.G.O.I. representative, W. J. Burk, New York State Department of Labor.
I.A.I.A.B.C. representative, John Roach, New Jersey Department of Labor.
Under the joint sponsorship of the National Fire Protection Association and
the United States Department of Agriculture, nine standards have already been
approved under this general heading. This is a permanent committee, and other
standards having to do with the prevention of dust explosions will be submitted
from time to time.
Z13.—Safety code for amusement parks
A.G.O.I. representative, T. C. Eipper.
I.A.I.A.B.C. representative, S. W. Homan, Pennsylvania Department of Labor
and Industry.
Various sections of this code are being developed by subcommittees and
several drafts have been submitted to the American Standards Association for
correlating and editing. The work is being carried on under the sponsorship of
the National Association of Amusement Parks and the National Bureau of
Casualty and Surety Underwriters, but owing to business conditions during the
past 2 years very little progress has been made.
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1933 MEETING OF I.A .I.A .B .C .
Z16.—Standardization of methods of recording and compiling accident statistics
A.G.O.I. representative, J. H. Hall, Jr., Virginia Bureau of Labor and Industry.
I.A.I.A.B.C. representatives, Evan I. Evans, Industrial Commission of Ohio;
A. O. Fried, Industrial Commission of Wisconsin; L. W. Hatch, New York State
Department of Labor; W. J. Maguire, Pennsylvania Department of Labor and
Industry.
This code is being sponsored by the I.A.I.A.B.C., the National Council on
Compensation Insurance, and the National Safety Council. A final draft of
part I on definitions and rates has been submitted to the sectional committee for
letter ballot but no action has as yet been taken.
Z20.—Safety code for grandstands
A.G.O.I. representative, E. F. Seiller, Kentucky Department of Labor.
A final draft of the subcommittee on portable steel and wood grandstands has
been completed and is now being put to letter ballot of the subcommittee. It
will then be submitted to the sectional committee and later to the American
Standards Association as a separate standard under the general heading of the
grandstand code.
Z26.—Specifications and methods of test for safety glass
This project was initiated in March 1933, and the National Bureau of Casualty
and Surety Underwriters and the Bureau of Standards appointed as cosponsors.
The following scope has been approved:
“ Specifications and methods of test for safety glass (glass designed to lessen
or prevent injuries resulting from accident) as used for all purposes, including
windshields and windows of motor vehicles, motorboats, and aircraft; goggles;
and bullet-proof windows and partitions.”
The sponsors are now completing the personnel of the sectional committee and
it is expected that the work will go forward early in the fall.
Z28.—Safety code for work in compressed air
The initiation of this project and the assignment of sponsorship to the
I.A.I.A.B.C. was approved in January 1933. The sectional committee is now
being formed and work will probably be started within a very short time.
The approved scope of the project under which the committee will carry on
its work is as follows:
“ Construction and operating rules for work in caissons, tunnels, or wherever
workers are subjected to air under pressure higher than atmospheric; including
protection from mechanical hazards, the use of necessary instruments and
apparatus, provision of locks, methods of lighting, communication and decom
pression, the keeping of records, medical attendance, periodic inspection and air
analysis, rest rooms, hours of labor, sanitation, ventilation, fire prevention, fire
protection, temperature control, and other conditions of work.”
BIS {1924).—Logging and sawmill safety code (revision to be called 01)
This code was developed under the sponsorship of the Bureau of Standards and
was approved as American tentative standard in January 1924. The National
Safety Council is now collecting material to be placed before the sectional committee
in connection with a revision which will advance the code to a full American stand
ard. The sectional committee is now considering, in cooperation with the
committee on dust explosions, Z12, the question of dust explosions as related to
logging and sawmill operations.
DISCUSSION
Chairman K e a r n s . Are there any questions that anyone would
like to ask at this time about this report, or about the progress of
codes?
Mr. K e e f e r (Illinois). The National Safety Council has been very
much interested, of course, in the safety-code work of the American
Standards Association. We have had a representative in Washing
ton, D.C., for several months in conferences with officials of the
N.R.A. I should like to ask Dr. Agnew, if I may, what chance there
is, in the first place, of securing recognition of the A.S.A codes in the
N.R.A. codes that are coming up for approval from time to time.
NATIONAL SAFETY CODES PROGRESS— DISCUSSION
175
Dr. A g n e w . We have made no formal representation to the N .R .A .
about that. Some organizations have made inquiries as to why we
should not have the safety codes written into General Johnson's
general industrial codes. Our reply to those inquiries has been that
while we believe that the proposal would be an extremely valuable
one, we have not felt quite free to press for it. The American Stand
ards Association has been very jealous of not becoming known in any
way as a lobby organization. So we have responded to this proposal
that we think that either the State bodies or perhaps the Industrial
Advisory Board or the Labor Advisory Board might be the proper
bodies to bring this up. I have transmitted copies of that correspond
ence with a little memorandum to the Secretary of Labor. I think
perhaps Dr. Iioyd might add something on that extremely important
point.
Dr. L l o y d (Washington, D.C.). As it actually works out in prac
tice, it is not the Industrial Advisory Board nor the Labor Advisory
Board which has taken the initiative in this matter, but the Con
sumers' Advisory Board. It is now definitely proposing to the Admin
istration that something should be said in the codes along two lines.
One involves the quality of the product, which is essentially a con
sumer consideration, making it a matter of fair practice property to
represent quality, and to maintain, as far as possible, good quality.
The Consumers' Advisory Board considers it is also a matter of con
cern to the consumer to prevent industrial accidents, because we all
know that accidents are costly. We know that the cost is far greater
than the mere compensation which is paid to the worker, it having
been estimated that industry pays four times that amount. We also
know that such increased costs of production are going to be reflected
in the price to the consumer. The Consumers' Advisory Board has
consequently considered it appropriate to its field to make some
move toward writing into these codes some element of accident
prevention by making it a matter of fair competition between the
producers to keep their accidents down as far as possible.
An effort is being made to have the matter of safety standards and
quality standards brought into some of these codes and to put all
manufacturers on the same basis in respect to those matters. At
some of the public hearings it has been proposed that a number of
these safety codes should be written into the industrial codes. I
recall particularly the hearing on the code for the soft-coal industry,
which has not yet been finally promulgated. The representative of
the American Association for Labor Legislation made a pronounced
request that since there are so many deaths of coal miners due to
explosions in mines, since these can easily be prevented by rock
dusting, and since there is an American standard code for rock
dusting of soft-coal mines, that that should be put into the industrial
code. It is not yet known whether that will be done. That is a
very striking instance of accidents that are very expensive and that
can very easily be prevented. One of our American standard codes
is available to tell just how it should be done.
Miss J o h n so n (Massachusetts). I understand that the American
Standards Association has encouraged regional agreements applying
to States on the adoption of uniform safety codes. I should like to
ask Dr, Agnew how that is progressing and whether any action
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1933 MEETING OF I.A .I.A .B .C .
is being taken by the association in connection with the movement for
interstate compacts. I do not know whether any other State has
enacted such legislation, but this year Massachusetts passed a
resolve providing for the appointment of a commission to take up
with competing States, or States in the vicinity, the question of
uniform labor legislation compacts, or agreements between the States
for uniform labor laws. Although that resolve mentioned specifically
hours of labor and wages, it is broad enough to include specific
questions in the matter of safety and industrial hazard. I am
wondering if the American Standards Association was planning any
action in connection with that commission.
Dr. A g n e w . The Safety Code Correlating Committee, of which
you are a member, has through a subcommittee developed a model
safety law. Our board of directors has felt (there has not been any
official action) that that work really lies beyond the scope of the
association. Consequently, I have informally conferred with the
Secretary of Labor in reference to that and have given the Secretary
copies of the developments up to date. It was my understanding
that it was the intention of Miss Perkins and her colleagues to discuss
that point with the joint bodies now in session. I do not know what
the plans are, but I should think that is a point which might well
come up for discussion and action by this joint body here today. It
seems to me that these two bodies are the bodies which should
handle such questions.
Chairman K e a r n s . The next speaker on the program is Mr. W.
Dean Keefer, who has been connected with the National Safety Council
for a period of about 15 years, first as business manager and later as
director of the industrial division. The National Safety Council,
through this industrial division under the direction of the speaker,
has done a splendid job in accident-prevention work in industry, in
the home, and in public safety. There is no one in America to whom
I would rather go for counsel and advice on industrial safety work
than to Mr. Keefer.
The New Deal and Safety
By W.
D ean K eefer,
Director Industrial Division, National Safety Council
The subject that your chairman assigned to me, The New Deal
and Safety, seems to carry with it the implication that in the past 20
years the safety men in industries have done a pretty good job of it.
But perhaps we are now entering a new era when it is about time to
cast aside some of our old methods, some of our old activities, and
look for something new, something with which we might combat new
problems.
Some of the industrialists with whom I have spoken in recent weeks
have expressed the fear that accident rates are going to go up, because
they see in the future or in the next month or two, thousands of workers
coming back to the job, perhaps with reduced skill, perhaps with
reduced stamina. They call attention to the fact that the mental
hazards of these jobs are going to be increased because the men have
been worried by idleness, they have financial obligations which are
pressing, and maybe sickness in the home.
THE N E W DEAL AND SAFETY
177
Unquestionably these factors are big factors which we must con
sider if we are to attempt to keep our accident rates down to the low
levels which have been established in 1930, 1931, and 1932. Un
doubtedly the fears that have been expressed by State labor depart
ment officials and by industrialists are justified. This is the first
point I want to discuss briefly: Do we want to cast aside all of the
plans, all of the activities, all of the methods which have proved to be
so satisfactory and so successful during recent years, and look around
for something brand new just in the hope that it may work miracles
for us?
Before I discuss that point in detail I want to review hurriedly the
success that has attended the accident preventionists in industry
during the past 20 years, and see if we can draw from the success
that has met the efforts of these men anything that will interest us
concerning the activities which they have followed in bringing about
this success. Perhaps the most comprehensive accident data or acci
dent statistics which we have available now have come to us through
the National Safety Council, which has estimated that there were
19.000 industrial fatalities in 1928, 20,000 in 1929, 19,000 in 1930,
17.000 in 1931, and 15,000 in 1932. There were no satisfactory esti
mates prior to 1928, so far as we can make out. From the period
of about 1920 to 1928 the figure usually quoted was 23,000, without
much change from year to year. Prior to 1920 the figure usually
quoted was anywhere between 23,000 and 35,000. However, in spite
of the fact that we do not have more convincing data, I think we can
rest assured that the safety men in industry have done a pretty good
job; success has fairly well attended their efforts. How far can we
1 n such fig
° ^
*1
mnot take them at their face
because
consideration the important
factor of exposure.
Here again I think we can turn to some of the records of the Na
tional Safety Council, the individual reports of individual industrial
concerns. There were 4,000 individual industrial concerns reporting
to the council in 1932, and from the tabulated records of these various
individual concerns we have figured the. frequency rates and the
severity rates. From 1926 to 1931 the indexes for frequency rates
declined 60 percent and for severity rates declined 36 percent.
It is on the basis of this downward trend that I feel rather optimistic
about the plans, methods, and activities which we have been using
in the past, and I wonder if we can afford to discard all of the things
which have been worked out and have proved to be fairly successful.
As I see it, the average State department of labor, industrial board,
or industrial compensation board has its safety activities pretty well
divided into three general classifications: (1) Formulation and en
forcement of safety laws, rules, and regulations; (2) encouragement
of backward employers to organize as their forward-looking competi
tors have done; and (3) helping backward employers, once any interest
on their part has been secured.
The first- activity I think needs little consideration. Let me make
one point, however. In all this work of formulating and enforcing
safety laws, rules, and regulations the work has gradually been on the
decline, and I think justifiably so, because there are literally thousands
of employers throughout the United States who are vitally interested
in safety work. Not only have these employers complied with the
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1933 MEETING OP I.A .I.A .B .C .
laws and rules and regulations of the States under which they work,
but many of them have gone way beyond that, not only doing the
minimum required by the State enactments, but actually doing
the maximum for the protection of their workers.
If I may be permitted to criticize any of the States in the United
States, I think that criticism should be leveled against those States
which have devoted too much time and attention to the enforcement
part of their programs.
The second function of State departments, that of encouraging
employers to take an interest in accident prevention, is certainly an
old job. I wonder if we want entirely to abandon encouraging the
backward employers to take an interest in safety work—to organize
safety work as they have organized sales, or as they have organized
production and accounting. Until all groups combine in selling
safety to these backward employers we are certainly not going to
attain the millenium which was mentioned by one of our former
speakers. Even though this may be an old job, we cannot afford to
throw it aside and look for something brand new with which to combat
a supposedly new problem.
The third point, that of helping employers once a fraction of
interest has been attained, from a safety point of view is perhaps the
most important function of a State department. The problem which
confronts you in this respect is quite similar to the problem which
confronts the National Safety Council along the same line. We know
that every year a few of the companies which become members of the
National Safety Council sign their names on the dotted line, pay $50
average annual dues, put up a few posters, and then expect that the
millenium has come and that accidents will naturally drop to zero.
They do not realize, sometimes, that the best the National Safety
Council can do for them under such circumstances is to give to them
the accumulated experience of thousands of other employers to give
them posters, pamphlets, leaflets, etc., which they can use; but, if
they are to be effective and accomplish anything they must be studied,
. adapted, and applied. By whom? By the council? By the State
department? No; by the employer himself. He has to be taught,
led by the hand, if you please, into what he considers an easy job, that
of preventing industrial accidents. In that respect, it seems to me,
your work is very similar to the work of the National Safety Council.
The council or the State or any other organization cannot alone
prevent accidents. The work must be done by the employer.
