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U. S. DEPARTMENT OF LABOR
JAMES J DAVIS, Secretary
BUREAU OF LABOR STATISTICS
ETHELBERT STEWART, Commissioner
BULLETIN OF THE UNITED STATES\
BUREAU OF LABOR S T A T IS T IC S /
WORKMEN’S
INSURANCE
AND
IT
*
*
i o r
JNO* *tO D
COMPENSATION
SERIES
PROCEEDINGS OF THE FIFTEENTH ANNUAL MEETING
OF THE
INTERNATIONAL ASSOCIATION OF INDUSTRIAL
ACCIDENT BOARDS AND COMMISSIONS
HELD AT PATERSON, N .J.
SEPTEMBER 11-14,1928
JUNE, 1929
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON s 1929
ANNUAL
MEETINGS AND OFFICERS OF THE INTERNATIONAL ASSOCIATION
INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
OF
Annual meetings
President
NTo.
Date
1
0)
2
3
4
Apr. 14, 15, 1914________
Jan. 12, 13, 1915________
Sept. 30-0et. 2, 1915
Apr. 25-28, 1916________
Aug. 21-2.5, 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________
5
6
7
8
9
10
11
12
13
.14
15
i Special meeting.
H
Secretary-treasurer
Place
Lansing, M ich ____ ___
John E. Kinnane______
Richard L. Drake.
Chicago, Til _ ___ _ . . _do_ __ __ _______
Do.
Seattle, Wash ___ ___
. . _do '
_____
Do.
Columbus, Ohio__ ____ Floyd L. Daggett______ L. A. Tarrell.
Boston, Mass ___ . . .
Dudley M . H olm an____ Royal Meeker.
F. M . W ilco x..
Madison, Wis _
Do.
Do.
Toronto, Ontario... . . . George A. Kingston.
Will J. French _
San Francisco, Calif ..
Charles H. Verrill.
Chicago, 111____________ Charles S. Andrus
Ethelbert Stewart.
Robert E. Lee
Baltimore, M d._
Do.
St. Paul, M in n ________ F. A. Duxburv . Do.
Halifax, N ova Scotia___ Fred W . Armstrong
Do.
Salt Lake City, U ta h ... O. F. M cShane__
Do.
Hartford, C onn.
__ F. M . Williams _____
Do.
H. M . S tanley._ ______
Atlanta, Ga___________
Do.
Paterson, N. J . . . _____ Andrew F. M cB ride___
Do.
Contents
TUESDAY, SEPTEMBER 11— MORNING SESSION
Chairman, Andrew F. McBride, M. IX, president I. A . I. A. B. C.
Page
Introductory remarks by the chairman___________________________________
1-2
Address of welcome, by Hon. A. Harry Moore, Governor of New Jersey2-4
Address of welcome, by Hon. Wilmer A. Cadmus, acting Mayor of Pater-'
son, N. J_______________________________________________________________
4, 5
Response to addresses of welcome, by James A. Hamilton, Industrial
Commissioner of New York_____________________________________________
5, 6
Address of the president, by Andrew F. McBride_________________________ 6-12
Business meeting:
Appointment of convention committees______________________________
13
Report of the secretary_______________________________________________ 13-17
Financial report of the treasurer..____________________________________ 17-20
Reports of committees:
Report of the committee on statistics and compensation insurance
cost_________________________________________________________________20-22
Report of committee on investigation of results of compensation
awards, by Rowena O. Harrison___________________________________ 22, 23
Report of joint committees of the I. A. I. A. B. C. and the National
Association of Legal Aid Organizations, 1928______________________ 23-25
TUESDAY, SEPTEMBER 11— AFTERNOON SESSION
Longshoremen’s and harbor workers* compensation act: Chairman, George A.
Kingston, commissioner Workmen’s Compensation Board of Ontario
Longshoremen’s and Harbor Workers’ Compensation for the Port of New
York, by Jerome G. Locke, deputy commissioner United States Em
ployees’ Compensation Commission_____________________________________26-30
Discussion:
Ethelbert Stewart, of Washington, D. C________________________ 30-51
Jerome G. Locke, of New York__________________________________31-49
Fred M. Wilcox, of Wisconsin___________________________________ 31-48
George A. Kingston, of Ontario_________________________________ 32-51
Walter O. Stack, of Delaware___________________________________ 32-51
Andrew F. McBride, M. D., of New Jersey___________________ _ 32-47
A. Klaw, of Delaware___________________________ ________________ 33-38
Leonard W. Hatch, of New York________________________________
33
John B. Andrews, of New York_________________________________ 34-52
William A. Marshall, of Washington____________________________ 35-43
Fred W. Armstrong, of Nova Scotia_____________________________ 35, 36
C. L. Heaberlin, of West Virginia_______________________________ 37-39
F. A. Duxbury, of Minnesota____________________________________ 38-52
W. H. Horner, of Pennsylvania__________________________________39-45
R. E. Wenzel, of North Dakota_________________________________ 42, 46
William M. Scanlan, of Illinois__________________________________ 45, 47
Willis B. Hall, of Maine_________________________________________
46
Parke P. Deans, of Virginia_____________________________________ 48-51
in
CONTENTS
IV
,
WEDNESDAY SEPTEMBER 12— MORNING SESSION
Medical session: Chairman, F. H. Todd, of the General Hospital, Paterson, N. J.
Page
“ Traumatic Labyrinthitis” ! The Period of and the Measurement of Dis
ability, by Jack Blumberg, M. D., of Elizabeth, N. J____________________53-55
The Fractured Female Pelvis; Subsequent Pregnancies and the Measure
ment of Disability, by Samuel A. Cosgrove, M. D., and William W.
Maver, M. D., of Jersey City, N. J_____________________________________55-62
The Traumatized Kidney: Measuring the Percentage of Disability, by
Stanley R. Woodruff, M. D., of New York City_______________________ 62-69
The Traumatized Urethra: Prognosis and Treatment; Measuring the Dis
ability, by C. Rutherford O’ Crowley, M. D., of Newark, N. J_______ 69-74
Discussion:
F. M. Williams, of Connecticut__________________________________74-77
74
Ethelbert Stewart, of Washington, D. C ________________________
William J. Arlitz, M. D., of New Jersey_________________________ 75-81
George A. Kingston, of Ontario__________________________________75-85
Jack Blumbeig, M. D., of New Jersey_________________________
76
William W. Maver, M. D., of New Jersey_______________________76, 77
C. Rutherford O’ Crowley, M. D., of New Jersey________________ 77-85
Edward M. Nash, of New York_________________________________ 79-85
Stanley R. Woodruff, M. D., of New York______________________ 79-82
80
Mr. Stiggins_____________________________________________________
William Spickers, of New Jersey_________________________________
82
WEDNESDAY, SEPTEMBER 12— AFTERNOON SESSION
Medical session: Chairman, William J. Arlitz, M. D., of Hoboken, N. J.
On the Relationship Between Single Trauma, Carcinoma, and Workmen’s
Compensation, by Jonathan M. Wainwright, M. D., of Scranton, Pa_ 86-92
Fractures of the Spine and Their Treatment, Amount of Disability, and
Indications for and Results of Operative Interference, by Charles A.
Elsberg, M. D., of New York City____________________________________ 93-101
Traumatic Accentuation of Chronic Disease, by Abraham E. Jaffin, M. D.,
Jersey City, N. J_____________________________________________________ . 101-112
Fractures of the Lower End of the Tibia and Fibula— Structural Changes
and Improper Alignment— Is the Disability Confined to the Foot and
Leg or Should It Be Considered as of the Total, by John J. Moorhead,
M. D., of New York City____________________________________________ 112-115
Discussion:
F. M. Williams, of Connecticut_______________________________ 115-124
Andrew F. McBride, M. D., of New Jersey___________________ 115-123
Maurice S. Avidan, M. D., of New Jersey____________________ 115-119
George A. Kingston, of Ontario_________________________________
116
Charles A. Elsberg, M. D., of New York--------------------------------- 116-121
John J. Moorhead, M. D., of New York______________________ 116-124
Joseph F. Londrigan, M. D., of New Jersey__________________ 116-119
Jonathan M. Wainwright, M. D., of Pennsylvania------------------ 117-120
Frederick W. Flagge, M. D., of New Jersey-------------------------------117
Ethelbert Stewart, of Washington, D. C ---------------------------------- 118-121
Abraham E. Jaffin, M. D., of New Jersey----------------------------------121
Fred M. Wilcox, of Wisconsin___________________________________
122
,
THURSDAY SEPTEMBER 13— MORNING SESSION
Occupational diseases: Chairman, Sam Laughlin, chairman State Industrial
Accident Commission of Oregon
How Chemistry Has Changed Industry, and as a Result Has Changed the
Tendency to Occupational Disease, by G. H. Gehrmann, M. D., medical
director E. I. du Pont de Nemours & Co-------------------------------------------- 125-129
CONTENTS
V
Page
Health Hazards in Industry, by J. J. Bloomfield, assistant physical chemist
United States Public Health Service_________________________________ 130-140
Discussion:
Ethelbert Stewart, of Washington, D. C ______________________ 140-154
John Roach, of New Jersey___________________________________ 141, 146
John P. Meade, of Massachusetts_____________________________ 142-144
F. M. Williams, of Connecticut_______________________________ 144, 146
Mrs. Nellie R. Slavback, of New Jersey_________________________
146
I. K. Huber, of Oklahoma_______________________________________
147
Fred M. Wilcox, of Wisconsin_________________________________ 147-153
Andrew F. McBride, M. D., of New Jersey. ____________________
150
Bernard S. Coleman, of New Jersey_____________________________
150
F. A. Duxbury, of Minnesota_________________________________ 151-154
155
William W. Kennard, of Massachusetts_________________________
William J. Maguire, of Pennsylvania__________________________ 155, 156
THURSDAY, SEPTEMBER 13— AFTERNOON SESSION
Accident prevention: Chairman, Walter O. Stack, president Industrial
Accident Board of Delaware
What is Being Done for Safety in Canada— The Work of the Industrial
Accident Prevention Associations, by R. B. Morley, general manager
Industrial Accident Prevention Associations, Toronto________________ 157-161
What Accident Prevention Can Do, by John P. Meade, director division
of industrial safety, Department of Labor and Industries of Massachu
setts___________________________________________________________________ 162-175
Safety Education in Industry Under State Supervision as a Means of Pre
venting Accidents, by Thomas P. Kearns, superintendent division of
safety, Industrial Commission of Ohio_______________________________ 175-180
The Growth of Occupational Diseases as the Result of Change in the Meth
ods of Industry, by E. B. Patton, director bureau of statistics and infor
mation, Department of Labor of New York__________________________ 180-182
Discussion:
Mrs. Nellie R. Slayback, of New Jersey_______________________182, 184
Ethelbert Stewart, of Washington, D. C______________________ 183-188
Carl C. Beasor, of Ohio__________________________________________
185
Walter 0 . Stack, of Delaware_________________________________ 185-187
William J. Maguire, of Pennsylvania__________________________ 186, 191
John P. Meade, of Massachusetts_____________________________ 186, 187
Stanley Warzala, of New Jersey_________________________________
188
R. B. Morley, of Toronto________________________________________
189
George E. Sanford, of New York________________________________
189
F. A. Duxbury, of Minnesota_________________________________ 190, 193
R. E. Wenzel, of North Dakota_________________________________
191
Leonard W. Hatch, of New York________________________________
192
W, F. Mowry, of Colorado______________________________________
192
;
FRIDAY SEPTEMBER 14— MORNING SESSION
Chairman, Fred M. Wilcox, chairman Industrial Commission of Wisconsin
Discussion of resolution as to advising or assisting legislative committees
in relation to pending enactments or amendments of compensation
laws, etc.:
F. A. Duxbury, of Minnesota______________________________________ 194-201
F. M. Williams, of Connecticut____________________________________ 195, 201
George A. Kingston, of Ontario______________________________________
195
R. E. Wenzel, of North Dakota____________________________________ 195, 199
Walter O. Stack, of Delaware_____________________________________ '___
196
William W. Kennard, of Massachusetts_____ _______________________
196
Charles E. Baldwin, of Washington, D. C ____________________________
198
R. M. Thigpen, of Alabama__________________________________________
198
Fred M. Wilcox, of Wisconsin______________________________________ 198-202
C. L. Heaberlin, of West Virginia__________________________________ 198-201
L. B. Kyle, of Oklahoma_______________________t______________________
199
Fred W. Armstrong, of Nova Scotia_________________________________
200
Ethelbert Stewart, of Washington, D, C----------------------------------------- 198, 201
CONTENTS
VI
Pago
Should the Association Attempt to Determine the Relative Benefits of
Existing Compensation Laws, by F. A. Duxbury, chairman Industrial
Commission of Minnesota____________________________________________ 203-207
Discussion:
Ethelbert Stewart, of Washington, D. C ______________________ 207-210
F. A. Duxbury, of Minnesota_________________________________ 208, 210
Fred M. Wilcox, of Wisconsin_________________________________ 208-217
R. E. Wenzel, of North Dakota_______________________________ 210, 214
William W. Kennard, of Massachusetts_______________________ 210, 217
George A. Kingston, of Ontario_______________________________ 212, 216
Leonard W . Hatch, of New York_____________________________ 214-217
C. L. Heaberlin, of West Virginia_______________________________
216
The Small Plant and Workmen’s Compensation Coverage, by Ethelbert
Stewart, United States Commissioner of Labor Statistics_________217-234
Discussion:
R. E. Wenzel, of North Dakota_______________________________ 224, 231
Ethelbert Stewart, of Washington, D. C ______________________ 227-232
Fred M. Wilcox, of Wisconsin___________________________________
227
Sam Laughlin, of Oregon________________________________________
230
George A. Kingston, of Ontario_________________________________
231
Business meeting: Chairman, Andrew F. McBride, president I. A. I. A. B. C.
Report of auditing committee_____________________________________________
232
Report of committee on resolutions_____________________________________ 232, 233
Remarks of the retiring president__________________________ ______________
234
APPENDIXES
A ppendix A.— Officers and members of committees for 1928-29____ 235, 236
A ppendix B.— Constitution of the International Association of Indus
trial Accident Boards and Commissions______________________________ 237, 238
A ppendix C.— List of persons who attended the fifteenth annual meeting
of the International Association of Industrial Accident Boards and
Commissions, held at Paterson, N. J., Sept. 11-14, 1928__________ 239-244
BULLETIN OF THE
U. S. BUREAU OF LABOR STATISTICS
WASHINGTON
NO. 485
JUNE, 1929
PROCEEDINGS OF THE FIFTEENTH ANNUAL MEETING OF THE
INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT
BOARDS AND COMMISSIONS, PATERSON, N. J., SEPTEMBER
-,
1 1 14 1928
TUESDAY, SEPTEMBER II— MORNING SESSION
Chairman, Andrew F. McBride, M. D., president I. A. I. A. B. C.
The first session of the fifteenth annual meeting of the Interna
tional Association of Industrial Accident Boards and Commissions
was called to order by the chairman, Dr. Andrew F . McBride.
The C h a i k m a n . It is indeed a great pleasure for me to welcome
you to New Jersey. W e are proud, indeed, to have the fifteenth
annual convention of the International Association of Industrial
Accident Boards and Commissions meet in our State, and I trust
that it may be a most successful convention.
This is a very worthwhile organization; it accomplishes much for
the general betterment of the positions we occupy in the respective
Provinces of Canada and States of the United States. I believe that
these meetings do much good. They bring together the men and the
women who are engaged in this work for better understanding, for
an interchange of ideas, and for a frank discussion of the problems
that confront us in our work, and in that way great good comes of
these conventions.
I am sorry only that the conventions are not attended by repre
sentatives from every State in the United States and from every
Province in Canada. These meetings really warrant attendance,
and I hope that the governors of the various States o f the United
States and the lieutenant governors of the various Provinces of
Canada will see to it that hereafter all of the conventions of the
International Association of Industrial Accident Boards and Com
missions are attended by one or more representatives from their
respective jurisdictions, so that greater good may come.
The work w^e are engaged in is a serious work; it is an important
work, and it merits the greatest cooperation and the greatest help.
Perhaps in the past some organizations have wasted their State’s
money unnecessarily by not rendering service for the expense entailed
in their attending conventions, but that is not so with this associa
tion. I believe that every dollar expended in travel or hotel bills,
1
2
FIFTEENTH ANNTTAX. MEETING OF I. A. I. A. B. C.
etc., is thoroughly justified by the amount of good accruing to the
States represented in our conventions.
It is a great privilege to introduce to you this morning the gov
ernor of this great industrial State of ours. New Jersey, as you well
know, is one of the greatest States in the Union industrially; within
the confines o f this State there is perhaps more industry per mile
than in any other State in the Union. It is not a large State ter
ritorially, but it is large industrially. I t is important, being ad
jacent to New York, the metropolis of the country— next-door neigh
bor to it— and having the second largest city in the United States,
Philadelphia, on the other side. The governor of this State is
intensely interested in the State and in the workers of the State,
and has shown it by the many splendid bills affecting the workers
and the industry of the State which he has made laws by his signa
ture. W e will now hear from our governor, the Hon. A . Harry
Moore.
Governor M oore . I came here to welcome you, and to tell you how
glad we are that you are here in New Jersey. Doctor McBride has
spoken with pride of the State. I know he loves the State because he
renders such wonderful service to New Jersey. I will say, without
fear of contradiction, that I do not know of a head of a labor depart
ment in the United States, or in the world, who gives more of his
time and of his talents than Doctor McBride, and when he believes
a thing is right, he goes through with it. He is the type of man to
have in an office such as that and one o f whom I am very proud.
New Jersey, as he said, is an industrial community, so much indus
trial that, small as it is (it is the forty-seventh State in the Union in
size), it is third in manufactured products of the United States.
When you look at the skyline of New York and see how wonderful
it is, remember the terra cotta over there comes from New Jersey.
And when you are talking o f wealth, New Jersey is sixth, in the
United States in wealth. When you think about farm products,
remember that little New Jersey is third, in comparison with size.—
and that is the only one of those figures that is in comparison with
size— third in farm products, because of its intensive farming, its
intensive agriculture, and its forward movement in that regard.
When you want to find the largest dairy farm in the world, you do
not go to Washington or to Oregon or to any other place in the world,
for right here in New Jersey is the largest dairy farm in the world—
the Walker Gordon Farms, outside of Trenton.
W e in New Jersey believe that we are first in compensation and in
trade relations in the United States. W e have the only industrial
museum, and I hope Doctor McBride will take you to see that indus
trial museum in Jersey City. It is up-to-date— there is nothing obso
lete there. There you can see the safety devices. When Doctor
McBride says to a manufacturer, “ You have to have lights that do
not throw a reflection on that machine,” he can say, “ Come with me,
I will show you the lights.” And if he says to a manufacturer, “ You
must protect this machine in such a way that it will be safe,” he can
take the manufacturer to the museum and show him what he means.
A ll these things are there in the museum. They are doing a remark
able work there. Every month there is issued a statement by the
Department of Labor of New Jersey, W e keep right up to the
ADDRESS OF GOVERNOR MOORE
3
moment in the great work that is being done. I do not want to talk
about that. Whenever I talk to men who know more about business
than I do I think of the story of the fellow who was hired one day
to come into* a big factory. An engine had broken down, and nobody
could start it. Finally they sent for this fellow; he came in, asked
for a hammer, tapped here and there for a few minutes, and then
said to the engineer, “ Start it.” The engineer started it, and away
it wTent. The young man sent a bill for $250, and when he got the
bill the president of the company said, “ My stars! For tapping with
a hammer, $250. Send it back to him and tell him to itemize it.”
The bill came back, itemized as follows: “ For tapping with a ham
mer, $1 ; for knowing where to tap, $249.” You men must know
where to ta p ; you must know your business; it is not for me to tell
you of it. After all, what is a conference? W hat does it mean to
you; what do you. get out of it? It is only as you get something out
of it that it means a thing to your State or your city. It will be a
waste of your time and of the money o f the city or State that you
come from, unless you take back with you a spirit which will carry
this thing through to a better, a larger, fulfillment.
I think it was Thompson who said:
By the red blood in an artery
Or the blue blood in a vein,
By the brute strength of a muscle
Or the grey cells of a brain,
We are apt to sit in judgment
On the passing caravan
And denominate some mortal
In the coterie, a man.
But there is a higher standard
Taught by Him who preached of old,
That can’t be bought with money
And it’s finer far than gold,
For it binds poor humans closer
In its sympathetic strain
Than the red blood in an artery
Or the blue blood in a vein.
That something is fellowship; that something is to get to know the
other fellow’s viewpoint; that something is not to be so bigheaded that
you think you are the only one who knows. The other fellow may
know something, and you can get something from him to take back
with you to your town.
Some of you come from cities, some of you come from States— some
of you come at the expense of a State or of a city— and you owe it to
your city or to your State to get the best you can out of this conven
tion and take it back. W hy ? When you read the Declaration of In
dependence you read these words, “ all men * * * are endowed
by their Creator with certain unalienable rights; that among these
are life, liberty, and the pursuit of happiness.” You men and
women represent that part of the Declaration of Independence— life,
happiness— because in the old days, when a poor fellow was all crip
pled up, he was thrown out of his job and went home to his wife and
children, done for and thrown on the scrap heap. He wasn’t getting
his right of happiness, was he ? And then along came this organiza
tion, or these laws in the States which say that the Declaration of
Independence says to that man that he is entitled to be happy. You
take him and fix up his arms, or his legs, or his spine, or whatever
4
FIFTEENTH AN N U A L MEETING OP I. A. I. A. B. C.
is necessary, and send him back to his wife and children; and they
are happy, aren’t they ? Therefore you are rendering service under
the Declaration of Independence.
In these days when men in politics are saving the Nation, as they
do every four years, let us look back and realize that this Nation was
formed, this Government was formed, for just three things— as the
Declaration of Independence says— life, liberty, and the pursuit of
happiness.
I congratulate you because I see in you the potentialities of a won
derful service to the States and the cities which you represent ; I see
you going back with the spirit that, no matter what opposition there
may be, you will act according to your conscience— not according to
any political party, not according to any political fealty, but accord
ing to your conscience— and carry out that part of the Declaration of
Independence as to life, liberty, and happiness, life and happiness
being part of your job.
I remember standing in Philadelphia not long ago— they were hav
ing the sesquicentennial, and I represented New Jersey. As I stood
there they were reenacting the evacuation of Yalley Forge. George
Washington came down the Jine on his gray charger, and as I looked
at him my heart beat fast; and then I saw the troops of New Jersey,
as well as the troops of the other twelve Colonies, coming down
the hill. A s I looked at them I visualized those splendid men of the
Revolution— splendid, not because of their uniforms, not because of
their military bearing, but because, though they were half starved,
yet they realized that they were performing a service; splendid be
cause, though they were half frozen, out of the travail of their souls
and out of the agony of their bodies came this Nation, and the flag,
and something else— the American spirit. When a man gets into an
office where he can be of service to the people, he should not sit back
and think that he knows it all. He can learn something from some
one else, something he can carry back to his city or to his State, and
thus he can be of greater service, of greater help, to his State, to
humanity, to his God.
Because of the potentialities which are yours, and because I believe
that you are honest enough to go back and perform your duty
without regard to any political connection, because I believe that
you have that spirit that realizes the opportunity for service which
is yours— because of all that, I welcome you to New Jersey, and say
that I, as governor, am glad to have you here.
[The chairman here introduced the Hon. W ilmer A . Cadmus,
acting mayor of Paterson, N. J., who welcomed the convention to the
city as follows:]
Mayor C a d m u s . Y ou who are delegates to this convention have
come to Paterson, our city, which we all love so well, and we want
you to go away from it in love with it also; we want you to love it
at first sight, if that be possible. Some of you may never have been
here before, but we want you to know that we greet you with a
handshake and with a pressure that denotes sincerity; we want you to
know that you are coming into our city just as you might come into
our own homes, to be greeted there most warmly.
Personally, I think it is a privilege and an honor to have a con
vention such as this come to the city of Paterson. W e deem it so.
ADDRESS OF ACTING MAYOR CADMUS
5
It is a wonderful wTork you are doing— something you should be
proud of, something we are proud of, and that is the reason we wel
come you so warmly, and we want you to go away from Paterson
feeling that our welcome was sincere in every way.
Conventions are places where some people go to have a good
time. I have attended conventions with friends, where every time I
looked around for them, I found they were out seeing the town or
something of that sort. That is all very well— we want you to see
our city— but conventions are places where men confer ; where men
learn the thoughts of others; where conferences are held that give
you something to take back to your homes and to use to advantage.
Conventions are places where we become better educated. W e are
never too old to learn. I f you come here and confer with those who
are doing the same type of work that you are doing, and get new ideas
and take them back, there is no doubt that you have been a real dele
gate; that you have not come just for the good time that we want
you to have; and that you have absorbed something worth while,
and will take it back to your home town.
The governor welcomes you to New Jersey— a wonderful State.
I welcome you to Paterson, a wonderful city in that State, and I
hope you will go away from here feeling that that welcome wra;s sin
cere. W e will try to make it so.
The C h a i r m a n . W e are fortunate in, having one of the most capa
ble men in our organization respond to the welcome given, usi by the
governor of our State and by the mayor of our city, the industrial
commissioner from the great State of New York.
Doctor H a m i l t o n . W e were all very much impressed by the ex
hilarating enthusiasm of the Governor of New Jersey. It is a
splendid thing that New’ Jersey welcomes us in this! way, because, as
has been pointed out, New Jersey is a great industrial State, as is my
own S t a te of New York, and we are interested in solving those prob
lems of industrial life. When we think of the thousands upon thou
sands of victims of industrial accidents and how the number seems
to be mounting, it might perhaps cause some of us to fear that we are
not solving that problem, but I believe that we are. And I believe
that in New York State, largely through the influence of this or
ganization, we are beginning to see daylight. For years and years
those figures mounted up. When we used to tell the people of our
State that there was not a single day that went by that there were not
at least 1,500 men, women, and children injured while on the job—
not on the highways and byways, but while at work— it was abso
lutely true. In New York State, on January 1, 1925, we changed the
noncompensated waiting period. Thereafter a larger number of
cases were reported, perhaps for that reason and perhaps because of
better reporting generally as the compensation law became better
known. Nevertheless, I believe that at the present time, through
these influences, through the education of the people in regard to
accident prevention as well as the operation o f the workmen’s1com
pensation law, we have virtually reached the peak. In New York
State for the fiscal year ending June 30, 1927, out of 588,000 indus
trial accidents reported there were 99,000 compensation cases in
which awards were made, and for the fiscal year just closed, June
30, 1928, the number of compensation casets in which awards were
6
FIFTEENTH AN NU AL MEETING OF I. A. I. A. B. C.
made was only 93,000, so that there has been a decrease in that re
spect from 99,000 to 93,000, and this is so because the attention of the
people of our State has been focused upon this particular matter of
accident prevention.
For years we were interested in the measure of social justice that
the New York State workmen’s compensation law afforded to the
victims of industrial accidents, but later on we realized that that was
not solving the problem. While the law was rendering assistance
when it was sorely needed, and that assistance was sure and certain
and definite, nevertheless we came to realize that the ultimate solu
tion o f this problem, in so far as the industrial life of New York
State was concerned, lay along the path of accident prevention, and
I believe that it is through the influence of this organization and the
statistics it has gathered— so that we have scientifically accurate data
and information upon which to proceed— that we have been in posi
tion to tackle successfully that problem in the Empire State. This
organization has every reason to be proud of its existence, and on
behalf of the State of New York I want to tell you that our hearts
are filled with gratitude for what you have done, and we hope that
you will go right on enlightening the public, so that in the days to
come we will have accident prevention rather than the mounting
statistics of industrial accidents. On behalf of this organization I
thank the governor, the mayor, and the ex-mayor of Paterson for the
generous welcome they have given to us.
[The president’s address was then read, as follows:]
Address of the President
By A n d r e w F . M c B r id e , M . D., Commissioner of Labor of New Jersey
On behalf of the State of New Jersey Department of Labor, I
desire to express deep appreciation for the honor that has been paid
to us by the decision of the International Association of Industrial
Accident Boards and Commissions to hold its fifteenth annual meet
ing in the State of New Jersey. While this is the first time in the
history of the association that it has held a meeting within the confines
of our State, I feel that it is peculiarly appropriate that it should
convene in the historic city of Paterson where Alexander Hamilton,
that great constructive American of early colonial days, arranged for
the application and use of mechanical energy that gave birth to infant
industries on the banks of the Passaic that encouraged and stimu
lated our people during those early times, and which, undoubtedly,
has done much to inspire American inventive genius with the courage
that has enabled our people to become leaders in industrial produc
tion throughout the civilized world.
In those early days when Alexander Hamilton was building a monu
ment of enduring worth to his political vision and economic fore
sight, a pioneering spirit of independence and self-confidence of such
proportions prevailed among our people that social legislation of the
kind comprehended under the generic term “ workmen’s compensa
tion insurance” would probably not only have been undesirable,
but would have met with opposition from the ones who might have
been favored by its passage.
ADDRESS OF PRESIDENT OF THE ASSOCIATION
7
The complexities of modern industrial life, however, have created
the necessity for these new social burdens, for it is unthinkable that
to-day humanitarian society would consider for a moment the possi
bility that workmen injured in the performance of duty by accident
arising out of and in the course of employment should bear the
whole loss as wrell as endure the suffering and pain inseparable from
personal injuries. It is a good thing tor modern society that the
old notion of the relationship that exists between employer and em
ployee (under the ruling that, in case of accident it was necessary
for the employee to show that his employer had failed to discharge
a legal duty which he owTed to him) has been abandoned in nearly
every one of the American States and a more just appreciation of the
worker’s value to society has led to the establishment of the principle
that compensation should be paid to the worker because of his injury
and the handicap from an accident arising out of his employment,
rather than that damages should be based on a claim that the
employer was dilatory and negligent toward his employee.
It is a cause for congratulation, too, that the judicial barriers
erected with such tortuous precision by the learned judiciary of the
last century under the operation of which an injured man was un
able to appear in court to have his claim heard if it could be proved
that the injury was the result of the act of a fellow servant, or was
tainted with contributory negligence, or that the injured man as
sumed the risk of the employment, have been removed. These bar
baric relics of the old and cruel period of trial for the working
man, when he was in a large measure a prey to the avarice of the
stronger groups of society, no longer obtain and he is nearsighted,
indeed, to the tremendous benefits that have flowed from this modern
legislation, who can not see in it an enduring sign of an approaching
time when men will really feel that in the broader and better sense
they are their brothers’ keepers.
It is fitting and appropriate that this convention should be held
within the confines of the great State of New Jersey, for here was
carried on a long legislative battle, covering a period of many years,
by the social forces within the State for the passage for the first time
of a law that contained an elective schedule of workmen’s compensa
tion benefits to replace the old comrnon-lawT principles that had ob
tained until that time. For the last five years I have attended these
conventions with regularity and interest, greatly to my edification
and instruction, and T feel that the grouping together of trained ex
perts once each year in convention assemblies such as this, where
these questions relating to the administration of this social legisla
tion can be discussed, is so valuable that no- State in the Union, nor
Province within the Dominion of Canada, can afford to be recorded
as absent.
While compensation benefits are, naturally, the first questions for
serious consideration by this esteemed assemblage, I am conscious
that workmen’s compensation insurance has been valuable in many
other respects not generally noted in the addresses usually delivered
by our speakers. It is true that when a workman is injured im
mediate financial assistance is a matter of major importance, super
seding all other consideration, and that generalizing and speculating
on the beatitudes that could be enjoyed if the accident had never
8
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
happened can have but little interest for the injured man suffering on
his bed of pain and have less value for the helpless dependents
of the industrial soldier who has made the supreme sacrifice in the
gigantic industrial efforts of our Nation. Nevertheless, no op
portunity should be passed at any convention of this organization
without giving the fullest and freest expression to the tremendous
influence that the passage of the workmen’s compensation laws has
had on the preventive efforts that are now being concentrated on the
accident problem of our country. It should be remembered that in
1911 when the first workmen’s compensation laws were passed there
was no organized effort on the part of society to add a fuller measure
of safety to the work hours of employed labor. Standardization of
industrial equipment, buildings, machinery, etc., had been given no
thought whatsoever by the engineers of that period and accident re
porting was of such a meager and unsatisfactory type that but little
value could be attached to available statistics. The facts of the
matter were that industry had no knowledge whatsoever of the toll
in life and limb that it was taking from the working forces of our
Nation, and a satisfactory appreciation of this human wastage was
never felt until workmen’s compensation laws were passed with the
added provision that all accidents should be reported, tabulated, and
made a matter of record for future studies. Lord Kelvin, one of the
greatest physicists of the last century, said: “ When you can measure
what you are speaking about, and express it in numbers, you know
something about it; and when you can not express it in numbers, your
knowledge is of a meager and unsatisfactory kind; it may be the
beginning of knowledge, but you have scarcely in your thoughts ad
vanced to the stage of a science.”
I f there is one thing that is badly needed in many of our jurisdic
tions, perhaps in every one, it is the necessity for a more general
recognition by departmental officials of the fact that good bookkeep
ing in the statistical division of industrial accident-prevention work
is an essential and important factor of administrative success. In
modern business the requirements demand a correct and accurate list
ing of debits and credits, for a successful industrial enterprise in our
day keeps in close and immediate touch with costs and production in
order that the balance sheet may show a favorable condition at the
end o f a fiscal year. Unless accident statistics are tabulated in a
careful manner it becomes impossible to determine whether or not
the working people in their daily employment are being given that
substantial measure of protection that was contemplated by the legis
lature when labor laws were enacted. While the pioneers in our
movement were badly handicapped by a lack of proper statistics, for
tunately, during the last 17 years a great improvement has taken
place in this line of administrative effort so that in most of the States
and Provinces it is possible to form some estimate of the toll that is
being taken by industrial accidents.
The International Association of Industrial Accident Boards and
Commissions may feel gratified to know that during the entire history
of the organization efforts have been made by it to impress upon its
members the necessity for the careful compilation of the statistical
records as an important adjunct to preventive work.
A resume of the progress that has been made in accident-prevention
efforts during this period shows clearly that each year greater and
ADDRESS OF PRESIDENT OF THE ASSOCIATION
9
more determined efforts are being made to operate industry safely.
The National Safety Council, with its ramifications in every State
and the weight of its tremendous influence being felt in the largest
industries in our country, holds annual conventions which are at
tended by 5,000 to 6,000 delegates and visitors, whose expenses are paid
either by themselves or the plants which they represent, to consider
and analyze methods calculated to prevent accident. A large number
of engineering publications are available to the student, while in the
larger groups the problem itself is considered a production matter
and the same careful attention to detail is given to it that is accorded
to the work of manufacturing products; in short, a network of safety
organizations covers American industry, while an intensive effort to
educate workers on the care and thoughtfulness that it is necessary to
exercise in everyday life is going on constantly. I feel that we have
an important part to play in this vast movement for a greater measure
of industrial safety, and that the compilation of industrial statistics
showing the costs of accidents and the burden that they impose on
industry itself is a most helpful factor in encouraging the laggard
employer to speed up on safety work.
I should feel very much dissatisfied if I thought that the only
advantage to the worker that could be noted in the administration
of workmen’s compensation laws was merely the collection and dis
tribution of the fund out of which the injured man is paid a compen
sation claim. Far from this, I am satisfied that the greatest advan
tage resulting from the enactment o f this social legislation is the
influence it has had in arousing our people to the necessity for a
vigorous preventive campaign that would eliminate from industry
those preventable and distressing accidents that to-day reflect upon
the business and administrative ability of our people. So far as the
administration of compensation itself is concerned, I feel satisfied
that in all the States and Provinces laws have been enacted that are
best suited for the economic and social needs of the people o f those
localities. From my observation of the subject I am not convinced
that it is possible to establish uniform rates and methods to apply
equally in all localities, but, rather, I believe it should be the aim of
this organization to pursue certain definite administrative practices
that might be helpful in many divergent administrative crises.
In New Jersey we try to prevent accident through the medium of
factory inspection and the promotion of safety education in our
industries. Efforts are made to encourage plant managers to take
their workmen into their confidence, establish safety committee^, and
carry on continuous safety propaganda in their plants. When acci
dents occur it is our aim to have hearings in each industrial locality,
easily accessible to those who are injured, and to insist that carriers
or self-insurers pay claims promptly and without unnecessary
equivocation.
The question of coverage is one that should be given serious con
sideration by every State in the Union, for, as the case stands now,
numerically large groups! of male and female workers who may be
injured during the course of their employment are excluded from the
benefits of this social legislation for reasons that are not within their
control. In New Jersey the question of casual employment involves
complications that many times work hardships on the individual, and
10
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
I hope that at some time in the near future some plan will be evolved
that will arrange for the establishment of a fund that may be used
for instances of this kind. Interstate workers constitute another
large body o f citizens who have been deprived of the relief guaran
teed to other citizens through the operation of the compensation laws.
I think it should be our policy to advocate a coverage broad enough
to cover every employed person independent of the character of the
man’s employment and dependent only upon the fact that the person
is employed for wages. The domestic and the farm worker need
protection as well as the factory hand or the building-trades man,
although in some jurisdictions no relief has been granted to these two
classes of employment.
In the case of occupational diseases in States where payments are
limited to groups of causes, workers may be excluded who have suf
fered severe injuries to health from the nature of their employment.
It is well to face these facts, admit them, and give such counsel as we
can in quarters where measures of relief may be expected to be influ
enced. The injured people should be given the most liberal medical,
surgical, and hospital treatment and the State should be prepared at
all times to decide whether or not in a certain instance a workman is
being given satisfactory treatment.
The industrial rehabilitation of injured workmen has attracted
such noteworthy attention during the past 10 years that but little
need be said in favor of its establishment. This, rehabilitation serv
ice should be in the hands of the most competent experts in their line
and not only should it include surgical and medical treatment but
also should undertake to help the injured person to find a new
place in industry where an honest and self-respecting living could
be earned. On these broad organic principles of common sense and
modern social justice, departmental activities can function that will
have a most helpful influence on the lives and the futures of those
unfortunate ones who may be struck down at their daily tasks in our
industries.
Even though there was less legislative activity this year than last
(because many of the legislatures meet in odd years), still on the
whole the cause of workmen’s compensation legislation has made
substantial progress. O f the 43 States having compensation laws,
only 7 met in regular session in 1928 (Kentucky, Louisiana, Massa
chusetts, New Jersey, New York, Rhode Island, and Virginia). A ll
seven acted on the subject of workmen’s compensation. Two States
not having compensation acts (Mississippi and South Carolina)
held regular sessions but took no action. The legislatures of seven
States met in extra session in 1928 (California, Illinois, IowTa, K an
sas, Nevada, North Dakota, and Wisconsin) but did not enact any
compensation legislation. In addition to their regular sessions the
Mississippi and New Jersey Legislatures met in extra session, the
latter in three extra sessions, but, except for the first New Jersey
extra session, their legislation is not yet available. The legislature
of Arizona met in extra session in 1927, after our^ meeting last year,
and passed a few amendments of minor importance. The Congress
of the United States has also been in session since our last meeting
and has contributed its part in the development of compensation.
The outstanding progress to report is the act of Congress extend
ing the benefits of the longshoremen’s and harbor workers’ compensa
ADDRESS OF PRESIDENT OF THE ASSOCIATION
11
tion act to employees within the District of Columbia. That Dis
trict, long without a compensation act, now has a law which may
well be used as a model by some of our States which wish to better
their own laws. The coverage of the act is probably its most out
standing feature, as it is binding on all employers having one or more
employees, excepting only seamen, interstate railroad employees,
employees covered by the Federal employees’ compensation act, and
employees engaged in agriculture, domestic service, and casual
employment.
O f the eight States acting on the subject of workmen’s compen
sation, the greatest number of amendments was passed by New York,
which showed an active interest in liberalizing the law and im
proving its administration. No single act of any of the States stands
out as deserving particular attention, with the possible exception
of the act of New Jersey, which increased maximum weekly benefits
from $17 to $20 and minimum weekly benefits from $8 to $10. The
general tendency of the legislation passed in the several States was
to extend the coverage of the act to employees of small employers,
to liberalize benefits, and to improve the administration of the acts.
The promptness wTith which Congress acted to correct the serious
obstacle to the better administration of the Federal longshoremen’s
compensation act after the Attorney General had ruled that district
attorneys should not appear in connection with the longshoremen’s
act calls forth the admiration of those who know how difficult it is
to get compensation legislation through the legislature.
Two Territorial legislatures passed workmen’s compensation laws.
The Philippine act is compulsory, applies to public as well as private
employments, is liberal in its coverage, allows fairly large percentages
of wages in the awards, but places the maximum on awards at 3,000
pesos or $1,500. Injuries covered include illness as well as those
resulting from accidents.
Following the report this year of the Porto Rican Bureau of Labor
to the legislature admitting the failure of the State fund, the
legislature passed a new compensation law. The exclusive State fund
system was replaced by the employers’ direct liability secured by
contributions to a competitive State fund, by insuring in an insur
ance company or mutual association, or under certain conditions) by
“ self insurance.” Administration of the act is now in an industrial
commission of three members in place of the former “ workmen’s
relief commission ” of six. The coverage of the act was extended to
include more workers but the compensation awards were decreased
in several instances, as: For death the maximum was reduced from
$4,000 to $3,000; for total permanent disability the minimum from
$2,000 to $1,000 and the maximum from $4,000 to $3,000, and instead
of allowing fixed amounts for permanent partial injuries scales are
now provided with minimum and maximum limits. By separate
acts the “ Porto Rico Mutual Insurance Association ” was provided
for and a liquidating board was created to liquidate the present
“ Workmen’s Relief Trust Fund.”
O f the eight Canadian Provinces having compensation laws, Que
bec, Alberta, Nova Scotia, and Ontario acted on the subject of work
men’s compensation. British Columbia, Manitoba, New Brunswick,
and Saskatchewan did not act.
31573°— 29------ 2
12
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
Quebec passed a new act which is wider in its scope than its prede
cessor and covers more industries, the benefits allowed were changed
and maximum amounts were placed on certain payments, insurance
is compulsory with certain exceptions, and, most important of all,
the act is administered by a workmen’s compensation commission of
three members which has been newly created and wThich has head
quarters in the city of Quebec. The Alberta act was amended by
increasing the possible coverage, by increasing the basis of awards
from 6 2 ^ to 66% per cent of average earnings, by making several
additions to the schedule of industrial diseases, and by making sev
eral other changes. Nova Scotia solved the difficult problem of the
fishing industry by providing for the employers’ liability, secured by
insurance in private companies, and by making special provisions for
losses of $50,000 or over. Other less important changes were made
in the Nova Scotia and the Ontario acts.
Among the great mass of decision^ rendered by the courts on the
subject of workmen’s compensation during the past year two deserve
special attention. The first is the case of Bountiful Brick Co. v.
Giles, decided by the Supreme Court of the United States on Feb
ruary 20, 1928. It is important to us because it recognizes as consti
tutional an interpretation of “ arising out of or in the course of ” as
including not only a death to a man on his way to work before enter
ing upon his employer’s premises, but also a man killed wThile on
his way to work while off the public road and taking a short cut
across the land belonging to another person. The case is interesting
as showing the development and possibilities in the cooperation be
tween industrial commissions and legal aid societies, as this is the
first time in which legal aid counsel, as such, argued a case before the
Supreme Court of the United States.
The other case was that of Chernik v. Clyde Steamship Co,, in
which the constitutionality of the Federal longshoremen’s and narbor workers’ compensation act was upheld in the Court of Appeals
of New York on April 10, 1928. No opinion was filed. It is under
stood that both parties to the action are anxious to take the case to
the United States Supreme Court, wThere it may be argued and
decided during the coming year.
In conclusion, permit me to congratulate this organization on the
splendid achievements that have marked its yearly progress since it
was organized and to hope that it will continue indefinitely to throw
light on the perplexing problems that are met daily by compensation
boards and commissions.
It would be difficult indeed for anyone to attend these conventions
and not return to his home office convinced of the integrity and high
standing of the men to whom has been intrusted the work of admin
istering the compensation laws of our country, nor to feel that he,
as a delegate, had not been greatly improved in his knowledge and
understanding of workmen’s compensation procedure as a whole. I
bid you welcome to our city and hope that your stay with us will be
a pleasant and a profitable one.
[On motion made, seconded, and carried, the address of the presi
dent was referred to the committee of resolutions.]
BUSINESS MEETING
[The following convention committees were appointed by the
president:]
Committee on nominations.— L. W. Hatch, of New York; G. A. Kingston, of
Ontario; A. E. Brown, of Maryland; W. M. Scanlan, of Illinois; P. P. Deans,
of Virginia.
Auditing committee.— W. J. Maguire, of Pennsylvania; Miss R. O. Harrison,
of Maryland; F. M. Wilcox, of Wisconsin; J. P. Meade, of Massachusetts; F. M.
Williams, of Connecticut.
Resolutions committee .— F. A. Duxbury, of Minnesota; F. M. Wilcox, of Wis
consin ; F. W. Armstrong, of Nova Scotia; E. I. Evans, of Ohio.
The C h a i r m a n . The next on the program is the report of the
secretary-treasurer.
REPORT OF THE SECRETARY
During the year just passed there has been no change in the list of active
members of the International Association of Industrial Accident Boards and
Commissions, there being 36 active members, as follows:
United States Bureau of Labor Statistics.
United States Employees’ Compensation Commission.
Arizona Industrial Commission.
California Industrial Accident Commission.
Connecticut Workmen’s Compensation Commission.
Delaware Industrial Accident Board.
Georgia Industrial Commission.
Idaho Industrial Accident Board.
Illinois Industrial Commission.
Indiana Industrial Board.
Iowa Workmen’s Compensation Service.
Kansas Public Service Commission.
Maine Industrial Accident Commission.
Maryland State Industrial Accident Commission.
Massachusetts Department of Industrial Accidents.
Minnesota Industrial Commission.
Montana Industrial Accident Board.
Nevada Industrial Commission.
New Jersey Department of Labor.
New York Department of Labor.
North Dakota Workmen’s Compensation Bureau.
Ohio Industrial Commission.
Oklahoma State Industrial Commission.
Oregon State Industrial Accident Commission.
Pennsylvania Department of Labor and Industry.
Utah Industrial Commission.
Virginia 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.
Manitoba Workmen’s Compensation Board.
New Brunswick Workmen’s Compensation Board.
Nova Scotia Workmen’s Compensation Board.
Ontario Workmen’s Compensation Board.
13
14
FIFTEENTH ANNUAL. MEETING OF I. A. I. A. B. C.
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 member
ship by the terms of the constitution itself and are exempt from the payment
of dues.
Mr. I. K. Huber joined as an associate member since the Atlanta meeting.
There are now seven such members, as follows:
Associate Members
George E. Beers, attorney and counselor at law, New Haven, Conn.
E. I. du Pont de Nemours & Co., Wilmington, Del.
I. K. Huber, Empire Cos. Bartlesville, Okla.
Industrial Accident Prevention Associations, Toronto, Ontario.
Leifur Magnusson, American representative, International Labor
Washington, D. C.
Porto Rico Industrial Commission
Republic Iron & Stee.l Co., Youngstown, Ohio.
Office,
Mr. Benjamin W. Kernan, of New Orleans, who joined the association as an
associate member just prior to the Atlanta convention, died on April 17, 1928
On January 19, 1928, Mr. Charles H. Verrill, a member of the United States
Employees’ Compensation Commission, and former secretary of the association,
died suddenly at his home in Washington, D. C.
The committee on investigation of results of compensation awards met in
the secretary’s office in Washington, D. C,, on April 10, 1928. The results of
that meeting will be included in the report of the committee.
Inasmuch as Dr. Francis D. Donoghue, medical advisor of the Department
of Industrial Accidents of Massachusetts, was attending the Fifth International
Conference for Medical Science as Applied to Workmen’s Accidents and Occupa
tional Disease, held in Budapest September 3-9, 1928, he consented to represent
the International Association of Industrial Accident Boards and Commissions
at that conference. His report of the meeting has not, of course, yet been
received.
As authorized by the executive committee at its meeting just after the Atlanta
convention the proceedings of the last three meetings were indexed and bound,
and copies furnished to the membership of the association. Bound copies of
Bulletin No. 212, which was not included in the previous binding, were also
distributed. The proceedings of the association now in the files of its mem
bership comprise four bound volumes.
At the meeting of the executive committee following the Atlanta convention
the honorarium of the secretary-treasurer was increased to $600.
In January, 1928, the secretary addressed a circular letter to the mem
bers of the association requesting information relative to the cooperation
between them and the legal-aid organizations. The result of that letter is
included in the report of the committee on legal aid.
The following principals and alternates represent the association on the safety
code correlating committee of the American Standards Association (formerly
the American Engineering Standards Committee) :
To serve until December 31, 1928—
P R IN C IP A L S
Ethelbert Stewart, United States Commissioner of Labor Statistics.
John Roach, Department of Labor of New Jersey.
L. W . tlatch, Department of Labor of New York.
BUSINESS MEETING
15
ALTERN ATES
G. N. Livdahl, Workmen’s Compensation Bureau of North Dakota.
Henry McColl, Industrial Commission of Minnesota.
M. H. Christopherson, Department of Labor of New York.
To serve until December 31, 1929—
P R IN C IP A L S
Sharpe Jones, Industrial Commission of Georgia.
Charles A. Waters, Secretary of Labor and Industry of Pennsylvania.
ALTERN ATES
H. R. Witter, Department of Industrial Relations of Ohio.
. G. R. Yearsley, Industrial Commission of Utah.
To date, the United States Bureau of Labor Statistics has published the fol
lowing safety codes, in the formulation of which the association took part:
Bulletin No. 331. Code of lighting: Factories, mills, and other work places.
Bulletin No. 336. Safety code for the protection of industrial workers in
foundries.
Bulletin No. 351. Safety code for the construction, care, and use of ladders.
Bulletin No. 364. Safety code for mechanical power-transmission apparatus.
Bulletin No. 375. Safety code for laundry machinery and operations.
Bulletin No. 378. Safety code for woodworking plants.
Bulletin No. 410. Safety code for paper and pulp mills.
Bulletin No. 433. Safety codes for the prevention of dust explosions.
Bulletin No. 436. Safety code for the use, care, and protection of abrasive
wheels.
Bulletin No. 447. Safety code for rubber mills and calenders.
Bulletin No. 451. Safety code for forging and hot-metal stamping.
Bulletin No. 463. Safety code for mechanical power-transmission apparatus.
(First revision.)
Copies of these codes can be obtained on request from the Bureau of Labor
Statistics.
In response to the letter sent out by the secretary on January 20, 1927,
appealing to the administrators of the workmen’s compensation laws of the
United States and Canada to cooperate in gathering records from which to
compile an American remarriage table, we now have on file information for
11,600 cases. Additional records are expected later. New York stated that
they intended to work up some material along this line, but owing to press
of work had had to abandon it, though they might be able to furnish informa
tion later. Letters from Indiana, Maine, Ohio, Ontario, and the United States
Employees’ Compensation Commission stated that the information is available,
but they are unable to furnish it because of the work involved. Georgia,
Minnesota, and Utah have promised to send in their forms at an early date,
while West Virginia will furnish records as to additional experience along
this line.
As the material at present on file covers a greater experience than that
upon which the Dutch remarriage table was based, it is desired to know
whether the association wishes the committee on statistics and compensation
insurance cost to go ahead with the compilation of the table, using the
material at hand, or whether the matter should be postponed until a further
amount of material is available.
The Association of Governmental Labor Officials of the United States and
Canada at its New Orleans convention passed the following resolution in
16
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
regard to legislation which prevents members of the various commissions from
attending conventions outside of their States:
Whereas several of the State legislatures in recent years have enacted legis
lation which restricts their labor department officials from attending conven
tions of this association, regardless of the fact that they are members ; and
Whereas many of these States have in the past, sent delegates who have made
valuable contributions from their experience in the administration and en
forcement of labor laws and in turn have received valuable information to aid
them in the administration of their law s: Be it
Resolved, That the attention of the State legislatures be called to the fact
that exceptions should be made to conventions where State officials are going
to conventions and conferences with other State officials administering the
same character of laws or performing the same functions; that we believe
these meetings have become real specialized institutes and that the State loses
more than it gains by prohibiting the attendance of labor officials at these
gatherings; and be it further
Resolved , That an effort be made to have such State legislatures exempt
those who make up the membership of this association and the International
Association of Industrial Accident Boards and Commissions from the restrictive
provisions of such acts.
It is suggested by your secretary that this association pass a similar resolu
tion, and take it home with you and inform the State officials that you mean
what you say. We continue to get letters urging that we hold conventions in
States where the legislature would forbid the attendance of the commissioners
at a meeting in any other State.
Purely for the purpose of the record and not in any sense to provoke dis
cussion in this convention, I will say that the self-insurers’ association of one
State is circulating a petition requiring the workmen to pay 25 per cent of
the insurance premium. Ultimately this question will become an issue. As
you know, one State— Oregon— charges each workman 1 cent a day, which
amounts to about 9 per cent of the total premium paid under the State fund
of that State. Twenty-five per cent would amount to somewhere around 2 ^
cents a day for each worker. I am advised by the Oregon commissioner that
most of the employers do not deduct this from the workmen’s pay roll but pay
it themselves, as it is not worth the amount of figuring involved. Incidentally,
this casts some side light on the terrible hardship that workmen’s compen
sation is upon employers.
The secretary is frequently called upon for statistical information which in
the nature of things could be secured only from the States and which under
present conditions can not be so secured. The question of actual coverage is
not answered by the terms of the law. The law which says that all persons
employing more than five people are covered by the law does not tell you how
many people are employing five persons or more. The Census Bureau has
stopped taking manufacturing establishments or employers in terms of em
ployees and are simply taking them in terms of value of output. The subletting
of contracts and the subletting of subcontracts have so divided the question of
legal employment that we know less and less each year about what “ cover ”
actually means. I recommend the serious consideration of the terms of the
California law, which, if you strike out certain industrial exceptions, would
give us a compulsory compensation coverage for every human being employed.
I have called special attention to some of the methods of side-stepping coverage
in an article which is listed on the program.
It is an old and time-worn, and I may say useless, theory or fetish that
would have this association work up a uniform compensation law, including
rates, etc. I am taking no time even to discuss the matter. But there are
certain things upon which in my opinion the longevity of this association
BUSINESS MEETING
17
depends which ought to be definitely worked out into a uniform code and
agreed upon— not only agreed upon, but the association should use its utmost
efforts to have them written into the law of every State. These are—
1. Extraterritoriality.
2. Complete coverage, with methods for securing it.
3. A method of securing and publishing annually information as to adminis
trative costs, which will take into consideration and be graduated by the benefits
in each jurisdiction.
Some time ago I sent out a circular asking for a statment of administrative
cost per case actually handled. One State ran as low as 22 cents. Other
States ran way up into dollars— I don’t remember the exact amount, but I
think one went as high as $12. But the injured man and society got more in
proportion in the State that cost $12 than in the State that cost 22 cents. There
for administrative costs must be stated in terms of ratio between the individual
and social gain and the actual administrative cost. Granting that this is not
an easy task, I insist it is not an impossible one. The quicker it is done the
better for the association and the various States. You are not going to get a
very high speed rate in the State that says its actual administrative cost is
22 cents for each case and utterly ignores the benefits bestowed.
The proceedings of the Atlanta convention have been published by the
United States Bureau of Labor Statistics as its Bulletin No. 456, and copies
are available at the headquarters here or will be sent from the bureau upon
request.
Respectfully submitted.
E t h e l b e r t S t e w a r t , Secret arif-Treasurer.
A u g u s t 31, 1928.
FIN A N CIA L ST A T E M E N T OF THE TREASURER
BALANCE
AND
R E C E IP T S
1927
Sept. 15. Balance, in bank $2,135.74; unexpended postage and tele
graph fund, $3.89________________________________________ $2, 139. 63
16. Montana Industrial Accident Board, 1928 dues____________
50, 00
New Brunswick Workmen’s Compensation Board, 1928
dues (exchange on above 25 cents)_______________________
49. 75
29. I. K. Huber, 1928 dues_____________________________________
10. 00
Oct. 15. Interest on registered Liberty bonds (two at $100 and one
at $500)__________________________________________________
14.88
Nov. 5. Industrial Accident Prevention Associations, 1928 dues___
10. 00
10. Interest on $1,000 coupon Liberty bond___________________
21. 25
50. 00
15. Manitoba Workmen’s Compensation Board, 1928 dues____
Recall of two $500 Liberty bonds (Nos. E -0 0 170425 and
E -0 0 192340)______________________________________________
1, 000. 00
21. 24
Interest on above Liberty bonds___________________________
1928
Jan.
1. Interest on bank account___________________________________
14. 95
Mar. 6. Interest on Canadian bonds as of Feb. 1, 1928 (5 of $100
each)_____________________________________________________
13. 75
Apr. 16. Interest on registered Liberty bonds ($700)________________
14. 87
19. Interest from Dec. 12, 1927, to Apr. 19, 1928, on $1,500
certificate of Paterson Mortgage & Guaranty Title Co__
29. 10
25. Interest on $1,000 coupon Liberty bond___________________
21. 25
Jul>
1. Interest on bank account___________________________________
7. 91
7. E. I. du Pont de Nemours & Co., 1929 dues_______________
10. 00
George E. Beers, 1929 dues________________________________
10. 00
12. Ontario Workmen’s Compensation Board, 1929 dues______
50. 00
13. Virginia Industrial Commission, 1929 dues_________________
50. 00
16. West Virginia Workmen’s Compensation Department, 1929
dues_____________________________________ ________________
50. 00
18
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
1928
July 17. Republic Iron and Steel Co., 1929 dues___________________
19. California Industrial Accident Commission, 1929 dues_____
21. Massachusetts Department of Industrial Accidents, 1929
dues______________________________________________________
Industrial Accident Prevention Associations, 1929 dues__
23. Connecticut Workmen’s Compensation Commissioner,
first district, 1929 dues__________________________________
New Brunswick Workmen’s Compensation Board, 1929
dues______________________________________________________
24. Arizona Industrial Commission, 1929 dues_________________
Ohio Industrial Commission, 1929 dues____________________
25. Pennsylvania Department of Labor and Industry, 1929
dues______________________________________________________
26. Leifur Magnusson, 1929 dues______________________________
28. Delaware Industrial Accident Board, 1929 dues___________
30. North Dakota Workmen’s Compensation Bureau, 1929
dues______________________________________________________
I. K. Huber, 1929 dues_____________________________________
Oklahoma State Industrial Commission, 1929 dues________
Aug. 1. Wisconsin Industrial Commission, 1929 dues______________
2. Illinois Industrial Commission, 1929 dues__________________
3. Nova Scotia Workmen’s Compensation Board, 1929 dues__
7. Iowa Workmen’s Compensation Service, 1929 dues_____
Connecticut Workmen’s Compensation Commissioner,
second district, 1929 dues________________________________
Connecticut Workmen’s Compensation Commissioner,
fourth district, 1929 dues________________________________
Georgia Industrial Commission, 1929 dues_____ ___________
8. New Jersey Department of Labor, 1929 dues______________
15. Connecticut Workmen’s Compensation Commissioner,
third district, 1929 dues__________________________________
17. Utah Industrial Commission, 1929 dues____________________
23. Connecticut Workmen’s Compensation Commissioner,
fifth district, 1929 dues__________________________________
Wyoming Workmen’s Compensation Department, 1929
dues______________________________________________________
29. Maine Industrial Accident Commission, 1929 dues_________
Sept. 1. and 4. Interest on Canadian bonds ($500)________________
4. Nevada Industrial Commission, 1929 dues_________________
$10. 00
50. 00
50. 00
10. 00
10. 00
50. 00
50. 00
50. 00
50. 00
10. 00
50. 00
50.
10.
50.
50.
50.
50.
50.
00
00
00
00
00
00
00
10. 00
10. 00
50. 00
50. 00
10. 00
50. 00
10. 00
50.
50.
13.
50.
00
00
75
00
4, 692. 33
D IS B U R S E M E N T S
1927
Sept. 15. Postage and telegraph fund________________________________
16. Chas. G. Stott & Co., 100 pencils for use at Atlanta con
vention___________________________________________________
Oct.
3. Glenn L. Tibbott, work at Atlanta convention_____________
Elizabeth Ragland, work at Atlanta convention___________
Mrs. W. G. Causey, work at Atlanta convention__________
4. Ethelbert Stewart, expenses attending Atlanta convention
over amount allowed by Bureau of Labor Statistics_____
21. Helen W. Johnson, reporting proceedings of the Atlanta
convention_______________________________________________
Maryland Casualty Co., bonding secretary-treasurer for
year ending Oct. 23, 1928_______________________________
Nov. 9. Glen L. Tibbott, partial payment for indexing proceedings,
Salt Lake City, Hartford, and Atlanta convention______
21. Glen L. Tibbott, partial payment stenographic and clerical
services, 1927-28_________________________________________
Eva M. Taylor, partial payment stenographic and clerical
services, 1927-28_________________________________________
Postage and telegraph fund________________________________
Dec. 2. Gibson Bros., printing 2,000 letterheads and 1,000 envelopes,
10. Paterson Mortgage & Guaranty Title Co., investment in
mortgage certificates_____________________________________
22. Ethelbert Stewart, partial payment honorarium 1927-28__
3. 89
1.
25.
25.
25.
80
00
00
00
9. 26
300. 52
12. 50
50. 00
75. 00
75. 00
5. 00
33. 75
1, 500. 00
200. 00
BUSINESS MEETING
19
1928
Feb. 18. Glenn L. Tibbott, final payment for indexing proceedings
Salt Lake City, Hartford, and Atlanta conventions______
Apr. 18. Ethelbert Stewart, partial payment honorarium 1927-28. _
George A. Simonds & Co., binding proceedings of Salt Lake
City, Hartford, and Atlanta conventions and Bulletin-No.
212 (75 copies)__________________________________________
June 14. Postage and telegraph fund________________________________
26. Ethelbert Stewart, balance of honorarium 1927-28________
July 9. Glenn L. Tibbott, balance for stenographic and clerical
services, 1927-28_________________________________________
Eva M. Taylor, balance for stenographic and clericalservices,
1927-28__________________________________________________
Aug. 1. Exchange on 1929 dues New Brunswick Workmen’s Com
pensation Board_________________________________________
14. Postage and telegraph fund________________________________
22. Exchange on 1929 dues Nova Scotia Workmen’s Compensa
tion Board_______________________________________________
July 27. Exchange on 1929 dues Ontario Workmen’s Compensation
Board____________________________________________________
Sept.
4. Balance, bank deposits---------------------------------------------------------
$100. 00
250. 00
98. 15
5. 00
150. 00
75. 00
75. 00
.2 5
15. 00
. 25
. 25
3, 100. 62
1, 591. 71
4, 692. 33
Su m m ary
r e c e ip t s
Cash in bank_________________________________________________________ $2,135. 74
3. 89
Cash in postage fund--------------------------------------------------------------------------Membership dues--------------------------------------------------------------------------------- 1, 379. 75
Itecall of two Liberty bonds------------------------------------------------------------------ 1, 000. 00
Interest:
Securities________________________________________________ $150. 09
Bank deposits------------------------------------------------------------------22. 86
------------172.95
Total_____ ______________________________________________________
4, 692. 33
DISBU RSEM EN TS
Binding proceedings, twelfth, thirteenth, and fourteenth conventionsPrinting_______________________________________________________________
Postage-------------------------------------------------------------------------------------------------Indexing proceedings, twelfth, thirteenth, and fourteenth conventions,
Reporting proceedings, fourteenth annual convention_________________
Bonding secretary-treasurer___________________________________________
Purchase of mortgage certificates, Paterson Mortgage & Guaranty
Title C o_____________________________________________________________
Honorarium and clerical service in secretary-treasurer’s office_______
Clerical service at fourteenth annual convention______________________
Exchange on dues for 1929 of Workmen’s Compensation Boards of
Ontario, New Brunswick, and Nova Scotia_________________________
Miscellaneous_________________________________________________________
Total-------------------------------------------------------------------------------------------Balance: Cash in bank______________________________________________
98.15
33. 75
18. 89
150. 00
300. 52
12.50
1, 500. 00
900. 00
75. 00
. 75
11 . 06
3,100. 62
1, 591. 71
4, 692. 33
1 Of this check for $5 for postage and telegraph fund, there is an amount of $4.63 unexpended at this time.
20
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
A SSETS
Cash in bank_________________________________________________________ _$!» 591. 71
Cash in postage fund---------------------------------------------------------------------------4. 63
Securities:
United States Liberty bonds-------------------------------------- $1, 700. 00
Canadian bonds_______________________________________
500. 00
Mortgage certificates, Paterson Mortgage & Guaranty
Title Co_____________________________________________ 1, 500. 00
-----------------: 3, 700. 00
Total____________________________________________________________
5, 296, 34
In addition to the assets enumerated above there are the following unpaid
dues:
1928:
Porto Rico Industrial Commission__________________________________ $10. 00
1929:
Idaho Industrial Accident Board____________________________________
50. 00
Indiana Industrial Board____________________________________________
50. 00
Kansas Public Service Commission__________________________________
50. 00
50. 00
Maryland State Industrial Accident Commission___________________
Minnesota Industrial Commission___________________________________
50.00
Montana Industrial Accident Board__________________________________
50. 00
New York Department of Labor_____________________________________
50. 00
Oregon State Industrial Accident Commission_______________________
50. 00
Washington Department of Labor and Industries___________________
50. 00
Porto Rico Industrial Commission___________________________________
10. 00
Manitoba Workmen’s Compensation Board_____ _____________________
50. 00
520. 00
The following securities are in safety deposit box S-363, National Savings &
Trust Co., Washington, D. C.— Ethelbert Stewart:
United States Liberty bonds:
$100
No. 1217874______________________________________________ _____________
No. 1217875____________________________________________________________
100
No. 236204_____________________________________________________________
500
No. A-00031671________________________________________________________ 1, 000
500
Dominion of Canada bonds (5) Nos. 1852-1856 inclusive, at $100 each___
Paterson Mortgage & Guaranty Title Co., certificate No. 6296, Series 221,
due Oct. 19, 1930________________________________________________________ 1, 500
3,700
Respectfully submitted.
E thelbert Stew art,
Septem ber
Secretary-Treasurer.
4, 1928.
[On motion made, seconded, and carried, the secretary’s report was
referred to the resolutions committee and the treasurer’s report to the
auditing committee.]
The C h a irm a n . The next order of business is the report of the
regular committees. The first committee report is that of the com
mittee on statistics and compensation insurance costs, of which Doctor
Hatch is chairmanREPORT OF THE COMMITTEE ON STATISTICS AND COMPENSATION
INSURANCE COST
The committee has nothing to present at this meeting for action by the asso
ciation. On one matter, however, it is in order to make a progress report at
this time. This is the revision of the standard plan for accident statistics
BUSINESS MEETING
21
originally formulated by your committee and adopted by the association. The
reports of the committee on statistics at the Hartford and Atlanta conventions
indicate how the movement for .such a revision originated and the steps taken
to carry it out under the procedure of the American Standards Association
(formerly the American Engineering Standards Committee) which procedure
lias heretofore been followed in a number of instances for the formulation of
safety codes in which this association has been interested. Since the last
convention further developments have been as follows:
The revision committee which, under the procedure of the American Stand
ards Association, is known as a sectional committee, has been appointed and
stands at present as follows:
Leonard W . Hatch, New York State Industrial Board, chairman.
Lucian W. Chaney, United States Bureau of Labor Statistics, secretary.
W. W. Adams, United States Bureau of Mines.
C. B. Auel, Westinghouse Electric & Manufacturing Co.
David S. Beyer, Liberty Mutual Insurance Co.
E. F. Blank, Jones & Laughlin Stetel Co. (representing the metals section of
the National Safety Council).
M. H. Christopherson, New York State Insurance Fund.
C. L. Close, United States Steel 'Corporation (representing the American
Iron and Steel Institute).
Edward Crane, Interstate Commerce Commission.
T. Norman Dean, Ontario Workmen’s Compensation Board.
Lewis DeBlois, National Bureau of Casualty & Surety Underwriters (repre
senting the National Safety Council).
Paul Dorweiler, Aetna Insurance Co.
E. I. Evans, Ohio State Insurance Fund.
John H. Hall, Virginia Bureau of Labor and Industry (representing the
Association of Governmental Labor Officials).
L. L. Hall, National Council on Compensation Insurance.
H. W . Heinrich, Travelers Insurance Co.
E. L. Hewitt, Detroit Industrial Safety Council (representing the rubber sec
tion of the National Safety Council).
John P. Jackson, New York Edison Co.
W. Dean Keefer, National Safety Council.
E. W. Kopf, Metropolitan Life Insurance Co.
M. G. Lloyd, United States Burleau of Standards.
W. J. Maguire, Pennsylvania Department of Labor and Industry.
J. A. Morford, National Industrial Conference Board.
O. F. McShane, Utah Industrial Commission.
Leifur Magnusson, International Labor Office, Washington, D. C.
L. R. Palmer, Equitable Life Insurance Society (representing the National
Safety Council).
E. B. Patton, New York State Department of Labor (representing the com
mittee on governmental labor statistics of the American Statistical Association).
D. J. Price, United States Department of Agriculture.
H. A. Rening^er, Lehigh Portland Cement Co. (representing the Portland Ce
ment Association).
Dan L. Royer, Ocean Accident & Guarantee Corporation.
E. L. Sinclair, United States Navy Department.
Ethelbert Stewart, United States Department of Labor.
David Van Schaack, Aetna Insurance Co.
W. G. Voogt, New York State Insurance Fund.
S. W. Wilcox, Illinois Department of Labor.
H. E. Wilrig, Lumber Mutual Casualty Co.
Herman R. Witter, Ohio Department of Industrial Relations,
There was a meeting of the sectional committee in New York City on March
9, 1928, attended by 16 of the members. At this meeting it was agreed that
the work of the committee should be confined to accident statistics for the aid
of accident prevention, and should not include statistics of compensation. The
scope of the committee’s work agreed on is; more specifically indicated by the
four working subcommittees which it was decided should be appointed by the
22
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
chairman, these being subcommittees on: (1) Definitions; (2) accident rates;
(3) classification of industries; and (4) classification of causes.
After the above-mentioned meeting the chairman appointed the following
as members of the four subcommittees:
On definitions:
W. Dean Keefer, National Safety Council, chairman.
Edward Crane, Interstate Commerce Commission.
Paul Dorweiler, Aetna Life Insurance Co.
Evan I. Evans, Ohio Industrial Commission.
W. W . Adams, United States Bureau of Mines.
On accident rates:
Lucian W. Chaney, United States Bureau of Labor Statistics, chairman.
T. Norman Dean, Ontario Workmen’s Compensation Board.
Lewis DeBlois, National Safety Council and National Bureau of Casualty
and Surety Underwriters.
John Price Jackson, New York Edison Co.
Edwin W. Kopf, Metropolitan Life Insurance Co.
On classification of industries:
E. B. Patton, New York Department of Labor and American Statistical
Association, chairman.
^
David S. Beyer, Liberty Mutual Insurance Co.
Leifur Magnusson, International Labor Office, Washington, D. C.
J. A. Morford, National Industrial Conference Board.
S. W. Wilcox, Illinois Department of Labor.
On classification of causes:
L. L. Hall, National Council on Compensation Insurance, chairman.
E. F. Blank, National Safety Council, metals section.
H. W. Heinrich, Travelers Insurance Co.
W. J. Maguire, Pennsylvania Department of Labor and Industry.
H. A. Reninger, Portland Cement Association.
Dan L. Royer, Ocean Accident & Guarantee Corporation.
The work in these subcommittees of preparing tentative revisions for presenta
tion to the sectional committee for its consideration is now well under way.
Respectfully, submitted.
L. W. H a t c h , Chairman Committee on Statistics».
[On motion made, seconded, and carried the report was received
and the committee was continued with power to act.]
The C h a irm a n . The next report is that of the committee on inves
tigation of results of compensation awards by Miss
O. Harrison.
REPORT OF COMMITTEE ON INVESTIGATION OF RESULTS OF
COMPENSATION AWARDS
By Miss
R ow ena
O.
H a r r is o n
At the Salt Lake City convention of the International Association of Indus
trial Accident Boards and Commissions a committee was organized on the
subject of investigation of results of compensation awards. At that time
it was pointed out that the various boards and commissions, with the exception
of the State of Massachusetts, were not following up, to any satisfactory extent,
the awards that were passed by them, to see whether they proved themselves
by events to be the proper award in the case, and that students in some
colleges and universities were investigating the results of workmen’s com
pensation laws.
At the Hartford convention of this association the committee recommended
that State compensation boards and commissions begin as soon as possible,
in each State, to inaugurate a systematic follow-up system of (1) all lump
sum settlements regardless of the nature of the injury; (2) all permanent par
BUSINESS MEETING
23
tial and permanent total disability cases, whether or not the same are settled
in lump sums; and that they use, as part of their plan, a questionnaire
prepared by the committee and which may now be found in Bulletin No. 432
of the United States Bureau of Labor Statistics, so that when a number of
States have made investigations, no matter how narrow or broad the investiga
tion may be (as there is no thought on the part of the committee of con
trolling the State investigations), we may have certain essential and com
parable information from all. It was further recommended that the secretary
of this association communicate with the principal tniversities and colleges in
the United States and offer, when the student undertook such investigation,
the cooperation of the Bureau of Labor Statistics or that of the International
Association of Industrial Accident Boards and Commissions.
The committee desires to report to this association that 650 universities and
colleges in the United States have been communicated wTith and offered the
cooperation of the Bureau of Labor Statistics or that of the International
Association of Industrial Accident Boards and Commissions in this line of
work. The International Association of Industrial Accident Boards and Com
missions, having charge of all records pertaining to the adjudication of the
workmen’s compensation laws, can make accessible to the student investigating
the results of compensation laws such information, which would be of assistance
to him, and can advise him of other students doing the same line of research
work, and on the other hand it will get the results of such work for the benefit
of State boards and commissions.
The committee, through its investigation of this work, finds that several com
missions, as a side issue and for their own satisfaction and benefit, when an
investigator of the bureau is in a locality in which there is a claimant who has
received a lump sum or who has a very serious injury and is drawing com
pensation for either permanent partial or permanent total disability, have the
investigator report on that particular case. The committee recommends that
States making such survey of the results of its own work use as a part of its
plan the questionnaire prepared by the committee, so that all of the States
may have knowledge of and profit by the experience of each.
The committee further reports that several States have started a systematic
investigation of the results of compensation awards, which investigations are
being made either through the mail or by inspectors with little cost to the
commissions.
Maryland is making its investigation through the mail. It is sending out
questionnaires on all lump-sum awards of over $500, in all permanent total
disability cases, in permanent partial disability cases of serious injuries, and
in all fatal cases where lump sums have been granted. Four-fifths of the
number of questionnaires sent out have been returned satisfactorily answered
and showing appreciation of our interest. Several of the questionnaires were
returned with a written invitation to visit the beneficiaries at their stores or
to see their homes purchased with the lump sums granted by the commission,
and some of the answers requested advice. Up to this time not a single re
opening of a case has been requested because of our investigation.
The results of these investigations are to be furnished to the secretary of
this association and combined by him in such a way as to furnish for all the
States the results of the investigation in each.
[On motion made, seconded, and carried the report was referred
to the resolutions committee.]
The C h a irm a n . The next order of business is the report of the
committee on national legal-aid organizations, by W . H . Horner,
chairman.