A short time ago I had an opportunity to talk to a State official in
one of the States, who told me of the criticism that had been leveled
against him and his associates because a catastrophe had occurred in
his State whereby some 12 workers were killed. This critic, I think
falsely, accused the State department of neglecting to enforce safety
laws, rules, and regulations in that State, and practically laid the
entire blame for that catastrophe upon the shoulders of the State
department. In my humble opinion, this commissioner in replying
to this criticism prepared a masterpiece, bringing out, among other
things, the very important fact that safety can never be legislated and
enforced into industry. Safety must be sold and taught into industry.
I wonder if all of us realize the importance and the truth of such a
statement.
THE NEW DEAL AND SAFETY
179
The New Deal certainly brings new problems, but let me repeat
my question: Does the New Deal make it necessary for us to cast aside
all 01 the plans and all of the activities which have proved successful,
and does that New Deal require us to look for new plans and new
ideas which we hope will bring success?
The second point I want to discuss briefly is this: If we are convinced
in any way, shape, or form that we can not afford to throw away all
of our old ideas and plans, then what is there that we can pick up from
the old regime? What plans should we consider at this time? What
old things should we still work on in carrying out the selling and
teaching program that we have laid out for ourselves?
What is new in safety? That question is a very hard one to answer.
There is not very much that is new, certainly not from a day-to-day
standpoint, and what may be new to me may be awfully old to 99 out
of 100 others. Perhaps it is partly due to my difficulty in answering
that question that I feel somewhat conservative on this matter. Is
there very much that is new? Has very much that is new come to
your attention, either through your own efforts or through the efforts
of the safety men who are working in your State?
Accidents are still occurring in much the same way as in the past
decade, aren’t they, and aren’t most accidents the result of unsafe
conditions and unsafe practices? Isn’t it still the job of the employer
to safeguard his machinery and equipment and to teach his men the
safest way to do their jobs? Those are the fundamentals, it seems to
me, of the accident-prevention program in industry.
I wonder if there are not many safety men, many State officials in
the United States, who in these trying times are just sitting back
waiting for the heavens to open and some new discovery to come out
that will create a royal road to success and relieve them of the
responsibility of fighting for results.
This reminds me of the old king in the ancient days who decided
that he wanted to learn mathematics. He called in the greatest
mathematician of the time and said to him, “ I want to be taught all
there is to know about mathematics in one lesson.” What did the
mathematician reply? He said something like this: “ In spite of the
fact you are the king, you cannot learn mathematics in one lesson.
You are going to have to sit down and study, just like every other
common ordinary individual. There is no royal road to knowledge,
certainly not in mathematics.”
I feel pretty strongly that there is no royal road to success in accident-prevention work, and perhaps our seeking for it is going to lead
us up some blind alley. In view of that fact, may it not be advisable
for us to do a little studying, a little work, a little thinking.
I call to mind a story that was told about Lloyd George some time
ago. Lloyd George, in giving advice to a young politician, said this:
“ If you want to learn anything about a subject and become an expert
on it, you have to study first of all. Then after you have studied, to
clinch your knowledge, sit down and write a book. If you don’t
want to write a book, do something, even make a speech. If you
can’t find an audience before whom to make your speech, go ahead
and make that speech to your wife. Maybe you won’t teach her an
awful lot, but she will certainly teach you a lot.”
Another example along this same fine comes to us from the ex
perience of Papini, who, you know, started out some years ago to
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1933 MEETING OF I.A .I.A .B .C .
write a book disproving the divinity of Christ. Some of us recall
that the more Papini studied on the subject the more convinced
he became that Christ was divine, and finally he wrote one of the
best books of its type, the book depicting the life of Christ and
absolutely proving His divinity.
I mention these illustrations simply to bring out the point that
studying, writing, speaking, and adapting are the things we must
do if we are to be successful in our accident-prevention work.
A short time ago I asked one of my friends here in Chicago: “ Tom,
you have done a lot of safety work in the last 20 years. You have
pulled a lot of stunts and I am wondering if you have not thrown away
a lot of those stunts, discarded them, called them no good. Sup
pose your boss came to you and said, Tom, look here. I am going
to restrict you to one activity now, from now on, just one activity.
What will that activity be?’ ”
Tom reflected a moment and said that if he were restricted to one
activity in safety, and only one, he felt that he would carry on pretty
much the same activity he had been carrying on for the past 8 or
10 years, that in which the foremen of the plant had a luncheon
meeting every day, under the chairmanship of the operating super
intendent, to discuss two things, operating problems and safety.
But he did not split it into two; he said operating problems, including
safety. I asked him to tell me more about it.
First, he told me that his job consisted of passing over to the chair
man of the meeting a short list giving a couple of the high points
on every accident that had occurred during the 2 or 3 days preceding
the meeting. The chairman would get up, start to read the list,
and say, “ The first accident we have here is to Bill Jones, out in
the heat-treating department. Tom, you are foreman in that
department. What about that accident?”
My friend, in telling this story, said the first two or three times the
chairman pulled this stunt the foreman would get up, scratch his
head, and say, “ I didn’t know that man was hurt. Tell me about
it.” And the general superintendent did. First of all, he said
something like this, “ Well, you are the foreman of your department,
aren’t you?”
“ Yes.”
“ You are supposed to be responsible for the production out there?”
“ Yes.”
“ And you are responsible for the safety of your men?”
“ Well, maybe.”
“ Well, if you are responsible for production and don’t know what
is happening to your men and don’t know what they are doing,
how can you get out a good production? If you don’t find out and
don’t keep up to date on what is happening to your men, you are not
going to be foreman of that department very long.”
As these meetings went on it was not very long before these fore
men got the proper cue and got up each time and said, “ Yes, that
man was hurt. I know how it happened. This is what I have done
to prevent its recurrence.” Or he would say, “ I don’t know what
to do to prevent recurrence. What can this group suggest?” Then
they would have a discussion of that particular accident and they
would usually come away with something that Tom considered very
THE NEW DEAL AND SAFETY
181
much worth while. That, briefly, is an outline of the method Tom
would carry on if all his activities were restricted to one activity.
I had the privilege of asking that same question of a man from
another concern. His answer was very different, but I think it
is equally interesting. He said: “ If I were limited to one activity,
and only one, I would continue to hold meetings every morning
of the year, meetings at which I get 15 to 20 of our workers and talk
to them about safety and fire prevention.”
The first 20 or 30 minutes in these meetings were spent in a sort
of lecture to these men. They gradually loosened up, got to be
more informal, and discussed the problems in their own departments.
This man told me that he had learned more from the men them
selves than he could ever hope to learn by making inspections of
those very departments in which these men worked.
One interesting experience that he told me about in connection
with this work was at a meeting he held. He had talked for 20 or
30 minutes when suddenly a tall fellow got up in the back of the
room, reached for his hat, and started out. My friend said, “ Wait
a minute. Why are you going out?”
“ Well, listen, Mister, if what you say is true, and I believe it is
true, your company can have my job right now. I am done. Do
you know what I had to do yesterday? I am a truck driver. I
was down at the station and the foreman put on my truck 3 bales
of scrap paper, 4 cylinders of nitrogen, 8 cylinders of oxygen, 3 cases
of dynamite, and some other stuff, and forced me to drive up the
middle of this city to the plant with that kind of load on my truck.
If what you say is true, I don’t want the job any longer.”
Well, the meeting was adjourned immediately. My friend en
countered the foreman of that department and asked him if it was
true. He brought about some changes that not only made it possible
for this man to keep his job but whereby the lives of many of the
citizens of that city would not be endangered by equally foolish jobs
in the future.
This man, in other words, said, “ If I were to be restricted to one
activity and one activity only, I would go on with this old plan of
conducting these safety and fire-prevention discussions with my men,
whereby every man comes into that meeting at least once a year.”
I could give numberless illustrations. I should like to tell you about
the answer given to me by the Youngstown Sheet & Tube Co. man,
something about the plan they formulated for the elimination of
unsafe practices. I should like to tell you about the work of Jones &
Laughlin Steel Co. in Pittsburgh. Their first answer to that question
was, “ We would rely upon the safety contest.” The answer to that
question has been revised, and it now has to do with the safety and
foremanship series of booklets that has been gotten out by the Na
tional Safety Council and which have been used successfully, not only
there, but in many other plants throughout the United States.
I don’t want you to misunderstand and get the idea that I am advo
cating the restriction of all safety activities in any plant to one activ
ity. Certainly that cannot be done. Nor do I say that any of these
activities can be transplanted from one plant and pushed down the
throats of the management of another plant simply because it worked
well in one. That cannot be done, because safety depends so much
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1933 MEETING OF I.A .I.A .B .C .
upon the attitude of the management and upon the convictions and
the ability of the safety man himself. To give you other illustrations
would simply lead to this conclusion: Industrial safety men in these
troublous times are not looking to any great extent for the heavens
to open and bring out some new discovery that will enable them to
combat their present problems. They are going back to their old
ideas and their old plans, which have worked so successfully. They
are taking into consideration new factors, they are speeding up, and
they are accepting the challenge brought about by the emphasis of
the need in industry; but they are sticking to the old, tried, and true
things which have proved successful.
In concluding, I should like to emphasize that one thought, that if
we are to continue to make progress and not slip backward, we have
to study, we have to write books and articles, we have to make
speeches, and we have to teach, sell, and adapt, and perhaps then
we may be doing about half of our jobs.
[Meeting adjourned.]
THURSDAY, SEPTEMBER 14—AFTERNOON SESSION
Second Joint Session of A.G.O.I. and I.A.I.A.B.C.
Chairman, Thomas P. Kearns, superintendent Division of Safety and Hygiene, Department of Industrial
Relations of Ohio
Chairman K e a r n s . The first number on the program this after
noon is an address, Cause Analysis of Accidents Causing Injury and
Near Injury, by Mr. C. B. Boulet, safety director of the Public Service
Corporation of Milwaukee, Wis. Mr. Boulet is eminently qualified
to speak on this subject. He has been with this corporation for ap
proximately 15 years. For 11 of those years he has been in charge of
the personnel work of the company, including the safety work. He
has given a great deal of personal attention to the problem of accident
prevention in this corporation. In speaking about the record of his
company, he told me of some very remarkable records it had made. I
asked him if he was going to mention that in his address. His reply
was no, that they didn’t want to live in the past. They were going to
live in the future. I think these records are worthy of mention.
For 3 of the last 4 years this company has won in the national
safety contest for large public utilities conducted by the National
Safety Council, as having the best accident record. Mr. Boulet
informs me that in the past 11 years, or since he has had charge of this
safety work and since the company has been doing organized, inten
sive safety and accident-prevention work, it has reduced its accident
frequency from 42.4 to 1.1. I think that is a remarkable achievement
and it is entitled to a lot of credit. I take great pleasure at this time
in presenting Mr. Boulet of the Public Service Corporation of Mil
waukee, Wis.
Cause Analysis of Accidents Causing Injury and Near Injury
By
C.
B. B oulet,
Public Service Corporation, Milwaukee, Wis.
A number of years ago in a small electric utility company the
generator suddenly stopped running. The local engineer could find
nothing wrong, so a long-distance call brought an expert from the
General Electric Co. in Chicago. The expert examined the machine
carefully, took a small hammer from his bag and tapped several times
at a certain point on the machine. The switch was thrown and the
machine operated. Asked for his bill he nonchalantly said, “ One
hundred five dollars and expenses." “ What!" said the owner of the
plant, “ one hundred five dollars for a few taps with a hammer?"
“ Yes", said the expert, “ five dollars for the taps and one hundred
dollars for knowing where to tap."
That is the secret of any curative science, knowing where to tap.
But to know where to tap takes years of study, of trial and error, of
experimentation, of analysis of causes. Without knowing the cause
of the trouble, it is impossible to prescribe the cure. So it is with
accidents.
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1933 MEETING OF I.A .I.A .B .C .
It is altogether possible that the number of accidents in any plant
might be reduced by any individual who might simply apply a number
of generally accepted principles of accident prevention. He is just as
likely to get results as the old grandmother who gave castor oil for
every ailment. Minor trouble might be corrected and favorable
results shown up to a certain point, but when that point is reached
the doctor who understands the symptoms must be called in to restore
the patient to perfect health.
And what is the doctor's procedure? To look at the patient and
prescribe a cure off-hand? No; not at all. He first of all discovers
the facts. All the facts which exist which might have a bearing on
the case—the patient's temperature, his pulse, condition of his tongue
and his eyes, condition of the blood, his heart, his lungs;—all these
are mentally tabulated by the doctor as facts, and when they have
been discovered a picture is completed which tells him at once the
cause of the trouble, and knowing the cause he is in a position to
prescribe a remedy.
But first of all he must have all the facts.
In the analysis of accident causes it is likewise necessary that all
facts be obtained and tabulated. A part of the difficulty experienced
by many engineers in their attempt to analyze accident causes has
been failure to go all the way in obtaining facts. Their opinion as to
cause has therefore been based on an incomplete record and conse
quently the cause as determined from the information available has
been incorrect.
Let us try to find the reasons for this half-way analysis.
There may be several: (a) Overanxiety on the part of the investiga
tor to reach a conclusion; (6) failure to distinguish between prime
and secondary conditions affecting the cause; (c) loss of sight of the
object of cause analysis, and consequent distorted facts developed
from those involved.
There is a natural tendency on the part of many of us to jump to
conclusions following an accident which has caused serious injury.
The facts which immediately appear in the foreground are accepted
as real causes, while careful scrutiny and further investigation might
develop underlying facts which have a far greater bearing on the real
cause than those which are so self evident.
I cannot attribute this failure to assemble all facts to laziness, but
rather to a desire to find at once the cause of the accident.
Likewise, what often is indicated to be a prime cause of an accident
should be classed more correctly as only a secondary or incidental
cause.
The third possibility is to me important.
Facts pertaining to accidents are developed usually through per
sonal investigation of conditions and through careful questioning of
the injured party and witnesses of the accident. The attitude of
those to be questioned must be correct or the true facts will never be
obtained. If the employee feels that an effort is being made to place
the blame somewhere, you may be sure that his loyalty to his fellow
employee will far outweigh his sense of duty to the investigator. It
is important, therefore, that he be promptly made to understand that
the reason for the investigation is to determine the cause of the acci
dent and that this is necessary if future similar accidents are to be
prevented. He must be made to feel that he is being consulted and
CAUSE ANALYSIS OF ACCIDENTS
185
his assistance in helping to stop accidents is being sought, if all facts
are to be developed.
The investigation of an accident should be confined to determining
facts through which to discover the cause. Overtures which make
of the investigation a legal affair, and cross-examination of witnesses
which tends to arouse their antagonism or suspicions, will prove of
no value in determining accident causes.
I appreciate the fact that many reports required by industrial
commissions and accident boards require only such information as is
relevant to the cause of injury and oftentimes the cause of accident
is not divulged.
Take, for instance, a certain report which recently came to my desk.
This report supposedly tabulated “ causes of accidents.” Among
other things in the report was a classification “ Electricity” or “ Elec
trocution” ; a certain number of injuries were classified under this
head, some of which were fatal while others were less serious.
From my own experience I know that every single electrical accident
I have investigated was brought about by certain underlying funda
mental causes, such as protective equipment not used, lack of super
vision, lack of instructions, poor mental condition of injured, worry,
etc.
Investigation of the causes of each of these accidents has taught a
definite lesson and has prevented recurrence of future similar accidents.
. Getting back to the industrial commission reports, simply classi
fying these cases as electrical, I cannot think of a single benefit
derived from this knowledge. The reason for this failure to arrive
at accident causes is, of course, evident. The prime duty of com
missions has in the past been considered to be the supervision and
determination of compensation because of disability due to injury.
I believe a great service can be rendered by you gentlemen if more
thought is given to the determination in each accident of real causes,
followed by the broadcasting of information as to how to eliminate
these causes of accident and thereby reduce the number of injuries.
I have made these preliminary remarks because, no matter how
elaborate a system of accident analysis is developed, it is worth
nothing unless the facts on which the analysis is based are correct
and complete.
Any accident cause analysis tabulation must have certain char
acteristics to be of value. First of all, it must be sufficiently complete,
so as to permit of proper classification of all accidents. Secondly,
it must be sufficiently simple to permit its application to various
industries and by engineers, superintendents, etc., who do not claim
to be experts in this field. Third, it must be in sufficient detail to
permit management and others to understand and derive from it
information necessary to apply proper remedies.
Such a classification is not easy to find. I have at hand a number
of classifications or tabulations which vary from the simplest form as
first used by a number of eastern public utility companies to a very
complete form suggested in the forthcoming report of the A.S.A.
committee on causes.
The simplest classification breaks down accident causes into three
main divisions:
1. Supervisor failure.
2. Employee failure.
3. Causes beyond control of injured.
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1933 MEETING OF I.A .I.A .B .C .
Under the first of these are seven subdivisions:
1. Class of work beyond experience or physical or mental ability
of injured.
2. Use of improper tools or devices.
3. Lack of proper instructions.
4. Protective devices not provided or inadequate in number.
5. Protective devices not used.
6. Lack of proper inspection and maintenance.
7. Insufficient light.
Under the second heading, employee failure, are seven subdivisions:
1. Rules or instructions not followed.
2. Intemperance.
3. Lack of concentration, carelessness.
4. Hurry.
5. Poor judgment.
6. Willfulness.
7. Unfit physical condition of the injured.
Under the third heading are five subdivisions:
1. Particles carried by air currents.
2. Contributory negligence of others.
3. Abnormal weather conditions.
4. Failure of equipment.
5. Nonindustrial.
For the small plant where it is impractical to expect a highly or
ganized safety department, I believe some such classification of acci
dents can be of inestimable value. Even in larger organizations which
have not previously analyzed accident causes, the code can be used
as a beginning. It has numerous advantages. It is simple, it covers
the main causes of accidents, and can be understood by the foreman,
superintendent, and manager. A study of results obtained under
this classification will prove helpful in determining the causes and
will point to the elimination of future accidents of a similar nature.
Under the more complex tabulation, which will be used by larger
industries, by national associations, and by industrial commissions in
an effort more easily to locate all factors contributing to accidents,
several contributory factors are tabulated.
For instance, a suggested code, now under consideration, requires
a 7-column field of a tabulating card. Accident causation under this
code is identified by such contributory factors as internal agencies,
broken down into 14 heads such as machines, pumps, prime movers,
elevators, conveyors, boilers, tools, chemicals, electrical apparatus,
etc. Each accident is classified under one of these heads.
A further break-down of any one of these material agencies in order
to tabulate the exact part of the agent causing the accident can also
be made, for instance, “ gears and pulleys” of machines, “ belts” of
pumps, “ tubes” of boilers, etc.
Third, the manner of contact is analyzed and classified under one
or more of 11 headings such as falls of persons on level, falls of persons
from one level to another, slips—not falls, struck against, drowning,
caught in or between, shock, burns, etc.
The accident cause is again classified according to performance of
person injured. Under this head is tabulated such conditions or
causes as operating or working at unsafe speed, using defective tools,
overloading, nonuse of safety devices, etc. Each of these items can
CAUSE ANALYSIS OF ACCIDENTS
187
again be broken down into specific causes; for instance, under operat
ing or working at unsafe speed, the exact cause might be given as
running, feeding too rapidly, driving too rapidly, throwing material
instead of carrying or passing it, driving too slowly, etc.
Lastly, the accident may be classified according to proximate
causes, and this classification broken down into physical causes and
supervisory causes. #
Under the first will fall such items as improperly guarded hazards,
defective equipment, unsafe dress or apparel, etc.
Under the second such causes as improper instruction and willful
disregard of instructions should be listed.
The National Safety Council in its Safe Practice Pamphlet No. 21
suggests a modified code covering cause analysis that is neither as
simple as the first which I have discussed nor as complicated as the
second.
This code segregates and classifies causes under five heads as
follows:
1. Machine or other agency involved in accident.
а. Mechanical.
б. Nonmechanical.
2. Manner of performing work or job.
3. Method of contact.
a. Inhalation, absorbing, burning, poisoning, etc. (acute).
b. Inhalation, absorbing, burning, poisoning, etc. (slow).
c. Falls of persons (on level).
d. Falls of persons (to different levels).
e. Slips.
/ . Falling or flying objects.
g. Caught in or between.
h. Struck against.
i. Drowning.
j. Shock (electrical).
k. Burning (electrical).
4. Mechanical causes.
5. Personal causes.
It will be noted that the code suggested by the N.S.C. follows to
some degree the code suggested by the committee on causes, but is
somewhat more elaborate. Personally, I lean toward the established
code as suggested in Safe Practice Pamphlet No. 21.
So much for methods used in classifying accident causes.
You, I am sure, would have little faith in a doctor who tabulated
your temperature, pulse, lung action, and blood analysis and then
took a good look at the tabulation, picked up his medicine case, and
walked out on you—perhaps to go to the golf course and play the
customary 19 holes.
That, however, is the chief difficulty with many agencies gathering
information on accident causes. They forget the objective which
they started out to attain. After all, the analysis of accident causes is
not an end in itself, but is rather a means to an end. What we seek
through this analysis is remedies to apply in order to prevent future
accidents of similar nature. The interpretation of statistics compiled
through the analysis is the final measure of its value.
I have seen many tabulations prepared by national trade associa
tions, accident-prevention organizations, and industrial commissions
256X6°— 34-------13
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1933 MEETING OF I.A .I.A .B .C .
that simply tabulate and leave the patient as is. The doctor who
would not even suggest a cure or at least prescribe a sedative would
certainly not merit his pay.
The job of you men, the most important job, is to interpret these
statistics and suggest remedies for the conditions indicated by the
facts presented.
The job of accident prevention, of selling employees on a new code,
a suggested practice or a change in method has been made immeasur
ably simpler in my own organization whenever we have been able to
show by careful analysis that a certain practice or procedure was the
underlying cause of an accident or near accident and should be
discontinued.
Experience continues to be the best teacher and it is our job, yours
and mine, to select from experience those lessons which will, if taught
by us to the men in the field, stop accidents.
What is true of the employees in my company is true of the em
ployers of labor over whom you exercise a certain jurisdiction. If you
can show them, by illustration, that a large percentage of actual
accidents have been due to a certain cause, if you can cite cases
proving your contention, and if you can then point out a definite
way to stop these accidents in the future, then your efforts at cause
analysis will be of some value. To continue simply to present statistics
and sit complacently by while accidents contmue to happen and
statistics continue to accumulate, is worthless to the employer of men
and will have no effect in the elimination of national economic waste.
Summarizing, I think the responsibilities of a forward-looking com
mission or accident board can be set forth as follows:
1. Determination of all the facts pertaining to every compensable
accident.
2. Analysis of these facts to determine:
a. Accident cause.
b. Compensation liability.
3. Publication of a description of these accidents, setting out:
а. Facts pertaining to causes.
б. Causes.
c. Remedies.
Again, I say it is your job to teach the lesson that your analysis of
information collected indicates must be taught if accidents are to be
stopped.
DISCUSSION
Chairman K e a r n s . I am sure that all of you feel that there is food
for thought in the suggestions made by Mr. Boulet, and some of you
may want to ask him questions about some of the points he made
regarding the cause analysis of accidents. Is there any question you
would like to ask Mr. Boulet?
Mr. S t e w a r t (Washington, D.C.). I think we all agree that that
was about the best analysis of accidents from the objective point of
view, so far as objective things can be recorded, that we have had.
The longer I live the more I feel that there is a principal cause of acci
dents that is not covered by our guarding of machinery or any ob
jective things that can be done. The superintendent of public
safety in Buffalo a number of years ago, when the automobile accident
CAUSE ANALYSIS O F ACCIDENTS— DISCUSSION
189
rate began to rise so rapidly, said, “ There is but one adequate remedy
for the increasing automobile accident rate and that is starting 5
minutes sooner. ” We put off starting until we must go at a break
neck speed to get there on time. Instead of taking the advice of that
superintendent in Buffalo, we have been increasing our speed rate,
setting back 5 minutes each week or month or so the time when we
start.
The speed rate which the speaker referred to in the factory is not
always set by the worker, and the individual is not always the cause
of the accidents listed. When you reduce the piece rate you increase
the speed rate, and your accident as a result of the increased speed
is not the fault of the individual, who is under a necessity that neither
he nor she can control, but is caused by your change in the piece rate.
That is an illustration of the mental cause that you cannot get any
X-ray picture of at all. Another thing that you cannot get an X-ray
picture of is the mental state of the employee caused, not always but
sometimes, by the attitude of the foreman or the straw boss. I
remember walking through a factory once with the manager or
superintendent. We were talking about the cause of accidents at
the time. I saw a girl at her machine crying. The tears were rolling
down her cheeks. I said to this fellow, “ You are going to have an
accident over there the first thing you know.”
He said, “ Why?”
I said, “ Not because that girl is crying, but because there is some
thing the matter with her that makes her cry.”
He looked around and said, “ I don’t know. Her boss reported her
yesterday.”
“ Maybe that is why she is crying and if you have an accident
maybe the boss will be the cause of the accident.”
In the extreme tension of industry, anything that throws off the
guard of the individual will have its effect.
A commissioner to whom I was talking this morning said, that
during the years she had been on that commission, very few of the
cases she had heard (practically none of them, I think her expression
was) had been caused otherwise than by the foolishness of somebody.
After years of experience with the labor question, I once made the
statement that I had never investigated a strike nor attempted to
settle a strike where the final, ultimate, or end cause of the strike was
not that somebody had forgotten to be a gentleman, and such forget
fulness on the two sides of the conflict is about 50-50. I wonder how
many accidents are caused by somebody who forgot to be kind,
somebody who forgot to be human, or somebody who forgot to know
what was going on.
The foreman ought to know the physical condition of the persons
working for him. So far as the mental condition is concerned, the
mental conditions produced in a factory by the unkind word, the
inhumane treatment, ought to be checked up. We ought to know
who in the establishment is responsible for it. Of course, you can
carry that too far too, but after all it must not be ignored.
One foreman said to me that whenever he had an accident he always
asked the fellow if he had had a row with his wife that morning or the
night before. Once when he asked a fellow that question, the fellow
thought the foreman was a fool as he was not married at all.
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1933 MEETING OF I.A .I.A .B .C .
Suppose you do miss fire once in a while. There are other things
that affect the mental condition which we safety men have not yet
discovered as a cause of accidents. Kindness in the factory, square
dealing, seeing eye-to-eye between men and men, and men and
women—in other words, the subjective cause of accident—I trust
will be your next field of study.
Chairman K e a r n s . Is there any further comment on that?
Mr. P a t t o n (New York). I want to congratulate Mr. Boulet on
his paper, but I want to point out to him that he must not criticize
industrial commissions or labor departments altogether for the lack
of information as to causes of accidents as distinguished from causes
of injuries. You are all familiar, I guess, with the study of H. W.
Heinrich of the Travelers Insurance Co. It has been out for some
years. In his study he indicates that 98 percent of all industrial
accidents are preventable. In other words, nearly all accidents are
due to some lack of supervision on the part of the employer. He
made a recommendation, you know, and our association committee
on statistics and costs has been wrestling with it for a long time, calling
on all States to get the facts on the causes of accidents as distinct from
the causes of injuries. Without waiting for the final report of that
committee and its adoption, we have been experimenting with this
idea in New York, and a number of other people have been experi
menting with it.
Mr. Boulet would like, and so would I, accident reports to indicate
whether the accident was caused by supervisor failure or by employee
failure. But do you think that the foreman who makes out that
report, knowing that the accident may become the subject of a com
pensation hearing, is going to say that the accident was due to super
visor failure?
At a meeting of claims representatives of insurance carriers a year
ago, I asked, “ What would be your objection, if any, if the New York
reporting form was amended", so as to call for not merely what Mr.