24
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
REPORT OF JOINT COMMITTEE OF THE INTERNATIONAL ASSOCIA
TION OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
AND TH E N A T IO N A L ASSO CIATIO N OF LE G A L-A ID O RG AN IZA
TIONS, 1928
The joint committee representing the two organizations, which was continued
at the Atlanta convention of this association for further consideration of the
legal-aid problem, has now reached the point where the next step is proper
contact between the various compensation jurisdictions and the legal-aid repre
sentatives or authorities located in these districts. At the convention of this
association in Salt Lake City a complete list of legal-aid organizations in opera
tion throughout the United States was submitted as part of the report of the
committee and is published in Bulletin No. 406 of the United States Bureau
of Labor Statistics. A later list was published in the July, 1928, issue of the
Monthly Labor Review of that bureau. The directory is available to the com
pensation authorities for the purpose of making plans for securing the services
of the legal-aid organizations in certain cases.
The plan which is being followed in the State of Massachusetts between the
State Industrial Accident Board and the Boston Legal Aid Society has been
referred to repeatedly in the reports of this committee as the most practical
way of cooperation between the two organizations, and we believe it can be used
to good advantage in other States in disposal of troublesome or controverted
cases.
In order to ascertain the extent to which the cooperation in the legal-aid
organizations in the various States is being utilized as suggested at the Salt
Lake City and subsequent conventions of the International Association of Indus
trial Accident Boards and Commissions, a questionnaire was prepared and sent
out by the secretary of this association to the workmen’s compensation and labor
officials of the various States.
Among the questions asked were the following:
1. Is there a legal-aid organization in the city in which your office is located?
2. If so, has a contact with that organization been formed along the lines
suggested by the conventions named above?
3. In how many workmen’s compensation cases has there been actual appear
ance before your commission of agents of the legal-aid organization as repre
sentatives of the injured?
In reply to question No. 1 the answer “ No ” was received from the following
States : Alabama, Arizona, Arkansas, Delaware, Idaho, Iowa, Kansas, Maine,
Maryland, Missouri, Mississippi, Montana, Nebraska, Nevada, New Hampshire,
North Carolina, North Dakota, Oklahoma, Oregon, Porto Rico, South Dakota,
Texas, Virginia, Vermont, and Wyoming.
The following States replied in the affirmative in answer to questions Nos. 1
and 2 : Colorado, Georgia, Louisiana, Massachusetts, and Rhode Island.
The following States answered “ Yes ” to question No. 1 and “ No ” to question
No. 2 : Kentucky, Minnesota, New Jersey, New York, Ohio, Tennessee, and
Wisconsin.
The States reporting actual appearance before the compensation authorities
of agents of the legal-aid organizations as representatives of the injured in reply
to question No. 3 were: Colorado, Georgia, Louisiana, Massachusetts, Rhode
Island, and Tennessee.
In the State of Minnesota the industrial commission gives legal aid in com
pensation cases. This situation also applies in the State of Pennsylvania, where
legal aid is furnished in some cases by attorneys connected with the workmen’s
compensation board. In the latter State the adjusters connected with the
BUSINESS MEETING
25
Bureau of Workmen’s Compensation represent the claimants in many contested
cases before the referees and the workmen’s compensation board.
A conference was held between the referees located in the city of Philadelphia
and the legal-aid authorities in that city for the purpose of discussing the legalaid problem. It was agreed that in cases where- the services of the legal-aid
association would be helpful such cases would be called to the attention of the
representatives of the legal-aid society.
Since the replies from the States where contact with the legal-aid organiza
tions has been made indicate that this arrangement has been satisfactory, we
desire strongly to recommend that advantage be taken of this service in the
States where there may be unusual delay in disposing of contested cases due to
the fact that; the injured person is not properly represented at the hearings
before the referees, workmen’s compensation boards and industrial commissions.
Respectfully submitted.
I n t e r n a t io n a l A s s o c ia t io n of
I n d u s t r ia l A c c id e n t B oards a n d C o m m i s s i o n s .
W. H . H or n e r , Pennsylvania, Chairman.
N a t i o n a l A s s o c ia t io n o f L e g a l A id O r g a n iz a t i o n s ,
J o h n S. B rad w a y , Secretary.
Mr. S t e w a r t . I want to raise the question— this is not a permanent
committee but one simply to form a contact with the legal-aid
organizations: Has this association not gone about as far as it can ?
It seems to me this is purely a local matter. I f the States where
they have legal-aid organizations wrant to form these contacts, they
have been advised by us how to do it. W e have said it over and
oyer again, and I wonder if we need to go any further. One of the
States that certainly got its money’s worth is Utah, for instance.
The legal-aid organization took up a case for it and carried that case
through the United States Supreme Court. There is no question
about the value of the legal-aid organization to these States; but it
is the affair, locally, of each State, and I wondered if the association
might not just as well relieve this committee of any further work.
Mr. H o r n e r . I want to say that I heartily agree with Secretary
Stewart; and I so pointed out in my report. I do not see that there
is any further work that this committee can do; it is your job now.
W e have brought the situation up to that point where it is up to the
members of the various jurisdictions as to whether or not they want
to avail themselves of that service.
[On motion made, seconded, and carried the report was received
and the committee discharged with the thanks of the association.]
Mr. S t e w a r t . I am going to ask the association to include in the
program a paper by Mr. Deans, o f Virginia, which is right now in
a mix up on this longshoreman’s bill, and I think we ought to hear
about it.
Mr. D e a n s. I want to say that I have not prepared any paper on
the subject; I read to Mr. Stewart last evening only a consensus of
opinion from the majority of my committee.
Mr. S te w a r t. It certainly states the situation down there in such
a way that it seems to me the association ought to have it.
The C h a irm a n . I f there is no objection the opinion of Mr. Deans
will be received this afternoon.
[Meeting adjourned.]
TUESDAY, SEPTEMBER 11— AFTERNOON SESSION
Chairman, George A. Kingston, Commissioner Workmen’ s Compensation Board of Ontario
LONGSHOREMEN’S AND HARBOR WORKERS’
COMPENSATION ACT
The C h a ir m a n . From our point of view the longshoremen’s prob
lem during these years has been an academic one— I mean from the
point of view of an inland jurisdiction like Ontario— but I have read
with a good deal of interest the problems presented in New York
and California and other ocean border States. I think we have not
had a convention but that somebody has had something to say about
this vexed longshoremen’s problem. I thought the Supreme Court
not long ago had settled it once and for all, but from what I have
heard the secretary say there still seems to be a problem which needs
some discussing. So this afternoon’s session is devoted entirely to
the subject of longshoremen’s and harbor workers’ problems under
compensation laws, and Jerome G. Locke, of the United States
Employees’ Compensation Commission, will address us on this sub
ject at the present time.
Longshoremen’s and Harbor Workers’ Compensation
for the Port of New York
By J er o m e G. L o c k e , Deputy Commissioner United States Employees’ Compen
sation Commission
I am glad indeed to have the opportunity to meet, for the first time,
the association in which I have enjoyed a membership for quite a
number of years. Prior to 14 months ago my connection with com
pensation administration was out in Montana, which is a long way
from most of the convention places that have been selected. Even
when the association was in Salt Lake City, two or three years ago,
there occurred a combination of circumstances that foreclosed my
plans for attendance. I am now going to hope that the fates will
deal more kindly in the future because I sincerely believe that the
annual meetings of this organization are milestones in the path of
progress toward equitable, scientific, and satisfactory handling of a
specialist’s business, the development of which is as yet only fairly
begun.
Many of the members of this association are more or less familiar
with the history of the longshoremen’s and harbor workers’ compen
sation act. The necessity for the legislation arose from the fact that
the jurisdictions of the several States do not go beyond their respec
tive shore lines and that there was no provision for handling accident
claims in thousands of cases of injury to longshoremen and harbor
workers of all kinds when these men were injured on navigable water,
26
LONGSHOREMEN’S COMPENSATION ACT
27
except by voluntary agreed settlement or through recourse to personal
injury suits in admiralty courts.
A s is always true where there is no form of compensation act,
injured men and their dependents in literally thousands of cases
obtained little or no benefit following accident, while the admiralty
courts became overburdened and congested with thousands of other
cases, the final adjudication of which often exacted unduly large
penalties from the employers and almost universally put at least 50
per cent of this money into the hands of attorneys and doctors rather
than into the hands of the injured workmen and their dependents.
Several of the S ta te s attempted to remedy the situation by extend
ing their compensation laws to cover injuries on adjacent navigable
water, but the United States Supreme Court frowned on this as an
unconstitutional extension of State jurisdiction.
Finally, after
several years of consideration and debate, the Congress enacted the
present longshoremen’s and harbor workers’ compensation act, which
became effective on July 1, 1927.
The act is compulsory as to employers and all inclusive as to work
men. It provides two forms of coverage, namely, self-insurance and
old-line insurance by policy with any approved carrier. The maxi
mum weekly rate is $25, not exceeding two-thirds of the weekly wage
or two-thirds of the weekly loss in earning capacity as the case may be,
and not exceeding $7,500 payable in any one case. Burial benefit is
$200; waiting period 7 days retroactive after 49 days’ disability, and
there is provided all necessary medical, surgical, and other attendance
at the expense of the carrier. The act also makes provision for safety
work and for rehabilitation. The entire cost of administration is
borne by the Federal Treasury.
Quite unlike any other compensation law with which I am familiar,
the Federal act sets up a dual form of administrative machinery.
A ll matters of general administration such as control of funds, regu
lation as to proper coverage for employers, provision of forms, co
ordination of general routine, compilation of statistics, direction
of safety work, control of rehabilitation, and other general adminis
trative features are vested solely in the United States Employees’
Compensation Commission at Washington. A ll decisions on contro
verted matters in individual cases is vested solely in the deputy
commissioner who presides over the district in which the injury
occurred. Appeal from his decision is to the Federal District Court
without review on the part of the commission. In short, all adminis
trative function is vested in the United States Employees’ Compen
sation Commission and all judicial function is vested in deputy
commissioners.
Inclusive of the District of Columbia, the United States has been
divided into 15 districts, each in charge of a deputy commissioner,
except in two cases where one deputy commissioner presides over
two districts, so that there are 13 deputy commissioners all told. In
the District of Columbia the act has been extended to cover all occu
pations as well as longshore and harbor work. District No. 2, to
which I have been assigned, embraces the State o f New York (except
the Great Lakes) and the port of New York, which includes about
one-quarter of the area, of New Jersey. Due to the fact that the
31573°— 29------ 3
28
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
great volume of our export and import, as well as passenger, traffic
is through the port of New York, district No. 2 furnishes a much
larger volume of cases than any other district. I am told that ap
proximately 40 per cent of the injuries on navigable water of the
United States are within the port of New York alone.
When I first came to New York, some 14 months ago, I found that
there was great apprehension on the part of employers, carriers,
and workmen that it would be next to' impossible to get the new
act fairly inaugurated and smoothly effective in less than several
years. I heard many stories from all sides as to some of the peculiar
local conditions that obtained, the practices that were in effect among
the people with whom we would have to deal, and many predictions
as to the difficulties to be met. Happily much of this widespread
belief proved to be fallacy. The policy in the New York district
has been based on a few cardinal principles that we believe to be
basic in the successful handling of any compensation law.
The primary purpose of compensation is to compensate cripples
and the dependents of those who have been killed and not to furnish
fees for professional men. W e therefore discourage the appearance
of attorneys and other representatives in cases and continually say
to the workmen, “ You don’t need a lawyer. It is our business to see
that you get the compensation which the law gives 3^011. You will
get neither more nor less regardless of the number of attorneys you
employ.”
Injured workmen need the compensation while under disability
and not after they have returned to work. Consequently, no case
should ever be permitted to drag longer than is absolutely necessary
to get the facts and apply the law.
A very large percentage of employers, carriers, and workmen are
honest and will cooperate fully and fairly in equitable settlements
by informal means and there is no necessity for extended hearings
or other red tape in about 99 per cent of the cases.
There are, however, among all classes a few individuals who are
disposed to cheat and these must be dealt with promptly, effectively,
and as drastically as the authority vested by the law will permit.
This has been done in the few cases where such action appeared to be
clearly warranted.
Selfishness is a human characteristic common to all of us and it is
the natural thing for an individual to present his case in the way
that he thinks will be most favorable to himself. In disputed matters
the truth of the situation is generally somewhere between the claims
of the contending parties and rarely all on one side of the case.
Doctors, despite their learning, experience, and painstaking en
deavors, are not infallible. They make mistakes. Settlements can
not always, therefore, be based solely on the findings of examining
surgeons but must sometimes be predicated in part on the other
known elements of the case, and these are not always in confirmation
of the doctor’s report.
^ In the settlement of compensation cases the psychology of the
situation is often quite as important as the facts and the law. The
great fundamental purpose of the act is to furnish relief to the in
jured and to do equity to both the workman m d the carrier, The
LONGSHOREMEN’S COMPENSATION ACT
29
more simple and expeditious the method by which this is brought
about, the greater the satisfaction on the part of all parties concerned.
Suspicion is a dangerous thing. To guard against it we have ad
hered to the policy of discussing actual settlements only when both
parties to the case are present or by letter or memorandum, copy of
which reaches both parties. Likewise, information on a case obtained
from the carrier is promptly furnished to the claimant and viceversa. There is no confidential dealing.
Last, but not least, compensation administrators are human and
liable to err. When a mistake has been made it is the duty of the
compensation administrator frankly to acknowledge his mistake, back
up, and start over.
Based on these basic principles the system for handling cases in
district No. 2 is as simple and direct as we know how to devise. The
employer is required by law to report the accident. The attending
pl^sician must report the nature of the injury and the disability.
The carrier must, under the law, begin payment within 14 days after
he has knowledge of the injury unless he controverts the claim. In
cases where payment is voluntarily begun our office takes no action
other than to check the reports until served with notice that com
pensation has been suspended unless some question is raised by either
carrier or claimant.
When compensation is suspended by the carrier a form is sent to
the claimant briefly reciting the facts in the case as these appear from
our files and the amount and nature of the payment he has had. He
is requested if dissatisfied either to report in person or otherwise to
advise within 10 days. I f he is satisfied or fails to reply, the case is
closed and both parties are given notice.
A ll matters of dispute of every kind go to claims examiners, who
are in effect examiners and arbitrators. It is the duty of the ex
aminer who handles the case to effect a settlement that complies with
the law by any method that he deems advisable and on terms that are
satisfactory to both parties. He may use the telephone, write letters,
have personal interviews, make field investigations, order medical
examinations by the staff attached to the office, conduct a conference,
or hold an informal hearing. The examiner has no power to order
action, but may adopt any reasonable method to get proper action by
agreement. Every action taken in the handling of a case, be it only
a telephone conversation, is recorded on a memorandum which is
put in our files, with copies to all interested parties. Approximately
99 per cent of the cases are handled and closed by this method.
Only cases in which there has been failure to obtain proper han
dling and settlement by agreement are put on the calendar for formal
hearing before the deputy commissioner. Such hearings are con
ducted in a manner quite similar to the trial of a personal injury suit
in court, except that the claim and notice of controversion take the
place of the bill of complaint and answer as pleadings and there is
allowed greater latitude in the introduction of evidence.
Usually the claimant does not have an attorney and his side of the
case is developed by examination at the hands of the deputy com
missioner. I f an attorney appears, his fee is fixed commensurate
with the service he has actually performed for his client. I f it ap
pears that there was no actual need for him in the case, the fee is so
30
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
nominal that he decides this class of practice does not' pay and sends
the next injured workman and his troubles direct to the compensation
offices.
In simple cases involving decision on questions of fact alone or on
questions of fact to which the application of law is clear, the deputy
commissioner announces his decision at the conclusion of hearing in
the form of an order that recites the questions involved and the
findings of fact and conclusions of law with reasons therefor, as well
as the nature and amount of the award, if any. Unless there is notice
of appeal within the statutory period of 30 days, the record other
than the deputy commissioner’s decision is not transcribed. In in
volved cases the record is transcribed and the decision written in
about the same form as a court decision after the deputy commis
sioner has reviewed the evidence and consulted such legal authority
as he can find. In exceptional cases the deputy commissioner may
call for briefs before preparing his decision. A s before stated, the
appeal is to the Federal district court.
In so far as I am able to judge, this simple system has worked
perfectly and with almost universal satisfaction in our district. I
have heard almost no complaint, and the spirit of cooperation on the
part of employers, carriers, and wTorkmen has generally been very
generous.
During the first year’s operation there were approximately 1,000
cases per month. A t the close of the year, on June 30, all o f these
had been finally closed except some 1,400, of which number about
600 were on the live roll drawing compensation for permanent dis
ability or death, and 800 drawing compensation for temporary dis
ability or in process of adjustment. There were only three appeals
to the courts, one of these a friendly suit for the purpose of
getting an interpretation of an obscure point of law. In another
the court sustained the deputy commissioner’s order in passing on a
motion to stay the award, and the appeal will likely be withdrawn,
while in the third case there is now substantial agreement as to all
issues except some $70, which will probably be compromised and the
case settled without trial.
Due primarily to the whole-hearted spirit of cooperation that has
obtained on the part of all those who are interested in the act and to
the efficiency, fidelity, and zeal with which claims examiners, medical
staff, and clerks in the New York office have labored to make the
administration of the act in this district all that it should be, I
think I can safely report that the new work has been fairly launched.
There now appears no reason why it can not be efficiently and satis
factorily handled in the future as it has been for the past year.
D IS C U S S IO N
Mr. S t e w a r t . Mr. Locke, you stated that the law covered all cases.
Doesn’t that law exempt from its operation boats under 18 tons?
Mr. L o c k e . Yes. I said that the longshoremen’s and harbor work
ers’ act is all-inclusive. That is not literally true; there is exempted,
first, seamen; second, Federal employees; and third, the members of
the crew engaged in loading or unloading a boat of less than 18 tons
net, provided those members have been engaged for that purpose by
LONGSHOREMEN’S COMPENSATION ACT— DISCUSSION
31
tlie master of the vessel. It does not exclude all vessels under 18 tons,
but only those where the loading and unloading have been secured at
the behest of the master of the vessel. The purpose of that provi
sion, I ain told, is to exempt fishing smacks from the operation of the
act.
Mr. S t e w a r t . I understand that in the single State of Virginia
that provision excludes from all compensation a very large number
of men.
Mr. W i l c o x . I understood Mr. Locke to say he has a transcript
of the testimony made. Is that required ? W hat is its purpose ?
Mr. L o c k e . It is optional with the commissioner as to whether or
not he has a transcript made. In conducting a hearing where I am
unable to .announce a decision at the conclusion of the hearing, it is
generally because I want to review the testimony— at least that is
one of the reasons— that the transcript is then made.
Mr. W i l c o x . Don’t you have a reporter in the department?
Mr. L o c k e . The testimony is all taken, but it is not transcribed, in
most cases, unless there is a notice of appeal; we save that work of
transcribing, that is all. A notice of appeal under the law must be
given within 30 days, and a reporter’s notes will not be so cold within
the 30 days that she can not transcribe them.
Mr. W i l c o x . I do not see the advantage. W ith your reporter in
the room, I do not see the advantage of spending the time transcrib
ing a record, when you must know right where the point as to which
you are in doubt is in the record, and you have the reporter there to
get it.
Mr. L o c k e . I do not quite understand your question.
Mr. W i l c o x . You are not going to be in doubt about the whole
field of the record— there will be some one point that you are in doubt
about ?
Mr. L o c k e . Y es; one or more.
Mr. W i l c o x . Then, why have an entire record transcribed in
order to clear your mind on those one or two points, when \^ou have
a reporter right there to turn to the notes and give you the thing
you need.
Mr. L o c k e . I do not believe that will quite work. In the first
place, in making a transcript of a record that is developed after
court procedure, you may have something pertaining to that point
on the first page, something on the thirteenth page, and something
on the one hundred and twelfth page, and in order to know of all
the things that pertain to that point in the record you will have to
have a complete record. So if it is going to be transcribed at all,
it must all be transcribed.
Mr. W i l c o x . That means that you read the whole thing?
Mr. L o c k e . N o ; the first thing I do is to find out what questions
we are hearing. I do not hear the whole field of questions. I f the
pleadings which have been filed in the case are not sufficiently specific
as to the actual questions involved, before we start the hearing at
all I get admissions into the record from the contending parties as to
what is involved, and that is what we try and nothing else.
32
FIFTEENTH AN N U AL MEETING OF I.
I. A. B. C.
The C h a i r m a n . Have you found that there is any conflict of juris
diction between your board and the local workmen’s compensation
board of the State ?
Mr. L o c k e . Not a single case in which there has been any conten
tion, and I want to acknowledge with thanks the cooperation that
we have had from the New Jersey commission and the New York
commission.
A s a matter of practice this is about the way it is done: I f the case
goes over to the New Jersey commission, it is first reported to that
commission and if it thinks it is without jurisdiction, it sends us the
papers and we assume jurisdiction and settle the case. The same
applies to New York.
The C h a i r m a n . But it is conceivable that there is a border-line
type of case ?
Mr. L o c k e . Y e s ; that is true, but it is also true that a large number
o f cases involve only a fewr dollars. You can not, in justice, in such
a case throw the man into a lawsuit to determine who is going to
have jurisdiction.
Mr. S t a c k . Which end of the gangplank-—the one resting on the
water i
Mr. L o c k e . I suppose we have had r ome of those cases, I do not
think there has been any decision on the matter. I do not think we
have had a formal decision in a single case involving a question of
jurisdiction, because always by agreement with the New York and
New Jersey commissioners either they would accept it or we would.
M r. S tac k . Y
ou
can n o t ex p ress y o u r p e rso n a l o p in io n ?
M r . L o c k e . M y p e rso n a l o p in io n is th a t i f th e m a n w a s o n th e
g a n g p la n k s t ill o v e r th e w h a r f he w o u ld be o n th e la n d .
Doctor M c B r id e . I am very much interested— of course, I think
we all are— to see that each injured person gets what is provided
without unnecessary expense to either side. I am particularly inter
ested about the counsel fees. New York has very few controverted
cases, as Mr. Locke says. I would like to know what the average
counsel fee in controverted cases is.
Mr. L o c k e . It depends altogether.
Doctor M c B r id e . W hat will it average ?
Mr. L o c k e . The highest fee I have ever awarded was $250, and
that was in only one case— a death case in which the attorney went
out and did a lot of real work to develop the facts. The highest
we have ever awarded in disability cases was $50; generally $25 for
an appearance if the attorney performed any service at all, and if his
service was not worth anything to the client, about $5.
Doctor M c B r id e . I want that in the record. W e have considerable
difficulty.
Mr. S t a c k . I f the one representing the client has found it neces
sary to consult physicians— to have certain examinations made by
physicians, as we frequently have before the State boards— is that
claim allowed by von or your representative— the expense that is
involved in the medical examinations plus the fee ?
Mr. L o c k e , It all depends on the case. W e have followed this
practice in our district: I f a case comes to a formal hearing and the
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
33
appearance that it should not have come to a formal hearing per
sists, because the carrier should have paid it without protest, we tax
the cost to the carrier. If, on the other hand, a claimant insists on
bringing a claim when he has nothing to hear and when he is not
going to get any more by bringing a formal claim than he other
wise would, we tax it to him. I f it is an action that has merit, we
apportion the costs between the parties.
Mr. S t a c k . Y o u m e a n y o u in c lu d e in th a t cost a n y ex p e n se th e
c la im a n ts h a v e b een to i n m e d ic a l e x a m in a tio n s ?
Mr. L o c k e . Yes.
Mr, S t a c k . And get away with it?
Mr. L o c k e . Yes.
Mr. A . K l a w . Isn’t it a fact that the commission has announced
a rule with reference to the gangplank question, that if a man was in
the act of going aboard he would come under the State law and if
he was coming off the boat it would come under the Federal law?
Mr. L o c k e . I can explain that. I think the attorney who repre
sented the United States Employees’ Compensation Commission at
Washington for the purpose of putting the act into operation ren
dered a number of opinions as to what he thought the law was, and
he rendered an opinion to that effect. That opinion, under the law,
is not necessarily binding on any deputy commissioner. It is the
opinion of a common lawyer, of course, so if a case actually comes
up involving that point, any deputy commissioner can follow that
opinion, but if he sees more and better law to the contrary, he is not
bound to follow the opinion.
Mr. K l a w . W as this discussion as to determining the average
weekly wage by agreement with the labor union in a particular
district?
Mr. L o c k e . W e have been, again largely due to the New York
commission, very fortunate in our district in that we have no ques
tions involving the earnings of longshoremen, because a conclusion
was arrived at by a gentlemen’s agreement before the act became
effective. For compensation purposes earnings of longshoremen are
fixed by agreement between the employers and carriers on the one
hand and representatives of the labor unions on the other, and sanc
tioned by the New York State commission, at $30 a week or a com
pensation rate of $20 a week, and that is for all longshore cases.
The truth of the matter is that that is merely a gentlemen’s agree
ment. I f the thing went into court the court might overturn it,
but the employers, the carriers, and the workmen have all been so
considerate in the matter that nobody has taken it into court, and
I doubt whether anybody will.
Mr. K l a w . Then a workman in the N e w York district would
receive a maximum of $20 a week.
Mr. L o c k e . A longshoreman only; not a maximum, but a flat
$2 0 ; we do not have maximum or minimum.
Mr. H a t c h . May I add a word about the rate in the New York
district, just a bit of evidence as to how well it works out? Prior to
the passage of the Federal act for longshoremen we had under the
New York compensation law this gentlemen’s agreement between the
34
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
longshoremen’s union and the employers and carriers as to a rate
when our maximum in New York was $20 by law, and when the New
York Legislature amended our law and raised the maximum to $25
the question came up whether or not that old rate was adequate.
Without action by the New York board, which had no power, as Mr.
Locke said— neither of us had any power to prescribe such a uniform
rate— the unions, employers, and carriers came to an agreement to
make the rate $20 in conformity with the Federal act, under which
the benefits are much the same as in New York, and that was done
without any trouble at all, just a question of what average would
about hit a normal case; and so far as the New York district is con
cerned, that $20 rate has gone into effect. That gentleman’s agree
ment on rate has been in effect under the New York law for quite a
number of years, and it has been taken up by the Federal commisioner and works there just as smoothly. Anyone who is familiar
with the difficulties in trying to find out what the average weekly
wages of a longshoreman are in the port of New York under condi
tions of employment there, where he works in one week for a dozen
different employers, just going where there is a boat to unload, real
izes that, from the point of view of the claimant himself, so long as
you get a fair average you have something that is much better for
him and is giving him equity infinitely more promptly than anything
you could get if you tried to investigate each case.
Mr. W il c o x . Mr. Locke, what is the status of members of a crew
doing longshoremen’s work ?
Mr. L o c k e . Just offhand I would say that a member of the crew
would continue to be a member of the crew even though he is doing
longshoremen’s work, because a man becomes a member of the crew
by virtue of the fact that he signs the ship’s articles and is a member
until he is released by those articles; that would be my personal
opinion.
Mr. A n d r e w s . The Federal act has two or three special provisions
authorizing the commission to make studies and recommendations on
the subject of accident prevention. Perhaps Mr. Locke can tell us
whether the administrators of that wTork have it under way.
Mr. L o c k e . I am sorry I can say but little about that; it is an
administrative duty vested solely in the commission at Washington.
I do know that it has made some preliminary studies of the situation
with the idea, o f working out some safety plans, but as to how far it
has gone in that direction or what plans it has in mind I have no
knowledge.
The C h a i r m a n . O f those at the first convention o f this association
which I attended, that in Seattle 13 years ago, there are only three
of us here to-day— Mr. Wilcox from Wisconsin, my good friend
Marshall from Oregon, and myself. Mr. Wilcox and I have attended
nearly all of the conventions since then,, with the exception of one,
but Brother Marshall became a victim of that law of which the
secretary spoke this morning, by which commissioners are not per
mitted to travel out of the State. W e are mighty glad, however, to
see Mr. Marshall’s face with us again, and I understand now, while
he is not in the Oregon workmen’s compensation work, he is in the
work we are now discussing, being a deputy commissioner having
LONGSHOREMEN’S COMPENSATION ACT— DISCUSSION
35
charge of a district. I am sure Mr. Marshall can at this point make
some contribution which will be valuable.
Mr. M a r s h a l l . I assure you that I have thoroughly enjoyed meet
ing some of these gentlemen with whom I have associated in past
years. I think it would be well to speak briefly on several questions
here as to which our conditions may vary.
One of the gentleman asked some questions about the agreed aver
age wage which I think obtains all along' the Atlantic coast. In the
agreements which have been reached between employers and the
labor unions on the Pacific coast, however, where the territory is
divided into two districts, the six southwestern States and the
Hawaiian Islands being in district 14, with the office in San Fran
cisco, and the five northwestern States and Alaska in district 15, the
situation is entirely different with respect to that question. There,
with but few exceptions, the longshoremen’s union is not affected,
and when the act went into effect there were very few places where
the records of the> individual longshoremen were in existence. There
were generally gang records, so called, where men were in the habit
of working in gangs, but that was not regarded as being a fair basis
for even estimating the earnings.
In the northwestern district, beginning with July 1, many o f the
ports started keeping such records for the first time. In the two large
ports, Seattle and Portland, they have kept such records. In the out
lying and smaller ports they have such records now for the entire
year. That has materially relieved the deputy from attempting to
determine what the rate should be in the individual case. In San
Francisco the efforts to secure an agreement between the existing
organization and the employers has so far met with failure. There,
too, I understand that they do not in any instance have individual
records of the longshoremen and it makes a most difficult problem
for the deputy in that district.
Another question was asked with respect to accident prevention.
I visited the commission yesterday and I understand that that subject
is being given considerable consideration. One safety engineer has
been appointed and is starting his work in the Chicago district, and
another left several days ago to go over to the southern Pacific coast
ports and work there. I understand there will be others; that there
will be additional men hired for the purpose of developing that work.
The C h a irm a n . The next on the program for the afternoon is
Fred W . Armstrong of the Workmen’s Compensation Board of Nova
Scotia, who will address us on “ Longshoremen and Workmen’s Com
pensation in H alifax.”
Mr. A r m s tr o n g . There was some misunderstanding in regard to
the paper I was supposed to have read. It turned out, when I got
word that I was asked to prepare such a paper, that there was really
no problem for us in connection with longshoremen’s work in Nova
Scotia.
A t the meeting in Halifax in 1924 there was a very good paper read
by the chairman of our commission, Mr. Paton, telling exactly why
we did not have the problem of the longshoreman or interstate com
merce in our Canadian jurisdictions; that there was no conflict be
tween the Federal Government at Ottawa and the different Provin
36
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
cial governments, due to the fact that the Privy Council, which is
the highest court of appeals for the British possessions, looked upon
the question when it was put up to it in a somewhat different light
from the way that your Supreme Court interpreted your Constitu
tion. In a good many cases the division of the powers of your State
and Federal Governments, as compared with the Provincial and
Federal Governments in Canada, is somewhat similar, and it is only
in a decision of this kind that the Supreme Court and the Privy
Council have taken an entirely different view. W hat it amounted to
was this: You have a conflict with regard to longshoremen in the
United States, while in Canada and the Provinces the longshoremen
automatically fell under the jurisdiction of the different Provinces.
It was not in connection with compensation that this subject came up,
but in connection with other matters that were decided long before
the compensation act. So, when the compensation acts were passed
by the various Provinces there wTas no question but what longshore
men were to be treated by the different boards exactly the same as
lumbering or coal mining or any other work that came under the
act. For that reason we have no problem at all, and that was the
reason why I wrote to Mr. Stewart that I did not think it was neces
sary to prepare a paper in regard to this, but that I would explain
the matter from the floor.
I f a longshoreman gets hurt, he is treated exactly the same as
any other workman in the Province. It is not necessary to go into
the question why the Supreme Court and the Privy Council decide
these matters differently; that is touched on in the article in the
1924 proceedings.
There is just one matter that came up in the discussion here that
I want to mention, and that is the question of average wage. W e in
Nova Scotia, knowing how hard it is to get at the longshoreman’s
wages, or his average wages, on account of his being shifted with
one gang one day and another gang the next day, having different
employers, entered into an arrangement, a gentlemen’s agreement,
with them that we would give them the maximum amount. That
was based on $100 a month earnings, which gives them the maximum
of $12.69 a week, which is not as large as that in some of your States
here. One of the points I want to ask Mr. Locke is this : You have
jurisdiction over New Jersey and New York— —
Mr. L o c k e . Part o f New Jersey.
Mr. A r m s t r o n g . W ell, what is known as the Port of New York.
Is there any difference in the rate of compensation in New Jersey
and in New York?
Mr. L o c k e . Yes.
Mr. A r m s t r o n g . The point I want to make then is this: I f you do
not decide these points as to which jurisdiction they come under,
these men will very likely go where they get the most compensation.
Mr. L o c k e . I do not want to attempt to answer that alone; I
would rather call on the chairman of the New Jersey commission.
I want to say this: There is no difference in the disability rate
between the Federal and the New York commission, I believe there
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
37
is a difference of $2.50 between the New Jersey and the Federal—
your maximum is $17?
Doctor M c B r id e . $17 now, $20 the first of January.
# Mr. L o c k e . Then the trouble will automatically disappear at that
time. A s a matter of fact, no one has raised the question of the $3
differential in rate.
The C h a i r m a n . I s any commissioner here sufficiently versed with
the subject to be able to discuss intelligently the employers’ point of
view? I think the commissioner shoujd see both points of view
when he comes to deal with these cases. Does anyone wish to have
the floor on this subject?
Mr. H e a b e r l i n , As commissioner of our West Virginia compensa
tion law I would like to get a little information from these gentlemen
with reference to their attitude or ruling on that point of the em
ployer. It seems to me quite a problem lor us, although we haven’t
very much inland work of that kind, and are not at all familiar with
the various problems that come up.. W hat I would like to ask is
what attitude the Government or District Commissioners take with
reference to enforcing the act against the employer, the fines or
penalties for failing to comply with the Federal act, when he can get
that compensation coverance from the State in which he resides or
has his main point of business.
You might get my point better when I say that our statute pro
vides that the West Virginia compensation fund is not a compulsory
fund, but any employer employing labor of any nature in the State
of West Virginia has a right to subscribe to the fund. W e have
heretofore carried a great number of those who are operating boats
on the Ohio River, and that class of work. W e deal with them
exactly as we do with our other subscribers, and they comply fully
with the laws of the State, and can not be sued for counterdamage
either; but I would like to know, if we approve the application of a
subscriber, a company which is chartered in West Virginia and plies
the Ohio River, to cover its liability and its risk so far as the satis
faction of the statute is concerned, will the Federal Government in
turn impose the fine for failing to subscribe also to the Federal fund ?
Mr. L o c k e . T o answer that I want to explain that what I am do
ing is not a part of my business, but a part of the business of the com
mission’s, in Washington; it is charged with all matters pertaining
to coverage of employers. There are two kinds of coverage under
the Federal act— self-insurance and old-line insurance. Old-line
insurance is only by those insurance carriers that have been approved
by the commission in Washington, so your State fund in West
Virginia may, if it desires, make application to the commission in
Washington to become a carrier under the Federal act. The New
York State fund and the Michigan fund and one or two of the other
State funds are under it. I f the commission in Washington approves
the application it may become a carrier. Having done that, it is in
the same position as any other carrier. In order to protect the
.longshoreman or the man who is going to be on navigable water it
is only necessary to put an indorsement on the policy reciting that the
longshoreman is protected as well as other classes of labor.
38
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. 0 .
In the event, of course, that your State fund was covering the lia
bility on land, and it had not been approved as a carrier or it had not
indorsed a policy covering longshoremen on navigable water, and one
of these men was injured on navigable water, the employer without
coverage would be subject to the penalty of the law for being with
out coverage, which is a fine of $1,000 or two years in the penitentiary.
I t does not deny the right to anybody, but it does provide that no
carrier may carryf a risk until that carrier has been approved by the
commission in Washington.
Mr. D u x b u r y . Then your expression as to the old-line companies
is not exactly accurate.
Mr. L o c k e . I do not mean that literally; I mean any insurance.
Mr. D u x b u r y . W hat you mean is, any duly authorized company?
Mr. L o c k e . Yes.
Mr. D u x b u r y . It may be a mutual, a State fund, or any other, if
it is duly authorized.
Mr. K l a w . I think it should be stated, in order to clarify the
situation in regard to Mr. Locke’s remarks as to the possibility of
the West Virginia State fund being approved by the United States
Employees’ Compensation Commission, that only those State funds
where the act itself specifically authorizes the fund to carry liability
of that sort could carry it.
In other words, as I understand the We/st Virginia fund it is
created for the purpose of carrying liability under the West V ir
ginia compensation law, and in the absence of a specific authoriza
tion, such as in the New York act, West Virginia could not apply to
the United States Employees’ Compensation Commission in order to
overcome the difficulty which Mr. Heaberlin raised.
The C h a i r m a n . I s there no provision in the State laws whereby
any industry can come under the State fund by application ?
Mr. K l a w . Only those industries which come under the compensa
tion law; in other words, the fund is created for the purpose of
carrying into effect the particular compensation law of that State
only, and the State fund, as I understand it, is not authorized to
incur potential liabilities in other lines. In other words, it is created
for one specific purpose, the compensation law of that particular
State, and it can not go out and write insurance covering liabilities
under other laws.
The C h a i r m a n . I take it there is no question about that, never
theless could it not accept applications from groups of employers?
Because after all a State fund is simply a fund contributed to by
employers in the State, covering a particular liability. I f those
employers are in the State you are not covering any potential lia
bility outside of the State, but you are covering a liability for an
accident that occurs within the State to men employed by people
within the State.
Mr. K l a w . The difficulty there, as I see it, would be that you
would be covering a liability which would not be covered by "the
compensation law for which the State fund was created, although the
employer might be in the State and the accident might happen in
the State. I f the accident was not covered by the compensation law
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
39
for which the fund was created, any risk of that nature would be
outside the purview of the fund.
The C h a i r m a n . Unless the law i$ elastic enough to cover further
application.
Mr. D u x b u r y . I think that is a vital question. W e had it demon
strated in New York. The New York fund, according to statements
made here, can be accepted and approved as a carrier of this class
of insurance. Now it is possible that the W est Virginia fund can
not b e .. W e would waste a lot of time in discussing it without in
vestigating the fact£. When the West Virginia fund makes appli
cation for that the commission will inquire into the limits of its
power and if the powers are limited the commission will know it.
Mr. M a r s h a l l . There is one angle that occurs to me: The Federal
act says substantially that the third form of coverage can be by State
funds in the States where the laws of those States authorize it.
There are several gentlemen here interested in this subject because
they are contemplating that very thing. In other words, Washington
and Oregon can not write that insurance at the present time because
their laws have not been so amended.
Mr. H o r n e r . That is true in Pennsylvania.
Mr. D u x b u r y . They can not do business outside o f the purpose
provided.
Mr. H a e b e r l i n . The W est Virginia act does not exclude anything
so far as West Virginia is concerned; it also provides that where
one of our subscribers has a man injured in New York, if he is out of
W est Virginia on the business of that concern, we protect our sub
scriber against liability from that accident.
Mr. S t a c k . That is only the West Virginia act.
Mr. H a e b e r l i n . I appreciate that.
The C h a i r m a n . M y own observation was from the point of view
of the law which is restricted only to- the limited extent of not per
mitting farmers and domestic servants to come under the law ; they
are excluded, but any other industry, no matter what it is, can apply
to the board in Ontario and get the protection of the law. Our law
is elastic enough to do that.
Mention has been made, of course, to State funds. There is a
kind of feeling that a State fund means a fund contributed to by the
State, which is entirely erroneous. It is not a State fund; it is a
fund that is contributed to purely and solely by the employers, and if
the employers wish to make contributions and form a group which
will be another insurance group, the same as those that are specifi
cally under the law, there is every opportunity under our law to do
that. I presume some of the State funds are restricted so that they
can not do that.
Mr. S t a c k . Y ou are thinking in terms of the Canadian Provinces.
You cover longshoremen and you cover your other domestic em
ployments under your one act, but here we have a different liability,
one under a Federal act and one under a State act. Those concerns
that are organized under the State law to cover the State liability,
liability under a local compensation act, may not cover liability under
the Federal act, unless, as Mr, Marshall says, authority is given by
40
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
the legislature of that State to write this outside compensation.
You have to think of two different laws.
M r . M a r s h a l l . One word may tend to clarify the question fur
ther. Irrespective of definite authority, if the schedule of compen
sation in the State is different from the Federal compensation, there
again they might not have authority to pay the different compen
sation.
Mr. A n d r e w s . This question first came up and was discussed while
the bill was pending. A t one stage a letter was sent to each one of
the managers of the State funds throughout the country, drawing
attention to the phraseology in the Federal bill, which very simply
provides that the employer may insure his risk under the Federal
act in any of the companies or funds authorized to do this business;
and the Federal commission is authorized also to make a JList of the
carriers which w7ill be acceptable. Now it happened, of course, that
in some of the State fund laws, as in New York State, it was pro
vided specifically that the State fund was authorized to insure under
the terms of this New York act. That was liberally interpreted by
tlie attorney general during the interim before the next legislature
met, when, in order to take care of any possibility of doubt, the
legislature added the words, “ or under the Federal compensation
act.” In California it was deemed necessary to do th at; in Michigan
it was not, because the wording of the Michigan State fund act was
broad enough to include that; in Ohio they have to go to the legis
lature, and in several other States they will have to, but the insur
ance must be under the benefit provisions of the Federal act, and not
under those of any State.
The C h a i r m a n . I wonder i f we could not devote a few minutes
t o a little round-table discussion on some of the problems that may
present themselves to us? I will suggest one, and no doubt many
o f you have others.
1 am going to take the liberty of asking Mr. Duxbury to say what
he does in his State on the subject of lightning accidents. I know
what he does, because we had a little discussion on this during the
luncheon hour to-day, but it is one of the problems which, no doubt,
all of the jurisdictions have to contend with, as to whether a man
injured or killed by lightning while he is working is injured or
killed in the course of his employment, and whether or not such an
accident arises out of the employment, Mr. Duxbury, will you take
five minutes on the subject ?
Mr. D u x b u r y . The subject is one that we discussed at luncheon
to-day, and I do not know that it is a matter of very great per
plexity except the contribution which Mr. Hatch brought to that
discussion. I think it is settled, so far as the general principle is
concerned, that accidents or death caused by lightning are compen
sable if it can be established as a matter of fact that the circum
stances surrounding the employment made the employee more sus
ceptible to the evil influence of lightning than the community in gen
eral. That may be a rather rough statement of i t ; it applies to some
other conditions rather than just particularly to lightning. The
perplexity always is in determining that fact, and my experience in
compensation administration for several years is that about 99 per
cent of the perplexities we have is in determining the fact. The
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
41
law is easy enough to apply, but it is the fact which is involved in
a lot of perplexities. To say whether or not, under a particular set
of circumstances, the individual employee is more likely to have
suffered from the effects of lightning than the community generally,
or what he would have done had it not been for the circumstances
of the employment, is something that really needs a Solomon to
determine, and Solomon, I think, would have had more sense than
to try it.
But we have lots of things to determine that are just as per
plexing as that, and it is largely a matter of inference from all the
facts that surround a particular case whether the fact is one way
or the other. One person with reasonable judgment may draw one
inference reasonably, and that inference will be sustained by the
Supreme Court every time, while some other person of equal capac
ity will draw another inference and that will also be sustained every
time. I think each individual case is a matter of perplexity.
When I worked 011 the farm (I was raised there) I remember being
in the field with a pitchfork in my hand when a sudden lightning
storm came up and crackled around a little while. I thought that
that pitchfork imperiled me, and stuck it into the ground and left it
there. I do not know whether it did .or not, but that is what I
thought, and possibly if we had a case like that, where the man had
an instrument of that kind in his hand and was affected by lightning,
I would be influenced to draw the inference that his employment
subjected him to more peril on account of the circumstances of his
labor. Scientifically it might be absurd. I suppose the question is
one for men who can qualify as experts on the question o f how
lightning might be attracted or if a certain person might be more
imperiled than people generally. I do not think you can get a
hard-and-fast rule in relation to it; you will have to consult your
own conscience, as I or .some other person with experience of that
kind would, and draw an inference. I am inclined to think that
because of the humanity which actuates you your inference will be
as favorable to the injured employee as it is possible to warrant.
There is a specific course, where there is nothing you can find sur
rounding the case that will balance your conscience by saying that
that wa(s nothing but a pure act of God, but when you get those
cases I do not know anything for you to do but pray.
I suppose most of these lightning cases arise this w ay: The first
thing the average fellow does when a lightning storm comes is to
run to shelter either to the nearest tree or the nearest barn or a
shed or something, perhaps more to escape the rain than the light
ning, the tendency to run to shelter seems to be natural to all of us,
and most lightning cases that we have had are due to that circum
stance; they ran for shelter and they were killed or injured while
seeking shelter. The problem we have had to deal with its the
question whether or not death or injury under such circumstances is
in the course of employment.
One word further: I f you ran up against a telegraph pole, and
the pole was struck, I would be inclined to think that the environment
there had something to d,o with making it more perilous than any
where else.
The C h a i r m a n , There is no shelter under a telegraph pole.
42
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
Mr. D u x b u r y . I would say the same thing with a tree. I remem
ber a case when I was a boy, of a man going out in the pasture to
drive in his cattle; he was struck by lightning in the open field.
I f he had stayed in his house he would probably have been all right.
The law seems to be well established, but the difficulty with me is
in determining the fact— whether you can determine as a matter
of fact that the circumstance^ and environments of his employment
created greater hazard than would otherwise have existed.
Mr, W e n z e l . I believe that the conclusions reached by Mr. D ux
bury are entirely correct with respect to a certain kind of law ; that
is, a law which provides for injuries arising out of and in the course
of employment. However, where you have the broader provision of
merely “ in the course of employment,” I doubt whether that per
plexity will exist or arise. I know that although I am the represen
tative of the employers in our bureau I would hold in any case
in which the person met with such an accident in the course of his
employment, in the course of his work, that it was in the course of
employment. I recognize, however, that where the distinction is
made in the law that the injury must arise “ out of or in the course
of employment,” then you have the difficulty .suggested by Mr.
Duxbury.
Mr. W i l c o x . I think the mind of an administrator, in thinking of
this subject, must immediately turn to a group of cases. You more
or less unconsciously bring together not only lightning cases, but
the windstorm, the cyclone, the tornado— which we speak of as an act
of God— and the heat stroke and frostbite cases. You dispose of
them all pretty much along the same line, because, after all, it is
a cardinal principle of compensation that the industry must cause
the injury. You can not hold industry liable for benefits to injured
workmen if, after all, that industry did not have something material
to do with the fact that the man is disabled; and so when you
come to deal with lightning cases you have to find out whether
or not anything about this man’s employment or his place of
employment added to the hazard of the lightning stroke. Like
wise with heat stroke and tornado and freezing cases, they are all
problems for the administrator, but in each of those cases we have
to find out whether the employment— the thing he was doing or
the place where he was doing it— added to his hazard. I f it did,
then there is liability; if not, then there i,s not.
Mr. Duxbury and I have argued on more than one occasion as to
whether or not there was any great perplexity in this type of case
and in other types of cases. I really do not think there is, because I
think it is quite easy for minds to become clear— reasonably clear—
as to whether or not the place of employment added to this particular
hazard.
W e had a case in Wisconsin where a man was working on a dam
in the Fox River and a storm came up and he was picked off; at the
time he was holding a flashboard that they were applying to the dam ;
it was wTet and he touched it with his other hand while it was being
fastened, and the lightning followed through his body into the stream.
W e took a volume of testimony which at that time— and I am still
impressed with it— I believed to be interesting. W e called men who
were professors at the University of Wisconsin and who had studied
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
43
this matter of electric currents and contacts, and the things that
attract the bolt, and they told us that scientists recognized two differ
ent types of lightning designated as type A and type B, and that
one of these types struck indiscriminately. W e usually think that
lightning strikes indiscriminately in any event, but these professors
said that physically they did work according to some formula; that
in one of these types the bolt would strike at random, and in the
other type the current would come out of the clouds and into the
atmosphere and hit points that attract, like high trees. W e under
take to meet that principle when we put lightning rods on our
houses and barns. W e do that for the purpose of reaching this one
type of electrical current, the type which hits, rather uniformly, the
things that attract current and is carried off into the ground. One
of these professors in his testimony said that in' those cases of the
type which hits all high points like trees and poles, if a man was
exposed under such a tree or pole then it would be a hazard o f which
the place where he was at that time formed an important element.
On the other hand, if it was a type which hit indiscriminately there
was nothing about it that was of importance.
Mr. M a r s h a l l . Does that give you any aid in determining which
it was ?
Mr. W i l c o x . This man was out on a dam on the level with the
water of Fox River, a wide expanse, and we concluded from the
testimony and from all the records in that case that there was nothing
there which might really be said to have been an attraction to the
current; that it struck indiscriminately.
I do not quite see the point that Mr. Wenzel makes. I think that
this language “ out of the course of employment,” or “ in the course
of employment,” or “ in employment,” and so forth, must after all
finally be loaded with this proposition that either the operation of the
industry itself, or the place where the man was at the time, exposed
him unusually or was the hazard upon which his liability was based.
I do not think that means that types of injury which like heart
disease might strike a fellow without any effort being expended
at the time, although he is at work, are compensatory. The fact that
he is at work at the particular time when the disease strikes him is
not the crucial thing; the question is whether or not the work caused
the heart failure.
Mr. D u x b u r y . For fear that Mr. Wilcox or I might be misunder
stood, because sometimes we are— I know that sometimes I am— he
suggested to my mind that I have perplexities where he does not
think I ought to have perplexities. I believe that is true. I f I had
Mr. W ilcox’s discriminating mind, I would have fewer perplexities
than I have; but I do have them. My experiences have been with
perplexities in determining what are the facts, and my perplexity
in this class of cases is to determine what the fact is with reference
to whether or not the injury is connected in any way with the in
dustry or the work which the man was doing, and that is a mighty
hard thing for me to determine with my limitations.
Mr. H o r n e r . I am inclined to agree with Mr. Wenzel’s viewpoint
that it depends largely on the provisions of the law. In Pennsyl31573°— 29-------4
44
FIFTEENTH A N N U A L MEETING OF I. A. L A. B. C.
vania the act reads that it shall cover all accidents occurring during
the course o f employment; we compensate cases of lightning, heat
stroke, ivy poisoning, and frostbite, provided it can be proven that
those things happened during the course of employment. Therefore
it seems to me that it is largely a matter of what your law provides.
The C h a i r m a n . That other expression would hamper a good many
jurisdictions. It is easy to determine that an accident happens in
the course of employment, but a more difficult problem to determine
that it arose out of i t ; that is what this presents.
Mr. H o r n e r . Our act reads, “ shall cover all accidents occuring
during the course of employment.”
Mr. W i l c o x . Would you cover heart failure?
Mr. H o r n e r . N o , sir.
Mr. W i l c o x . W h y , if a man is at work?
Mr. H o r n e r . There was a case in Pennsylvania where a man was
compensated for heart failure. The man was unloading flour; he
was hired by the man who had the contract to unload that car, but
the principal employer failed to post notice that lie would not be
responsible for accidents occurring on his premises. The case was
carried before a referee; medical testimony was offered that the lift
ing of bag after bag, even though this man was probably afflicted
in that way, finally caused his death and compensation was awarded,
and the board sustained it,
Mr. W i l c o x . Y ou are introducing a new element— you are intro
ducing the carrying of the bags as to why his heart gave way. I am
asking whether any State compensates for heart failure without
undue evil causing the giving way of the heart.
Mr. H o r n e r . W e have not treated heart failure in that way, so far
as Pennsylvania is concerned.
Mr. W il c o x . I think Pennsylvania does exactly as the rest of us
do; it waits to see whether there is some hazard in the industry that
causes the injury.
The C h a i r m a n . Take the man who falls from a scaffold in an
epileptic fit and is killed.
Mr. W i l c o x . W e compensate him; he was not injured because he
had an epileptic seizure, he was injured because he fell from the
scaffold.
The C h a i r m a n . Suppose he was on the floor ?
Mr. W i l c o x . Then there was nothing about the employment that
created the hazard from which he suffered.
Mr. S t a c k . I would like to ask Mr. Wilcox if in his illustration
he does not forget that the accident has to happen in the course of
the employment and out of the employment— not the injury but the
accident.
Mr. W i l c o x . When you speak of a man falling from a scaffold, he
fell from the scaffold because of the seizure.
Mr. S t a c k . But the seizure was the cause, not the falling.
Mr. W i l c o x . But his injury was not because of the seizure, because
if he had been seized anywhere except upon a scaffold he would be
a whole man, or just as good, after the seizure was over, but he falls
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
45
from a height and is injured; the putting of an epileptic in that
place was wrong to begin with.
Mr. S t a c k . Don’t }^ou overlook the fact that the accident did not
arise out of his employment but was due to his misfortune in having
epileptic fits ?
Mr. W i l c o x . When we are talking on compensation we are talk
ing on compensating for the disability which a man has. I recognize
the fact that some States are holding away, or did in an earlier day
hold aw^y, from the idea that a man who had an epileptic seizure
and fell from a height or fell into machinery— moving parts— was a
noncompensable case, but I think all the States are back to the view
point now that when you put an epileptic at work on a scaffold or
around dangerous machinery you subject him in his condition to a
hazard for which the industry must respond when he has an epileptic
seizure and that there is liability; and that is independent of whether
or not he knows it. W e do not have to know what the previous
disability of men may be in order to decide whether they get com
pensation.
The C h a i r m a n . You would not compensate him if he were stand
ing on the floor and simply toppled over, although lie hit himself
pretty hard on the floor ?
Mr. W il c o x . He would have struck hard on any floor probably.
The C h a i r m a n . Would you draw a distinction between striking
a cement floor and a wooden floor— that one is compensable and one
is not ?
W hat do you do, Mr. Marshall, with blister cases? A man while
working gets a blister on his hand, and at some time or other it
breaks and becomes infected and very serious disability results?
Mr. M a r s h a l l . I do not recall having such cases so far under the
Federal act.
Mr. W i l c o x . It happened under your Oregon act.
The C h a i r m a n . Have any of the delegates had that problem ?
Mr. W i l c o x . I can not conceive of compensation administrators
not having cases of blistered hands, and blisters breaking and becom
ing infected, and things of that kind. I do not see the reason why
they are not compensable.
The C h a i r m a n . Wherein is the accident?
Mr. W i l c o x . I do not think you have to have an occupational
disease amendment in order to get compensation for the breaking
of a blister.
Mr. D u x b u r y . It depends upon the construction of what con
stitutes an accident.
Mr. H o r n e r . In Pennsylvania, if you could fix definitely the time
and place when that blister came on the hand it would be a com
pensable case, but if it came on from the constant using of an instru
ment it would probably be a case of occupational disease.
The C h a i r m a n . Does the action depend upon the getting of the
blister, the breaking of the blister, or the getting of the infection
into the wound?
Mr, S c a n l a n . The infection of the wound is the answer.
46
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
Mr. W i l c o x . There is the question of the man who claims he got
the blister the first day of the month and who comes to you the
last day of the month and complains of an infection; of course
we have many cases in which men do not report their injuries, and
they are the worst problem that the compensation administrators
have to deal with. The man who claims to have been injured and
lets no one know about it until weeks and perhaps months have
gone by is the fellow who perplexes me, Senator Duxbury, and not
so much these other questions. You have to settle them as you
would any other litigated question. It is a question of integrity,
credibility, and medical proofs, and everything that goes along
with it.
Mr. W e n z e l . It occurs to me that the issue in a case of that kind
would be whether the man got his blister while he was handling a
shovel, or a pick, or his fork.
Mr. H all. I had a case like that and I will tell you how I solved
it to my own satisfaction, if you please, though we have other cases
of blisters that we can not solve so readily. This was a case of an
ex-service man; he was out with others one evening helping to dig
a cellar for a little hall they were going to build, and in doing that
work with the pick and shovel he raised a large blister on the palm
of his hand. He went to work the next morning with that large
blister on his hand. He was second hand in a woolen mill and his
duty was to look after the machinery. Some machinery went wrong
and it was his duty to fix it, and in the using of a screw driver
and a wTrench he twisted that blister off and had a subsequent infec
tion. I said that the raising of that blister in the work the night
before was not the accident that placed him in a condition of weak
ness as to that particular part of the epidermis on his hand, which
was weaker when he went to work the next morning than it had
been the day before, but that when he broke that blister, the same
as a pin prick, that was the accident and it was in the course of his
labor.
The C h a i r m a n . Y ou held that the breaking of the blister was the
accident and not the getting of the infection ?
Mr. D u x b u k y . W h y make that distinction? You have been doing
too much thinking about whether that was the accident; the breaking
of the blister or the infection entering the place is the accident.
The C h a i r m a n . There is an important case— no doubt the mem
bers of the convention will remember it— in which the Priv}^ Council
held that the accident was the impinging of the germ on the hand—
that was the infection— and in that particular case, where a man
was working in a dirty situation, fertilizing or something of that
sort, it was easy enough to draw the inference that that germ
came from that particular spot in which the man was working. But
it might be difficult to draw such an inference in a great many cases.
Mr. D u x b u r y . In this case Mr. Hall cited, had the blister been
broken the night before and the infection come on some time after
he got back to his regular employment, it would not have been com
pensable; though it would have been infected while he was employed.
Mr. H a l l . That is something you can not prove, because we carry
infection around with us all the time; the germs wait for a chance
to work through the epidermis,
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
47
Mr. D u x b u r y . The accident is when the germ enters; it would
have been a realm where nobody knows when it did happen— in
capable of human proof; that’s all.
The C h a i r m a n . I s there anyone else?
Doctor M c B r id e . I was very much interested in the discussion
concerning persons hit by lightning, W e have not had a case of
that kind in New Jersey since the beginning of the work. I f I were
deciding a case of that kind— our act specifically states “ arising in
the course of employment ”— I would decide that the case was com
pensable. There is no question in my mind that if the person
was in his usual vocation I would say that the case wras compensable.
I do not know how my conferees feel about it.
The C hx\i r m a n . I suppose that is another of the problems that has
to be solved by answering the question: W as there special exposure?
W e had a case where a man was employed by a brewery, receiving
empty bottles back from the laundry and turning them into the
laundry. A wasp came and stung him while he was engaged in
the operation. The question whether the smell of beer on the empty
bottles was such an attraction to the wasp that it constituted special
exposure in that particular instance wTas considered.
D o c t o r M c B r id e . The s t in g o f a w a sp is an a ccid en t.
The C h a i r m a n . But did it arise out of the employment? There
is no question that it arose in the course of employment.
Mr. S c a n l a n . I think we are talking as though wTe were a court
of last resort. I think each commission is governed by the deci
sions of the supreme court of the State. W e have decisions, and
that is true of many of these States. Our court has not been quite as
liberal as some of the other supreme courts, and therefore its deci
sion is much different.
Mr. W i l c o x . I think you are lost, Doctor McBride, on that wasp.
I think that compensation administrators, by overliberality in some
of these fields, do not help legislators and the public to make our acts
as liberal as they ought to be. I am convinced that no employer
ought to be made liable for any injury to an employee where the
industry or the place of employment has not contributed to it, and
that when we undertake, in our desire to construe these words in all
their outside meanings and to be liberal, to tack on those other
classifications of cases in which the employer has had no responsibil
ity whatever, we just gum up the machine and do the thing that
sets the public mind against the whole field of legitimate compensa
tion legislation.
Mr. S c a n l a n . I might suggest that why we get what we call bad
decisions from the courts of last resort is that often— as Mr. W il
cox has said— a person wants to be liberal and give somebody some
thing, and finally the case reaches the court of last resort and it up
sets a lot of things. I think a person ought to be careful and stay
within the act and not try to liberalize it too much.
Doctor M c B r id e . It is not a desire to be liberal but to be just. I
still believe that if the man had not been in that particular place, he
would not have died; it was because he was in that particular spot
that the lightning struck him ; surely it was his employment.
48
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
Mr. W i l c o x . Y ou can say that same thing if a man wa$ riding
along the street and a wasp stung him.
Doctor M c B r id e . I do not think I would. It is dissimilar ; he
might ward off a wasp, but there is no chance of his warding off a
stroke of lightning.
Mr. W i l c o x . A ll the more reason why the employer ought to be
relieved from its effects because the employer could not ward it off,
either.
Mr. S t e w a r t . I was just thinking, lightning strikes so seldom, it
seems to me------Mr. D u x b u r y . And never twice in the same place.
M r. S t e w a r t . Y o u wouldn’t be there if it did. It seems to me
that this question of the longshoreman act excluding boats of less
than 18 tons is of rather more importance than bee stings and light
ning strokes. In Virginia there are 18,000 men in one State who are
deprived of any possibility of compensation. It would take lightning
a long time to kill 18,000 men.
A M e m b e r . It occurs to me that the question of lightning and be
ing struck by lightning interests every man here and every board in
every commission, while the question of those 18,000 mien in V ir
ginia interests only that one particular board, and it can remedy that.
The C h a i r m a n . Y ou mean the 18,000 men have n o benefit of the
local State compensation law ?
Mr. S t e w a r t . That is the question. They are excluded from the
Federal law.
A M e m b e r . May they not remedy that themselves ?
Mr. S t e w a r t . I would like to call on Mr. Deans for an explana
tion.
Mr. D e a n s . I haven’t any speech to make. Last evening Mr. Stew
art and myself were in conversation as to the question of the juris
diction of the different States on small boats under 18 tons— Mr.
Locke, from the New York district, has told you that boats under 18
tons are excluded.
Mr. L o c k e . Not all.
Mr. D e a n s . Y ou exclude the fishing boats when you take the crews.
I might say the small boats— boats of, say, 5 tons— do not have to
take out any papers. W hat are the State jurisdictions going to do in
those cases? The longshoremen’s act does not cover them, and so
that question comes up. I f I understand it correctly, New York has
taken jurisdiction; the same thing is true of California, and I believe
Georgia has. W e have a discussion in my own State on the ques
tion. W e are now in the court of appeals on the question of whether
it is Federal jurisdiction or whether we have jurisdiction,
M y interpretation of the law was that where it was purely local and
of no particular prejudice to the Federal maritime laws the State
should take jurisdiction.
New York says that maritime jurisdiction is established by the
long use of the Garcia case. (257 U . S. 233) and by the nature o f the
work (261 U . S . 479).
In California you have quite a number of cases of fishermen going
up into Alaska who are hurt. Your longshoremen’s act does not
LONGSHOREMEN’S COMPENSATION ACT---- DISCUSSION
49
take jurisdiction. I understand that California has taken jurisdic
tion recently. Justice McReynolds said in the Alaska Packers5 case
(276 U. S. 467) that the work was local, in character, and therefore
it came under the local jurisdiction of California. In 256 Pac. 857,
you will find a California case o f a pleasure vessel, where a man met
death by drowning in navigable water.
In the Georgia case the fishermen were in navigable water. I
believe the State of New York has had a case on the question of a
barge in navigable water. Possibly Mr. Hatch might tell us some
thing of that.
You know that the United States Supreme Court in the Rohde
case (257 U . S. 466) held that compensation was applicable where
the employee injured was not under a maritime contract.
I f we do not have some uniform ruling or law upon the proposi
tion we will have to get some local enactment to strengthen the laws,
because, as Mr. Stewart pointed out this morning, somewhere be
tween 10,000 and 15,000 fishermen, oystermen, or crabbers in the
small boats have to go into navigable waters, and they get hurt.
Can the State take jurisdiction or do we have to go back to the
Federal law and get an amendment to the longshoremen’s act? I f
I understand the history of the enactment of the longshoremen’s act
it was the people interested in the fishing industry who had men on
vessels under 18 tons excluded.
Mr. L o c k e . I can only say, for the benefit of the gentleman who
just spoke, that in the New York district we have taken the view
that the exclusion of vessels under 18 tons net does not apply to all
vessels under 18 tons net, because the language of the statute is that
there shall be excluded vessels under 18 tons net where the master gets
the men to load or unload the vessel. I f the vessel be under 18 tons
net, and if the crew has not been engaged by the master for loading
or unloading, we hold jurisdiction to be in this district. There are,
of course, vessels of less than 18 tons net where the master does en
gage the men; these are, primarily, fishing' vessels. There are also
occasional cases here of vessels under 18 tons net, in the nature of
barges, where a master may engage the men, but those are not very
numerous. Usually if there is a man working on that vessel who is
loading or unloading he is engaged not by the master but by the
owner or the firm who has a contract to transport the freight, so
that the law does not exempt very many men in this district.
I am not qualified to say what remedy can be applied; it seems to
me the Federal law is clear now as to the exemption that is made,
and if the exemption is too large and many men are cut out of the
compensation benefits it must be a case, then, either of amending the
Federal law in Congress so as to narrow that exemption or of the
several States faced with these problems extending their own com
pensation acts to cover them. I do not know which is the proper
thing to do.
Mr. D u x b u r y . From the course of this discussion there seems to
be an impression that if an accident occurs on navigable waters it is
then outside of the local law. I think there is no basis for that
whatever. It is not a question of whether or not the accident occurs
on navigable water, but whether or not the employment is maritime
in its nature,
50
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
As you all know, we have instances of construction of bridges
across the Mississippi River, which is navigable water, and of men
working on the construction of those bridges, being employed on
scows and other crafts in such construction. Their employment is
not maritime in its nature, and does not come under the Federal laws
at all, but under the State laws, as is the case with many of these
other instances of working on boats for particular purposes that are
not maritime in their nature. W hat that means is subject to many
interpretations, but if the employment be maritime in its nature, the
decision of the Supreme Court of the United States puts it outside
of the jurisdiction of any State to determine what the rights of
these men are. It may assume jurisdiction— it may usurp jurisdic
tion because it has no jurisdiction in fact— and determine the rights
of the parties and abide by it, but it has no jurisdiction if the employ
ment is maritime in its nature.
Mr. S t e w a r t . W hat does that mean?
Mr. D u x b u r y . The Constitution of the United States took such
employment out of the jurisdiction of the States and put it under
the jurisdiction of the Federal Government, and the only thing to
determine is whether the employment is maritime in its nature. I
am convinced that the harbor act includes employment that is mari
time in its nature; that ought to be covered by compensation as well
as anything else that is covered, but I think that limitation ought to
be taken out of the act. I feel that the law is defective in so far as
it does not afford complete coverage for men engaged in maritime
employment, without the limitation on tonnage or anything of the
kind. When that is taken out, you will still have those perplexities
with reference to whether the employment is maritime in its nature.
I f it is, it is a Federal question; if it is not, it is a local question.
Mr. S t a c k . For instance, in Delaware Bay we have large fishing
industries. W hat, in your opinion, is the position of a man not
engaged by the master of a small boat, but by an association of oyster
merchants, or fishers, to go out into the bay to get oysters, not cross
ing the line, but working in Delaware on navigable waters? Such
men are employed by people who are in the oyster business for the
purpose of making money, and are sent, not by masters of the boats,
but by an association, to fish for oysters.
Mr. D u x b u r y . It is a perplexing question, but my ofFhand c o n
clusion is that that is not a maritime employment in its nature, and
that the employment is one that is within the jurisdiction of the
State. This law would not take jurisdiction of it because the law
can go only to the limits which the Constitution of the United
States has specified. That case falls in the category of nonmaritime
employment; it is subject to your local laws and could never be made
subject to the United States law.
Mr. S t a c k . Mr. Deans has the same case.
Mr. D e a n s . Y ou and I agree on that.
Mr. S t a c k . Marjdand has the same.
Mr. D e a n s . Our question is undecided; two members of the com
mission have decided that it is a question for maritime jurisdiction
and one of us has taken the contrary view, and we are now in our
LONGSHOREMENS COMPENSATION ACT---- DISCUSSION
51
supreme court on the question. I was trying to ascertain from you
what the other States were doing.
Mr. D u x b u r y . It is not impossible for one court to decide one way
and the United States court another way.
Mr. S t a c k . The Bell Telephone Co. hired a pile driver1 to pick
up a cable that rested on the bed of a canal, and to hold the cable
out of the way of the dredge boat while the work was being done.
One day when it was stormy, the drawbridge being out of commis
sion, three men, including the pile driver, started ashore in a small
boat, were upset, and the pile driver was drowned. The insurance
carrier refused compensation on the ground that the man was en
gaged in maritime labor. A n appeal was taken, but about that time
the insurance company decided that the board in Delaware was right
and the appeal was withdrawn and it paid compensation.
Mr. D u x b u r y . There are many cases where men engaged in erect
ing docks have been drowned by dropping into navigable water.
There was no question about it, their employment was not maritime
in its nature and because of that they were under the jurisdiction
of the State authorities and the State laws, but I anticipate that
there will be some apparent conflict of jurisdiction between the
Federal commission and the State commissions on this matter. O f
course, the Federal law is a pretty liberal law compared with other
lawSj and men will want to get under the Federal law when they do
not belong there because they get more compensation. That is
human nature, but with the Federal law as it is, there will be cases
where it will be perplexing to determine whether or not the em
ployment is maritime in its nature.
Mr. S t e w a r t . H o w would it do to refer this question to the com
mittee on resolutions and ask that committee to frame an appropriate
resolution on the subject?
Mr. D u x b u r y . I have been honored with the position of chairman
of the resolutions committee. I would much prefer that those who
have studied the subject prepare a resolution to be referred to the
committee, because the technical preparation of the resolution is a
thing I am not prepared for. I have no doubt that that resolution
ought to be so framed that it will not indicate that we are trying to
express an opinion about something on which we do not know the
technical language.
Mr. D e a n s . Don’t you think it would be wise to wait until the
two courts have decided the question— the courts of Maryland and of
Virginia?
Mr. D u x b u r y . I do not think that will affect the matter. I think
all that will amount to is to determine whether or not that is under
Federal jurisdiction, and it might not determine this question. ^
M y view of it is that that limitation ought not to be in there; the
limitation that the Constitution prescribes is perplexing enough with
out putting that one in. The Federal law should be a full coverage
where the Federal jurisdiction extends, and in that case the State
law covers the rest of i t ; then you have nothing left out.
The C h a i r m a n . Perhaps, Mr. Stewart, the gentleman from V ir
ginia will prepare some resolutions in collaboration with the commit
52
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
tee on resolutions, and before the convention is over something can be
done which will solve the problem.
Mr. D u x b u r y . I think Mr. Locke could b e of some assistance on
that, as he is familiar with the law.
Mr. A n d r e w s . W hile we are discussing Federal problems in com
pensation legislation, I would like to ask whether it is not possible
for the various compensation commissions to get information con
cerning the value to a railway employee injured in interstate com
merce of his suit for damages under the present Federal liability act
as compared with what he might have had under the existing State
law.
This question, you will recall, was up before this body three years
ago, and you had a special committee which it was hoped would get
such information. A t that time it did not seem, quite SO' vital because
of the other overshadowing issue, but now it does appear that within
the course of a few months it will be very important information to
have. It is important also for the reason that in the five noncom
pensation States the representatives of railway organizations often
apparently misunderstand the merits of compensation and, mis
takenly perhaps, oppose the adoption of the compensation principle.
I f you are commissioners in the States where compensation exists
and could gather a small body of information, it would be very help
ful in those other States, and at the same time it would be very help
ful indeed in the near future, for some proposals are to be laid be
fore Congress with reference to accidents to railway employees
injured in interstate commerce. So I would like to ask if the com
missioners can not think of ways of getting such information, State
by State, and of bringing it together in the course of the next few
months, so that it may be enlightening for those two particular pur
poses.
The C h a i r m a n . Y ou have heard the request of Doctor Andrews.
I think the request is a reasonable one, and it will be referred to the
executive committee to formulate some plan to collect that informa
tion.
[Meeting adjourned.]
WEDNESDAY, SEPTEMBER 12— MORNING SESSION
Chairman, F. H. Todd, M. D., of the General Hospital, Paterson, N. J.
M ED ICAL SESSION
The C h a i r m a n . The first paper, “ Traumatic labyrinthitis— the
period of and the measurement of disability,” will be presented by
Dr. Jack Blumberg.
“ Traumatic Labyrinthitis ”— The Period of and the
Measurement of Disability
B y J a c k B l u m b e r g , M. D., General Hospital, Elizabeth, N. J.
To gauge the disability resulting from inner ear trauma is some
times extremely difficult. I f one considers that functionally the
labyrinth is a prolongation of the brain proper, the difficulties are
apparent in view of the fact that trauma to the brain itself is so
difficult of measurement in terms of disability. The symptoms are
to a great extent subjective; but sufficient objective signs exist to
enable the examiner to form a definite opinion in practically every
case. In one instance an interval must elapse to observe the progres
sion or recession of symptoms before diagnosis can be made and this
instance will be noted later.
Briefly, the labyrinth consists of the cochlea and the auditory
nerve comprising the hearing portion, and the vestibule and semi
circular canals with the vestibular nerve comprising the static por
tion, or that part governing equilibrium, all lying in the petrous
portion of the temporal bone. The auditory nerve goes to the central
centers of hearing; symptoms from the hearing portion are almost
purely subjective and consist as one would suppose in disturbances
of hearing, namely tinnitus and varying degrees of deafness.
On the other hand the central connections of the vestibular nerve
are many and observation of effects from the central ramifications
permits an estimation of labyrinthine disturbance. Through con
nections by way of Deiters’ nucleus irritation of the labyrinth affects
the oculomotor, trochlear, and abducens nuclei, causing eye move
ments, and this effect goes to both eyes from each labyrinth. A
branch to the cerebellum is the basis for the symptom of past point
ing and a third branch to the triangular nucleus in the medulla gives
rise to the vegetative symptoms of labyrinth irritation— dizziness
and nausea.
Given then a patient who has sustained a head injury presenting
spontaneously dizziness, nystagmus, disturbance in equilibrium, and
past pointing, that case must be considered as having labyrinthitis
until proven otherwise— a labyrinthitis taken to mean a disturbance
rather than a true inflammation.
53
54
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
The earliest stage will be a simple hypersemia, with slight tinnitus
and dizziness evidenced. These cases generally clear up within from
one to two weeks with no permanent disability.
A severe case of labyrinthine hypersemja comes under Brunner’s
classification of “ concussion of the brain with ear symptoms.”
Here tinnitus ,is generally absent. I f present it is very slight.
Dizziness is, as a rule, present although it is slight and it is of the
labyrinthian type— that is, the dizziness is systematic and visible
objects seem to turn only in one direction. I f the turning dizzi
ness is not of this type, it is not caused by the labyrinth. In order
that reliance may be placed on this symptom, it must be volun
teered by the patient and not suggested by the examiner. Under
labyrinthian dizziness come also those forms where the complaint is
that something is turning in the head, or while sitting the chair
sways, or where the sense of being pushed backward, forward, or
sidewise exists. The dizziness described is not constant ; it occurs
in attacks and may be brought on by alcohol or excitement. Like
the dizziness, nystagmus is present, is slight, and occurs in attacks.
These patients generally exhibit a slightly positive Rhomberg, or
modified Rhomberg. Tilting the head sharply backward will often
bring on the symptoms and syringing the ear with 10 cubic centi
meters of tap water will elicit a pronounced nystagmus. Note that
here the picture is that of an irritated labyrinth. Whereas mild
liypersemia tends to spontaneous resolution in two weeks and shows
normal reactions to the caloric and turning tests, this .latter type
of case shows exaggerated responses on slight provocation. It is
especially important to note that more than one examination may
be necessary to determine the condition, because, as said, the symp
tomatology is periodic. Since there is no treatment known for this
condition, and since there is an accompanying head injury, and since
the dizziness as judged in cases having no legal aspect whatsoever
tends to be permanent, these people should be given a minimum
rating of 30 per cent permanent total disability.
The next step in labyrinthian .injury is concussion of the inner
ear. Ricker states that in concussion of the brain the so-called
prsestat.ic blood circulation exists; the blood vessels are dilated, there
is a slowing of the blood flow, and lymph and lymphocytes are ex
uded in the perivascular and perilymphatic spaces. According to
Brunner, this same pathology exists in concussion of the inner ear,
and he has named it vasomotor internal otitis. Concussion of the
inner ear gives a picture of a weakened labyrinth in distinction to
the picture of an irritated labyrinth last described. A s a rule
tinnitus is absent but a distinct diminution in hearing exists, gen
erally unilateral; if bilateral the hearing defect is more marked
on one side. The hearing defect is of the inner ear type, or middle
and inner ear type combined. Spontaneous dizziness, nystagmus,
disturbances in equilibrium and past pointing are slight, but reac
tion of the caloric and rotation tests is never increased, in many
cases is weakened, and in most cases is absent.