Boulet does in his paper but that still more complex form of which he
speaks. They almost hooted me out of the room. “ We are not
going to have our policyholders report to the Department of Labor of
New York that this accident was caused by the fact that their foreman
gave improper instructions, or failed to issue instructions, or that the
machine was improperly guarded." I said, “ In New York and in
many other States liability for payment of compensation has no
relation whatever to negligence on the part of employer or employee.
You would have to pay no more even though you do report you are at
fault." These representatives said, “ That is all right, but we are
not going to require policyholders to report facts indicating that they
are at fault."
I have made a serious effort to get this sort of information in a
supplementary form. So far the results have been disappointing.
Before the depression close to 500,000 accidents a year were reported
to the New York State commission. How would It be possible ever
to get sufficient appropriations from the legislature to make the kind
of investigation of each of these accidents that Mr. Boulet says we
ought to have and which I think we ought to have? It is one of
those things that appear now to be beyond the bounds of practica
bility. On the other hand, the present accident causes tabulations
which we print do not stop merely with “ electrocution." The present
CAUSE ANALYSIS OF ACCIDENTS— DISCUSSION
191
standard cause code recommended by the association and in general
use in the country has between eight and nine hundred different
classifications. Electrocution accidents are subdivided into quite an
imposing list.
The figures indicate that over a period of years falls of persons have
been one of the most serious types of accidents. Furthermore we have
those falls subdivided into some 40 or 50 kinds of falls. If the safety
man is provided with that information, it is up to him as safety man to
discover what hazards exist which help to bring about falls. When
the report comes in that a man slipped, that is all the foreman says
and that is all the compensation referee wants to know—all he wants
to know is the fact necessary in deciding whether an award is to be
made or not. We know that the floor may have been slippery or the
light poor, etc., or he may have had a sudden shock or fright—all those
things help to bring about falls.
Can anyone tell me how any State legislature can be expected to
provide sufficient funds for the kind of subjective analysis and fact
finding that theoretically we ought to have? I see no practical way
out of it. In New York whenever a hazardous condition is found to
exist that is causing accidents, we isolate a certain number of incoming
accidents of that sort, and send out agents to investigate them on the
spot, while the accident is fresh. From that sample of accidents we
learn what is the best thing to be done in the matter of accident
prevention. As yet I do not see any more practical way of handling it.
I am willing to admit that theoretically all the 500,000 accidents should
be investigated and that 10 or 20 times that many near accidents were
never reported. As has been pointed out, a near accident is just as
much a warning or indication to a safety man, or ought to be, as an
accident, but we have to limit ourselves to our possibilities. What we
can do must be considered as well as what we ought to do. I cannot
agree with the statement that merely because in New York we have
100,000 tabulated accident causes broken down into more than 800
different subdivisions, that that tabulation is not of service as a guidepost and as an indication to any safety man who is seeking to prevent
accidents in his plant.
Mr. B o u l e t . I fully appreciate the difficulties that have been
mentioned. I should like to quote this: “ Nothing will ever be ac
complished if first all objections must be overcome.” I appreciate
there are difficulties. We know that well. We have our troubles;
the commissions have theirs. There are problems that I know nothing
about so far as the commissions are concerned. I simply tried to
bring to you something that would be of value to me. It is probably
selfish, but I believe that ultimately something must be worked out.
If we are to stop accidents there must be some practical way worked
out and that way should be found.
Chairman K e a r n s . I quite agree with Mr. Boulet that a good deal
more care and attention should be given to cause analysis, and insofar
as it is possible to do it, the industrial commissioners should, after
a careful study, give out information as to the causes that would be
helpful in the prevention of such accidents. In many cases, and I
know from our own experience in Ohio, you seldom get sufficient
information on the accident report itself to make the detailed study
that Mr. Boulet refers to; yet I think it is a wonderful thing for gov
ernmental labor officials, factory inspectors, men and women charged
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1933 MEETING OF I.A .I.A .B .C .
with the enforcement of safety regulations, and particularly those
making investigations of accidents, to keep in mind those different
things that should be investigated in order to determine the cause
of the accident as well as the cause of the injury. I do not believe
that any of us who are engaged in safety work at the present time
are giving sufficient attention or attaching sufficient importance to
the matter of investigating the cause of the accident, where that
is possible, rather than the cause of the injury. I think the records
show that there are perhaps 300 accidents occurring to one accident
resulting in injury.
I think it an excellent idea to investigate all of our minor injuries,
to make a thorough investigation, because after all each of them is
potentially a major accident, and according to the law of averages
sooner or later those minor injuries are going to result in major injuries.
The same thing is true of accidents that cause no injury. The accident
may not cause an injury today, tomorrow, or the next day, but sooner
or later if such accidents continue to occur they will cause an injury
and it may be a very serious one.
So I think it might be a good thing for us to give considerable
thought to that subject of investigating causes of accidents that do
not cause injury, as well as those that do cause injury, and find a
remedy to prevent the recurrence of these accidents also.
Mr. K j a e r (Washington, D.C.). The United States Bureau of
Labor Statistics gets quite a few copies of the accident reports in the
iron and steel industry made to the different States. I have noticed
that a good deal of the necessary information is lacking on some of
them that should really be in the report. There is no one to blame
for that except the employer who sends out the report. The industrial
commissioners cannot be blamed; they cannot compile the facts when
they do not get them. I think the fault lies directly with the employer
in that case.
Chairman K e a r n s . Perhaps that is true; yet I think, on the other
hand, it might be said that in many instances the industrial com
missions and accidents boards do not make use of some of the informa
tion they do get. To be perfectly candid about it, I think a good deal
more attention should be given to the general question of accident
prevention by all of the industrial commissions and accident boards
throughout the country. I realize that they do not always get this
information, but certainly they get some information that could be
used to advantage among the employers and safety men of the State
in the matter of promoting accident-prevention work.
Mr. E l m e r F. A n d r e w s (New York). Mr. Patton has described
our system. One of the things that might be of interest is that we
photograph every first report of accident. That goes to a unit where
a card index is kept to show the accident experience of each factory
in the State. Furthermore, a second photostatic copy goes to our
inspection division. We have inspectors traveling in the districts
where accidents occur, and we have inspections of every major plant
in New York. Our factory inspectors are advised immediately after
an accident is reported. Then the inspector in that district takes it
up personally with the management of the factory on his next visit.
So far, we think that does a great deal of good. We are getting very
fine reactions from the employers.
MECHANICAL GUARDING AT POINT OF MANUFACTURE
193
Mr. B e aso r (Ohio). I should like to bring out something that
I think they should know here. We send out to our field men each
month a record of the serious and near-serious accidents. Those
men go into the plants, with all the information they have; and talk
the thing over with the particular employer, not to criticize but to
help. We have found in Ohio, as Mr. Patton has in New York,
that these people are not going to incriminate themselves by saying
that it was the foreman’s fault or the supervisor’s fault. With the
idea of teaching the employers to keep that record, we are suggesting
to them the keeping of that data in such a manner that the manager or
person in charge of the plant will know exactly the person who is
responsible for the injury or the accident. It is being suggested to
them that they not only keep such records of injuries but also keep a
record of their accidents.
Our field men are reporting that it has been taking very well with
a number of employers and they are following out the scheme, so
much so that for some time a certain group of employers, such as the
electric-industry men, have their safety men attend round-table
meetings about once a month. Of course this information goes to
nobody else but those men in the meeting. They lay the record of
each plant right on the table and are able to make a cooperative
effort to help each other. I think some of those plants even extend
into another State, but since it is similar work, they are getting these
other fellows in, perhaps to help them.
Standardization of Codes and Mechanical Guarding
at Point of Manufacture
By
R obert
McA.
K eow n,
Engineer Industrial Commission of Wisconsin
[Bead by Mr. Wise, Industrial Commission of Wisconsin]
When accident-prevention work was first undertaken by some of
the States more than 20 years ago, the lack of standards to guide the
inspection personnel was soon apparent. Without standards it was
impossible to secure uniform compliance where more than one inspector
was assigned to the work.
The first regulations, adopted either by legislative act as in some
States, or by the board or commission having supervision of the
work as in others, appear in the light of present-day experience as
rather crude, but they served their purpose at least to a degree, and
as time went on and more experience was gained these regulations
were revised and new ones adopted as new methods and processes in
industry introduced new accident hazards.
With many of the States and some cities adopting regulations for
the safety of employees and the public, and many insurance companies
having their own standards, the need for some central organization to
undertake standardization of regulations on a national scale became
almost a necessity. With this object in mind the United States
Bureau of Standards called a conference in Washington in January
1919 for the purpose of considering methods to be used for the pro
mulgation of a set of national safety standards. At this conference
there were approximately 150 representatives of the Federal Govern
ment, State boards and commissions, and engineering associations.
More than 50 safety codes were discussed with the idea of developing
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1933 MEETING OF I.A .I.A .B .C *
national standards that would supplant the large number of individual
State regulations on each subject.
The American Engineering Standards Committee, now the Ameri
can Standards Association, had already been organized (1918) by
five major engineering societies for the purpose of carrying on stand
ardization work, and as a result of two Washington conferences
arrangements were made to have safety standards included within
the scope of their activities. Since then the safety code work has been
made a part of the American Standards Association program.
In order that standards finally approved by the American Standards
Association may in fact be American standards, the association has
outlined definite methods of procedure for the guidance of any organ
ization wishing to have standards approved. These methods are
outlined in the American Standards Association method of procedure
from which the following statements are taken:
The association recognizes four such methods: (1) Sectional com
mittee method; (2) existing standards method; (3) proprietary
standards method; (4) general acceptance method.
Of these four ways for the development of standards, the sectionalcommittee method is the one most generally used. According to the
association, the name of the committee is so called because of the fact
that its personnel represents a true cross-section of the industries and
organizations concerned with the development of any standard.
The rules of the association require that for safety codes sectional
committee memberships shall be made up as follows: (a) Manufac
turers (makers of equipment); (b) employers (users of equipment);
(c) employees; (d) governmental bodies having regulatory power or
influence over the field in question; (e) independent specialists, such
as staff representatives of technical societies, consulting experts with
no exclusive business affiliation, and educators; (/) insurance inter
ests. It will be recognized that with a committee organized in this
manner, the standard finally proposed for approval should be quite
generally acceptable.
The existing standards method is, as the name implies, a method
for having an existing standard approved by the association, but can
only be used where in fact the existing standard is qualified to receive
approval.
The proprietary standards method is, according to the association,
for those standards that were formulated in the first instance and
thereafter revised entirely under the auspices of the sponsor organiza
tion, and which are in fact competent to be approved by the associa
tion as national standards.
The general acceptance method for procuring national standards is
primarily for simple projects and for which the organization of a
sectional committee is not deemed advisable. This method consists
of a conference of those individuals or groups principally concerned,
supplemented by a sufficiently large number of written acceptances
of the conference recommendation from all of those substantially
concerned with the scope and provisions of the recommendation.
The 1932-33 year book of the American Standards Association lists
44 accident- and fire-prevention codes that have been approved as
the American standard and 18 such projects not yet completed.
The American Standard Safety Code on any particular subject
may not be as rigid as are the requirements in individual States that
MECHANICAL GUARDING AT POINT OF MANUFACTURE
195
have had regulations for a number of years, and in some instances it
might not be desirable to lower the State standard, although it should
be borne in mind that where a State has a standard that appears to be
more rigid than the balance of the country, if it relates to apparatus
that is used country wide, the customers in that State will pay more
for such apparatus. As an example of this may be cited the grounding
of noncurrent-carrying parts of electrical equipment. Wisconsin for
a number of years required the grounding of all such parts for voltages
exceeding 100, but when the code was revised in 1930, the majority
of the State advisory committee was of the opinion that this require
ment should be made to conform to the national standard. The
arguments were that State and national standards should be uniform,
and that for some kinds of electrical appliances, particularly small
equipment, it would be safe only for the manufacturer to make the
ground connections as they must almost of necessity be built into the
machine. Instances were cited where insulation had been broken
down when such work was done by local electricians. This position
was taken notwithstanding the fact that many Wisconsin users of
electrical equipment had already made the change and although there
have been a number of fatalities on noncurrent-carrying parts that
had become “ alive” due to insulation becoming defective and where
the voltage was presumably below 150. This is a matter, it seems to
me, that should be given further consideration to determine whether
or not manufacturers of this equipment should supply ground con
nections on all appliances using the ordinary lighting circuit.
Where a State has no regiuations in any particular subject, the
advantage of having an American standard either to adopt as is or to
use as a guide in formulating regulations will be apparent.
In 1923 it was desired to issue a code regarding the use of spray
coating in Wisconsin, and as far as could be ascertained no State had
any regulations specifically covering this subject. It was therefore
necessary for the advisory committee appointed to suggest a set of
regulations, to visit plants where this method of painting was carried
on, and by a process of elimination frame regulations that would
prohibit those conditions which were observed to give unsatisfactory
results. This meant days and days of work before the committee was
prepared to make its recommendations to the industrial commission.
Since the original adoption of the regulations, they have twice been
revised because of the use of new materials or for other reasons, and
within a short time will be subjected to another revision.
A similar condition existed with reference to the commission’s
general order on trench guarding. The original order stated that
trenches, “ * * * must be securely shored up.” On a contested
case the supreme court ruled that this was not definite enough and
that the employer must be told how to shore them. There were
not to our knowledge any existing regulations on this subject, so the
advisory committee drafted a set of timber requirements for trenches,
and after several hearings they were finally accepted as being rea
sonable and were adopted. The results obtained have been gratifying.
Probably one of the most uniformly adopted codes is that for
boilers, known as “ A.S.M.E. Boiler Code.” As far as we have
ascertained there is but one State having boiler regulations that does
not accept boilers made in accordance with this code. The adoption
196
1933 MEETING OF I.A .I.A .B .C .
or acceptance of boilers built according to a standard code has many
advantages, which may be listed briefly as follows.
(a) The advantage to the boiler manufacturer who does an inter
state business. Boilers can be manufactured in quantity in advance,
taking advantage of quantity buying of materials and of slack seasons
for employment.
(b) The purchaser can get a better price and prompt shipment.
(c) Resale value of standard boilers is higher because of acceptance
in a larger field.
(d) Boiler insurance companies operating in many States can give
better inspection service due to inspectors becoming familiar with
standard construction.
(e) Responsibility centered with manufacturer, over whom State
officials can easily exercise control, and as a result the boiler is made
uniform and safe at the source.
(f) Prevents dealers from making the State a dumping ground for
worn-out and obsolete boilers.
(g) Employees benefit from the greater safety due to concentrating
on one set of specifications and develop to the greatest extent safety
features that are universally approved.
There have been instances come to our attention, when having shop
inspections made of new boilers, that the boiler because of some sub
standard condition, could not be accepted under the State require
ments. Such boilers are not scrapped but are sold elsewhere. Fre
quently, also, boilers because of age and design are not permitted a
working pressure in excess of 15 pounds. These boilers are taken out
of service, given an overhauling, and sold elsewhere as second-hand
power boilers.
Another example of the value of uniform requirements is to be
found in the case of elevators. Elevator manufacturers submitting
proposals for elevator installations in various States can more readily
satisfy the customer if the requirements of the State are in accordance
with national standards.
In discussing this matter with insurance company inspectors, who
in Wisconsin are licensed to make elevator inspections that are
accepted in lieu of regular State inspections, and who operate in a
number of States, the thought is frequently expressed as to the
desirability of a standard code and particularly for one that is enforced
by the State officials who have jurisdiction. If the insurance inspector
is not able to “ sell” the assured on the necessity of complying with the
standards, the only thing that the insurance company can do, if it
does not wish to put up with the conditions, is to cancel the policy.
Sometimes, if the insurance inspector is too insistent in securing com
pliance with the code, the assured will cancel the policy. This is a
condition that should not be tolerated, and the owner should be made
to comply with the code no matter with what company he carries
insurance.
Another case showing the value of national standards is found in
building construction and particularly with respect to structural
requirements. Some points that might be mentioned are:
(a) Live load requirements for structural design can be uniform.
(b) Allowable unit stresses in any particular type of building ma
terial should be the same. Existing building codes at present differ
as to allowable working stresses.
MECHANICAL GUARDING AT POINT OF MANUFACTURE
197
(c)
Organizations, national in scope, provide standards that can
be universally adopted. They are as follows: (1) Steel—American
Institute of Steel Construction; (2) concrete—American Concrete
Institute; (3) wood—National Committee on Wood Utilization; (4)
masonry, solid and hollow—American Society for Testing Materials.
Standards of the above organizations have been adapted to the
Wisconsin State building code. If such standards were in general
use the buying public would benefit. Without such general standards
the responsible designer and manufacturer is always at a loss to
know whether his work is in competition with other designs and
products. The#result is that such designers and manufacturers are
forced to meet irresponsible competition, with a consequent lowering
of ideals rather than raising them.
Examples are frequently brought to light in Wisconsin, from outof-State designers who do not have any particular standard to follow,
in which variable assumed loadings and working stresses are used. #
In manufactured materials the same results are found. Wisconsin
has certain requirements on hollow building units. Neighboring States
have none, except perhaps in individual cities; consequently, out-ofState manufacturers have difficulty in marketing their products in
Wisconsin. This is particularly true in regard to concrete blocks.
Another phase of the matter is the opportunity that Wisconsin manu
facturers have to dispose of inferior products in other States where
there are no regulations. This could be avoided by standard require
ments.
By the standardization of allowable working stresses and of build
ing material in general, the buying and building public would benefit
and a curb would be placed upon irresponsible designers and manu
facturers.
There are instances where State authorities do not wish to adopt
national codes because of their length. As an example of this we
may cite the power press code. Wisconsin’s requirement is contained
in a single order, but mention of the national code is made in a foot
note, referring to it as a valuable source of information on the subject.
States mafing new safety regulations or revising existing require
ments will assist to a large degree in promoting the national standard
ization program if they will make free use of the national standards
that have already been prepared.
The National Safety Council through its A.S.S.E. engineering sec
tion has had for a number of years a standing committee on research,
standards, and code, one of the principal functions of which is to
promote use of national safety standards.
That the American Standards Association appreciates the coopera
tion that it is receiving from your organizations is indicated by the
following quotation taken from the association’s 1929 year book:
The State governments are also actively participating in the work. This co
operation is chiefly through national organizations of State commissions. The
most active of these are the International Association of Industrial Accident
Boards and Commissions and the International Association of Governmental
Officials in Industry, through which the State governments are taking a leading
part in the entire safety-code program.
So far in this discussion no mention has been made of mechanical
guarding at the point of manufacture, although the bringing about of
this condition will undoubtedly be made much easier if uniform safety
standards are adopted.
198
1933 MEETING OF I.A .I.A .B .C .
There are a number of reasons why safety of operation of machinery
should be taken into consideration by the manufacturer, a few of
which are as follows:
1. A more workmanlike and finished job can be done at the factory
when the guarding is given consideration while the machine is in
process of design than can generally be done by the purchaser.
2. The purchaser dislikes very much to buy a new machine and
then have some inspector come along and inform him that he must
provide additional guards to make it comply with State requirements.
3. The complete guarding of a machine makes a good selling point
for the manufacturer.
4. A machine designed with safety of operation in mind is more
efficient than one not so designed.
For a number of years our department has been making use of a
small form upon which the inspector reports substandard conditions
found on new machines. On this form the inspector gives the
following information: Name of maker of the machine; address;
name of machine; name of manufacturer using machine; address;
suggestions for safeguarding.
Upon receipt of this information from the inspector a letter is
written to the machine builder calling attention to the ways in
which the machine in question does not comply with safety stand
ards, pointing out to him some of the advantages of guarding before
selling and requesting his cooperation. In general the results
obtained have been very encouraging. Occasionally, however, a
reply is received that leads one to believe that not all manufacturers
are alive to the situation. A certain plant purchased a large and
expensive woodworking machine upon which there was an unguarded
sprocket chain and wheels. A letter to the manufacturer was referred
to the legal instead of the engineering department and brought
the reply, that since their machines were shipped to all parts of the
world it would be impossible to keep up to date on all of the various
guarding standards, and therefore they shipped without guards.
They completely overlooked the fact that proper guarding of this
sprocket chain and wheels would have passed muster in any country
regardless of their standards.
Only recently a bulk gasoiine storage station employee, while
reaching for the clutch lever on a newly installed gasoline pump,
missed the lever and lost two fingers in the gears that were only
partially enclosed. Correspondence with the pump manufacturer
brought a reply enumerating the States where this pump was accept
able as fully complying with safety requirements. Upon being in
formed, however, that complete enclosure of gears was required, he
took steps to replace the guards on all recent installations. The
pity of it was that a person had^ to be permanently injured before
this was brought about, and besides his employer was called upon
to pay additional compensation because a substandard condition was
the cause of the injury.
One frequent source of injuries is that caused by machinery used
in highway construction, including quarry and gravel-pit outfits.
Most counties and contractors using this class of machinery are not
well equipped to do any guarding, particularly during the season
when it is used on the job.
199
MECHANICAL GUARDING AT POINT OF MANUFACTURE
For a number of years there has been a large working exhibit of
this kind of machinery in Madison during the annual road school
conducted by the Wisconsin Highway Commission. Each year it
has been our practice to make an inspection of this equipment and
to write to the manufacturers, pointing out the respects m which it
did not meet the State safety requirements. The cooperation
received from these manufacturers has been very fine, and at their
request we have sent a man to their plants, even to other States, to
discuss with their engineering departments methods of safeguarding.
Whether this guarding is in all cases furnished as standard equipment
with machines sent to other States we do not know, but the improve
ment in safetv of machines furnished to Wisconsin purchasers has
been quite noticeable.
Another way in which buyers of machinery can secure guarding
by the manufacturer is to include specifications for safety along with
and on a par with other specifications. If such specifications are
sent out when asking for bids, all bids will be submitted on the same
basis. Safety specifications should be based upon practical and
recognized safety standards and should require that all machines
furnished must be equipped with properly designed, constructed, and
installed guards. In some cases it will be desirable to go into details
even more than this and state the guards desired.
The following table, compiled from United States census reports,
gives some information on the concentration in the manufacture of a
few important classes of machinery:
Proportion of United States total of specified classes of machinery manufactured in
States noted as leading producers7 1929 1
I
|
|
I
|
|
1
|
|
1
1
|
1
1
1 XX
1 XX
11
7
7
5
Aver
age
num Value
of
ber of prod
wage ucts
earn
ers
1 XX
1U.S. Department of Commerce.
No. 67.) Washington, 1932.
7
7
Num
ber of
estab
lish
ments
coco
Agricultural implements..................... .
Electrical machinery................................
Foundry and machine-shop products,
including woodworking and laundry
machinery..............................................
Machine tools...........................................
Prime movers...........................................
Textile machinery....................................
States classified as leading
producers
83.9
84.2
83.4 X 84.2
72.2
72.9
64.8
71.5
84.2
70.3
82.5
83.5
85.4 X X X X X X X X X X X
74.6 _ X X ___ X _ _ X X X __X
_XX X
81.6 X X X _ _ X
84.0 ~ — -- -- -- X -- X X -- -- X X
Manufacturing Market Statistics.
XX
Classes of machinery manufacturers
Percent of United
States total
I California
|Connecticut
I Illinois
1Indiana
1Iowa
|Massachusetts
1Michigan
1New Hampshire
I New Jersey
1New York
1Ohio
I Pennsylvania
I Rhode Island
1Wisconsin
Num
ber of
States
classi
fied as
lead
ing
pro
ducers
X
X
X
X
- X
(Domestic Commerce Series
It will be noticed from this table that 7 States produce in value
83.4 percent of the agricultural implements, 84.2 percent of the elec
trical machinery, 74.6 percent of the machine tools, and 81.6 percent
of the prime movers of the United States. With this concentration
in a few States many of which are among the leaders in the safety
movement, it would not seem to be an insurmountable task for
industrial boards and commissions to make considerable progress in
securing cooperation from their respective State manufacturers of
equipment.
200
1933 MEETING OF I.A .I.A .B .C .
In closing, I would like to urge upon your organizations the contin
uing with even greater force of the support that you have given these
programs in the past, to the end that the day may soon come when
all safety standards will be national in scope and all machines guarded
at the point of manufacture.
DISCUSSION
Mr. P a t t o n . In a meeting of this body at Toronto Mr. Lewis
DeBlois read a paper embodying the experience obtained by corre
spondence with every State in the United States. He wrote to each
of the States to get its safety requirements on a long list of pre
scribed topics. The replies indicated a bewildering array of differ
ences. For instance, why should a guard rail in one State be required
to be 36 inches high ana a guard rail of precisely the same sort in
other States be 42 inches high? There are many such illustrations.
Mr. DeBlois was making the point that in order to stimulate the
manufacturers to safeguard machinery at its source, it would be
very helpful if the States, through their standard practice bodies,
should eliminate these minor and nonessential, and in a number of
cases perfectly useless, differences that now exist. In other words,
it would greatly strengthen the drive for manufacture of machinery
which would be safe, if the different States would get together even
more than they have done in the past in making safety requirements
standard. It is sometimes difficult for the manufacturer in making
a machine to have to build it in seven different ways because each
of seven different States has a different way of safeguarding it.
Chairman K e a r n s . I have always felt that an exposed gear, an
exposed set-screw, a shaft end, or any other piece of machinery that
is open is just as hazardous in one State as it is in another. If it is
strictly and satisfactorily guarded in one State I think the same re
quirement should be used m the other States for proper protection to
the employees.
In Ohio in the last few years we have been endeavoring to make our
codes conform as closely as we could to the requirements of the A.S.A.
standards. I think all of the States should do that, so far as it is
possible. Of course, local conditions make it necessaiy sometimes to
adopt additional requirements or to modify the requirements, or, in
some cases, to make them more stringent, but on the whole it seems
to me that it would be to the advantage of everybody concerned if
these codes were standardized. I think we should all work to that
end.
Dr. L l o y d . This is an old question that is brought up here today.
I think it was 10 years ago that I addressed this association on some
what similar lines, pointing out the advantages of uniform require
ments in the different States. This paper brings out something that
I think is perhaps a new idea to some of us, the part the State authori
ties can play in obtaining better practice among the manufacturers.
It is true that there are varying requirements in the different States,
but in the case of the guard rail, a man who builds his guard rail 42
inches high meets the requirements of both the 42-inch State and the
36-inch State. When it comes to the guarding of gears, I do not think
there is any such differentiation that we can point out. A gear is
either enclosed or it is not enclosed. When enclosed it is safe.
MECHANICAL GUARDING---- DISCUSSION
201
Mr. McKeown describes the practice that has been followed in
Wisconsin, and apparently it is getting results. I think we can get a
great deal more in the way of results if that practice were copied in
other States. I think most State authorities are content to point out
to the owner of the establishment the ways in which his installation
fails to comply with the regulations, but Wisconsin is going farther
than that. It finds out who is the manufacturer of that equipment
and calls his attention to the defects and urges him to supply machin
ery that will meet the requirements. If the manufacturers received
such requests as that from a great many of the States, I think it
would be much more effective in getting machinery guarded at the
point of manufacture, where it can be done much better than by
trying to apply the guard after installation. We would thus get a
more general supply of equipment that is thoroughly protected by the
manufacturer. Putting a guard on a machine after it is installed is
usually to some extent a#patchwork job. If the manufacturers
would all build the guard into the machine it would give us much
better results. We would get them at less expense, because, taking
it all around, it is less expensive to do the thing right at the start. It
is perhaps not possible to sell the guarded machine at as low a price
as the unguarded machine, and there is not the incentive to the manu
facturer to put on sometiling to increase its cost. If, however, the
customer realizes that sooner or later he will have to pay that expense
the manufacturer undoubtedly can sell the guarded machine in the
first place and it will be better guarded and better designed.