Although the actual damage is much greater than in the previous
classes due to the additional defect in hearing, since treatment is
o f some avail the rating in this class of inner-ear injury is 35 to 45
per cent permanent total disability.
MEDICAL SESSION---- DOCTOR, COSGROVE
55
The last degree of inner ear trauma is generally caused by frac
ture of the petrous portion of the temporal bone, although death of
the labyrinth as evidenced by deafness and total loss of reaction to
stimuli may exist independently of fracture.
Fractures are of three types— longitudinal, crossing, or rupture
of the tip of the petrous bone. Longitudinal fractures per se do not
affect the labyrinth except as the causative trauma may cause a con
cussion of the inner ear. Crossing fractures generally destroy the
vestibule, giving total deafness, and even if the vestibule is spared,
may destroy cochlea and semicircular canals by hemorrhage, giving
a totally dead inner ear. O f particular interest in crossing fractures
is the fact that healing is by fibrous union, one case examined after
15 years having the fracture still filled with connective tissue.
O f all fractures in the temporal bone fortunately the longitudinal
are the most frequent, as the prognosis for hearing is best in this
type. Fracture in the roof of the external canal and rupture of the
drum are generally present. A s improvement is progressive, it is
best to wait at least six months before the permanent disability is
rated, the end result generally being not over 30 per cent permanent
total. In crossing fractures the normal drum picture is the rule.
Since functional examination shows deafness and nonirritability of
the labyrinth and there is no hope of improvement the permanent
disability can be gauged early and equals the total loss of hearing
in one ear, plus an additional 10 per cent permanent total for the
loss of equilibrium regulation on the affected side.
It could not be hoped in this short paper completely to cover all
phases of inner ear disturbances, but from what has been given it
can be seen that the careful functional examination of the inner ear
plus cognizance of any other effects of head injury are necessary for
the examiner to make an accurate estimate of the period and meas
urement of disability in traumatic labyrinthitis.
The C h a i r m a n . W e will defer the discussion on this paper until
after the papers which are to follow. Dr. W illiam Wallace Maver
will read the paper, u The fractured female pelvis— subsequent preg
nancies and the measurement of disability,” prepared by himself and
Dr. S. A . Cosgrove.
The Fractured Female Pelvis: Subsequent Pregnancies
and the Measurement of Disability
By S a m u e l A l l is o n C osgrove , M. D., F. A. C. S., Consulting Obstetrician
Bayonne Hospital, Attending Obstetrician Jersey City and Christ Hospitals,
Jersey City, N. J., and W i l l i a m W a l l a c e ! M a v e r , M. D., Rontgenologist to St.
Vincent’s and Misericordia Hospitals, New York City, and Christ and Green
ville Hospitals, Jersey City, N. J.
Fracture of the pelvis is relatively rare compared with the total
incidence of fractures of all types, the estimates of its frequency
varying from 0.54 to 1.22 per cent. There is little doubt that it is
more common than is generally supposed, however, and that the more
general use of Rontgenologic examination has contributed to its more
frequent recognition. In spite of this, detailed case reports in the
literature are few ; we have been able to find less than 300 in American
reports, though there are doubtless many more than are indicated
56
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
by this, for Quain, whose bibliography was most relied upon for
these, reports only those cases associated with rupture of the bladder;
besides, many cases occur which are not reported.
O f 91 cases from the more recent literature, 22, or 24.2 per cent,
were in females. It must be recognized that the vastly increasing
use o f the automobile not only is increasing the number of pelvic
fractures but will tend to increase the relative number of females
suffering such injuries, as heretofore the dependence of such fractures
on occupational accident made for a great preponderance of males
suffering therefrom. The latter tendency is shown in the following
analysis of causes of injury, of which those due to automobile acci
dents constitute 29.7 per cent, and those due to industrial causes,
24.2 per cent. I f automobile accidents were eliminated, industrial
accidents would make up 34 per cent of the whole.
C a u s e of I n j u r y
Industrial:
Crush by crane
Mine eave-in
Fall from scaffold
Falling* timber
Other falling bodies
Steam shovel
Ore or coal cars
Automobile:
Passengers
Struck or run over by
Cases
2
4
4
3
2
1
6
13
14
Cases
Other transportation agencies:
Wagons
4
Street cars_ _
8
Trains—
Fell from
. _
3
Struck by
1
Bicycles, falls from
3
Sleigh, thrown from
1
Horses, thrown from
2
Miscellaneous:
Falls on stairs
4
13
Falls from height___________
Tripping on floor or pavement4
Attack by animal_____________
1
Moreover, woman’s entry more widely into the fields of com
mercialism and travel naturally exposes her to the same accidents
as man; and while injuries of the pelvic girdle have certain points
in common in both sexes, we find in woman added factors that must
be understood when treatment is undertaken, and when adequate
compensation is attributed to her for injuries sustained.
Some authors state that all fractures of the pelvis depend on
severe injury; on the other hand, they have occasionally been known to
follow slight trauma, and several cases are recorded of its dependence
on muscular violence. They are usually the result of sudden pressure
upon the thighs or hips directly, pressure transmitted through the
spine or sacrum, anteroposterior crushing injuries, or direct pressure
on individual bones, as in falls on hard surfaces.
Fractures of the individual bones of the pelvis are usually the re
sult of milder forms of trauma, and are not so prone to be associated
with injuries to the viscera. Trauma of a more severe type usually
involves two or more bones, and displaced fragments are frequently
noted which tend to produce visceral damage as an immediate compli
cation, followed by disabling deformities of greater or lesser sig
nificance.
The variety of these fractures with reference to the parts of the
pelvis involved is great, and they are frequently multiple. More
than 50 per cent involve the rami of the pubis and of the ischium.
Those of the ilium, sacroiliac joints, acetabulum, body of the pubis,
sacrum, body of the ischium, and tuberosity of the ischium occur in
the order named.
MEDICAL SESSION---- DOCTOR COSGROVE
57
Considering the pelvis from the anatomical standpoint, we recall
that it is composed of three pairs of bones, the ilia, the ischia, and
the pubic bones forming the anterior and lateral walls, the sacrum
and the coccyx the posterior aspect. These bones are securely held
together by dense ligaments, and form a compact basin, which has
been divided into an upper, or false, pelvis, and a lower, or true,
pelvis, by the ileopectineal lines.
The upper, or false, pelvis contains parts of the intestines and colon
and serves as an attachment for a number of muscles as well as blood
vessels and nerves. The lower, or true, pelvis contains the bladder,
the organs of gestation in the female, the sigmoid, and the rectum,
besides also serving for the attachment of tendons and muscles. In
this part of the pelvis the organs are closely housed together and do
not have the mobility of those in the upper pelvis. This partly ex
plains the frequency of visceral damage complicating fractures of
the true pelvis and the comparative freedom from damage of the
organs contained in the false pelvis.
In thos^e fractures depending on severe trauma the death rate is
high, due to concomitant injury rather than to the fracture itself ;
thus Quain, in the earlier cases of his series, found 86.7 per cent
mortality from bladder rupture alone, this accident occurring in 50
per cent of all cases; although in the later cases, due to more prompt
surgical treatment, this death rate was reduced to 38 per cent; the
average for the whole series was 74 per cent. Sequelae also depend
principally on complicating injury of other structures. Uncompli
cated fracture results in from 33 to 86 per cent of cases in full
recovery, with little or no deformity. However, marked deformity
may occur from extensive comminution, from the intrusion of the
head of the femur through a shattered acetabulum, from disturbance
of bony development following injuries in the 3^oung, and from
persistence of excessive callus formation. Such deformities are
irregular, altering the symmetry of contour of the pelvis, and of
course, in the female, constitute a factor of potential obstetric im
portance. They depend, in part, on timely recognition and suitable
treatment of the original injury.
In our experience, the most disabling type of pelvic fracture is that
involving the pubic bones through the symphysis, with separation
of the fragments. These are usually accompanied by damage to the
sacroiliac articulations and are prone to leave the subject with
impaired and painful locomotion, and visceral complications, which
render her more or less an invalid.
The least disabling appear to be fractures of the ilia and sacrum.
The former occasionally affect posture and body contour, but we do
not recall a case of permanent disability subsequent to the usual frac
ture of the sacrum; as a rule they unite solidly in about three months,
without deformity.
W e find no record of injury of the uterus itself, the Fallopian tubes,
or the ovaries, in connection with fractures of the pelvis; the free
mobility of these structures is a large factor of protection; it is
easily conceivable, however, that their blood supply and the broad
ligaments might be injured, especially as lesions of the iliac vessels
have been noted in 4.5 per cent of all cases; no specific description
of such injury has been found. In the female, as in the male, the
58
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
close juxtaposition and attachment of the bladder and urethra to
those portions of the pelvic girdle most susceptible to fracture makes
damage to these structures the most frequent complication; the
vagina, the soft tissues of the pelvic floor, and the rectum, may be
involved; scarring dependent on such involvement may rarely be of
obstetric importance.
Considering the influence of any of the deformities or disabilities
complicating, or consequent upon, fracture of the pelvis in relation
to future pregnancy, we must first of all weigh the marriage ability
of the subject. Here we enter upon a field of rather intangible social
values. From our own observation of the frequency with which piti
fully crippled women do marry, while so many physically well-quali
fied women never achieve, if you please, matrimony, it does not seem
to us that the social handicap represented by such deformities is valid
ground for the estimation of disability, unless it should be severe
enough to be utterly crippling; in the latter case, the disability as
regards locomotion and capacity for gainful employment would
probably offer an adequate basis for such estimation, without regard
ing the social disability at all.
Excepting complete, or nearly complete, cicatricial stenosis of the
vagina, no condition resulting from the injuries under discussion
would act as an insuperable bar to coitus and conception; even high
degrees of dyspareunia due to laceration of the vagina and perineum
could not be so classed, nor could interference with normal libido
caused by injuries of the lower cord or sacral plexus.
So great is the mobility of the pregnant uterus, and its capacity
for accommodating itself to a variety of conditions adverse to its
growth, that it is not probable that any of the consequences of pelvic
fracture would interfere with the development of a normal intra
uterine pregnancy. It is possible that, if the adnexa were involved,
either in direct injury or in secondary inflammatory processes inci
dent to such fractures, the tendency to extrauterine pregnancy would
be increased; however, the impossibility of recognizing such tendency
in advance, and the possible concomitance of such lesions of the adnexa
with those arising from more common etiologic factors, would tend
to eliminate such tendency from calculation.
This leaves for our consideration, therefore, only the question of
the influence of previous fracture on the mechanism of labor. I f a
woman survives a fracture sufficiently severe to displace fragments
into the true pelvis, our conclusions must be purely speculative
relative to the effect of these displaced fragments as an impediment
to the normal descent of the foetus, unless the encroachment is so
obvious that its obstructing effect is conceded by a ll; and we believe
it is only fair that the injured party should have the benefit of a
doubtful decision.
Fracture of the pubis and of the ilium, with upward displacement
of one-half of the pelvis, may not prove to be a serious handicap
to normal delivery. The deformed, asymmetrical pelvis, without
projecting fragments, may still permit of a normal delivery in most
instances, and it is therefore not possible nor wise to state that such
a pelvis precludes it. W e have all been astonished to witness, at
times, a successful spontaneous delivery through a deformed pelvic
tract after all preparations had been made for Caesarean section,
MEDICAL SESSION---- DOCTOR COSGROVE
59
W e know of no method by which the degree of disability of the
fractured pelvis in the child may be computed. J udging by the ulti
mate results obtained in apparent severe fracture deformities in
children, we are inclined to the opinion that the child’s fractured
pelvis may not offer the serious handicap to delivery in future life
that the fractured adult pelvis may. One can readily appreciate that
in a field of so much speculation it is difficult to state with any degree
of certainty what ultimate result may be expected.
In regard to all these possibilities, the paucity of case reports and
the comment of standard obstetric texts alike attest to the rarity of
such problems. In Quain’s series of 127 cases complicated by rup
ture of the bladder there is mention of one case of laceration of
the vagina, but the description does not permit conclusion as to the
extensiveness thereof, nor its obstetric significance. Culbertson de
scribes an extensive multiple fracture o f the pelvis occurring during
pregnancy, six weeks before delivery; this case was delivered by
Caesarean section at term, but it would seem as though this were
resorted to to avoid disturbance of the recent fracture rather than
because of interference with labor due to deformity. Senger de
scribes a severe crush, at age 17, necessitating subsequent delivery
by Caesarean section because of resulting deformity.
The texts are disappointingly brief in their comment. W e were
unable to find any reference to these conditions in those of Berkeley
and Bonney, Edward P. Davis, Joseph B. DeLee, or George Peaslee
Shears. Several others dismiss the matter with such statements as
that “ fracture may produce deformity from callus or irregular
union” ; that this is “ rare,” “ the rarest cause of pelvic deformity,”
“ unusual,” “ may arise,” “necessarily obstructive if involving true
pelvis.” Several authors account for its rarity by pointing out the
extremely high immediate mortality of severe injuries of this nature.
Oldfield has seen one case. Newell says in part, “ In rare instances
healed fractures of the pelvis may render delivery through the pelvis
impossible. * * * This cause of dystocia is a very uncommon
one * * * patients succumb to the internal injuries which ac
company the fracture * * * few survive and fewer still become
pregnant. The effect on labor depends on the location of the
fracture, the degree of callus formation, and the displacement of the
ends of the bones.” He points out what is highly important, that the
ordinary pelvic measurements give little or no clue to the internal
conditions, and that the pelvis must be thoroughly palpated— if nec
essary, under anesthesia— and at the time of labor, to determine
satisfactorily the degree of obstruction. He believes that where any
doubt of the competence of the pelvis exists delivery by Caesarean
section should be elected.
W e are unable to add personal experience with these types of
dystocia.
Cragin alone discusses at some length the not infrequent fracture
of the lower sacrum and coccyx from falls in the sitting posture, as
in skating, with sliding forward of the lower fragment, the resulting
deformity sometimes being capable of seriously impeding labor.
This does not necessitate resort, however, to an unnatural channel
for delivery in all cases; the displaced fragment may be excised, or
3 1 5 7 3 °— 29-----5
GO
f if t e e n t h
annual
m e e t in g
OF I. A. I. A.
b.
c.
refractured, or moderate forceps traction may suffice to overcome the
obstruction.
Similar injury not infrequently occurs as a result of obstetric
trauma, either in delivery by forceps or, more rarely, in spontaneous
delivery; some obstruction to subsequent delivery might result, as
when it is due to nonobstetric causes.
Changes in the dimensions of the pelvic strait also result from
obstetric trauma in the forms of separation of the symphysis pubis
or subluxations of the synchondroses; the former may be deliberate,
as the result of symphyseotomy; the two types of injury may be
combined; also separation of bony fragments may occur from the
operation of pubiotomy; all of these injuries, with the possible ex
ception of excessive callus formation following the last-mentioned
procedure, tend to facilitate rather than retard subsequent delivery.
In examining any of these cases the examiner should have as his
primary object a fair and kindly attitude to the injured party and
an unbiased and conscientious state of mind to all. He should be
conversant with the details of the accident and the history given by
both parties relative to the character of the same. The period of
disability and the extent of medical attention should also be made
known to him. This data should be augmented by a complete and
careful X -ray study. It is necessary that the X -ra y examinations
include a set of films made by the stereoscopic method, as well as in
the lateral plane. The X -ray report should include a description of
the general contour and degree of symmetry; a notation of the pres
ence of developmental anomalies or deformities; a description of old,
previously existing fractures or dislocations with an estimate of
their duration; and a detailed description of the recent line or lines
of fracture; the position of the fragments, the degree of union, and
any visible alteration of the normal symmetry of the major or minor
pelvis should be carefully noted. In the event of apparent narrow
ing of these parts, a subsequent X -ray examination should be made
to determine the actual dimensions of the pelvic outlet by the
“ Thoms ” method, which offers a convenient and expeditious method
of pelvic measurement, and enables one to obtain accurate dimensions
which can not fail to be of value in estimating the probable
disability.
After going over the above phases of the injury, a complete physi
cal examination should be made, and, where circumstances permit, a
vaginal examination. The individual’s posture, gait, the coordina
tion of ordinary movements of locomotion and everyday life should
be studied, and notations made of evidence of impaired function.
The following should then be considered in respect to the particular
individual:
1. Does the fracture interfere with the woman’s earning capacity
by producing early fatigue, due to malapposition of bony structures
or muscles, or impairment of normal muscle coordination?
2. Does the fractured pelvis detract in any way from her physical
attractiveness by producing asymmetrical lines of body contour,
impairment o f her normal gait or posture, or lead to a chain of
nervous and mental disorders that unbalance her temperament?
3. Does it render her ineligible for future marriage by producing
physical obstacles to coitus and fecundation; and if she becomes
MEDICAL SESSION— DOCTOR COSGROVE
61
pregnant, what are the chances for a successful delivery of the foetus
through the damaged pelvic outlet?
4.
Does it affect other organs contained within the pelvis and by
so doing render her a potential invalid ?
Other points will probably arise, but these are some of the questions
which must be carefully considered by the physician before he can
attempt to arrive at a conclusion regarding proper compensatory
reward for the woman with a fractured pelvis. In some instances it
may be difficult to state with any degree of certainty what ultimate
result may be expected.
In the treatment of marked degrees of obstruction from any of the
causes described, Caesarean section is, as pointed out by Newell, almost
always the procedure of choice. This, per se, carries with it but little
element of risk. Moreover, since these cases are among the rarest
causes of dystocia, and as indications for Caesarean section other than
they exist in about 4 per cent of all obstetric cases, and as there is also
a by no means small mortality in delivery not associated with obstruc
tive dystocia, the special risk of these patients inherent in the neces
sity for operative delivery is so small as to be negligible.
A determination of the percentage of disability depends upon an
honest and conscientious attempt to correlate in terms of compensa
tion to the individual a sum adequate to repay her for personal
damage sustained, which produces a handicap in future life. A
proper molding together of all the facts aids us in arriving at a prac
tical conclusion. The earning power over the period of life expec
tancy ; the relationship of impaired body function to the work of the
individual as it affects future earning power; the effect o f the injury
upon the physical attractiveness of the woman calculated to prevent
her from obtaining a suitable mate when she becomes of marriageable
age; and the possibilities of successful future pregnancy, are all
phases of a wide field of conjecture subsequent to fracture of the
pelvis. „
In consideration of all of which, the following scheme for the
measurement of disability may be submitted:
1. In those cases in which the result of pelvic fracture and its
concomitant injuries, results, or sequelae warrants an award of perma
nent total disability from the standpoints of interference with loco
motion or with gainful occupation, no additional disability need be
calculated with respect to future pregnancy.
2. In those cases in which no disability, or a temporary partial or
permanent partial disability is awarded because of results interfering
with other functions, there should be an additional disability calcu
lated with reference to pregnancy potentiality in females within, or
younger than, the child-bearing age, provided any of the following
conditions are present :
a. Extensive crushing, resulting in obvious asymmetry of the
whole pelvis.
i. Distortion of the carriage, with compensatory obliquity of the
pelvis resulting either directly from the fracture, or from con
comitant injuries, as of the spine or of the femora.
c.
Distortion of the symmetry of contour of the pelvic inlet, or
cavity, or outlet, by excessive callus, displacement and malunion of
fragments, or intrusion of other bones, as the head of the femur.
62
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. 0 .
d. Actual or probable interference with the symmetrical develop
ment of the pelvis, in the young, by involvement of bony epiphyses
by the fracture line.
e. Extensive cicatricial distortion of the soft parts of the pelvic
floor calculated to interfere with coitus or delivery.
3. Such pregnancy potentiality should be considered as 50 per
cent of the individual’s total potentiality.
4. In event that coitus is completely impossible as the result of
the injury, the full 50 per cent disability should be allowed.
5. In all other cases, the allowance on the basis of increased risk
in delivery should not exceed 10 per cent of the 50 per cent assigned
to pregnancy potentiality, or 5 per cent of the individual’s total
capacity.
B ib l io g r a p h y
Ryan, William John, Ann. Surg., 71:347 (March, 1920).
Brunn, Harold, and Prince, L. D., Calif. St. Jour. Med., 1 9:10 (October,
1921).
Newell, E. T., Jonr. Tenn. Med. Assn., 12: 202 (October, 1919).
Milch, Henry, Jour. Bone and Joint Surg., 8: 832 (October, 1926).
Grandy, C. C., Am. Jour. Roent., 8 :5 1 1 (September, 1921.)
Watts, J. A., Med. Rec. and Ann., 2 0 :7 (January, 1926).
Watts, Wm. B., So. West. Med., 9 : 8 (August, 1925).
McClanahan, Z. H., Colo. Med., 22: 422 (December, 1925).
Senger, William, Ibid.
Kerr, J. M. M., “Operative Midwifery,” Wm. Wood & Co., 1916.
Newell, Franklin S., “Caesarean Section,” Gyn. and Obst. Mon., Appleton, 1921.
Oldfield, Carlton, “Herman’s Difficult Labor,” Wm. Wood & Co., 1920.
Tweedy, E. Hastings, and Wrench, G. T., “Practical Obstetrics,” Henry
Frowde, London, 1919.
Cragin, Edwin Bradford, “Obstetrics,” Lea & Febiger, 1919.
Davis, Edward P., “Operative Obstetrics,” W. B. Saunders, 1912.
Polak, John Osborn, “Manual of Obstetrics,” P. & S. Book Co., N. Y., 1922.
Williams, J. Whitridge, “Obstetrics,” Appleton, 1924.
Shears, George Peaslee, “Obstetrics,” J. B. Lippincott, 1924.
De Lee, Joseph B., “Principles and Practice of Obstetrics,” Saunders, 1928.
Berkeley, Comyns, and Bonney, Victor, “Difficulties and Emergencies of
Obstetric Practice,” P. Blakiston’s Son & Co., 1915.
Edgar, J. Clifton, “Practice of Obstetrics,” P. Blakiston’s Son & Co., 1926.
Barnes, Robert, “A System of Obstetric Medicine and Surgery,” Lee Bros.
& Co., 1885.
Quain, E. P., Surg. Gyn. and Obst., 23: 55 (July, 1916).
Culbertson, Carey, Surg. Gyn. and Obst., 27:851 (December, 1923).
[Doctor Maver showed lantern slides illustrating the foregoing
paper. See illustrations I, I I , I I I , and IV .]
The C h a ir m a n . The next paper will be by Dr. Stanley E . W ood
ruff, on “ The traumatized kidney— measuring the percentage of
disability.”
The Traumatized Kidney: Measuring the Percentage
of Disability
By S t a n l e y R. W oo d ru ff , M. D., professor of genito-urinary surgery, Post
Graduate Medical College, New York City
The title of this paper I have been asked to prepare is well taken,
for after a complete search of the literature for the past 10 years I
find that little or nothing has been done in the matter of checking up
the aftereffects of renal injury. It has seemed sufficient to most ob-
I. F R A C T U R E OF T H E R A M I OF T H E PU BI C B O N E W I T H
F R A G M E N T DISPLACED
I N T O T H E T R U E P E L V IS
II. F R A C T U R E O F H O R I Z O N T A L R A M U S OF R I G H T P U B IC B O N E — M O D E R A T E L Y C O M M I N U T E D
II I . S E V E R E B I L A T E R A L C O M M I N U T E D F R A C T U R E O F P E L V IC BO N ES W IT H D I S P L A C E M E N T O F F R A G M E N T S
IV. F R A C T U R E O F T H E S A C R U M
MEDICAL SESSION---- DOCTOR WOODRTJEF
63
servers and urologists to be quite satisfied if a patient with a bleed
ing kidney from traumatism ceases to show hsematuria in a fairly
satisfactory length of time and is discharged without inquiring to
any extent into the exact amount of damage accrued. The coming
of industrial-accident boards and commissions with the universal
compensation insurance at present in vogue, the damage suits at
tendant upon automobile and other accidents, not only will now
create an incentive to the study of the aftereffects of injuries to the
kidney but will force upon the medical profession the necessity of
being able to report the exact percentage of loss of function.
Let us for a moment discuss the cause and effect of renal injury.
The kidney is a soft glandular organ fed by an enormous blood sup
ply. Its small size in proportion to the amount of blood entering it
is most conducive to a high pressure within and consequently presents
little or no opposition to rupture when traumatized.
That the blood supply of the kidney has much to do with (its
rupture was proven by Kuster, who was unabfe to cause rupture in
the kidney of cadavers but found it a simple matter when the same
kidney was injected through the blood vessels.
Personally I am convinced that the overincrease in intrarenal
tension caused by the external violence, and not the actual blow of
the object on the kidney itself, is the cause of a large percentage of
these cases. This would likewise tend to explain those types known
as “ rupture from indirect violence ” and “ rupture from muscular
effort,” and may likewise explain the large number of ruptured
diseased kidneys reported.
Three methods are described by writers on the subject as being the
cause of rupture of the kidney. The first is by direct violence. This
naturally is the cause of the greatest number. When the blow is
directed against the anterior portion of the body the kidney is
squeezed against the rigid back muscles, ribs, and spinal processes,
and rupture in varying degrees, dependent, of course, upon the
amount and direction of the force against the body, takes place.
When the violence is directed against the back, it is in direct apposi
tion with the kidney and rupture occurs by direct contact— rib or
spinal fracture.
Rupture by indirect violence takes place when there is no direct
evidence of an actual traumatism to the kidney occurring. Examples
of this are reported cases of the patient falling a certain distance
and landing upon the feet, or by a slight fall without any apparent
trauma, as in Fox’s case, where the patient m erely.fell from a
chair, or those fairly numerous ones where the entire injury has been
on one side of the body and it has been the opposite kidney which
shows rupture. This was the fact in two of my own cases.
The third type is that by muscular activity, and there are several
cases reported where patients; have slipped on some movable object,
temporarily lost their balance, and finally regained it, to be followed
later on by actual kidney rupture and, in one case, death from
hemorrhage. It is difficult to conceive the mechanism of this type.
The kidney lies entirely upon the muscles of the back close to the
spine, the anterior muscular abdominal wall being at considerable
distance in front. There is nothing of a muscular nature that can
directly seize the kidney and squeeze it sufficiently to cause rupture.
64
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
Fox reports a most interesting case of this type; a man, 59, stepped
on a loose street-car rail, lost his balance without falling, and finally
managed to regain it. Shortly after he felt faint and nauseated and
complained of pain in the right lumbar region. He passed a small
amount of bloody urine but soon developed a complete anuria. A t
examination the next morning the patient was in coma with a full
and rapid pulse, accelerated respiration, and a slightly distended
abdomen. Catheterization revealed about one ounce of dark-colored
fluid. Before cystoscopy could be done the patient died very sud
denly. Post-mortem examination showed a healthy but transversely
ruptured right kidney, the organ being practically divided into two
equal parts. The left kidney was found to be aplastic and consisted
only of rudimentary sac; this condition, of course, explained the
anuria. In this type, no doubt, the increased intrarenal pressure is
caused by the sudden stiffening of the abdominal muscles.
Renal injuries with external wounds are comparatively rare in
peace times and are usually due to stab or bullet wounds.
Preexisting disease of the upper urinary tract, such as hydrone
phrosis, pyonephrosis, and renal and uretal calculus are most potent
factors in allowing rupture to take place by causing a thinning out
and weakening of the parenchymal structure. A number of such
cases are described by Bailey, and this condition should always be
held in mind by compensation boards when adjusting.
The right kidney is more susceptible to injury than the left in the
ratio of 100 to 70. Whether this is due to the lower anatomical
position of the right kidney is problematical. The longer pedicle
and greater motility o f the left kidney may assist it in resisting
traumatism by slipping away when struck. I t is certainty odd to
observe, as in two of my cases, rather severe left-sided injury with
rupture of the right kidney.
A s external violence is the chief etiological factor in rupture of
the kidney, one would expect the enormous preponderance of such
injuries in the male, Bailey reporting 99 males to 9 females, although
the statistics of the coming years will alter this in a marked degree
on account of the universal use of the automobile, which recognizes
neither age nor sex; children particularly will form a fair quota of
these injuries in the future. The frequent looseness of the kidney
in the female will no doubt still continue to exert an influence to cause
a lessened number of renal injuries in this sex.
W hat are the results of kidney rupture ? Little or great, depend
ing entirely upon the amount. There may be nothing but a slight
linear subcapsular fracture with a small amount of blood in the urine,
a rapid healing, and no particular immediate aftereffects. Again,
the kidney may be mashed into a pulp or torn into pieces, and sepa
rated entirely from the ureter and blood vessels.
In this latter
type there will be no blood in the urine but death will supervene
in a very short time from hemmorrhage. When rupture of the
kidney does not include also rupture of the renal pelvis, there is
usually no extravasation of the urine, as Tuffier has well shown that
the exposed surfaces of the parenchyma do not secrete urine when
rupture occurs.
The peritoneum is sometimes torn and the products of the kidney
rupture may enter the abdominal cavity.
MEDICAL SESSION---- DOCTOR WOODRUFF
65
Hemmorrhage is naturally the chief and first complication. In
fection and urinary extravasation may follow. The hemmorrhage is
quite usually comparative to the number and size of the blood vessels
torn. Extravasation of urine does not take place unless the renal
pelvis is torn and is not of as grave an import as when the lower
portions of the urinary tract are severed— there being much less
tension of the urine coming from the kidney and the perirenal space
being much larger and more cavernous.
Infection takes place more readily in the presence of preexisting
renal disease, but may occur through the blood stream even without
the presence of urinary extravasation and be the cause of subsequent
kidney pathology.
A n interesting case of a traumatic nature for complete destruction
of the kidney is narrated by Pisani, in which he cites the case of a
man struck by a truck, five months previously, on the right side and
flank, causing a fracture of the right scapular with haemothorax. He
recovered in about a month. A t this time a sharp pain in the right
renal region, accompanied by fever, began to bother him. A month
later a similar attack occurred, with high temperature, headache, and
frequency of urination. In another month he complained of a feel
ing of weight in the right flank, loss of appetite, frequency of urina
tion, pains in the lumbar region, and hematuria. An exploratory
operation was done upon the right kidney, and this organ was found
to be totally infarcted, due to evident traumatic thrombosis of the
artery.
Symptoms
The symptoms of rupture of the kidney are sudden hsematuria,
pain, and sometimes tumor in the affected side, this all naturally
depending upon the severity of the violence and the amount of
rupture. The hsematuria usually occurs at once and is often persist
ent, lasting in some cases for as long a time as two months. The
amount or blood in the urine is a fair criterion of the amount of
rupture but not at all conclusive, as in the most severe types where
the kidney is wholly or nearly torn from the pedicle, there may be
little or no blood in the urine. The pain is usually proportionate to
the amount of violence and the quantity of blood or urine extravasated. The size of the tumor palpated may well depend also on these
last two factors. Varying degrees of shock and collapse may be
noted. Peritonitis, if present, is indicated by its usual symptoms.
Diagnosis of rupture of the kidney is usually first shown by the
hsematuria, bearing in mind, however, that the more serious injuries
may show little or no blood in the urine excepting at the very onset.
The pain is practically always associated with the damaged kidney
and may be of varying intensity. Tumor is not always felt because
it is not always present, and even then may be impossible to palpate
on account of muscular rigidity, abdominal distension, or exquisite
tenderness of the affected side. Cystoscopic examination is not
always indicated and is not here included as a diagnostic measure.
In two cases I noted very little distension or rigidity but rather
a sense of loss of muscular tone, as if palpating a fluctuating cavity.
66
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
A prominent symptom of rupture of the kidney is frequency of
urination, in part due to the heematuria and probably reflex in
some cases.
Treatment
This requires considerable acumen and experience on the part of
the attendant. By far the vast majority of accidents of this type
require simple rest in bed, with anodynes both externally and in
ternally to relieve the pain, and a process of watchful waiting.
However, in the severe cases, this process must be intensified, and
where shock and other evidences of severe bleeding are present im
mediate incision and inspection of the kidney will save many lives.
One must here use due caution in being sure that the shock is not
due to the injury of some other portion of the body. Incision and
drainage of the products of the rupture and even nephrectomy may
later be necessary. I f operation is decided upon, a cystoscopic ex
amination should always be done in order to prove the presence
of another functioning kidney. I f operation is not decided upon,
it is better to omit cystoscopy on account of the possible subsequent
reaction or infection, so that the treatment resolves itself within
a few hours into the question of operation or no, and upon the de
cision may rest the life of the patient. I f the question appears to
be at all doubtful, it is much safer to make an exploratory incision.
The question naturally interesting this audience is not the one
where operation and nephrectomy takes place, but that in which the
injury has not been so severe but that the patient has recovered,
and the que3tion of the percentage disability following such accidents
must be considered. Only four cases are to be found in the literature
to date where the functional end results have been studied.
Shupe reports a young man who fell 30 feet, hitting his back in
the descent and landing on his feet on a hard pavement. He com
plained at once of renal colic and showed a slight tenderness in
palpation of the left kidney. There was very little shock but con
siderable blood in the urine. His treatment consisted of rest in
bed. In two days there was no macroscopical blood and in one
week it had disappeared when examined by the microscope. Two
weeks afterwards cvstoscopy was done and both kidneys found to be
functioning normally.
Wesson reports three cases, one an eight-year old boy, run over by
an automobile. There w^as right iliac fracture and crushing of the
second and fourth lumbar vertebrae. Hsematuria for a few days
and, after two month,s had elapsed, a swelling in the right side
developed. This was incised and a large amount of clear fluid con
taining urea was evacuated. Cystoscopy and functional tests at
this time showed both kidneys to be normal.
A man, 41, developed a large swelling on the left side one month
after being struck by a car rail at that point. The swelling was
opened, and about a gallon of urine drained. A t this time cysto
scopy showed no urine from the left kidney. One month later, after
healing of the sinuts, the functional output revealed a 50 per cent
lessening from the left kidney as compared with the right but neither
casts nor evidence of infection.
MEDICAL -SESSION1---- DOCTOR WOODRUFF
67
A man, 45, fell 25 feet and struck on the right side, breaking several
ribs. Hsematuria lasted for 31 days. A t the end of this time
cystoscopy and functional tests showed a 50 per cent reduction from
the right kidney. Reexamination after one year by cystoscope and
pyelogram revealed the upper calix replaced by scar tissue, the
surviving renal portion being entirely normal and functioning the
same 50 per cent.
M y own personal experience has to do with 16 cases, in two of
which nephrectomy was performed.
1. This case was of a vocational school boy of 18, who was struck in the
right side of the back by a block of wood insecurely fastened and flying from
a lathe. He developed at once severe hgematuria with renal colic. The pulse
was much accelerated and palpation gave a sense of loss of tissue in the back
muscles. After 12 hours without improvement operation was decided upon,
cystoscopy performed, revealing a normal left kidney and active hsematuria
from the right. A large amount of extravasated blood was evacuated from the
perirenal space and the kidney found to be comminuted and torn across into
two parts.
2. A male, 28, was jammed between two railroad cars. He had immediate
shock and hsematuria at first, wThich suddenly ceased. There was severe pain
in the side and evidence of a mass. Immediate operation was decided upon,
cystoscopy performed, and the opposite kidney found to be functioning normally,
with nonfunction from the injured side. Exploration revealed the kidney tom
from its pedicle and absolutely separated into two pieces.
3. Male, 33, with a history of injury to the right side, accompanied by pain
and hsematuria, four years previously. Cystoscopic and Rontgenological exami
nation reveals an intensive pyuria, an absolute loss of function of the right kid
ney, a large mass of irregular shadows in the right renal area, and by pyelogram
an immense calculus pyonephrosis. The question here naturally arises: Is
the calculus pyonephrosis subsequent to or did it antedate the injury to the
right side?
4. Female, 30, referred by an attorney for examination relative to a suit for
damages. Patient received an injury to the right kidney two years ago, char
acterized by hsematuria lasting three weeks with pain and tenderness. These
symptoms were followed by chills and fever and a diagnosis was made of
pyelitis of the right kidney on account of the symptoms and the presence of
pus in the urine. Patient still complains of pain and pyuria and has started
suit for damages, My cystoscopic and Rontgenological examination revealed
the urine from the bladder and both kidneys to be free from pus, the renal
functional test showed an equal and normal output from both kidneys and the
pyelogram revealed a normal right renal pelvis.
5. Male, 38, referred by attorney for examination. One and a half years ago,
after unusual muscular exertion, he complained of extreme pain in the right
side and hgematuria for four days. At this time he states that he has severe
pain in the back, becoming agonizing when bending over. He walks in a
stiffened upright position when conscious of observation. When observed with
out his knowledge, he seems to- bend fairly freely. Cystoscopic and Rontgeno
logical examination revealed a double or fused kidney on the opposite side,
an equal and normal functional output from both kidneys, and pyelographic
study fails to show any pathological condition of his right kidney.
6. Boy, 14, struck by automobile, evident injury to the left side and kidney,
accompanied by fairly severe hgematuria which gradually let up but continued
for 21 days. Two months afterwards examination revealed the urine micro
scopically free of blood or pus and by cystoscope both the kidneys were
functioning equally and normally.
7. Male, 28, painter, fell 20 feet from scaffold, striking on his back, complained
of severe pain in the right, side, and at first urination noticed considerable
amount of blood, complicated by fracture of the twelfth rib. This patient was
extremely restless and difficult to keep in bed. The physical signs and pain
were probably aggravated by the rib fracture. No tumor could be palpated and
the patient showed no signs: of shock, and although the hsematuria was rather
severe, vigilant expectant treatment was decided upon. No complication oc
curred and the patient finally made a good recovery. One year later he was
68
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
given a routine examination which revealed a perfect and equal function from
both kidneys.
8.
Female, 32, enters the hospital with a history of having been thrown down
and kicked in the back by her husband four months previously. At this time
she had hematuria and severe pain in the left-kidney region. Under rest in bed.
the hsematuria subsided, but the pain continued in a lessened amount; in the
last three weeks* it has increased again and tenderness is more marked than
before. At examination a tender, fluctuating swelling is noted in the right
flank, and cystoscopic and Rontgenological study reveals a nonfunctioning cal
culus pyonephrosis of the left kidney, which no doubt antedated the injury.
Incision of the loin abscess, and subsequent nephrectomy was performed.
In four other cases of the usual t}^pe of injury, followed by hsema
turia and evidence of rupture of the kidney, I have been able to make
cystoscopic and Rontgenological study going over a period of from
one to four years subsequent to the injury. In all four of these there
is absolutely no evidence of any deleterious effect upon the functional
capacity of the kidney.
Summary
After careful perusal of the literature of the past 10 years as pub
lished by Wesson, Fox, Pisani, Delzell and Harrah, Campbell, Bailey,
Graves and Casper, Jefferson, Klingensmith, Marshall, Reese, Shupe,
and Young, and my own experience, I believe that the result of
traumatism to the kidney, as viewed in terms of the percentage loss
of functional disability, depends entirely upon the amount and type
of destruction of the organ and the presence or absence of complica
tions, particularly infection. My study of those cases injured and
not subjected to nephrectomy, who have recovered without the inter
vention of infection, would surely prove that by far the vast number
of ordinary cases of rupture of the kidney recover without any appre
ciable diminution in the functional ability of the injured kidney. I f
infection takes place and it is relegated to the renal pelvis alone,
there may or may not be alteration in the kidney function. Such
cases should be easily curable under the attention of a competent
urologist by renal lavage and urinary antisepsis. I f infection in
cludes also the parenchyma, then serious results are bound to follow,
as pyelonephritis, pyonephrosis, and possible renal calculus are almost
sure to develop. As has heretofore been noted, the presence of pre
existing renal disease must be taken into consideration in all kidney
injuries and it will at times become a difficult problem to satisfy
oneself in this matter.
In all events, the exact condition following traumatism to the kid
ney can be absolutely checked up by the present-day methods of
cystoscopic and Rontgenological examinations.
REFERENCES
Kiister, Archiv fur Klinische Chirugie, 1895, 1,676-686.
Fox, O. E., “ Ruptured kidney due to muscular action,” Atlantic Med. J.
31:183 (1927).
Bailey, H., “ Injuries to the kidney and ureter,” Brit. J. Surg. 11:609
(1923/24).
Tuffier, Etudes-Experimentales Sur La Chirurgie du Rein, Paris, 1889.
Pisani, L., “ Total infarct of the kidney by traumatic thrombosis of the vascu
lar peduncle,” Arch. ital. di urol. 2 : 403 (1926).
Shupe, T, P., “ Traumatism of the kidney,” Ohio State M. J., 19:104 (1923).
MEDICAL SESSION---- DOCTOR WOODRUFF
69
Wesson, M. B., “ The treatment of traumatic rupture of the kidney,” Ann.
Surg. 83:246 (1926).
Delzell, W. R., and Harrah, F. W., “ Eleven cases of ruptured kidney,” J.
Urol. 19:131 (1928).
Campbell, E. R., “ Traumatic rupture of the kidney.” J. Tenn. State M. A.
19:209 (1926/27).
Campbell, E. R., “ The traumatized kidney,” Internat. J. Med. & Surg. 40: 397
(1927).
Graves, S., and Casper, J. A., “ Complete traumatic rupture of the kidney:
report of a case,” Kentucky M. J. 19:304 (1921).
Jefferson, J. C., “ Lacerated kidney due to indirect violence,” Brit. M. J.
1:1053 (1923).
Klingensmith, W. R., “ Traumatism of the kidney.” J. Arkansas M. Soc.
21:133 (1924/25).
Marshall, V. F., “ Traumatic rupture of the kidney,” Am. J. Surg. 36:195
(1922).
Marshall, V. F., “ Traumatic rupture of the kidney,” Journal-Lancet, 43: 345
(1923).
Reese, G. W., Comminuted fracture of the ilium with ruptured kidney,”
Atlantic M. J. 30: 284 (1926/27).
Young, Text Book of Urol., 1927.
The C h a ir m a n . W e will now proceed with the program, the next
paper being by Dr. C. Rutherford O ’Crowley on “ The traumatized
urethra— prognosis and treatment— measuring the disability.”
The Traumatized Urethra: Prognosis and Treatment;
Measuring the Disability
By C. R u t h e r f o r d O ’C r o w l e y , M. D., of Newark, N. J.
Although injuries of the urethra make up a comparatively small
number of cases causing disability in varying degrees, the proper
immediate and subsequent treatment that should be instituted is not
clearly understood by the majority of physicians who have the op
portunity of seeing these cases first.
Peacock and Hain state that (1) Injuries to the lower urinary
tract are not infrequent, and are caused by straddling falls, by falls
from a height crushing the pelvis, and by automobiles. (2) Eightynine per cent of these injuries occurred in the male. This is due to
their occupational hazards, and the anatomical relations of the male
urethra to the pubic arch. (3) Immediate symptoms, in their order
of frequency, are hemorrhage, shock, retention of urine, extrava
sation, and peritonitis. (4) Latent symptoms occur in the fol
lowing order: Dysuria, frequency of urination, loss in strength,
urinary infection, impairment of sexual power, haematuria, peri
odical retention, and backache. (5) Immediate operations: Supra
pubic cystotomy and laparotomy, and suprapubic puncture.
(6)
Late operations : Dilating sounds or bougies, combined suprapubic
cystotomy and external urethrotomy. (7) The average time of hos
pitalization is 16 weeks. (8) The average period of disability is 23
months. (9) The automobile is directly responsible for one-third of
these accidents. (10) The industrial disability phase is a very im
portant one, as it involves extensive hospitalization, loss of time,
and only 33 per cent of them all can be cured. (11) Fifty-five per
cent of these cases were entitled to industrial compensation.
70
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
O f the industrial accidents 18.7 per cent were due to the automo
bile, while of the nonindustrial accidents 50 per cent were due to
automobiles.
The results of treatment show 33 per cent cured, 41 per cent im
proved, and 25 per cent mortality. The degree of disability varied
from 20 to 100 per cent, and averaged 47 per cent.
Falls of all kinds produced 32 per cent of these injuries and 55
per cent were industrial accidents. The “ straddle f a l l 55 forces the
urethra against the pubic arch. A very slight wound to the mucous
membrane of the urethra may occur, with a few blood cells occurring
in the urine. Or the pubic bones may receive a simple, compound,
single, or multiple fracture, with severing of the urethra in its subpubic portion, also puncturing and lacerating the bladder.
Forty-six and four-tenths per cent of the series were due to crush
ing injuries, 3.5 per cent to chemical irritation, 7.1 per cent to
surgical misfortunes,, 10.7 per cent Avere due to blows, 17.8 per cent
to straddle falls, and other falls caused 14.5 per cent.
Seventy-one per cent of the cases had fractured pelves. Only 9.8
per cent of all fractured pelvis cases admitted had urinary tract in
jury of sufficient magnitude to require special attention. Some had a
few blood-cells in the urine or required catheterization for a few
days.
Crushing fractures of the bony pelvis are responsible for many
wounds of the lower urinary tract. These occur by the body falling
from a height, as tumbling from a window or roof, by a pitch out
of an automobile, or a direct crush, as a truck wheel passing over
the pelvis, or a crush between freiglit-car couplings, or by the body
being caught under falling objects, as walls, or under a rolling log.
It is the fragments in fractures of the pelvis which cause severing
of the urethra and the penetrating wounds of the abdomen.
Hsematuria occurred in 80 per cent; shock occurred in 66.6 per
cent; retention occurred in 66 per cent; extravasation occurred in 40
per cent \ peritonitis occurred in 10 per cent.
Expectant treatment was instituted in 50 per cent, including the
patients most severely injured, with serious complications. The mor
tality for this group was 28.5 per cent. Shock and other visceral
injuries often governed the immediate treatment. The other 50 per
cent were treated by operative measures, and here the mortality was
21.4 per cent.
A retention catheter was employed in 30 per cent of cases. Often
this is sufficient treatment.
Suprapubic cystotomy was performed in 33 per cent. I f catheter
ization is possible, and there are no contraindications on account of
shock, or other wounds, an early exploration of the bladder is indi
cated. In cases of extreme shock and other severe injuries, it may be
necessary to delay operation until the general condition has improved.
Internal urethrotomy was performed in 26 per cent. This opera
tion has a tendency toward greater contraction of the urethra when
the scar tissue organizes.
Suprapubic cystotomy and laparotomy was performed in 13 per
cent. In these cases there was a question of involvement of the peri
toneal cavity by rupture or perforation of the bladder. I t is always
MEDICAL SESSION---- DOCTOR O’CROWLEY
71
a safe procedure to explore the bladder when any doubt exists as to
possible perforation.
Suprapubic puncture was performed in 6.5 per cent. This should
be performed only in an emergency. It gives no definite information
and merely relieves the bladder of retention for the time being.
Urethrotomies, either internal or external, and punch operations of
the vesical neck, gave little permanent relief to these obstructions,
as scar tissue continued to form. In the late traumatic cases sounds
relieved 79 per cent. Dilatation of the urethra by this method is by
far the most satisfactory treatment.
Combined suprapubic cystotomy and perineal section was used in
40 per cent. This was frequently necessary in order to find the vesi
cal end of the severed urethra. External urethrotomy was performed
in 37 per cent. This operation restores the caliber of the urethra and
affords an opportunity for draining the periurethral tissues, and
eliminates a great deal of scar tissue, which would otherwise form.
Joseph recommends suprapubic puncture of the bladder in cases
where catheterization is not possible. He believes it less dangerous
than a clumsy or hastily performed catheterization. Joseph prefers
a suprasymphseal drainage which often renders further surgery un
necessary. Moreover, even if operation later becomes necessary, the
establishment of suprasymphyseal drainage is of great importance in
healing of the wound. The sequence of interventions in injuries of
the urethra should thus be retention catheter, capillary puncture,
suprasymphyseal drainage, exposure of the urethra, and suture of
the urethra. In 1905 Pfeil enumerated the sequelae of injuries to
urethra as follows: A stricture causing no symptoms but needing
treatment from time to time, 10 per cent; fistula with slight dripping,
20-30 per cent; frequent painful urination, dripping, cystitis, pain on
defecation and seminal emission, 50-66% per cent.
Jastram gives details of 21 severe cases and principles for treat
ment. He advises cautious introduction of a soft catheter, at once,
leaving it for a retention catheter if infection is not present. W ith
severe infection cystotomy should be used after external urethrotomy,
preferably with an arrangement for aspiration.
McWhorter advocates the use of a seton instead of a rubber
catheter in cases of injured urethra. He believes that the rubber
tube causes a certain amount of oedema and this intereferes with
drainage. Grimault and Chevassu report 4 cases of traumatic
rupture of the urethra in which complete cure verified by urethros
copy was obtained by urethrorrhapy and suprapubic drainage.
Young states that crushing of the urethra against the lower sur
face- of the public arch is a not uncommon accident, and is caused
by a fall or blow on the perineum. The injury to the urethra may
be in the nature of a bruise, without rupture of the mucosa, a longi
tudinal tear, or a transverse tear. Transverse tears may involve a
part or all of the circumference. There may be in addition bruising
and devitalization of varying portions of the two ends. I f the tear
does not extend all the way across the urethra, the edges are held
near each other, and restitution may eventually take place. I f it
is complete, however, the two ends retract on account of the elasticity
of the urethra, and may come to be separated by a considerable dis
tance. In this class of cases the bulbous urethra is most frequently
72
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
involved, though the membranous urethra may be torn away from
the bulb. Consequently, extravasation and hsematoma which may
occur are confined by the perineal fascia (Colles), unless this also is
lacerated. The spread is then first along the perineum, then to the
lower abdominal wall, avoiding the thighs, while later the penis
and scrotum may be involved. I f the triangular ligament is torn,
the extravasation may extend into the periprostatic region, the
ischiorectal fossae, or the prevesical space.
The various sequelae of extravasation may occur, as described above.
In complete rupture— the commonest kind— the urine can not escape
through the distal urethra, and the urinary extravasation, driven by
the full force of the bladder musculature, is rapid and extensive.
Infection is the rule. Once the acute stage is past, the complication
wrhich is almost constant and of great- importance in stricture. Prob
ably owing to the depth of the infection which occurs and the great
extent of the fibrotic repair process these strictures are much denser
and firmer than gonorrheal strictures, they contract more rapidly and
are more difficult to dilate. I f the ends of the urethra have not been
properly approximated after the injury, the urine may pass through
tortuous fibrotic channels or entirely through fistulous tracts to the
perineum or elsewhere on the outer surface.
The penile urethra may be ruptured, usually when the organ is
erect, by blows or by other twisting or bending forces.
In fractures of the pelvis the urethra often escapes injury, but it
may be torn across or lacerated by bone fragments. The mem
branous urethra is the portion usually involved. The mechanism of
these injuries is different from that of the ones caused by blows on
the perineum, which are seldom severe enough to cause a bony frac
ture. When it does occur it is usually a transverse break of the
inferior pubic ramus, which has little effect on the injuries of the
urinary tract. The commoner pelvic fractures result from crushing
forces, like the wheels of wagons or automobiles, or the buffers of
railway cars, acting from front to rear or from side to side. The
fracture therefore, oftenest. of the pubes, is accompanied by displace
ment of the adjoining tissues, in the course of which the urethra is
torn and usually torn entirely across. It must be remembered, how
ever, that this is true only of the severer injuries and that the urethra
escapes in the great majority of pelvic fractures. When it does
happen, however, the consequences are serious and the damage may
be extensive. The urethra may be lacerated for quite a distance, so
that it is ultimately occluded by a wide and dense band of fibrous
tissue. The prostate and bladder may also be lacerated, so that
they too are involved in the fibrous change, and in addition a variety
of false passages, including sometimes an entirely new channel from
the bladder to the urethra or perineum, may be produced. Losses of
substance may allow urethral diverticula and blind pockets to form.
Lacerations of the corpora cavernosa, pudic nerves, ejaculatory ducts,
and seminal vesicles may interfere with the sexual function, produc
ing loss of erection or sterility, or both.
In the immediate complications, injury to the corpora cavernosa,
pudic arteries, or preprostatic plexus may determine serious hemor
rhage, Karejy the rectum may be involved, but in any case infection
is almost inevitable. It occurs even in the absence of intervention,
MEDICAL SESSION---- DOCTOR O’CROWLEY
73
and is probably due to invasion by the bacteria which frequently
live harmlessly in the normal urethra. To these things urinary
extravasation is added.
In the diagnosis of injuries of the urethra one must keep in mind
the sort of traumatism in which it may occur, and search for it
carefully. The principal symptoms are pain, hsematuria, in the
form of urethrorrhagia, and difficulty of urination. Typically the
bleeding comes from the meatus and is independent of voiding. It
may be lacking, however, when the injury is partial, with no break
in the mucosa, or sometimes when the injury is proximal to the
external sphincter, so that the blood remains in the posterior urethra
or finds its way into the bladder. In the former case a locaj. tumefac
tion (hematoma) along the urethra is present and in the latter the
bladder may even be obstructed by clots. In some cases the patient
may be able to void with little difficulty, in some he may be able
with great effort to emit a small quantity, and in others (the ma
jority) he can not void at all. There is usually not the tenesmus
seen in injuries of the bladder, and not infrequently all signs of
urinary extravasation are lacking at first. Indeed, the patient is
sometimes able to state clearly that the perineal swelling came on
just at the time when he first attempted to void after the accident.
He really voids into his perineal tissues. W ith successive efforts
the tumefaction grows. Its distribution depends on the location of
the tear, as described above. It is studied by palpation of the
perineum and abdomen and by rectal examination. I f a swelling
can be felt by rectum, obscuring the prostate, the extravasation
(urine or blood, or both) has reached above the triangular ligament.
Distention of the bladder, determined by palpation or percussion,
rules out rupture of that organ.
In many cases it will be found that owing to the absence of void
ing someone has attempted catheterization. This usually does no
good and insures infection. Whenever there is any question of a
rupture of the urethra all instrumentation should be avoided. I f
there is no injury to the urethra, catheterization is not necessary;
if there is injury there should be immediate operative exploration.
Cases of urinary retention following bodily injuries with no lesion
of the urinary tract may be confusing, but in the absence of positive
signs of any such lesion, one may safely wait, since retentions of this
sort eventually relieve themselves without harm to the patient. I f
there are doubtful signs, as perhaps slight hsematuria or slight peri
urethral tumefaction, it is better to explore, since early operation
may save life if there is injury, and does no harm if there is not.
In conclusion, it is to be emphasized that ruptures of the urethra
not followed by retention and not accompanied by tumefaction or
severe urethrorrhagia, and purely interstitiajl ruptures, need no treat
ment. A ll other cases should be subjected to immediate intervention.
In the presence of a urethral rupture all explorations and catheter
izations should be avoided. These only lead to infection. I f there
is retention and it is impossible to intervene at once, recourse should
be had to suprapubic puncture of the bladder.
Treatment consists in sewing the extremities of the canal together
and diverting the urinary1current by means of cystostomy in order
to avoid infection by a permanent catheter.
74
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C«
Extravasation of urine is to be treated promptly by diversion of
urine and multiple incisions into the cellujitis with drainage. The
mortality in extravasation cases treated after 24 hours is exceedingly
high.
R eferences
Deboucher and Michon, “A case of traumatic rupture of the perineal urethra
treated by immediate urethrorrhaphy,” Bui. et. mem. Soc. Nat. de chir. 52:1214
(1926).
Farman, F., “ The operative treatment of rupture of the male urethra,”
Calif. & West. Med. 25:188 (1926).
Grimault, L., and Chevassu, M., “ Four cases of traumatic rupture of the
urethra,” Bui. et. mem. Soc. Nat. de chir. 52:1232 (1927).
Huddy, G. P., “ Results of internal urethrotomy,” Brit. J. Surg. 13:458 (1926).
Jastram, M., “ Treatment of injuries of the male urethra,” Deutsche Ztsch. f.
Chir. 177:70 (1923).
Joseph E., “ Unfallheilkunde der Bias und Harnrohre,” Moratschr. f. IJnfallhlk. 33:263 (1926).
Kaufman, O., Handbuch der unfallmedizin, Stuttgart, Enke, 1907.
McWhorter, G. L., “ The use of the seton in repair of torn or strictured
urethra,” Surg. Gynec. & Obst. 44:2147 (1927).
Peacock, A. H., and Hain, R. F., “ Injuries of urethra and bladder,” J. Urol.
15:563 (1926).
Young, H. H., Practice of Urology.
D IS C U S S IO N
The C h a irm a n . I am sure we have all been most interested in this
series of papers, and we will now have a discussion on the first
paper, “ Traumatic labyrinthitis.”
Mr. W i l l i a m s . I desire to ask Doctor Blumberg a few questions.
In the experience which I have had in these cases— I suppose such
as all of you have had— where the injury to the inner ear results
in deafness, we make the award which the particular schedule which
we have calls for; but where the injury goes to the outbranch of
the nerve and has nothing to do with hearing but has to do with
being able to maintain equilibrium, we have a great deal of trouble.
People are absolutely unable to do any w7ork that they know howT to
do as a result.
Mr. S t e w a r t . Eight along the line of what Mr. W illiam s has
said, I would like to ask Doctor Blumberg some questions. I realize
that we have had here this morning probably the best medical
ability on the subjects treated that could be obtained in New York.
W hat little I understand of the papers, they were certainly
remarkable.
Doctor Blumberg, as I take his paper, deals principally with the
serious trouble of the ear, such as boiler makers would have, and that
sort of thing. Now, after all, it seems to me that we are coming up
against another condition entirely. The boiler maker, with his rivet
and hammer, is going to pass away because of electric and acetylene
welding. On the other hand, there is an increasing type of noise,
noise, noise— our own offices; take our own offices, with these electric
adding machines running all the time, with the street noises outside—
take those inside the loop in Chicago— we are producing, it appears
to me, through the ear a nervous condition of the human race that
is going to be more widespread and much more difficult to measure
than that caused by those noises wThich really affect the hearing.
MEDICAL SESSION---- DISCUSSION
75
A very large percentage of the boiler makers are more or less
deaf— we know what that does— but if we put an able, intelligent,
girl of sweet disposition into a room with 40 or 50 electrical machines,
in three or four years she has a disposition like a cross-cut saw; she
flies all to pieces, and we find ourselves being forced in self-defense
to say, “ No typewriter in my office ”— I mean the machine.
Now, I prophesy the annihilation of the human race through its
own noise. I am not going to set any date. I think, perhaps, if
Archbishop Usher hadn’t undertaken to figure back to ascertain the
date of the commencement of the human race there wouldn’t have
been as much noise in the world as there has been, so I am not going
to set any date. But, seriously, all joking aside, it does seem to me
that we are producing a great amount of noise, and the effect of the
noise we produce, some of which is entirely unnecessary, is reducing
rapidly the efficiency— and to my mind shortening the life— of the
human race.
Now, I am wondering if it is not that sort of study of the ear—
of that condition which is coming and which is growing, rather than
the study of those more severe injuries which we can measure more
or less, but which are disappearing— which should be made. To my
mind one of the great problems of industry to-day is noise and its
effect not upon the ear but upon the nerves.
Doctor A r l i t z . This’ paper of Doctor Blumberg’s does not deal
with occupational deafness or occupational neurosis; the subject is
one which has been tremendously bothersome to the compensation
department of the department of labor. The type of deafness or the
symptomatology that is mentioned in Doctor Blumberg’s paper is
that which occurs after head trauma, or after bodily shock, and
where in a large proportion of the cases there is no evidence of a
fracturing of the skull. It has been a, very confusing subject to us
in the compensation bureau, having in mind that it is our duty to
award the injured employee the largest amount of compensation
possible. W e thought it would be " a wise plan to have a paper on
this subject and to have a general discussion, so that in the future
we might be able to do full justice to those who have been injured
in this manner.
Mr. K in g s t o n . I wonder if what wTe are doing in the way of a
rating for the deafness in one ear would meet with the judgment of
Doctor Blumberg. W e rate industrial deafness in one ear as 3 per
cent, in terms of total working disability. O f course that is only a
guess. I do not know that there is anything scientific about it. W e
have worked on that principle and it gives to the average man a
lump-sum settlement of about from $300 to $500, depending on his
wages, for such disability; and for the total loss of hearing in both
ears we rate that at 30 per cent.
The deafness that Mr. Stewart spoke of, of course, is an industrial
disease, and unless that is' covered by the particular act in question
there is no compensation at all. I wonder how many of the juris
dictions include industrial deafness or boiler-makers’ deafness as an
industrial disease in the provisions of their act in respect to which
compensation is payable.
The C h a ir m a n . Doctor Blumberg will you close this paper?
3 1 5 7 3 ° — 2 9 ---- 6
76
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
Doctor B lu m b e r g . In so far as the total loss of hearing in one ear
is concerned, rated at 3 per cent, I think that is rated entirely too
low. A man who has total loss of hearing in one ear should be rated
at least 10 per cent permanent total disability— total wage loss; a
man who is totally deaf in both ears should be rated at least at 50 per
cent permanent total. The man who is deaf in one ear has lost a
very important defensive mechanism; his occupational hazard has
been tremendously increased as he is so much more exposed to addi
tional accident.
How can the measurement of the vestibular portion of the ear be
arbitrarily made? A s I understand the compensation law, the man
is not rated as disabled a certain percentage for any particular work;
my understanding of the law is that the man is disabled a certain
percentage for any work. Now a man who has a labyrinthian
hyperemia, a man who is attacked by occasional vertigo, by occasional
dizziness, by occasional nausea, that man can still work. That man,
perhaps, may be totally incapacitated as a painter, as an iron worker;
he may be totally incapacitated for those occupations which require
certain distances or certain height; but he can fill very many gainful
occupations fully.
The percentages as given are based, first, where the hearing por
tion is concerned, on the particular percentage of loss of hearing;
secondly, on the amount of dizziness, on the amount of disturbance
that that man generally has. In that type treatment of the inner
ear is sometimes of some avail. The percentage there was given at
80 per cent. Those people can do some work. It is only where there
is a hazard of heighth from the ground, wThere the man may suddenly
get dizzy and fall down, that he is totally incapacitated, but he can
do these other kinds of work.
On the proposition of the psychic or the psychological effect of
noise, I can not see how that possibly can be rated. I f you start
there, you will simply have to start rating the effects of every act
that each individual does in his - daily life. To say that noise is
increasing the irascibility of people and changing their tempers may
be perfectly true, but my contention would be that the vivid color
schemes which we see every now and then and the type of clothes that
people wear, are just as much at fault perhaps as noises; that even
the foods we eat have a certain effect on the total human; and if you
are going to start gauging the psychic or psychological effect of
noise you will have to gauge everything that the human being does.
In so far as thei boiler maker proposition is concerned, at most I
would rate him only for his deafness— temporary. Very often if
the occupation is changed the deafness is very much decreased and in
many cases is cured.
The C h a irm a n . The second paper is now open for discussion,
“ The fracture of the female pelvis.”
Mr. W i l l i a m s . Those cases are fortunately very rare, but I wonder
if Doctor Maver has any statistics about how many of them have
more serious results along the line of either nervous disorders or
beginning psychosis. How many of those cases result in disturbed
mental conditions ?
Doctor M a v e r. I do not have any statistics available with reference
to the possibility that Doctor Williams has brought up relative to
MEDICAL SESSION---- DISCUSSION
77
nervousness developing subsequent to a fractured pelvis. Such cases
have been reported, and they seem to come mostly in the younger
adults. I f we can exclude any organic lesion subsequent to the
fracture and if it is purely a mental condition, I would be of the
opinion that there would be no real reason for calculating disability
on those grounds alone, because we are all familiar with the fact
that a great many of them do improve and clear up practically al
together after they obtain their award.
Mr. W i l l i a m s . This case has been running along six or seven years
with very little physical disturbance, but the mental condition is just
the same.
Doctor H a v e r . No bladder complications at all, or uterine com
plications ?
Mr. W i l l i a m s . N o .
Doctor M a v e r . I confess I do not know how you can arrive at any
calculation of that mental disability.
The C h a i r m a n . The third paper is now open for discussion, “ The
traumatic kidney,” by Doctor Woodruff.
Doctor O ’C r o w l e y . I heard a very interesting, remark here a min
ute ago by your secretary when he said that he prophesied that there
would be gradual annihilation of the> race by noise. I wish to take a
little exception to that by saying that we as urologists expect to
prolong the human race by the use of sounds,
I was very much interested in hearing Doctor Woodruff’s paper,
and I am sure this association is to be congratulated upon having
such men as Doctor Woodruff present the subject, because there is
no better authority of whom I know.
I have seen more traumatic injuries of the kidneys than I have of
the urethra. Doctor Woodruff left a little gap in his paper for me
to mention these displaced kidneys that come up before accident
compensation boards. W e feel to-day that the kidney is so well
protected in the ordinary fall that it is not going to be displaced in
a way that it will require a moving u p ; it is generally recognized that
nephroptosis of one kidney rarely comes singly; it is one part of a
picture, of the general abdominal content. The operation for hang
ing up the kidney is being done less to-day than it ever was.
Kattarrus, an international authority, who died a few years ago, in
his volume on urology goes over this subject very carefully.
A few years ago I had the case of a little boy who was knocked
down by the fender of an automobile. He started to pass a little
blood. Doctor Kerns called me in. The boy was not in shock; he
had a pinkish urine, not a profuse hsematuria. I played a watch
ful waiting game with this boy and he went along all right.
I rarely see these compensation cases until after they have had
operations— many times useless operations, bungled operations.
There should be some way in which a case with a distinct specialized
trauma in any part of the body could be gotten to an authority.
I say that for the reason that the man will be better off, the com
pensation board will be better off, and the insurance company will
be better off.
I want to tell you about a case of malingering that went through.
About a year ago I was called in for expert testimony on the Globe
78
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
Indemnity side in the case of an Italian who had been sitting on
the back seat of a “ flivver ” with two other fellows. A car on Bloom
field Avenue jammed them, and the car happened to stop short.
Nobody was injured, but this individual was knocked off the back
seat to the floor. He was brought in to St. Girard’s hospital, which
had a very bad name, and he was kept there for a while. He said
he was very sick. H e had just a tiny scratch on his back— a screw
driver was supposed to have penetrated him in the side. M y assist
ant was called and found that he had a pyonephrotic kidney. This
was within six weeks after the injury. A pyonephrotic kidney is
a big kidney with tissues destroyed, replaced by pus. It is impos
sible for anything like that to take place in that length of time. The
case went to trial. I was in the court room, with 12 men in the jury
box. Many times there are peculiar ways of thinking about these
cases; I have seen it. The man was suing for $3,500. As it went
along the lawyers got together with the judge. I was not called.
The case was called off, and the individual was given $1,800. One
of the adjusters in the Public Service Corporation, a patient of mine,
was in the office, and he said, “ You were on that case? ” I said,
“ Y es; but I didn’t get a chance to go on the stand.” He said, “ That
family has made trouble for us right along, they have been trimming
Public Service right and left, ancl we have been trying to get them,
but we can not do it.” *
Mr. K in g s t o n . Just one question that has to do with the question
of rating for kidney disability. I wonder if Doctor Woodruff would
express an opinion of what he considers a fair rating for the complete
loss of one kidney— how does it affect the man’s working ability?
W e have had three or four such cases; I forget now what the causes
were in all cases, but one case was a young lad where the surgeon
operated removing the kidney, and we rated that 15 per cent disa
bility. That has become standard rating with us for such cases where
it is not complicated with any other condition.
Doctor A r l i t z . I do not know if you realize just what the impor
tance of Doctor Woodruff’s paper and of Doctor O ’Crowley’s paper
is. I f you have had any experience on the compensation board you
would appreciate just what it means. The trouble with cases of this
kind and the compensation bureaus where they must be rated is that
wTe can not get men like Doctor Woodruff or Doctor O ’Crowley to
attend the hearings. This work is usually taken care of by men who
have very little, if any, knowledge of this subject, and they make
the ratings. In some instances; the ratings are entirely too small and
in other instances they are entirely too large.
I have in mind several very important cases where one kidney had
been removed following trauma. Just what percentage of disability
should be allowed to an individual of that kind Doctor Woodruff
failed to mention, and I am curious to know.
Another thing: Doctor Woodruff makes mention of the fact that a
kidney may be traumatized to a considerable extent and the condition
may be followed by a recovery in the sense that the kidney function
ates in a manner approaching the normal. In a case of that kind
there must be considerable scarred tissue, and it seems to me, even if
the kidney did functionate normally in a macroscopic sense, still
MEDICAL SESSION---- DISCUSSION
79
there is a microscopical loss of function, and the individual should
be compensated for it. Those are the problems that bother the men in
the compensation bureau. I would like to ask Doctor Woodruff if
he will make t]jat a little bit clearer.
Doctor N a s h . Doctor Woodruff’s paper was extremely interesting
to me and clarified a number of points from
medical standpoint,
particularly in differentiating between the symptomatology in those
cases where there is involvement of disease of the kidney. The next
paper was extremely interesting in giving a great many statistics
relative to injuries of the urethra. Most of the facts given are of
interest to those who treat the case, but we who are engaged in an
advisory capacity by insurance companies must constantly answer
the question of cause and relation.
There was some mention of latent symptoms following trauma to
kidneys. I would like to know a little more about the latent symp
toms and what Doctor Woodruff considers a reasonable length of
time between an alleged accident and the development of symptoms.
This problem arises constantly, and this question must be answered
constantly by doctors who appear before compensation boards, or
who have to advise employers in regard to the payment of claims
for these patients.
I believe it was Doctor O ’Crowley who mentioned something about
displaced and movable kidneys. It is my impression that every
kidney that can be felt is surely not one that has any pathological
significance.
The C h a ir m a n . I f there is no further discussion, Doctor Woodruff
will answer these questions.
Doctor W o o d r u f f . I purposely omitted from my paper the dis
cussion of displaced kidney. O f course, Doctor O ’Crowley snapped
it up immediately, and some others, but I did not feel that displaced
kidney had any place in that paper. That is a question that per
haps comes up in your compensation boards too as much as any other,
and it is always, absolutely every time, the old question of the hen
and the egg— which was first. I have never known it to fail. I have
seen quite a few of those discussions and been in on them in courts.
The patient will swear by all that he ever knew or hoped to be that
that kidney never was in that position before, but we all know as
medical men that there are a large number of loose, movable, or dis
placed kidneys— even in this room. Now, how are we going to arrive
at any conclusion or say anything in a paper about a condition of
that kind. It just can not be discussed, xior can it be truthfully
enunciated just what to do as to them. I do not know.
Mr. K in g s t o n . Have you ever known of a case where you could
diagnose it as positively due to trauma ?
Doctor W o o d r u ff . N o ; I do not think so. A patient may be
traumatized and come in and say, here is this kidney— it might have
been there before. I have a great many cases coming to my office,
particularly female, where I feel a kidney, and I have learned to say
nothing about it unless there are symptoms referable to it and the
patient knows it. God forbid me from ever telling a woman that
she has a movable kidney because she is a lost soul right there. That
80
FIFTEENTH AN N U AL MEETING OF I. A, I. A. B. C.
is why I did not mention it, because the discussion about movable
kidneys is too great. That ought also to answer Doctor Nash.
Mr. K in g s t o n . M y question: was about 15 per cent disability.
Doctor W o o d r u f f . I think that is quite fair, although the percent
age rating for the loss of one kidney depends again on circum
stances. In the first place, it is probably too small a rating for a
woman, because a female, if she is not too far along in years, expects
to have children, and although many women go through pregnancy
with one kidney— I have seen a number of them do it— yet we always
feel that one kidney in a pregnant woman is not quite 100 per cent.
I believe that loss of one kidney in a woman should receive a
higher rating than 15 per cent. I believe that the age of a male
has something to do with it. I believe that in the younger males
your 15 per cent may be a little low, because of the fact that the
young male is liable to infective diseases of the other kidney or even
accidents to his other kidney.
Mr. K in g s t o n . Would you say that a man who has lost one kidney,
one who is a laboring man ordinarily, must change his occupation
to lighter work?
Doctor W o o d r u f f . N o ; I wouldn’t say that, because he is not much
more liable to injury than anybody else.
Mr. W i l l i a m s . W hat would a life insurance company say to a man
who had lost one kidney and wanted to take out a life policy ?
Doctor W o o d r u f f . The company passes all, practically. I f the
urinary examination is perfect they pass. The company may rate
them up a little bit.
Mr. S tig g in s. Would you say that the loss of one kidney neces
sarily actually disables a man for work ?
Doctor W o o d r u f f . N o ; not at all; it does not disable him at all.
There are hundreds— yes, thousands— of men with one kidney around
this country to-day working just the same as they ever did.
Mr. S tig g in s. I understand you to be of the opinion that every
case of the loss of one kidney should be judged by the particular
circumstances ?
Doctor W o o d r u f f . On its own footing.
Mr. K in g s t o n . It is only a potential disability.
Doctor W o o d r u f f . It is not a disability at all; it would depend
entirely upon the condition of the other kidney. O f course, if the
other kidney is diseased then your percentage disability must go up
high.
I f you had a diseased kidney on the other side, whether a surgi
cally or medically diseased kidney, then the loss of one kidney means
everything. In the presence of double nephritis the patient’s term
of life is very short because of the additional work thrown upon the
functional capacity of that kidney.
Doctor Arlitz asked about the function of the kidney in which
scarred tissue is present. That has very little effect, because when
a kidney heals up the scarred tissue is not very great; it depends
entirely upon the size and upon the amount of damage that has been
done to the kidney, relative to the amount of scarred tissue. A
kidney that has been amputated, cut in two for any reason, such as
MEDICAL SESSION— DISCUSSION
81
removal of a cyst or something of that kind, will function 100 per
cent.
I have seen many kidneys with a good-sized hypernephroma of
the kidney where the function of that kidney was not interfered
with at all, not a particle. So that the scarred tissue, as a rule, does
not affect to any great extent the functional capacity of the kidney.
Doctor Nash asked about the latent symptoms of kidney injury—
what are they? W ell, I do not know, unless they are neurotic.
I do not recall anything unless they are neurotic, or unless the
injury causes actual disease in the kidney. I f actual disease such
as infection takes place we have the usual symptoms of renal disease,
and the time between the accident and the appearance of symptoms—
an injury of the kidney of any amount at all will cause immediate
symptoms. I f the kidney is ruptured to any extent there is imme
diate hsematuria, and there is usually immediate pain on that side,
so that if a patient is injured and two or three months afterwards
complains of hsematuria, that haematuria is not due to the actual
injury. It may be due, if present, to the result of the injury, in that
renal disease has been initiated by the injury, but the symptoms of
renal injury occur immediately.
The C h a irm a n . N o w we will discuss Doctor O ’Crowley’s paper.
Doctor A r l i t z . This is always a very) interesting subject and also
a very trying subject to those of us who have labored in the compen
sation bureau. Cases of traumatized kidney usually present them
selves at the bureau with this history, that they are going to Doctor
Woodruff, or to Doctor O ’Crowley, about once or twice a week, or
twice a month, to have sounds passed. Now we at the bureau call up
Doctor O ’Crowley or Doctor Woodruff and say, “ How long will
this thing last?” “ W ell, you can not tell how long it is going to
last; we may have to dilate him for six months and maybe we will
let him go then, and he may be all right, but he may come back in
three months and we will have to go through the same process again.”
I believe many of the cases are about like that.
How are we to measure the percentage of disability? It is essen
tially a speculative matter, but we must measure it. M y first ex
perience with, Doctor O ’Crowley was in the case of a man who went
to see a specialist by the name of Vane, I think his name was, in
Plainville. He was to have his bladder examined. The doctor in
jected what he thought was novocain; it was bought in a sealed bottle,
but it happened to be alcohol. The man developed a tremendously
painful urethral stricture. Four or five doctors were in attendance
when this operation was performed. He went from Doctor Dubois to
Dr. Raymond Detiris, who performed a urethral operation which ap
parently was not very successful and he went about for several years
wearing a big rubber appliance. I think Johnson & Johnson, who
were making that novocain at that time, paid him $6,500 in settlement
of the case, but that did not settle the case; he then commenced ac
tion against Doctor Dubois. That fellow went from bad to worse.