It seems to me that State officials can do quite a lot to bring that
about if they will follow Wisconsin’s practice of going to the manu
facturer of the machinery in case anything is not sufficiently guarded.
Many manufacturers are already doing a good job on that. You see
over here at A Century of Progress and in other exhibits of machinery
numerous examples of machinery that are completely guarded by the
manufacturer. An effort is needed to bring the slipshod manufacturers
into line to do the same thing, and a little pressure from all sides might
accomplish more in that direction.
Chairman K e a r n s . Have you any idea, Dr. Lloyd, as to how many
States have a statutory requirement that machinery and equipment
shall be guarded in accordance with the requirements of the code of
the State before it is shipped into the State?
Dr. L l o y d . I do not know of any State that has such definite
requirements. I suppose it might be possible to enforce that. On
second thought, I think that has been done in one or two States, but
I am not sure. I think possibly Minnesota has such a requirement.
Mr. K j a e r . I believe several laws cover the point that new machin
ery installed must be guarded in a certain way.
Dr. L l o y d . I s it illegal to bring it into the State without the guards?
I think some State has started a movement in that direction, but I
am not positive of it. A requirement of that kind might be very
effective in getting results.
Mr. E l m e r F. A n d r e w s . I think the Federal Department of Labor
is very much interested in this subject. I know the American
Standards Association is. Perhaps there is a clearing house in Wash
ington for information for all of the States so that there may be stand
ardization in guarding machinery and in enabling legislation. It
202
1933 MEETING OF I.A.I.A.B.C.
would be fine if those interested would communicate with Miss
Perkins. I am sure she would be glad to hear of any suggestions and
whether the idea is thought to be a good one by the various States and
their representatives.
Mr. J o h n B. A n d r e w s (New York). I recall that more than 20 years
ago when industrial codes and the machinery-guarding proposition were
advanced, one of the strongest arguments raised in favor of the code was
its elasticity. In a State the representatives of the different interests
would serve on the code committee. They would draw up the safety
code through an educational process, and then as conditions changed
in industry from month to month it would be unnecessary to wait for
the next session of the legislature in order to make desirable modifica
tions in the code. With the advance of the American Standards
Association code, I am wondering what has happened to elasticity on
a national basis. Can anyone throw any light upon how many of these
codes, when once established by the A.S.A., have been modified by
the same educational procedure after they have once been adopted?
Are we losing something of that educational effect in the development
of codes by the representative process within the State, with the
State’s expert assistance, or are these A.S.A. codes, as uniformly
adopted, being modified with the changes in industry? I have been
impressed with this a little in making a study of the advance of this
very important branch of labor legislation in the last 20 years. I find
that some States which have been rather inactive in the development
of safety codes have suddenly, within 1 year, adopted as many as 20
codes in a single State. I should like to know how many of the A.S.A.
codes have been frequently modified to meet new conditions.
Mr. S t e w a r t . So far as the codes that have been sponsored by this
organization are concerned, there have been, I think, a number of
changes in every code with which I have had anything to do in the
past. Take the abrasive wheel code. There have been at least two
changes, and the association has just approved a third. I think that
is true of all the codes. Of course, in the nature of the thing, these
codes are looked after by the manufacturers’ associations—the manu
facturers producing the machinery. If there is any proposed im
provement in the machinery that necessitates a change in the code,
they see that a request is made that the code provides for that new
machinery. The sectional committees of the A.S.A. take up suggested
changes and perfect the code. I know especially that that one code
has been changed three times since it was adopted.
Mr. K j a e r . T w o of the States—Nebraska and Maryland—have
adopted the A.S.A. codes verbatim. I think they are the only two
that have done so. Nebraska specifies the A.S.A. codes where the
matter is not covered by other requirements of the State, and Mary
land has adopted a number of them. Outside of that, not a single
code has been adopted that conforms exactly to the A.S.A. code.
There have been changes in the A.S.A. codes, some by amendment.
On the whole, the majority of the codes conform to the A.S.A. codes.
Some of the States use these codes only as a guide for their inspectors
mstead of adopting them exactly. In these States the feeling is that
the codes are to be used to advise the employer instead of demanding
that he conform to the standard.
Dr. L l o y d . Dr. Andrews brought up a point that perhaps needs
further consideration, that is whether the adoption of the ready-made
MECHANICAL GUARDING— DISCUSSION
203
code involves a loss in the educational process of the people who have
to live with that code within the State. I do not think the two things
are incompatible. In most of the States it is required by law that a
public hearing be had before the regulations are adopted. Frequently
there are local committees to draw up a code or at least to consider it
before it can be brought before a public hearing. It is my view that
full use can be made of these codes prepared on a national basis with
out losing the advantage of the local discussion. If the national codes
are brought to the attention of the local committee, if they are used as
a basis for the local committee’s work, after full discussion in a public
hearing, if we could get into operation some machinery by which the
local committee would always get the benefit of the enormous amount
of work done on the subject before the national code has been pro
mulgated, it would be very helpful. It would be extremely helpful,
when such committees are working in the several States and when
these public hearings are being held, if someone who has been
intimately connected with the development of the national codes
could be present to explain why some of these requirements are in the
code—requirements to which perhaps some local objection is made.
Experience can be related justifying those requirements and the
necessity of them pointed out.
Then we would have in practice a code that is locally prepared and
adapted; yet it would be substantially identical with the national
code, because the local committee would have the same reasons for
adopting the national code as the national committee had. In many
cases I know that codes or preliminary drafts of codes have been
altered by local committees or State committees, due to objections
raised in public hearings, because there was nobody present who
could explain why certain requirements were in the national code.
They are usually there for a good reason. It is the experience in
other States that justifies the requirement, and if, by hearing such
experience, the local committee could be satisfied that the requirement
is a good one, we would not have so many of these local variations.
I hope the American Standards Association will sometime be in
position to pay the necessary expenses of sending to any State that is
devloping a code, or having a local hearing, a man who can explain
why the national code is a good one and why it is to the advantage of
that State to adopt it verbatim or without making serious changes in
it. Usually there is a good reason for everything in it, but the local
people do not always know what that reason is.
Mr. K j a e r . That is just the reason the American Standards
Association codes were adopted in Nebraska. There was a member
of the staff of the American Standards Association in Nebraska. He
interviewed those people and showed them the desirability of the
national codes. Consequently the codes were adopted verbatim.
Miss J o h n s o n (Massachusetts). When we were adopting the light
ing code the Federal Bureau of Standards sent Dr. Lloyd to speak
at the public hearing on the code. While the code adopted was not
identical with that of the American Standards Association, it was a
lot more like it than otherwise would have been the case.
Chairman K e a r n s . We are all agreed, I think, that standardization
is a good thing and that we should all do what we can to bring it about.
I think also that we feel it advisable, where it can be done, to have all
machinery and equipment guarded in accordance with the require
26616°—34-----14
204
1933 MEETING OF I.A .I.A .B .C .
ments of the State regulations before it is shipped into the State. We
do not have such a law in Ohio, but we are attempting to overcome
that by contacting the employers of the State and asking them to
write into their purchase orders a proviso that the machinery or
equipment must conform to the requirements of the Ohio law. As a
result, we have had frequent requests from manufacturers of machinetool equipment in a number of States throughout the Union. Many
of our employers are carrying out that idea.
[The following resolution, which was drafted for consideration and
possible action by both the I.A.I.A.B.C. and the A.G.O.I., was read
by Mr. Patton:]
Resolved, by the I.A.I.A.B.C. and the A.G.O.I. in joint convention, that it be
recommended to the National Recovery Administration that some such clause as
the following be included in each of the industrial codes:
Every employer coming under the jurisdiction of this code shall comply with all
safety and health laws and regulations of the State in which the work place is
located. In all occupations in which workmen are not protected by State laws
or regulations the employer shall comply with provisions of any standard safety
code approved by the American Standards Association which provides protection
against any hazard encountered in such occupation.
Resolved, That a copy of this resolution be transmitted to General Hugh S.
Johnson, Administrator of the National Industrial Recovery Act.
Mr. P a t t o n . There has been a great deal of discussion as to the
safety provisions, or lack of safety provisions, in the N.R.A. codes,
and this resolution is put forward for consideration as to whether or
not it is the opinion of these two bodies that all such codes should
include the statement that the State safety and health laws and
regulations should be observed, and that insofar as there was no State
safety law in effect the employers should comply with the safety code
approved by the American Standards Association.
[A motion to adopt the resolution was made and seconded. There
was considerable discussion as to the propriety of such a resolution
from the joint session of the I.A.I.A.B.C. and the A.G.O.I. before the
motion was put to a vote and carried.]
[The method of transmitting the resolution to General Johnson was
discussed, followed by a motion, duly seconded, instructing the secre
taries of the two organizations to act jointly in sending the resolution.
The question of including the Consumers9 Advisory Board in the
resolution was also discussed, after which the motion was put to a
vote and carried.]
[Meeting adjourned.]
Appendixes
Appendix A.—Officers and Members of Committees for 1933-34
President, Joseph A. Parks, chairman Massachusetts Department of Industrial
Accidents.
Vice president, G. Clay Baker, chairman Kansas Commission of Labor and
Industry.
Secretary-treasurer, Charles E. Baldwin, Assistant United States Commissioner
of Labor Statistics.
EXECUTIVE COMMITTEE
Joseph A. Parks, Massachusetts Department of Industrial Accidents.
G. Clay Baker, Kansas Commission of Labor and Industry.
Charles E. Baldwin, Assistant United States Commissioner of Labor Statistics.
Matt H. Allen, North Carolina Industrial Commission.
Peter J. Angsten, Illinois Department of Labor.
Fred. W. Armstrong, Nova Scotia Workmen’s Compensation Board.
Parke P. Deans, Virginia Department of Workmen s Compensation, Industrial
Commission.
T. M. Gregory, Ohio Department of Industrial Relations.
R. E. Wenzel, North Dakota Workmen’s Compensation Bureau.
COMMITTEE ON STATISTICS AND COMPENSATION INSURANCE COSTS
Chairman, L. W. Hatch, New York Department of Labor.
Secretary, S. Kjaer, United States Bureau of Labor Statistics.
Charles R. Blunt, New Jersey Department of Labor.
Marie Brindell, Kansas Commission of Labor and Industry.
Albert E. Brown, Maryland Industrial Accident Commission.
E. I. Evans, Ohio Department of Industrial Relations.
O. A. Fried, Wisconsin Industrial Commission.
Sharpe Jones, Georgia Department of Industrial Relations.
William J. Maguire, Pennsylvania Department of Labor and Industry.
Howard B. Myers, Illinois Department of Labor.
O. E. Sharpe, Quebec Workmen’s Compensation Commission.
Walter O. Stack, Delaware Industrial Accident Board.
George T. Watson, West Virginia Workmen’s Compensation Department.
MEDICAL COMMITTEE
Chairman, Francis D. Donoghue, M.D., Massachusetts Department of Industrial
Accidents.
J. E. Belanger, M.D., Quebec.
D. E. Bell, M.D., Ontario Workmen’s Compensation Board.
James J. Donohue, M.D., Connecticut Board of Compensation Commissioners.
H. H. Dorr, Ohio Department of Industrial Relations.
L. Kraeer Ferguson, M.D., Pennsylvania.
G. H. Gehrmann, M.D., Delaware.
Philip H. Kreuscher, M.D., Illinois.
LeRoy P. Kuhn, M.D., Illinois.
M. D. Morrison, M.D., Nova Scotia Workmen’s Compensation Board.
Cadis Phipps, M.D., Massachusetts.
C. W. Roberts, M.D., Georgia Department of Industrial Relations.
Joseph H. Shortell, M.D., Massachusetts.
H. U. Stephenson, M.D., Virginia.
205
206
1933 MEETING OF I.A .I.A .B .C .
COMMITTEE ON SAFETY AND SAFETY CODES
Chairman, Thomas P. Kearns, Ohio Department of Industrial Relations.
Vice chairman, R. B. Morley, Ontario.
Will J. French, California Department of Industrial Relations.
A. B. Funk, Iowa Workmen’s Compensation Service.
O. R. Hartwig, Oregon State Industrial Accident Commission.
John P. Meade, Massachusetts Department of Industrial Accidents.
E. B. Patton, New York Department of Labor.
L. M. Rickerd, Washington Department of Labor and Industries.
John Roach, New Jersey Department of Labor.
Ira M. Stouffer, Indiana Industrial Board.
ELECTRICAL SAFETY CODE COMMITTEE
Chairman, Charles H. Weeks, New Jersey Department of Labor.
J. Fred Cherry, Virginia Department of Workmen’s Compensation, Industrial
Commission.
L. L. Elden, Massachusetts Department of Industrial Accidents.
B. P. Foster, Delaware Industrial Accident Board.
C. P. Keogh, New York Department of Labor.
A. H. Meier, Indiana Industrial Board.
J. E. Wise, Wisconsin Industrial Commission.
COMMITTEE ON FORMS
Chairmany Sidney W. Wilcox, New York Department of Labor.
A. J. Altman, Wisconsin Industrial Commission.
A. C. Dale, Pennsylvania Department of Labor and Industry.
Miss R. O. Harrison, Maryland Industrial Accident Commission.
P. V. E. Jones, Manitoba Workmen’s Compensation Board.
S. Kjaer, United States Bureau of Labor Statistics.
Hal M. Stanley, Georgia Department of Industrial Relations.
Mrs. Emma S. Tousant, Massachusetts Department of Industrial Relations.
COMMITTEE ON REHABILITATION
Chairmany George A. Kingston, Ontario Workmen’s Compensation Board.
Donald D. Garcelon, Maine Industrial Accident Commission.
Hal M. Stanley, Georgia Department of Industrial Relations.
Mark M. Walter, Pennsylvania Department of Labor and Industry.
Voyta Wrabetz, Wisconsin Industrial Commission.
COMMITTEE ON WORKMEN’ S COMPENSATION LEGISLATION
Chairmany Abel Klaw, Wilmington, Del.
T. A. Edmondson, Ohio Department of Industrial Relations.
Howard Keener, Arizona Industrial Commission.
O. F. McShane, Utah Industrial Commission.
Charles F. Sharkey, United States Bureau of Labor Statistics.
Appendix B.—Constitution of the International Association of
Industrial Accident Boards and Commissions
A r t ic l e I
This organization shall be known as the International Association of Indus
trial Accident Boards and Commissions.
A r t i c l e II— Objects
1. This association shall hold meetings once a year, or oftener, for
the purpose of bringing together the officials charged with the duty of admin
istering the workmen’s compensation laws of the United States and Canada to
consider, and, so far as possible, to agree on standardizing (a) ways of cutting
down accidents; (6) medical, surgical, and hospital treatment for injured workers;
(c) means for the reeducation of injured workmen and their restoration to in
dustry; (d) methods of computing industrial accident and sickness insur
ance costs; (e) practices in administering compensation laws; (J) extensions
S e c t io n
APPENDIX B.— CONSTITUTION
207
and improvements in workmen's compensation legislation; and (g) reports and
tabulations of industrial accidents and illnesses.
S e c . 2. The members of this association shall promptly inform the United
States Bureau of Labor Statistics and the Department of Labor of Canada
of any amendments to their compensation laws, changes in membership of their
administrative bodies, and all matters having to do with industrial safety,
industrial disabilities and compensation, so that these changes and occurrences
may be noted in the Monthly Labor Review of the United States Bureau of
Labor Statistics and the Canadian Labor Gazette.
A r t ic l e
III—Membership
S e c t i o n 1. Membership shall be o f
S e c . 2. Active membership.—Each
two grades, active and associate.
State of the United States and each
Province of Canada having a workmen's compensation law, the United States
Employees' Compensation Commission, the United States Bureau of Labor
Statistics, and the Department of Labor of Canada shall be entitled to active
membership in this association. Only active members shall be entitled to vote
through their duly accredited delegates in attendance on meetings.
S e c . 3. Associate membership.— Any organization or individual actively inter
ested in any phase of workmen's compensation or social insurance may be
admitted to associate membership in this association by vote of the executive
committee. Associate members shall be entitled to attend all meetings and
participate in discussions, but shall have no vote either on resolutions or for
the election of officers in the association.
Sec. 4. Honorary life membership.—Any person who has occupied the office of
president or secretary of the association shall be ex officio an honorary life
member of the association with full privileges.
A r t ic l e
IV—Representation
S e c t io n 1. Each active member of this association shall have one vote.
Sec. 2. Each active member may send as many delegates to the annual meet
ing as it may think fit.
S e c . 3. Any person in attendance at conferences of this association shall be
entitled to the privileges of the floor, subject to such rules as may be adopted by
the association.
A r t i c l e V—Annual dues
S e c t i o n 1. Each active member shall pay annual dues of $50, except the
United States Employees' Compensation Commission, the United States Bureau
of Labor Statistics, and the Department of Labor of Canada, which shall be
exempt from the payment of annual dues: Provided, That the executive com
mittee may, in its discretion, reduce the dues for active membership for those
jurisdictions in which no appropriations are made available for such expendi
tures, making it necessary that the officials administering the Law pay the a n n u a l
dues out of their own pockets for the State.
S e c . 2. Associate members shall pay $10 per annum.
S e c . 3. Annual dues are payable any time after July 1, which date shall be
the beginning of the fiscal year of the association; dues must be paid before the
annual meeting in order to entitle members to representation and the right to
vote in the meeting.
A r t ic l e
VI— Meetings of the association
1. An annual meeting shall be held at a time to be designated by
the association or by the executive committee. Special meetings may be called
by the executive committee. Notices for special meetings must be sent out at
least one month in advance of the date of said meetings.
S e c . 2. At all meetings of the association the majority vote cast by the active
members present and voting shall govern, except as provided in Article X.
S e c t io n
A r t ic l e
VII—Officers
S e c t i o n 1. Only officials having to do with the administration of a workmens*
compensation law or bureau of labor may hold an office in this associationexcept as hereinafter provided.
S e c . 2. The association shall have a president, vice president, and secretary,
treasurer.
208
1933 MEETING OP I.A .I.A .B .C .
Sec. 3. The president, vice president, and secretary-treasurer shall be elected
at the annual meeting of the association and shall assume office at the last
session of the annual meeting.
Sec. 4. If, for any reason, an officer of this association, during the term for
which he was chosen, shall cease to be an official of any agency entitled to active
membership, he may serve out his term of office in this association; but, if for
any reason a vacancy occurs, the executive committee shall appoint a successor
to serve for the remainder of the term.
A r t ic l e
VIII—Executive committee
S e c t i o n 1. There shall be an executive committee of the association, which
shall consist of the president, vice president, the retiring president, secretarytreasurer, and five other members, elected by the association at the annual
meeting.
Sec. 2. The duties of the executive committee shall be to formulate programs
for all annual and other meetings and to make all needed arrangements for such
meetings; to pass upon applications for associate membership; to fill all offices
which may become vacant; and in general to conduct the affairs of the associa
tion during the intervals between meetings. The executive committee may also
reconsider the decision of the last annual conference as to the next place of
meeting and may change the place of meeting if it is deemed expedient.
A r t ic l e
IX —Quorum
S e c t i o n 1. The president or the vice president, the secretary-treasurer or his
representative, and one other member of the executive committee shall consti
tute a quorum of that committee.
A r t ic l e X
—Amendments
This constitution or any clause thereof may be repealed or amended at any
regularly called meeting of the association. Notice of any such changes must
be read in open meeting on the first day of the conference, and all changes of
which notice shall have thus been given shall be referred to a special com
mittee, which shall report thereon at the last business meeting of the conference.
No change in the constitution shall be made except by a two-thirds vote of the
members present and voting.
Appendix C.—List of Persons Who Attended the Twentieth Annual
Meeting of the International Association of Industrial Accident Boards
and Commissions, Held at Chicago, 111., September 11-15,1933
CANADA
Manitoba
P. V. E. Jones, workmen’s compensation board, Winnipeg.
New Brunswick
John A. Sinclair, workmen’s compensation board, St. John.
Nova Scotia
Fred W. Armstrong, workmen’s compensation board, Halifax.
Ontario
A. W. Crawford, Department of Labor, Toronto.
H. J. Halford, workmen’s compensation board, Toronto.
Quebec
J. E. Belanger, M.D., workmen’s compensation board, Quebec.
O. E. Sharpe, workmen’s compensation board, Quebec.
Mrs. O. E. Sharpe, Quebec.
Saskatchewan
Alfred Higgin, workmen’s compensation board, Regina.
APPENDIX C.— LIST OF PERSONS ATTENDING
209
UNITED STATES
Arizona
Howard Keener, industrial commission, Phoenix.
California
Mrs. Mabel E. Kinney, division of industrial welfare, Los Angeles.
Delaware
C. W. Dickey, E. I. du Pont de Nemours & Co., Inc., Wilmington.
Abel Klaw, E. I. du Pont de Nemours & Co., Inc., Wilmington.
Emil J. Riederer, Atlas Powder Co., Wilmington.
District of Columbia
Miss Mary Anderson, director, United States Women’s Bureau.
Charles E. Baldwin, assistant commissioner, United States Bureau of Labor
Statistics.
Miss Tracy Copp, Federal Board for Vocational Education.
S. Kjaer, United States Bureau of Labor Statistics.
M. G. Lloyd, United States Bureau of Standards.
Charles F. Sharkey, United States Bureau of Labor Statistics.
Miss Estelle Stewart, United States Bureau of Labor Statistics.
Ethelbert Stewart, Washington, D.C.
Georgia
Sharpe Jones, department of industrial relations, Atlanta.
Mrs. J. C. Petette, Atlanta.
Hal M. Stanley, Atlanta.
Robert Thrasher, department of industrial relations, Atlanta.
T. E. Whitaker, department of industrial relations, Atlanta.
Miss Marcia Whitaker, Atlanta.
Illinois
Peter J. Angsten, industrial commission, Chicago.
Mrs. Peter J. Angsten, Chicago.
Frank Baldwin, Chicago.
A. W. Becker, industrial commission, Chicago.
H. R. Berg, American Mutual Liability Insurance Co., Chicago.
Miss Mae Callahan, Chicago.
Thomas E. Cambridge, International Harvester Co., Chicago.
A. N. Christian, International Harvester Co., Chicago.
Joseph D. Cronin, industrial commission, Chicago.
N. S. Davis, III, M.D., Chicago.
Walter F. Dodd, Chicago.
J. D. Dooley, Norwich Union, Chicago.
John D. Ellis, M.D., Chicago.
G. E. French, Liberty Mutual Insurance Co., Chicago.
T. G. Glenn, General Electric Co., Chicago.
Ross Grant, Chicago.
Samuel S. Graves, M.D., Chicago.
C. G. Gregory, International Harvester Co., Chicago.
F. M. Harvey, M.D., Crane Co., Chicago.
A. J. Hummert, industrial commission, Chicago.
Mrs. A. J. Hummert, Chicago.
Anton Johannsen, industrial commission, Chicago.
William Kerr, Chicago.
Mrs. Laura Kerr, Chicago.
Paul R. Kerschbaum, department of labor, Chicago.
A. L. Kirkpatrick, Chicago Journal of Commerce, Chicago.
LeRoy P. Kuhn, M.D., Lumbermen’s Mutual Casualty Co., Chicago.
R. G. Leland, M.D., American Medical Association, Chicago.
Abe Levin, industrial commission, Chicago.
Joseph L. Lisack, industrial commission, Chicago.
J. E. MacLean, Bankers Industry Insurance Co., Chicago.
Miss Winnie May, industrial commission, Chicago.
Howard B. Myers, department of labor, Chicago.
Charles A. Nowak, Chicago.
210
1933 MEETING OF I.A .I.A .B .C .
Mrs. Charles A. Nowak, Chicago.
Charles Nowak, Jr., Chicago.
Lawrence J. O’Connell, industrial commission, Chicago.
M. J. O’Brien, Chicago.
Russell I. Piale, Metropolitan Casualty Insurance Co., Chicago.
Miss M. Josephine Powers, Chicago.
B. S. Quigley, Liberty Mutual Insurance Co., Chicago.
E. H. Rategan, M.D., industrial commission, Chicago.
Garvin H. Richards, industrial commission, Chicago
A. F. Riggs, General Electric Co., Chicago.
Miss Hilda Roughley, industrial commission, Chicago.
W. H. Rutherford, Chicago.
F. L. Smith, M.D., Western Electric Co., Chicago.
Miss Edith Stewart, Chicago.
D. P. Thayer, Pere Oil Co., Chicago.
A. M. Thompson, industrial commission, Chicago.
E. E. Thompson, industrial commission, Chicago.
Miss Mary Trant, industrial commission, Chicago.
Indiana
Ira M. Snouffer, industrial commission, Indianapolis.
Iowa
Ora Williams, industrial commission, Des Moines.
Kansas
G. Clay Baker, commission of labor and industry, Topeka.
Marie Brindell, workmen’s compensation commission, Topeka.
Maine
Donald D. Garcelon, industrial accident commission, Augusta.
Mrs. Harriet Garcelon, Augusta.
Maryland
Albert E. Brown, industrial accident commission, Baltimore.
Robert H. Carr, industrial accident commission, Baltimore.
Omar D. Crothers, industrial accident commission, Baltimore.
Miss Rowena O. Harrison, industrial accident commission, Baltimore.
Massachusetts
Miss Helen C. Barry, Boston.
Miss Elizabeth Merrick, Roslindale.
Joseph A. Parks, chairman industrial accident board, Boston.
Mrs. Joseph A. Parks, Boston.
Mrs. Emma S. Tousant, department of industrial accidents, Boston.
Minnesota
J. D. Williams, industrial commission, St. Paul.
Mrs. Gertrude Williams, St. Paul.
New York
Elmer F. Andrews, department of labor, New York.
John B. Andrews, American Association for Labor Legislation, New York.
H. C. Barelman, Employees’ Mutual Liability Insurance Co., New York.
R. M. Crater, American Telephone & Telegraph Co., New York.
E. B. Patton, department of labor, division of statistics, New York.
Mrs. E. B. Patton, Bronxville.
John L. Shea, New York.
Ruth A. Yerion, Commonwealth Fund, New York.
North Carolina
J. Dewey Dorsett, industrial commission, Raleigh.
APPENDIX C.— LIST OP PERSONS ATTENDING
211
North Dakota
R. E. Wenzel, workmen’s compensation bureau, Bismarck.
Ohio
Carl C. Beasor, industrial commission, Columbus.
H. H. Dorr, M.D., industrial commission, Columbus.
Mrs. H. H. Dorr, Columbus.
Miss Mildred G. Durbin, Columbus.
T. A. Edmondson, department of industrial relations, Columbus.
Mrs. T. A. Edmondson, Columbus.
Miss Lucille Edmondson, Columbus.
E. I. Evans, division of workmen’s compensation, Columbus.
Thomas M. Gregory, industrial commission, Columbus.
Thomas P. Kearns, division of safety and hygiene, Columbus.
Wellington T. Leonard, Columbus.
Mrs. Wellington T. Leonard, Columbus.
D. M. McDonald, Firestone Co., Ohio.
W. E. Obetz, M.D., industrial commission, Columbus.
Mrs. W. E. Obetz, Columbus.
Miss Mabel Obetz, Columbus.
Miss Helen C. Simons, industrial commission, Columbus.
E. E. Watson, Columbus.
Pennsylvania
W. F. Ames, Bethlehem Steel Co., Bethlehem.
Miss Margaret Bach, Philadelphia.
Howard E. Bricker, M.D., Philadelphia Rapid Transit Co., Philadelphia.
Mrs. Howard E. Bricker, Philadelphia.
W. H. Horner, Permanent Self-Insurers’ Association, Harrisburg.
Raymond Scott, General Accident Insurance Co., Philadelphia.