He was 100 per cent disabled and he committed suicide.
One of the gentlemen here said that the world would eventually be
destroyed by sound, and Doctor O ’Crowley said he was going to
save the world with sound, which reminds me of w man who came
into my office on three or four occasions with decidedly bloody urine
82
FIFTEENTH AN N U AL MEETING OF I. A. I, A. B. 0 .
which was alleged to have been the result of an injury. The urine
was tremendously bloody. I had it examined; it was positive. He
came back two weeks later and went through the same procedure,
with a positive blood finding. He came back twro weeks after that—
he always came in by appointment— and again a tremendous amount
of blood. I called up the people I represented and said, “ I don’t
see what I can do in this case; here is a man who has a bloody urine
and he gives the history of trauma. I would advise you to settle
the case.” They paid him $2,500, which was rather a small amount
o f money for that type of injury, but the curious feature about the
case was that he went around and told several people how he had
gypped Doctor Arlitz. He used to go in and see Doctor Dowd each
day before he came to my office and Doctor Dowd would pass a big
sound on him and cause the hemorrhage, then he would come down
and show me just what he could do.
Doctor W o o d r u f f . I wTould like to say a word about Doctor
O ’Crowley’s paper, which was fine. I think the subject a much more
important subject than ruptures of the kidney— far more important—
because ruptures of the kidney, if left alone, only have a death rate
of about 5 per cent— less than that— while ruptures of the urethra in
unattended cases have a death rate of at least 95 per cent. Don’t
forget it. There is no more dangerous condition to-day than rupture
of the urethra, because if the urethra is ruptured the urine is bound
to escape through the rupture, extravasate into the periurethral
tissues and cause infection and death, and it will do it in practically
95 per cent of the cases unattended. I am saying that from my own
knowledge.
Mr. K i n g s t o n . I have one question to ask; it is not directly re
lated to the subject, but it is, perhaps, a related subject. W e have
a great many cases of orchitis, and the question is whether orchitis
can be induced other than by direct trauma. W e have been advised
that it is a very rare occurrence to have orchitis as a result of acci
dent, and when it is to be considered at all as the result of accident
there must be evidence that the trauma was directly responsible.
Doctor S p i c k e r s . I wa,s very glad to hear a part of Doctor O ’Crow
ley’s paper. I enjoyed it very much, and I feel, as he does, that the
best way to treat ruptured urethra is by immediate operation. I
think a great many times the mistake has been made of trying to
sew the ends of the urethra together without doing a suprapubic
cystotomy, and I think the only way to hope for success in the healing
of urethra is by combining the operation with the opening of the
bladder above the pubis. However, I feel that there are certain
cases of injury to the urethra where the urethra has not been com
pletely severed, where a simple incision in the perineum will be
sufficient for cure; and I would like to ask Doctor O ’Crowley if he
has ever seen or treated cases of that character, where he simply
opened the urethra, put in a small drain, and the patient would go
on and urinate. There may be some leakage from the perineum for
some time but afterwards a very excellent result would be obtained
by subsequent passage of sounds.
The C h a i r m a n . I f there is no further discussion we will ask
Doctor O ’Crowley to close.
MEDICAL SESSION---- DISCUSSION
83
Doctor O ’ C r o w l e y . I am very glad of this discussion. I remember
the case that Doctor Arlitz spoke about very well, but I never did
know the ultimate outcome of that individual. He certainly was a
miserable urological wreck.
Doctor Arlitz brought out the question that we see these cases
after they have been operated upon. They are apparently well and
are trying to go back to their occupation, but we find that they have
a stricture that needs dilating. Such a man comes into the office
from one of the insurance companies, which wants to know how long
it is going to be until this man will be away from physicians. That
is a very hard thing to estimate. The only rule I adhere to is that
I try to determine how much of an injury this man had to his
urethra at that time— at the time of his accident— whether he had a
fractured pelvis with complete severance, or whether he had just a
rent or tear; the kind of treatment he had had, and whether it was
inductive to infection. I gauge the length of time that the indivi
dual will be under medical care by half a dozen treatments in my
hands, to see to what extent I can dilate the stricture, and where my
maximum point in office treatment is. I may decide that an excision
of that scarred tissue, and reuniting the two ends of good urethra
might be better, cutting down a long-drawn-out dilation; it might
be better for the individual and better from the compensation stand
point and from that of the insurance company.
But I do not think any physician handling dilating instruments
the first time that an individual comes in, which is way past the
time of his accident and they are the ones we usually see— can tell
how long that individual is going to need treatment. W e do not
think, as they used to, that he is going to be sounded all his life,
but we do know that we are going to dilate the stricture of that man
several times at intervals of once in four or five days or a week, and
see if we can get him up to a normal urethra for him; then we are
going to stretch the intervals between and see how far this man can
go— it may be six months or a year— and then we may let him go
entirely away from us. That is the only way I can ever give a report
to any of these companies.
To go before a compensation bureau and tell it after one examina
tion of a condition like this, how long this man is going to be par
tially incapacitated is an impossible thing.
In a good many of these cases that have to be dilated, one of the
paramount symptoms that comes up before the compensation board
is the loss of sexual function. A great many individuals who have
only minor injuries to their genital regions have psychical impotency;
they have idiopathic conditions, and even some malformations of the
genitals. Many of those cases drop into the class of psychical im
potency cases, so I discount a great deal of that as a symptom to be
judged in awarding a percentage of disability for compensation.
I think the most important thing that I spoke of in my paper—
Doctor Woodruff emphasized that— was extravasation of urine. I
get many extravasations of urine in a year— idiopathic, very few
traumatic. I have the patient transferred from the pneumonia ward
and extravasation starts out of a clear sky. A good many cases are
due to instrumentation, but through all the experience I have had
I know that if you do not, get after extravasation within the first 24
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FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
hours you are licked; that increasingly the percentage goes higher
and higher, the loose tissue there make gangrene sepsis, and the
individual goes into general sepsis and dies. Still doctors here have
seen cases, with four or five days’ extravasation, where you open up
and let out quarts of pus and the individuals have gotten well.
The antibodies are fast enough if the resistance is good, but it is not
the rule. The rule for the doctors who first see these cases, whether
they have tumefaction and extravasation, is that surgical interven
tion is most imperative.
The doctor is right in his contention that if you are doing any
surgical intervention upon the urethra for complete laceration of the
urethra, you should divert that normal infected urine and give the
parts in their natural habitat a chance to reconstruct themselves, but
not with the catheter in there— that causes oedemia— and try to side
track your urine that way; because in the hands of the average
surgeon a little incision into the bladder is a minor operation and
you get a better chance, with less danger of infecting the area.
Complete laceration always comes when you have fractured pelvis,
but with these interstitial tears that are rather slight, if you can lo
cate them and they are anterior in the urethra, it is a simple propo
sition to deflect the flow of urine through the perineum and let the
anterior urethra take care of itself.
The last thing I have to talk about is what we see mostly— what
I think most of the cases referred to me are— that is, testicular con
ditions. The men come in; they have been lifting a bag of sand,
straining, or something else, most always unduly, and they have a
swollen testicle. They have been in bed and in the hospital, and
it is late when we see them. I never see these cases first; I can never
make a diagnosis except from the hosiptal chart and how the case
looks from the patient’s history. W e who see them late have nothing
but the history and the late physical examination on which to form
any kind of an opinion at all; the earmarks are left. W e have a
great many of these cases come in. You ask about orchitis. Not
many of the orchitis cases are traumatic orchitis; that is very rare,
but we do see it once in a while. A case of traumatic orchitis that
I saw recently was that of a man caught in a flywheel belt; he had
one testicle that came up large. That was traumatic orchitis, and
I saw him right away.
A D e l e g a t e . Can that com e fr o m a l i f t p u r e ly ?
Doctor O ’ C e o w l e y . N o; I will say that you do not get traumatic
orchitis from an indirect injury, but from a direct injury you may.
But these jndirect-orchitis cases are either gonorrheal or tubercular,
and in a vast majority of them I have sent back that report. W e
see the epididymitis cases, but in general use it is called orchitis,
and the physician has to differentiate between a tubercular condi
tion and a gonorrheal condition. Many times you get a negative
history; the patient tells you he never had anything like that in
his life before, but I do not go at them that way. I say, u How long
ago did you have gonorrhea? ” “ W ell,” he says, “ I think I had a
little strain four or five years ago.” That lets the thing out.. That
became swollen because he has had an exacerbation of that trouble
which he has had smoldering there. He has never been cured of
MEDICAL SESSION---- DISCUSSION
85
this gonorrhea, and his accident lighted up this condition again.
It looks like a swollen testicle when you look at it.
Doctor N a s h . When one states definitely and dogmatically that
there is no possible causal relation between a lift or indirect trauma
and orchitis, I think it is fair for the doctor to say something to the
lay people here about such expressions of opinion as are given by
Chace of England, who has a theory that excessive strain to the
lumbar muscles or to other muscles produces an increased cremasteric
reflex with a change in the circulatory apparatus around the scrotal
region, as a result of which one can have orchitis. The expression of
the opinion by Keyes is that a strain of the lumbar muscles can also
send a stimulus along the cremasteric muscle and the nerve supply to
the scrotal region, producing orchitis. Personally I do not believe
these things, but I think it is fair to express the opinions of others,
and I would like to have Doctor O ’Crowley say something about this
subject.
Doctor O ’ C r o w l e y . I am glad the doctor brought that up. I be
lieve the same way, but I do believe that there has been a preexisting
lesion in that side of the scrotum. I think that these have been
erroneously diagnosed. I do not see how lifting and cranking cars
and other things that so many people have to do every day, things
that you think would strain the testicle, things that the vast majority
of the male population do every day, are enough for that. I say there
must have been a preexisting lesion in these individuals, either tuber
cular or gonorrheal or syphilitic, causing that; there must have been
some preexisting condition, because I have seen very few traumatic
conditions of the testicles and they have been 100 per cent traumatic
and no preexisting lesions.
I am only telling you my experience with these orchitis cases. It is
not to be thought of by you gentlemen as much as epididymitis, and I
think we have to differentiate between tubercular and gonorrheal epi
didymitis and these so-called cases coming before the compensation
boards called orchitis.
Mr. K i n g s t o n . I s it easier to get traumatic epididymitis than
orchitis ?
Doctor O ’ C r o w l e y . Y es; much easier. Many times indirect vio
lence can start it up. You take a predisposed individual with a
lesion and if he receives the strain or blow on the scrotum, he would
be apt to get a tubercular epididymitis. W e see that but we do not
think it is a causative factor; we think it is a predisposing factor.
The P r e s id e n t . I want, in behalf of the association, to thank the
doctors who have read papers here this morning for our convention;
likewise to thank those who entered into the discussion. I want to
thank Doctor Todd for having presided at the meeting, and Doctor
Arlitz in particular, who is responsible for our medical program.
[Meeting adjourned,]
WEDNESDA Y, SEPTEMBER 12— AFTERNOON SESSION
Chairman, William J. Arlitz, M. D ., of Hoboken, N. J.
M ED ICAL SESSION
The C h a ir m a n . The first paper this afternoon will be one on “ The
relationship between single trauma, carcinoma, and workmen’s com
pensation,” by Dr. Jonathan M. Wainwright, of Scranton, Pa. Doc
tor Wainwright has some very interesting and some very novel and
original ideas on this subject.
On the Relationship Between Single Trauma,
Carcinoma, and Workmen’s Compensation
By J o n a t h a n M. W a i n w r i g h t , A. M., M. D., of Scranton, Pa., chief surgeon to
Delaware, Lackawanna & Western Railroad, Glen Alden Coal Co., and Moses
Taylor Hospital.
The possibility of a single trauma causing carcinoma is very much
doubted or even considered impossible by many careful observers. It
seems best, therefore,, to present as the wtext of this discourse ” three
cases which would seem to the average judicial layman to prove defi
nitely that a causal relationship may occur. I f we will admit that
the relationship has been a true one even in one case, we must conse
quently admit that it may likewise be a possibility in any other case
in which this relationship comes up for serious consideration.
Case 1 (fig. 1).— H. W., 42 years old, automobile mechanic. Eight weeks
before observation he struck himself a severe blow with a wrench at the exact
point of the tumor shown in the photograph. The external surface of the
cheek was not broken but the mucous membrane on the inner side was broken
and bled. This wound in the mouth healed after about two weeks. At about
this time a “ pimple ” formed on the skin surface. This broke open, began to
bleed, and grew rapidly, so that the condition shown in the photograph was
produced about eight weeks from the original injury. A biopsy at this time
showed squamous epithelioma.
Summary: A young man; no previous trouble; a blow sufficient to break the
mucus membrane? in the mouth; skin carcinoma appearing in two weeks, reach
ing the condition shown in eight weeks; microscopic confirmation.
It is hard to believe this was a coincidence or that the blow “ called attention
to the trouble.” The writer advised the insurance company that this blow
caused the cancer and this opinion was accepted.
Case 2 (fig. 2).— D. P., 62 years old, motor-truck driver. Two years before,
while driving his truck, his right ear was frostbitten. The skin at the top of
the pinna remained rough, thick, and tender, and gradually this thickening
became more prominent at the point shown in the photograph. This prominent
point has remained and has very slowly increased in size.
Examination
June 26, 1928, showed at the point indicated a hard nodule about one-eighth
inch in diameter, not ulcerated, movable on cartilage. Excision. Microscope
shows basal-celled epithelioma.
Summary: This man had no thought of compensation, and beyond the human
tendency to attribute all our ills to some external factor had no reason to
attribute his skin carcinoma to the frostbite, Abnormal skin was noted from
86
FIGURE 1
86—1
FIGURE 2
86—2
FIGURE 3
MEDICAL SESSION---- DOCTOR W A IN W R IG H T
87
the time of the frostbite till the excision of the cancer two years later. Frost
bite, pathologically speaking, may have a different mode of action from a blow,
but it damages tissue, leaves some “ scar ” tissue, and, from a legal point of
view, the two should be considered identical.
Case 3 (fig. 3).— (Reported by Drs. L. L. and 0. P. Brown, in Southwestern
Medicine, February, 1928, Vol. X II, p. 69.) B. T., 15 years. Seven months
before observation went into a burning building. His foot went through a
burned board, causing an abrasion about the middle of the shin. The wound
never healed. Seven months after tlie injury the ulcerated area was grafted.
Complete failure. Wassermann negative. The ulcerated area continued to
spread, and at the end of one year it was 3 inches in diameter. Biopsy at this
time. Dr. Willis Waite, pathologist to Hotel Dieu, El Paso, Tex., reported
squamous epithelioma. Doctor Waite kindly gave a slide to the writer’s labora
tory, where this diagnosis was confirmed.
Summary: A boy, 15; skin carcinoma in a very unusual place. Certainly no
cancer was present before, and became aggravated. Wound never healed after
injury. One year later miseroscopic proof of squamous epithelioma.
It would seem that these three cases should convince anyone that
carcinoma can follow a single trauma. The sequence is rare. I f we
assess the real cases against the thousands of traumata occurring
every day it is enormously rare. Furthermore, in the malignant con
ditions, either carcinoma or sarcoma, as they are met with clinically,
the cases being presented under such circumstances that an antecedent
trauma should be accepted as a cause, are again very rare. Coley
(Annals of Surgery, April, 1911), in an elaborate presentation of
this subject, reports 970 personal cases of sarcoma, with a history
of trauma in 23 per cent and 250 cases of carcinoma, with a history
of trauma in 32 per cent. O f these 120 were breast carcinoma, with
a history of trauma in 43.3 per cent. McWilliams reported 44.6 per
cent for breast carcinoma. In many of these cases the data are not
convincing, and while these figures fairly accurately represent alleged
trauma, neither Coley nor anyone else believes that the percentage
of cases which should be accepted as definite from a legal point o f
view is nearly as large as these figures.
It was thought that the enormous number of injuries in the Great
W ar would offer valuable information on the relation between trauma
and both carcinoma and sarcoma, but inquiries have been singularly
sterile. Eegaud, after an enormous experience in Paris, kindly states
to the writer under date of February 27, 1928, that he has not ob
served cancer after a war wound. The French Minister of W ar also
very courteously wrote on June 6, 1928, that the ministry also had
no record of such cases. Apparently only one case, and that a sarcoma
of the maxilla after gunshot wound, has been recorded by the British.
(Pickwell, British M. J., Dec. 17, 1927.)
The United States Veterans’ Bureau has apparently no cases of
carcinoma after injury. The bureau does have records of 56 cases
of sarcoma. The abstracts of these cases have been furnished through
the kindness of Dr. E. O. Crisman, medical director. The connection
is reasonably definite in only a few of these cases, and as they are all
sarcomata, in which class the facts are fairly well established, they
do not come within the present inquiry.
Dr. W . S. Bainbridge, from his place on the International Con
gress of Military Medicine, has had an unusual opportunity to study
the results of war wounds and has done so with his usual energy
not only for the Great W ar but for several other previous wars, and
his results have been equally barren.
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FIFTEENTH AN N U AL MEETING OF I, A. I. A. B. C.
It would seem now that we should consider two points as proven:
1. That carcinoma (and sarcoma, too) may arise from a single
trauma; 2. That such cases are extremely rare.
It now remains for us to try to evaluate these two facts in such a
way that justice is done both to the employer and the employee. And
we should consider how as commissioners, referees, and medical
advisers we can help an employee with cancer truly due to trauma
to receive the compensation to which he is entitled by law even if he
does have an extremely rare condition. On the other hand, as a
writer has said in another connection, we should prevent an employee,
however sincerely he may believe his own story, from selling his old
cancer to his employer.
Segond, who has tried to put this subject on a working basis in
France, has postulated five so-called guaranties as follows: (1) The
authenticity of the trauma; (2) sufficient importance or severity of
the trauma; (3) integrity of the part prior to the injury; (4) corre
spondence of the tumor to the exact site of the injury; (5) a date of
appearance of the tumor not too remote from the time of the acci
dent to be reasonably associated with it. Two others have been
suggested: (6) Continuous pathological manifestations, pain, swell
ing, haematoma, etc., at the site of the injury up to the time of
appearance of the tumor; (7) microscopic proof of cancer.
These guaranties need discussion.
The importance of the authenticity of the trauma is obvious. The
severity of the trauma is of great importance. It should be de
manded as an essential that there was something more than a “ bump ”
which is vaguely remembered and to which little or no attention was
paid. The injury must be of sufficient severity to devitalize or at
least considerably alter normal tissues. It must be sufficient to cause
definite pain, swelling, ecchymosis, more or less impairment of func
tion, etc., conditions which should leave some real scar tissue.
The integrity of the part prior to injury is of course important,
but it is a point on which there will rarely be any information except
lack of previous symptoms.
The correspondence of the tumor to the exact site of injury is a
sine qua non.
The question of the time elapsing between the injury and the tumor
symptoms is extremely difficult to adjudicate. Some writers feel
that a sarcoma should appear within three weeks to a year, carcinoma
six wreeks to a year. Most writers have considered that the distal
limit should be from two to three years— definite cases, however, are
recorded in wThich carcinoma has developed in well-marked scar
tissues or sarcoma in fracture unions after many more years. A time
limit, therefore, can hardly be set, and this factor must be weighed
with other factors in each individual case.
It does not seem proper to demand continuous pathological man
ifestations as well-established cases have shown the first tumor
evidences even years after the immediate trauma symptoms have
subsided.
Microscopic proof is of academic interest but not of much medico
legal importance. A ll that a referee needs to know is that the
claimant has a lump which disables him or may have killed him.
Its exact nature is immaterial.
MEDICAL SESSION---- DOCTOR W AIN WRIGHT
89
Cases raising the question of single trauma and carcinoma will
involve most frequently the skin, second the breast, and third the
abdominal or thoracic viscera. It will be best to consider those three
sites in a little detail.
1.
The shin.— The three cases cited are typical of those that will
arise. Fortunately in this country we have little or no cancer classifi
able as an occupational disease. In England chimney sweep’s cancer
is still a factor and mule spinner’s cancer in certain textile workers
is causing the authorities considerable anxiety. This is caused by
constant irritation of the scrotum by oil used in the machinery.
Doctor Kennaway, of the London Cancer Hospital, has kindly fur
nished me with clinical notes and slides of a carcinoma of the right
first finger of a man wTho for a long time was engaged in oil spraying
in mosquito work. He habitually kept his first finger on the nozzle of
the spraying apparatus to guide it, and the constant irritation of this
finger by the oil evidently produced the carcinoma. The theory is,
that the greater portion of oil used in England comes from Rumania
and contains some specially irritating chemical substance. The Sur
geon General informs me that no such case was reported in our
canal work. I f, as seems to be the tendency, occupational diseases
are later to be made compensable, the connection between carcinoma
and chronic irritation must be further studied.
In connection with the skin the very definite connection between
single trauma and melanocarcinomas must be remembered. Many
definite cases have been recorded in which a blow or, more important
still, a stab wound or a cut of a pigmented wart or mole have been
immediately followed by a rapidly spreading and very fatal form
of cancer (melanocarcinoma or melanoma). I think no one who has
studied it questions this fact, and when a definite trauma is proved
before such an occurrence there is little room for argument. One of
the most interesting cases of this kind came under my observation.
Mrs. S., 55 years old, had a congenital brown mole over one shoul
der blade. She had ridden in motors a great deal for many years
with no difficulty. One day she purchased a new car and im
mediately left her home in northeastern Pennsylvania for a tour in
New England. Some point on the back of the seat of the new car
rubbed on this mole and when she reached Boston at the end of the
second day the mole was bleeding and felt sore and irritated. When
she arrived home at the end of two weeks, the mole, which was about
1 inch in diameter, presented over its whole surface an angry,
bleeding fungating mass elevated about three-fourths of an inch.
A wide excision was at once made. Microscopic examination showed
melanocarcinoma. Death occurred five years later from a growth
in the stomach. It was never proven whether this growth was a
recurrence or an independent stomach carcinoma.
Another phase of skin cancer is concerned with those that develop
in scars without any additional trauma. The occasional occurrence
of such cases is unquestionable. They occur most frequently in
scars of burns but they may occur in any scar. They may occur
many years after the bum has healed. The writer has a patient who
had a burn on the thigh when 8 years old. A carcinoma developed
in this scar at the age of 43. Biegel (quoted in Coley’s article from
which much in this paper has been extracted) reports a man who at
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FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
the age of 74 developed a “ cancer ” in the scar of a foot amputation
done in childhood.
From this it will be seen that any scar may, rarely, develop car
cinoma many years after the injury. I f the original injury was
chargeable to an industry it would seem that such an end result,
even if it is fatal, should in justice be charged again to the industrial
injury. Unless there are special time limitations in State laws, I
can hardly see how such a claim can be opposed if the facts are as
outlined.
2. Carcinoma of the breast.— O f the male breast J. B. Murhpy has
said, “ Carcinoma is very frequently the sequence of a mild trauma of
single occurrence. * * * It is the only place in the body where
this is so.” Two years ago the writer made an analysis of records
of 418 male breast carcinomas and was much impressed by the fre
quency with which trauma was alleged as a cause. Some cases are
reported of carpenters, shoemakers, and the like where constant
pressure of tools has been considered the cause, and these cases must
be considered if repeated injury attains the same status in compensa
tion laws as single injury. Further cases have been reported in men
in which breast carcinoma has followed blows by base balls, gunshot
wounds of the nipple, laceration of the nipple, and a sword thrust, so
closely that acknowledgment of the trauma as a cause seems necessary.
The relation of trauma and breast carcinoma in women is more
obscure, but with the ever increasing number of women in industry
and business it is important. Several surgeons with unusually large
experience in breast diseases have recently told the writer that they
have seen no breast cancers which they could fairly consider as due
to trauma. Lane-Claypon, of the British Ministry of Health, after
an elaborate study of 500 breast carcinomas in women compared to
500 noncancerous women concludes that in injuries, both with and
without bruising, there is a close association between the injury and
the subsequent development of cancer.
Coley (loc. cit.) reports 37 present cases of breast carcinoma and
2 of sarcoma with antecedent injury. A study of the case histories
reported by both Lane-Claypon and Coley shows many cases which
these authors themselves probably do not consider convincing. How
ever, there are several which should convince any impartial observer
that at least it is possible for a single blow to cause breast carcinoma.
Therefore in a breast carcinoma case at litigation the possibility
of true relation should be accepted as a general principle and the
facts in the individual case should be carefully weighed according to
the principles noted by Segond.
3. Injuries to the thoracic and abdominal viscera.— In the thorax
the only viscera needing consideration are the lungs. The possibility
of external trauma through the bony chest wall, injuring the lung
sufficiently to cause trauma seems too remote to need discussion.
The alarming increase of primary lung carcinoma in recent years
may later be important as an occupational disease in those exposed to
gasoline, coal tar, etc.
Injuries to the abdomen are also a very remote possibility as the
cause of carcinoma, but they can not be dismissed entirely as in the
case of the thorax. They must be considered, if for no other reason
than that they are not infrequently brought into court no matter
MEDICAL SESSION---- DOCTOR W A IN WRIGHT
91
how grotesque they may be. A German court found for a man who
once fell flat on his abdomen on a boat deck. Five years later he
developed an intraabdominal cancer. Such an affair "belongs more
to a comic opera than to a court of justice. In the writer’s experience
a man slipped off the step of a switch engine and sprained an ankle
so slightly that he did not have to stop work. Some time later he
developed a carcinoma of the rectum, for which he solemnly brought
suit as caused by the sprained ankle. In the case of another man a
rectal cancer in the course of its natural progress perforated and set
up a fatal peritonitis. His widow brought suit because a few weeks
previously he had slipped on his employer’s floor. Fortunately in
both these cases the good sense of Pennsylvania referees ended these
affairs, but only after unnecessary waste of time and money by the
State, the defendant companies, and the plaintiffs and their lawyers.
These cases, of course, should never have gone beyond an honest
family physician.
Coley was apparently convinced by an abdominal case as follows: A
man aged 35, always well, December, 1909, in a train collision received
very severe and extensive contusions,, principally of the head, spine,
and lumbosacral regions, and was in bed four and one-half weeks.
About three months later Coley saw him and found principally
marked rigidity of the upper abdomen and loss of 65 pounds in
weight. Six months later he showed a loss1 of 5 more pounds; he
was cachectic, emaciated and feeble; upper abdominal rigidity was
still present and in addition a tumor in the epigastric region. Death
occurred nine months after the injury. Autopsy showed extensive
carcinoma involving practically all the abdominal organs, but ap
parently primary in the liver. (The case never came to trial as the
State law forbade a suit for damages 44if the next of kin be an alien
or nonresident.” )
Even in this case there is of course no definite proof that the acci
dent caused the cancer, but in all human probability it did so, and
probably any commission or court would so find and even the doctors
should not disagree. So that, even in the abdomen, we should admit
a possibility but the evidence should be weighed against the prin
ciples of Segond with especial care and rigidity.
Aggravation o f a preexisting carcinoma by' tramrm.— I t is accepted
without question by scientific medicine that a reasonably severe trauma
of any kind applied directly to a carcinoma may aggravate it, make
it grow more rapidly, and may hasten a fatality which is inevitable
unless curative treatment can intervene.
Supposing that, after a severe blow on a carcinoma, it does grow
more rapidly and the patient dies. Both sides to the argument should
agree that death was inevitable, but that due to the injury the death oc
curred several months or years earlier. As I understand it compensa
tion commissions have no power to divide the burden. They have no
middle course, but must find either that the death was due to the trauma
and award complete compensation for a fatality when it is admitted
that the only thing the trauma did was to produce the fatality at an
earlier time, the length of which can not possibly be even approximately
determined. In other words, the end result is sold to the employer
simply because it came quicker. On the other hand, if the commis
3 1 5 7 3 ° — 2 9 -----7
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FIFTEENTH AN N U A L MEETING OF I„ A. I. A. B. C.
sion feels that the end result should not be sold to the employer,
the claim must be dismissed completely. Either decision is bound
to work an injustice to one party or the other. It would seem that in
such cases the law should allow the commission to reach a compro
mise decision by which the employer does1not have to pay a death
claim in full but such smaller amount as seems to the commission fair
in view of the facts in each of such special cases.
Coley in his conclusions says, “ That a single local injury may
cause a carcinoma as well as a sarcoma is no longer open to question.”
I hope enough has been said herein to confirm this view and to make
it generally accepted as, a possibility.
In the face of the equally well demonstrated rarity of such a defi
nite connection the difficulty is properly to evaluate each individual
case. A careful comparison of the individual facts to Segond’s postu
lates should lead to a just decision, and it might be well if they were
established by statute as has been done by some States in the similarly
vexed question of hernia. The authenticity of the trauma, the
severity of the trauma, the prior integrity of the part, and the exact
correspondence of the tumor to the site of] injury should generally
be readily determined.
The time element is one of the most difficult problems and unfortu
nately one on which the medical adviser may be unable to offer
definite help. I f a definite tumor is felt at or immediately after
the accident it was of course there before. I f it is first noticed after
two or three weeks the connection becomes more trustworthy. The
period of greatest probability may fairly be considered to be one
month to two years. Howrever, a definite distal limit can not be
fixed, as witness the man of 74 who developed a carcinoma in the
scar of an amputation done in childhood. I f a visible scar is present
or if it is considered proven that a definite thickening or lump re
mained from the injury to the appearance of the carcinoma, the time
element loses considerable of its importance. For instance, we would
rarely consider 22 years as within the range of possibility. Yet LaneClaypon reports the case of a woman who struck her breast against a
bedpost in 1900. She was quite sure there was no lump then; a
hard painless lump appeared “ soon ” afterwards. In 1922 the lump
began to grow; that is, it developed into carcinoma. I f the facts
were truly as alleged and if the early lump was at the exact point of
injury, it is evident that permanent deep-seated scar tissue formed
and became malignant 22 years later and that under these circum
stances the blow should fairly be considered as the cause of the
carcinoma. Lane-Claypon reports a still more convincing case with
an interval of 11 years. I am afraid therefore that the medical pro
fession must agree that it is impossible to set a definite distal time
limit.
The C h a i r m a n . I f there is no objection we will have the papers
in order and after all the papers have been delivered then we will
have our general discussion, beginning with the first paper.
The next paper we will have is by Doctor Elsberg. This paper
will be on “ Fractures of the spine and their treatment, amount of
disability, and indications for and results of operative interference.”
Years ago we thought fractures of the spinal column rather a rare
thing, but those of us who have had experience in the compensation
MEDICAL SESST01ST— DOCTOR ELSBERG-
93
bureau know that they are not at all rare, and from time to time
we have had so-called experts come before the commissioners and
testify to any and all sorts of terminologies that we were satisfied
were not just right. W e will be very glad to have Doctor Elsberg
give us something in detail relative to these conditions.
Fractures of the Spine and Their Treatment, Amount
of Disability, and Indications for and Results of
Operative Interference
By C h a r l e s A. E lsb e r g , M. D., professor of neurological surgery, Columbia
University, New York City
A few years ago, the writer was asked to give his opinion regard
ing the percentage of disability in the case of a young man who had
fallen from a scaffold some time before and had sustained fractures
of the bones of both feet and a fracture of the lower dorsal vertebrae.
The bones of the feet had healed in poor position, the feet were
deformed so that walking was difficult, and there was considerable
weakness of the lower limbs from a spinal-cord injury. The ques
tion that I was asked to answer was this: How much of the patient’s
disability of locomotion was due to the deformed feet, and how
much was due to the fractured spine ? The insurance carrier claimed
that the greater amount of disability was due to the injury to the
bones of the feet (which I believe carried a smaller amount of com
pensation than would the spinal injury), while the other side had
expressed their belief that most of the loss of function was due to
the spinal-cord lesion.
This question— and it was a real problem— led me to restudy my
cases of fracture of the vertebrae. Some o f the conclusions I arrived
at then are given to you to-day in what follows. In speaking of
the amount of disability that may result from a spinal injury, I shall
not give you many figures or statistics, but shall limit myself to an
account of some of my personal experiences, and the lessons I have
learned from them.
The importance of a fracture of a vertebra depends not so much
upon the fracture itself as upon the degree of dislocation of bone or
bony fragments and the amount of injury to the spinal cord and nerve
roots. The nature and extent of the spinal-cord lesion can and
should be determined by a complete neurological examination. Usu
ally, but not always, good stereoscopic X -ray films will disclose the
amount of injury to the bones and changes in the size and shape of
the vertebral canal.
By means of these two methods of examination, conclusions can be
arrived at (1) whether there are signs of a complete transverse
lesion of the cord; (2) whether at the affected level only a part
of the cord has been injured, and if so, what fiber tracts have been in
volved; (3) how many of the spinal-cord symptoms are due to a
haematomyelia— a gross hemorrhage into the cord; (4) how much
is due to pressure by fractured or dislocated bone or by distortion
of the vertebral canal.
In this connection, one must always remember that, after a trauma
to the vertebrae, the X -ray examination may be entirely negative,
94
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
and yet the patient may have a most serious cord lesion. On the
other hand, it is not at all unusual for the X ray to show a very
marked fracture and dislocation of bone in an individual who has
few or no signs or symptoms of injury to the spinal cord or nerve
roots.
Fractures o f Spinous or Transverse Processes of the Vertebrae
It is surprising how often the X-ray examination will reveal a
fracture of a spinous or a transverse process in an individual who
has only slight pain and stiffness of the back after a muscular strain
or a slight trauma to the back. The pain and stiffness may be so
slight that the patient is able to continue his work and medical aid
may be sought only after a number of weeks have passed, but more
often he is incapacitated for a few weeks, and sometimes for a
longer period.
A n X ray taken years after the injury may show the spinous or
transverse process still ununited by bone to the vertebra. The mere
fact, therefore, of the X -ray finding of such a fracture is not proof
positive that an injury that was recently sustained was the cause of
the fracture found at the X -ray examination.
These slighter injuries to the bones of the vertebral column would
hardly require consideration in this paper, were it not for the fact
that trauma is believed to be an important etiological factor in a
number of more or less diffuse diseases of the spinal cord. W e do not
know how often a slight injury to the back may cause a minute
hemorrhage or other microscopic change which may give no spinalcord symptoms but which may be followed years later by a slowly
progressive spinal-corcl disease.
Such a result may be rare, but its possibility must be kept in mind,
and this has led, not infrequently, to litigation in the courts.
Injuries to the Spinal Cord, W ith or W ith ou t Dem onstrable
Evidence on the X Ray o f Fracture of the Spine
A trauma may be immediately followed by slight or by marked
symptoms and signs of a spinal-cord lesion, although the X ray does
not show any fracture or dislocation of bone. The spinal-cord
symptoms may be due entirely to u concussion,” which is a real en
tity, and in which there are minute hemorrhages into the cord tissue.
On the other hand, a fracture may not be seen on the X ray although
it is found at an operation or a post-mortem examination.
In many instances, the injury to the structures within the vertebral
canal was caused at the time of the impact of the force, which caused
an overstretching or rupture of ligaments and a momentary disloca
tion of a vertebra which then slips back into its normal position.
I f the cord has been only slightly injured the symptoms due to
loss of motor and sensory power may be only slightly marked; but,
if the cord has been crushed in its complete transverse diameter,
there is at once a loss of all motor power, all sensation, of the reflexes
below the level of the lesion, and with it a loss of the functions of
the bladder and bowels.
The statement just made would make it appear as if it were easy
to distinguish at once between a complete crush of the spinal cord
MEDICAL SESSION---- DOCTOR ELSBERG
95
at a certain level and a partial injury. This is often not the case.
Not so rarely, after a concussion or the cord all power and all
reflexes and the control over bladder and rectum are lost for a
number of days; and in hasmatomyelia (a bleeding into the substance
of the cord) the same symptoms may exist for days or weeks.
From the standpoint of operative treatment it is important to
appreciate this. Because it has often not been appreciated, one
reads of patients “ with a complete transverse lesion of the spinal
cord ” who were “ improved55 or “ cured55 by operation. The
spinal cord tissues can not regenerate; and, if a patient has a com
plete crush of the cord, the condition is always an irremediable one.
Many of those suffering from concussion of the spine or from a
traumatic hsematomyelia recover to a great extent without any opera
tion at all.
How then, in an individual in whom no gross evidence of a frac
ture of the spine exists and who has after his injury the signs of
a complete transverse lesion of his spinal cord, -can one determine
whether or not the injury has affected the entire thickness of the
cord? Only by waiting and by daily repeated careful examinations.
The patient with the signs of a complete transverse lesion— loss of
all power, loss of all sensation, loss of reflexes, loss of control of
the bladder and bowels— will have one purely spinal reflex left. I f
the examiner scratches the sole of either foot there will be a plantar
flexion of the large toe. I f this plantar flexion of the large toe can
be elicited for more than about two weeks, with the persistent loss
of everything else, the injury to the spinal cord is almost certainly
irremediable. I f, on the other hand, within the' first few weeks,
scratching the sole of the foot causes a dorsal extension of the large
toe— the so-called Babinski sign— then one may conclude that the
patient did not actually have a complete transverse lesion, although
he had at first the clinical signs characteristic of such a lesion.
Patients with the symptoms of a complete transverse lesion have
sometimes been subjected to operation because of the belief that the
pressure of blood in the vertebral canal might be enough to cause
the symptoms. A s the pressure in the spinal blood vessels is never
high enough to cause much compression of the spinal cord, such a
view is erroneous, and there is never any justification for an opera
tion to relieve such a presumed compression by blood clots.
It was once generally believed that after a complete transverse
crush of the spinal cord the ensuing flaccid paralysis and loss of
reflexes were permanent. W e now know that, excepting in injury
to the lumbosacral cord and roots of the cauda equina, after a num
ber of months the lower limbs become spastic, and exaggerated
knee jerks, ankle clonus, and “ Babinski ” can again be elicited.
“ Mass ” reflexes occur, by which the lower limbs are drawn up to
the body, and these have sometimes been mistaken for voluntary
movements of the limbs. But there is never any return of real
voluntary motor power, never any return of sensation, never any
return of voluntary control of the bladder, although the bladder
may empty itself automatically on the least irritation, such as might
occur while the patient is being placed upon a bedpan. A ll these
signs are the result of the return of automatic activity of the spinal
cord below the affected level, I know of a number of instances in
96
FIFTEENTH A N N U A L MEETING OF I. A. L A. B. C.
which patients were subjected to operation at this stage, because it
was erroneously believed that the cord lesion was not complete and
there fore irr emedi able.
The patient with heematomyelia as a result of trauma to the verte
bra may first present the signs of a complete transverse lesion and
then may begin to improve so that finally (sometimes only after one
to two years) he has regained a great deal of control over his limbs
and much sensation has returned. Unfortunately, however, if con
trol of the bladder and rectum does not reappear within the first
few months, it will rarely return at all.
The patient who after a spinal injury has only the signs of an
injury to part of his cord may recover completely. Usually, how
ever, some weakness or stiffness of a limb or limbs, some disturbance
of sensation, persists and some atrophy of muscles may follow.
The patient may apparently have good use of his limbs, but a neuro
logical examination will always show that there are disturbances that
have remained.
In this connection it is important also to remember that a patient
may have sustained an injury to the lower lumbar vertebrae and
may have little or no loss of power in the lower limbs, possibly a
drop-foot on one side and a little disturbance of sensation, perhaps
only over the buttocks and around the arms, and may have had
an irremediable crushing of the lower roots of the cauda equina
which will leave him with a loss of good control of the bladder for
the remainder of his days.
Fractures and Dislocations of the Spine W ith Gross or X-Ray
Evidence of the Bony Injury
The most frequent gross deformities that are seen are a gibbus— a
prominence of one or more spinous processes especially in the tho
racic or lumbar regions. In the cervical region the position of the
head and neck often changes, so that the head sinks forward and
somewhat downward. X -ray films may show a forward or backward
dislocation of the body of a vertebra or part of a vertebra, a crush
ing of one body, so that the body is of triangular shape on lateral
X ray and is much thinner on films taken anteroposteriorly.
Fractures of the odontoid process of the axis were once considered
accidents which were regularly fatal, but I have seen four cases in
which the X ray showed a fracture of the odontoid but in which the
patient had practically no symptoms or disturbances excepting a
stiffness of the neck.
In fractures or fracture dislocations of the cervical vertebrae, there
may be a great amount of deformity of the vertebra with but few
symptoms.
On the other hand, on account of the great amount of mobility of
the cervical vertebrae, a complete crush of part of the cervical cord is
very frequent, especially after diving and automobile accidents.
Immediate Prognosis in Fresh Fractures and Dislocations o f
the Spine With Cord Injury
In my experience, 9 out of every 10 patients with the signs and
symptoms of a complete crush of the cervical cord actually have a
complete transverse lesion, and in these the immediate prognosis is
MEDICAL SESSION---- DOCTOR ELSBERG
97
almost always a poor one. Many, if they do not die from the shock
of the injury or of lesions in other parts of the body, begin to have
intermittent fever within the first few days. When this fever is not
due to an acute infection of the bladder or to a pulmonary complica
tion, it is probable that the patient has an advancing myelomalacia
and that symptoms of involvement of the medulla with paralysis
of respiration will soon occur. Patients with a complete transverse
lesion may, however, remain alive for many months or for several
years, before they succumb to exhaustion, to chronic infection from
bedsores, or from infections of the bladder and kidneys.
Some patients have, at first, only the signs of a partial lesion of
the cord, but after a few days, due to a secondary softening, they
develop the symptoms and signs of a complete transverse cord lesion.
Others, who had at first the evidence of a complete transverse
lesion, begin to improve after a few days or weeks and the recovery
may be considered. These patients had the symptoms of but did
not actually have a complete transverse lesion.
Prognosis of Injuries of the Spine and Spinal Cord With
Special Reference to Disability and Earning Capacity
The patient with a complete transverse lesion of the cord, if
he lives for any length of time, ,is fully incapacitated from work
for the remainder of his or her life.
The patient with a fracture of the low^er dorsal vertebra© and
a marked lesion of the lumbosacral cord, may live for years, but
the diminution of power in the lower extremities, and especially
the total or partial loss of control of the vesical and rectal functions, makes him in the majority of instances useless as far as
earning capacity is concerned.
The individual who sustained a fracture of one of the lumbar
vertebrae with complete crush of the roots of the cauda equina
may live for many years, but his earning capacity is always greatly
reduced, both by the diminution in the power of the lower limbs
and by the bladder and bowel disturbances.
The patient with a partial injury to any part of the spinal cord
may recover so much of the function that has been lost that he
is able to resume his full earning capacity. While it is impossible
to make any categorical statement on this subject, because so much
will depend upon the amount of injury to the cord, one may say
that a reduction of earning capacity occurs in at least 60 to 70 per
cent of the patients, due either to a remaining weakness and a
secondary atrophy of an upper extremity or of both upper and lower
limbs, to persistent bladder disturbances, to secondary deformities,
etc.
The main amount of improvement after a spinal-cord injury wTill
occur within the first six months, and little functional improve
ment will occur after about one year has passed.
After the maximum amount of improvement has occurred, some
patients begin to develop increasing signs of cord involvement,
which may be due either to secondary degenerative changes in the
spinal cord itself which are irremediable, or to changes in the
affected vertebrae from new bone formation which may be greatly
improved by operative interference.
98
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
Finally, as has been already mentioned in the remarks on fracture
o f the spinous or transverse processes, any individual who has sus
tained a vertebral trauma without cord symptoms or wTith such
symptoms with complete recovery, may in later years develop a
progressive degenerative spinal-cord disease.
Statistics of the end results of spinal injuries must always be
accepted with some reservation, for in most instances facts regard
ing the final condition of patients reported as “ .improved ” are not
given. Frazier, in his collection of a large series of cases from the
literature, especially mentions this.
Prognosis of 228 cases of fracture {Frazier)
Com
plete
trans
verse
lesion
End result
R ecovery__________ _____ ____ ______ ______
Im proved_______________ ___________ ______
U nim proved________ ________________ _____
Immediate death__
_____ ______________
■Subsequent death..............................................
N ot stated____ _ ____________________ _____
Total___________________
___
N o in
volve
Partial Root
involve
ment
lesion
ment of root
or cord
N ot
stated
Total
Per
cent
0
9
11
17
23
1
J5
23
2
2
12
3
5
5
1
0
0
2
27
41
0
1
2
14
1
2
0
2
1
1
48
85
14
22
38
21
21.0
37. 3
6.1
9.6
16. 7
9.3
61
62
13
85
7
228
100.0
The general statement, the higher the lesion the more grave the
prognosis, is to a certain extent true, and this is borne out in most of
the statistical tables. For the reasons already given, the percentage
of immediate and later deaths is probably larger than would appear
from Frazier's collected series.
In 25 personal cases followed up by Frazier, the earning capacity
was unaffected in 7, was reduced in 7, and was lost in 11. Thus, com
plete disability occurred in 44 per cent of the patients that this
author was able to trace.
The figures of some of my own experiences show the following:
In 18 of 22 patients with complete transverse lesions of the cord,
death occurred within six weeks of the time of the injury. Four
patients lived for periods of one to three years, totally incapacitated.
O f 22 patients with incomplete cord lesions, 12 recovered to such an
extent that they were able to return to their usual activities, 6 were
able to do a certain amount of work, and 4 were totally incapacitated.
O f 4 cases of spinal trauma with haematomyelia, 1 patient died within
two months, 1 succumbed to complications about two years after the
injury, 1 recovered a great deal of power but vesical and rectal con
trol did not return and he was unable to return to work, and 1 re
covered almost completely.
Indications for Treatment in Fractures of the Spine, and Influ
ence of Operative Treatment Upon Subsequent Course of
Symptoms
Patients with fresh fractures of the spine with cord and root
symptoms should rarely be subjected to operative interference. I f a
patient has a complete transverse lesion of the cord, operative inter
ference can do no good, and if the signs are those of a complete trans
MEDICAL SESSION---- DOCTOB ELSBEEG
99
verse lesion but the patient has not a complete lesion, th^re is no
harm in waiting. The claim so often made, that if the patient has
a complete crush of the cord, the operation can do no harm as the
condition is hopeless anyway, and if the patient has not a complete
lesion, the operation may do good, is fallacious and should be aban
doned. I have already indicated to you that possible pressure from
effused blood never justifies an operative interference.
The only patients with a fresh fracture of the spine in whom oper
ative interference might be indicated, are those in whom with the
symptoms of a partial loss of function, there is evidence on the X -ray
films of a marked deformity of the spinal canal with pressure upon
the spinal cord by dislocated bone or bone fragments, and, only very
rarely, the patients in whom there are severe root pains from pressure
of dislocated bone upon one or more sensory roots. That the latter
condition is very unusual is shown by the fact that in the not incon
siderable number of cases of fracture of the spine that I have seen in
the last 20 years there was only one case of an incomplete cord lesion
in which the severity of the root pain was in indication for surgical
interference.
Only very occasionally (I believe in not more than 1 to 2 per cent
o f patients with incomplete cord symptoms) does the X ray show
so marked a deformity of the spinal canal that immediate operation
is imperative.
In the large majority of instances it is advisable to wait, for the
patient can be operated upon one or two weeks later if there be an
indication for operation, with a better chance of benefit than immedi
ately after the injury has been sustained.
It is my firm belief, therefore, that only exceptionally should the
surgeon interfere early after a fracture of the spine, and a waiting
policy is indicated in almost all of the patients.
The nonoperative treatment is of very great importance and is
mainly a nursing problem— the prevention of bedsores, the care of
the bladder and bowels, etc. The patient should always be placed
upon a water or an air mattress and the greatest care be taken that the
back, especially over the sacral region, the heels, and hips are pro
tected against pressure.
The smallest suspicion of redness in any of these regions calls for
the most careful treatment. I f the patient is incontinent, the great
est care should be taken that the skin around the buttocks and genital
regions does not become irritated from the moisture or the soiling
of the bedclothes. One should always make certain that an apparent
incontinence is not really an overflow of a distended bladder. I f
there is retention, the bladder should be emptied at regular intervals
by catheter. The strictest asepsis in every detail can in many cases
not prevent cystitis and its complications. The bladder should be
washed out every day with a bland solution— after the urine has been
evacuated.
Immobilization of the spine is rarely necessary excepting in the
cervical region, where a posterior padded splint or plaster of Paris
may be useful. In many instances it is sufficient, even in fractures
o f the cervical vertebrae, to support the head on each side by a sand
pillow. When necessary the patient should be moved or turned
always with the greatest of care.
100
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
After several weeks, careful massage of the affected limbs should
be begun perhaps with other mechanico and electro therapeutic
methods.
I f after an injury to the vertebral column a diagnosis of traumatic
hsematomyelitis is made, operation is never indicated.
In which patients is there a justification for operation, at a later
stage; i. e, months or years after the injury?
While each case must be considered by itself, the following state
ments can be made:
1. Operation may be of benefit a few months after the injury in
patients with persistent spinal symptoms in whom the X ray shows
more or less marked angulation or deformity of the vertebral canal.
In these patients, a wide decompressive laminectomy may allow the
cord to bulge backward and thus an acute angulation of the cord
be relieved. I have in some instances seen a great deal of improve
ment follow such a decompressive operation.
2. Operative interference is indicated in those patients in whom
there has occurred, months or years after the vertebral trauma, so
great a production of new-formed bone, visible on the X -ray films,
that the patients have progressive signs of interference with the
functions of the spinal cord due to the increasing pressure of the newformed bones. In the writer’s experience there were several cases in
which the patients wTere very greatly improved by the operation at
which the new-formed bone was removed and a wide decompres
sive laminectomy performed.
3. In a few patients there is persistent pain due to adhesions be
tween the membranes and scar tissue around sensory roots, even
though the X -ray examination fails to show any bony abnormality.
Some of these patients have so much pain that an operation becomes
imperative, if they are not to become drug habitues. In some of them
pain may be relieved and spinal symptoms improved after the
division of adhesions and of constricting bands. But one can never
promise the patient certain relief from the decompressive laminectomy
and the division of adhesions.
Occasionally, when the root pain is strictly limited to one or two
sensory roots, a laminectomy and division of the affected root may
give complete relief.
Where pain is the most disturbing symptom and is persistent and
very severe complete relief may follow a laminectomy and division
o f the anterolateral tracts of the spinal cord. These tracts transmit
the sensations of pain and of temperature, and after an anterolateral
tract division sensibility to pain and to hot and cold is lost below the
level at which the tracts were divided.
4. Occasionally, after a fracture of the spine with injury to the
spinal cord, a persistent spasticity of the lower limbs prevents loco
motion, although there is good motor power. Such a patient can be
put upon his feet again by the division of the proper posterior roots.
This operation, based upon the investigations of Foerster, is now
rarely performed, but it is a very useful operation in some o f these
patients with persistent spasticity of the lower limbs after a spinal
injury.
5. In rare instances, in patients with traumatic haematomyelia, in
whom marked symptoms persist or in whom, many months after the
FIGURE
A —A N G U L A T IO N OF T H E DURA A N D CORD
T H E S P IN E (D IA G R A M M A T IC )
100—1
AFTER
FRACTURE
OF
F I G U R E B.— R E S U L T A F T E R O P E R A T I O N OF T H E P A T I E N T S H O W N IN F I G U R E
A. T H E R E M O V A L OF T H E A R C H E S OF T H E T H I R D A N D F O U R T H V E R T E
BR A E H A V E R E L I E V E D T H E A N G U L A T I O N O F T H E C OR D
100—2
F I G U R E C —A P P E A R A N C E OF C O R D A T L E V E L OF O L D T R A N S V E R S E C O R D
L E S IO N
F I G U R E D.— F R A C T U R E OF T H E T R A N S V E R S E PR OC ESS ES O F O N E S ID E OF
T H E FI RS T , S E C O N D , T H I R D , A N D F O U R T H LU M BAR V E R T E B R A E F R O M M U S
C UL AR V I O L E N C E
100—4
F I G U R E E — C R U S H I N G F R A C T U R E OF T H E S E V E N T H C E R V I C A L V E R T E B R A DUE
T O A U T O M O B I L E A C C I D E N T W I T H M A R K E D A N G U L A T I O N OF V E R T E B R A L
CANAL
100—5
MEDICAL SESSION---- DOCTOR JAFFIN
101
injury, an advance of symptoms occurs which is probably clue to an
increase of fluid in a cord cavity, a laminectomy with incision of
the cord and evacuation of the fluid will be followed by a marked
improvement in the power of the lower limbs. I have twice seen
great benefit from such an operation, although in both instances the
bladder incontinence was not improved.
[Doctor Elsberg showed lantern slides illustrating his paper. See
Figures A , B, C, D , and E.]
The C h a i r m a n . The commissioners who are serving for the State
of New Jersey will tell you that some of their greatest trials and
tribulations are in connection with cases where the traumatized in
dividual alleges an accentuation of a chronic disease. These chronic
diseases include cancer, diabetes, arthritis, heart disease, tuberculosis,
appendicitis, and the Lord knows what. The rule has been, if we
believe that there has been an accentuation, to award a certain
amount of compensation.
I think Doctor Jaffin has one of the hardest subjects to deal with,
and he will now present his paper to you.
Doctor J a f f i n . I want to say first that in dealing with this topic
in general it is necessary to bear one thing in mind, that we are
going to talk about the relationship of trauma, not to the etiology
of disease, but only to the accentuation of the disease. It has been
difficult, even for the writer, to divorce the two aspects of the sub
ject, and I want to emphasize this before I go further, because in
the discussion it is almost impossible sometimes, in speaking of
various diseases, to keep this factor in mind.
Traumatic Accentuation of Chronic Disease
By A b r a h a m E. J a f f i n , M. D., attending physician Jersey City (N . J.) Hospital
The discussion of a subject so comprehensive in its scope as trau
matic accentuation of chronic disease can hardly be undertaken in
great detail within the limits of any paper to be presented before this
meeting. Because of its ever-increasing importance, however, both
from a scientific, as well as from a medicolegal aspect, its present
status is well worth investigating and its future value established
by a more careful study and follow-up of all cases in question.
In this country, little study has been made of the effects of trauma
on preexisting diseases, while abroad there is already a considerable
literature on the subject. Most of the facts and observations, how
ever, must be gleaned from records of experiences with trauma in
general. The usual point of view has been that of the trauma causing
the disease, rather than the study of its actual relationship in ac
centuating previously existing disorders.
The difficulties facing the writer attempting to present this sub
ject to an audience composed, as this is, of men with larger personal
experience than the writer, are apparent. Few men, however, can
have opportunity enough in their own lifetime from which to draw
very extensive conclusions. It may be possible, then, to present a
brief survey of the subject from as many sources as possible within
the limited time at our disposal. These are mainly from such works,
papers, reports, personal communications, and experiences as are
102
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
available. A few conclusions from these sources may then be estab
lished. O f equal importance, however, if not more so, would be the
stimulation of further observations along this line.
The subject is a very difficult one. It requires full, broad, and
open-minded study of all of the facts in any given case. The great
est care is necessary in weighing the evidence fairly. In a general
wTay we may assume that an individual may be the subject of disease
as manifested by defective function of pathological changes without
subjective or objective evidence for some time. Examples of this
are common enough in tuberculosis, lues, early cardiovascular
disease, notably coronary sclerosis and aneurism, diabetes, etc.
Such an individual, accustomed to a certain reasonable daily
routine, may go on for a long time performing satisfactorily his
daily duties in spite of the slowly progressive processes above men
tioned. It is evident, however, that such an individual is a subject
of diminished resistance or stamina and will react differently to
shock or trauma, either of which would obviously lower his resistance
still further. This trauma need not be as much as would be neces
sary seriously to affect a normal individual. This is a most important
point to be considered in estimating the relationship between the
degree of trauma and its consequences. The body that is the seat
of a preexisting disease, lacking the compensating resistance, reserve,
and recuperative powder of the normal individual, will naturally
suffer more and longer and even permanently from a trauma that
might cause a normal individual little or only temporary disability.
What, then, are the factors of greatest importance in so far as the
individual’s resistance to trauma is concerned? They are: First,
normal vasomotor tone; second, normal blood; third, good nutrition.
A ll of these are most essential in providing normal resistance. Ob
viously, then, an individual suffering impairment of any of these,
will not only suffer greater disability from trauma, but also be
apt to suffer aggravation of the preexisting processes responsible for
the lowered resistance.
Obviously, trauma with or without any degree of shock will tend to
lower the vasomotor tone by a fall in blood pressure, and in other
ways lower the body resistance, so as to favor the activation of any
preexisting disease. The loss of blood is, of course, a very impor
tant additional factor.
It is very apparent, therefore, from an industrial aspect, I might
say at this point, that when an unhealthy worker is engaged on an
equal basis with an able-bodied individual, the former’s susceptibility
to disability from an accident is an increased liability to the employer
or insurance carrier. A knowledge of the employee’s handicaps in
the beginning would be to mutual advantage in the end.
The periodic health examination is the best example of the frequent
discovery of various functional and organic disorders unknown to the
individual. This system has for a long time been in practice by
organizations employing large numbers of workers, with excellent
results to both sides. From the employees’s side we have the benefits
of preventive medicine and for the employer an economy that more
than compensates for the. cost of the medical services required.
A consideration of the influence of trauma in accentuating disease
must include some analysis of the different mechanisms of the body
MEDICAL SESSION---- DOCTOR JAFFIN
103
and their resisting powers. W e are chiefly interested in the question
of what diseases are most likely to be aggravated by trauma, and how
long after trauma the latter influence may still be effective. The
time element is a most important item, and it is necessary to have
some accepted period of time within which the connection between the
trauma and its effects may be established under various circumstances
in various conditions.
From what has already been said about lowered resistance, etc.,
we may at once take up the more common chronic constitutional
diseases and summarize certain conclusions that past experience
may have established. To date, there is hardly any doubt that
the largest number of problems with reference to the question to
be discussed comes up in connection with two of the most common,
and therefore the most important, diseases; namely, tuberculosis and
syphilis. Further on, I will refer to a number of other important,
though less frequent, diseases and conditions.
Tuberculosis
While there are many widely diverging opinions on the question
of injury as a factor in extra thoracic tuberculosis, most authors
are in agreement on the influence of trauma in aggravating pre
existing phthisis. So positive are some that they state, “ for medico
legal purposes, active tuberculosis following an injury should be
considered a valid cause for claims for damages when an attempt
is made to determine the responsibility. (Fishberg, 1922.)
Quoting Dr. Percy K id d: “ W e find the occurrence of phthisis
in connection with trauma may be due to laceration or contusion
of the lung and infiltration of its tissues with blood or inflamma
tory products favoring the entrance and germination of the tubercle
bacilli, which are more or less ubiquitous. From the rapidity with
which pulmonary symptoms appear in most of the cases, it seems
more reasonable to suppose that injury to the chest wall may rouse
into activity some latent tuberculous focus, probably by laceration
or loosening of its fibrous capsule.”
In one or two instances, when the patient gave a history of injury
to one side of the chest, the physical signs of the disease were con
fined to the opposite side.
F. Parkes Weber arranges possible traumatic tuberculosis in three
groups: (1) Definite trauma of some kind, injury by accident, sur
gical manipulation, etc., followed either by acute generalized tuber
culosis, with death in a month or two, or by metastatic localized
tuberculosis m parts removed from the seat of injury; (2) signs
of pulmonar}7 tuberculosis first noticed after a supposed injury to
.the lungs; this condition he thinks is rare; (3) instances in which
injury to bones or joints or other parts than the lungs is followed by
tuberculosis more or less localized to the seat of injury.
H is conclusions on the matter are that it must always be difficult
and doubtful to decide what part has been played by the trauma in
any particular case of alleged traumatic tuberculosis. Searching
question^ must be asked: (1) Did the injury merely accelerate the
progress of lung tuberculosis? (2) W hat were the possible extent,
distribution, and activity of the original tuberculous lesion at the
104
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
time of injury?
(3) W as there any clinical evidence that the
patient was actually tuberculous at the time of the injury?
Brockbank, of Manchester, believes that a severe contusion of the
chest, without actual injury to the pleura or lungs, might depress
vitality in a person with bad tuberculous heredity so much that the
tubercle bacilli which had previously just failed to get a hold in
the lungs were thereby enabled to do so. He had one man under
his care in the hospital who died from miliary tuberculosis which
developed within a few weeks after a bad crush to his chest, and
which he thought was brought on by the accident.
Ritter, also, argues that shock as well as trauma may lower vitality
so that latent tuberculosis germs may change tuberculous infection
to tuberculous disease. However, shock in this sense is to be con
sidered only such as would follow trauma. Tuberculosis may de
velop then in tissue free of germs at the time of the injury, but
invaded later through the blood stream. Frequently tuberculosis,
when accentuated by trauma, becomes rapidly fatal. A number
of examples are sighted such as injury to a tuberculous testicle or
operations in connection with gynecological tuberculosis having been
followed by a general miliary infection.
Barnett believes that bad results following accident are more
marked in a tuberculous subject than in any other. I f the case be one
of pulmonary tuberculosis, the general resisting power is lowered;
the same is true to a less extent when tuberculosis of other organs is
present. I f tubercular disease of bone or joint be the form the dis
ease has taken, although the general health may be fairly good at
present, an accident to the affected part will much accelerate the
pathological condition.
Magruder, in a very comprehensive discussion in this connection,
also agrees that traumatism in those already tubercular may be the
means of localizing the lesion or facilitating the dissemination of
the disease throughout various organs and tissues of the body. Dam
age to the tissues lowers the resistance of the injured part of the
body and invites local infection, while shock to the nervous system
and the enforced confinement after certain accidents, often among
bad hygienic surroundings, act still further by depressing the general
health and promoting infection. The duration of the time between
the reception of the injury and the first evidence of the development
should in all cases be considered.
According to Fishberg, the appearance of clinical symptoms of
phthisis may be delayed for some time, of course, in quiescent lesions,
which are activated as a result of traumatism. The aggravation of
the condition in the chest or the extension of the process may appear
some time after the accident, and haemoptysis may appear even imme
diately. But in apparently healthy persons the symptoms may ap
pear many months or years later. Hawes mentions several cases in
which phthisis developed 2 to 10 years after injury, and Fishberg
agrees with him. It takes about eight weeks foi a tubercle to de
velop, and one tubercle is by far not enough to give symptoms or
signs by which it can be recognized by the physician. In fact, when
a few days after an injury signs of phthisis are found, especially
wThen tubercle bacilli are found in the sputum, we may conclude that
we are dealing with a preexisting disease, which was, at most, aggra
MEDICAL SESSION— DOCTOR JAFFIN
105
vated by the accident. But in cases in which the symptoms, such as
fever, emaciation, cough, and expectoration, etc., make their appear
ance three to six months after the injury in a person known to have
been well before the accident, and the physical signs appear even
later, it is clear that there was a causative relationship between the
injury and the disease.
German authorities have limited the time for the appearance of
the symptoms to six months, although there are undoubtedly excep
tions which must be judged on individual merits. The United States
set a 3-year period for compensation for tuberculosis incurred in line
of duty during the war. It is also pointed out by this author that
many, if not most, persons harboring latent or healed tuberculous foci
with virulent tubercle bacilli may suffer reactivation of the process
after an injury. Severe injuries to the- chest have been known to heal
in normal individuals even wThen complicated by pneumothorax and
haemothorax. But in those with preexisting lesions of the lung, active
or dormant, the subsequent course is apt to be quite different. The
intensity of the injury is no criterion o f the probability of its rela
tionship to the phthisis, subsequently developed. A s pointed out by
Wolff-Eisner, tuberculous osteomyelitis after violent bone injury is
rarely observed, while after slight injury to bones local tuberculosis
has frequently been noted. Similarly slight injury to the chest may
flare up a latent process. This is not an uncommon experience in
persons thought to be healthy. John B. Hawes points to development
of consumption in football players after the autumn season from
injury received on the field. In this connection it is worth noting
that the special diet usually prescribed by the trainer, as well as the
excessive exercise for months during the training period, undoubtedly
reduces the resisting power of even gridiron heroes.
Most authors agree that the site of the lesion is not necessary at
the point affected by the blow. This has already been referred to.
It is pointed out that haemoptysis is not absolutely essential to
establish the relationship between the injury and phthisis, because
laceration of the lungs may occur without causing hemorrhage.
When haemoptysis occurs and a quantity of blood is expelled, it is no
criterion of the size of the torn vessel, nor must there remain any
external marks on the chest wall, because an injury may lacerate the
lung or pleura without leaving any external traces.
The dissemination of the infection from the breaking up of a
latent lesion through trauma has already been mentioned. There is
an agreement among authorities that the effect o f trauma on pul
monary tuberculosis is in true proportion to the extent of activity of
the preexisting process.
W hile not bearing truly on the subject, it is well worth noting
in passing the frequency with which active pulmonary tuberculosis
has been observed to follow surgical operation; this, too, is naturally
another form of trauma. I have personally observed at our clinic a
number of patients referred for pulmonary tuberculosis shortly after
surgical operation such as tonsillectomy, herniotomy, chronic appen
dix, etc. This observation has been confirmed by many authors.
Baldwin and his associates also called attention to the direct con
nection between injury, contusion, or blow, and outbreaks of tuber
culosis, They also refer to the frequency of tuberculosis within
106
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
few weeks after surgical operation.
after severe contusion of the brain.
According to Magruder:
Meningitis has been observed
A study of cases in literature in which the connection between injury to the
chest wall and development of tuberculosis of the lungs appears very close
seems to indicate that the disease occurs more frequently after contusion and
slight injury to the chest than after fractures of the ribs or penetrating wounds of
the chest, wall. In spite of this fact in 159 individuals who received penetrat
ing wounds of the chest wall, Deme showed that 17 died some time afterward
of pulmonary phthisis. English estimates that over 48 per cent of injured
persons who develop traumatic pneumonia and subsequently recover, as a result
of the injury and pneumonia fell victim later to pulmonary phthisis. Weiner,
in an analysis of statistics in 436 cases of phthisis pulmonitis, found clear evi
dence *of trauma in 8 per cent. In a record of 238 cases of individuals suffering
from pulmonary consumption, Lenigen found that 23 gave a clear history of
traumatism and in but one of those was tuberculosis iri evidence before the
injury. Mendelsohn reports 9 cases which, without fractures of the ribs or
laceration of the lung, developed tuberculosis shortly after contusion of the
chest, Speltont, in a report of 56 cases in which traumatism, of the lung had
been followed by pneumonia, found that tuberculor infection had subsequently
taken place in the exact area of the lung tissue which had been the seat of
the preceding traumatic pneumonia. Accidents in which an individual falls
a great distance or is badly shaken up and receives injuries, not necessarily
of the chest wall, may, by tearing loose some preexisting adhesions of the
pleura, excite an active tubercular pleurisy.
Fairchild says:
Some authorities believe, though, that in those cases where pulmonary tuber
culosis develops two or three months after all constitutional and local symptoms
have subsided, it can not be assumed that the accident is the cause of the
disease.
Tuberculosis of Bony Structures
In Calmette’s recent work on Tubercle Bacillus Infection there is
apparently no discussion of trauma with reference to pulmonary
tuberculosis, but he does discuss some contradictory experiments by
various foreign investigators on the relationship of trauma to bone
and joint tuberculosis. W ith reference to the latoer, I would quote
the following:
On many occasions attention has been called to the influence of traumatism,
particularly during the period of skeletal growth, as prompting the localization
of tuberculosis in bones or joints. Some time ago, Max Schuller tried to demon
strate this and performed certain experiments about which there was some
commotion. After having infected his animals, he submitted them to various
traumatisms and observed tuberculous osteoarthritis develop at the points of
injury. Noninfected animals, on the other hand, although subjected to similar
traumatism, exhibited only a haemarthrosis, which cured spontaneously.
These experiments of Schuller were later repeated with more perfect tech
nique and quite different results by Lannelongue and Archard (Internat.
Congr. on Tuberc., Berlin, 1899), by Friedrich (Munchan. med. Wchnschler
(1899), 46:1313) Honsell, (Ibid. (1900), 47:1831), Fr. von Friedlander, and
others, so that at the present time surgeons are rather of the opinion that
the r61e of traumatism in the generation of bone and joint tuberculosis' is rela
tively limited.
Meningitis may follow injury to or operation upon tuberculous
joints or other foci of tuberculosis. In these cases, the injury is the
determining factor.
The influence of trauma on the development of bone tuberculosis already
the seat of early or quiescent disease is the same as in other localities produc-
MEDICAL SESSION---- DOCTOR JAFFIN
107
ing a focus of low resistance, in which area of depression, the inflamed
tissues are easily infected by bacilli coincidentally set free from some pre
existing tubercular gland or other lesion. (Magruder, p. 22.)
Syphilis
Syphilis is another disease in which trauma often plays a very
important role in aggravating or accentuating a latent infection or
process into one definitely active and progressive.
Stokes considers it “ simply another expression of the tendency of
disease to take advantage of powered tissue and general resistance.
In fact, it was an axiom of the older syphilologists that one might
always find latent or concealed syphilis becoming outspoken at a
locus minoris resistentiae. He refers to numerous examples of gum
matous changes in war wounds during the late war. Gumma of the
testes following trauma and delay or nonunion of fractures are also
known to be at times due to gummatous changes.” He quotes Klauder, who describes cases in which the Wassermann reaction became
positive after trauma although repeatedly negative before. “ Landouzy’s case of an army officer who, after 25 years of latent syphilis,
developed an osteitis following a fall from his horse is typical of a
considerable series. Injury to the head has long been thought to be
the starting point of clinical manifestations of paresis in certain
patients, although such observations are not above criticism. * * *
The traumatic influence may, as Gougerot and Clara point out, fol
low every type of injury mild tor severe, sudden or prolonged, single
or repeated. Bone changes and soft-tissue gummas furnish the best
examples. It has been noticeable in my experience that trauma is
by no means an invariable excitant of gummatous changes, even in
supposedly eligible subjects. In fact, if surgical injury is a fair
example of physical trauma, the incidence of gummatous manifesta
tions in patients with late syphilis is very small, provided the gumma
previously present is not operated upon or traumatized. The reac
tion of gummas that have been operated upon or traumatized is im
mediate and disconcerting, a rapid and destructive extension and
prolongation of the process being the almost invariable result. The
importance of these issues for industrial medicine and workingmen’s
compensation is apparent. There is an unpredictability about the
response of the tissues of a syphilitic person to trauma which, while
it permits many to escape, always brings down disaster on the wrong
head.”
Heavy physical exertion is definitely recognized as predisposing
to aneurism.
Stokes further reports in detail many examples of the effect of
trauma in producing a flare-up of a quiescent syphilis at the point
of lowered resistance. So much is he impressed with the importance
of this connection that he emphasizes the following: Whenever un
favorable reaction to injury is out of all proportion to the gravity
of the injury or the seriousness of the exciting cause, suspect syphilis,
especially if the onset of reaction symptoms is delayed.
Subjects with hereditary syphilis will be prone to show prolonged
convalescence mainly after injury to the nervous system such as con
3 1 5 7 3 ^ 2 9 -----8
108
FIFTEENTH
annual
MEETING OF I. A. I. A. B.
c.
cussion of the spine; the hereditary syphilitic is often the subject
o f neurasthenia, hysteria, or of a general nerve degeneration and so
is a bad subject for such accident. (Barnett, p. 92, 1910.)
Magruder quotes Ravogli (Syphilis in Its Medical, Medicolegal,
and Sociological Aspect, 1907) with reference to the increased fragil
ity of the bones in syphilis and the liability of fracture at the site
of the gummata. Also bone lesions have been observed to develop
in luetics in regions subjected to prolonged irritation. W ith ref
erence to the relationship between trauma and the appearance of
gumma, Schepelman believes that if the evidence appears later than
six months, one may deny the claim, because the in jury caused by the
trauma has healed to such an extent that locus minoris resistentiae no
longer exists.
Malignancy
W e are, of course, not interested in the debatable point as to
whether trauma is an etiological factor in malignancy. When we
come to the subject, however, of aggravation or accentuation of the
same, we find opinions strongly in favor of the latter.
Mock and Ellis submitted the following for the consideration of
courts of law, compensation boards, etc.:
A preexistent malignant tumor may be aggravated or accelerated in its growth
by a trauma; the trauma may be the first factor to call the patient’s attention
to the tumor. Treatment should be instituted at once to> eradicate the tumor
or at least to prolong the patient’s life. Under ourJpresent; laws which provide
for compensation in case of aggravation of an existing condition by trauma, the
employer or his insurance company would be held responsible for this treat
ment, provided aggravation could be shown, and would be forced to pay for
the permanent disability which might follow. He should not be held responsible
for the subsequent death of the patient due to malignancy which will occur in
the majority of these cases, for the trauma could not aggravate to the point
of fatality a preexistent condition which had already doomed the patient posi
tively. Nor should he be held responsible for hastening the death, for this point
could only be one of speculation on the part of the medical profession.
Ewing also refers to those cases of malignancy first discovered
after trauma but which antedated the injury. He agrees that trauma
is very likely to aggravate a malignant growth, especially if the
former is a recurring one. I t may then “ cause an alteration in the
course o f the tumor, a change in the local lesion, and a shortening
o f the duration of the disease.”
Some investigators are inclined to believe that a “ precancerous 55
lesion may in the same manner be altered to a cancerous growth
through trauma.
Central Nervous Diseases
The most important chronic diseases of the central nervous system
that might be accentuated by trauma have already been covered under
the subject o f lues— namely, tabes and general paresis. I f the symp
toms and course o f either after trauma are definitely more severe
there is little doubt as to the influence of the injury on the pre
existing disease. The period of time, however, between the trauma
and the aggravation of the disease must be taken into consideration.
There is another large group of nervous disorders that are very
much accentuated by' trauma or shock. While these can not be con
MEDICAL SESSION---- DOCTOR JAFFIN
109
sidered under the heading of organic disease, they do, however, play
a large and troublesome role medico legally.
Fright has induced epilepsy, chorea, and other nervous diseases
in individuals already predisposed to or suffering from these condi
tions but not among those previously healthy.
Predisposition, then, to nervous conditions proves an important
causative factor in the development of traumatic neuroses. A l
though many instances are recorded in which no personal or family
taint can be discovered, many more cases are imperfectly investi
gated and such predisposition exists without its presence having been
determined (Magruder).
In addition to the emotions of fright, extreme fear, etc., as con
tributory factors in the causation of functional nervous conditions,
suggestion proves immensely important as an additional promoter.
Suggestion may be active in a variety of ways. The frequent recita
tion of the details of an accident to friends and acquaintances, the
influence of physicians who, unfortunately, venture untrained neuro
logic opinions on the ultimate significance of the resulting symptoms,
and, too, that of lawyers during their discussion of the merits of a
claim for damages, frequently impress the minds of the injured
individuals in such a manner that their ideas of the permanency
or seriousness of their damage becomes more definite. In other
words, the potential neurotic may, through injury or shock, develop
a large train of symptoms without any intention of malingering,
which is spoken of as a “ traumatic neurosis.”
Cardiovascular Diseases
When we come to consider these we again find that the luetic
group is readily accentuated by trauma— aortitis and aneurism, for
instance.
The arteriosclerotic types suffer, apparently, to a lesser extent,
although here, too, the individual’s life may be shortened rather
abruptly, especially if the disease is advanced and approaching the
limits of compensation.
Arteriosclerosis, by predisposing an individual to diseases and degenerations
of all the organs in the body, becomes an active factor in the prolongation of
disability in those accidentally injured. The frequency of a complicating and
often fatal pneumonia following even slight injury in those with hardened
arteries is well recognized.
Arteriosclerosis causes sudden death more often than any other affection of
the arteries and as death in such cases frequently follows some unusual
exertion or some injury wThich would not in itself prove fatal, post-mortem ex
amination is often necessary to determine the real cause of death. (Magruder.)
Kahn and Kahn, in the Heart Journal of June, report their ex
perience with heart strain from its industrial aspects. They cite
case histories which lack data for accurate diagnosis, but present
sufficient evidence of the damaging effects of excessive physical ef
fort in individuals that were apparently well.
It seems much fairer to assume that there was preexisting heart
disease in these cases, which was accentuated in all of them by the
trauma of overexertion and “ strain.” The principal factor in
most, if not in all, of them was undoubtedly some form of vascular
degeneration, either sclerotic or luetic.
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FIFTEENTH AN N U AL MEETING OF I. A. L A. B. C.
It is surprising to note, however, the apparent disagreement of
another author in the same number— Clark, on “ The Effects of Acci
dents on Cardiac Employees.” This apparent difference of opinion
is, however, due to the fact that one author (Kalin) deals with the
factor of violent exertion, whereas Clark lists patients who had
trauma to extremities or head, such as fractures and dislocations.
The difference is obvious.
It is of further interest to note that the experience of Donohue,
of the Industrial Accident Board of Massachusetts, agrees with that
of Kahn, of New York, with reference to the accentuation of pre
existing heart disease from trauma involving severe strain or pro
longed convalescence.
Gastrointestinal Diseases
W e have already considered malignancy. To a certain extent gross
injury may possibly hasten the inevitable course of cancer of the
gastrointestinal tract. A n interesting personal observation occurred
very recently in my own service at the Jersey City Hospital in a
young man suffering from peptic ulcer. He was discharged last May
after a course of medical treatment for a bleeding ulcer; he remained
quite well and went back to his work as a railroad man. A few days
ago he fell off a moving locomotive onto his abdomen about three
hours after a meal. Shortly thereafter he vomited blood and again
several hours later. The following clay he had tarry stools. Here
we may definitely state that trauma accentuated the course of his
disease.
Diabetes
It is well known that diabetes is susceptible to considerable unfa
vorable influence from trauma severe enough to be accompanied by
more or less shock to the autonomic nervous system. Perhaps it is
due to the increased secretion of the adrenal under these circum
stances with its, attendant effects on the liver and blood sugar. In
an unfavorable case grave trauma might very readily precipitate
an acidosis.
Graves’ Disease
Although we still do not know the cause of this disease and asso
ciate all its clinical manifestation with hyperthyroidism, there is
little or no doubt that the onset is often due to or at least associated
with trauma to the central nervous system. Consequently further
trauma will obviously add to the severity of the existing disturbance.
Here, undoubtedly, the shock of the trauma is the important factor
involving the sympathetic nervous system.
Malaria
Many observers have reported malaria developing in individuals
harboring a latent infection after trauma. It is again an expression
of lowered resistance, apparently, and is analogous to the recurrence
of a positive Wassermann after injury in cases of latent lues. Baehr
noted while in the Balkans during the World W ar that wounded sol
MEDICAL SESSION---- DOCTOR JAFFIN
111
diers frequently developed severe chills and fever that were not due
to infection but were caused by malaria that had lain dormant for a
long time. In some way following the injury, the plasmodia returned
to the blood stream and the typical clinical picture of malaria
followed.
In several instances we have had cases transferred from the sur
gical service for obscure, nonsurgical postoperative fever in which
we have been rewarded in our studies by the discovery of plasmodia
and the complete cure with quinine. Obviously, the surgical trauma,
here, was analogous to the experiences in the war.
Haemophilia
This is another condition notably susceptible to aggravation
through injury.
In closing, I would say that I have tried to deal with the more
common experiences only and to collect what evidence I could from
available literature. There are, probably, many more chronic dis
eases that I have not touched upon. Together with those mentioned,
there is a large field for further study.
I f I have succeeded to any extent in stimulating greater interest
in that direction, the result will increase the pleasure and personal
benefits derived in the effort.
Permit me to express my deep appreciation of the honor and privi
lege afforded me in addressing you and to apologize for presenting
much with which you may already be familiar.
B ib l io g r a p h y
Fishberg, Pulmonary Tuberculosis, Lea and Febiger, 1922, pp. 638-648.
Kidd, Percy, Albutt and Rolleston’s System of Medicine, second ed., V, p. 289.
Weber, F. Parkes, British Medical Journal, 1916.
Brockbank, E. M., Incapacity or Disablements in its Medical Aspects. Lewis,
London, 1926, XI, p. 880.
Ritter, John, Handbook of Tuberculosis, Chicago, 1923.
Barnett, H. Norman, Accidental Injuries to Workmen, Rebman Co., New
York, 1909.
Magruder, W. Edward, Claims Arising from Results of Injuries, the Spectator
Co., 1910.
Flesh-Thebesius, M : Med. Klinik (1923), X I X : 21, 50.
Baldwin, Petroff, and Gardner, Tuberculosis, Truca Foundations Studies, Lea
and Febiger, 1927.
Fairchild, Railway Surgeon, April 17, 1900, p. 565, quoted by Magruder.
Stokes, John H., Modern Clinical Syphilology, Sanders, 1926.
Schepelman, Trauma und Chronische Infections, Krankheiter Med. Klinik 11:
512-514 (May 2, 1925).
Moch and Ellis, Journal A. M. A., 86; 257, Jan. 23, 1926.
Ewing, J. Amer. Journal of Surgery, 40 : 30, Feb., 1926.
Baehr, G., personal communication.
The C h a i r m a n . The next paper will be one on Fractures of the
Lower End of the Tibia and Fibula— Structural Changes and Im
proper Alignment—-Is the Disability Confined to the Foot and Leg,
or Should it be Considered as of the Total?
I can recall many instances where insurance claim adjusters found
a great deal of fault with my viewpoint when I said this individual
should have 25 per cent loss of a foot or that individual should have
40 per cent loss of the foot. O f course, they all had an argument;
112
FIFTEENTH A X X U A L MEETING OF I. A. I, A. B. C.
but in the back of my head I always had the idea that a badly
aligned fracture of that type was more than a local condition. See
ing that some of these men go around 10, 12, or 15 years suffering
with pain in the ankle, pain in the leg, pain in the thigh, and pain
in other places, getting home after a day’s work very much distressed,
it occurred to me that the disability was more than that, so we sub
mitted this subject for an analysis to Dr. Moorhead. Dr. Moorhead
will tell you something about the subject.
Fractures of the Lower End of the Tibia and Fibula— 1
Structural Changes and Improper Alignment— Is the
Disability Confined to the Foot and Leg or Should
It Be Considered as of the Total?
By J o h n J. M o o r h e a d , M . D., professor of surgery, Post Graduate Medical Col
lege, New York City
I f a man was a quadruped and not a biped, the fracture of the last
big joint of the hind leg might not be much of a handicap. How
ever, the biped standard on which man has been erected makes
fractures of the ankle or lower leg a problem in statics if we are to
maintain equilibrium and propulsion.
Viewed from a mechanical standpoint, the ankle joint is a mortise
of three bones, tibia, fibula, and astragalus. Essentially, the tibia
and astragalus are the activating important elements, inasmuch as
the fibula serves mainly to prevent outward side slipping of the joint.
Having in mind the architecture of this joint, it is pertinent to
recall certain elements as to the normal carrying angle of this joint.
1. The axis of the lower limb has a vertical carrying angle rep
resented by a line passing downward from the anterior iliac spine to
the tibial tubercle and thence to the middle of the joint to end in the
interspace between the great and the next toe. The lateral carrying
angle is represented by a line passing downward from the anterior
spine to the great trochanter, thence to the external condyle of the
femur, thence to the external malleolus, to end at the base of the little
toe. For memory purposes we can call these the crease and the seam
of the pants lines.
2. From an X -ray standpoint^ a vertical line dropped down the
outer margin of the tibia bisects the astragalus, just as a lateral line
bisects the astragalus when passed through the middle of the tibial
malleolus.
3. Normal plantar flexion of this joint is about 130°; normal dorsal
flexion about 100° ; normal internal rotation is about 15° ; and normal
external rotation about 20°.
4. It is very important to recognize that restoration of ankle func
tion is in terms of restoration of the seesaw action between the lower
end of the tibia and the summit of the astragalus. In other words,
we accurately fit the concave tibia into the convex astragalus.
5. The tendo Achillis must be “ in neutral ” with the foot at right
angles.
These five precepts are fundamentals, and deviation from them
means deformity with more or less disability.
MEDICAL SESSION---- DOCTOR MOORHEAD
113
Now the outcome of fractures above the ankle as high as the upper
third of the leg is likewise often predicated upon restoration of the
tibia-astragalus arch. Shortening and angulation, to be sure, are
elements of importance; but what does it profit if we regain normal
length and contour in a fractured tibia if at the ^ame time our ankle
function is impaired?
In passing let us not forget the clinical axiom that fracture of the
shaft of the fibula is of little importance because overlapping causes
no shortening, the fibula bears no weight, and it is practically never
a source of nonunion.
So much, then, for the preliminaries, and now for the end results.
Is malalignment in lower leg fractures a disability confined to the
ankle or should it be regarded a$ affecting the entire limb ?
Here we are entering controversial territory, and before journeying
further let us briefly survey the elements comprising end results.
For some years I have been estimating end results in terms o f: (1)
Function, (2) union, (3) contour.
Function is the ability to perform. Union is the state of repair.
Contour is the external appearance. I f all three are perfect, then
the outcome is perfect. Hence it remains to allot to each of these
an arbitrary percentage value if we would rate our end results by
figures and not by words.
A good result to you may mean a fair result to me. I may call
my result poor, but you would call it fair. Words, however exten
sive our vocabulary, are nothing like as accurate as figures.
A t the cattle show they rate the exhibits by certain predetermined
elements based generally on the two factors— actions and looks. Last
year’s Ford is subject to the same analysis.
I f they do these things so well for cattle and automobiles, can we
not apply the same criteria to humans ?
Function is the end in view, and we all agree that restoration of
function merits the highest rating. Hence in our classification we
allot 60 per cent for this element. To union we allot 20 per cent;
to contour 20 per cent. Now, the summation of function (60 per
cent), union (20 per cent) and contour (20 per cent) equals 100 per
cent or perfection. Applying this arbitrary method of estimation
to a fractured lower leg we proceed as follows:
Function, in terms of standing, walking, balance, joint, muscular,
vascular, and neural action is impaired obviously. I f it is impaired
one-half we allot 30 per cent for this element.
Union is solid, but the callus is irregular, adherent, tender. Hence
we take off one-fourth for this and allow but 15 per cent for union.
Contour is fairly well preserved, but there is some angulation, short
ening, oedema, and cyanosis. Hence we take off one-fourth for this
and allow but 15 per cent for contour.
Hence we have function, 30 per cent; union, 15 per cent; and
contour, 15 per cent. 30 + 15 + 1 5=60. Our end result is thus 60
per cent, and this from 100 per cent equals 40 per cent, which is the
extent of disability in this case.
To me this seems more satisfactory than attempting to designate
our findings by adjectives or adverbs. It makes little difference as
to the scheme we use; the point is that assessors should have some
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. 0 .
bases for computation, and these should represent impaired values in
terms of figures and not by the use of words.
There are certain fractures of the lower end of the tibia and fibula
that give so excellent an outcome that disability m almost minimal.
These are what I term type 2 fractures; that is, there is no initial
overlapping of fragments such as pertains in type 1. There are thus
two grand divisions of any fracture in any part of the body; namely,
type 1, or overlapping, and type 2, or nonoverlapping. Either of
these types may be simple or compound.
Hence our first approach to the problem is to type our fracture. I f
type 1 disability is almost inevitable; if type 2, disability will be
minimal.
Next we attempt to estimate the disability after the manner just
stated, in which we allot 60 per cent for perfect function and 20 per
cent each for perfect union and perfect contour. W e take into con
sideration such important factors as sex, age, race, occupation, station
in life. A painful, stiff ankle may totally disable a laborer, but a
bookkeeper may go on with his sitting-down job. A n eversion de
formity following a Pott’s fracture may disbar a policeman or a
fireman; but the ordinary employee would not be seriously affected
by such a deformity unless it also entailed disability. The other
elements as to sex, age, race, and station in life are also important,
so that a final estimate must consider all these factors as well as
those related strictly to the anatomy and surgery of the injury.
There are, then, certain fractures of the lower leg which cause a
grade of disability affecting the whole limb. These belong to the
type 1 group in which the ankle mortise is seriously damaged, and
there is also overlapping or displacement of the fragments so that
shortening or angulation also exist. In other words, we have de
formation of the joint and of the shaft, both of which contribute
to the gait defect, the joint limitation, and the altered carrying
angle. Some of these cases may alter the pelvic tilt to such an extent
that lateral spinal curvature occurs. From this severe grade there
are many variations down to the simplest form of the type 2 group in
which restoration of function is practically perfect. Purposely,
nothing has been said as to treatment, nor as to compound fractures.
W e are not concerned with details of that sort just now because our
inquiry relates solely to end results.
In passing we may be permitted the observation that early reduc
tion of any fracture, especially a joint fracture, usually means easy
reduction. I f we wait beyond 18 to 24 hours, cedema and muscle
and tendon contracture are already present as complications, and we
then are treating, not the fracture alone but also some of the imme
diate sequelae. W e waste too much time in our fracture work be
cause we are not quite ready to admit that a broken bone is as much
of an emergency as a broken appendix. Very soon, however, every
hospital will be so staffed that a crew will always be available for
the growing number of traumatic cases.
Prompt attention to this large group of lower-leg fractures will
certainly limit the disability and deformity. Imperfect or improper
treatment is frequently a responsible factor; but there are, as stated,
a number of these lower-leg fractures in which deformity and dis
ability depends upon irreparable structural damage
MEDICAL SESSION---- DISCUSSION
115
Conclusions
(1) Lower-leg fractures as to prognosis depend primarily upon the
initial extent of structural damage, and secondarily depend upon the
treatment.
(2) Essentially there are only two types of fracture; namely,
type 1, showing overlapping or separation of fragments ; and type 2,
in which there is little or no separation or overlapping.
(3) Fractures of the type 1 group are sources of disability and
deformity; those of type 2 group usually repair without disability
and deformity. v
(4) End results can be estimated on a percentage basis if wTe agree
upon certain arbitrary components and values.
(5) Function, union, and contour are suggested as these com
ponents ; and 60 per cent is suggested as the value ratio of function,
and 20 per cent the ratio for union and for contour.
(6) Figures afford us a more accurate expression^ o f opinion than
words. Incidentally, a method of this sort permits us to make a
comparative estimate at any stage of observation.
(7) Early reduction means easy reduction and lessening o f dis
ability and deformity.
(8) Disability should be limited to the foot and leg when there
is: (a) Absence of compensatory tilting of the pelvis or spine; (b)
absence of limitation in the joints above the ankle; (c) absence of
neural or vascular damage.
(9) Disability should be of the total when there is: (a) Compensa
tory tilting of the pelvis or spine due to shortening, angulation, or
anchylosis; (&) joint limitation above the ankle; (c) neural or
vascular damage.
D IS C U S S IO N
The C h a i r m a n . The papers which have been presented this after
noon are now open for discussion. The first paper is that of Doctor
Wainwright on trauma as a cause of cancer.
Mr. W i l l i a m s . Some of us who have had to listen to evidence about
malignant disturbance alleged to be due to trauma have had to hear
experts who would try to make you believe that there was a hard
and fast tie between sarcoma and carcinoma, instead of there being
a multitude of malignant types tending from one to the other. I
would like to hear what Doctor Wainwright has to say on that.
Doctor M c B r id e . I want to express the thanks of the members of
the association to Doctor Wainwright for having delivered his very
excellent paper. I think that perhaps those men who are engaged in
hearing these cases might want to ask some questions concerning it.
Doctor A v i d a n . W e have had a few cases in the department— only
six months ago a woman was caught in the breast and developed
carcinoma— but the medical profession has nothing to say; it is all a
question o f law. The deputy commissioners make the decision as to
whether or not it is compensable, The law says that any injury that
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FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. G.
will tend to aggravate or hasten the man’s death by one hour is com
pensable, so we have no control over it.
Mr. K i n g s t o n . I recall with a great deal of interest a paper on this
subject by a very eminent surgeon, Doctor Bloodgood, of JohnsHopkins, delivered at the Baltimore convention six years ago. It
would be very interesting to compare Doctor Wainwright’s excellent
paper with Doctor Bloodgood’s paper at Baltimore.
There is a question which wTe often have put up to u s: After more
or less serious injury to some part of the anatomy where malignancy
develops within a month or so, we have usually held that there can
be no relation between the malignancy and the trauma, whereas if
the malignancy develops six months later and at the very point of
the trauma, we feel that possibly there may be a causal relationship;
I would like to have that point confirmed.
Doctor E l s b e r g . During the last 10 years I have had very interest
ing experience with tumors of the brain. I have noticed with increas
ing frequency, when the head is shaved in preparation for an opera
tion, that I find a scar on the head where the tumor was supposed to
be located, and without any history of the patient’s ever having had
any injury of the scalp. So frequently have I fcund brain tumors
in that general location that now I feel very much better, in beginning
an operation for tumor of the brain, if I happen to see a scar over
the scalp in the region where I suppose the tumor is.
I have been forced to the conclusion that there is some relationship
between injuries to the head, as evidenced by scars in the scalp, and
tumors of the brain underneath in that general location.
Doctor M o o r h e a d . When Doctor Wainwright was preparing his
paper he was kind enough to send me a letter asking me a lot of
pertinent questions in regard to this situation, and I wrote back at
great length on the same sheet of paper on which he made these
inquiries, and, in brief, I will say this, that in my experience I have
never known of a case o f malignant growth under the surface of the
skin to occur as the result of a single isolated trauma. I have had
one experience and I think I told him of it— that of a woman who
had a blow on the breast in whom the relationship seemed so very
definite that I was forced to concede it.
I have known superficial malignancies to occur as the result of
prolonged trauma, and I have had the experiences we have all had
of seeing an epithelioma develop at the site of a large scar.
Doctor L o n d k i g a n . I have listened with a great deal o f interest
and pleasure to Doctor Wainwright’s paper, and I hesitate to speak
of a paper that has been so carefully and well prepared. However,
through my experience in examining about 250 patients in a month,
I can not agree that a single or even a double trauma is productive
of malignancy. I f it were so, I think we would have a greater num
ber of malignant cases than I see at our clinic. During the past year
I can recall only two which were supposed to have followed trauma;
one, to my mind, was not the result of trauma but of a lot o f bad
teeth present for a long time and causing chronic irritation.
The case Doctor Wainwright cited where the mole on the shoulder
was irritated by the back of the seat of the automobile would, I
think, prove that the trauma, where the part of the anatomy trauma
MEDICAL SESSION—-DISCUSSION
117
tized later on develops malignancy, is just an incident to the malig
nant growth that follows.
The C h a i r m a n . The next paper for discussion is Doctor Elsberg’s
paper on “ Fractures of the spinal vertebra.”
Doctor W a i n w r i g h t . I was tremendously interested and very
much instructed by Doctor Elsberg’s paper, and glad to see that he
had come to many of the conclusions we had worked out ourselves
and to the same results. For instance, there were two camps of
people, one that always used to operate on fresh fractures o f the
spine and tho other that never did. I have been in both camps. I
was in the first for a little while and never saw any results; now I
am with Doctor Elsberg— we never operate except for some special
reason.
One thing that perhaps is a little aside from Doctor Elsberg’s view
of this matter but must come up to him sometimes, especially in con
nection with cases like one or two that he showed, is where there is
a pressing fracture of the bones of the vertebrae with or without
symptoms. A good many of these cases are comparatively without
symptoms at the time of the injury; several months or years later
they do complain of some symptoms, due to the disturbance of the
whole anatomy because one end of the bone— of an anterior bone of
the vertebrae— has fallen down. W e think we are getting fair results
now in those cases by doing a fusion operation early, sometimes of
the Albee type, but the particular type you do does not matter very
much. A good many of those cases seem to come along later on in
life, with very severe symptoms, and we think that we are getting
better results, seeing fewer cases with symptoms two or three years
later. A t the present time we are in camp No. 1; as far as that goes,
we are still quite enthusiastic about doing fusion operations early on
patients who have crushed fractures of the bones of the vertebrae,
not basing our indications for operation on the present symptoms,
but simply for future results, thinking that the fusion operation, if
done early, is going to! prevent serious trouble later on.
Doctor M o o r h e a d . I am at the disadvantage of not having heard
Doctor Elsberg’s paper, but I am familiar wTith his views as regards
when to operate and when not to operate, and judging from what
Doctor Wainwright has said he has not changed his views. In
fractures of the skull and spine, instead of operating in the great
majority of cases men like Doctor Els worth and Doctor Taylor be
lieve that certain definite indications that ought to be met before
operating occur rarely, and that the operation should be done for
one indication only, that being pressure.
Doctor F l a g g e . I am very much interested in fractures of the
spine. I believe I see over a hundred fractures of the spine a year,
and I have seen fractured spines that were operated on and those that
were not operated on, especially the complex fractures. I have seen a
lot of them remain undisturbed, with wonderful results. I have seen
some of them splinted, with good results; I have seen some splinted
with poor results. I personally believe that unless you have a
serious pressure on the cord or there is some particular reason, such
cases ought to be let alone, and t h e n in 75 per cent of the cases you
will find excellent results. I do not believe in operating on them
right away,
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FIFTEENTH ANNUAL. MEETING OF I. A. I. A. B. CJ.
Doctor L o n d r i g a n . I have not heard anybody m a k e a definite rat
ing of the disability resulting from injury to the spine. That has to
be taken into consideration, whether or not wTe have nerve involve
ment as a result of the fracture. The percentages mentioned by
Doctor Moorhead in his paper would not apply— would that apply
to the spinal column ?
I have seen some very good results from fractured spine and I
have seen some very bad ones, in wThich there was no displacement,
just the lineal fracture of the bone, by wThieh a man was totally and
permanently disabled without apparent involvement.
I have also seen fractures of transverse process. I would like
Doctor Elsberg to speak on that. I have seen more fractured trans
verse processes with separation of the fragments, without union, in
which there is a permanently painful back, where a man usually has
to use a support all his life.
Mr. W i l l i a m s . In order that it m a y be put upon the record and
perhaps do some good, I wish Doctor Elsberg would tell us what
has been his experience with the result of chiropractors dealing with
lame backs.
The C h a i r m a n . The next paper is Doctor Jaffin’s.
Mr. S t e w a r t . I wrant to say just a few words about Doctor Jaffin’s
paper, not directly but indirectly, and to submit a proposition to the
association.
A t the Salt Lake City convention Mr. Wenzel, who, I believe, is
here at this convention, proposed a resolution committing this asso
ciation, if I remember it, absolutely to taking cognizance of accentu
ation of chronic diseases or conditions as a result of trauma. It was
committed to the medical committee. The matter was again taken
up at the Hartford convention. There have been so many papers—
at the Atlanta convention and here— particularly Doctor Jaffin’s
paper— that I want to suggest that to-morrow afternoon, after Mr.
Duxbury’s paper, in which he is going to touch more or less upon
that subject, that the matter be thrown wide ope a, that the associa
tion go to it head-on and either make a decision or appoint a com
mittee to report next }^ear. That- will enable this association to take
a stand. A t Hartford we sidestepped it; we neither approved nor
disapproved of the Wenzel resolution; we simply refused to accept it.
Now, it is a question that this association can not afford to side
step. I do not mean to tell you what side I am on, but I do think
that the time has come when, either to-morrow afternoon or by ap
pointment of a special committee to-morrow afternoon, we ought to
prepare ourselves to take a definite stand next year.
The C h a i r m a n . The next paper open for discussion is that of
Doctor Moorhead. W ill you start that discussion, Doctor W ainwright ?
Doctor W a i n w r i g h t . I hardly know how to start that discussion.
I have followed Doctor Moorhead’s teachings in traumatic surgery
very closely and have swallowed everything he has said— hook, bait,
and sinker— and he presented this subject again to-day so very
clearly and completely and cogently that I ha\e not changed my
m ind; I still go along the way I always have.
MEDICAL SESSION— DISCUSSION
119
Doctor A v i d a n . I want to thank Doctor Moorhead for presenting
this interesting paper; it is one of the very few papers I have
heard on the subject. O f course, this subject of percentage of dis
ability— you speak to 100 physicians, you ask them how they estimate,
and each one will tell you a different story. Doctor Moorhead goes
at it from a medical, scientific basis; he is very accurate on his path
ological diagnoses, and he takes into consideration the normal rela
tion of the parts, the physiological relation, what the deviation is,
which is very important, you can not measure disability with any
accuracy; that is impossible. W e can all make accurate diagnoses,
and that is very important.
The doctor uses the words “ carrying angle ” in terms of the foot.
I prefer to use “ weight-bearing angle, or power ”— that is the most
important function of your foot, the weight bearing. I f you do not
give a man with a traumatic weak foot a metal plate he can not
work. To my mind that is a very important term to use, “ weight
bearing.55 I prefer that to “ carrying angle.’5
The classification of Doctor Moorhead, I think, is all right. I
think it is something to be considered, to be thought about. W e have
to have some basis, but there are a lot of things to be considered in
making an estimate. W e have to know what are the most important
movements of a joint.
The doctor spoke about the heel cord; I think that is one of the most
important tendons in the foot. Take a shortened Achilles tendon;
you have an aching foot. Unless you correct that, that man is going
to court and make a lot of trouble. You have to correct those condi
tions before you make a final estimate; that is the final therapeutic
treatment of these cases; you have to put a man as nearly normal as
possible. I f you don’t, you have the compensation court.
Again, about the estimate of disability : It has been very disap
pointing to go to the compensation courts and have a doctor go on
the stand and in an arbitrary way make an estimate with no reason.
I hope the day will come when that is done away with entirely. I
thing if the doctors would get together on all these cases, we could
all come to a conclusion. This business of going on the stand and
one saying 10 per cent, and one 9 per cent, and then the referee giving
8 per cent or 7 per cent, is all wrong, and I think one of the things the
medical profession should do is to correct that. The referee is honest
and he tries to be fair, but he is helpless.
The doctor spoke about the disability in terms' of a foot or a leg;
he said unless the knee is involved— that is, the joint above the ankle,
the knee, or hip— it should go in terms; of the foot. That gives me
an important point. In fractures about the ankle, the lower shaft or
tibia, we have a condition known as traumatic vallecula, and that
changes your carrying angle. I f I am wrong I want Doctor Moor
head to tell me. In these traumatic vallecula cases, if they are not
properly treated we find a strain on the internal lateral ligament,
which produces a weakening of the knee and a strain on the sacroiliac.
There is a deviation in the weight-bearing power.
Doctor L o n d r i g a n . I agree only with Doctor Wainwright’s state
ment that he followed Doctor Moorhead’s teaching in this particular
subject. It is always a great deal of pleasure to me to hear Doctor
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FIFTEEN TH AN N U AL MEETING OE I. A. I. A. B. C.
Moorhead read a paper. I always get knowledge and information
that are worth while.
In estimating disability he rated function at GO per cent. In our
estimates of disability we do not take into consideration the changes
or the part involved, we take reduction in function; we attempt to
estimate that part of the function which has been lost.
In keeping with that I have in mind our own commissioner of
labor who at some time during his life sustained a fracture o f one
of the metacarpal bones of the hand. I would like to have the doctor
look at that, I think he has about as good function of his hand as
any man I know, but there is a change in the contour of that hand.
I f Doctor Moorhead will elaborate as to the reasons for allowing
20 per cent, for contour— in other words, if a man has a fractured
tibia with only a loss of contour, would that bo a 20 per cent loss
of the leg ?
The C h a i r m a n . Doctor Wainwright, will you answer the various
questions that have been propounded to you in connection with
cancer ?
Doctor W a i n w r i g h t . In regard to the commissioner’s question
about the relationship between sarcoma and carcinoma and various
other types of malignant disease, I do not think the particular type
changes; whatever the general principle is, that we ought to apply
to the question. The difference between sarcoma and carcinoma is
pathological; that is a difference of degree, not a difference of prin
ciple, and I do not think in the compensation co irt or-law court the
particular type of malignant disease has any great significance. As
was said in the paper all the law has to know is that the man had
a lump and what it did.
A s to the question of the time element, that is a difficult one to
consider. W e usually do not accept carcinoma over one month. In
the first case I showed you, where it appeared in two weeks on the
jaw, that man did not come in to me from the claim point of view;
he came to me as to? a physician, to cure him. He told me what he
thought was the truth. He was very certain that there was no
trouble on that spot in his face before; he was very certain that that
tumor had come in the two wTeeks, and the photograph proved what
that had developed into, so we can not definitely lay down an arbi
trary period, either as to primary time, or the minimum time, or the
maximum time.
The scars Doctor Elsberg mentioned on the sc? Ip, in cases of brain
tumors, raise a most disturbing element, and this certainly ought to
be investigated further. I hope very much that Doctor Elsberg will
explain it some time later on. It is going to raise a new point of
view, if scars on the scalp to which the patients have paid no particu
lar attention and do not think it is worth while to mention to their
doctor, are going to be followed by tumors; it is going to raise the
curtain on a whole new field of investigation as to the relation
between trauma and cancer.
A s Doctor Londrigan said, it is of course a very rare cause or
connection, but the mere fact that Doctor Londrigan sees 250 cases a
month and doe,s not happen to notice the connection does not prove
that it does not occur. It is very rare, but the point from the legal
point of view is, not whether it is rare, but whether it can occur.
MEDICAL SESSION---- DISCUSSION
121
Because one man does not see it in 250 cases a month does not mean
that it can not occur. I f it can occur in one case— there are lots scat
tered through literature— it proves the possibility of the principle
that one single trauma can cause a carcinoma. From the legal point
of view, that is all we want to know. A s a matter of fact, what we
medical men need when we get up in connection with our legal
brethren is a more clear-cut logic. I f I had my way, I would have
logic taught in every medical school the first year, when a man enters
medical school, and have it repeated every year so that we would
learn some of the rules and not jump to conclusions. W e do not
know anything about logic; we either exclude the whole business or
swallow it.
The C h a i r m a n . Doctor Elsberg will you close your paper?
Doctor E l s b e r g . Far be it from me toj have meant to be under
stood that permanent scars as an evidence of some preceding trauma
to the .skull were the cause of intercranial tumors. A ll that I said or
meant to say was a statement of fact, which was that it is remarkable
how frequently one finds in the scalp over the region of the brain,
when operating for tumor, a scar, so that I have gotten to the state
of mind that whenever I see a scar on the scalp over the region where
I am going to operate for brain tumor, I feel a little better and I
think I am pretty sure to find a tumor under that. Further than
that I won’t go.
Regarding what the commissioner asked concerning the chiroprac
tors, I should say that 1 out of every 3 or 4 fractures with complete
symptoms that I see, I see as a result not of their injury but of the
treatment by the chiropractors. I think that must be said with due
credit to the chiropractors.
Regarding the question of fractures of the transverse processes,
what I said in my paper I think sums up the subject.
The C h a i r m a n . Doctor Jaffin, will you close your paper?
Doctor J a f f i n . I have nothing to add to what I have said. The
subject is entirely too big to talk about or even discuss, but I am
very glad that the secretary has thought it a subject worthy enough
to bring up for further discussion and commitment.
The C h a i r m a n . Doctor Moorhead ?
Doctor M o o r h e a d . I do not know that there are any questions to
answer except the one Doctor Londrigan put with regard to the
percentage allowance for any of those three elements. I think every
body will agree in allotting a larger percentage to function; that is
the end in view in everything, and whether you are allotting 60 per
cent, as we do, is a matter for your own determination. The thing
I would like to stress would be that if we all— this association and
others— could agree, if we could get this thing down to a percentage
basis and then all follow it up, how much better it would be for us
in classifying our end results, and how much easier it would be.
You know what an American dollar is; I know what a French franc
is ; we know what a German mark is ; why not agree on a set of stand
ards. W e have a set of standards for everything else; why don’t
we have a set of standards for this ?
Mr. S t e w a r t . I would like to call the doctor’s attention to the
fact that the statisticians have been cussed and cussed and cussed
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FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
for 40 years for trying to statisticize mankind. I am simply giving
you doctors a little warning as to what you are up against.
Mr. W i l c o x . In estimating disability because of injuries to the
limb, or foot, we rate our percentages, I suppose, on the basis of
total loss of function or usefulness; don’t you, doctor?
Doctor M o o r h e a d . Yes.
Mr. W i l c o x . The late lamented Carl Hookstadt made a very
extensive study of the relative amount of disability as a wage earner
between two types of injuries, one of them the loss of the arm and
the other the loss of the leg, and he demonstrated, so far as figures
will demonstrate and from actual studies in the field of men who
had been injured, that the loss of the leg was a more serious handi
cap for the wage earner than the loss of the arm, and it is significant
that in no compensation act do we rate disability to the leg greater
than disability to the arm. The percentages cf permanent total
disability for injuries to the arm exceed those for injuries to the
leg. In only one or two States are they rated equally. It is the
usual practice to give a lower rate for injuries to the leg than for
injuries to the arm in its effect upon wage earners. Almost the
very first statement Dr. Moorhead made was about the need of a
leg to get to work on. I do not know whether c-r not he has given
thought to the question of the relative effect upon wage earners of
loss of leg and of loss of arm.
The C h a i r m a n . I would like to say a word about Doctor Moor
head’s theory on the percentage of disability and why w^e do not
establish a definite rule of measure. I think that is because of this
fact: About 10 years ago Professor Mayo put this question to Pro
fessor Martin, of the University of Pennsylvania, and he said, “ How
many men in general practice do you suppose are competent to
treat a fracture?” Doctor Martin hesitated and said, “ Perhaps
10 per cent.” Mayo’s reply to that was that not over 2 per cent of
the men in general practice were competent to treat fractures, and
I think that that is nearly true.
The reason we fail to arrive at a definite conclusion in connection
with the assessment of damages in these trauma cases is because of
the fact that this is not taught in the colleges. The average man
who gets into the practice of medicine sees a man with a colloidal
fracture, and he will come in and state that the man is 100 per cent
disabled. The man may see such a fracture orce in a year, or a
Pott’s fracture once in two years, or he may see a fracture of the
femur once in two years or four years; then he comes into court
and attempts to estimate the percentage of disability. It can not
be done until you teach the subject properly in the medical schools.
The men in the last two years ought to have a lot of instruction along
these lines.
And again, we know the average experience the interne gets in
the hospital. As a matter of fact, he takes charge of most of the
fracture cases. The visiting surgeon walks in and sees Doctor Jones
has been there three months, and he says, “ W hat have you here? ”
“ I have a fracture of the femur.” “ It looks all right,” and he passes
on to the next.
MEDICAL SESSION---- DISCUSSION
123
The same thing happens with a fracture at the wrist or ankle.
The men who come for tuition in the hospitals fail to get the tuition,
and the same thing applies in their last years in college. I f these
boards! would stress the fact that colleges ought to teach this subject
the last two years in college, and if we stressed it that they ought to
teach it in the hospitals, we would get better results.
Doctor M c B r i d e . The only thing I might add is that I think per
haps you are rather extreme in your criticism of the average attend
ant at the hospital. I do not think it is quite as bad as that. I would
not want to have these laymen get that impression.
Mr. S t e w a r t . We k n o w it.
Doctor M c B r i d e . That may be so with some surgeons, but, I think,
not with all; they at least insist on X rays and have their cases X
rayed a number of times—I know I always do that. Perhaps we
may be more careless than we should be. I quite agree that the average
physician is not qualified to pass upon percentages of disability. I
say that because I have observed the thing particularly for the past
five years, and I am glad this question came up because we will take
it home to ourselves, each of us doctors, and we will try to analyze
the question. You have a patient who has suffered some disability,
whether it be industrial or whatnot; the person is injured; he is
your patient; the members of the family have been your patients for
a long time, perhaps; there are always so many possibilities that
can arise- following any serious accident or any serious disability.
The result may be a splendid one, but you are going to safeguard the
future of that patient as to any recurrence or any disabling effect
later on, as much as you possibly can, and be thoroughly honest about
it. In other words, you are going to protect, as you should, that patient
and that patient’s dependents, if he or she have any, so far as that
is humanly possibly.
This mistake is often made, and I think the mistake is an honest
one, that a doctor—for example, one working for an insurance com
pany or for an employer—is going to be honest and safeguard, in
so far as he can, the rights of the employer, he is going to look upon
the result of a disability, if that result is a reasonably good one and is
reasonably sure to improve in his opinion, and say that the per
centage of disability is only so much, figuring that the disabled part
is going to improve with use, whereas the opposite is true if the part
affected is not used. We have that come up frequently in our com
pensation courts, because they say: We don’t want the permanent
estimate at this time because we feel certain that the stiffness sur
rounding a fracture, in a joint particularly, is going to improve with
use, and we are quite certain that in six months from now, or in
eight months from now, or a year from now there will not be any
permanent disability in that affected part. We have a good deal of
difficulty sometimes.
I have adopted this principle, in so far as it is possible to carry it
out: You get the physician} representing the carrier, or the employer,
or the group of individuals who might be interested, to make an
estimate of disability according to his best belief and judgment, after
a proper examination. He will make just as close an estimate as he
possibly can; he won’t give any leeway at all. Then you take the
31573°— 29------ 9
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
version of the family physician. Many times he is quite able. He
will try to safeguard the rights of his patient and that patient’s
dependents, and he will give what he believes is an honest estimate,
but for fear that he might make a mistake he is going to make that
a little more liberal, so that the future may be assured. That is the
only difficulty we have in estimating; and when I, being a doctor,
came into the work the habit was quite prevalent for the referee or
deputy commissioner to expect that the family physician or the
physician in attendance in the case was going to estimate high and
the physician representing the carrier would estimate low; they
were interested, one on one side and one on the other, and the referee
or deputy commissioner (a practice which we broke up) forthwith
attempted to say that one is too high and the ether is too low, and
I am going to make it in between.
I say you can definitely establish the amount of disability. I f you
can not it is an indictment on the medical profession. You can esti
mate disability accurately. It can be done; that is what we do in
our department. We have the doctors' at issue get together and prove
the actual disability. If they do not agree we say: The State will
furnish you with a third doctor, or with two or three doctors. We
are disinterested except to> see that justice is done, to see that the
injured person gets the relief he or she is entitled to. That is our
only interest. I f they say: “ We think your State doctor is' biased,”
then we say, “ We want you two gentlemen to get together and you
two select some competent person, some competent medical authority,
and upon his say-so the amount of disability ought to be determined.”
I thing that is the proper way to do it,
I think we have been very much enriched this afternoon by having
had these very excellent papers presented to us. The men are all able
men, they have gone to a good deal of trouble to prepare these papers,
and this association is deeply indebted to them. I know that I voice
the sentiment of the entire association when I express to them the
sincere thanks and appreciation of the association.
These papers will become a part of the history of this organization
and will be printed and preserved for all time. We are all going
to have the advantage, not only of having hearel them to-day, but of
being able to use them in the future, by referring to them.
Mr. W i l l i a m s . I do not think this meeting ought to break up until
I say for myself that I have had the first edition of Doctor Moor
head’s book on my shelf ever since it was printed, and the second
edition; they are tools of my trade to-day, and if he will tell us when
he is going to get out a new edition, I will get that.
Doctor M o o r h e a d . About three-fourths of the text for that new
edition is now ready. The contract for the printing has been signed
with W. P. Saks & Co., of Philadelphia. There will be about 600
pages and it ought to be in the hands of the public the first of Jan
uary; it will retail for about $6.50.
[Meeting adjourned.]
THURSDA Y, SEPTEMBER 13, 1928-M O R N IN G SESSION
CHAIRMAN, SAM LAUGHLIN, CHAIRMAN STATE! INDUSTRIAL ACCIDENT COMMIS
SION OF OREGON
OCCUPATIONAL DISEASES
The C h a i r m a n . It falls to my lot to preside this morning, and I
appreciate this honor very much. I presume it is a sort of compen
sation for having traveled such a great distance to attend this con
vention. I think I am the only representative from any of the
Pacific Coast States, neither California nor Oregon being repre
sented at this meeting. I am a very firm believer in meetings of this
sort where we get together for the purpose of exchanging ideas, which
is one of our best methods o f education.
W e will now listen to a paper by Dr. G. H . Gehrmann on “ How
chemistry has changed industry, and as a result has changed the
tendency to occupational disease.”
Doctor G e h r m a n n . I want to call your attention to the fact that
I am dealing simply with the situation as met in our own line of
manufacturing. I am not attempting to vouch for activities along
other lines, although I am sure there is a certain amount of progress
in every branch.
How Chemistry Has Changed Industry, and as a Result
Has Changed the Tendency to Occupational Disease
By G. H.
Gehrm ann,
M. D., Medical Director E. I. du Pont de Nemours & Co.
Modern industry owes its tremendous growth, its highly scientific
methods of production, and its present amazing wealth of wonderful
products to the relatively recent advances in chemistry. Chemistry
has advanced from its almost obscure and mysterious position to a
realm of importance, second to none. The mysterious old fellow
with his test tubes and retorts, hidden and obscure, has emerged with
a triumphant store of knowledge that has enabled him to perform
miracles.
Chemistry has become the very foundation of modern industry, in
stilling into it greater possibilities, higher efficiency, and newer ideas.
The chemist takes a handful of ordinary cotton and by one process
changes it into an explosive powerful enough to shatter the toughest
of steel, and by a second process changes it into a dainty mirror
for milady’s dresser, or a beautiful shiny coat for an automobile.
Industry has made marvelous advances, not only along the lines
of newer and better products, but also in newer, better, and safer
methods of producing them. Chemistry has made it possible to
manufacture products which, although highly toxic or dangerous,
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FIFTEEN TH A N N U A L MEETING OF I. A. I. A. B. C.
either in themselves or in the making, are absolutely necessary as
a means toward higher accomplishments.
For exampje, consider the manufacture of nitro cellulose, which is
produced in tremendous quantities each year. The production of this
material is dependent upon the treatment of cotton with highly
concentrated acids. Before present-day methods were evolved the
process was not only highly dangerous but actually cost the lives
of many employees, and in others caused painful injuries and often
prolonged illness. Prior to the present methods of handling I have
seen from 50 to 75 nitro-cotton fires in a few hours in a smajl
plant consisting of five units; now under improved methods a fire
is a rarity and a case of nitrous fume poisoning is almost unheard of.
The improvement in this one line of manufacturing has resulted
in the saving of many lives and the elimination of great numbers of
occupational cases. Nitrous fumes attack the air passages, causing
a rapid corrosion and pulmonary oedema. The exact amount of
fumes necessary to cause symptoms is undetermined and varies some
what in different individuals. Symptoms of illness may come on
shortly after exposure or may not appear for several hours. As
yet, no form of treatment has been devised that will cure the condi
tion, all present measures giving relief only, and it is my belief that
the only cure lies in absolute prevention of inhalation.
The demands of modern civilization act as a stimulus to chemical
research to provide products in greater quantities, more lasting in
quality, efficient in their adaptation to daily uses, and, with all, a
minimum in initial cost and maintenance. Consider the automobile
of to-day, in contrast wTith that of a few years ago. The mechanism
is perfected to such a point that we can almost forget its very exist
ence. The riding qualities are greatly improved, the finish is prac
tically as durable as the metal itself, and the nickeled parts no longer
require hours of labor in order to maintain the luster. The very
fuel that goes into the motor is more efficient in producing power,
less destructive on motor parts, and in every way more suitable for
obtaining the best results.
Only by chemical research have these improvements been devel
oped, ana the application of the newer ideas have necessitated
changes in methods of manufacture and, in many cases, the produc
tion of newer materials, many of which are capable of producing
occupational illness, unless the methods of manufacturing and han
dling are controlled by highly scientific methods.
A few years ago Midgeley discovered that the addition of very
small, almost minute, quantities of tetraethyl lead to ordinary gaso
line changed the type of explosion, rendered the fuel more efficient,
and made an ideal antiknock solution. Prior to this time tetraethyl
lead had never been made on a commercial basis and so nothing was
known of the methods necessary for quantity production. The be
ginning months of manufacture were attended by many cases of
illness and a few fatalities. Later developments have completely
eliminated the defects in handling, and the present basis of manu
facture has rendered it an entirely safe process.
The advent of this product and the illnesses following it seem to
have created the impression that tetraethyl lead poisoning is an
entirely new disease, whereas it is purely a rapidly developing lead
Oc c u p a t i o n a l
d is e a s e s — d r . g e h r m a n n
127
poisoning, with a predilection to nervous tissue. There wag a failure
to realize that here was a form of lead that would enter the body
more rapidly than any of the known compounds, and in addition to
entering through the alimentary and respiratory tracts, it would
rapidly enter through a channel theretofore considered as practically
negligible, the skin.
Circumstances arising during the early days of manufacture seemed
to indicate that here was a product so toxic in nature and so difficult
to handle that the idea of further manufacture should be abandoned.
However, by the aid of combined chemical and scientific efforts, con
ditions have been changed, and now the same material has been
manufactured for over two years without a single case of even the
slightest symptoms. In other words, chemistry first developed a
product capable of producing serious and even fatal illness, and
after developing this product, chemistry developed a safe method
of producing and handling it.
Our experience in the du Pont Co. with poisonous materials—and
we handle many of them—has led us to feel that no matter how toxic
or harmful a product may be, it can be made safe to manufacture
and handle with the proper equipment and a well-trained organiza
tion to operate it.
One of the greatest developments of recent years has been that of
the lacquer finishes applied to automobiles, to furniture, and in short
to practically every article which was formerly protected with paint
and varnish. Along with this new lacquer, there has been extensive
development of the spray method of application. The spraying of
lacquers has raised the question and stimulated the investigation
as to the hazards and occupational diseases that may arise as a result
of the introduction of these newer products.
Many rumors and almost weird tales have been circulated from one
to another, with the usual additions and distortions, until there has
arisen a tendency to classify spray painting with smallpox and
bubonic plague.
I have personally received many complaints from various sections
of the country, telling of the symptoms and diseases produced by
inhaling lacquer fumes. Furthermore, I have personally investi
gated most of these complaints and have yet to find a true case of
lacquer poisoning. Let me cite one case with the results of our
investigation.
I received a communication from a large city in Pennsylvania
stating that an employee of a refinishing concern had been refused
insurance because of physical ailments brought on as a result of
spraying lacquer. I visited the man in question, and he informed
me that it was true that he had been refused insurance on account of
this physical condition, and stated that lacquer spraying was the
cause of his trouble. Investigation revealed the following facts:
This man had been spraying lacquer in a refinishing shop, with good
ventilation, for about one year. He was 45 years old, claimed never
to have been sick enough to have a doctor since he could remember,
and, with the exception of one occasion two years before had never
been examined. He did admit having had a severe tonsillitis, which
later developed into a double peritonsillar abscess about two years
previous. His occupation, prior to his present, and for a period
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MEETING OF I. A. ]. A. B.
c.
of 28 years, was that o f a painter. He was decidedly prejudiced
against lacquer and stated that men were dying every day as a result
o f exposure. Upon direct questioning, however, he did not know
of anyone who had actually died, neither did he have any idea as to
where those fatal cases might have occurred.
Physical examination showed that this man had badly infected ton
sils, a severe heart lesion, high blood pressure, and kidney disease.
A complete train of results, directly traceable to infection and pos
sibly due to some extent to lead absorption that occurred during his
28 years as a painter.
I could cite innumerable other cases which, upon investigation, have
proven the falsity o f their claim. Our own experience in the manu
facture of lacquer over a period of several years has been carefully
supervised by medical attention and physical examination.. The con
ditions met with in the manufacture and experimental work have in
every way simulated conditions met with in the spraying industry.
In no case have we found involvement of any organ of the body which
could be directly traceable to exposure. Dermatitis has occurred oc
casionally, but has been readily overcome by treatment or temporary
change of work. The committee appointed by the State o f Penn
sylvania and the National Safety Council conducted a careful and
scientific investigation of this subject, and I believe that, for the
sake o f brevity, we can sum up the entire situation in these few words,
“ Eliminate benzol and lead, and spray with adequate ventilation.55
The recent introduction of stainless steel and chrome nickel has
called upon industry to produce ever-increasing amounts of chromic
acid, the manufacture of which provides the possibility of chrome
ulcers. These ulcers may be caused by the chromates used in the
manufacture or by the chromic acid. They appear principally in the
nasal passages, and may progress to such an exte nt as to cause per
foration of the septum. A ll untoward symptoms and undesirable
effects have been completely overcome by the installation of proper
ventilating hoods.
Chemistry has solved many difficult problems in the explosives
industry by careful study of the manufacturing process for the pro
duction of high explosives. Nitroglycerin, trinitrotoluol, fulminate
of mercury, and tetryl are all made with comparative safety and
seldom detonate accidentally.
Workers in nitroglycerin suffer with extremely severe headaches,
which come on a few minutes after contact with 1he fumes or liquid.
Remedial measures offer very little relief; but the workers soon
develop a temporary immunity. A few days5 absence from work
and the use of alcoholic liquors will soon render them susceptible to
the violent headaches. Consequently, nitroglycerin workers are apt
to be very steady and total abstainers. I know o f no permanent
systemic effects that are produced, and do not think that there are
any. A few days ago I examined a man who had worked in nitro
glycerin for 35 years and found him to be in good physical condition.
Tetryl and fulminate of mercury produce dermatitis and skin
ulcers unless handled with proper precautions. Individuals with
delicate skins or a tendency to skin conditions must be eliminated
from this type of work, the darker-skinned types being more suit
OCCUPATIONAL DISEASES---- DR. GEHRMANN
129
able. These employees must be taught the necessity of frequent
cleansing of the exposed skin areas and daily applications of bland
ointments. In conjunction with these precautions, there must be
sufficient exhaust ventilation to remove the dust and fumes.
The advent of the dye industry to this country brought with it
possibilities of many toxic conditions. Our early experiences were,
perhaps, not all that could be desired, but at the present time, under
improved methods, we are able to handle and manufacture dyestuffs
with comparatively little trouble. Benzol, as used in the manufac
ture of anilin, is used in a closed process and consequently gives no
trouble. Anilin, nitrobenzene, and the benzene derivatites will cause
the production of methemoglobin with cyanosis. The symptoms
occur shortly after the inhalation of fumes or contact with the skin,
and although the afflicted have all the indications of being severely
ill, they recover in a few hours without any apparent permanent
effects. Our early days of handling these products taught the neces
sity of introducing improved methods of manufacture, together with
precautions in handling, and these two factors have practically elimi
nated our difficulties.
I could continue to relate many additional instances illustrative of
the advantages of modern chemical methods over those of a few
years ago, and in each case conditions have so improved as almost to
eliminate the possibilities of occupational disease. New products
will from time to time be developed and with the development of each
new product will arise the question as to just how serious a health
hazard it may be. Fortunately, industry is realizing more and more
the importance of the medical department and the medical depart
ment is fast becoming an integral part of the organization, with a
definite purpose of improving industrial conditions. The medical
department of a properly organized industry now has the oppor
tunity of studying the effects of new products while they are in the
experimental stages rather than waiting for an opportunity to observe
the results after production has started. The result can not be pro
ductive of other than improved industrial conditions, a marked re
duction in occupational diseases, and a general improvement in public
health.
In closing I would say that it is my belief, based on actual experi
ence, that any product can be safely manufactured, provided the
manufacturer will follow the advantages offered by the developments
of modern chemistry and preventive medicine.
Mr. W e n z e l . I want to ask a question of the doctor. I would like
to ask if you can give us a very brief statement of the symptoms that
follow the use of the Duco finish in the ^mall refinishing plants. W e
have had three cases of alleged disability resulting, and we have found
on investigating that there were both fumes and a sort of dust.
Doctor M c B r id e . I think we had better delay the discussion to the
conclusion of the papers.
The C h a i r m a n . The next paper will be by J. J. Bloomfield on
“ Health hazards in industry.”
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FIFTEENTH ANNUAL MEETING OF I. A. I. A. B. C.
Health Hazards in Industry
By J. J.
B l o o m f ie l d ,
Assistant Physical Chemist, United States Public Health
Service
The number of new health hazards in industry are very limited.
The application of our growing knowledge of chemistry to industrial
processes has been the means of bringing to light once more certain
hazards to health, since in some instances the chemicals involved in
these new applications are of such a nature as to constitute a source
of injury unless precautionary measures are exercised. Specific
examples of such instances are the increased uses found for such in
jurious substances as lead, benzol, mercury, and chromium com
pounds and certain toxic gases. As far back as 1822, Prof. C. Turner
Thackrah published in London a book entitled, “ The Effects o f
the Principal Arts, Trades, and Professions on Health and Lon
gevity,” in which he wrote with a wide degree of knowledge of certain
industrial problems that are still in existence. He describes lead
poisoning among potters and asks: “ Could not the process be effected
without the immersion of the hands in the metallic solution? Or
could not some article less noxious be substituted for the lead ? ” ;
disuse of lead in glaze is highly desirable. Speaking of brass work
ers, he says: “ The founders suffer from the inhalation of the vola
tilized metal. In the founding of yellow brass in particular, the
evolution of oxide of zinc is very great.” He suggests magnetic
mouthpieces for machine workers who are engaged in filing, in order
to prevent the metallic particles from entering the breathing tube.
H e makes reference to baker’s itch and to chimneysweep’s cancer.
Professor Thackrah was in all probability one of the first observers
systematically to make use of a physiological observation as a routine
procedure in industrial hygiene. For measuring “ the capacity of the
lungs ” he used a glass bell jar inverted in water, and he quotes the
results of many such determinations on workers, and compared the
results with soldiers as a standard of persons in health.
Again with carbon monoxide human experience; with the poisonous
effects of this gas had its beginning during the prehistoric ages when
man first began to use fire. Dr. L. Lewin has traced references
to the action of this gas back through the ancient Greek and Latin
literature, and concludes that this poisoning “ of all stands alone in
its close relation to the history of the civilization of mankind.55
Many more such examples of the existence and knowledge of pres
ent day health hazards are to be found recorded in writings of our
predecessors in the field of industrial hygiene. Over 100 years have
passed since the publication of Professor Thackrah5s valuable book—
a century marked by enormous strides in the scope and intensity of
industry, and along with this a parallel increase in the urbanization
of peoples. The strides which have been made in the conduct of
industry have, however, more than kept pace with the problem of
safety for the worker, and to-day there is no doubt that the average
worker lives and wTorks under conditions far more conducive to life
and health than ever before.
Perhaps the major factor in this progress of safety in industry
in this country may be attributed to the passage of the workmen’s
compensation acts, which spread so rapidly from State to State
OCCUPATIONAL DISEASES---- DOCTOR BLOOMFIELD
131
between 1909 and 1913, when 23 States enacted laws of this type.
Besides the benefits which these acts bring in the way of securing
relief from the financial burden of industrial accidents and diseases,
these acts also serve an important function in that they exert some
influence in the prevention of industrial accidents and diseases by
their indirect pressure. Another very important factor in the de
velopment of industry has been the farsightedness of certain em
ployers of labor who have seen the benefit to industry, as well as
the humanitarian value, of the safety movement, and have gone far
ahead of the compensation acts and ahead of any legal compulsion
and developed safe and excellent conditions in their factories.
This commendable attitude on the part of certain employers of
labor has been brought to the attention of the writer not only
through personal observations made during visits to various indus
tries but also through the many inquiries addressed to our office
concerning the possible hazards that may be associated with certain
contemplated processes in industry.
Industrial poisoning often reduces a worker’s health below normal
and sometimes causes the worker to leave his job. The fact that the
worker may be poisoned may even escape recognition. For this
reason industrial poisonings are often much more elusive than are
industrial accidents, and the actual progress which has been made
in the control of poisonings is perhaps not so great as in the case of
accidents. The statistical returns of cases of industrial poisoning
and of deaths from such causes are not very complete, but they serve
to throw some light on the situation with regard to certain indus
trial poisons and one in particular— lead. There is little or no doubt
that lead still constitutes a real industrial poison of first importance.
This disease is still active among painters, smelters of lead ores, per
sons engaged in the manufacture of storage batteries, chinaware,
and sprayers of enamels containing lead. But the most recent sta
tistics show that lead poisoning is certainly on the decrease; the
death rate from chronic lead poisoning fell from 2.5 per million in
1910 to 1.4 per million in 1924. Among potters, as a result of 1,800
medical examinations in 1921, a rate of 77 per 1,000 was established,
as contrasted with 132 per 1,000 established for an earlier period.
In the printing trades, Doctor Hoffman found but five dieaths
in the year 1925. He concludes that since the aggregate number of
printers is not less than 300,000 “ the relative rate of incidence is
very low and no longer a matter of serious concern to both employ
ers and employees.” The two industrial groups which suffer to the
greatest extent from lead poisoning are painters and electric storage-battery makers, and Doctor Hoffman’s statistical studies show
that in the period 1914^-1924 nearly 53 per cent of the deaths caused
by lead poisoning were among painters. O f 920 cases of lead poi
soning in New York State, approximately 50 per cent were among
storage-battery makers. One may say that the statistical reports
are inaccurate, and undoubtedly this is so, but there is every reason
to believe them to be more accurate at the present 'fime than ever
before, and comparatively they show a decrease in some forms of
lead poisoning.
T h e m e d ic a l m a n o r th e c o m m issio n e r o f c o m p e n sa tio n is fr e q u e n tly
c a lle d u p o n in th e c o m p e n sa tio n co u rts to ex p re ss h is ODinion as to
w h e th e r a m a n h as su ffered or is su ffe r in g fr o m le a d p o iso n in g .
132
FIFTEENTH AN N U AL MEETING OF I. A. L A. B. C.
Owing to the excellent work recently done on this subject by gov
ernmental and university agencies, there is now some basis of diag
nosis and treatment to rely upon. The work of Doctor Aub and his
colleagues done at the Harvard Medical School on the laboratory
studies of lead poisoning represents a contribution of first impor
tance in the field of physiology and pharmacology of lead. This
study has served to clear up many disputed points with reference to
this poison and has laid bare the rational method for the treatment
of this disease. The industrial physician who is now confronted
with a case of lead poisoning knows that by a careful regulation of
the diet it is possible to remove the lead from the circulation and store
it in the long bones of the body. Once this j.s accomplished the toxic
symptoms subside. The patient may then gradually be deleaded by
a careful regulation of diet designed for this purpose.
Again the studies conducted by this office in connection with
the question as to the possible hazard associated with the handling
and use of tetraethyl lead gasoline have served to throw further light
on this subject. This study is an excellent demonstration o f the
effectiveness of laboratory methods in the control of the poison
hazard. The stipple cell as a diagnostic test for lead poisoning may
not be beyond certain criticism, but there is little doubt that it is a
very valuable aid in depicting the degree of change in the blood, due
to this material. The value of the blood study of the industrial
worker is greatly enhanced when made at various intervals. It is
these comparative studies which inform the plant physician that
changes are progressing rapidly or slowly and that transfer of the
worker is or is not imperative.
There is still much to be done concerning the prevention of lead
poisoning. A good deal can be accomplished by the use of efficient
local exhaust ventilation to control the spread of the toxic material
into the workroom air. Where the material is in the form of dust or
fumes, the mechanical inclosure of the process constitutes a very
excellent procedure. Where it is impossible to remove completely
the substance by any means now at one’s disposal there is still the
possibility of protecting the worker by the use of respirators and
masks. Much can also be accomplished by the practice of personal
hygiene on the part of each worker.
In spite of the fact that widespread publicity has been given to
the dangers associated with exposure to carbon monoxide, this subtle
gas still exacts its toll of human life yearly. Very recently the
writer completed a nation-wide survey on the problem of automo
bile exhaust gas in streets and repair shops of large cities. The
results for the street tests did not reveal the existence of a health
hazard from automobile exhaust gas. They did show that the traffic
officer stationed from six to eight hours a day at a congested inter
section may possibly be exposed to a health hazard, and that this
potential hazard may be minimized by diminishing the duration of
exposure. The results of the study made in automobile repair shops
revealed a dangerous condition which demands serious consideration
upon the part of health officers and sanitarians. This hazard in
repair shops can be reduced to a minimum by providing adequate
exhaust ventilation and also by not allowing the motors of auto
mobiles to run longer than 30 seconds, unless the car is in necessary
OCCUPATIONAL DISEASES---- DOCTOPt, BLOOMFIELD
133
motion, or the exhaust is connected to the outside air by a direct
air-tight outlet of ample caliber. Without such outlet no automobile
engine should be allowed to run indoors, except to reach its berth or
to leave it by the shortest route. The great danger to life is unques
tionably in the small private garage containing one or two cars.
Under any circumstances the discharge of an automobile exhaust into
a roofed inclosure should be regarded as a hazardous act. Carbon
monoxide poisoning around blast furnaces, gas works, and similar
establishments can be completely avoided by the use of a carbon
monoxide gas mask or hose mask, whenever any work has to be done
near the source of danger.
Benzol as an industrial hazard has during the past few years been
receiving increased attention. The importance of this substance as
an industrial hazard was the subject of a three-year investigation by
the National Safety Council, in cooperation with the United States
Public Health Service. In this study the nature, extent, and se
verity of poisoning by this substance was determined as well as the
toxic quantities of material involved. This study showed that per
sons who were subjected to the inhalation of over 100 parts of benzol
per million parts of air might be expected to come down in time
with benzol poisoning, and that this poisoning could be ascer
tained in its earliest stages by means of the examination of the
blood as indicated by a leucopenia with a decrease in the percentage of
polymorphonuclear leucocytes and an increase in the percentage of
lymphocytes. It was found by animal study that the higher homologues of benzene— toluol and xylol— may be used with a great degree
of impunity. The use of benzol in industry is justified only where
it becomes absolutely impossible to conduct the industrial process
without it and then only under the supervision of the plant physician.
To the plant physician should be intrusted the complete care of the
workers and his judgment based on blood studies should be the sole
guiding factor in deciding whether or not the worker should continue
at his appointed task.
The hazards associated with the process of spray coating have been
receiving much attention of late. There is no doubt that the use
of the spray gun with lead paints and benzol-containing materials
may constitute a very real industrial-health hazard. In the case of
the application of vitreous enamels to cast iron or sheet metal, a
silicosis hazard may exist unless adequate precautions are taken for
the suppression o f dust. These adequate precautions must be con
scientiously taken if the worker is to be protected.
Quite recently attention has again been called to the health hazard
in the use of mercury and mercury compounds. In 1922, Dr. Alice
Hamilton and her associates presented a study of the hazards as
sociated with the fur-cutting and the felt-hat manufacturing in
dustries. Mercury nitrate is used in the preparation of the fur for use
in making felt hats, the process being known as “ carroting.” Despite
the highly poisonous character of mercury it continues to be used for
this purpose and clinical records show chronic mercurialism among
a large number of workers in the felt-hat industry. Such poison
ing has also been reported among metallurgists operating highfrequency induction furnaces, where mercury vapor was found to
escape from the discharge gaps of the high-frequency converters. O f
134
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
great interest at this time is the news coming to us from Germany
that laboratory workers are also not immune from poisoning by this
metal. In a recent article Prof. Alfred Stock of the Kaiser-Wilhelm Institut fur Chemie describes typical mercurialism among
his laboratory workers. Tests for mercury in the air of the labora
tories revealed the presence of this substance. About a year ago the
writer made similar determinations in a gas laboratory where con
siderable amounts of mercury were used in the analysis of rare gases.
The presence of mercury in the air in sufficient quantities to produce
symptoms of poisoning were found in this instance also. The objec
tive symptoms of chronic mercurialism are manifested by a coppercolored discoloration of the mucous membrane of the pharynx, of
the pillars of the fauces, and o f the gums. This discoloration should
not be confused with infective inflammatory processes, which it some
what resembles. The gums are swollen, and there- is enlargement of
the capillaries. Superficial erosions appear upon the mucous mem
brane of the gums, and upon the buccal mucous membrane in the
vicinity of the upper molar teeth. Perialveolar abscesses frequently
occur and cause considerable discomfort. Occasionally there is an
appreciable increase in the flow of saliva. Urine; analysis and dif
ferential blood counts show the urine and the blood to be unaffected
by the mercury absorbed. Subjective symptoms are characterized by
tenderness of the gums and hypersensitiveness of the teeth, particu
larly those containing amalgam fillings. Activity o f intestinal peris
talsis is slightly increased, occasionally developing into mild attacks
of diarrhea. Obstinate constipation is developed during absence
from work for one to two weeks. Gastrointestinal disturbance is
manifested by pain due to accumulation of gas; there is often disten
tion and feeling o f weight in the hypogastric and iliac regions. There
are occasional attacks of diarrhea. Shifting neuralgic pains are
occasionally felt in the various joints and in the chest.
It is felt that our knowledge of this problem of mercury poisoning
is rather limited and much may still be learned by a thorough study
of those industries which use this metal or its compounds. The
problem of the prevention of mercurial poisoning in laboratories and
industrial establishments can best be solved by inclosing all appa
ratus in which mercury is used and by conveying the fumes or dust
away from the worker’s face by adequate local exhaust ventilation.
In the case of the felt-hat industry the problem would best be solved
by the substitution for mercury nitrate of some les,s toxic compound
in the process of carroting the fur.
Quite recently the newspapers gave wide publicity to the cases of
poisoning among workers employed in applying a luminous paint
containing radium. In August, 1925, Castle, Drinker, and Drinker
presented a paper on the subject of necrosis of the jaw in persons
employed in applying luminous paint containing radium. These
workers made an analysis of the possible toxic agents employed
in the process of applying this paint and eliminated everything but
radium. The profound effect of radium even in minute quantities
on living cells is very well known. In addition, experimental evi
dence shows that there may be a selective deposit of radium in the
bone, and that the effects of radiations of the sort emitted by radium
may prevent both bone growth and the repair of fractures. Cases
OCCUPATIONAL DISEASES---- DOCTOR BLOOMFIELD
135
of jaw necrosis in patients who have received treatment with radium
for mouth cancer have been recorded. From the available literature
on the subject it seems that continued exposure to radium radiation
usually produces pain, sensitiveness, and anesthesia of the skin o f
exposed fingers or hands; burns, or destruction of the skin and under
lying tissues. The effect upon the blood and blood-making organs is
usually a profound leucopenia affecting both the polymorphonuclears
and lymphocytes; a decrease in blood platelets; also a milder anemia
accompanied by a high color index. Sterility is also not an un
common finding.
Similar findings on the disturbed blood picture of workers exposed
to radium have been reported in this country by Williams, who
made a study of workers engaged in measuring radium preparations.
In the case of the workers engaged in applying a luminous paint con
taining radium, exposure to this substance was observed through two
processes, namely, exposure to radiation and absorption of radium
salts by inhalation. ^ Here again, protection of the workers should
proceed along the lines of personal hygiene, adequate local exhaust
ventilation, in order to minimize the danger of air-borne radium
salts, and as a check that these precautions are really effective, a
systematic medical examination should be carried out. Regular ex
aminations of workers exposed to radium, including blood examina
tions, should be practiced. The wearing of a dental film by all
workers should also be a routine procedure, since such films will
reveal the exposure to radium by becoming fogged.
One can not leave the subject of industrial poisoning without men
tioning the hazards associated with gases, vapors, and acid mists.
Gases and vapors given off by petroleum and its products have long
been recognized as somewhat injurious when inhaled in high enough
concentrations. Petroleum gases and vapors have not, however, been
considered as actively poisonous, in the sense that hydrocyanic acid
and phosgene are poisonous. Light Mexican crude oil and certain
crude oil found in Ohio have been found to contain hydrogen sul
phide gas, which is much more toxic than carbon monoxide. The
United States Bureau of Mines, the United States Public Health
Service, and the American Petroleum Institute have recently com
pleted a cooperative study on the toxic gases associated with
Mexican and other high-sulphur petroleums and products. This
investigation disclosed the fact that hydrogen sulphide gas is toxic
in concentrations as low as 0.005 per cent, and men exposed daily to
such percentages would in all probability suffer irritation of the eyes
and respiratory tract, or subacute poisoning. As the concentration
rises the effects become more intense, and the length of time elapsing
before signs of severe poisoning and death is shorter. When a con
centration of H 2S of 0.07 per cent is reached dogs are affected almost
immediately and collapse instantaneously (acute poisoning), fol
lowed by suspension of breathing, heart failure, and death. The con
clusion, from the similarity between dogs and men in their response
to H2S, is that the above concentration would probably cause like
symptoms in both. Acute poisoning by H 2S acts on the nervous
system and results in a respiratory paralysis that is followed by
cardiac failure and death.
Protection to men entering atmospheres containing petroleum gaseS
and vapors of H 2S is afforded by various types of respiratory
136
FIFTEENTH ANNUAL MEETING OF I. A. I. A. B. C.
apparatus, such as gas masks, hose masks, and oxygen-breathing
apparatus. Each has its own limitations as well as advantages and
must be used only under proper conditions. For example, canister
gas masks are suitable only when sufficient oxygen to support life is
present and may be used only for a short period. Hose masks protect
against any irrespirable atmosphere that the wearer’s skin will
endure. Self-contained oxygen-breathing apparatus protects against
all irrespirable atmospheres and allows much greater field of action.
The weight of the apparatus and the necessity of special training of
the wearer are the chief disadvantages. This apparatus can be used
for about two hours. Besides protecting workers with various types
of respiratory devices it is feasible to confine all gases and vapors
from these petroleum products in closed systems of manufacturing
equipment. Workers should be trained in rescue methods and in
first-aid treatment, particularly in methods of artificial respiration
and the administration of oxygen to men overcome by this gas.
The development of modern refrigeration has been the means of
creating a huge new industry for the manufacture of refrigerating
machines. The various substances used as refrigerants are some o f
our common and oldest gases, such as ammonia, sulphur dioxide, and
recently methyl chloride. The latter gas, while used extensively in
the chemical industries and as a local anesthetic,, has received little
or no attention in the literature of industrial hygiene. Since this
substance has come into more general use as the cooling medium in
refrigerators its toxicological importance demands attention. Quite
recently Baker reported a series of cases of intoxication with com
mercial methyl chloride in a manufacturing plant engaged in making
refrigerators. Doctor Baker found that this gas is absorbed by
respiration in amounts sufficient to intoxicate workmen, unless
special precautions are taken to guard against this danger. Some
o f the commoner symptoms are vertigo, staggering gait, sleepiness^
ranging from slight drowsiness to falling asleep at work or while
eating, ptosis of the eyelids, anorexia, nausea, and loss of weight.
Visual disturbances were also recorded and in some cases certain
patients developed a fine tremor. Methyl chloride is a toxic agent
that is very slowly removed from the body and, therefore, becomes
cumulative in its action. It can be detected in the urine as am
monium formate before symptoms of intoxication develop, a finding
that may be used as a control of the situation by the plant physician.
Upon removal from work most of the symptoms subside very slowly,
it being a matter of two to three weeks before workers return to
normal.
The control of the situation in factories can best be handled by
inspecting all systems conveying the gaseous products and in the
case of methyl chloride periodic examination of the urine for am
monium formate will detect poisoning long before symptoms of
intoxication develop. In the control of the problem of escaping
gases in household installations it has been suggested that the use
in the main gas line of a small amount of some chemical that has
potent odoriferous qualities would serve as a warning to users of
electrical refrigeration that dangerous gas is escaping into the home
atmosphere.
Another example of the application of a well-known chemical
compound to a new process is the utilization of chromic acid in chro
OCCUPATIONAL DISEASES---- DOCTOR BLOOMFIELD
137
mium plating. As a result of the research carried out by various
laboratories on the electrodeposition of chromium from chromic acid
baths, chromium plating has now come into commercial operation
and tremendous interest and activity have developed in this field. It
is well known that the spray of chromic acid produced during the
process of plating may be injurious to the workers, and some con
cern was evinced by industrial establishments engaged in chromium
plating. As a result of the many inquiries addressed to this office
concerning the possible health hazards involved in this process a
study of the situation was recently completed by the writer’.
The injuries caused by chromic acid are not systemic in nature, in
that they do not produce disease of the kidneys nor attack the lung
tissue, but they do give rise to local ulcerations and chronic cell irrita
tion. Breathing air containing chromic acid mist will result in
definite injury to the nasal passages, this injury usually resulting in
perforation of the nasal -septum. Contact of abraded skin with,
chromic acid gives rise to ulceration and formation of “ chrome holes.”
It was felt that although this hazard was not a grave one it did tend
to lower the general physical and psychical tone of the workers and
hence constituted a real hazard. The survey made by the writer dis
closed the fact that in most establishments visited chromic acid was
present in amounts as high as 34 milligrams per 10 cubic meters of
air. Physical examinations of workers exposed to chronic acid spray
disclosed the fact that practically all persons suffered from chrome
ulcers and damage to the nasal tissue. As a result of this .study
it was possible to formulate certain recommendations to eradicate
completely this hazard. By the use of a properly designed sys
tem of transverse ventilation, with an adequate air velocity—namely,
2,000 feet per minute—it is possible to remove all traces of chromic
acid from the air. To be effective the plating solution should be
at least 8 inches below the top of the tank and the ventilating duct
should be at the top of the tank. Protective clothing in the form of
rubber boots, gloves, and aprons should be used when feasible to
prevent contact of chromic acid with any abraded skin. Since this
study revealed the fact that a daily exposure to even as small a quan
tity as 1 milligram of chromic acid in the air will cause definite injury
to the nasal tissue, it was recommended that periodic medical examination^ with prompt treatment of the slightest skin affections .should
be practiced. It has been suggested that such treatment may consist
of applying a wash of ammonium polysulphide and protecting the
damaged tissue with a waterproof covering.
In the control of the industrial poison hazard the plant physician
must play a large part, as well as the hygienist and safety expert.
In general, there are three lines along which one may proceed in the
control of the industrial-poison hazard. It seems obvious that the
first of these must be such means as may be introduced for the con
trol of the spread of the toxic material in the atmosphere of the
workroom. Where the material is in the form of dust or fumes, the
mechanical inclosure of the process constitutes a very satisfactory
procedure. Exhaust ventilation may be introduced for the removal
and collection of the toxic agent. And lastly, where it is impossible
to remove the substance by any means at our disposal the possibility
138
FIFTEENTH ANNUAL MEETING OF I. A. I. A. B. C.
of the protection of the worker by surrounding his nasopharynx with
a mask or respirator may be worthy of consideration.
An excellent illustration of how much may be accomplished by
effective ventilation was recently demonstrated as a result of some
studies just completed by the office of industrial hygiene and sanita
tion of the United States Public Health Service. This office has for
the past 10 years been investigating the hazard to health in dusty
trades, and has already completed studies in the cement, coal mining,
granite cutting, and metal polishing industries. As a result of
these exhaustive studies it is quite clear that all types of dust when
present in fairly large quantities have a real effect in increasing sus
ceptibility to acute respiratory diseases, such as asthma, pneumonia,
and bronchitis. Those dusts containing considerable amounts of
free silica in the form of quartz predispose to a peculiar type of
fibrosis of the lungs, which is readily followed by tuberculosis. In
the study of this problem among granite cutters this office gathered
detailed information on morbidity and mortality experienced by a
group of 1,000 workers in this industry. Clinical and Rontgenographic examinations were made and the working environment was
also studied in detail. It was to this latter problem that the
writer confined his activities, namely, a study of the various proc
esses of granite cutting and the extent of the dust exposure asso
ciated with each process or occupation as revealed by a dust count.
In analyzing our information the granite workers were divided into
four groups, A, B, C, and D, according to the amount of dust to
which each group was daily exposed. Group A, which contained
those workers making use of pneumatic tools, was found to be ex
posed to a concentration of dust varying from 37,000,000 to 60,000,000
particles per cubic foot of air. Group B was exposed to a concen
tration of dust varying from 27,000,000 to 44,000,000 particles per
cubic foot of air. Group C, which contained most of the attendant
labor, was exposed to the general plant atmosphere containing an
average of 20,000,000 particles, and Group D was exposed to a rela
tively lower concentration, namely, from 3,000,000 to 9,000,000 parti
cles per cubic foot of air. The dust in the atmosphere of these
plants was found to be of a potentially dangerous size (98 per cent
less than 10 microns in diameter) and contained about 30 per cent
free silica in the form of quartz.