Stephen B. Sweeney, M.D., director bureau of workmen’s compensation, Harris
burg.
Mrs. Stephen B. Sweeney, Harrisburg.
Walter Tiern, Pennsylvania Self-Insurers’ Association, Philadelphia.
A. L. Watson, Koppers Co., Pittsburgh.
Puerto Rico
P. R. Martinez, department of labor, San Juan.
Miss O. Martinez, San Juan.
Virginia
Parke P. Deans, department of workmen’s compensation, Richmond.
Mrs. Parke P. Deans, Richmond.
J. Errett Hall, industrial commission, Richmond.
West Virginia
R. H. Giles, workmen’s compensation commission, Charleston.
George T. Watson, workmen’s compensation commission, Charleston.
Wisconsin
Carl A. Kasper, Employers’ Mutual Liability Insurance Co., Wausau.
C. W. Kroening, Employers’ Mutual Liability Insurance Co., Wausau.
B. E. Kuedale, Employers’ Mutual Liability Insurance Co., Wausau.
Harry R. McLogan, industrial commission, Madison.
V oyta W rabetz, industrial commission, M adison.
INDEX TO PROCEEDINGS OF INTERNATIONAL ASSOCIATION
OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS,
1933
A
Accident prevention:
Cause analysis of accidents (Boulet). Bui. 602, pp. 183-193.
History of. Bui. 602, p. 151.
Mechanical safeguards. Bui. 602, pp. 196-204.
New deal and safety (Keefer). Bui. 602, pp. 176-182.
Accident reporting (Baker). Bui. 602, pp. 19-22, 183-193.
Accident statistics, National Safety Council. Bui. 602, p. 177
Accidents, industrial:
Cause analysis (Boulet). Bui. 602, pp. 183-193.
Classification of. Bui. 602, pp. 185-187.
Number of. Bui. 602, pp. 150, 177.
Age, back injuries. Bui. 602, p. 91.
Agreements, voluntary. Bui. 602, p. 145.
American remarriage table, resolution on. Bui. 602, p. 136.
American Standards Association, safety standards. Bui. 602, pp. 194-195, 197.
Ankylosis. Bui. 602, pp. 123, 124, 125, 131.
Anomalies. (See Back conditions.)
Appeals, legislation 1933. Bui. 602, p. 140.
Arthritis, as contributing cause in back injuries (Magnuson). Bui. 602, pp. 90-95,119.
Association of Governmental Officials in Industry. (See International Association of Governmental Labor
Officials in Industry.)
Attorneys’ fees. (See Lawyers* fees.)
Average weekly wage. (See Wages.)
B
Back conditions:
Analysis of 1,000 cases. Bui. 602, pp. 121-122.
Anomalies as contributing causes (Magnuson). Bui. 602, pp. 90-95, 96-98,117-118.
Backache, trauma as distinguished from disease (David). Bui. 602, pp. 81-90.
Bone anomalies. Bui. 602, pp. 90-95,96-98, 117-118.
Cost of. Bui. 602, pp. 121-122.
Final disposition of cases (Kuhn). Bui. 602, pp. 117-124.
Fusion of vertebrae (Forrester). Bui. 602, pp. 111-113.
Physical examination of the injured back (Ellis). Bui. 602, pp. 71-80.
Spinal fractures. (Kreuscher.) Bui. 602, pp. 113-117.
----- (Potter.) Bui. 602, pp. 9&-108.
Strains. Bui. 602, pp. 118-119.
Wedge-shaped vertebrae, healed fracture and healed vertebral disease (Potter). Bui. 602, pp. 96-108.
Benefits, compensation. Bui. 602, p. 141.
Bone anomalies as contributing causes in spine injuries (Magnuson). Bui. 602, pp. 90-95, 96-98, 117-118.
C
Child labor. (See Minors.)
Clinics. Bui. 602, p. 131.
Committee on statistics and compensation insurance cost. (See Statistics and compensation insurance cost,
committee on.)
Committees. (See I.A.I.A.B.C.: Convention, and standing committees; also committees under specific
subjects.)
Compensation. (See Workmen’s compensation.)
Congenital defects. (See Bone anomalies.)
Cost:
Back injuries. Bui. 602, pp 121-122.
Compensation. Bui. 602, pp. 107, 108.
Medical and hospital. Bui. 602, pp. 108-109.
D
Daggett, Floyd L., death of. Bui. 602, pp. 9,135.
Date of injury. Bui. 602, p. 47.
Diagnosis, back injuries. Bui. 602, pp. 71-80,88,92.
Disaster fund. Bui. 602, p. 14.
Duxbury, F. A., death of. Bui. 602, pp. 9,135.
213
214
IN D E X
E
Electrical Safety Code Committee, report of (Weeks). Bui. 602, pp. 10-U
Executive committee, I.A.I.A.B.C. Bui. 602, p. 205.
Extraterritoriality, court decision. Bui. 602, pp. 143-144.
Education as to workmen’s compensation. Bui. 602, pp. 29,32.
F
Fact, judge of. Bui. 602, pp. 28-29,30.
Federal and State laws, harmonizing of. Bui. 602, pp. 53-55Forms, committee I.A.I.A.B.C. on. Bui. 602, p. 206.
Report (S. W. Wilcox). Bui. 602, pp. 11, 34, 67-68.
Resolution on. Bui. 602, p. 136.
States adopting. Bui. 602, p. 37.
Uniformity. Bui. 602, pp. 33-39.
Fractures, back:
(Kreuscher.) Bui. 602, pp. 113-117.
(Potter.) Bui. 602, pp. 96-108.
Health insurance.
Bui. 602, pp. 58-63.
H
I
Insurance companies. (See Private insurance companies; Mutual insurance.)
Insurance principle in practice of medicine (Leland). Bui. 602, pp. 56-63.
International Association of Governmental Officials in Industry, joint sessions with. Bui. 602, pp.
148-204.
International Association of Industrial Accident Boards and Commissions:
Committees. Appointment and reports, convention committees. Bui. 602, pp. 1, 18, 135-137.
----- Standing. Bui. 602, pp. 205-206.
Constitution. Bui. 602, pp. 206-208.
Convention:
List of previous. Bui. 602, p. II.
Persons attending. Bui. 602, pp. 208-211.
Program, resolution. Bui. 602, pp. 136, 137.
Dues, resumption of. Bui. 602, pp. 9,135.
Members, list of. Bui. 602, pp. 8-9.
Officers. Bui. 602, pp. II, 205.
Proceedings, twentieth annual convention, Chicago, Illinois, September 11-14,1933. Bui. 602.
International Association of Public Employment Services, recommendation for joint session with. Bui.
602, pp. 148-149.
L
Laws. (See Legislation.)
Lawyers’ fees. Bui. 602, p. 139.
Legislation, workmen’s compensation:
Changes in (Sharkey). Bui. 602, pp. 137-143.
Committee, I.A J.A .B .C . on (Klaw). Bui. 602, pp. 11-18, 206.
Defects in. Bui. 602, pp. 5-6.
Federal and State, conflict of. Bui. 602, pp. 53-55.
Massachusetts committee on uniform. Bui. 602, p. 176.
National Recovery Act, conflict with. Bui. 602, pp. 53-55.
Occupational diseases. Bui. 602, pp. 49-50, 140-141, 142-143.
Puerto Rico. Bui. 602, pp. 145-147.
Uniformity. Bui. 602, pp. 39, 49, 55, 176.
Loss of use, percentage of, Wisconsin schedule. Bui. 602, pp. 123-130, 132.
Lumbago. Bui. 602, p. 120.
M
Malingering. Bui. 602, pp. 26, 92, 106-107, 126-127,133-134.
Maritime accidents, court decision. Bui. 602, p. 144.
Massachusetts committee on uniform legislation. Bui. 602, p. 176.
Mechanical safeguards and safety codes (Keown). Bui. 602, pp. 193-204.
Medical advice. Bui. 602, pp. 127-133.
Medical and hospital care. Bui. 602, pp. 56-63, 108-109.
Medical care, report of committee on. Bui. 602, pp. 58-59, 61, 62, 67.
Medical committee, I.A.I.A.B.C. Bui. 602, p. 205.
Medical testimony. Bui. 602, pp. 51-53.
Medicine, insurance principle in practice of (Leland). Bui. 602, pp. 56-63.
Minor, obligations and rights, notice and demand (Baker). Bui. 602, pp. 19-22
Minors, employment of. Bui. 602, pp. 19-22, 138.
Mutual insurance, rates. Bui. 602, p. 43.
IN D E X
215
N
National Recovery Act:
Codes, resolution re safety provision. Bui. 602, pp. 173-174, 204.
Conflict with State laws. Bui. 602, pp. 53-55.
National Safety Council, accident statistics. Bui. 602, p. 177.
Neurosis. Bui. 602, p. 92.
New Deal and safety (Keefer). Bui. 602, pp. 176-182.
No-dependent cases. Bui. 602, pp. 12,13,16-17.
O
Occupational diseases:
Coverage. Bui. 602, pp. 47-50.
Legislation, 1933. Bui. 602, pp. 140-141,142-143.
Osteroarthritis. Bui. 602, pp. 103-104.
P
Paterson Mortgage & Title Guaranty Co., certificate of. Bui. 602, pp. 9,136.
Permanent disabilities, Wisconsin schedule. Bui. 602, pp. 123-130, 132.
Physician:
Choice of. Bui. 602, pp. 60-61, 109.
Fees. Bui. 602, pp. 120, 129-130.
Honesty of. Bui. 602, pp. 25-26, 107, 108, 109, 110.
Physiotherapy. Bui. 602, pp. 72, 131-132.
Poison-oak poisoning. Bui. 602, p. 145.
Politics. Bui. 602, pp. 4-5, 27-28, 110, 138, 145.
Puerto Rico, workmen’s compensation situation in (Martinez). Bui. 602, pp. 145-147.
Pre-existing conditions:
Back injuries. Bui. 602, pp. 81-90, 98-102,119-120.
Court decision. Bui. 602, p. 143.
President’s address (Wenzel). Bui. 602, pp. 1-7.
Private insurance companies:
Failure. Bui. 602, pp. 40, 41, 45-46.
Honesty. Bui. 602, p. 36.
Occupational diseases. Bui. 602, pp. 47-48.
Rates. Bui. 602, pp. 42-45.
Security required. Bui. 602, pp. 40, 41, 46,138-139.
Selection of risk. Bui. 602, p. 42.
n
Rate-making authority. Bui. 602, pp. 44-45.
Rates:
Mutual insurance. Bui. 602, p. 43.
Private insurance companies. Bui. 602, pp. 42-45.
Reconstruction Finance Corporation, loans to State funds. Bui. 602, p. 32
Rehabilitation, committee I.A.I.A.B.C. on. Bui. 602, p. 205.
Rehabilitation services, cooperation with (Kratz). Bui. 602, pp. 63-67.
Relief workers, coverage of. Bui. 602, pp. 139-140.
Resolutions, I.A.I.A.B.C., report of committee on. Bui. 602, pp. 135-137. (See also resolutions under spe
cific subjects).
S
Sacroiliac injuries. (See Back conditions.)
Safety and safety codes, committee I.A.I.A.B.C. on. Bui. 602, p. 205.
Report (Kearns). Bui. 602, pp. 68-69.
Safety codes:
Electrical safety code committee, I.A.I.A.B.C. Bui. 602, p. 206.
Report (Weeks). Bui. 602, p. 11.
Safety codes and regulations:
(Baldwin). Bui. 602, pp. 136,151-166.
List of, by States. Bui. 602, pp. 153-166.
Progress (Agnew). Bui. 602, pp. 166-176.
National Recovery codes. Bui. 602, pp. 174-175, 204.
Standardization of (Keown). Bui. 602, pp. 193-204.
Safety devices. (See Mechanical safeguards.)
Second injuries:
1933 legislation. Bui. 602, p. 141.
Proposed legislation. Bui. 602, pp. 11-18.
Security. (/Sec Mutual insurance; Private insurance companies; Self insurers.)
Secretary-treasurer, I.A.I.A.B.C., report of. Bui, 602, pp. 8-10.
Selection of risk. Bui. 602, p. 42,
IN D E X
216
Self-insurers:
Failure. Bui. 602, pp. 40,46-47.
Security required. Bui. 602, pp. 39-41.
Sickness insurance. Bui. 602, pp. 58-63.
Silicosis. Bui. 602, pp. 48-49, 60,142-143.
Spine. (See Back conditions.)
Standardization. (See Forms; Legislation; Safety codes.)
State funds, loans by R.F.C. Bui. 602, p. 32.
Statistics and compensation insurance costs, committee I.A.I.A.B.C. on. Bui. 602, p. 205.
Report of. Bui. 602, p. 70.
Strains, back. Bui. 602, pp. 118,119.
T
Tenure of office, administering officials. Bui. 602, pp. 4-5,27-28.110.138,145.
Third-party cases, legislation, 1933. Bui. 602, p. 140.
Tickbite. Bui. 602, p. 145.
Trauma, backache (Davis). Bui. 602, pp. 81-90.
Tuberculosis, back injuries. Bui. 602, pp. 102,103, 111.
U
Uniformity.
(See Forms; Legislation; Safety codes.)
V
Vertebrae. (See Back conditions.)
Vocational rehabilitation services, cooperation with (Kratz). Bui. 602, pp. 63-67.
W
Wage, average weekly, committee I.A.I.A.B.C. on. Bui. 602, p. 136.
Wages, calculation of. Bui. 602, pp. 38-39, 50-51, 55, 141.
Widows, remarriage table. Bui. 602, p. 136.
Workmen’s compensation:
Cost. Bui. 602, pp. 107,108.
Progress (Parks). Bui. 602, pp. 22-28.
Purpose, Bui. 602, pp. 15, 22, 31, 65.
X
X-rays, back injuries. Bui. 602, pp. 71,90,91,95,111-112.
@FedFRASER