Tuberculosis, the disease most prevalent among granite workers,
was studied to determine its existence in these four groups. It was
found that there was a very high rate of absence from work due to
tuberculosis in groups A and B, while almost no absence on account
of this disease was noted for groups C and D. In studying the death
rate from tuberculosis in these four groups it was found that groups
A and B had a very high rate, while groups" C and D suffered from
an extremely low death rate from this disease. Upon analyzing the
statistics for the prevalence of active tuberculosis cases by length of
service in these four groups it was noted that after 15 years of expo
sure the percentage of active casest in groups A and B increases with
extreme rapidity, whereas we found a low incidence of tuberculosis
in groups C and D, even among men who had worked for 30 years
or more in this industry. One may conclude from these results that
a certain amount of granite dust is tolerated by the human system.
OCCUPATIONAL DISEASES— DOCTOR BLOOMFIELD
139
Also, in viewing our findings from every angle, there is an indication
that there is a very close relationship between sickness, especially
that o f tuberculosis, and the magnitude of dust exposure. It would
seem logical, since the excessive dustiness is intimately connected
with certain occupations, that the solution would lie in the removal
of dust at its source, namely, in these particular occupations. The
only effective means o f accomplishing this end is by the installation
o f local exhaust ventilation in connection with those processes pro
ductive of dust, and by housing where possible in separate quarters
other activities not associated with dusty conditions. For this reason
the writer made a study o f the efficiency of such ventilating systems
in practical operation in several of the newer granite-cutting plants.
The primary difference between these newer plants and those consid
ered in our detailed study was the use of efficient local exhaust venti
lation for all granite-cutting processes.
In the plants with local exhaust ventilation groups A and B were
found to be exposed to an average count o f 10,000,000 particles per
cubic foot of air as compared with an exposure of nearly 60,000,000
particles for the same group in the plants not equipped with efficient
ventilation. Group C, which contained those persons exposed to the
general plant atmosphere, was found to be subjected to a dust concen
tration less than 10,000,000 particles in the newer plants as compared
with an exposure of 20,000,000 particles for the same group in the
older plants. From these figures it is apparent that the plants
equipped with efficient local exhaust ventilation have succeeded in
diminishing the dust count to a point where the hazard is at a mini
mum. This comparison is of the utmost importance in demonstrat
ing the possibilities in the ventilation of granite sheds by means of
modern devices.
Assuming that industry must continue to use hazardous materials,
and assuming that mechanical and personal safeguards have been
provided for the protection of the worker, we arrive at the second
real means of defense against serious poisoning, namely, the sys
tematic and regular examination of the worker, coupled with the
continuous use of laboratory tests on the blood and other body fluids.
I t has been pointed out how in the case o f lead, benzol, or radium,
we possess laboratory criteria in the form o f blood tests which reveal
the existence of early poisoning before serious damage has resulted.
One need hardly emphasize the point further that no worker should
be employed in a trade requiring the use of lead, benzol, or radium
without careful control o f the blood by examinations made every two
or three months. Numerous instances are known in which men have
become poisoned simply because the employer failed to provide the
necessary medical assistance before the disease arrived at a terminal
stage. The recognition by the employer o f the value of the physical
examination and the repeated study of the condition of the worker
at stated intervals is one of the most important steps which must be
made before industrial disease shall become obsolete.
The third means of defense against industrial poisoning, and one
that means complete solution of the problem, is the elimination of
poisonous materials in industry. The committees on benzol and
31573°— 29------ 10
140
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
spray coating o f the National Safety Council, realizing this fact,
concluded:
We would therefore urge that the serious attention of manufacturers now
using benzol should be given to the possibility of substituting one of these or
other relatively harmless substances wherever the conditions of a given manu
facturing process make it possible to do so.
REFERENCES
Thackrah, C. Turner. The effects of the Principal Arts, Trades, and Profes
sions on Health and Longevity.
Lewin, L. Die Kohlenoxyvergiftung, Berlin, 1920.
Hoffman, F. L.
Deaths from lead poisoning. Bulletin No. 426, United States
Bureau of Labor Statistics, February, 1927.
Aub, Fairhall, Minot, and Reznikoff. Lead poisoning. Medicine Monographs,
VII, Williams & Wilkins Co., Baltimore, 1926.
Leake, J. P., and others. The use of tetraethyl lead gasoline in its relation
to public health. Public Health Bulletin No. 163 (1926.)
Bloomfield, J. J., and Isbell, H. S. The problem of automobile exhaust gas in
streets and repair shops of large cities. Public Health Reports, March 30, 1928.
Final report of the committee on benzol. National Safety Council Bulletin,
May, 1926.
Greenburg, Leonard. Benzol poisoning as an industrial hazard. Public
Health Reports, 1926.
Final report of the committee of the chemical section, National Safety Council,
on spray coating, September, 1927.
Monograph on felt-hat manufacture in the United Stales and Europe. Five
articles reprinted from the Journal of Industrial Hygiene, 1922.
Turner, J. A. Mercurial poisoning. Public Health Reports, February 22, 1924.
Stock, Alfred. Z. angew. Chem. 39: 461-6 (1926).
Castle, W. B., Drinker, K. R., and Drinker, C. K. Necrosis of the jaw ini
workers employed in applying a luminous paint containing radium. Journal of
Industrial Hygiene, August, 1925.
Williams, R. C. Preliminary note on observations made on physical conditions
of persons engaged in measuring radium preparations. Public Healthy Reports,
December 21, 1923.
Investigation of toxic gases from Mexican and other high-sulphur petroleums
and products. Bureau of Mines Bulletin No. 231.
Baker, H. N. Intoxication with commercial methyl chloride. J. A. M. A., vol.
88, No. 15, April 9, 1927.
Bloomfield, J. J., and Blum, W. Health hazards in chromium plating. Public
Health Reports, September 7, 1928.
Thompson, L. R., Brundage, D. K., Russell, A. E., and Bloomfield, J. J. The
health of workers in dusty trades. I. Health of workers in a Portland-cement
plant. Public Health Bulletin, No. 176.
D IS C U S S IO N
Mr. S t e w a r t . I want just a word at this moment. Doctor Bloom
field mentioned Hoffman’s figures on the death rate from lead poison
ing. Now the Bureau of Labor Statistics, it is pretty well known,
publishes that report, and I want you to understand that Doctor
Hoffman’s figures are based upon deaths. W e are perfectly willing
to stand by that statement, that the death rate in lead poisoning is
decreasing, but to let that statement stand alone may be a little bit
misleading.
That does not mean that there is such a decrease in lead poisoning
among the employees, but only that the physicians have come to
understand the disease better and the victims do not die. But, while
I believe that, even with the increased number of industries in which
some form of lead is used, it is probable that serious lead poisoning is
on the decrease, yet it is going merrily on, and I am willing to
OCCUPATIONAL. DISEASES---- DISCUSSION
141
stand by Hoffman’s statement when, it is applied to the incidence of
lead poisoning in the living worker. In the first place we now havo
the industrial physician, who does not have to wait until there is a
blue line across the gum before he can detect lead poisoning. W e also
have outside physicians who know what the blue line means— a few
years ago they did not know what it meant. Not very long ago a
doctor sent a man to the hospital for a surgical operation for appen
dicitis. The physicians in the factory where the man worked found
it out and rushed there in time to stop it. They were going to cut
out this fellow’s appendix, when as a matter of fact he had painter’s
colic.
A s I, say, I am standing by the report we have printed as to the
decrease in death rate, but I do not want that to be misconstrued as
meaning that there is the same percentage of decrease in lead poison
ing among the workers.
The C h a i r m a n . W e will have the discussion on the papers that
have been read— the first paper was by Doctor Gehrmann.
Mr. R o a c h . I will <say a word on lead poisoning. I thoroughly
agree with Ethelbert Stewart, that while fatal cases of lead poisoning
have probably decreased, there is still the poisoning o f workers from
lead, which is going along quite merrily.
I think it was in 1919 that the United States Public Health Serv
ice made an investigation of certain industries in New Jersey, Penn
sylvania, and I think Ohio, one of which was the pottery industry.
A ll of the lead workers employed in the pottery industry in our
pottery district were given a very careful and painstaking physical
examination by the investigators, and no cases of lead poisoning
were detected, although one or two suspicious cases gave rise to the
thought that perhaps they might have been affected by their work.
But this very excellent result that was found in the pottery industry
was due not to the fact that the industry itself was taking extraor
dinary precautions to prevent lead poisoning but to the fact that
lead was not being used in the industry in the quantities that it had
been used in the early days of the pottery industry in England.
From my experience in the inspection of factories and the regula
tion of dangerous employments I feel confident that i f industry
wants to operate carefully and free from poisoning cases it can be
done, but you must remember that most of the men who are employed
in these poisonous trades are illiterate men. Many of them are
foreign workers who can not speak the language, and when they are
placed on a dangerous job and the foreman says, “ W ell, Mike, be
careful; if you don’t you are going to get hurt,” that kind of an
asinine precaution has absolutely no health value.
T. do know that in one of the large plants in our State— not so long
ago either— where there had been many cases of lead poisoning in
the handling of dry secondary lead metals, that the plant manage
ment determined after these cases were brought to their attention—
alid especially, I suppose, because they are compensable at the present
time and the experience rating of the plant was mounting— that it
would banish lead poisoning from that industry; and it did it suc
cessfully by moistening the materials, by hiring a better class of
men— that is something that is not very often stressed, that the grade
of the worker in the poisonous trades has a very decided influence on
142
FIFTEENTH A N N U A L MEETING OF I. A.
C. A. B. C.
the amount of poisoning that occurs— by insisting that foremen warn
these men carefully, watch them, guard them every minute of their
working period, and positively insist on the men, despite the difficulty
of the operation, wearing respirators.
Now, I have no brief to defend respirators’. God knows I would
rather go to jail myself than have to work the rest of my life in a
lead plant wearing a respirator, but if that work is going to be done,
a very substantial measure of protection from the effect of lead in the
air can be secured by strict and stern insistence on the use o f
respirators. In our last bulletin a report wTas sent in from this’ plant
showing the amount of protection that was given these men handling
these s e c o n d a r y metals by the precautions that have been taken.
Lead poisoning is with us and it is going to be here a long' time,
and I feel sure that if the medical profession everywhere, and espe
cially in the industrial centers where men are exposed to lead, were
well informed on lead poisoning symptoms that we would have many
more cases reported to our statistical bureau than we have at the
present time.
Take the case o f benzol: For 20 years in the Newark district they
were using benzol, and I know one old gentleman over there who hon
estly believed that if he had the inclination he could drink benzol
and it wouldn’t do him any harm. He is1sure that benzol will not
create poisoning, because he says, “ Just look at it; here I have been
using it for 20 years and we haven’t had a single case in this plant.5*
W ell, Doctor McBride knows that until three years ago we never
had a single case of benzol poisoning reported in the State o f New
Jersey, but since that time, owing to the amount of information that
has been spread on the subject of benzol poisoning, and the local
atmosphere of suspicion in that district that has been created by the
publication of information on the risk from benzol poisoning, we
have had in three years 13 fatal cases o f benzol poisoning from those
plants that first poison the breathing atmosphere and then try to
purify it by means of exhaust ventilation. I want to tell you that
it can not be done.
In the case of the handling of toxic coating substances, they poison
the whole breathing atmosphere so that you can not purify it and
the men working there are made sick. I think Doctor Gehrmann will
back that up. I know that his company had an experience in the
State of New York of such a nature that in the manufacture of
certain textile leather fabrics it abandoned the use of benzol after its
engineering department had decided that mechanical engineering
could not make that work safe. So it seems to me that the depart
ments generally should know this; that effort should be made all over
this country to spread this information on the toxicity of these
substances, on the symptoms that should be noted; and when you do
that you are going to arouse public opinion to the point where substi
tutes will be provided for these dangerous poisons that now are
taking a very heavy toll indeed.
The C h a i r m a n . I am going t o call on Mr. Meade, of Massa
c h u se tts, to discu ss th is.
Mr. M e a d e . From Doctor Bloomfield’s talk I gathered the very
interesting information that his department has made a very careful
study of the hazards in the stone-cutting industry. The department
OCCUPATIONAL. DISEASES---- DISCUSSION
143
with which I am connected has for several years also been interested
m that problem, and while we have had but a few cases of tuber
culosis arising in that industry in Massachusetts, yet we are certain
that its incidence is more far reaching than appears upon the surface.
W e have followed the plan of good mechanical procedure; we have
adequate local exhaust ventilation, and in one center in particular for
three years much of our time was taken up in securing the installa
tion of these devices. The work was difficult at the beginning. There
were many who believed it could not be done. There were those who
said that it was a waste of time and money and effort, but nearly all
of the plants have been equipped with fairly good control at the
point of origin especially on the surface-grinding machinery used in
connection with the making of granite monuments. The benzol
poisoning experience in our State is somewhat similar to that, of
course, in New Jersey, but not on such a broad scale, not on such an
extensive scale, though we have followed up closely the use of benzol
and have required that in the inspection of every plant our repre
sentative secure, so far as it is possible for him to do so, a list of all
of the industrial poisons used in the plant. In that way we have been
able to stress frequent inspection where there was undue exposure,
in the case of lead poisoning, or where there might be the possibility
of any exposure in the case of the use of benzol.
In one o f the shoe factories in our locality, about a year ago, a
young girl, 19 years of age, was employed at a very simple opera
tion in the applying of cement to the rubber heels that are used
upon the shoes. That cement contained a very heavy portion of
benzol, and this young girl simply inhaled the fumes. She was taken
to the hospital upon the onset of the disease, which at first was not
understood, and after three or four days died, as a result of inhaling
the fumes from that cement in which there was a large portion of
benzol.
Immediately we sought to deal with that situation by investigat
ing the cement manufacturing industry. W e found that the use
of benzol was more general than we had had reason to believe, and
in some places we succeeded in securing the use of toluol instead of
benzol. That only indicates the nature of work that our inspectors
have to do. It is true that we depend very largely upon the coopera
tion of the manufacturer to do these things, and it is equally true
that there is a possibility that after a while there may be a relapse
into the use of benzol, and that brings up the question of constant
examination of the materials that are used in certain industrial
plants.
The papers I have listened to this morning have been very help
ful, but after all we have pretty nearly the same experiences every
where. In other words, those papers are pictures of the experience
of all the industrial States.
I read very carefully that article by Doctor Hoffman in connec
tion with the incidence of fatal lead poisoning, and of course, Mr.
Stewart has brought out what is the truth. It is true that there
has been a big reduction in the number of fatal cases in lead poison
ing. Doctor Hoffman brings out the very interesting fact, for in
stance, that the ratio of the number of fatal lead poisoning cases
in Great Britain to that in Massachusetts and other industrial States
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
of this country is four to one. That is interesting, because I think
it establishes at least one thing: It establishes a wider knowledge
among physicians of the symptoms of lead poisoning. I think that
may be due also to this fact: That through the constant publication
of the experience of industrial States, and of the work done in the
investigation of industrial diseases, knowledge of the surroundings
of the employee in the place of his employment is now looked upon
by the average physician as an important factor in his diagnosis,
and it has led to the early detection of lead poisoning. That is
what has caused a reduction in the incidence of fata] lead poisoning.
I think, as Doctor Bloomfield summed it up, there are two im
portant things in all of this industrial health work; first and fore
most, there is the attention to be given to the point of origin— the
need of mechanical inclosure, and the need of adequate local exhaust
ventilation at the. point of origin— and then, finally, the work o f the
plant physician in looking at the blood picture and watching the
physical condition of the employee. The one may be, under State
auspices, quite well enforced; that is, it is within the scope and au
thority of statutory law— statutory power— to bring about the safe
guarding of these points of origin that are harmful and dangerous
to the employee. But the other side of this program, so far as the
physical examination of the employee is concerned, the moment that
we begin to undertake that great task under public auspices then
there is no end to the trouble that may follow in its trail. The selec
tion of employees based upon their physical condition is, of course,
a safe way to exclude employees who are prone, because of their
physical constitution to occupational disease. It is a good way to
exclude them from that employment. In the hands; of an intelligent
physican that power is good— I mean what I say, an intelligent physi
cian, one who knows the manufacturing processes of the plant, one
who knows what the hazards and dangers of exposure to given sub
stances are, and one who is preeminently practical in his diagnosis
and conclusion; but in the hands of one who lacks this experience it
would be a bad thing, it would be a serious thing, it would be a harm
ful thing to the man who must go into the market and compete for a
job. There is danger in that direction, but there is no danger in
requiring adequate mechanical inclosure and local exhaust equip
ment. When the industrial organizations of oar great industrial
States— I refer to those under governmental auspices— supported by
those that are doing wonderful work under private auspices, when
these two forces have joined and cooperated, as they certainly should
do, then we will see the beginning of a better day, so far as freedom
from the dangers and hazards of serious occupational poisoning for
the employees is concerned.
The C h a i r m a n . I will call on Mr. Williams, of Connecticut, to
discuss this further.
Mr. W i l l i a m s . The great hopefulness of the entire problem under
discussion this morning is due largely to the fact that, once having
our attention called to dangers, we began to think about it, and
then when we found it cost money, we thought more about it. It
has gotten to the place now where we have a lot of physicians scat
tered around the country who do not have to wait until they see
OCCUPATIONAL DISEASES---- DISCUSSION
145
blue lines on the gums to diagnose lead poisoning, but it is only
a few years since that was necessary.
The installation of a department of industrial medicine at Harvard
University as well as at other medical schools, for industrial physi
cians, is one of the most hopeful things on the horizon. Such physi
cians are getting to be quite well paid and quite numerous. Other
medical schools can not indefinitely compete unless they have chairs
of industrial medicine.
When you read some of the works on occupational diseases which
were printed a few years ago, it reminds one of what Josh Billings
used to say, “ They had better not know so much that warn’t so.”
For 14 years I have administered compensation law in the head
quarters of the brass and copper industries of the world. Our people
visit the office in person, and I have been asked to grant awards
for everything that could possibly be conceived of as arising out
o f or in the course of employment, and have even had the claim
made for something called “ brass poisoning.” There are certain
compositions of lead with brass where you get an occasional lead
poisoning, but brass itself is not poisonous. In handling the brasses,
in order to prevent structural changes in the metal they have to
be greased quite often, and those greases are rather good mediums
for bacterial culture, and that is where most of the so-called brasspoisoning comes from.
Now our great concerns in Connecticut who are sincere insurers
are establishing industrial hospitals; they are installing students
in industrial medicine, exercising careful supervision, and bringing
up a line of practitioners that have far more knowledge that the ordi
nary general surgeon or practitioner.
It is concerns like the one which was represented here to-day—■
concerns which have specialists and do not wait until the man is
dead, but prevent his dying— which strike the hopeful note.
One of our biggest insurers, I found to my great pleasure, was in
terested in our work enough to send a representative of the company
down here to stay through this meeting. I think it is a very hopeful
thing. Industrial medicine has become a specialized field, and there
is far more need for the fellow with thorough medical education and
knowledge of industrial hazards than there is for having 16 special
ists go over a man before they operate on him. That thing is growing,
and it can not come too soon.
There is one great factory down in my district where they had
the old-fashioned wet grinding of pottery, and some mysterious dis
pensation of Providence caused a somewhat extensive fatality among
its workmen right along for several years, but when it was discov
ered that the constant inhalation of particles of mingled glass and
silica was not exactly helpful, that disease arose and a man’s lungs
were attacked, they began finding methods of doing the grinding
differently. I do not think we will hear much more of that after a
few years— simply to help a poor fellow whose lungs are half turned
into scarred tissue already, for no matter how finely you grind
the glass up it still has sharp edges on it and it will stick in your
lungs.
The world is getting better all the while, and workingmen are
going to be better taken care of, both for humanitarian reasons and
146
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
because it is more profitable to take care of them than it is to kill
them.
The C h a i r m a n . I am going to call on Mrs. Slayback, of New
Jersey, to discuss this.
Mrs. S l a y b a c k . It so happens that in my district in New Jersey
there is a plant which makes cement for belts such as the girls use—
such cement as that girl put on the rubber heels— and I happen to
know that that cement contains nearly 60 per cent of benzol.
I have in mind at this time to link up the industries of New Jersey
with the homes of New Jersey. For a number of years the depart
ments of labor have been taking care of the industrial poisons in our
manufacturing plants, but this question of benzol goes much further
than the factory; it follows straight into the homes. The housewife
to-day is using lacquers put on furniture by means o f the common
insecticide spray, which she buys for 50 cents in a hardware store
and uses within her home, exposing everybody in the household to the
poisonous fumes of benzol. I want to ask the men who are here this
morning why it is impossible to have a poisonous label put on a can
of lacquer which contains benzol? W hy should not our homes be
protected to the extent that the housewife will know what she is
using ? I have been told by men connected with my own department
that lacquer does not contain benzol, but when manufacturing plants
in my own district admit that the lacquer which they put out con
tains benzol as a thinner, I am going to believe the manufacturer.
I believe to-day that we as industrial workers have not performed our
full function until we get a poison label put on a can of lacquer that
contains benzol or on a can of belt cement containing benzol, just the
same as a druggist or chemist is obliged to put poison labels on iodine
when it is sold.
Mr. K o a c h . I would like to speak on the question of brass poison
ing. A ll the literature on the question up until the present day
has been founded on error, because I think that Hamilton and
Hayhurst and a number of other experts are able to support the
theory that there is some risk of poisoning from brass, although of
course it is not in the same category with lead or benzol or mercury or
some of the other more toxic substances. I think perhaps the
reason there is not so much brass poisoning to-day is because we
are not using so much zinc in the composition. Now brass is made
from copper and zinc and a small percentage of lead or some other
alloy, heated to a high temperature. The zinc oxide comes off in
the form of powder or gas, and the workmen get what is known as
brass chills. So it would not be quite fair to the- factory inspection
departments to assume that in brass foundries where they are mak
ing yellow brass with a percentage of zinc in the composition there
is no risk from brass founder’s chills, unless the apparatus is ven
tilated and the vapors are removed to the outer air.
Mr. W i l l i a m s . Mr. Koach must have misunderstood me. Doctor
Hamilton’s book on industrial poisons is one of the latest, one of the
best, and I have got it; she feels as I do that brass itself is innocuous.
I was talking about the books that wrere written some years ago, of
what somebody in a factory told somebody else, and he told the man
that wrote it.
OCCUPATIONAL DISEASES---- DISCUSSION'
147
Mr. S t e w a r t . I want to call attention for just a minute to certain
lines of articles which are being manufactured which are neither
necessities nor luxuries, nor are they conveniences— they are being
manufactured and sold on a pure fad basis— very many of which
have a trail of graveyards behind the manufacturers.
It seems to me that the departments of labor, with their inspectors,
ought to point out the fact that we are manufacturing things which
are purely fads— fads that are exceedingly hazardous and dangerous
in the process o f manufacture. One of these articles is luminous
paint, whether used on watch dials or on any other thing. Radium
necrosis is even more serious than phosphorus necrosis.
I want to say one more thing. So far as I know, this is the first
meeting to discuss the changes that are coming and have come in
health hazards, due to changes in processes of manufacture. W e get
a little in the magazines once in a while about those things, but this
is the first really organized discussion of this subject ever had in
this country so far as I know, and the report thereof ought to be,
and I propose to see that it is, circulated among the medical schools
of this country to show the necessity of not only the industrial physi
cians, but of all physicians, knowing something about industrial
disease. I have never in my life had a doctor ask me what I did,
what my job was; it may be that some doctors do ask a patient about
his work, but the whole question of occupation as an element of
disease seems to be ignored except by the plant physicians or the
industrial physicians and the physicians attached to the various
State departments, and I wonder if they reach one-half of 1 per cent
of the people who are really working in these poisons. I think that
out of this meeting we are going to get some reaction from the
doctors, get them to wake up to the fact that a very large proportion
of the illnesses of mankind grows out of the kind of work people are
doing.
The C h a i r m a n . Has anyone else anything to offer to this dis
cussion ?
Mr. H u b e r . I will drop back to Doctor Gehrmann’s paper. The
Empire Refining Co. (Inc.) is greatly interested in the benzol propo
sition, as Doctor Bloomfield will admit, but we do not know and will
not know to what extent benzol is poisonous until the courts tell us.
W e have depositions and testimony swearing that benzol is not
poisonous, but we also have the other side, that even if you write
the word “ benzol55 you might be poisoned. W e will not know to
what extent benzol is poisonous until the courts tell us, because we
have 265,000 damage suits pending* in the courts to-day.
W e used to have any number o f accidents from gas fumes— we
work gas from Oklahoma to Kansas City. W hat our chemists did
1 do not know, but they find to the very second the least gas escape,
and can save themselves before they are poisoned. Our safety-first
department could not do i t ; it was our chemist who did it. I believe
that for all the industries chemists can probably do us more good
than can be done by discussing whether or not benzol is so deadly
poisonous.
Mr. W i l c o x . I never think about the question of occupational dis
eases or undertake to discuss the subject without mingled feelings
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
of hurt and pity— hurt, because of the disappointment I feel in de
partments of government that ought to be carrying the message
back to the legislatures on the hazards in industry of the type we are
discussing and the absolute moral obligation on the part of every
State to cover it under the compensation act; and pity, because of
the fact that there is such a woeful lack of information on what
the hazards are and what progress we might make if we would amend
our laws so as to cover liability for the diseases of occupation just
as we do for the effects of accidental injury.
Judge Williams said that our interest in this subject will be a great
deal keener when we have to pay for something, and I think that is
pretty well recognized as its effect upon safety work for the purpose
of preventing accidental injury. I see no reason why the same result
should not be expected to follow if our laws were amended so as to
cover diseases of occupation. I say 64diseases of occupation55 instead
of “ occupational diseases,” intentionally and I do it because we are
prone to think of the words “ occupational disease ” as meaning lead
poisoning, benzol poisoning, and those few things we have been
schooled to believe are occupational diseases, and forget one outstand
ing disease— the greatest disease of occupation of all— that is, tuber
culosis. And so I say 66 diseases of occupation,” so that you won’t
be forgetting about a lot of things of which you ought to be thinking.
Doctor Bloomfield gave a left-handed compliment to industry by
saying that industry was going way ahead of the compensation work.
W ell, it won’t have to go far to be ahead of the States, so far as
compensation is concerned, in the matter of caring for industrial
diseases, because, men and women, it is nothing less than a travesty—
there is just a handful of States that are recognizing any part o f
their problem in this field, just a handful. The last thing I did
before I left my office on Saturday last was to dictate a letter to Mr.
McShane, of Utah, who had written me concerning the operation of
our law and particularly as to the ultimate cost of doing what we were
doing. I wrote him quite at length after I had had a tabulation pre
pared of seven years experience in Wisconsin. W e have covered
every disease o f occupation— understand it, I said every disease of
occupation— since 1919, and we have the tabulated experience for that
period. I wrote Mr. McShane, and after I had had a tabulation
made of this experience— not the kind of a tabulation we would ordi
narily make in our statistical department, but one on which I had
help from the departments throughout the United States— I asked
my girl if she would not send a copy of that tabulation and of my
letter to Mr. McShane to all of the compensation departments in the
United States, and so I hope you will have it within a few days, and
I hope it may be of some help to you.
Our attitude with regard to occupational disease is based very
much on fear— fear of the employer, fear of the administrators— that
it just can not be done. I remember that my good friend Senator
Duxbury at one time mentioned the fact that the reason for our
failing to do some things is because of the hardness of the job; he
didn’t know whether he was equal to the job. W ell, I give him
more credit for believing that he can not do the job, and, whether it
is easy or hard, I say to the men who are engaged in this field of
service that it does not do them justice when they refuse to tackle
OCCUPATIONAL DISEASES---- DISCUSSION
149
a job because it is a hard job. God knows, if there is any group
of people that needs your protection and needs the benefits of com
pensation it is the men who are injured by diseases of the occupations
in which they work. Men who are engaged in safety work will
tell you that 50 or 75 per cent of all accidental injuries might be
avoided if the employee would just be careful and not be careless.
It is not so with diseases of occupation; the men who are serving
their master^ best are walking right into these hazards and taking
on the disease day by day unwittingly— an insidious attack upon their
systems. I f I have to discriminate as between these employees—
the man who is accidentally injured and the man who is injured by
the disease of his occupation— I want to know that the man who is
injured by the disease of his occupation gets his compensation,
whether the man who stumbles and falls downstairs and breaks an
arm gets anything or not.
There is no reason for the exclusion of any injury from the bene
fits of compensation. I f we mean all these high-sounding things we
have been declaring in and out of these conventions year in and year
out as to the wonderfulness of this compensation system— shouting
it from the housetops— how do you satisfy your conscience when you
forget about the diseases of occupation? It is a convenient con
science that fails to recognize it. It is not an expensive proposition
to cover occupational diseases; and if you will cover them in your
compensation act it will have the same effect as when we covered
accidental injuries, and you will have all employers in the State
interesting themselves in it as they are now in preventing accidents.
They are not all du Pont companies that operate in the State of
Wisconsin or in your States— companies which have medical experts
and medical advisers, which are giving this attention constantly.
The great bulk of employees are working for employers who have no
medical examiners and where nobody is gi ving any attention to this
subject. W e will bring it to their attention when we amend the laws
so as to cover these liabilities.
The number of States that are covering these things under the
benefit laws can be counted on the fingers of one hand almost— New
Jersey, New York, Massachusetts, Ohio, North Dakota, California,
Wisconsin, and perhaps Connecticut— I am never quite sure what
they do in Connecticut— and a number of other States perhaps touch
them slightly.
I can not quit this question now without saying one thing more to
you, and this is not a criticism of the administrative department in
any State which has the schedule plan. I have no patience at all
with that schedule. M y reason for that is because it is a studied
effort to deny benefits to a certain group. When Mr. Bloomfield tells
us of the hazards of the stone cutting and grinding industries as to
tuberculosis, we ought not to forget to cover tuberculosis in our laws,
and so when you have, as you may and probably will have at this
next session of the legislature,, applications in your State to amend
your law so as to include occupational diseases do not follow the lead
of those States that have proceeded on the schedule plan. Meet this
thing like men and women, and give those benefits to every man who
takes on disease because of the work that he does.
150
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
Doctor McBride will tell you that he does not want you to follow
the law of New Jersey and cut out a group of people that ought to
be covered. Do not follow the schedule plan. When you want to
know what it costs, inquire of those States that are giving full cover
age. I t costs little more to cover them in Wisconsin than it does in
Ohio, where they have the schedule plan. When our law was adopted
in Wisconsin the compensation rating and inspection bureau, and
the compensation insurance board had to deal with the question of
how the rates for insurance coverage were to be loaded to cover this
disease. W e had no experience to go upon, so we put 1 cent in the
rate. I f the rate was $2, that made it $2.01; if it was 9 cents we
made it 10 cents. I am not upholding that at all, but we agreed that
within a year we would make a study of the thing and get it on a
scientific basis. A t the end of the year we were convinced that after
all when you had put up to the employers of the State (and you will
find the same thing when you put it up to the employers of your
State) that they have to take care of these things, they will do as
Doctor Gehrmann is doing. They will find out what the hazard
is and will protect their men from it. Then it won’t cost you any
thing, because you can save these men from occupational diseases.
God only knows whether you can save them from accidental injuries.
A t the end of the year we took the 1 cent out and it has not been
in since. The rates in Wisconsin for compensation coverage now,
including all occupational disease,, are based on identically the same
premium that they collect in the State of Illinois, where they do not
have much of any coverage of diseases, and New Jersey, and New
York, Massachusetts, and all these other States.
Mr. D u x b u r y . Put Minnesota in.
Mr. W i l c o x . Yes, and in Minnesota. W e took out the 1 cent and
we are now having our full coverage, including occupational diseases,
without one red penny in the rate over and above what the other
States are collecting without that coverage. It would be an insignifi
cant thing. When you once get to work you will save these men
from these injuries, and it will not cost you more, except work such
as Doctor Gehrmann and these other people are doing in the highly
organized plants where they are giving attention to these subjects.
I f there is anything in the table which you receive from Wisconsin
on which you want additional information or on which we can be
of help to you, we want to give it. I do not see how a compensation
administrator can turn his back on the man who suffers with an
occupational disease and tell such man that the law does not protect
him, and that the administrator can not do anything for him, and
then forget about it when the legislature meets.
Doctor M c B r id e . W e ought to get all the information w e possibly
can on this question of occupational diseases, as it is of tremendous
importance. W e, as leaders in this field, ought to supply all the
information w e can.
Mr. C o l e m a n . Last year the medical director of one of the com
pensation clinics of New Jersey was invited to present a paper before
their industrial hygiene session of the American Public Health Asso
ciation on the medical aspects of occupational disease. A s a result a
committee of some of the leading industrial physicians of the United
OCCUPATIONAL DISEASES---- DISCUSSION
151
States was formed to adopt standards for compensation in the matter
of occupational diseases. Our committee has had several meetings
during the past year and is presenting its first report at the meeting
in Chicago next month. I have here a copy of that report; of course,
I am not permitted to read it in its entirety, but I want to read a
paragraph or two following Mr. W ilcox’s remarks:
We have in this country therefore two different methods of dealing with
the problem. A blanket law is theoretically best and appears to work well
where in use, but, there is a very prevalent opinion among those directly con
cerned with compensation work that definite and specific schedules facilitate
administration and are beneficial to the industrial worker in that they tend to
promote legitimate compensation cases; the schedules may be unfair where the
compensation of process is specified. It is difficult to conceive why one individual
should secure compensation for a scheduled disease and another with the same
disease be refused because he happens to be in a different occupation.
It is obvious also that occupational diseases must present distinct problems
for lay officials. It should be the duty of a State medical officer or| officers to
establish whether an individual claimant has or has not the disease for tvhich
compensation is sought, rather than leaving the matter of diagnosis to the
contention of opposing physicians and lawyers. Such contentious procedure
nullifies the concept underlying compensation laws. With skilled official medical
service available to compensation tribunals, it would be possible to carry out
with a higher degree of efficiency means for the prevention and control of
occupational disease. In this connection recognition must be given to the
necessity of establishing occupational disease clinics under State auspices.
Such clinics would aid in diagnosis, insure proper treatment, and add to our
knowledge of the extent and character of occupational disease.
I can think o f no better way for this conference to study this
matter than to appoint a committee to act in cooperation with the
committee from the industrial hygiene section of the American
Association of Public Health.
Mr. D u x b u r y . I have been listening to this discussion to-day and
the papers yesterday afternoon with more than usual inte-rest. In
fact I believe some of my friends here will wonder why it was that I
did not say anything. I can usually talk about things that are not
serious, but when I get real serious then I think.
M y friend Mr. W ilcox has intimated to you that I had an attitude
of mind that suggests a constitutional laziness; that the minute
things get really difficult, I lie down on that. I do not think he quite
meant that; he knows me a little too well for that. Still it does not
do any harm once in a while to realize, so far as we can, the possible
consequences of some proposed change.
I am thoroughly sold on the principle that there is just as much
reason for compensating disability incident to industry or occupa
tional disease as there is for compensating disability incident to
industrial accident. There can not be any distinction. I f the one is
justified the other is. It is just as important to the workman and to
his family and to society that the consequences of his occupation,
resulting in his disability through a thing that may be called disease,
is taken care of, as it is that that same situation is taken care of when
it is the result of accident. That has been recognized, and then we
approach the question with a great deal of caution because of various
reasons.
Remember the closing remarks of our venerable secretary; when he
sat down he indicated that there was a possibility and a probability
and a growing conviction in his mind that nearly every disease that
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
men and women suffer from can be traced in some measure to their
occupation; that their occupation is making them sick and killing
them. That conception scares people; it makes them afraid to under
take such compensation; it scares legislators. They think if this
thing 1$ thrown wide open that every sickness of the workingman and
the death of every working man or woman will mean compensation.
They are afraid of that extreme, and because of their fear in relation
to that they adopt this nonsensical plan we have in Minnesota, and
which they have in New Jersey, and which they have in some other
States, that limits compensation to just the particular few things that
we call occupational diseases. W e are guarding against that unseen
danger of which we are afraid.
Over in Wisconsin they are not afraid of anything. Mr. W ilcox
is a regular John the Baptist, and he impressed the faith that they
have upon them, and they took the plunge. He has told you their
experience and I am looking forward when I get home to the pleas
ure of reading that letter which he said he wrote. I have gradually
become convinced that that apprehension is not very well founded
and that it involves a question of wise administraf ion of the law.
O f course they have wise administration of the law over in W is
consin; we all know that. Whether we are wise enough in Minne
sota to administer the law or not may be reasonably questioned, but
the thing ought to be done, because if the compensation commission
of Minnesota has not got ability enough or sense enough or is too
lazy properly to administer the law, we ought to resign and let
somebody else do it. W e ought not to shirk a responsibility; and
while I admit that I am one of those timid souls that sometimes
hesitate to assume things that are involved in so much difficulty, I
do not think that ought to be any excuse for Minnesota not making
the laws it ought to make. I f I am unfit to administer the law I
ought to resign, or not be reappointed when my term expires; but
there is difficulty. I am always seeing things in the dark and I can
see that if we start out along the line that Mr. W ilcox suggests, that
the State of Wisconsin and every other State that does that will
have to realize that they are only in the kindergarten stages of the
subject. I do not know what they do in Wisconsin with reference to
some things I am going to suggest, but in Minnesota, in the present
state of our law, if we have an occupational disease that results in
temporary disability coming within our schedule, we can compensate
for the temporary disability and we can furnish medical treatment,
hospital treatment, to cure or to relieve as far as possible; but in
many of those instances we can not bring them back so they are 100
per cent— they are going to have some consequences in the nature of
permanent partial disability. Do our schedules take care of that?
No. W hat are you going to do about that? Some of them do; over
in Wisconsin they have a system by which under the wise adminis
tration of their present commissioner they can probably take care
of that.
W e have a system by which we are required to guess at the presence
of disability or loss of use of that most wonderful instrument of
creation, the hand, and we do that, but as a matter of fact who knows
enough to say whether there is a 20 per cent or a 40 per cent loss of
use of the hand. Percentage means a certain portion of the entire
OCCUPATIONAL DISEASES---- DISCUSSION
153
use and that entire use is the most marvelous thing in the world.
When you get a disability resulting in a general physical disability,
that a man is not as good as he was before, he is not 100 per cent—
no two are alike, you know— you have to know what his normal con
dition was when he was all right. Now he is not normal, he is not
quite as efficient as he was before, and you have to determine humanly,
with human instruments, with the human mind— which I admit is
very limited— just what percentage will compensate that.
I do not mean, by mentioning that, that we ought not to start on
a right basis, because I believe that we can determine the effects of
occupational diseases just as accurately as we can determine the
effects of accident. Some of your laws will have to be amended.
Our law will have to be amended, because our supreme court in its
wisdom held very definitely some time ago that there was nothing in
the schedule in our law which permitted us to compensate a person
upon the ground that he had lost a certain percentage of his general
efficiency. In other words, we have a schedule for permanent total
disability. It might be admitted that he was not totally disabled;
because of the condition of his back or something of that kind, he is
never going to be as good as he was; but we have not a single schedule
that applies to his case. W e can only say that in our judgment he
is one-quarter permanently totally disabled— that is, one-quarter of
his total efficiency (is gone— but we have no schedule for that. The
court said that as we have no schedule for that we can not compen
sate for that, and that is true in most of the jurisdictions.
W e have in Minnesota what they call a pretty good law as tested
by the ordinary tests of compensation laws. W e have a $20 maxi
mum, we have unlimited medical care, and we have a lot of the
things that go with a high-class law, but I have got to the stage
where I say that our law is a regular cruelty, and we might as well
admit it and commence to make it better. Get away from this
bigotry about the virtue of your laws, condemn them, and try to
find out what they ought to be, and have courage to recommend it.
I am going to.
Mr. W i l c o x . I did not mention Senator Duxbury’s attitude,
because I thought he was lazy or anything of the kind; I want
everybody to know that I think he has the ability to administer
any of these provisions. W hat I wanted to do was dispel from your
mind the thought that the administration of an occupational disease
amendment in your law is a hardship. It is nothing of the sort.
You can administer it as easily as you can administer any other
feature of your law. I think it is too bad, men and women, when
we who have been selected to administer these laws, who surround
ourselves with the finest type of employees for examiners and in
vestigators, who take doctors into our confidence, and who go on
year in and year out determining the extent of the disability to that
finest of members, the hand, say that we have doubts and that we
do not think we can do it, when you and I know that we will submit
our home rights, our family rights, our property rights, everything
in this world, to a jury of 12 men selected, not because of the things
that they know about the job that they are tackling, but because of
the things that they do not know.
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FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
It is the experience of every lawyer, every man who has had trial
experience in common-law damage suits, that when the question of
the dangers of electrical current and electrical wires and so forth
are involved, we wrould never permit an electrician to sit on the
jury; and if it was benzol poisoning that was to be considered,
Doctor Gehrmann would not stand a chance of getting onto this jury
of 12 men. W e submit it to a barber and the fellow who digs in the
ditch, and other men who are good and fine so far as their job is
concerned but who know absolutely nothing of this field. W e do it
because— well, we want to play on the chance of a jury throwing
the thing our way instead of some other way.
Just one more word about the gentlemen’s remarks about the
retention o f the schedule. When I used the word “ schedule” I
meant a provision, and I wras thinking of it only as the provision
which excluded certain diseases because of the fact that they were not
mentioned; that is the purpose of a schedule. I was not thinking
about this other thing, where you evidently— I didn’t know that
that was so— compensate for lead poisoning if it comes from one par
ticular plant, but if it comes from another plant then you do not.
W ell, I have less patience with the schedule which refuses to compen
sate for lead poisoning because it occurs in factory A rather than in
factory B than I have with the schedule which eliminates certain
types of occupational diseases altogether. To my mind it has no
place in any law.
Mr. S t e w a r t . For the purposes of the record I want to say that 12
States and the United States Government compensate for occupa
tional diseases. These are California, Connecticut, Hawaii, Illinois,
Massachusetts^ Minnesota, New Jersey, New York, North Dakota,
Ohio, Porto Rico, Wisconsin, and the Federal act covering long
shoremen and harbor workers, the Federal act covering private em
ployment in the District of Columbia, and the act covering Federal
employees. Some of these have very broad coverage, and have not
found it at all expensive. Mr. Leslie, of the rate-making bureau for
the insurance companies, says that the companies usually figure the
increase in the rate at 2 per cent, but he thinks that is high and
that they are going to come down to i y 2 per cent. Now that is the
case, so far as scaring the legislature is concerned.
W hat I meant by the statement that in my judgment a vast major
ity of the illnesses grew out of occupation was not intended to be
flaunted before the legislature^ at all. I thought I made it perfectly
clear that we ought to call the attention of the medical universities
to the fact that every physician that is turned out and every physi
cian that gets a license to practice ought to know enough about the
facts in the case at least to ask a man his occupation and determine
from that information what the remedy should be. That remark
was aimed at the universities and not at your legislatures. As to
the cost of this thing, so far as our experience is, 2 cents is the maxi
mum and nil is nearer the case.
Mr. D uxbtjry . Just one word. I made a reference to what our
friend, the secretary, said just for the purpose of trying to indicate
the extreme view that some people have on the subject. O f course,
I knew he didn’t mean that, and you knew he didn’t mean that,
because he, like myself, is apt to indulge in extravagant expres
OCCUPATIONAL. DISEASES---- DISCUSSION
155
sions. One more thing I want to say. It is quite remarkable how
we are impressed with the importance of including occupational
disease within our law, all admitting practically that it is a momen
tous question of vast importance. Now they say it is not going to cost
anything. Either it is not of very much importance or else it will
cost something; that is all there is about it.
Mr. K e n n a r d . I have only a word to say, and I say it with reluc
tance because of the kind things that have been said about Massa
chusetts with reference to occupational disease, which perhaps should
lead me to keep still, but in fairness I do not think I should let the
statement of Mr. Wilcox go without explanation. H e listed Massa
chusetts among the jurisdictions which cover occupational diseases.
That is not so. Our supreme court has said specifically and cate
gorically that our law does not cover occupational disease, and I
think I am quoting it exactly, word for word.
Perhaps a word of explanation. W e have awarded compensation
in Massachusetts for lead poisoning, for benzol poisoning, and even
for tuberculosis, pneumonia— in short, we have awarded compensa
tion for diseases in many cases— but we always have to find, in order
to sustain such a decision, that the inception of the disease, or one
of the predominating, aggravating causes, one which can be demon
strated as being an aggravating cause of that disease, has the char
acteristics of an injury. In other words, our law is based upon
injury and in order to cover disease there must in the first instance
appear to have entered into that disease as a factor something in the
nature of an industrial injury. The subject is somewhat compli
cated, but that is the best explanation I can give to you in the few
minutes that I want to take.
W e do have in Massachusetts, and we have it now, a good deal of
agitation over health insurance, because if I understood Mr. W ilcox’s
proposition that is what he wants— health insurance confined to
industrial workers. Our health insurance law has attempted, so far
as it has made any progress, to be inclusive, of all inhabitants rather
than being confined to industrial workers.
Mr. M a g u ir e . I would like to say a few words in regard to Penn
sylvania. I was very much interested in the remarks of Mr. Wilcox
and Mr. Duxbury relative to the inclusion of legislation for occu
pational diseases, especially so since Pennsylvania does not now
have that provision in its law.
The situation in Pennsylvania is exactly like the situation in
Massachusetts, just stated by the gentleman from Massachusetts,
but I feel that there has not been enough information disseminated
throughout the State relative to occupational diseases; there hasn’t
been any association actively in back of legislation of this kind.
So far as I know, the Legislature of Pennsylvania met and
amended the workman’s compensation law at its last session; there
was no effort— at least not an active effort— except in the labor
department itself, urging the passage or the amendment of the law
to include occupational diseases. That is purely my own impres
sion. There might have been something that I do not know of.
However, I think that it is incumbent upon some organization,
whether it be this or the National Safety Council or some similar
31573°— 29------ 11
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FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
organization, to appoint a committee on compensation legislation
to go into the States when the legislatures are meeting and promote
the enactment of legislation in which they are interested. I do
not think that it would be at all unconstitutional for this associa
tion to do it.
I wTant to say th is: Mr. Stewart said that he would see to it that
the universities were circularized relative to the training of indus
trial physicians. I feel that if it is worth doing that, it is worth
while working up a good paper on the advisability of the enactment
of occupational disease legislation for dissemination and distribution
to the legislatures in the various States.
I am sure that if you can prove to the legislators of Pennsylvania
that it will not cost the manufacturers or others a cent to compensate
occupational disease, they would be willing to pass such legislation.
[Meeting adjourned.]
THURSDAY, SEPTEMBER 13— AFTERNOON SESSION
Chairman, Walter O. Stack, President Industrial Accident Board of Delaware
ACCID EN T PR EVEN TIO N
The C h a i r m a n . The chairman wants to congratulate you on the
splendid program for the afternoon; the subjects are of vital interest,
not only to the employers and employees, but to society and the home.
The first paper will be “ W hat is being done for safety in Canada,”
by R. B. Morley, of Toronto, Canada.
What is Being Done for Safety in Canada— The Work
of the Industrial Accident Prevention Associations
By R. B.
M orley,
general manager Industrial Accident Prevention Associations,
Toronto, Canada
It is with the keenest pleasure that I come before the fifteenth
annual convention of the International Association of Industrial
Accident Boards and Commissions to tell you something of the work
being carried on by the Industrial Accident Prevention Associations.
Your close contact with the whole accident situation makes each
of you a friend of mine and enables me to talk as among friends.
During the early part of the summer, I had occasion, while I was
away for a short holiday, to call on the village blacksmith and ask
him for a sufficient number of horseshoes to enable us to have a game
of quoits. He very obligingly referred me to the pile at the side
of the shop, from which I extracted a sufficient number of discarded
horseshoes. Carrying these along the village street on my way back,
I was hailed by an old man whose remark was something like this:
“ Quoits to-night? W ell, take care and take out all those nails so
that you won’t tear your fingers.” The old man naturally did not
know that I had been professionally in safety work for nearly 15
years, but he was passing on to a stranger the benefit of his own
experience and indicating the method of avoiding an accident.
Ontario’s Compensation Law
The late Sir William Ralph Meredith, chief justice of Ontario, was
appointed by the Government to make a report on the question of
compensation for injuries and that report resulted in the workmen’s
compensation act (Ontario) which became effective on January 1,
1915, and has served as a model for all compensation laws in Canada.
That act has rid industry of litigation in dealing with accidents to
employees and has made for promptness and certainty of payment to
injured workers without unduly burdening the employer. An analy-
157
158
FIFTEENTH A N N U A L MEETING OF I. A. I
A. B. C.
sis of our act will, I believe, reveal that it is the most generous
in its benefits to injured workers and I say this without disparaging
any other jurisdiction.
Organized Accident Prevention
While the act was being framed, industry suggested that there
should be some effort made at organized accident prevention and a
section was added to the act which authorized the employers to set
up accident-prevention associations. This section, with amendments
to date, reads as follows :
(1) The employers in any of the classes for the time being included in sched
ule 1 may form themselves into an association for accident prevention and may
make rules for that purpose.
(2) If the board is of opinion that an association so formed sufficiently repre
sents the employers in the industries included in the class, the board may
approve such rules, and when approved by the board and by the lieutenant
governor in council they shall be binding on all the employers in industries
included in the class.
(3) Where an association under the authority of its rules appoints an in
spector or an expert for the purpose of accident prevention, the board may pay
the whole or any part of the salary or remuneration of such inspector or
expert out of the accident fund or out of that part of it which is at the credit
of any one or more of the classes as the board may deem just.
(4) The board may in any case where it deems proper make a grant toward
the expenses of any such association. (Added by sec. 30, ch. 24, 1915.)
(5) Any moneys paid by the board under this section shall be charged
against the class represented by such association and levied as part of the
assessment against such class. (Added by sec. 30, ch. 24, 1915.)
(6) The word “ class ” in this section shall include subclass or such part of a
class or such number of classes or parts of classes in schedule 1 as may be
approved by the board. (Added by sec. 30, ch. 24, 1915.)
Accident prevention is fundamentally sound from either the eco
nomic or the humanitarian point of view, and under section 114 of
our act the plants in 18 out of the 24 classes of industry have set
up accident-prevention organizations.
The compensation act, as I said, came into effect on the 1st of
January, 1915, and on the 12th of February of that same year,
or about six weeks later, the Furniture Manufacturers Safety Asso
ciation (representing employers in class 3) was incorporated and
began its work.
Industrial Accident Prevention Associations
The Industrial Accident Prevention Associations is a federation
of 15 of the 18 associations established under section 114, with final
federation having taken place a little over 11 years ago, or to be
accurate, on July 17, 1917.
The objects of the Industrial Accident Prevention Associations are:
(a) To coordinate the activities of the various safety associations comprising
the membership, so that the work may be done with the greatest efficiency at a
minimum cost. (&) To cooperate with employers and employees in safety
work and in a general safety campaign to reduce accidents and industrial
disease, for the benefit of both employer and employee, (c) To make rules
for the prevention of accidents and industrial disease, such rules to be binding
upon employers in the various classes comprising the membership when ap
proved by the workmen’s compensation board and the lieutenant governor in
council. {&) Generally to do such things as may reduce losses due to acci
dents, including matters authorized at any special or general meeting of the
association. (Added 28.2.22.)
ACCIDENT PREVENTION---- R. B. MORLEY
159
The organization is controlled by a group of directors who are
elected annually from among the 15 classes included in our member
ship. Those directors give unselfishly of their time and effort and
I have yet, after seeing various types of organization work, to find
another group of men who will devote so much thought to voluntary
work.
A s I said, I have been in safety work for nearly 15 years and
I should probably be one of the last men to advise against taking
a chance. I know that chances have to be taken by individuals and
by groups of individuals and our whole campaign of accident pre
vention is built on the thought that the unnecessary chances should
be eliminated and that safety and efficiency go hand in hand. Re
membering this, we have built up an effective inspection force under
our chief inspector. These men are trained for accident-prevention
purposes and their duties take them into approximately 7,000 plants
each year. Their object is accident prevention and not the enforce
ment of rules and regulations, although their work is based on the
general rules and standards of the Industrial Accident Prevention
Associations which have been approved by the workmen’s compensa
tion board and the lieutenant governor in council, and are enforce
able. W e have preferred, however, to adopt the idea of education
and cooperation rather than legislation and compulsion. Each
member of the field force goes to a plant with a general knowledge
of conditions in industry and with certain information regarding
the specific situation in that plant for the past several years, and
his inspection, therefore, means a practical service to the industry.
Inspectors are carefully instructed in their work and are trained for
accident-prevention purposes from all sides; that is to say, if the cor
rection of physical hazards is requisite in the plant, the inspector will
recommend that such be done, and if it is a matter of a plant meeting,
with or without motion pictures, so that the employees may be
reached, the inspector will handle this phase of the situation as well.
In addition to the inspection services, we are enabled to keep a close
check on the general experience of the industries included in our
membership, as we receive from the workmen’s compensation board,
with which there is, of course, the closest kind of contact, brief re
ports known as accident memos, which give information regarding
accidents on which claims have been made and which, in most cases,
involve a loss of seven days’ time or more and, consequently, mean
compensation to the injured worker. These accident memos are in
valuable in enabling us to check the experience of the various firms
on our lists, and the information sent to industries whose accident
frequency was running too high has frequently resulted in a com
plete change in the experience of that plant.
Nearly seven years ago, the directors of the associations approved
of the distribution of safety literature and this now means the
Monthly Memorandum for Industry containing information of
interest to the executives, safety bulletins for shop posting, pay
envelope inserts, special cards and leaflets and, once a year, the
safety calendar.
The annual safety convention of the Industrial Accident Preven
tion Associations has served to demonstrate in an effective way that
industry will cooperate in accident-prevention work. The last con
vention of the associations was held at Hamilton, Ontario, on the 8th
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FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
and 9th of May, and we had 1,110 registrations there, which was an
increase of approximately 25 per cent over the former year. The
convention lasted for two days and outstanding speakers from the
United States and Canada were present. Too much emphasis can
not be laid on the value of meetings of that type and the effect on
plant men through their contact with others interested in safety
work.
The associations, as has been noted by the reference to section 114
of the workmen’s compensation act, derive their funds from the
workmen’s compensation board and we operate entirely on the budget
system, that is to say, each year, in November, a budget is prepared
for the following year. That is submitted to the December meeting
of our executive committee and after that committee is satisfied, the
budget goes to the workmen’s compensation board, which body has in
variably accepted the recommendations of our committee. The
budget of the Industrial Accident Prevention Associations as ap
proved for 1928 was $93,720. This may not appear a great deal
against a total pay roll of about $300,000,000 of the membership of
the associations, but it must be remembered that our $93,000 does not,
in any way, include the safety work being done by the individual
plants. They, of course, provide their own safeguards and carry on
certain forms of safety work, as directed by the management, and in
the last analysis I look upon the getting and holding of the interest
of the executives as the most important part of our work.
The Cross Roads of the World
In June, 1925, Mr. Albert Thomas, director, International Labor
Office at Geneva, wrote to me saying that the Governing Body of the
International Labor Office had set up an advisory committee in con
nection with certain phases of their work and an invitation from the
Governing Body was extended to me to act on the safety subcommittee
as the representative from' Canada. Since that time, I have had the
pleasure of acting on that committee and in November, 1927, sat in
at Geneva as a member of the committee when representatives from
Great Britain, France, Germany, Finland, Switzerland, Italy, Bel
gium, Holland, and Canada framed the report which was discussed
at the meeting of the International Labor Office in May of this year.
Geneva has been called the “ crossroads of the world ” and at pres
ent Geneva is an international city to an extent that can exist in no
other part of the world. When we find representatives of the 55
countries included in the League of Nations discussing accident
prevention there, we must believe that a new day has dawned for
the accident-prevention movement.
Results
The heights that great men reached and kept
Were not attained by sudden flight,
But they, while their companions slept,
Were toiling upward through the night.
Accident prevention is like everything else; you can not get some
thing for nothing. Some plants have undoubtedly reached great
heights in their accident-prevention work. In Chatham, Ontario,
for instance, the International Harvester plant there, manufacturing
ACCIDENT PREVENTION---- R. B. MORLEY
161
wagons, operated for over 900 days without a lost-time accident.
The Port Colborne plant of the Canada Cement Co. went over 521
days. Recently, the Point Anne plant of the same company has
beaten that record and both of these plants, as well as their plant
at Hull, Quebec, and the plant at Fort Wayne, Manitoba, have won
the trophy of the Portland Cement Association in the last several
years. Larger and smaller plants have operated for months and
in some cases years without a lost-time accident or have made most
extraordinary cuts in their accident, experience by paying adequate
attention to the problem in their individual plants. This, is proof
of the statement that accident prevention is something that can be
accomplished, but you can not get results by sitting down and hop
ing that something good will happen. There must be what the
Honorable Doctor Cody, speaking at our safety convention in T o
ronto some three years ago, termed “ the will to safety.55
Employers’ Functions in Accident Prevention
It must be accepted as a fact that the operating executive of a
plant can do more than anyone else in that plant to secure results.
These points are suggested as functions of the employer:
1. The operating head of the industry must be convinced of the
necessity for and the desirability of effective accident-prevention
work.
2. Safety must be made part of the production program of the
plant.
3. A n analysis of the accidents in that particular plant must bo
made and compared with the general experience of other lines of in
dustry.
4. Safeguarding of mechanical and process hazards must be car
ried out.
5. Supervision of all ranks must be carefully checked.
6. Plant housekeeping must be given its proper measure of at
tention.
7. Safety education of all ranks through bulletins, pay envelope
inserts, plant meetings with motion pictures should be carried on con
tinuously.
The heart of the objects of the Industrial Accident Prevention
Associations is that phase relating to the cooperation with employer
and employee. The associations stand, therefore, in a peculiar light.
W e have been able, through the policy adopted by our directors, to
carry on a campaign which has produced concrete results and at the
same time avoided any clash with either employer or employee. W e
have all been “ fed with the same food, hurt with the same weapons,
subject to the same diseases, healed by the same means, warmed and
cooled by the same winter and summer.55 The prevention of accidents
has a significance far beyond material value, that is to say, an in
calculable human significance, and on this ground alone it is and must
continue to be a practical and satisfactory form of industrial activity.
The C h a i r m a n . The next paper is on the subject “ W hat accident
prevention can do,55by John P. Meade, of Massachusetts.
162
FIFTEENTH A N N U A L MEETING OF I. A. X. A. B. 0 .
What Accident Prevention Can Do
By
J o h n P . M eade,
director Division of Industrial Safety, Department of Labor
and Industries of Massachusetts
The principle of compensating workmen for injuries arising out
of and in the course of their employment is to-day an integral part
of the industrial system of the United States. This movement had
its origin in the belief that the consumer should bear some part of
the burden just as he ultimately carries the cost of plant and ma
chinery depreciation. Employment injuries are an outstanding prob
lem in the social order. They affect the individual, the family, and
the home. This experience is common in the administration of
workmen’s compensation laws.
In the last decade the economic and social effect of work injuries
has become well known. It is now possible to appraise the loss
of man power to industry in the States operating under the work
men’s compensation law through a study of its tabulatable injuries,
particularly those resulting in permanent partial disability or end
ing fatally. Through the compulsory reporting of industrial in
juries, these facts have been made known and the human side of
industry is made apparent in the light of this experience. It is
this feature of the workmen’s compensation law that will accom
plish more for employees and the social order than the payment of
compensation because of incapacity due to industrial injury.
Through this instrument, the public conscience has become aroused
and intelligent action focused upon this problem. Fatal injuries
among those actively engaged in providing for their families; dis
memberment accidents, including the loss of limbs, to mechanics who
served years of apprenticeship in the acquisition of their trade;
sudden deprivation of eyesight through traumatic eye injuries to
men employed in the operation o f intricate machinery; and loss of
health and physical power because of the inhalation o f poisonous
fumes— now challenge the attention of governmental activities for
accident prevention.
Exercising the police power of the State to make work places
safe and conserve the human side of industry established new juris
diction for law and better control of machine dangers. The de
velopment of this principle in places of employment brought in
creased protection to workmen and reduced the severity of machinery
accidents. The old law was concerned only with outstanding dan
gers in power transmission equipment. It provided generally that
the belting, shafting, gearing, and all machinery having movable
parts in all factories, workshops, and mechanical and mercantile
establishments, if so placed as, in the opinion of the State depart
ment, to be dangerous to employees while engaged in their ordinary
duties, shall be securely guarded as far as. practicable. This simple
declaration constituted nearly all of the legal machinery enforced
by the police power to protect employees from injuries arising out
of and in the course of their employment. Such legislation did not
reach the source of many painful injuries. It accomplished nothing
in the way of dealing with accidents sustained at the point of opera
tion.
ACCIDENT PREVENTION— JOHN P. MEADE
163
In recent years the growing interest in the problem o f conse
quences due to industrial accidents led to a movement for the better
protection o f employees working at the hazardous trades. Legislators
had experienced the difficulty of formulating effective measures
dealing with a question requiring technical and expert knowledge.
In, some States the legislators had decided not to attempt to enact
laws specifically dealing with the point of operation o f machinery,
but remained content simply to declare in the statutes that work
places must be made safe. The need for more definite provisions to
safeguard employees from dangerous exposure became better known.
Legislatures passed enabling acts authorizing governmental depart
ments to make rules and regulations to deal with intricate dangers
in work places. The movement for accident prevention then reached
a higher plane of efficiency. It marked a new era in conserving the
human side of industry. Statutory provisions were enacted, defining
the procedure in this connection, laying the foundation for a system
of legislative requirements resting upon the basis of expert knowl
edge of machinery construction and intimate acquaintance with the
causation of industrial injury.
Many of the industrial States embarked upon an extensive plan
in code making, while others seemed inclined to a more moderate use
of this power. This would indicate that the accident experience in
each State might have been used as the basis for its activity in the
development of this system. Reason, good judgment, and experience
seem to approve this procedure. Accident records are now available
in all of the industrial States, clearly defining the danger zones in
industry. When it is evident that more than one-half the permanent
disability injuries in a State occur in two industries and further
investigation narrows the hazardous exposure to a few machines,
efficient rules and regulations for the protection of employees will
deal comprehensively with these definite points. Enforcement of
law under these circumstances is more productive of actual progress
than a code with a multitude of provisions that fails to deal ade
quately with fertile sources of machine injuries.
This policy was followed in Massachusetts and codes adopted by
the department of labor and industries include rules and regulations
dealing with machinery standards; working conditions in foundries
and the employment o f women in core rooms; the prevention of acci
dents in building operations, and pertaining to the painting busi
ness; requirements for the care of employees injured or taken ill in
establishments; for the safeguarding of woodworking and power
punch press machinery at the point o f operation; lighting code for
industrial establishments and suggestions for the prevention of an
thrax, and safety in the manufacture of benzene derivatives and ex
plosives.
It may be o f interest to know what this system of lawmaking for
the control of industrial hazards and the prevention of industrial
injury has accomplished. Not only has it directed attention of em
ployer and workmen to the need of joint cooperation in accidentprevention work, but injuries because of contact with machinery
have been reduced.
164
FIFTEENTH AN N U AL MEETING OF I. A. ]. A. B. C.
Machinery accidents for the years ending June 30, 1919, and June 30 , 1927
Cause of accident
1919
1927
Injuries at point of operation______________________________________________________ 14,764
711
Accidents caused by belts _
_
__ ____ __________ ____________________
702
On gears_______________________ ____ ___________________________ - ________________
49
By projecting set screws, keys, and bolts___ _____________________________________
All others________________________________________________________________________ 2,264
5, 651
191
298
15
2,354
18,490
8,509
Total.
_ _____
__ _______ - _____ _______ _______ _________________________
A reduction in the severity of injuries has also taken place. In
1919, out of a total of 67,240 tabulatable accidents 1,750, or 2.60 per
cent, included permanent partial disability injuries. In 1927, out of
a total of 64,167 tabulatable injuries, the number of permanent par
tial disability cases dropped to 1,232, or 1.92 per cent of all tabulat
able injuries for that year. These injuries included loss of fingers,
thumbs, hands, toes, feet, limbs, and the sight of eyes. Even in the
absence of comparative information regarding exposure hours, there
is ample proof that machinery accidents and their severity have
been reduced.
To accomplish efficient accident prevention work, such activity
must be made an integral part of business policy. The management
must be convinced that such work is practical and that it is es
sential to the progress of the concern. Foremen and superintendents
should be made to understand that the work in this connection is
an important part in their service to the company. Employees must
realize that this movement is one of importance to themselves and
their families. The cost of labor turnover caused by industrial
injury, the increased spoilage of machinery, and losses in materials
are frequently traced to the same cause. The competent factory
official now realizes that the cost of injuries to employees may be
almost accurately appraised and that cost systems are incomplete
which do not provide adequately for the inevitable outlay in this
direction. In many instances, large corporations carry on accidentprevention work because of the compelling reason that it is cheaper
to do so than it is to pay for work accidents. Others find a satis
factory reason for maintaining such work in the knowledge that in
dustrial accidents should be reduced in the interest of the individual,
the home, and the community.
Experience has demonstrated the value of efficient plant organi
zation in keeping work places safe. Well-defined principles of
action now provide the basis for intelligent direction of this type
of safety work. These include the locating of plant dangers or
working hazards and establishing cooperation between employees
and management in correcting them and in reducing exposure to
injury. In an organization founded on this procedure, with the
supervisory officials participating in the active work with the em
ployees, accident-prevention work reaches its highest practical value.
On the other hand no progress is made when a safety organization
becomes indifferent to its possibilities for the saving of human life
and is allowed to become inactive and to fail in the performance of
its duty,
ACCIDENT PREVENTION---- JOHN P. MEADE
165
Organized accident-prevention work has proven its value in every
plant where it has been given a fair trial. It is the general expe
rience in all the industrial States that where this work is done well,
a substantial reduction in the accident rate has taken place. Indus
trial establishments everywhere have found this to be true. Work of
this kind made it possible for a large corporation in Massachusetts,
employing 2,700 people, to operate eight consecutive weeks in this
year without lost-time accidents. In four of these weeks there were
493,109 man-hours’ work. Well-organized safety committees meet
regularly in this plant and interest is steadily maintained in the work
by the executives of the corporation. Accident-prevention work is
directed by a central committee, with the advice and assistance of a
well-qualified safety engineer. Each room in the establishment has
an individual whose work will take him around to each part of it
and this employee spends a half hour daily on routine inspection
work as laid down for him by the safety committee. This includes
looking after floor conditions and passageways, observing processes
in which industrial poisons are used, examining doors and windows
leading to fire escapes and egresses, and noting that employees do not
remove machinery safeguards without permission. Each of these
departmental safety men is provided with a metal badge containing
the company’s authorization for its use. Through this system, defec
tive factory conditions are located and corrected; failing on slippery
floors prevented; safeguards required by law are used; objects over
which workmen may stumble and fall are kept out of passageways,
and immediate first-aid treatment of cuts and bruises is insisted
upon. Finally, workmen are taught to refrain from dangerous prac
tices sure to result in painful injuries. These are some of the prac
tical things accomplished by an active organization in which work
men and employers join to protect human life and health and the
conservation of the productive power of labor. This is the most po
tential means by which employment accidents and diseases of occu
pation may be prevented.
Again, this committee investigates every serious work injury and
fixes the responsibility for its occurrence. A ll of the factors present
in the case are carefully examined. This information becomes a mat
ter of record and is available for the use of the committee. Through
this practice, a system of instruction for employees is maintained
which deals with the experience gained from their own work injuries.
Meetings of the committee are held regularly and the accident rate in
the different departments compared. In one large corporation hav
ing plants in several States, injuries to employees arising out of and
in the course of employment have been reduced 60 per cent since the
beginning of this safety work. The exercise of the police power alone
will never wholly remove hazards from industry or bring about a
satisfactory reduction of the accident rate. This can only be ac
complished by the management and employees of our great manu
facturing plants when they join together and make this work a vital
part in their industrial relations. Accident-prevention work finds
here its most potential means for safeguarding the life and health of
employees. In small plants where only a few workmen are employed
it is obvious that this work can not be done on this extensive scale.
In such establishments the superintendent or foreman must carry the
responsibility of keeping the workroom safe.
166
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. c .
It is a well-established fact that if industries were combed clear
of mechanical hazards we would still have serious industrial acci
dents. While machinery accidents have been reduced because of
the intense work done in safeguarding points of danger, accidents
due to other causes have increased. Accident-prevention work in
this field is difficult because it involves the human equation and is
concerned with the exercise of due care. No mechanical devices can
reach or control the underlying causes in these injuries. In 1927
machinery caused 13.3 per cent of all tabulatable injuries arising out
of and in the course of employment in Massachusetts. These
included 8,566 accidents, of which 47 were fatal. Falls o f persons
were responsible for 15.5 per cent, or 9,922 accidents, with 67 deaths.
Handling objects caused 31.5 per cent, or 20,227 accidents, includ
ing 30 deaths, 2 permanent total disabilities, and 769 permanent par
tial injuries. These figures -clearly indicate that in the field of acci
dent prevention more remains to be accomplished in the reduction
of nonmachinery accidents than in those caused by contact with
machinery. In the two last-named cause groups the personal con
duct of the worker while engaged at his task is a factor of the utmost
importance. Many falls occur through incidents which can be
brought within control. Slipping on the floor is the .cause of many
sacroiliac injuries to employees. These are painful and usually fol
lowed by an extended period of incapacity for work. In the pro
gram for accident-prevention work in Massachusetts examination of
floor conditions of industrial establishments occupies a prominent
place. Passageways and gangways must be of even surface, kept
clean and in good repair, free from nails and tools or objects over
which persons might stumble and fall. Nearly all floor accidents
are due to preventable causes. Drippings from humidifiers in tex
tile mills often produce hazards of this kind. Oil-soaked spots at
the end of looms make the work places dangerous for employees
while engaged in their ordinary duties.
Where floors are washed daily notice should be posted, warning
employees of the danger. Last year a workman who slipped on a
wet floor reached out his right arm to prevent falling, and his hand
became caught between the gears of the main and crank drive shafts
on the loom. Amputation of some of his fingers took place, and he
suffered the loss of the use of others.
Another man going around the end of a spinning frame fell on
the floor where it was saturated with oil, and sustained a serious
injury to the lower part of his spine.
Head injuries are common in the experience of accidents caused
by falls. In a glue-manufacturing establishment an employee fell
upon a wet floor, and sustained a fractured skull. Another employee
in a yarn mill slipped on a greasy spot on the floor, and incurred
an injury that impaired his hearing.
Such experiences figure prominently in the work injuries of Mas
sachusetts. Last year 3,144 accidents happened from slipping on a
floor level. O f these 6 proved fatal, 1 resulted in permanent total
disability, and 13 in permanent partial disability. These injuries
are nearly all due to causes which can be eliminated. W ork places
of operators must be closely scrutinized and floors carefully exam
ined. Unclean or littered floors, unsafe methods of storing, pack
ACCIDENT PREVENTION---- JOH N P. MEADE
167
ing, and placing of materials have done much in recent years to
increase the number of nonmachinery accidents.
The building trades are afflicted with a greater number of nonma
chinery accidents than any other industry. These employments are
filled with hazards not found in other lines of work. In manu
facturing establishments processes of work are practically the same
day after day, while in the building industry conditions are chang
ing constantly. The shifting of the working force on the job is
peculiar to the building trades. It multiplies the occasions of dan
ger. Workmen succeeding each other in the different stages of
construction work frequently assume unnecessary risks. This ex
perience is common in the investigation of building-trades accidents.
Explosions arising from the use of solvents in plastic floor material
are now the cause of much apprehension among workingmen in the
building trades. A n employee was recently engaged in the spread
ing of this material, in which a high percentage o f gasoline was
used, while working in the construction of a 12-story building. I t is
believed that an extension electric light fell to the floor while the ma
terial was being laid and that either the heat of the filament or a
spark from the bulb ignited the vapors and caused an explosion. The
employee was literally burned to death. The smoke-covered walls
gave evidence of the struggle he made to escape. The marks of his
finger nails on the new plaster showed with what desperation he
groped his way to the newly hung and closed door as yet unfitted
with a knob or other means to open it. Such unusual and dangerous
conditions of employment must be reckoned with in the future by the
intelligence and judgment of the workmen and employers in the
building trades.
How to safeguard human life under these circumstances is no
easy task. Some authorities have expressed an opinion that proper
ventilation in building-construction work is the best preventive of
these disasters. It is said that the amount of volatile and inflammable
material used in such plastic flooring is greater than what would be
used in painting a similar area, and hence there is greater necessity
for proper ventilation. The most practical thing under these circum
stances is to provide for the rapid removal of combustible vapors.
The same danger is present in painting or varnishing operations.
Some volatile thinners, such as turpentine or mineral spirits (pe
troleum distillate between gasoline and kerosene) seem to be neces
sary. These thinners are capable of vaporizing and producing explo
sive mixtures with air. Adequate ventilation of spaces where paint
ing or paint-removing operations are in progress should be arranged.
The removal of air must take place at the floor level, since most of
the combustible vapors are much heavier than air and tend to collect
at the lowest point in the room.
Early in the summer of this year, more than 2,000 building-trades
mechanics were employed at one time in the construction of a large
mercantile building in the city of Boston. The scaffolding, staging,
hoisting machinery, and working platforms were examined daily by
an inspector from the Department of Labor and Industries of Massa
chusetts, covering a period of five months. Notwithstanding this
careful supervision, three men were killed on this job on April 18.
One met his death in the forenoon when a section of the column made
168
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. 0 .
of wood fell from the top of the building while he was working
in an excavation outside of the wall of the building, killing him in
stantly. The death of the other two occurred in the afternoon of the
same day when cement hoppers containing 1,000 pounds each were
placed, but not equipped with suitable shoring supports. Lack of
this shoring, in a large measure, was responsible for the collapse of
the staging and the cause of the death of these men.
In the construction of another 14-story commercial building the
daily working force averaged about 700 employees and this went up
without a fatal or serious accident. The same policy of daily in
spection of scaffolding and work platforms was made in this building
during the course of its erection. Leaders in the building trades,
both workmen and employers, will find here an opportunity for con
structive work in maintaining safe places of employment. Only
a few of the well-established hazards of the building trades are men
tioned here. They are enough, however, to indicate that the building-trades industry has been in a class by itself in relation to em
ployment hazards. It is extremely difficult to maintain organized
safety work in this industry. When a building is completed, the
general contractor or builder starts a new project in another locality
and must begin his accident-prevention work all over again. Con
struction work will always present serious difficulties in this con
nection. The men who work at the process of erecting buildings are
a more fluctuating group than those employed in manufacturing.
These facts impair the essential continuity of accident-prevention
work, as building operations are diversified in type and carried on
at widely different points. The experience of certain building con
tractors who have made accident-prevention work an integral part
of their business policy is that work injuries can be reduced. Indus
trial injuries are man-made and can be man-stopped. Regular in
spection work of buildings in the course of erection is necessary in
accident-prevention work in the building trades. This is necessary
to maintain supports and contrivances used as staging or scaffolding
in safe condition for employees. Rails and the boards on working
platforms and stagings should be examined regularly. The safe
guarding of ladders and stairways, floor openings, and hoisting ma
chines, and protection from falling material, are essential points in
protection from accidents. A ll these requirements need to be checked
up daily.
The accident experience of 1925 in Massachusetts shows the largest
number of lost-time industrial injuries among employees in the build
ing trades, and in the last two years these occupied second place in
the classification by industry. In one building under construction in
the year 1927, 69 subcontractors were engaged in the work. Inspection
of working platforms was made with the appearance of each suc
ceeding group of workmen. Constant supervision was given to the
working operations on this job, and yet five lives were lost in the
construction of the building. Inside the building one of the greatest
risks is the unguarded floor opening or well. These are a great
source of trouble because when a contractor does provide a rail
around these openings other subcontractors or workmen are con
tinually taking them down for the purpose of working in and around
the walls or openings and neglecting to replace them, (Safety rails
ACCIDENT PREVENTION---- JOH N P. MEADE
169
and toe boards of wire screening are so necessary for employees that
a great majority of legitimate contractors provide them. Adjustable
railings at the loading side of the material hoists often present seri
ous hazard to the mechanics in the building trades. In many cases
these are not provided or are placed directly at the edge of the open
ing and frequently not replaced after the hoist leaves the floor. The
purpose of the railing, in part, is to prevent workmen from leaning
over and looking into the well, and this check is especially needed
when an elevator is away from the floor. Four men were badly
injured through the exercise of this practice during the construction
of a large theater building.
In the house-painting business many serious accidents are due to
the practice of suspending hooks on gutters without further support
from the staging. The requirement that these must be secured in
dependently by a tie line to some suitable part of the building is
frequently ignored by small concerns who engage in this business
with limited means and often fail to> cover employment risks with
compensation insurance. W ork to prevent accidents under these cir
cumstances can be measured only by the size of the inspection staff.
In this field it may be truly said that “ the harvest is great, but the
laborers are few.”
The building-trades industry contributed 13.9 per cent of all in
dustrial accidents in Massachusetts for the year ending June 30,1927.
Fifty-eight o f these were fatal, or 18.3 per cent of all fatal injuries
in that year. There were six permanent total disability cases, or
35.3 per cent of all such injuries in the same period. Waste o f man
power in this industry is a challenge to accident-prevention work and
State labor departments as well. Protecting the human side of in
dustry in the building trades is conserving the economic resources
of the State. Accident-prevention work should be organized from
within and the saving of human life be made an integral principle
in the conduct of this industry. Some of the construction concerns
of the country recognize what accident-prevention work can do
under these circumstances and have done much to reduce accidents.
Nonmachinery injuries in Massachusetts include diseases of occu
pation. In Johnson’s case (217 Massachusetts, p. 338), Massachu
setts Supreme Court Reports, this definition of injury appears :
Personal injury is any injury, or damage, or harm, or disease which arises
out of and in the course of the employment, which causes incapacity for work
and takes from the employee his ability to earn wages.
In this case the employee had been exposed to poisoning from his
occupation of grinding lead for a period of 20 years, and the question
arose as to the date of the injury. This the Massachusetts Industrial
Board found to be the date “ when the accumulative effects of this
poisoning manifested itself and Johnson became sick and unable to
work.” This decision has been cited with approval in other Mas
sachusetts Supreme Court cases, including O ’Donnell’s *case (257
Massachusetts, p. 164), and Bergeron’s case (243 Massachusetts,
p. 366), which were decided by the Supreme Court of Massachu
setts after it had considered the Pimental case (235 Massachusetts,
p. 598), and had stated that the “ workman’s compensation act
does not in terms include occupational disease.” In this case it
was held by the court that neuritis— a disease induced by muscular
170
FIFTEENTH AN N U A L MEETING OF I. A.
[. A. B. C.
action in rolling cigars— “ while it properly may be found to have
arisen during the course of the employee’s employment can not be
found to have arisen from it in such a sense as to entitle him to com
pensation under the workmen’s compensation act.”
I have cited these cases at length to indicate the status of occu
pational diseases under the workmen’s compensation act in Massa
chusetts and to show that they fall within the classification o f non
machinery injuries. The rapid and exacting nature of mechanical
processes and the unwholesomeness of many industrial occupations
have brought new risks to vitality and health. The study of danger
ous trades and occupations and occupational disease is the first step
in this type of prevention work. The need o f adequate protection
for employees who come, in contact with industrial poisons in any
form is entitled to a prominent place in a program for the preven
tion o f work injuries. Control o f dust, fumes, and gases at the
point of origin is an essential part of this work. Only those well
experienced in the inspection of industrial plants can handle it ade
quately. Knowledge of the practices necessary to protect the em
ployee from dangerous exposure is necessary. One must be familiar
with the means for the prevention of inhaling lead oxides used in
the manufacture of storage batteries, or fumes arising from the use
of cyanide in connection with metal hardening. He should be fa
miliar with means for the control of dust in the operation of surfacegrinding machinery in the stone-cutting trade and be able to advise a
manufacturing concern as to how best to control the danger arising
from the use of benzol. The use of this industrial poison in the
manufacturing establishments of the country is just now holding
the attention of experts in safety work. Two years ago, when the
committee on benzol, of the chemical rubber sections of the National
Safety Council, made its report, this statement appeared:
Even when effective systems of exhaust ventilation keep the concentration
of benzol in the workroom air below 100 p. p. m., there is a substantial hazard
involved.
Coating compounds of nitrocellulose with a benzol content are
often dangerous to employees even when exhaust ventilation is pro
vided. The use of this poison in the leather-finishing business and in
the rubber trades has caused apprehension among those concerned.
Last year, in a shoe-manufacturing plant in Massachusetts, two
women employed in spreading cement on rubber heels were taken sud
denly ill, and removed to the hospital where one of them died. These
women had been employed for a period of six months. A n open pan
of cement was laid upon the bench at which they worked. W ith a
2-inch brush they applied this cement over the heel parts. Investiga
tion showed that about 30 gallons a day of this material were used,
in which a 5 per cent solution of benzol was included. This cement
had been used for a month prior to the time the women were over
come. No local exhaust equipment was installed on the work bench,
but good general ventilation prevailed in the room. Investigation
showed that this benzol cement had been used in many other plants.
The cement manufacturer used a substitute solvont after this ex
perience and no case of such poisoning has appeared in the last 16
months in the factory where these women worked,
ACCIDENT PREVENTION---- JOHN P. MEADE
171
A n important feature of the work to prevent industrial diseases
in Massachusetts is the statutory requirement that every physician
shall report to the department of labor and industries the case of
any patient whom he believes to be suffering from an ailment con
tracted as a result of the nature or" circumstances of his employment.
Examination of work places can then be quickly made and causa
tion of injury determined. Local exhaust equipment may be found
ineffective or unnecessary exposure to industrial poison prevail.
This frequently is the case even shortly after thorough inspection
has been made. Control of causes leading to occupational disease
rests largely upon regular and careful inspection of the plant and
the education of employees in sound practices of personal hygiene.
This work has prominent place in the movement to prevent in
dustrial injuries.
Accident-prevention work has no greater problem to deal with
than the menace o f infected injuries. Most of these are preventable.
Adequate first-aid treatment is the means to accomplish this result.
Slight punctures often lead to loss of fingers, hands, or limbs. More
than two-thirds of all infections are caused by cuts and punctures.
When the skin is broken, disease germs enter easily. This explains
why fewer bruises result in infection, as the skin is not broken
as a rule. A most common source of infection is the nail puncture.
Usually these wounds are deep and hard to keep free from dirt.
Some years ago the Industrial Commission of Wisconsin reported
the death of an employee from infection caused by stepping on a
tack.
A n infection following a puncture of the foot by a rusty nail re
sulted in fatal injury to a young, able-bodied man 26 years of age
who was employed in a large industrial establishment in Massachu
setts. W hile making his rounds, he stepped on a rusty nail. The
investigation made in this case established the fact that for 36 hours
afterwards nothing was done to the wound. He went to the hospital
when the wound became infected and after a few days died.
Failure to apply efficacious first-aid treatment was very likely re
sponsible for the death of this employee. Here was a man in the
prime of life and in his most productive years struck down in the
height of his usefulness by a simple injury. The dependents in
cluded a widow with several small children. These were the con
sequences of this injury.
In 1919, the Industrial Accident Board of Massachusetts con
ceived for the first time the idea of reporting in tabulation form
the nature and extent of disability due to infected injuries. In that
year, 5,178 cases of infection ensued from slight injuries. The
nature o f these injuries that year was as follows:
Abrasions, contusions, bruises_________________________________ 826
O f this number four resulted fatally and three ended in perma
nent partial disability to the employee.
Burns________________________________________________________
167
Cuts, punctures, lacerations_________________________________ 3,414
O f this number, 13 were fatal and 1 was a permanent partial
disability.
81573°— 29-------12
172
FIFTEENTH AN N U A L MEETING OF 1. A.
I. A. B. C.
There were 2 dislocations, 8 fractures, 9 sprains and strains in
which infection was present. A ll other injuries not specified in this
group reached a total of 749. Out of this number, 2 became fatal and
28 resulted in permanent partial disability. These injuries consti
tuted 7.7 per cent of the tabulatable injuries, or 1 case of infection
in every 14 cases tabulated. O f the total number, 3,414 cases, or 65.9
per cent, were due to cuts, punctures, or lacerations. A comparison
of these statistics with those for 1927 shows an increase of 43 infected
injuries in the latter year. The total number of such injuries in 1927
was 5,221, of which the nature of injuries was as follows:
Abrasions, bruises, and contusions, 934, including 5 fatals.
Burns and scalds, 120.
Cuts, punctures, and lacerations, 3,074, including 10 fatals.
Fractures, 6, including 2 fatals.
Sprains and strains, 4 ; all others 1,076, including 2 permanent partial dis
ability cases.
Amputations or loss of use, 7, all of which were permanent partial disabilities.
The total number of injuries resulting in infection was 8.1 per cent of the total
tabulatable injuries.
In 1927, 1 out of every 12 tabulatable injuries resulted in infec
tion as compared with 1 out of every 14 in 1919. Here is a field
in which accident-prevention work can accomplish progress. Simple
means can be followed which will reduce these preventable injuries
to a very small number. Such injuries thrive on neglect. They can
be prevented by the exercise of due care.
In 1907 the Legislature of Massachusetts adopted the following
statute which since that time has been amended at different times:
Every person operating a factory, shop, or mechanical establishment where
machinery is used for any manufacturing or other purpose, except for elevators,
or for heating or hoisting apparatus, shall keep and maintain, free of expense
to the employees, such medical or surgical chest, or both, as shall be required
by the department, containing plasters, bandages, absorbent cotton, gauze, and
all other necessary medicines, instruments, and; appliances for the treatment
of persons injured or taken ill upon the premises.
Every such person employing 100 or more persons shall, if so required by
the department, provide accommodations satisfactory tc it, for the treatment
of persons injured or taken ill upon the premises, and also suitable and sanitary
facilities for heating or warming food to be consumed by those employees of
the factory, shop, or mechanical establishment who so desire.
Every person carrying on a mercantile establishment where 20 or more
women or children are employed shall in the manner aforesaid provide such
medical and surgical chest as the department may require.
Through such legislation it was hoped that slight injuries to employees in industrial establishments would be controlled so as to pre
vent not only incapacity for work but the loss of human energy and
life. The rapid spread of infected injuries in Massachusetts caused
the department of labor and industries in 1918 to exercise the author
ity given in the statute to require persons employing 100 or more
workers to provide suitable facilities for the treatment of persons
injured or taken ill upon the premises. To-day, in every factory or
shop, a first-aid room must be maintained if 100 or more persons are
employed. This room must be provided with ventilation directly to
the outer air or by window or other suitable opening, or equipped
with an approved exhaust system. It shall contain at least 200
square feet of floor space, the floors and walls shall be smooth, and
the floors constructed of impervious material. A qualified nurse or
other person trained and competent to administer first aid shall be
ACCIDENT PREVENTION---- JOHN P. MEADE
173
employed on the premises and on call ready to administer first aid
only, unless further advised by a physician. This first-aid room must
provide equipment essential to its various needs. These provisions
are required by law because the care of infected wounds is essential.
A s instruments used in the work of accident prevention, they save
human life and strength only as cooperation is given by the em
ployees.
In 1921, the Massachusetts Department of Labor and Industries
conducted an inquiry into 500 cases of infected injuries, and the out
standing fact in this investigation was that it was usually four to
nine days before first-aid treatment was applied to the injuries sus
tained. This fact merely confirmed existing theories with respect to
infected injuries. It showed that failure to receive first-aid treat
ment promptly was an important factor. It proved that employees
did not promptly respond to such treatment and that they were not
concerned about what appeared to be slight scratches or simple
lacerations or punctures. In thousands of factories and workshops
first-aid rooms are provided for the care of persons injured or taken
ill upon the premises. Numerous concerns employ skillful physicians
to whom employees have access in time of accident and ill health.
Industrial nurses and persons well trained to render first-aid treat
ment are now engaged in this work in the modern industrial estab
lishment. Notwithstanding the fact that these means are placed at
the disposal of employees, septic injuries seem to thrive and flourish.
Slight injuries must be treated promptly if the danger of infection is
to be averted. Kecords of these cases must be accurately maintained
by persons in charge of first-aid rooms. These are of assistance to
the accident-prevention work in the plant. To the inspector from
the State department they point clearly to the danger zones in the
establishment. They are a challenge to the labor departments of the
industrial States and are entitled to greater attention in all accidentprevention work.
Factory inspection rests upon the principle that work places should
be made safe for employees. Its fundamental purpose is to protect
the life and health of workmen from hazards arising in connection
with machinery and industrial processes. The factory inspector
to-day is the embodiment of the system, of legislation reflecting the
demand of an enlightened public sentiment to protect those whose
work for society frequently meets exposure to serious industrial
hazards. The suffering caused the victim of industrial accidents
and the poverty coming to families where the head was stricken
down while engaged in his daily work combined to arouse the people
of this country to the need of providing for health and safety in
industry. Conserving the life, health, and energy of our employees
or wage earners is not an individual question; it is one requiring
social action, and is now recognized as a legitimate function of
government. Gradually, new principles born of this experience have
found their way into our industrial life, and to-day, accident-pre
vention work has won the interest and approval of the manufactur
ing States and has inspired activity in the work of reducing human
waste in industry.
No program of factory sanitation is now considered adequate or
complete which does not provide for clean, pure drinking water in
174
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
each factory and which does not require washing and toilet facilities
to be kept in proper and sanitary condition for the use of employees.
W ell ventilated and lighted workrooms, with loc kers where the na
ture of the employment makes them necessary, are now required.
Types of emergency stopping devices, such as friction clutches,
motor stops, or engine stops, must meet with the inspector’s approval.
The construction of materials for guards is carefully examined.
They must be suitable in connection with belts and pulleys, so that
spokes will be guarded and that the section of pulley receiving the
belt will be adequately covered to prevent anyone being caught be
tween belt and pulley. Set screws and revolving* parts, in running
gears and sprocket wheels, couplings and collars, dead ends of shaft
ing, and all the well-known mechanical dangers will be carefully
noted.
Exhaust and ventilating systems require frequent examination.
More outlets may be added to the equipment and its capacity to with
draw fumes and dust from the point of origin improved. Noting
that cranes and crane runways are in safe operating condition; super
vising the care of chains, cables, ladles, crucible tongs and hoes, ropes,
slings, and other appliances included in the details of foundry work;
requiring that proper stairways and handrails be provided, that floors
be maintained free from tripping and slipping hazards, and that haz
ards at point of operation and in power transmission machinery
be properly safeguarded— are common items in the inspection o f an
industrial plant. The most efficient organization of inspection work
is based on experience acquired in the investigation of accidents.
The causation factors underlying industrial injury are now well
understood. Each industry has its own tradition in this respect.
This is well known to the average inspector. In Massachusetts,
approximately 1,400 industrial injuries are made the subject of care
ful investigation each year. From this experience a wide knowledge
of injury causation is obtained. When this is associated with the ap
plication of the law to dangers in modern industrial establishments,
the most useful type of accident prevention work is done. A person
who is equipped with skill derived from such contacts is usually well
able to treat with problems found in the course of factory inspection.
H e learns that most of the real hazards in industry now arise from
unsafe practices and is able to suggest safer ways to accomplish
the result. His advice may be most useful when it is quite outside
the scope and authority invested by the police power. Contact with
danger points in industry is the main principle of knowledge in his
qualifications for this work. In a furniture factory he quickly
learns that the woodworking machinery includes the dominating
machine hazard. In the metal trades, his experience shows him that
the power punch press is an important factor in the accident fre
quency of the plant. In the plant engaged in manufacturing rubber
products calender rolls come promptly to his mind, and his interest
may quickly afterwards center upon the compounding room, where
litharge and oxides of lead, urotropin, and other toxic substances are
frequently used. The practice of these habits usually makes him
skilled in the location of work places where danger lurks, and this
leads to the safeguarding of hazards and the protection of employees.
It is work of this kind that will prevent man-power ^aste in in
ACCIDENT PREVENTION---- THOMAS P. KEARNS
175
dustry. It also means the alleviation of human suffering, the saving
of life, and the preservation of the family. That is what accidentprevention work can do.
The C h a i r m a n . The next paper of the afternoon is “ Safety edu
cation in industry under State supervision as a means of preventing
accidents,” by Thomas P. Kearns, of Ohio. Mr. Kearns can not je
here, having been detained at home, and he has requested Mr. Bettor,
of his State, to read his paper.
Safety Education in Industry Under State Supervision
as a Means of Preventing Accidents
By Thomas; P. Keiarns, superintendent Division of Safety, Industrial
Commission of Ohio
[Read! by Carl C. Beasor]
The need for safety education as a means of preventing accidents
is an established fact. The idea is comparatively new but is funda
mentally sound. Education is the most potent influence in American
life to-day; education applied to> industry has increased production
and profits and established higher standards of living among Amer
ican workmen.
The greatest menace to life and limb, the most important factor
in economic losses to both employer and employee, and the greatest
foe to the higher ideals of industrial endeavor in this age, is the
inexcusable and lamentable accident record of industrial America.
This is another well-established fact, supported by statistical infor
mation gathered from every State in the Union, and it is only natural
that the education that has been productive of so much economic
progress in industry should be applied to combating the influence of
the greatest enemy to that progress— industrial accidents.
For many years after the inception of the safety idea, the entire
accident-prevention activities of many States were confined to arbi
trary enforcement of mandatory laws and other regulations or re
quirements governing industrial conditions through the exercise of
police powers in the hands of State inspectors. A s a matter of fact,
this is the principal method used in most States to-day and in some
the only method. Factory inspection and the exercise of its attendant
enforcement authority has without doubt served a very useful pur
pose. It has been the means of eliminating innumerable hazards from
industry, thereby preventing many accidents and injuries, and the
inspection departments, often working under severe handicaps, are to
be highly complimented on the splendid results accomplished in this
direction.
Notwithstanding the progress that has been made by the States
along this line, however, the continuing toll of life and limb taken
by accidents has made it obvious to those engaged in the safety
movement that arbitrary enforcement of statutory laws and regula
tions does not suffice to solve the problem. In other words, it has
become apparent that the installation of mechanical safeguards and
protective devices, while indispensable, is not alone sufficient to
prevent accidents. There are many so-called psychological causes
176
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
of accidents, such as lack of knowledge, inexperience, chance taking,
lack of foresight, carelessness and indifference, which obviously can
not be guarded against through the medium of mechanical safety
appliances or controlled through statutory enactments.
While I am thoroughly convinced that the educational phase of
accident-prevention work is the prime factor in the ultimate solution
of the problem, I say unhesitatingly and without reservation that
I am not in sympathy with the attitude of those who claim that
90 or 95 per cent of all accidents can bo prevented through educa
tional methods alone. In other words, I think that the installation
of safeguards is not only desirable but essential to the success of any
safety program : First, because an open gear or an unguarded belt
or flywheel is a constant menace to every workman, regardless of
how well trained or careful he may be, due to human fallibility; and,
second, I do not believe that it is possible to secure the cooperation
or support of the workers, so essential to the success of a safety pro
gram, unless and until the employer has tangibly demonstrated his
interest in the protection and welfare of his employees by spending
whatever sums may be necessary to eliminate all physical hazards,
in so far as it is practical, through the installation of mechanical
safety appliances. Since there are, and perhaps always will be,
some employers who must be compelled to provide safe working con
ditions in their plants through the exercise of the police powers of
the State, it would appear that, regardless of the educational safety
work carried on, so-called factory inspection must go on and factoryinspection departments will have to continue to share a joint respon
sibility for industrial safety with the educational agencies of the
safety movement.
Admitting, if we will, that safety education is necessary, the ques
tion naturally arises as to who is to be educated. Ordinarily when we
think of educational safety work we have in mind the education of
the employee and that is of course the ultimate objective. The
worker must be taught the fundamentals of safety; he must be con
vinced that he has a definite responsibility in accident prevention;
he must be taught the dangers and hazards of his employment and
how to overcome and avoid them; he must be taught to work safely
and to follow safety rules and safe practices in order to prevent in
jury, not only to himself but to his fellow workers, and he must be
impressed with the fact that he owes it to himself, to his family, and
his employer to do so. In short, he must be taught, as we are in Ohio,
that safety is better than compensation. But in my mind the safety
education of the employer is the primary essential; it is the founda
tion on which we must build. W e must have intelligent apprecia
tion on the part of the employer of his responsibility for safeguarding
his employees, and until the employer realizes his responsibility and
understands what he must do to meet his obligations and does it, we
are not going to make much progress in interesting the worker in
safety. Even to-day comparatively few employers grasp the full
significance of the safety movement, either in its economic, social,
or ethical implications, nor do many of them realize that accident
prevention has a definite body of principles and extensive data,
requiring for its successful application some one who is thoroughly
familiar with and capable of applying this data in a systematic and
ACCIDENT PREVENTION---- THOMAS P. KEARNS
177
scientific manner. It is for this reason, therefore, that we must edu
cate the employer to the desirability or safety by showing him that
accidents are caused, that the causes can be located and removed, that
reduction o f accidents brings more uniform and increased production,
and therefore, that it is highly profitable to prevent them, or, as we
tell employers in Ohio, “ safety pays dividends,” not only in dollars
and cents, but in human happiness and ethical rewards as well.
When the education of the employer has been accomplished we
may then reasonably expect him to take the necessary steps to
insure the safety of his employees and quite evidently this is a
responsibility that properly belongs to the employer. He alone has
the power and authority to authorize guarding, promote safety
organizations, and do the numerous other things necessary to bring
about safety-plant conditions. Responsibility is always coextensive
with power and the employer is therefore primarily responsible for
the success or failure o f safety measures in the plant.
The State has a very definite responsibility in this matter and a
splendid opportunity to render assistance to employers in this direc
tion. It is the duty of every Commonwealth to protect its citizens
in so far as it is humanly possible to do so, whether on the street,
in the home, or in the workshop, and to lend all assistance possible in
the promotion of any plan or program that will best achieve the
desired results.
A s regards industrial safety the State is in the most advantageous
position possible to emphasize the ethical, humanitarian, and social
side of accident-prevention work for the reason that it is generally
recognized that its interest in the movement is impartial and uni
versal and it enjoys the further advantage that an employer is in
clined to feel that he is legally as well as morally obligated to cooper
ate with the State, whereas he might not hold this same attitude
toward an outside agency.
The State in presenting the facts of the accident situation to em
ployers, foremen, and workers can bring these facts more impressively
to their attention, because it is generally recognized that the figures
and statements prepared and issued by the State are objective and
unprejudiced.
Again the State is in a position to insist on a report of all accidents
and in consequence its figures are more complete and comprehensive,
bear the stamp of authority, and present to all concerned a more
accurate picture of the accident situation than figures gathered by
any other group or organization.
For this and various other reasons the State is in an exceptionally
favorable position to assist in the education of employers and em
ployees as to their part in advancing the cause of safety and to
energize the entire industrial-safety movement within its boundaries,
provided, of course, the necessary funds to carry on the work are
available.
In this connection we feel that we have a very fortunate situation
in Ohio. Pursuant to a constitutional amendment to the workmen’s
compensation act, made possible through the splendid cooperation of
both employer and employee representatives, a cooperation which
we have enjoyed in all questions pertaining to compensation and
safety, 1 per cent of the premiums paid into the State fund are set
178
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
aside to be used by the industrial commission for the investigation and
prevention of industrial accidents and occupational diseases, and
this apportionment is used exclusively for educational safety work
through the medium of the division of safety and hygiene o f the
industrial commission which was organized for this specific purpose.
The fact that the employer pays for the service and that no comulsion of any kind is brought to bear makes it much easier to win
is support and, cooperation than would otherwise be the case. W e
have had most gratifying results in the many activities we have
undertaken, results that could not possibly have been achieved
through coercive methods.
Organized in July, 1925, as a result of the amendment above
referred to, we have been operating now for a little more than three
years. A s much of the work is somewhat in the nature of pioneering,
we have proceeded with a great deal of caution, entering on new
activities only when conditions seem to favor success. As a result
we have not had a failure in any project undertaken. I mention this
fact because of the importance of a successful record in creating con
fidence in the division on the part of employers and employees, which
I believe to be essential for carrying forward the work in hand, as
well as in developing new projects.
One of the first and most important steps taken by the division
following its inception was to organize a statistical laboratory in
charge of a highly trained and experienced statistician where all
accident claims filed with the commission are thoroughly analyzed
with a view to determining the most prolific sources of accidents in
industry generally and in the various branches of industry, their
cause, degree, manner o f occurrence, etc., thus making it possible for
the division and our engineers to direct their efforts toward the pre
vention of these accidents to the exact source of their origin and to
do it in an intelligent and comprehensive manner.
This information is tabulated and issued in bulletin form monthly
to employers desiring same and is supplemented by annual reports
which minutely analyze the accidents occurring during the preceding
year.
A staff of safety engineers who have had a long and successful
accident-prevention experience and who are selected solely on the
basis of experience and qualifications carry on the field work of the
division. These men form the point of contact between employer
and the division. They are assigned to the principal industrial cen
ters of the State, their territory being selected with particular refer
ence to the major industries with which they have had experience
and with which they will come in contact. They are sent in a purely
consultative capacity to employers, under instructions to render them
every possible service in carrying on scientific accident-prevention
work. Among these engineers there are those specially trained in
particular fields, such as construction, electrical, and mechanical en
gineering. Special problems arising in these fields are referred to
these engineering specialists for their advice and counsel. Safety
surveys of the plants are made by these engineers and special inves
tigators. Employers throughout the State have been quick to take
advantage of this service and as a result hundreds of surveys have
been made and safeguarding remedies suggested. Close contact is
E
ACCIDENT PREVENTION-— THOMAS P. KEARNS
179
also maintained by these engineers with chambers of commerce, trade,
and other organizations that manifest an interest in safety and
assistance rendered to them in any safety program they wish to
promote.
A full-time medical adviser who has specialized in problems of
occupational diseases and industrial hygiene is on the staff and
available for consultation on industrial health problems. Research
in this field is part of the work of the division.
Qualified speakers on safety topics are available for meetings,
either in the shop or at any outside gathering where the interest
warrants them. Speakers are also supplied for meetings of labor and
commercial organizations, luncheon clubs, and similar groups. In
addition to the speaker’s service, motion-picture films conveying the
message are made available to all organizations desiring them.
A publication service has been established which makes available
for distribution safety pamphlets and bulletins of an educational
nature, monthly bulletins covering accident statistics for preceding
month, special studies covering accident experience of various indus
trial groups, and the proceedings of the larger and more important
safety conferences held under the auspices of the division. The
division also issues a monthly magazine under the title of the Ohio
Industrial Commission Monitor. This is designed to interest em
ployers, safety workers, and others in the accident situation, in safety
activities planned or under way; decisions and rulings of the com
mission and related material, also to furnish specific, usable infor
mation on accident causes and remedies. While comparatively a new
venture, it bids fair to become a very potent influence in the dissemi
nation of the safety message. Through this medium safety advocates
are kept apprized of safety activities and records throughout the
State and competitive interest is aroused which will undoubtedly
prove helpful to the cause.
During the last year a safety poster has been issued monthly and
distributed in liberal numbers to all employers coming within the
provisions of the workmen’s compensation law. Special emphasis
is placed on the Ohio situation and on the ultimate goal of a definite
yearly reduction in industrial accidents, particular attention also
being given to no-accident months, two of which were planned for
this year— one in April, which was productive of splendid results,
and the other in October, which we hope will produce equally as
favorable a record.
One of the most important and far-reaching safety-first efforts of
the year is concentrated in the all-Ohio safety congress which con
venes on November 13 to 15 next for its second annual session. A t
the congress held in 1927 more than 2,000 representatives of Ohio
industries were in attendance. Great care was exercised in selecting
speakers recognized as leaders in safety thought and action in their
respective fields. Great enthusiasm was manifested and a real stimu
lus was given to safety work in the State. This year preparations
are being made for a much larger attendance and the fields covered
by exhibits and discussions will be greatly enlarged. On every hand
we are receiving assurances of cooperation and support in making
this congress even more successful than last year’s, and we are confi
dent that it will be bigger and better in every respect,
180
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
That the work of our division has been productive of good results
is best indicated by the reduction in premiums in the years 1927 and
1928. That our efforts are being appreciated is evidenced by the
interest manifested in our work by both employers and employees
through frequent reports of no-accident records, numerous requests
for assistance of the division in carrying on plant safety work, and
the many commendatory letters received relative to the work of the
division and the services it is rendering.
Whatever measure of success we have attained is, of course, due
largely to the splendid reaction of our employers and employees to
safety efforts under the direction of the State and to the fine spirit of
cooperation manifested by the Industrial Commission of Ohio, every
member of which is thoroughly sold on the value of this method of
reducing the frightful toll of life, limb, and wealth taken by pre
ventable industrial accidents and as a means of ultimately solving
the industrial-accident problem.
I think we may be pardoned some feeling of pride in the record of
our State along the lines of this discussion, for we are of the opinion
that this plan represents a significant development in the industrialsafety movement. W e have had our periods of elation and moments
of depression, but we expect to keep persistently and everlastingly at
the work of instilling the safety spirit and idea into the minds and
hearts of management and men, confident that every year will see
us nearer the ultimate goal of industrial accidents brought to an
irreducible minimum.
The C h a i r m a n . W ith your consent we will defer discussion until
Doctor Patton has presented his subject, “ The Growth of occupa
tional diseases as the result of change in the methods of industry.”
The Growth of Occupational Diseases as the Result of
Change in the Methods of Industry
By E. B.
P atton,
director Bureau of Statistics and Information, Department
of Labor of New York
The appearance of my name on the program was more or less in
the nature of a mistake. In conversation with Commissioner Stew
art during the summer I happened to throw out this suggestion, and
later received a copy of the program in which I was put down for
a paper.
The point of view which I expressed to Commissioner Stewart was
that it seems to me that we are now in what may very properly be
called a chemical revolution in industry, somewhat similar to the
industrial revolution in industry with w^hich we are all familiar and
which took place, roughly speaking, a hundred years ago with the
development of steam appliances and the introduction of modern
machinery; the age of the hand type of manufacture, Avhich had
long existed, was replaced by what has been known as the mechanical
age. Very soon the problem of accidents growing out of that new
mechanical age developed, but it was not, roughly speaking, until
some hundred years later that we developed a modern system of
workmen’s compensation to care for the injuries arising out of this
modern mechanical age.
OCCUPATIONAL DISEASES— E. B. PATTON
181
For the last few years, and with increasing rapidity each year
now, it seems to me, there is a development in industry which is to
a considerable extent shifting the basis from a purely mechanical
one to a chemical one.
I have been following with a good deal of interest the recent re
ports of the American Chemical Society now in session, and I want
to read a paragraph of the statement made by the president of the
American Chemical Society, pointing out the value of chemistry in
modern life ; he said:
The output of chemical products in this country has advanced in 50 years
from an insignificant sum to more than $2,000,000,000 annually at present. It
would be impossible to estimate in addition the enhanced value of other indus
trial products, the economies effected, the wastage utilized, the new things
done, and the old things done in a better way, as a result of chemical guidance
and supervision.
This is a chemical age, and we live, move, and have our physical being as a
result of chemical processes; whether we travel on foot, in Cronheim shoes and
Rayon stockings, or roll to wTork on rubber wheels and concrete roads, we travel
in comfort by chemical grace and good will. If we land in the hospital, the
chemist has anticipated our1coming; he is there before us with antiseptics and
chemicals and medical relief for suffering, and restoration of health.
You are all, I am sure, wTell aware of the growth of chemical proc
esses in industry and that the number of workers engaged therein has
increased remarkably, and even more particularly of the tendencies
toward further development and increase of that sort of thing.
A s I understand it, the principle of workmen’s compensation is
that the worker shall be compensated for the disability arising out
of and caused by his employment. For the last 15 years we have been
congratulating ourselves that, although it took us a hundred years to
wake up to the fact, we have at last brought about a system of com
pensation for such disability, and we are inclined to feel that, if we
compensate for the accidents which do occur and if we succeed, as
the papers brought out here this afternoon, in preventing accidents,
the problem has been largely solved. The thought I want to present
is that unless we adjust our minds to the idea that more and more the
disabilities arising out of the worker’s employment are not caused by
accident in the ordinary old-fashioned sense of the term, but are
more in the nature of diseases of the occupation, we are making a
mistake, and that, in so far as we content ourselves with merely com
pensating for injuries caused by mechanical means and the preven
tion of such accidents, thinking we are solving the whole problem—
as long as we hold that idea— we are getting out of the sweep of
current progress and current development. To-day, in order to
maintain the original idea of workmen’s compensation— that of
compensating the worker for disabilities caused by his employment—
we have to take into consideration disabilities not perhaps so spec
tacular in their character, but nevertheless just as real and just as
severe as though they had been occasioned by accident in the oldfashioned sense of the term.
It is true that a hand mangled in a gear or a leg broken by a falling
scaffold is spectacular; nevertheless, the loss of sight or the effect
upon any of the organs of the body by the insidious processes
arising out of chemical processes is just as serious, and unless that is
compensated for we are not carrying out the idea of workmen’s
compensation.
182
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
Now, I am not here to make a suggestion for the amendment o f the
law, necessarily, but I would like to throw out this idea: It seems
to me that experience has demonstrated in our workmen’s compen
sation, so far as we now have it, that on the whole it is more desirable
to make the coverage a blanket one, saying that all accidents shall
be compensated for except those specifically enumerated. It seems
to me that this early in the game,, now that what I call the chemical
revolution is upon us, it might be well to extend the coverage of
our compensation laws so as to include diseases o f occupation, and
I think it is at least worth considering whether or not we should
make that coverage a blanket one and specifically enumerate the
exceptions. I know that all of you are questioning in your minds
as to how you are going to handle tuberculosis, this, that, or
the other thing. M y point is1 that even if you feel that a specific
disability ought not to be included in the blanket coverage, do not
exclude everything else on the blanket coverage. In other words,
put the burden of proof— where it seems to me it properly belongs—
on the employer, the occupation, the industry, to prove that the acci
dent or the disease did not arise out of the occupation; let the assump
tion be that the accident or disease did arise out of the occupation.
M y suggestion would be that the same principle that is1 applied to
accidents be applied to the matter of diseases of occupation.
I did not bring any statistics with me, but I think all of you will
agree with me that this problem is one not only of pressing impor
tance, but of increasing importance, and that we can not properly be
said to be carrying out the principle of workmen’s compensation
unless we extend the scope and coverage of our laws so as to include
diseases of occupation as well as accident.
I am well aware that to a certain extent that is now being done,
but I am also aware that in no State is the coverage of occupational
disease anything like as extensive as is that of accidents proper. In
New York State, for example, it has long been true that you can
compensate for occupational disease, provided you can relate that
disease to an accident— that you can, by some hook or crook, bring
evidence into the record that will tend to indicate that that disease
was necessarily the result or grew out of an accident. There are,
of course, in many of the State laws a specific list of occupational
diseases which in those States are compensable, but we should have
our attention drawn to the greatly increased hazard of occupational
diseases which is brought about by the introduction of chemical
processes.
D IS C U S S IO N
The C h a i r m a n . I f we are ready we will discuss Doctor Patton’s
address at this time.
Mrs. S l a y b a c k . I think this is a tremendousily important thing,
but it is a tremendously serious thing, too. I have a feeling that
perhaps industry is asked to take care of a great many things that
do not wholly belong to industry, and I feel with regard to this
extensive coverage of the diseases of occupation that perhaps we have
thrown more responsibility on the employer and not raised the
responsibility of the employee.
OCCUPATIONAL DISEASES— DISCUSSION
183
I f a man or woman worker does not take care of his or her own
health in private living conditions he or she becomes more liable
to the inception of disease in the plant, and I feel that we have gotten
into a terrible whirl when we say that the person who contracts an
occupational disease gets it wholly out of his occupation, unless we
can prove that that worker takesi good care of himself or herself
outside the factory. W e must not make the worker feel that indus
try is going to take care of the worker, unless the worker is going
to help take care of himself.
Just now I am-having a terrible time to get men who work in a
large soldering plant, on soldering machinery, to gargle their throats
and wash their mouths and even wash their hands before they eat
their lunch. Perhaps that is an extensive question and one on which
it is going to be hard to draw the line between the responsibility
of the worker and the responsibility of the employer, but somehow
or other I feel sympathetic with the employer just now.
Mr. S t e w a r t . S o far as the employer is concerned, perhaps I am
not as sympathetic as I might be or ought to be. He can say to his
employees: You come here at 8 o’clock and punch the clock or you
don’t work in this factory. H e assumes that authority and he en
forces it, and the fellow toes the mark. There isn’t any question
about it. And the employer can tell the employee that he has to
wash his hands and he has tot gargle his throat or he gets out. It is
entirely within the employer’s power. I am not able to work up any
great amount of weeps for the manufacturer in his power to enforce
reasonable or even radical safety methods and principles.
The thing that disturbs me, Mr. President, is the unsympathetic,
ignorant— when I say ignorant I mean uniformed— worker. I made
an investigation at one time on the effect of the ventilation in fac
tories. I found that the women came from homes where the windows
were never opened, where the living conditions were almost unspeak
able. They came to factories where the light and the air were
splendid, and they had more accidents when they first came in than
they did after they had worked a few hours. In other words,
the health conditions were better in the factories than they were in
the homes.
That is the thing that worries me. The manufacturer can enforce
his rules. There is no use of worrying about that; he can do it if
he wants to. A ll he has to do is to say: “ This factory opens at 8
o’clock; you punch the clock, you be here, at 8 o’clock or you don’t
get paid.” But the woman who works under fairly good factory con
ditions goes home and cooks and eats and sleeps under conditions that
are unthinkable and impossible, and tuberculosis sets in. Where does
it come from ? Does it come from the home or does it come from the
industry ? That is what is worrying me.
Certain things, of course, we can definitely state. I f it is lead
poisoning or anything of that sort, that comes from the materials
handled, we can answer that, but there are a great many other dis
eases— tuberculosis is one of them, anemia, a general breakdown from
impossible home conditions— I have not quite reached the place
where I am willing to charge the manufacturer with that. I am go
ing to charge somebody with that. I am willing to charge it, don’t
184
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
worry about that. The question is simply to whom to charge it.
I doubt that it is the manufacturer’s responsibility.
Henry Ford said he would pay $5 a day, but the home conditions
must be $5-a-day home conditions, and he made home inspections and
saw that the home conditions went up to that standard. You can
not do that and manufacture Fords or do much of anything else.
Aren’t we up against a proposition here where society, where the
health department of a city or town, is responsible for the home
conditions, at least within certain limits ?
My investigation convinced me that for at least a very large per
centage of the workers in the clothing factories— not the sweatshop,
but the factories— in New York the conditions were infinitely better
than in the home; that immediately the woman came from the home
into the factory, she built up and up, and her chances of accident de
creased rather than increased as she left her home. That is one o f
the things we can not forget, and who can be charged with that I
don’t know. A s I said before, I am perfectly willing to charge it
if you will show me the man.
Mrs. S l a y b a c k . I can not let Mr. Stewart’s words go by like that.
Any factory inspector here knows that the manufacturers do not tell
the man who does not get in promptly: “ You get here promptly or
you don’t work.” They may clo^e the door to him for 15 minutes
and charge him for it, but if a manufacturer employs skilled workers
he is no more likely to tell that man that he can not work there be
cause he does not get there on time than I am likely to invite you to
go out airplaning with me this afternoon. You can not go out on
the street and pick up skilled men. Henry Ford can say to his men
down in the assembly plant, “ You will transgress in that toilet but
once more” (and I happened, on my last visit to Mr. Ford’s most
wonderful plant, to see a man told to come up to the office and get his
pay because he had transgressed in the wash room), but Mr. Ford can
take a man and in three days make him a competent workman to do
the particular job which he has for that man. A man working in
a crucible steel plant, or a man reducing chromium ore, or a man
drawing some kind of a special chromium wire— which is not an
extensive industry and is a highly skilled one— however, is not likely
to lose his job because he is 15 or 20 minutes late.
Even though Mr. Stewart may think that the, manufacturer has it
all his own way, he has it only where there is unskilled labor. W hy ?
Because unskilled labor abounds. I f unskilled tabor were not plenti
ful he would not have it even there. I am sorry to have to contradict
you, but I know from the expressions of the gentlemen around me
that they will support that opinion.
Mr. S t e w a r t . Generally speaking— I am not going to make this
an all-inclusive rule, but generally speaking— the skilled man that
the manufacturer can not afford to discipline because he can not get
a substitute for him, is getting a wage which puts him in a social
status where he does know that his windows must be open; his home
conditions are not the conditions of the common unskilled laborer.
W e can almost let the fellow alone who is getting $10 or $15 a day
if he hasn’t sense enough to open the window in his sleeping room,
for by the time he dies there will be another man equally skilled,
but there are comparatively few of the high-priced men whose living
ACCIDENT PREVENTION— DISCUSSION
185
conditions are bad. There are some of them, but it is the low-wage
men, to the uninformed men, the men who come from countries where
health and decency, as we understand health and decency, is almost
a class question, being confined to the lords, who don’t know any
thing about it and never did— that is where your large volume of
what I will call social disease rather than occupational disease (I
don’t mean that in the technical term, but in the sense of bad living
conditions) comes from for which 1; am not quite prepared to charge
the manufacturer. Yet if you can show me somebody else to charge,
I will.
Mr. B easor . Does not this revert back to the question of educa
tion ? I f we educate the employer will he not see that his employees
are educated to get the results he wants? Not many years ago we
did not have the employers educated to the fact that goggles were
a good thing to wear. How many now will not keep their men
wearing them all the time? How many men will not want to wear
their goggles all the time? I f we educate the employer he will find
some way to educate the employees, whether it is gargling their throats
or wearing goggles, or what not. Sell it to him first and he will sell
it to the employees.
The C h a i r m a n . I f there is no further discussion on the paper by
Mr. Patton, we will take up the paper read by Mr. Morley. Presi
dent McBride suggests that we might take up the first three papers
collectively rather than individually.
Doctor M cB ride . These are three very excellent papers, and if there
is any question anyone here would like to ask, now is to time to do it.
The C h a i r m a n . The Chair listened with much interest to the paper
read by the general manager of the Industrial Accident Prevention
Associations of the Province of Ontario, and congratulates Mr. Mor
ley on its efficient management.
Accident prevention work is, in my opinion, not only a great hu
manitarian agency worthy of the moral and financial support of
every community, no matter how small, but more. Because of its
sympathetic humanitarian efforts to save life and limb, it so directly
affects the individual, the home, the church, and the State as to make
it an invaluable economical agency.
Without boasting or attempting to lessen the spirit of cooperation
and brotherly interests so generously given by the manufacturers of
your association, Mr. Morley, I want to call the attention of the con
vention briefly to what we are doing in Delaware along the line of
accident prevention. There we have a State safety council, sup
ported solely by the manufacturers and a limited number of indi
viduals, that fosters: (1) Safety education in all schools in the State,
and by the way if some of the promoters of the juvenile stage could
witness the earnestness and instinctiveness of some of our school boys
and girls “ doing their stuff ” in fire drills and accident prevention
training they would find so much new material that “ Our Gang ”
and Wesley Barry could be given a rest; (2) individual plant in
structions and safety schools in which not only the industrial workers,
but the plant managers are instructed in safety education; (3) and
last, under the public safety and miscellaneous division, the import
ance of safety is given much publicity through the press o f the State,
186
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. 0 .
which has been most liberal in publishing such material as the coun
cil believes helpful, without cost to the council; in the distribution and
posting in public places of safety posters; in an organized automobile
safe drivers’ club; in an active committee on automobile safety, rail
road grade crossings, uniform signals, and water safety; considera
tion of the latter is better to protect the health not only of our own
people, but also of tourists.
So successful was the work of the council last year, the indus
trial accident board of the State unreservedly said to the press that
the activities of the Delaware Safety Council had made it possible
for the board to reduce the cost of compensation insurance 6.6 per
cent.
Tabulation of the results of the interplant safety contests in the
State shows that our industrial members— that is, industrial plants
that are active members of the safety council— have reduced both the
number and severity of accidents to less than one-half the average
prevailing in similar industries. Our safety council believes “ we are
our brother’s keeper ” ; that if we are to accept our full responsibilities
to our fellow man, we can not be indifferent to his health, or anatomi
cal breaks, and losses. I have been actively connected with the Safety
Council of Delaware for some years, and so convinced am I of its
benefits to the employer and employee that I did not hesitate to say
to the council some months ago substantially this: That as a result of
the work done by the safety council we find among employers and
employees a sympathetic response to appeals for cooperation concern
ing common interests that has* created an industrial atmosphere of
good fellowship which is an added asset to the State. Not only are
employers and employees cooperating with our safety council, but
State and city school authorities, State and city police departments,
the industrial accident board, and other official agencies are assisting
in the work.
Again, Mr. Morley, I congratulate you.
Mr. M a g u ir e . I would like to ask a question of the commissioner
from Massachusetts. In listening to his paper I understood that
Massachusetts passed a law in 1907 requiring all industries estab
lished in the State to install first-aid packages or first-aid rooms, and
that for those rooms there is now available to the inspectors a com
plete record of infected accidents since the act became effective. X
would like to know how completely that law is observed in Massachu
setts, and how complete the record of infected accidents, especially in
the smaller manufacturers’ plants, is.
Mr. M eade. T he law enacted in 1907 provides th at m edical chests
be in stalled in all m anu facturin g establishm ents regardless o f size.
I t w as am ended 12 years later so th at not only m edical and surgical
chests were required, but the departm ent o f labor and industry was
given authority to require o f such establishm ents where 100 or more
persons were em ployed th a t th ey each in stall a first-aid room and to
m ake rules and regulations in connection w ith its adm inistration.
One of the many provisions that have been made under that author
ity is that there must be maintained in the first-aid rooms in manu
facturing and mechanical establishments— because the law was again
amended to include mechanical establishments— a record of all in
juries treated on the premises for which first-aid assistance was given.
ACCIDENT PREVENTION---- DISCUSSION
187
That does not mean that after first aid has been given to an injured
employee the nurse there or the person competent to render firstaid treatment has authority to continue the treatment o f the injured
person; by no means. The only authority that he or she has is to
give first-aid treatment.
So far as infected injuries are concerned, I think you will recall
that in my paper, I said that our investigation showed, in 500 cases
that were looked into because of the apparent number of infected
injuries, that it was from 4 to 9 days before employees in those cases
had sought any first-aid treatment. That was due to the fact that
their injuries were either slight cuts or slight punctures which, per
haps, they thought at the time did not amount to anything and there
fore did not require any service. Out of that the point was made
that these very slight injuries should be attended to promptly on the
part of the employee, and the inspector on going into the plant,
knowing something about that condition, having received notice,
perhaps through the office, of the number of injuries that occurred
there, could make a personal investigation and find to what extent
the employees were addicted to that practice, and whether or not the
first-aid room functioned properly and was open and the nurse avail
able at all times for treatment of that kind.
The C h a i r m a n . The chair would like to know, who, under your
law, shall say the person in charge of the first-aid room is qualified.
Mr. M e a d e . The department of labor and industry. It proceeds
this way: First, it requires the concern to furnish evidence that the
person is qualified, and that is done either by the plant physician or
the physician who goes to the plant occasionally. I f he examines
some one and says that person is competent to give first aid, we
accept the physician’s statement, which we file. Secondly, if that
person takes a course, we will say, under the auspices of the Red
Cross or some other organization that is interested in setting up a
school for teaching first-aid treatment, and can show a certificate, we
accept the certificate and place it on file. That applies where 100
or more persons are employed, but in the smaller plant there is no
such regulation, by any means.
Mr. S t e w a r t . On that first-aid business and the reporting of
accidents, here again the power of the manufacturer to enforce rules
comes in. Take the Swift plant in Chicago; if an employee gets a
scratch where blood shows— it does not need to bleed, only look
red— that employee must go to the first-aid room and have that
treated and recorded ; and believe me, he goes. I f a girl in the sau
sage-stuffing room pinches her finger or something, and even shakes
her hand, there is somebody in that room who. is delegated to see
that that girl goes to the first-aid room and has that matter attended
to and recorded. The percentage of those insignificant things which
afterward develop into serious cases, Swift & Co. of Chicago believes,
is sufficient to justify that and the keeping of that enormous record.
It offered those files to me to figure out the percentage, but there
were trainloads of them; no bureau of labor would figure that out.
The company has never seen fit to figure it out but it is convinced
that no matter what kind of a scratch it is it must be recorded, even
if it is not treated. So far as enforcing rules is concerned, you have
31573°—29------13
188
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
in the stockyards of Chicago an enforcement of a rule about report
ing any little scratch that shows that the employers can enforce any
kind of a rule if they want to.
Mr. W a e z a l a , I must say that in fairness to truth and in fairness
of practice, that I agree absolutely with Mr. Stewart in the matter of
the enforcement of rules. W e have rules relating to safety and we
have rules with reference to occupational disease. W e furnish our
workmen who are engaged on processes that might lead to occupa
tional disease with clothing, underwear, rubber gloves, and every
thing else. In addition to that we require that they bathe— we fur
nish everything, hot and cold water, soap, and towels, and so forth.
W e have started enforcing the rules. W e noticed that this did not
work. The great trouble is that we are unwilling, and every manu
facturer is unwilling, to bounce a fellow, especially if he is a good
workman, just because he has failed to obey some rule; that is the
great trouble. A man fails to be on time— well, you overlook it.
W e had habitual violators of the rule with reference to bathing,
and as these men are our trained operators we were unwilling to fire
them, so we devised a different scheme. W e thought that if we
rewarded them for bathing it would work, and developed competi
tion, giving a man two days off with pay, or some such money, until
we got them to the point where if our bathing facilities gave out
they would complain; we have them to the pcint now where they
go out and bathe voluntarily.
I believe there are ways of doing it, nevertheless I must agree
with Mr. Stewart that enforcement, whether you do it through
coercion or some other way, lies entirely with the manufacturer.
Mr. S t e w a r t . I h a v e just one more word to say about that.
Perhaps the first institution that introduced bathing facilities for
employees and along with it compulsory rules for bathing had a
strike. It is the way you go at i t ; 99 per cent of everything in this
world, as I see it, is attitude. You can fail at most anything by
going at it in a foolish wav. I f you take the position that compulsory
bathing, compulsory washing of certain clothing, compulsory wear
ing of goggles is not welfare, that it is a part of the job and a pro
tection against occupational disease for which the employee will be
held responsible, it does not require force— it on]y requires a little bit
of intelligence and tact— to put it across.
Years ago a certain company put in bathing facilities and made
it a rule that the girls must take a bath on the company’s time once
a week. W ell, there was a strike— the girls were insulted— and I
think that was the most justifiable strike that I ever got mixed up
with in my life. The intention was all right, but the way the com
pany went at it made its employees angry.
In the first place, it is up to the employers either to get some sense,
or hire somebody who has sense, as to how to 1reat employees along
these subjects and along these lines.
Mr. W a r z a l a . Again I thoroughly agree. When we instituted
that system it was not a question of welfare, but a question of busi
ness and profits. Before we adopt this method of furnishing men
clothes and of requiring bathing, we had sickness. W e manufacture
ACCIDENT PREVENTION---- DISCUSSION
189
anolin, benzol, and other chemicals, the fumes of which make men
sick and eventually lead to occupational disease.
W e have found a way, through just this method of cleanliness,
because we have found men, particularly the foreigners, wear under
wear two or three weeks, and the things would become permeated
with fumes; not only was the employee sick himself but he made his
family sick. Since the adoption of this practice we do not have
occupational sickness. W e explained to them that it was a protection
to them as well as a protection to us; that when they were sick we
had no men to operate our machines, to run our processes; that it
was a question not of welfare, but of business.
Mr. M o r ley . I think that the point that was brought out a moment
ago is one overlooked in a great many cases; that is, the protection of
the worker.
I remember two cases in Ontario, one wThere an employer called
me one day and told me the workmen’s compensation board had
levied an additional assessment against him because of his bad expe
rience. I asked for the details, and he told me that the total cost
was bound up in one case, that of a young man who had lost an arm.
He told me the story about this young m an; that he had lost his arm
while he was doing what he termed a “ fool trick.” I asked him
whether that “ fool trick ” had been done before. He said, “ Often.
I have spoken to him myself in passing by, and I have seen the fore
man knock the man down for doing it.” I said, “ Have you thought
of discipline?” He said, “ I couldn’t afford to let him go.” I said,
“ W hat did you do when he lost his arm?” He said, “ I got another
man.”
The other case was this: In a plant where goggles were the rule a
young man came to wrork; he was told that he would have to wear
goggles on his particular job. Three or four days later he came in
without them; he had left his goggles on the piano or somewhere
else. The superintendent told him that goggles were the rule, and
that he would have to wear goggles in the future. Four or five days
later he turned up again without goggles, and he was sent home to
think it over and told to come back in three days. The next morning
the boy’s father was looking for the superintendent at the plant, who
thought he had a fight on his hands. The father said, “ I f my boy
hasn’t sense enough to protect himself, thank heaven he is working
in a plant where they look after him.”
Mr. S anford . Mr. Meade stated at length what accident-prevention
work could do. I want to give a few facts as to what accident-pre
vention has done. Up to 1918 most of the accident-prevention work
in our plants was in the nature of providing safeguards for machine
equipment, very little being done up to that time on educational
methods, and in 1918, the first year of wThich we have statistics at all
comparable with later dates, our lost-time accidents totaled 12,
caused by belts, gearing, and other forms of power transmission
machinery. A t that time some of our people thought that we were
going about as far as we could on accident-prevention work.
190
FIFTEENTH A N N U A L MEETING OF I. A
I. A. B. C.
Without going into any details on accident-prevention methods
adopted since 1918, I believe the following figures might be of in
terest showing reduction in 1927 from 1918, a 10-year period:
Per cent of
reduction
Accidents
Accidents
Electrical
Electrical
Handling
on power transmission machinery________________________________25. 0
on point of operation of machines________________________________68. 2
shocks and burns in testing departments_______________________83. 3
shocks and burns in other departments_________________________ _63. 0
of molten metals________________________________________________ _80. 7
The above are only a few of our cause classifications. W e have a
substantial reduction in every class.
On injury classification, the lost-time eye cases totaled 1,139 in
1918 and 58 in 1927, or 94.9 per cent reduction. Infections were
reduced 59.7 per cent; fractures were reduced 51.2 per cent; and
amputations were reduced 28 per cent. The total reduction for all
classifications was 74 per cent.
The employer has several factors which ought to show him that
accident prevention is a good thing. One of these is the item of
compensation payments to injured employees. I believe that every
employer, whether he is self-insured or carries insurance with an
insurance company, would naturally get that figure annually at least,
and his accident cost would be reduced, with reduction in his com
pensation payments. W e have found that increased cost per case,
caused by reduction of waiting period or increase in maximum pay
ments, serves as an incentive to our men to get even more active in the
reduction of accidents so as to compensate for additional and in
creased payments. W e have made a reduction in compensation pay
ments for several years. Two of these reductions, however, I will
cite.
January 1, 1925, the waiting period in New York was reduced
from two weeks to one week. During the year 1925 our compensa
tion payments were reduced $35,000 below those of 1924.
October, 1927, the maximum payments in New York were increased
from $20 to $25. The first eight months of 1928 show a reduction
in our compensation payments at Schenectady from the first eight
months of 1927 of about $20,000.
Mr. D u x b u r y . I have gotten one point at least out of this dis
cussion this afternoon. For a long time I have been inclined to the
conclusion that there was no justification for compensating the re
sults of accidents that happened suddenly and by force that did not
also apply to disabilities of an occupational disease nature. This
discussion this afternoon has confirmed me in that impression, but
there is a technical thing which has to be dene in order to amend
most of our laws. There are lots of ways to bring the thing about,
but there are certain laws that already have that situation.
It does seem to me that this association ought to have a committee
on legislation, such as the State Bar Association and the American
Bar Association have. Here we have a conciete instance where we
ought to have a committee on legislation by which we can advise
those who are interested in how this thing can best be brought about.
In our State I think I could bring it about by amending one sec
tion of our statute and repealing another section; that is, I would
ACCIDENT PREVENTION---- DISCUSSION
191
repeal the section which attempts to schedule the occupational dis
eases which we will compensate, and amend the other section so that
it will take care of it. It seems to me that is the way it could be
accomplished in our State.
Then there is another thing: I was much interested in this dis
cussion about what my friend Stewart called the “ fool way ” to do
things. I f you use intelligent means of going at it you can accom
plish i t ; if you use a fool method you do not accomplish it.
I applied that to a situation which exists in our State and has as
long as I have been observing it— that enactment in our law with ref
erence to safety regulations and some other things. Unfortunately
it uses the word “ order ” ; whenever we find conditions that need
remedy we have to give the employers an u order,” make an order
on them to do so and so. Just as soon as you give the employers an
order they feel as if they were being bossed or imposed upon by
some higher authority, and they resent the idea that they are being
ordered around; it is offensive. I f we were to change that law and
have it say that we are to leave with employers some suggestion, we
could get it done by suggestion lots of times when we could not by
orders.
I am going to have our law amended with reference to that. It
gives the wrong impression sometimes to our investigators or in
spectors; they feel that they are giving orders to do something
instead of going there in another kind of capacity— that of trying
to cooperate with the employer, to assist him, and to give him
friendly suggestions they may have gained from experiences they
have had with other employers. That amendment may help their
attitude as well as the attitude of the employer.
Mr. M a g u ir e . I would like to express myself as being in hearty
accord with Mr. Duxbury’s suggestion for the appointment of a com
mittee on legislation— I do not know whether it would be well to call
the committee just that, but at least a committee on cooperation
with the States in workmen’s compensation and accident-prevention
work. I f we could get such a committee, one that will distribute
information regarding the best laws and the best method of reporting
accidents and things of that sort, it would certainly be helpful to
the States in getting through uniform statutes and uniform practices.
Mr. W e n z e l . I do not believe that this organization is anything but
a representation of administrative officials; the problem of legisla
tion is entirely with our legislatures and with our Congress. I be
lieve there is a field in which the organization can be of use, but it
seems to me that that field is limited, and if any action is taken along
this line it should be so limited. Lobbying has been frequently
spoken of in times past, often to the detriment of the person who was
supposed to be lobbying. There is a kind of lobbying, to my mind,
which is absolutely proper and correct. I have been a lobbyist of
that type myself, representing an employers’ organization. I never
asked a man to vote yea or nay upon a question, but I did present
to legislative committees facts which might pertain to a particular
subject. I believe that it is perfectly proper for this organization to
undertake such a work, to prepare, collect, and present facts which
may relate to a particular piece of legislation, but I do not think at
192
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
any time that this organization should take the position of lobbying
generally, or of securing votes, or of attempting to influence, except
by facts as they may bear upon a particular subject.
Mr. H a t c h . I gather that what is contemplated by the proposal
of Mr. Duxbury is not a thing that would in any shape or color bear
the color of lobbying. The incident which Commissioner Stewart
cites is essentially this: A legislature proposes to enact some legisla
tion in workmen’s compensation, or is considering such legislation,
and it writes to the secretary of this organization asking for informa
tion. I submit to all of you that, generally speaking, when it comes
to legislation our legislators need information, and it is a wholesome
sign when some legislature says: Probably there has been experience
on this point somewhere and there are people who are dealing with
this thing under existing laws and who know something about how
things work under a given law; and the most sensible thing in the
world is for that legislature to say: “ W ho has that experience and
who can tell us about it? ” And where in hea\en’s name would it
normally turn except to this organization?
I think we have a proposal here that is full of possibilities for
much greater usefulness on the part of this organization, not by way
of lobbying for anything, but by way of bringing to the assistance
of some State, when it is undertaking to do something with compen
sation by way of legislation, the combined experience as it has been
observed and studied by the men who are handling that very thing.
I am very much in favor of the proposition; I am not at all fearful
that we shall be setting up a lobbying organization. I am confident
that there are more ways than one in which this organization as an
organization can be useful in such ways, mainly in furnishing infor
mation about the job we are all handling to some particular agency
or person or office who wants to know. W e do know by experience
how a given proposal does work or is likely to work.
M r . M o w r y . It strikes me that the suggestion made by Senator
Duxbury is one of the best that I have listened to at this meeting.
I say that because it peculiarly fits into our situation. W e are con
templating, in fact we are faced with a number of changes in our
compensation law and in our entire procedure. I thing it is fair
to say that the entire department since 1915 has been built up by men
who have had very little, if any, primary experience in compensa
tion work. W e have the usual problems ranging all the way from
proper handling of first reports of accidents to the entering of proper
awards, and the practical system of trying to get at the facts.
I can see where a committee of this sort would be of wonderful
value to the States who frankly do not have much contact with the
people here in the East. W e are at a loss, many times, to know
what system to use, what scheme to devise. I am not speaking now of
the substantial features of the law, but of the administrative end
of it.
To give an illustration: I talked yesterday and spent some time
with the New York commissioner. I heard a long dissertation on the
value of sending everything to a trial calendar. The day before I
listened to a presentation of the idea of sending it to an arbitrator.
Those are samples of the problems that we in Colorado confront,
ACCIDENT PREVENTION---- DISCUSSION
193
and when you add to th at the disposition o f the legislature to cut
appropriations to hold down the am ount o f help and the salaries,
these short cuts mean a lo t to the m an w ho has charge o f the respon
sib ility o f g ettin g a certain volum e o f w ork done, especially if he has
only $ 10 to spend where he ou ght to have $50. I think that su g
gestion is good. I hope you w ill p u t it through.
Mr. D u x b u r y . I am g o in g to present th at question as one o f the
resolutions, so th at w e w ill have it in form. I w ill try to have those
resolutions ready to be subm itted some tim e early in the forenoon to
morrow, and in d oing that I w ant it to be understood th at it is on ly
for the purpose o f g ettin g the subject m atter before the association
and that there w ill be no pride o f authorship or phraseology, but
th at I w ill expect the members to w hip it into such shape as it ought
to be.
[M eeting adjourned.]
,
FRIDAY SEPTEMBER 14— MORNING SESSION
Chairman, Fred M. Wilcox, chairman Industrial Commission of Wisconsin
Mr. D u x b u r y . Before proceeding with the printed program I
would like to bring up the question which was a matter of sugges
tion during the closing hours ox the meeting yesterday. I have a
very rough resolution that I wish to present now :
Resolved, That the executive committee be, and it hereby is authorized
and empowered to take such action as such committee may determine with
regard to advising or assisting members or committees of State legislatures
or of Congress in relation to pending enactments or amendments of compensa
tion laws, safety laws, or other labor laws that have been the subject of the
meeting of this association, and to appoint committees or representatives of
this association to personally appear before legislative committees when request
for such action has been made and pay the necessary expenses of such com
mittees or representatives.
Remember that it was suggested by myself in the course of the
discussion, though not from any previous consideration thereof,
that it seemed to me, in view of the fact that we are frequently con
sidering what laws ought to be and coming to some conclusion with
reference to matters of that character, we ought to take action of
some kind by which our conclusions may be brought before legis
lative bodies where those matters are pending.
There was some expression during the course of the debate that
having a regular committee of that character might indicate that
we were going into the business of lobbying and trying to force our
conclusions upon legislatures, and that that might not be in very
good taste; then there was an expression which was prompted by a
statement of the secretary with reference to an experience which
he had in appearing before a legislative committee at the invitation
of the legislative committee and to his embarrassment in knowing
whom he should represent.
I am bringing the matter up in the form of this resolution, in view
of our practices at various times, particularly at the Salt Lake con
vention where a special committee was authorized and appointed
for the purpose of doing what it could to bring about legitimate
compensation legislation for harbor workers and workers in inter
state commerce. I happened to be a member of that committee and
we did nothing very effective because we had no authority other
than jusu simply to communicate with members of Congress and
senators of our own States and some other members of the com
mittee, though we may have had some little influence in bringing
about that legislation. As we did that in that instance, it does not
appear that we have the idea that it is outside of our functions to
do that, and it isn’t outside of our functions; the responsibility
in the exercise of these functions ought to be placed somewhere.
The executive committee represents this body when it is not in ses
sion, and we generally find that it has the wisdom not to do any194
DISCUSSION-—GENERAL
195
thing that would not be approved by the association. A fter the
suggestions made in the meeting here yesterday afternoon it oc
curred to me that some authorization of that kind to the executive
committee would take care of any exigencies that might arise, and
that was the purpose of framing this resolution.
I will read the resolution again, following my statement, so that
you will know why it was written. [Kereads resolution.] I move
the adoption of the resolution.
[Mr. Stewart seconded the motion.]
Mr. W i l l i a m s . I f I understand what my friend has in mind, the
method of doing it would be something like this: A ny legislative
committee of any State legislature or of Congress, if it cared to pay
the bills o f this association which might result, would write either to
the president or to the secretary for such information; then, if there
was a committee of this kind in existence and it was asked to do
something, nobody could possibly say that it had no authority.
Mr. K i n g s t o n . The Senator submitted this question to us yester
day, and our secretary brought the matter up because of the tech
nical difficulty arising out of an incident in connection with some
State last year. His difficulty was that he felt he could not use offi
cial information because of the fact that he was not so authorized by
this association, and the premise upon which the suggested resolution
was based was that of request.
Now, if I understand Mr. Stewart aright in his remarks of a
moment ago, his idea is that this association should act on the initia
tive. I question the wisdom of that. I heartily support the reso
lution in the form in wdiich Mr. Duxbury has presented it. I do not
think there is any harm at all in passing that resolution, but if we
are to go farther and concern ourselves with the initiative, with get
ting a law in Florida and getting a law in the Carolinas, I think we
are opening the way to accusations of being a propagandist organiza
tion. I do think that we ought not to expose ourselves to the accu
sation of a desire to put a) particular type of law in any of the stat
utes. W e were accused years ago of being a propagandist organiza
tion for the State fund. There is no doubt that certain interests did
seek to use this association for purposes opposed to the State fund
idea some years ago. That has not happened lately, but it is just
as important, I think, that we should keep our skirts clear from any
idea that we are a propagandist organization for any particular
type of legislation. Let us concern ourselves with administrative
problems and give all the assistance we can where assistance is asked
for, but I think we ought not to go on record as becoming respon
sible for initiating any legislation, either in the form of an amend
ment to what we consider a poor law, or in establishing a new law
in a State where there is no such legislation at all.
Mr. W e n z e l . I am heartily in sympathy with the remarks just
made. A s an individual I take this position, that my views should be
forced upon you and yours upon me only as the facts may bring con
viction. I think as an organization we should do the same. A s I
said yesterday, I believe the limits, of legislative assistance by this
body should be in the presentation of facts. That necessarily means
that you must gather them in advance and present them, but I am
opposed, absolutely, to this organization becoming a propaganda or
196
FIFTEENTH ANNUAL, MEETING OF I. A. I. A. B. C.
ganization, to force or insist that some State shall adopt our views
regardless of the peculiar conditions in that State or the demands of
the people of that State. I for one would go home and refuse to con
tinue to contribute as a subscriber to this organization if that attitude
were taken. I believe it is entirely wrong and outside of the province
of this organization. I do believe, as I said yesterday, that it is per
fectly proper to gather the facts as they may apply to a particular
situation because we have the means of gathering them, means that
a single State has not, but when we have accomplished that we should
end there.
Mr. S t a c k . W hat d o y o u m e a n b y “ req uests m a d e ” — req u ests m a d e
b y whom?
Mr. D u x b u r y . W ell, o f course, that is a little indefinite; it must b e
implied that requests have been made by these committees and others
before which you appear.
Mr. S t a c k . In other words, the request shall come from the legisla
tive and not from the labor organization ?
Mr. D u x b u r y . There is nothing here with reference to labor or
ganization. It says, “ They can furnish this information to members
of committees of these legislative bodies.” I do not think that that
means that when the information is requested by a labor organization,
for instance, that that would be the proper source of request; I do not
think it would be. I think the request should come from somebody
connected with the legislative body where the matter is pending,
either a member or a committee of that body.
Mr. W i l l i a m s . This is an international organization. W e have
talked about legislation of the States and Cong] ess.
Mr. D u x b e r y . That is with our usual idea that the United States
of America is the world.
Mr. K e n n a r d . I would like to ask Mr. Duxbury one or two things.
He speaks of a legislative committee to represent this association.
In my years of attendance in this association I have found very few
things upon which this association agrees, and I anticipate that we
are going to have a discussion a little later which will bring out that
there is quite a material and fundamental difference in the feeling
about what a compensation law should do, to start with. Is it the
Senator’s expectation that this legislative committee when invited
shall go before the committee o f the legislature and propound the
viewpoint of the association as an association, because I am afraid
it will not know what that is, or is it the purpose to present the
matter from the various angles based on the information which we
have ? I speak of that because of my personal experience; each year
I am asked to go before the Massachusetts committee in executive
session and talk about the various bills which have been introduced.
It has always been my position, in doing that, that it was for me
to give to the committee what seemed to be the advantages of the
various bills and their disadvantages. I f asked for my personal
opinion I would give i t ; I do not give the opinion of my commission,
because I rarely know it.
Is this legislative committee expected to give information on both
sides of what maj be controversial— because there is hardly a section
of any compensation law which does not have in it the elements of a
DISCUSSION— GENERAL
197
controversy an attempt to give a judicial standpoint, or are we to give
the standpoint that the legislative committee— I speak of our com
mittee as the legislative committee— itself has? Is it going to give
the standpoint of the individuals or to attempt to give the stand
point of this association ? Is it the Senator’s anticipation that it will
present the two sides of the question, if there are such, give the com
mittee of the legislature information along the lines that have been
suggested, and let it pass upon whatever controversial points there
are in the matter, the representative of our committee giving the
benefit of our experience bearing upon particular matters? Cer
tainly, if this commission points out information to a State attempt
ing to change its whole plan, I do not think it will meet with any
great favor. W e have had some experience in Massachusetts; one of
the commissioners from a neighboring State came there attempting
to tell Massachusetts that it ought to adopt a law similar to the one
they had. He was cheered by some and jeered by others. The sit
uation left behind was not entirely a pleasant one, and in my opinion
it would not inure to the credit or the standing of this association if
we are going to take a decided stand upon controversial matters.
I believe there is a field in which such a committee might be of
assistance; I believe that it might so present information that it
would find itself with a reputation for fairness of presentation which
might in time lead to confidence, but I think that the moment that
it attempts to present the matter from the standpoint of a partisan
or an advocate, its value will greatly diminish. I started to ask you
a question and ended by giving my own viewpoint.
Mr. D u x b u r y . I think your viewpoint would be practically what
my answer would be. As I said at the beginning, there are many
perplexities connected with this, and the suggestions that were made
last night contained many viewpoints. It is a difficult thing for
anybody in a particular instance to represent the views of this asso
ciation, because anyone who has been here a great deal knows that
that is a hard thing to determine.
O f course, this association can, like a caucus, determine that it
favors such and such views, but there is some serious question about
how we can get at this question of being useful, bettering conditions
with reference to this character of laws, without at the same time
being offensive, not only to people to whom we want to be useful, but
also to some of our own members.
I recognize that there is some difficulty connected with this, but
it is true that we have deliberately done that in several instances,
one of which I cited, where we attempted to authorize this associa
tion to take definite action in relation to pending legislation and as to
procuring legislation. Maybe we were outside of our province when
we were doing that; maybe we ought to do that more than we do.
I do believe that the information that the members of this association
have from their consideration of the subject, and from the discus
sions and debates which they have had in their meetings, would be
very useful to members of legislative bodies or others contemplating
such legislation in getting a better class of enactments, but, as I say,
it is a delicate subject. W e all know that there was more or less
resentment because of what some people thought was an attempt
to use the association to promote certain types of laws and to discredit
198
FIFTEENTH A N N U A L MEETING OF I. A. ]. A. B. C.
others, and we concluded long ago quite unanimously that that is not
a wise thing for this association to indulge in. It is hard to state
the dividing line, but I think that with the limitation that the execu
tive committee shall do that only upon request there is not likely to
be any very serious consequences, and it might be the means of per
mitting us to be useful where we can be useful.
Mr. B a l d w i n . Mr. Kennard referred to this resolution as the
forming of an executive or legislative committee. A s I understand
the resolution it does not in any sense contemplate the formation of
a legislative committee or any other committee; it simply gives to
the executive committee authority to furnish information and to
collect information to be presented to legislatures, legislators, or
others upon request.
Mr. D u x b u r y . The essence o f it is that it leaves the question o f
what should be done in any instance to the wisdom o f the execu
tive committee and vests in it our confidence that it will not do
anything that is embarrassing.
Mr. T h i g p e n . A s from one of the States that really is in dire
need of a consulting committee, if I might so rame this proposed
committee, we of Alabama would heartily indorse it. In the last
legislature we had two bills presented which would have given us
extremely beneficial changes in our compensation act, but these died
before they reached the legislative committee. I am convinced that
if at that time we had presented the bills in that way,, if we could
have had a conferring committee in this association, that the result
would have been to our good.
I want to say again that we of Alabama are for all the legislative
information and assistance regarding compensation laws of the
Nation and the entire world that we can get.
The C h a i r m a n . W e should bear in mind that o u r executive com
mittee is made up of the past president, the incumbent president
and secretary, and the vice president and three other members— am
I right?
Mr. S t e w a r t . Five other members.
The C h a i r m a n . There are nine then on the executive committee,
and selected as they are they ought to give us some assurance of
real balance when it comes to action being taken on what request
should be recognized and what the course should be.
Mr. H e a b e r l i n . I am not at all familiar with the workings of this
association, I regret to say, having attended only this meeting. I
believe that the resolution offered, to say the least, goes far afield in
its object. M y conception of your organization is one to advance the
fundamental and economic principles of compensation laws and rates
and regulations. I think a regulation authorizing your executive
committee to wait on various legislative committees at the request of
such committees for the purpose of informing them as to sound
principles of compensation theories adaptable to their own State
needs, would be all right. It is my opinion, that you would find
scarcely any one State whose needs would be adapted to the same
compensation act that would fit the needs of another State, and, for
my own part I should seriously object to the resolution if including
DISCUSSION— GENERAL
199
labor laws. I think that the Senator is far afield, in that too many
controversies in labor legislation exist that have nothing to do with
and no distinct connecting point with legislation as to compensation?.
Mr. W e n z e l . I do not want any misunderstanding as to my atti
tude here. I want to say that personally I value very highly the
work of this organization. I should dislike very much to see any
thing come up that would disrupt the organization in any way. I
feel, however, very strongly that the resolution is still a little too
broad, and I believe it should be limited entirely to the presentation
of facts, letting the local legislature make its own conclusions from
the facts. Let us not become a propaganda organization for any
particular type of law in a particular State.
Mr. K y l e . I can see no objectionable feature to this resolution. I
can not conceive or concede that it is in any way a propaganda move
ment, for the reason that, as I take it from, the resolution, it does not
seek to empower our executive committee to take the initiative in any
movement. I think it is almost impossible to separate labor laws
and compensation laws; they are very closely allied in my opinion.
The C h a i r m a n . Whether or not we are going to authorize this
committee to recommend, or to engage in a contest, back in Wisconsin
or Oklahoma or some other State, on child labor laws, and laws on
women’s hours and minimum wage, and things of that sort— that is
what Mr. Heaberlin thought was meant by reference to labor laws.
Do you think we ought to get into any job of that sort?
Mr. K y l e . No, sir. I take it that our executive committee would
be possessed of the necessary discretion in those matters and would
not enter into, engage, or consider any labor law not directly con
nected with our compensation law.
The C h a i r m a n . I think you are quite right in that assumption,
but Mr. Heaberlin did not want it passed over.
Mr. H e a b e r l i n . I would suggest that assumption, and admitting
that your committee has that wisdom, it certainly would not be to the
credit of this association to include something in the resolution that
we did not expect the committee to do.
Mr. K y l e . I do not think that the resolution was meant to include
things that the committee was not expected to do. A s I said before,
labor laws are so closely allied and connected with our compensation
laws that I do not think that that clause would be objectionable.
The fact is that it might be given a broader construction than is
intended. I do not think it is objectionable and I do not think it
should be eliminated from the resolution, because, as I stated, the
two classes of laws are so closely allied that they are entitled to con
sideration. It is quite true that there is a wide variance in the laws
of the different States, but our executive committee, profiting from
an exchange of experiences, you might say, as the result of these con
ventions, or from a construction of the laws of the different States,
could very readily tell what information would be applicable to
that particular State and the different conditions arising in that
particular State, and since, as I view it, it is not intended that this
committee take the initiative in any movement whatever, but merely
act as an advisory committee, I do not think that that could, should,
or might be construed as propaganda— when “ requested,”
200
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B, C.
The C h a i r m a n . I am sure there is no one here who does not want
this association to be as helpful as it can be and still maintain its
integrity, and Senator Duxbury and those who are sponsoring this
thing are simply evidencing that desire. There has been expressed
on the floor at our meetings and in the lobbies and in private con
versations ofttimes the position of many members of this group, that
they ought never to interfere with the legislature in their own home
States, and if they sit by back home as calmly as they would have me
believe they do it occurs to me that the legislature in that State ought
to have some rather impartial group to go to for help. It can not be
supposed that this executive committee would ever give any informa
tion of detailed character on any contentious subject. Its help, its
views must always be a composite, and for my part I do not see any
objection to this resolution.
I am hoping that wTe will find it desirable to let: this executive com
mittee at least try this thing out over the next legislature session.
Mr. A r m s t r o n g . I want to make myself clear in regard to the
question of what I think the duties of compensation boards are, and
this differs very radically from the views expressed by our chairman
yesterday, as well as by those of some of the other members, I have
no great objection to the resolution as read by Mr. Duxbury, but it
may be the entering wedge that may cause a lot of trouble in this
association.
Mr. Stewart says that five States have no compensation laws. W e
may go ahead and get these five States to pass compensation laws;
then the question may come up here that some of those laws give only
5 per cent, and we want to advocate that there should be no limit, or
we want to make it 66% per cent. Where are we going to end if we
carry on propaganda of this kind ?
M y views in regard to the duties of a compensation board are to
give the legislature, when asked,, all the information possible that it
can in regard to legislation along the lines proposed; but to go and
tell the legislature that you want to raise your percentage from 5 or
55 per cent to 66% per cent, to cut out your limit— instead of paying
medical aid for one month, to pay it for the full time, or instead of
putting the limit of $100, to put no limit— then the board gets into
trouble.
This may be more up to States where there are State funds, because
in those States we have to meet the employers and to meet the work
men, and if we go to the legislature, as somebodj' has suggested, and
advocate that it give more compensation or pay the widows and
children more, we are jumped on by the employers and told, That
is not your business, you are appointed as an administrative and a
judicial body.
Did you ever hear the judges in a State calling a meeting of all the
judges and advocating that the legislature make changes in the laws?
I never did.
The C h a i r m a n . I will tell you of one. In the State of Wisconsin
the circuit judges of that State have an organization which meets
regularly, and they counsel the legislature as to what changes ought
to be made. I protest this notion that men who know should sit down
and close up like clams and wait until somebody comes around and
coaxes them to ask this or that or give this or that information.
DISCUSSION— GENERAL
201
Mr. D u x b u r y . I felt long ago that I could not boast about Minne
sota’s compensation law because of the many defects and deficiencies,
but I am proud of one thing, and that is that we are expressly required
by the law to suggest and advise amendments in relation to laws.
Mr. W i l l i a m s . S o are we in Connecticut.
Mr. D u x b u r y . W h y shouldn’t we be? W e are more likely to know
something about what ought to be done, being familiar with all the
facts and all the workings of the law and what its defects are. I am
impressed, too, by some remarks that have been made here, that if we
are to follow the ideals which have been expressed in the discussion
against this resolution, we have very little to do in this association.
I have been priding myself for some time that we are gathered here
for the purpose of seeing where we could better our laws, and judg
ing from the experience of others, when we get the information, how
we can better our laws. I f when we get the information we are to
shut up like clams and not say anything about it— if we can not use it
when we get it, and if we can not suggest any changes for fear we
are going to be offensive— there is no use coming here, getting the
information, and becoming better informed about compensation laws.
W e had better be offensive if it offends those who do not want any
improvement.
Mr. H e a b e r l in . I do not want to leave the impression that I op
pose the executive committee’s opportunity and duty to advise. I
believe that the phrase, “ Workmen’s compensation law,” is broad
in its application and will include any necessary information that
this committee could give to any State, and I am sincere in my posi
tion that the resolution should not include the words “ labor laws,”
because they certainly are separate and distinct from compensation
laws in the majority of instances.
Mr. D u x b u r y . I was going to suggest that that portion of the
resolution ought to be stricken— “ safety laws or other labor laws.”
Mr. S t e w a r t . “ Safety laws ” might be left in there.
Mr. D u x b u r y . Unless there is objection I want to strike out the
words “ and other labor laws.”
The C h a i r m a n . I s that satisfactory, Mr. Heaberlin ?
Mr. H e a b e r l in . That is satisfactory. I suggest that the resolution
be read.
M r. D u xbu r y—
Resolved, That the executive committee be, and it hereby is, authorized and
empowered to take such action as such committee may determine with regard
to advising or assisting members or committees of State legislatures or of
Congress in relation to pending enactments or amendments of compensation
and safety laws-------
Mr. W il l ia m s . I suggest the word “ assemblies ” for “ legisla
tures ”— that might include Quebec.
A M e m b e r . W hy not make it “ law-making bodies ” ?
Mr. D u x b u r y . “ Law-making bodies” then; that would include
those fellows in Canada that we so frequently forget until we need
them; then we know they are valuable.
law-making bodies in relatiqn to pending enactments or amendments of com
pensation and safety laws, and to appoint committees or representatives of this
association to personally appear before legislative committees when request for
202
FIFTEENTH AN N U AL MEETING OF I. A. [. A. B. 0 .
such action has been made, and to pay the necessary expanses of such commit
tees or representatives.
[The question was called for and the resolution was adopted as
corrected.]
The C h a i r m a n . I wish at this time to make some observations
aside from the regular program, yet to my mind appropriate to this
first meeting of the association in New Jersey.
If you were representing the first State to have a workmen’s com
pensation law; if you had been present at the birth of this organiza
tion at Lansing, Mich., in 1914; if your State had never failed to
have representation at a single meeting of this association or to lag
in its fealty to the fundamental purposes of the organization—
then you would know the thrill and joy of interest that is in me.
Other commissioners have also been long in service to their States*
and to this association, and for quite similar reasons have like
thoughts and feelings. Notwithstanding, there must and does come
to myself and to these other commissioners much of sadness and
regret.
When Mr. Kingston announced at the session Tuesday afternoon
that W . B. Marshall, of Oregon, was in the convention hall, I felt
doubly repaid for having come on to Paterson. It was my first
meeting with Mr. Marshall since the Seattle convention in 1915, al
though each of us had continued to serve our States through all
the intervening years. But most of those men who were in at the
beginning have dropped out of the service— seme from personal
choice or necessity, some by reason of death, bur, most of them re
lieved for reasons that are inimical to good compensation admin
istration.
It is only a handful of us that had the privilege of knowing the
lamented Judge Yaple of Ohio. Perhaps fewer still knew Dagget
of Washington, Kinnane of Michigan, Pillsbury and French of Cali
fornia, and Crownhart of mv own State. And there wras Holman
of Massachusetts, Duffy of Ohio, Simonds of Vermont, and many
others who organized compensation administration for their respec
tive States and helped to chart the course of this association. French
is back in the service in California, and Marshall is administering
the longshoremen’s act in the Northwest, so we may hope to have
their counsel and advice for future years. But m m y of the pioneers
are gone from the service, usually taken just at the time they could
have served us best, and it is realization of that loss which hurts
most.
And now we have come on to New Jersey, to the State whose indus
trial worth and resources were pictured so wonder fully by the gov
ernor. It is the State that, notwithstanding size, ranks third in the
value of manufactured products. It was the third State to have a
workmen’s compensation act. It has furnished tie country with the
most outstanding instrumentality for demonstrating safety of opera
tion and process— the safety museum.
And it has given to labor law administration the finest o f men. You
will travel far and wide in fruitless search for another McBride.
Where will you find a man that has given e q u a l l y with John Roach
to the whole cause of protection from injury? In what State has
mastery of administrative detail been better secured than by Mr.
DETERMINATION OF COMPENSATION LAWS
203
Weeks? A State that finds within its borders, coincident with its
need, men of this caliber for the administration^ of workmen’s com
pensation and other labor laws, must first have committed itself to a
lofty purpose in its dealings with management and men.
A s I contemplate this fine background and note the perfectly evi
dent purpose of this State to deal wisely and impartially and hu
manely with the worker and his employer, because of the character of
men she has assigned to the task, my mind turns to one little known
to visiting members, but known to all New Jersey— General Bryant.
He was one of God’s chosen few. None knew him but to love him.
I came to know him early in my service. I met him often. I joyed
in his friendship. I marveled at the combination of rare judgment
and insight and firmness and kindness that characterized his every
act. I went to him for counsel and valued his advice. Much was the
good he did for States other than his own.
I shall cherish always my last meeting with him. W e spent sev
eral days in the Pinchot conference at Milford, Pa.
Then I
came on with him to New Jersey and spent several days in close
study of his State’s plan of administration and the type of service
rendered. During this time, I lived with him, ate with him, slept
with him. I helped strap to his broken and twisted -body the braces
of leather and steel that injury and disease compelled him to wear.
Through each of those wonderfully spent days, I noted in all his
work and dealings such patience as few possess. I marveled that
out of a body so broken and bent and gnarled there could come such
sweetness of spirit, such love for all mankind, such heart in every
act and deed.
There was only one General Bryant. Intimate acquaintance with
him such as was enjoyed by his staff and so many New Jer
seyans, must have left an ineffaceable influence upon the department
and upon his State. Those members of the association who knew
General Bryant would not wish to come into the State he loved so
dearly and on a mission for which he would have given his all, with
out acknowledging our deep appreciation of him and all he meant
to the cause of intelligent, humane, painstaking development and
administration of labor laws. Out of a full heart, I speak these
words of him.
W e will have at this time the paper which Senator Duxbury has
prepared.
Should the Association Attempt to Determine the
Relative Benefits of Existing Compensation Laws?
By F. A.
D uxbury,
chairman Industrial Commission of Minnesota
May it be understood in the beginning that my purpose in pre
senting the question in the title to this paper is not to urge upon
you any particular conclusions of my own, but to attempt to get
the subject before this association for discussion, to the end that
whatever action is taken, either for or against the suggestion, it be
based upon your deliberate consideration with the fullest possible
3 1 5 7 3 °— 2 9 -----14
204
FIFTEENTH AN NU AL MEETING OF I. A. I. A. B. C.
information of the objects to be served, the difficulties involved, and
possible adverse consequences likely to result.
It may not be inappropriate to state here some of the circum
stances that have resulted in the questions being presented at this
time. Among the reasons for such statement is to inform you that
the subject matter is not one that is original with me, and for the
further purpose of showing in some degree the reason why I do not
intend to urge any conclusions of my own as to how the matter
should be determined.
Those of you who attended the Baltimore convention in 1922, or
who may have read the proceedings of that convention, will recall
a rather unusually interesting paper read by Mr. George A . Kings
ton, of Ontario, entitled “A comparison of permanent partial dis
ability ratings and awards.” This paper and the discussion result
ing is reported in the proceedings of that convention (Bureau of
Labor Statistics Bui. No. 333), commencing it page 97. That
paper was based on the responses received from several jurisdictions
as to the amount of compensation payments that would result in such
jurisdictions in five hypothetical cases submitted to the administra
tive bodies of such jurisdictions. These responses indicated a wide
difference in the amount of compensation which would be paid in
the different jurisdictions in these particular hypothetical cases.
The discussion following the paper seemed ^:o indicate that, in
some instances at least, the result in some of these particular cases
submitted did not accurately reflect in every particular the relative
merits of the law in certain jurisdictions, and was not an entirely
satisfactory test of the relative benefits of the k ws in at least some
of these jurisdictions.
Since the Baltimore meeting there has been no further express
consideration of the subject in the meetings of this association until
the meeting at Atlanta in 1927. At that meeting, a motion by Mr.
F. M. Wilcox of Wisconsin was adopted to the following effect:
That the executive committee be requested to give consideration to the
question of whether some one of the commissioners should not be assigned
the task of giving us at the next convention a survey of relative benefits under
each jurisdiction on a representative group of specific injuries, the factors
to be considered in each case to be designated by the executive committee.
The motion included a further subject of relative costs of ad
ministration, but that portion of the motion does not come within
the purview of this paper.
Several months prior to this meeting, the s€*cretary-treasurer of
this association asked the writer to undertake the task of “ making
a survey of relative benefits under each jurisdiction on a representa
tive group of specific injuries ” in compliance with the above-stated
portion of Mr. W ilcox’s motion. Correspondence with the secretary
and wTith Mr. Wilcox developed the fact that the executive com
mittee had not attempted to designate the factors to be considered
in compliance with the motion, and that even if that had been done,
the preliminary work involved in such a survey was quite beyond
my own time and means, as well as requiring more statistical talent
than I possess. It was finally agreed that the subject ought to be
presented to this meeting for the purpose of discussion and to de
termine in the first instance whether it is expedient for the as-
DETERMINATION OF COMPENSATION LAWS
205
sociation to attempt the thing suggested, and if so, to define the
means and manner in which the work shall be done.
It seems quite certain that, if it is determined that a survey of
this character ought to be made, the executive committee or a
special committee should definitely determine just what shall be
the factors and basis of such a survey. The work of procuring
and compiling the data must be done, it seems to me, by some
organization equipped properly to accomplish the object, and the
conclusions to be drawn from the compiled data would be a proper
subject for a paper or a committee report.
As I stated in the beginning of this paper, I have no settled
conclusions on the fundamental question of whether or not the
surve}^ ought to be attempted, and it is not my purpose to indicate
by anything contained in this paper any conclusions of my own.
The purpose of this paper is to attempt to bring to you for your
consideration and action the primary question of whether such a
survey should be attempted by this association, and if it be deter
mined that it should be done, to have you prescribe the manner and
means of making such a survey.
In considering that question, I think it should be done uninflu
enced by the fact that the suggestion came from one of the oldest
and most highly respected members of the association, and that the
Atlanta convention by its action on the motion, in effect at least,
seemed to have approved the proposition.
In view of the limitations which I have imposed upon myself in
relation to the expression of any conclusions of my own as to what
this association should do in the premises, it might be consistent to
close this paper with what has been said. On the other hand, it may
stimulate a more thorough discussion, which is one of the prime ob
jects of bringing the matter before you at this time, briefly to state
some facts and conditions which it seems to me are important in
considering what action is wise on the part of the association.
Practically everyone who has had experience in the administra
tion of compensation laws is convinced that every existing compen
sation law is far from perfect, that some are better in certain re
spects than others, and that every jurisdiction could improve its law
if certain features of the law in other jurisdictions were incorpo
rated in its law, and no doubt in many other ways.
It can not be denied that, in spite of the maxim that comparisons
are always odious, many improvements in the provisions of exist
ing laws have resulted from the discussions in the meetings of this
association in which some weakness of existing laws was disclosed
and a better provision was found in another jurisdiction or in
several other jurisdictions.
The time has passed when we need to waste any effort in justify
ing the general principle of compensation laws. In most of the
jurisdictions belonging to this association, especially where these laws
have existed for some time, we can now render service better by
studying how to improve the law to make it better serve the funda
mental purposes of the compensation laws.
I do not intend to imply that the ideal situation would be to have
the provisions of compensation laws identical in all jurisdictions. I
think all will agree that varying local conditions require certain
varying provisions in the several laws.
206
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
In the debates that have occurred in connection with several
propositions this association has considered in times past, I have
been impressed with the thought that compensation laws as they now
exist in the several jurisdictions belonging to this association differ
very materially in their fundamental characteristics and purposes.
These differences probably have resulted from a failure on the part
of legislatures, and of courts called upon to construe these laws, to
comprehend what seems to me to be the proper fundamental char
acteristic of compensation laws. In many instances, it seems that the
legislature in enacting the law, and the courts in construing its pro
visions, have considered the law to be a legislative rule or control
o f indemnity or damage liability for personal injury in the rela
tions where the law applies, which relations vary in the different
jurisdictions.
I am not entirely satisfied that in some instances certain actions
of this association, in the recommendations which it has made with
reference to modifications of compensation laws, have not been
founded, in some degree at least, on this conception of the purpose
of compensation laws. I think it vitally important that, before this
association .takes any definite action with reference to the matter
which is the subject of this paper, a clear and definite understanding
of what should be the fundamental character and purpose of com
pensation laws should be discussed and well understood.
I believe that no one will seriously contend that the amount of
money which is paid to an injured workman under compensation
schedules bears any necessary relation to the measure of damages in
the way of indemnity for the result of any particular accident in
volved. Nevertheless, much of the criticism of the results of com
pensation laws seems to be based upon a comparison between the
money payments under the compensation law and the amount con
ceived to be adequate indemnity for the consequences of the accident.
The fact that a young man who may be earning a learner’s wage
receives a specified number of weeks of compensation for loss of
an eye at the minimum rate, amounting to slightly more or less than
$600, while a man advanced in years whose working period is practi
cally ended, receives for losg of an eye the same number of weeks
of compensation at the maximum rate, aggregating $3,000 more or
less, is frequently cited in criticism of the justice of compensation
law provisions. Many other such apparent criticisms of compensa
tion laws will occur to anyone who has had experience in the admin
istration of these laws.
It is undoubtedly true that if compensation laws are to be con
sidered as a system of statutory indemnity for the effects of an
injury, such criticisms are warranted. It does not follow, however,
that because in Minnesota compensation of $3,600 is paid for the
loss of a leg at a certain age and wage, that the Minnesota compen
sation law is a better compensation law than that of Massachusetts
where $1,049.53 would be paid in compensation under the same state
of facts, as appears in a table in Mr. Kingston’s paper referred to
above.
I f the wisdom and virtue of compensation laws are to be tested
by the amount of money paid for compensation in a specific instance
and we are to disregard all other provisions and purposes of the
DISCUSSION---- GENERAL
207
law, such as the rehabilitation of persons injured in industrial acci
dents, we lose sight of the real and substantial justification for this
class of laws.
It seems to me that the theory and principle of indemnity must be
disregarded in order to justify a common effect of compensation
laws giving to the individual whose injury and disability are caused
absolutely by his own fault the same consideration and benefits as
are given one wholly without fault, suffering an identical injury and
disability. It is something other than the theory of indemnity
which can justify full compensation benefits to a workman not
physically sound, whose accident would have been comparatively
trivial and probably not disabling to a physically sound individual.
I understand that there are some laws which authorize diminishing
the benefits where it appears that the disability existing after an
accident is caused in part by existing infirmities. Such provisions,
however, seem to me to be suggested by the theory of indemnity for
the results of the accident, and to lose sight of what I believe should
be the fundamental purpose and character of compensation laws.
Is it not possible that, in some measure at least, these laws have
been framed wTith regard more to the ideals and requirements of
insurance actuaries than to what should be the rights and liabilities
that best serve the interests of society ?
I venture to suggest that if this association concludes to make
a survey to determine the relative benefits of existing compensation
laws, that, as a preliminary to such survey, a diligent and careful
study be made to determine the proper characteristics and provisions
of any law that deserves to be called a compensation law, and that
such survey be made for the purpose of determining how well any
particular law measures up to these ideals and considerations. It
seems to me that this subject is one of vital importance, and one
which has been, so far as my own experience goes, very much neglected and generally not understood. I shall be gratified indeed
if what I have been able to suggest should result in a discussion and
consideration of what seems to me so vitally important to the better
ment of compensation laws generally.
D IS C U S S IO N
Mr. S t e w a r t . W e have discussed the wisdom of determining the
administration costs of the compensation laws in the States, and I
have said, and it has been practically agreed to, that it would be a
whole lot better that the association do it, that we do it ourselves,
than to have somebody on the outside do it for us.
The Wilcox resolution in Atlanta was along that line; that had,
as I understood it, for its primary purpose that the committee on
statistics should determine the cost of administration of these laws.
Mr. Wilcox added to it a clause that the committee should compare
the administrative costs with the benefits derived by the injured
workman.
It seems to me— and I think before you get through with this dis
cussion you will agree with me— that you have put on the commit
tee on statistics an utterly impossible job, taking into consideration
the time we have to spare.
208
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
While I still believe that you had better show your administrative
boss that we have somebody to do this, yet if you propose to tie it
up with impossibilities, then for the purposes of the record I move
that the committee on statistics and costs, which originally meant
administrative costs, be relieved from all of the various suggestions
and pending resolutions that have dragged down through the years,
and that it be instructed to drop the whole subject of administrative
costs.
Mr. D u x b u r y . M y paper had nothing to do with that part of Mr.
W ilcox’s motion. There were two separate parts to the latter, one
relating to administrative costs, which was not assigned to me. I
had nothing whatever to do with that, and I think I pointed that
out in my paper, that it was not related to administrative costs; that
that did not come within the province of my paper, for the reason
that in the correspondence which I had I was asked to consider only
the subject which I have considered in my paper. The other matter,
that suggested by the secretary, I did not consider at all.
Mr. S t e w a r t . Can I get a second to my motion ?
The C h a i r m a n *. Mr. Stewart, will you wait until I say a word
with regard to the resolution that I offered at Atlanta ?
I do not think there is in that resolution any suggestion that I
wanted the comparison of administrative costs to be made upon the
basis of the benefits of the law. I think if you will go back to the
wording of the resolution you will find it quite clear that my desire
was to have the study of administrative costs made according to the
various types of compensation coverage. I wanted the States that
have State funds compared one with another; I wanted the States
that have straight insurance coverage also compared one with an
other, and the costs in those States which have competitive State
funds compared.
* * * and second, the question of whether there -should not be committed
to some commissioner the study and discussion at the next convention of the
relative costs of administration of the various jurisdictions grouped according
to character of insurance protection, and otherwise as the committee may
direct.
That was my purpose. I did not think it was fair in a study of
administration costs to compare Wisconsin, a true insurance protection State, and likewise Connecticut, with Ohio and West V ir
ginia. It was not profitable, from our standpoint; and that is the
reason I had no such thought as Mr. Stewart has drawn from that
resolution.
Now, may I, while I am on my feet, and I have the advantage of
you this morning because the obligation of upholding this resolution
is upon me, say I did not have any thought of slipping anything over
on the Atlanta convention, though I did come during the closing
hours------Mr. D u x b u r y . I d id n ot m ea n th a t.
The C h a i r m a n . But Mr. Stewart will bear me out in my assertion
to you that for many years I have thought that we ought- to pursue
that method in our conventions. Our programs are failing. That
is not very complimentary, and if there has beer any good conven
DISCUSSION— GENERAL
209
tion we have had one here, nevertheless we are getting pretty well
fed up on this kind of a program; aren’t we Mr. Stewart ?
Mr. S t e w a r t . Yes, yes.
The C h a i r m a n . And it is the view of people who have been attend
ing these conferences year in and year out that we will have to get
back to the round-table plan of helping ourselves and helping each
other.
Now I offered this resolution for a comparative study of benefits
in specific cases in the specific States. I know what Kingston’s ex
periences have been. He delivered the same kind of a paper on
another study that he made at Columbus. I heard that and I listened
to people in the lobby afterwards who wTere not satisfied with the
rating that their States got, who thought Kingston picked out the
questions in order to show up Ontario to the best advantage, and to
put down some other State. He didn’t do anything of the kind;
that isn’t Kingston. Nevertheless those were the criticisms, and
there were some at the Baltimore convention, who felt likewise, about
the paper he delivered there, so I said:
I want this executive committee to pick out the factors that are to be inquired
into by the man who writes this paper, so as to take the burden off of him; that
what he is doing— making this comparative study— is a job of this association
and committed to him.
Compensation has been declared by you and by myself and by the
courts, times without number, to be a system undertaking to put
on industry and on the ultimate consumer the loss that men are
sustaining in wages because of industrial injury, but we proceed to
put just some small fraction upon industry and let the men lug the
balance of it. I think it is high time we commenced seeing what
our various States are doing. Back in the home State— you have
heard it from the people in your State and I have heard it in mine—
men stand up and shout from the housetops what a wonderful law
we have in Wisconsin, and what things it does, when they do not
know a thing about what it does; they tell the public a lot of stuff
that is not so. They are doing that in your State just as they are in
mine, and I think it is time we showed up in some public document
the shortcomings of States and the meaning of responsibilities by
other States, so that when people discuss these subjects they will
discuss them with reasonable intelligence.
But I had something different from that in my mind. I wanted,
of course, to have the States convinced of their own shortcomings;
I wanted those other States that have met their problems to get the
credit for it; but I had in mind something entirely different from
that. I wanted that study after it had been made to be sent out—>
broadcast— to every State before our convention assembled, and to
have our program based upon that study, I wanted the executive com
mittee to put upon the program the round-table discussion type of
program for the day— to pick out certain of the States shown up in
the survey in one light or another, and to ask representatives from
those particular States to come and tell us how they compensate for
permanent total disability, for example— Oklahoma and Illinois, put
them on the program, and Wisconsin and New York, and as many as
you want— and why they do it that way. Then let us talk about the
systems we have for a specific thing. Let us have our study made on
210
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
hypothetical questions which the executive committee puts up to us;
for example take deaths; what you do on remarriage; what you do
on temporary disability; how you meet medical aid; and how you
meet burial expense— just a mass of subjects we could gather for
this survey— and then utilize that survey as the basis for the round
table-discussion plan of program instead of the one we have had.
I have a study that the National Council has made and I know the
differentiations in the insurance rates of the various States, but I
am disposed to think, Mr. Stewart, that perhaps the secretary had
better not use them. I do not want to give credit, this morning to
States that have met their obligations or to criticize those that have
not, as I view it, and I think it is just as well perhaps that these
figures should not be spread upon the record.
[Reads insurance figures.]
Mr. S t e w a r t . Y ou have read from a sheet of index numbers o n
premium ratings compiled by the insurance companies. I am not
going to attack that, but that is not what the committee was
instructed to do. As to cost of administration based upon premium
ratio or premium index, if that is what you want, it is simple enough
if you will give your cost of administration for various occasions.
The C h a i r m a n . Mr. Stewart, let it be known here, n o w , and
forever, that I never proposed in that resolution at the Atlanta con
vention that you should make a tabulation of admiristration costs on
any other basis than a comparison of state-fund Stal e with state-fund
State, and of insurance State with insurance State, and that indem
nity benefits had nothing to do with the study that X wanted.
Mr. S t e w a r t . W e d id n o t so u n d e rsta n d th e r eso lu tio n .
Mr. W e n z e l . I am in thorough sympathy with the W ilcox resolu
tion in so far as it applies to a study of comparative benefits in the
various States. I hope that a committee will be appointed and that
such a study will be made; and when such a study has been made,
now that the resolution presented by Senator Duxbury has passed,
I am going to come back here and make a motion chat to that com
mittee be delegated the task of bringing other St ites up to North
Dakota.
Mr. K e n n a r d . I have been listening to this discussion, and I have
tried to find out where we are and what we are i alking about. I
understand that Mr. W ilcox’s resolution had to do with the question
of administrative costs. I understand that what Mr. Duxbury is
talking about is something deeper and more fundamental than
administrative costs. It is in no way tied up with Mr. W ilcox’s
resolution or what he desired to accomplish.
Mr. D u x b u r y . Those two things are embodied in Mr. W ilcox’s
resolution, but I had assigned to me only the one.
Mr. K e n n a r d . Y ou have accomplished what you have undertaken,
Senator, as I understand it, but that is only distantly related to the
matter which Mr. Wilcox desires to have investigated by the
statistical committee.
W e quite commonly see, or I do, some statement as to what consti
tu te s an ideal compensation law, and there has been some effort to
draw a standard compensation law for uniform compensation laws.
I think that Mr. Duxbury’s fundamental idea is the ideal that we
DISCUSSION---- GENERAL
211
started with. I f we start with different ideals we are going to land
at different ports.
There are two theories of compensation law existing in this con
vention and in the laws of the States; one— and we have that one in
Massachusetts— is that a compensation law should follow its name;
it should compensate a man for his loss due to an injury in an indus
try. W hat is the injury that he suffers in industry? It is the loss
of what his day’s or week’s labor will bring him, namely, his earn
ings; and our compensation law in Massachusetts has followed that
proposition very closely. W e give to a man, as near as we can figure
it, a certain fixed proportion of his wages, this being dependent upon
the extent to which his ability to earn wages suffers, not only at the
time of injury, but taking events as they come along and running
over a period of four or five hundred weeks and sometimes the bal
ance of his life. It seems so simple to me. W e do not have dam
ages; we do not attempt to say, at the time a man is injured, or a
week after, or a month after, that this man has suffered a $700 loss
because he has lost two fingers. W e pay compensation weekly until
he has gotten back to a position where his injury no longer reduces
his ability to earn wages. That is the theory which I, personally,
have always had of a compensation law. The very word itself means
to compensate. W hat are you compensating him for? Are you
compensating him for his loss of beauty? Are you compensating
him for his suffering? Are you compensating him for all the ele
ments which enter into the verdict of the jury when you have a court
action for damages? Our theory in Massachusetts is that we are
not compensating for that; therefore, I was in a quandary, because
I felt that jurors who attempted to say beforehand that every man
who suffered the loss of a leg had suffered the same damage from
industry and in industry were entirely wrong.
There are those in this convention who believe that along the line
of damages is the logical and proper way for this law to be inter
preted ; as I understand it, some of us do not think so. I had gotten
the impression from the Senator’s paper that what he had in mind
was to discuss that fundamental proposition; then we can begin
to talk about the comparative merits of the laws in the States. Per
haps Vermont has a compensation ideal which is entirely different
from that of New York. I f so, then we ought to find out, if we
have any way of finding out or any way of getting information,
for the benefit of those who are interested in the subject, what
is to be said for the various ideals— as to which is the ideal on which
a compensation law should be built. O f course, the moment it is
a question of damages you are in a field where you have nothing
but temperament and the frame of mind of the man who is assessing
them; everybody knows that you can go before one jury and get
$5,000, and you can go before another jury and get $20,000.
That, as I see it, is the trouble with damages. I f you are going
to attempt to assess the results of an injury upon a man arbitrarily
and in a fixed amount, then it is perfectly apparent that you are
not giving anything like justice unless you place your estimate at
a point which is going to compensate to the fullest the man who
needs the most compensation and who is deserving of the most
compensation, and let the rest ride in on his back.
212
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. 0 .
It is a pretty theoretical proposition, as I see it, and at the same
time one to which we must give consideration. As I attend these
conventions it seems to me that we fumble around because we
do not talk with the same meaning. W e start a debate, and nobody
knows what the words mean. W e talk about occupational disease—
I do not know what occupational disease is, and I doubt whether
Mr. Wilcox does. Last night after I had talked with him I came
to the conclusion that probably we did pay for occupational diseases
in theory, if not in lawT, and so it goes all along the line. W e talk
about the comparative benefits of compensation laws. Benefits of
compensation laws can be compared only when you start out in
theory alike.
I f New York gives $10,000 or $15,000 to a man of family who has
been killed, that is damages that are assessed, for we all know that
the death of one man may be an economic benefit to a family and
the death of another man a serious loss.
O f course, if once you get a common ideal then you have some
common ground. I heard the commissioner of public works in
Massachusetts in speaking of the building of roads say that there
is no such thing as a best automobile road, that what is the best
road depends upon the foundation upon which you build the road,
and so I submit that there is no best compensation law, that it
depends upon the foundation. When you get your foundation, which
includes, of course, all the local elements that enter into it— cost of
living, wages, and so forth, ad infinitum— and start with a common
ideal, then you can begin making comparisons between the States
as to which one has the best law. The probabilities are that each has
the best law for its own State up to a certain point .
A s I say, the whole proposition is one which as a theoretical dis
cussion has something to be said for it and is interesting, but until
we start on the same basis we are going to get stalled on the track;
there will be no finish, there will be no winner, and there will be no
competition so far as the comparative costs are concerned. That is
a question which I presume is a moot question. Given the necessary
factors I presume Mr. Stewart and the association ought to be able
to find that out without a great deal of trouble
I anticipate the
greatest difficulty is getting the factors. Being given the factors,
I should think the proposition might w7ell be taken care of.
But as to the discussion of Senator Duxbury’s resolution, in so far
as I understand Mr. W ilcox’s proposition he has thrown it out in
the back yard, and whether wre now w7ant to bring it into the house
and nurture it is the question Mr. Duxbury has raised, but so far
as the resolution or the remarks of Senator Duxbury now stand, it
seems to me it is a question for the convention to consider whether
or not we want to discuss that academic, if you please— or not en
tirely academic— proposition. W hat is the whole theory that) goes
to make up compensation, and what is the doctrine upon which it is
founded ?
Mr. K i n g s t o n . Mr. Kennard took the words right out o f my mouth
in his last remark, that this proposition is bordering on the academic.
Reference has been made to the comparative survey which I had the
privilege of making at the convention in Columbus 12 years ago, as
well as that at the convention in Baltimore six years ago. One of
DISCUSSION— GENERAL
213
the things that I regretted in connection with each of those surveys
was that it did appear, from the results of my study, as if I was
trying to put Ontario into the limelight in comparison with the
other jurisdictions, and I appreciate very much, Mr. Chairman, your
observation this morning which acquitted me of any such intention.
It did so turn out, however, that Ontario was near the top of the
list, and I regretted, when I found the situation to be what it was,
that I had to go on with the the study in that way.
The result of the discussion in Baltimore led me to the conclusion
that there is little to be gained by making such a survey. Those who
were at Baltimore will recall how, immediately the paper was pre
sented from Maine to Delaware and I don’t know where not, the
delegates had their backs to the wall immediately in defense of their
own particular types of law, and they seemed to resent the particular
place where the schedule, which I prepared from the information
which they themselves gave to me, placed them with relation to other
States. I do realize that it is very difficult to place Massachusetts,
because of the particular type of the Massachusetts law; no matter
what set of factors you take for the purpose of making a survey, it
is not going to reflect truly the Massachusetts law. I realized that,
and I made a footnote in my paper which gave some indication of
that. Massachusetts, however, is practically the only exception. No
matter what set of factors you may choose to adopt as the basis for
this survey, you will find exactly the same condition Mr. Wilcox finds
in this paper to which he refers and exactly the same condition I
outlined in my review at Columbus, varying, of course, in detail as
appeared in the survey which I made at Baltimore— you will find
one State at the top and another State in a hopeless condition at the
bottom.
There is no doubt that there is a wide disparity between the top and
the bottom in this survey, and it is one of the regrettable things that
you find that condition. I f we could take such a survey and tell it
from the housetops or in our legislative halls, because that is really
the place where it ought to be told and if we could get it home to the
gray matter of our legislators and instill into the minds of such legis
lators that they ought to do something, particularly in those States
that we feel are not paying any compensation, we might serve some
useful purpose, but that comes back again to the question of propa
ganda. Is it our particular business or concern here, as an associa
tion, or is it my particular concern in Ontario whether Delaware
pays so much less than we do, or whether Wyoming or North Dakota
pays more or less than New York does? I t is all right for North
Dakota to have a pride in her own position or Minnesota to have a
pride in her position, but is Jit not after all a legislative problem, and
are we seriously concerned with bringing Connecticut or Delaware or
Maine up to the level of NewT York, or Minnesota, or North Dakota,
or Illinois, or Michigan, or Ohio, or any of them? I am afraid it
will come down to that situation, and if we produce a survey next
year along the lines suggested, the moment the survey is made half
a dozen delegates will have their backs to the wall immediately de
fending the position in which they happen to be placed in the sur
vey. I am afraid not much more good will be accomplished than was
accomplished as the result of the survey at Baltimore.
214
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
I recall the very happy remark made by Harry A. Mackey, of
Philadelphia, who was then a delegate at the convention, when dele
gates from all over the room were throwing stones at me for compari
sons which I made; he got up and said that I ought to be thanked for
bringing the survey before the meeting. He said, in effect, “ I did
not come here to defend the Pennsylvania law, and I am not here
to defend it; but a survey of this sort serves to bring home to some
of us the defects in our own law, and that is the ay we ought to look
at it.” A t the same time I doubt whether many of the members
looked at it in that way, and I question very much whether such a
survey is of more than academic interest, and I do not know that it
helps us very much in the solution of our administrative problems.
Mr. W e n z e l . I am very sorry indeed to be placed in the position of
laughing at the convention— in view of the man} happy associations
here I would much rather laugh with the convent ion— but you passed
a motion just a little while ago and I opposed it u'oon the very ground
that I thought it was no business of this association to meddle with
the affairs of States except to the extent o f supplying informaion.
Now you have before you the proposition of ascertaining just what
the relation of the States is, and you back water. O f course you will
back water; you are bound to. W hy did you pass the resolution a
little while ago? Somebody before long will move a reconsidera
tion of that motion.
Mr. S t e w a r t . I think that Mr. Hatch, the chairman of that com
mittee, and the other members of the committee have been very
much enlightened to-day as to what can be done in regard to the in
struction which wre have had for the last five 01 six years to obtain
comparisons of administrative costs. It seems to me you have to do
one of two things— either tell us to get administrative costs and stop
there, or else relieve us of the whole proposition. This thing has
been hanging on, the committee being absolutely afraid to touch it
because of the complications that have arisen heie to-day.
Now this talk here to-day— what can a statistician do with that?
Statistics have certain limitations. W e can go ahead and tell you
that it costs 22 cents a case in Tennessee and $12 a case, we will say
for instance, in New York. That is as far as we can go on admin
istrative costs, but you have tacked it on to us to know all that that
22 cents means in Tennessee and what that $12 means in New York.
Most of what it means, it is absolutely impossible for a statistical
committee to handle in any sort of way. So again I move that these
instructions for the committee on statistics and costs to go ahead
with the report on statistics of administrative costs be withdrawn and
the committee discharged from that obligation; I do not mean that the
committee be discharged— it is a permanent committee— but that in
structions be withdrawn, as mentioned.
[Mr. Kingston seconded the motion.]
Mr. H a t c h . Perhaps it will help to make clea:' just what the diffi
culty of the committee in carrying out the instructions is, if I point
out one or two things. Any study of benefits or administrative costs
is of interest only for the purpose of comparing what is true in one
State with what is true in another State. W e will all agree to that.
Now, then*we are going to compare, we will say, the administra
tive cost in Tennessee with the administrative cost in New York. W e
DISCUSSION— GENERAL
215
will suppose that the data are available by which we can say that for
all cases closed in Tennessee the cost was so much, say 22 cents, and
that in the State of New York it was so much, say $10.
From the scientific point of view I want to say that that does not
mean a single thing by itself. W e are comparing here two samples
of something, but the two samples are not the same kind of thing
at all. W hat do they do in their administration in Tennessee ? How
long does it take them to settle a case? How promptly does the
workman get his money? How often after the court makes a deci
sion does the case go to appeal? How long is it before the appeal
is settled? The whole question of how you conduct your adminis
tration, and how efficient it is, has to be gone into at length as regards
Tennessee and as regards New York, so that, if tfiese figures are going
to be worth anything to you, we can make the statement that where
a State was this and this and this in its administrative procedure,
and gets this and this and this result by that procedure, in the States
where those factors are the same the figures are this and this.
I do not believe I need to do anything more than to state what the
statistical problem is to convince you that, from the technical point
of view, you are asking of the statistical committee, with the resources
it has and the time its members can give to this thing, an impossible
task. That is all I want to make clear on this administrative cost
proposition.
As for Commissioner W ilcox’s proposition about comparison of
benefits, I am strongly of the opinion that this association ought to
make such a study if it can do it, but you have the same difficulty
there, technically, that you have with the other proposition. I am
in favor of this association doing it. I will say that theoretically
I am in favor of gathering this information for the simple reason
that other people are doing it.
That table of index numbers that you heard referred to this morn
ing is being quoted all over the country, and it is being said that this
State is doing three times as much as that State, or four times as
much as that other State. Now who is saying that? The two parties
most vitally interested. On the one hand employers are saying: “ In
our State we are doing so much more than this other State that we
can not afford to do more until that other State gets in line.” The
injured workmen are saying in the other State: “ In this State we
get only so much, whereas injured wrorkmen in that State get four
times as much, and we can not understand, on any theory of justice,
no matter what the theory of compensation is, why there should be
that difference in the two jurisdictions.” So that the parties which
have a lively interest in this thing are talking about it and consider
ing and studying it. Now the issue on that statement comes back to
just this: Is this organization going to be an active influence by fur
nishing authoritative information, coming from those who probably
know more about it than anybody else, or are we unable to do that?
That is the theoretical side.
Practically, I do not see how, in the near future, it will be possible
to make such a study for the whole field of benefits and get anywhere.
It might perhaps be possible to make a beginning and to study com
parative death benefits, perhaps comparative death and total disability
benefits— and when you have covered those you have covered a large
216
FIFTEENTH AN N U AL MEETING OF I. A. L A. R. C.
percentage of the total benefits in the State— but if it is gone into at
all it will have to be gone into in a modest piecemeal way, and then,
I can assure you, with all the duties that the members of the committee
on statistics in this association have in their individual jurisdictions,
it will take a long time to get the job done.
So that though I feel that this is a highly desirable thing, at least
so far as administration costs are concerned, I would support Com
missioner Stewart’s motion.
The C h a i r m a n . Are you ready for the motion ?
Mr. H e a b e r l i n . I want to say it is rather a coincidence that I have
viewed this matter as an individual. I recently engaged a reputable
actuarial firm and requested it to make a survey of the comparative
value of the compensation law in our own State for our own use in
West Virginia, with reference to the coming session of our legislature,
so as to be able intelligently to inform it what our situation was with
reference to our neighboring States.
[The question was called for and the motion was carried unani
mously.]
The C h a i r m a n . The committee is relieved of any duty in that re
gard. Now, are you ready for the question on whether we can in
the future impose upon the executive committee the obligation of
selecting somebody to make this study of comparative costs on
specified cases?
Mr. H a t c h . I have an idea that I am going to broach. W e have
already, as I said a while ago, some figures that are being widely
used and widely quoted, and so far as I know they are very reliably
compiled figures for what they pretend to be. Now, once again, you
have to define what your figures are in statistics. These figures
are prepared by the National Council on Workmen’s Compensation
Insurance. How would it be to invite the actuary of that organiza
tion to present at the next meeting o f the association a paper explain
ing what those figures are, how they are compiled, and what they do
and do not mean. Then this association or any of our members, when
those figures are quoted, will be in a position to discuss them with
exact knowledge of what they do and do not mean, and see that
whenever they are used they are properly used. That is merely a sug
gestion, as perhaps getting us a little along this road of a study of
comparative figures.
The C h a i r m a n . Do y o u offer that as a substitute for the proposal
I made at the Atlanta convention?
Mr. H a t c h . I move that as a substitute.
[The motion was seconded by Mr. Williams.]
Mr. K i n g s t o n . I f that can be worked out it is an excellent idea;
if it were possible to put that survey in the hands of delegates a
month or six weeks prior to the convention, so that we could give
it a little study, we would be able to discuss it when we come to
the convention.
Mr. H a t c h . I have no doubt that that paper could be secured
in advance and distributed to the members.
The C h a i r m a n . Be it remembered, men, that these very figures
are the basis for the rates that your industries are paying in your
own States for your compensation coverage.
COYEEAGE OF THE SMALL PLANT
217
Mr. K e n n a r d . A s you have already referred to the executive
committee the question of the legislative position of this board as
represented through delegates, this question having tied up with
it, as brought out by Senator Duxbury’s discussion, the question
of whether or not it would be feasible to invite this actuarial study,
and whether we would get anywhere in so doing and what the
modus operandi should be, this is something that this meeting
can not discuss. I move the matter be referred to the executive
committee, which having heard this discussion and knowing what
the situation is, may be trusted to act in a constructive way.
[Mr. Stewart seconded the motion.]
Mr. H a t c h . I think, perhaps, that is a wise proposition and I
am willing to accept that as an amendment to my motion.
The C h a i r m a n . I am not very thin skinned about this thing;
I am not very thin skinned about wThat my State is doing. I would
like to have a study made of death benefits, as I have the impression
that Wisconsin is not paying what it ought to pay for deaths. W hat
I have been in doubt about is whether or not many of the States are
impressed with what their individual State is doing— whether it
is actually doing what it ought to do. I think it is time we had
to stand up and take a position one way or the other.
Are you in favor of the suggestion, Mr. Kennard, that the matter
be referred to the executive committee with power to act?
Mr. K e n n a r d . I am.
[The motion was put to a vote and carried without dissent.]
The C h a i r m a n . The next number on the program is Mr. Stewart’s
paper “ The small plant and workmen’s compensation coverage.”
Mr. S t e w a r t . The reason I have prepared this paper, I will say
to you frankly, is the protests that we have received in the Bureau
of Labor Statistics in the Department of Labor from workmen
against the administration of the law or the nature of the law in
the various States— that is, this fellow is included, this factory is
excluded; I got hurt and I find that I am not insured; what does
the compensation law mean— and that sort of thing. Now those let
ters and protests are not few in number, they are large in number.
In other words, in the minds of a very significant percentage of the
working people the whole compensation scheme and theory are skid
ding and skidding very rapidly.
The Small Plant and Workmen’s Compensation
Coverage
By E t h e l b e r t S t e w a r t , United States Commissioner of Labor Statistics
There is very little, if any, doubt that the work of accident pre
vention has been introduced and accelerated in this country by rea
son of the workmen’s compensation laws. Where workmen’s com
pensation applies and can be made to apply you find a live human
interest in accident prevention. In many instances it has become
really human; but, to stop kidding ourselves, the interest generally
has only the image of a human on one side and the image of an eagle
on the other.
218
FIFTEENTH A N N U A L MEETING OF I. A. I. A. B. C.
W e are beginning to wake up to tlie fact that the small plant is
taking little or no interest in the question of accident prevention.
When workmen’s compensation laws were enacted the people had a
feeling that those injured in industrial employment, together with
their families, were going to be reasonabty well taken care of, and
they sat back with that smug assurance which characterizes the
American mind (and I suppose all minds) when it has succeeded in
having a law passed.
The fact of the business is, however, that even by the terms of the
law the number of workmen in the United States who are protected
by compensation is so small compared with the whole that, so far
as the laws and the records show, only a relatively small proportion
of the workers in the country are insured.
Granted, that the question of compulsory and voluntary election as
it is written into the laws of most States confuses the problem beyond
all hope of understanding by the layman, nevertheless certain facts
stand out.
In no law in the United States is there compulsory insurance for
all establishments or employments under any and all circumstances.
The nearest we come to it is in the California law and the new law
covering employees in the District of Columbia, which will be taken
up later on.
W e must remember that by the latest census records over 40 per
cent of the manufacturing establishments of the United States employ
an average of 2.7 workers per establishment. So far as any informa
tion we have is concerned these establishments are not covered in
the following States: Alabama, Alaska, Arizona, Colorado, Connec
ticut, Delaware, Georgia, Kansas, Kentucky, M ain3, New Hampshire,
New Mexico, Ohio, Rhode Island, Tennessee, Texas, Utah, Vermont,
Virginia, and Wisconsin. The theory seemed to be that the man who
worked in a small plant could afford to be killed or maimed and his
family would be delighted, and society would have money enough on
hand to buy a poultice plaster for the workers in these small plants.
There is a feature in some of the laws which permits voluntary or
elective coverage. There is not a State in the Union from which I
can get statistical returns that knows how many and what per cent
of establishments, according to size, have voluntarily elected to come
under the workmen’s compensation law. They can tell me how many
have come in. They can not or do not or will not tell me how many
have not come in. The workmen in those plants rhat have not come
in are not insured. This leaves an unknown number of small plants
with no inducement to clean up, to have safety devices, or to protect
their workers in any way.
There is another clause in many laws which recuires employers in
extrahazardous occupations to come in, and this includes all em
ployees engaged in the hazardous occupations. Here we do not know
what proportion of the employees are covered and what proportion
are not. It is fair to assume that once in, the election covers all.
W hat constitutes extrahazardous employment is defined differently
in the States by the statutes, and can not as a matter of fact be de
fined at all. The girl in a lawyer’s office, entirely excluded from the
law, who climbs up a stepladder to get a law book and falls and
breaks her leg has a broken leg just the same as tUe fellow who gets
COVERAGE OF THE SMALL PLANT
219
one o f his legs broken in climbing up and down a ladder in an iron-ore
mine. She has no protection. She is working in an industry entirely
out of the range of most of the State laws.
But why quibble over the States that cover 1, 2, or 3 ? There are
plenty of industries such as mercantile, clerical, etc., which persons get
hurt who are not covered at all. The point I wish to raise is that
the atmosphere o f compensation laws cavers the large plants and
not the small ones, and that atmosphere permeates all the so-called
compulsory and elective laws. W e have not, we are not to-day put
ting the pressure of compensation laws on the small plants to make
them clean up and institute safety devices.
A s I understand the laws, in certain States establishments having
less than a certain number of employees can not come under the com
pensation law even by election or voluntary choice. These States
with the specific number of employes are— Alaska, 4 ; Arizona, 2 ;
Delaware, 4 ; New Hampshire (as to factories), 4 ; Texas, 2.
It seems to me, after my brief and quiet occupancy of the secretary
ship of this organization, that the extrahazardous institution ought to
be compelled to come in under any circumstances and without regard
to the number of employees. Extrahazardous employees numbering
four in New Hampshire or Delaware need protection more than those
in nonhazardous occupations. It comes down to this— that in certain
States certain people were afraid that the law would cost too much.
I will pause a second to refer to the omission in practically all
laws of casual workers. By and large, there is no more hazardous
occupation and no class of people w7ho have less to depend upon or
fewer friends to take care of them than the so-called casual workers.
Without going into detail I will say right here that the National
Safety Council has pointed out that the home accidents show a higher
rate than do accidents in practically any other industry. Coverage of
domestic employment is not compulsory in any State. Farm acci
dents, in the States where we have any idea about them, are more
frequent than accidents in many of those industries covered by the
laws.
W e are dodging the cooperative movement, the partnership move
ment, and the subcontractor and the sub-subcontractor movement,
even where it is not the result of an insurance company plan.
M y purpose here is simply in a general and sketchy way to- show
that, generally speaking, the compensation laws use their pressure
on the large plant to provide safety methods, and also, speaking gen
erally, do not use the same pressure or any pressure to impel the
small manufacturer or employer to install safety methods.
I t was made very clear at the Atlanta convention that this fact
is being used to throw more and more workmen out of the scope o f
compensation protection. It used to be the theory that workmen’s
compensation laws were intended for the workingmen, and I can
remember that when that statement was made at the Baltimore con
vention by Carl Hookstadt it was backed up and cheered by the mem
bership generally. A t the Atlanta convention it was positively
denied that the workmen’s compensation laws were intended for the
workingmen and nobody challenged the statement. This associa31573°— 29------ 15
220
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
tion lias on at least two occasions positively refused to go into any
scheme which would extend the education of the workmen, even as
to the existence of these laws or as to their rights under them.
Trend of Compensation Coverage in Various States
Some time ago I asked the various States to answer a number of
questions along the line of this increasing number of uninsured em
ployees. The practice of letting subcontracts for particular parts
of a job, where the number of men employed by the subcontractor
or the sub-subcontractor would be less than that covered by the law,
is becoming more and more common.
Over and above that of the large total number of workmen excluded
from compensation b}^ the minimum coverage of the law, there are
two or three other points to bring up..
In the first place the National Safety Council has developed the
fact that a very large percentage of accidents is what it terms
home accidents. These are entirely uncovered except by election in
California and one or two other States. The few instances where
home accidents are compensated may be considered negligible.
Then we come to the small plants, which though employing enough
people to be covered by the law, are unable to secure insurance. The
report from Alabama says: “ The small industries comprising this
group consist of sawmills, small coal operators, laundries, stores,
etc. The larger insurance companies exclude extrahazardous occu
pations of all sorts and small businesses.” Arizona reports refusal by
insurance companies to carry mining and farming and mercantile
establishments. However, the State fund o f Arizona accepts and
covers every risk for which application is made. The same may be
said of California. Colorado reports insurance companies refusing
to accept coal mine risks, which are, however, for the time being taken
care of by an Employers’ Mutual Insurance Co. The other small
plants which are refused insurance are taken care of by the State
fund. Delaware reports but one case of refusal— that of work on the
extension of a sewer under the surface railroad tracks. The work was
to be done by a recentty patented boring machine and the machine
could best be operated by five men, the minimum number of employ
ees under the State law. The safety engineering department o f the
railroad examined the plans and decided there was no risk to the
railroad and issued a permit to have the work go on. The contractor,
however, could not get compensation insurance.
In Georgia there is only one concern which will write insurance
on portable sawmills, and window cleaners are on the prohibited
list in that State as in many others.
In Illinois the following industries are unable to secure workmen’s
compensation insurance: Window washers, tuck pointers, iron deal
ers (commonly known as junk dealers), and house or building wreck
ers. A ll insurance companies except two are reported to have with
drawn from insuring coal mines, and I understand that since this
information was furnished, even these two companies have withdrawn
from the coal fields.
In Iowa coal mines can not secure insurance, I am told by Com
missioner Funk, who says, “ I find that the smaller coal operators are
COVERAGE OF THE SMALL PLANT
221
unable to secure insurance because insurers decline to accept their
risks on any terms.”
In Kansas all the coal mines, except those owned by railroads, which
are self-insurers, find it impossible to secure insurance. There are
other classes of small operators, who are unable to secure insurance,
but they are banding together1at present and taking out policies un
der a life and accident insurance company which is doing business
in the State without the definite approval of the superintendent
of insurance. There is, however, a significant case in Kansas, and
that is Osage County, in which there are 24 coal mines. They have
severally and jointly made application as self-insurers, the 24 oper
ators collectively binding themselves to pay any loss under the com
pensation act to an employee of any of the 24 mines. Each company
pays $10 as a deposit and then 5 cents on each ton of coal produced
during each month. On the basis of last year’s production in this
field and the number of accidents reported, that 5 cents will more
than pay the compensation provided under the act.
Minnesota reports that some companies have certain prohibited
risks and that it is almost impossible for operations of logging and
lumbering, small portable saw and lath mills, and also quarries to
obtain insurance in either stock or mutual insurance companies.
Missouri reports that all classes of insurance carriers have adopted
the principle of selective risk and are refusing to insure coal mines,
window washers, scrap-metal yards, and other extrahazardous and
undesirable risks. Missouri has no State fund, and therefore that
source of pressure upon these concerns to become less hazardous is
lacking.
Oklahoma reports that the entire coal mining industry in the
State is without insurance of any kind.
Rhode Island reports that the jewelry refining industry is unable
to get insurance, and there is no State fund with which to protect it.
Tennessee reports that coal mines, sawmills in the outlying districts,
and some sawmills in the smaller towns are being refused insurance.
Texas reports a rather peculiar and interesting situation. The
insurance companies will not insure cotton-oil mills, and power and
light plants, and some companies do not insure oil drilling and
producing operations in certain sections of the State, especially
where there is at present extra poisonous gas. However, it appears
that the law creates an association under the employers’ liability
law which is compelled to insure them when they make application
for such insurance.
Vermont reports lumbering and logging, including sawmills, and
to a certain extent woodworking industries, as having great diffi
culty in securing compensation coverage. This is also true to a lesser
extent of the slate industry. The smaller companies in lumbering
and logging operations are reported as being in a particularly
bad way.
The situation in Virginia has been pretty well covered by others
and need not be taken up here.
Pennsylvania finds trouble in a number of industries, but particu
larly in that of coal mining.
And while we are on the subject of coal mining I want to say
that in those coal mines in Pennsylvania which are under the State
222
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
workmen’s insurance fund (and it is fair to assume that many of
them are under it because of the trouble in securing insurance) the
premium rate for the years 1923 to 1927 inclusive, was 3.2 cents
per ton. It was increased to 3.5 cents per ton in 1927. The total
loss incurred on account of accidents for the same period was 2.7
cents per ton. In Ohio the losses, including medical attendance,
amounted to 5.5 cents per ton. Ohio pays a maximum of $18.75
a w^eek and a death benefit of that amount for 416 weeks, while Penn
sylvania pays $12 per week. (The figure was raised to $15 last year,
but my figures do not include last year’s experience.) Ohio’s coal
premium rate is $3 per $100 of the pay roll. Her compensation cost,
including medical attendance, which as stated above is 5.5 cents per
ton, was in the year 1926, 20 per cent above the premium. That
is to say, at a premium: of $3 per $100 of pay roll it cost Ohio an
additional 60 cents per $100 of pay roll. Ohio pays the highest
compensation of any State in the Union for coal. Utah’s premium
is $3.90 and she insists that she is making money on it.
Now, there is either some mighty poor housekeeping in the coal
mines of the States where the insurance companies require $7.90
for premium, and there ought to be some pretty strenuous efforts
made to introduce safety work there, or there is some pretty bad
thinking on the part of the insurance companies.
But to proceed, from Massachusetts I get from the commissioner
of insurance the report that many companies refuse to insure under
workmen’s compensation building wrecking, window cleaning, roofers,
junk dealers, fireworks manufacturing, and stonecutting and polishing.
I am advised that 45 employers upon their own initiative sought
the assistance of the New Jersey bureau to help them get compen
sation insurance after they had been refused.
South Dakota reports that the sawmills and woodworking indus
try in the western part of the State is rapidly approaching the
status of inability to secure insurance.
When I asked the various States what proportion of plants or
of employees wTere unprotected I found that net a single State had
any comprehensive figures on the subject.
Private insurance companies, whether stock or mutual, are not
compelled to accept all insurance risks in any of the States except
Utah and Arizona, and even there they have methods which amount
to nullification of the law.
Whether or not this matter so far as the insurance companies are
concerned is growing or decreasing is another subject upon which the
States have no statistics. Most of them believe that outside of coal
mining it is decreasing. Oklahoma says, “ The number is con
stantly increasing or rather has increased somewhat during the
past year.” Tennessee says, “ In our opinion the number of unin
sured employers is growing.” Vermont thinks the number is
increasing slightly. Virginia says, “ In our opinion the number
of uninsured employers is growing.”
In answer to the question as to what they believed was a proper
solution of this problem a great majority stated that compulsory
insurance regardless of coverage, and a State fund at least a com
petitive State fund, seem to be the only answer
COVERAGE OF THE SMALL PLANT
223
South Dakota makes a statement which raises the whole issue.
It states that in its opinion legislative action should be taken along
the lines of penalizing for failure to obtain insurance, and adds
these significant words, “ Employers are prone to let protection
go and take chances with action at common law.” Now, if this
latter statement be true, with the present and growing attitude of
the workmen toward the law, it is my conviction that it is up to this
association to do certain things.
One is to use its entire power,
and the power of the other organization including factory inspectors
and labor commissioners, to induce the small plants to pay some
attention to the ordinary requirements of safety and cleanliness, to
reduce their accident rates, and then to insist that there shall be a
commensurate reduction in premium rates.
It might be wise to encourage such groupings as that of the coal
miners of Osage County, Kans. New York has just made a move in
regard to this problem which to my mind is entirely in the wrong
direction. It has increased the rates for the small plants, apparently
on the theory that it can scare them into better practices. M y
own judgment is that it will make more and more enemies of the
whole workmen’s compensation law scheme and that more and more
employers will, as South Dakota says, fall back on the common
law, particularly in those States in which the law makes that possible
through election.
Changes Necessary in System
I want to say a few words as to my opinion of the basis of the whole
trouble. W e imported workmen’s compensation law from Germany,
where the theory was that everybody in an industry must be insured
and a rate must be made that would pay the losses in that industry;
in other words a jackpot by industries of the whole compensation
question. In my opinion that is the proper theory. Coal should take
care of coal whether one man is employed or a thousand men are
employed in a mine. The industry as such should take care of the
industry and pay a rate that will do it. The American idea, which
is being pushed for all it is worth, is to insure each individual and
give him a rating based upon his accident experience. That is an
incentive to the large concern to install safety methods so that acci
dents are reduced to a minimum as rapidly as possible. There is no
such incentive to the small manufacturer. lie is not able to put in the
safety devices that the large plant puts in, and the insurance company
makes his rate so high that he can not afford to insure. And through
this individual rating device we are increasing the number of work
men who are not insured, and enormously increasing the number of
workmen who would vote against the whole scheme, because, as the
railroad men contend, they are better off under the liability law.
Some of the bad features of workmen’s compensation laws as at
present constructed and administered, and insurance regulations as
at present conducted, will have to be ironed out or we will see the
workmen of the United States bring their vote to bear solidly to
wipe out the present form of workmen’s compensation insurance and
to install something that has fewer bad spots in it.
California has just changed its law in regard to agriculture in a
way to which I would like to call attention. Under the old law the
224
FIFTEENTH AN NU AL MEETING OF I. A. I. A. B. C.
farmer was not protected unless he elected to come under the law
and so notified the commission. Now he is assumed to be protected
unless he elects not to be protected and so notifies the commission.
This may seem to be a very small difference, but watch what its effect
in California will be.
The longshoremen’s act was applied to the District of Columbia,
and covers everything except domestic service, agriculture, and casual
labor. Probably there is no class of labor thst needs protection so
much as casual labor.
Another point about which I would like to have }^ou think is the
refusal of insurance companies to take the extrahazardous risks. O f
course with no general pooling of all labor in a compensation jackpot
you can readily understand their reason for doing this. A t the same
time it is rather amusing to find a State fund— Nova Scotia— where
when the fishermen risk became too expensive the private insurance
companies came in and said the State fund was all right for nonhazardous concerns but the fishermen should be left to private carriers.
Perhaps there is a barb on this hook, as the fishermen were strong
enough in the legislature to compel a low premium rate, while private
companies can put up a rate which will make the other fellow cut bait
or fish with a vengeance.
D IS C U S S IO N
The C h a i r m a n . I know you would like to give your experiences
in your States on the problems you have had and just how you are
meeting them, and I should like to hear them.
Mr. W e n z e l . North Dakota has a small-plant problem to the nth
degree. It has the problem, not from the standpoint of the competi
tive insurance States, but from the standpoint of the exclusive Statefund (so called) States. It has the problem, not of getting the small
plants covered, but of determining what to do with them after they
are covered. It has that problem to the >/th degree, because more
than 50 per cent of the total number of classifications covered in
North Dakota have nothing but small plants, and that notwithstand
ing the fact that we have reduced the total number of classifications
from 245 to 160 since my appointment as commissioner five years ago.
North Dakota also has the problem in other classifications, but in
no case is it the problem of securing coverage. In every case it is
the problem that is presented to insurance companies in competitive
insurance States. For example, I have kept an accurate record of
the situation in the coal-mining industry over a period of three
years. That record shows that five of the largest coal companies
pay approximately 70 per cent of the total premiums each year, but
each year’s loss record shows that they are responsible for only 19
per cent of the losses. It is quite clear th a t,: f this were a competi
tive insurance State, the small mines would have considerable diffi
culty in obtaining coverage; in fact, it is quite likely that if the
attempt were made (under a competitive system) to compel the
private companies to cover those small mine;; it would be likely to
result in driving them out of the business entirely.
There is no need of going into a further discussion of these mat
ters. The point I wish to bring out is this: That the association
is overlooking a large field of usefulness by not devoting at least one
day of its annual session to round-table discussion by groups having
DISCUSSION— GENERAL
225
similar problems. The administrator of a competitive insurance law
does not and can not know much about the administrative problems
that confront the administrator of an exclusive State-fund law or
even of a competitive State-fund law.
Now, one can wave his arms, get red in the face, and shout with
the voice of Saint Peter that the employees in the small plants must
be covered, and that insurance companies must write the insurance,
but the administrator of a competitive insurance law (most of which
laws eliminate the really small plants by excluding all those which
have less than three or four or live employees), seemingly does not
get the viewpoint of the insurance company that must deal with these
small plants and pay the losses out of the premiums it collects. W e
in North Dakota take the smallest of the small plants (“ one or more
employees,” says our law), and we have to pay the losses, fix the
rates, and collect the premiums. The man who says that we do not
have a problem in attempting to do justice to all the employers within
a particular classification, in the light of the illustration I have
presented, is not conversant with the facts, nor can he ever be,
because he will never meet the problem.
That is wThy I say, by way of constructive and not destructive
criticism, it is high time that the international association, in its
annual meetings, give opportunity for the consideration of mutual
problems at group round-table discussions. One day devoted to that
sort of thing is not too much to ask, and I now make bold to request
that one day of the 1929 session be devoted to such round-table
discussion by groups.
A C T U A L R E C O R D ON T H E S M A L L -P L A N T P R O B L E M IN N O R T H D A K O T A
[Basic facts: Total classifications in North Dakota, 160; number of years involved in check-up, 7; number
of classifications involved, 78, or 48.75 per cent of total]
Group 1
Description of manual
1926
rate
7-year
earned
premiums
Cigar manufacturing _______ ________________________
Plating and finishing
_ _
Tar manufacturing
_
__ ____
Lightning-rod erection
_ _
__ _ __ _______
Erection ornamental iron and brass
Paper hanging
Tunneling _
W ool merchants
.
. _
_ _ _ _ _ _ _ _
Newsagents
.
_
_ __ _______
Domestics .
__ ____________ _______ ____________
Motion-picture product_______ _____________________
$0.09
1. 25
3. 50
11.00
5. 00
1. 75
10.00
. 90
. 55
1. 15
1. 30
$61. 52
92. 59
11. 32
31. 32
1. 37
52.16
32. 55
54. 71
31. 57
30. 85
17. 40
i $52. 65
i 73.08
417. 36
316. 22
M an
ual
2171
3372
4741
5080
5100
5440
6251
8103
8747
9002
9615
T otal___________________________________________
Surplus
Deficit
$0.70
1,043.03
i 1.11
i 45.17
i 28.19
i 47. 37
i 27. 21
i 26. 60
i 14. 84
1,043. 73
Group 2
2013
2570
2574
2623
2702
3124
3380
3650
3726
3866
4130
5085
5462
Flax tow mills
$4. 00
1. 20
Mattress manufacturing
_
__
_ _
1. 95
Awning and tent manufacturing
1. 70
Tanners____ __ __ _ _ _ ___ . . . __________
___
Logging and lumbering
6. 00
Hand tool manufacturing
______ ________________ _ 1. 50
4. 00
Acetylene welding
_ _ _ _ __ _ _ ___ Battery manufacturing
1. 00
Steam-boiler installation
_ _ __________________ __ 5. 00
Carriage and wagon assembling
_
_ _ _ 1.15
Glass merchants __ __ __ __ __________________ . ___ 1. 50
W indmill erection _ __ _________________________ __ 7. 00
Glaziers, away from shop..................................................
2. 20
i No injuries in 7 years.
$464. 93
361. 73
227. 65
279. 01
296. 62
170. 75
183. 75
205. 73
354. 06
164. 59
174.44
112. 37
343. 23
$2,228.12
$266. 47
i 195.63
180.40
567.54
25.48
644.00
37.24
1,071. 76
52.75
192. 23
45.03
i 290.06
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
226
A C T U A L R E C O R D ON T H E S M A L L -P L A N T P R O B L E M IN N O R T H D A K O T A — Continued
Group 2— Continued
Man
ual
6003
6046
6102
6202
6223
6253
6280
6400
7590
8200
8212
8216
8810
9078
9081
9180
Description of manual
Pile d rivin g----------------------------------------Landscape gardening---------------------------Railroad construction and maintenance.
Oil production------------ ------------------------Dredging______________________________
Caisson w ork_____ ____________________
Blasting 2______________________________
Fence construction_____________________
Incineration.____ _____________________
Bag and paper stock dealers___________
Bottle dealers__________ ______________
Grain weighers, inspectors______ ______
Public libraries_______ ________________
Commissaries, cook cars_______________
Skating rinks__________________________
Merry-go-rounds, etc----------------------------
1926
rate
,-year
earned
premiums
$8.00
$464.10
161.16
178.10
301. 08
231. 67
147. 75
440. 68
127. 96
455. 00
283. 33
108. 55
154. 74
280.10
166. 80
119. 82
317. 20
1.65
5. 95
3.45
3. 65
14. 00
17. 50
1. 65
4. 00
1.70
2. 65
.40
. 17
2.50
.95
6.00
Surplus
$263. 56
i 139. 29
18. 97
i 257. 02
i 197. 54
i 127. 26
i 378. 94
i 109. 28
i 390. 35
i 245. 34
i 94.00
i 133. 78
91. 02
6. 57
i 103. 59
i 267.05
7, 276.90
Total..
Deficit
5,190.73
Group 3
2150
2660
2803
2860
3063
3504
4150
4365
5081
5345
6324
8004
8100
9182
9220
9403
9501
$526.
626.
772.
786.
789.
560.
529.
595.
508.
593.
732,
726.
905.
870,
601.
572.
510.
Artificial ice manufacturing_____________
Cobblers_______________________________
Carpentry, shop________________________
Furniture manufacturing_______________
Sheet-metal fabrication-------------------------Agricultural implements manufacturing.
Optical goods manufacturing----------------Photographers---------------------------------------Iron-work erection, outside_____________
Plastering, including lathing____________
Laying gas mains----------------------------------Poultry dealers_________________________
Hide and leather dealers________________
Amusement park employees____________
Cemetery em ployees___________________
Garbage collectors______________________
Painting, in shop____ ____ _____________
: 1,216. 79
Total.
$249. 71
$408. 00
1,'783." 75
479. 92
606. 45
302. 67
284. 39
416. 80
336.14
3, 770. 96
3, 795.93
1,233.07
50.30
652.93
481. 06
281. 05
448.06
4, 697. 47
10, 903. 72
Group Jj.
0003
1463
1802
2500
2583
4036
4601
5183
7006
7202
7535
8262
8831
9620
Florists and nurserymen-------------------------------Coal briquette manufacturing_______________
Marble and stone cutters____________________
Clothing manufacturing-------------------------------Dyers and cleaners__________________________
Concrete block manufacturing----------------------Drug and medicine manufacturing__________
Plumbing and pipe fitting___________________
Ferry-boat operation________________________
Livery and sales stables_____________________
Installation and repair of electrical apparatus _
Junk dealers.------------ -----------------------------------Veterinary surgeons, including hospitals-------Undertaking---------- ------- -------------------------------
$]. 40
6. 00
1. 50
.16
1.40
1.55
1.10
2.00
4. 60
3. 40
2.25
9.00
2.10
1.10
Total.
844. 72
1,464.05
1, 620. 83
1,877. 41
1,035. 66
1, 966.14
1, 229. 71
1,179. 58
1,094. 71
1,422. 09
1, 944. 89
1, 726. 72
1, 536. 99
1,257.01
$3,514.19
1,263.32
n,
$1,020. 73
698. 66
329.10
474. 34
381.05
4.47
434.82
135.21
1,166.43
270.66
103.81
257. 46
21, 200. 51
4,897.80
$2, 276. 72
2, 556. 61
2,421. 05
2, 665. 83
2, 925. 40
2,015.69
2, 700.13
$1, 568.16
17, 561. 43
13.25
5,156.45
Group 5
5545
6200
6320
7384
8000
8284
9544
Roofers____________________________________________
Well drilling_________________________ _____ ______
Laying steam mains_______________________________
Ice handling, in connection with railroad operation.
Department stores________________________________
Livestock dealers__________________________________
Advertising sign manufacturing........ ..........................
T ota l.
$7. 00
6. 75
8. GO
3. 25
.25
2. 75
5.00
1 N o injuries in 7 years.
2 1 injury since last date covered b y report which will cost over $30,000.
$3,026.64
11,329.92
1,455. 27
2,194.03
865. 79
350.47
14, 717.03
DISCUSSION---- GENERAL
AVERAGE
P R E M IU M
PER
227
C L A S S IF IC A T IO N A N D
S P E C IF IC G R O U PS
NET
D E F IC IT
FOR
THE
Average premium per
classification in—
Group
Net deficit
7 years
Group
Group
Group
Group
Group
..
__
___ __________
1 _ ............. ........... ..................
2____________________ . . . __
___ __
_______ _____
___ _
_ ______ ____
3_________________________
4_________________________
. ___ . . ______ ________ __
5 .______________________ ________ _________ __ __________
$37.94
250. 93
659. 81
1, 514. 32
2, 508. 78
1 year
$5.42
35.85
94. 25
216.33
358. 39
$827.51
1,351.19
6, 206.25
258.65
8, 633. 78
SUM M ARY
Of the foregoing classifications 9 have only slight hazards, 30 have extra
ordinarily high hazards, and 22 have had no injuries in 7 years.
T otal premiums
Group
Group
Group
Group
Group
1 (11 classifications)________________________
2 (29 classifications)________________________
3 (17 classifications)________________________
4 (14 classifications)________________________
5 (7 classifications)_________________________
$417. 36
7, 276. 90
11, 216. 79
21, 200. 51
17, 561. 43
Net deficit
$827. 51
1, 351. 19
6, 206. 25
258. 65
8, 633. 78
Total______________________________________ 57, 672. 99
17, 277. 38
Average premiums per classification in 7 years______________________ $739. 39
Average premium per classification in 1 year________________________ 105. 62
Is there or is there not a small-plant problem in North Dakota?
Mr. S t e w a r t . I can not let Mr. Wenzel’s statement pass without
calling attention to the fact that there is a complete misunderstand
ing. W e are not both talking about the same thing. The subject of
my paper had to do with the workers in the small plants who are not
insured because the insurance company will not cover the employer,
and I said that of course in the State-fund States the workers are not
losers. I did not say that the State fund was not a loser. Mr. Wenzel
shows that it costs the State-fund States more to carry the small
plants than they get out of them in premiums. I have no thought of
disagreeing with that statement. As a matter of fact, I think the
State fund of New York shows that it is carrying a number of small
plants that do not pay into the fund enough to cover the expense of
carrying them. I have no doubt that Ohio would show the same
thing. But the worker does not lose his compensation. From my
point of view the essential thing is that the worker shall not lose his
compensation. I am not half so anxious as to whether or not the
State is making money.
Mr. W il c o x . The statement of Commissioner Wenzel, of North
Dakota, confirms the very\ thought I had in mind when I urged
that North Dakota, an exclusive State-fund State, had no problem
other than such as one may cjaim with respect to any type of risk
subject to compensation. Coal mines have problems. So do machine
shops, laundries, and all the rest. But their problems are not com
parable with the coverage problem as applied to small risks. The
small-plant problem is the problem of obtaining insurance from
any source and at a rate that is not prohibitive. In its most serious
aspect, it is the problem of that State which must depend altogether
228
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
upon the course that private insurance companies select for them
selves. The State that has a competitive State fund is somewhat
relieved because such fund may be prevailed upon to adopt plans
in cooperation with the compensation board or commission, which
offers opportunity for coverage when it may not be obtained else
where. The exclusive State-fund State is altogether relieved from
any begging, coaxing, or threatening plan of operation. It has
the question of coverage entirely within its own hands, and it
becomes alone a matter of adequate inspection, pay-roll auditing, and
rate making.
Wisconsin has no State fund and perhaps reference to some of
our experience will be of interest and value.
On November 5, 1926, we sent out a letter 1o all the insurance
companies operating in this State in which we said:
Certain individual risks and also some risk classes are quite generally
declined by compensation-insurance companies. The employers involved find
it difficult to procure the compensation coverage required by law. Will you
please write us your ifieas for meeting this situation? In this relation, will
you also favor us with lists covering: (1) Risk classes in which you have
had applications for insurance during 1927 and declined to issue policies; and
(2) risk classes, if any, for which compensation insurance is not offered by
your company.
W e received many replies and then used a follow-up letter on
November 19, 1926, and a bureau meeting was called for December
14, 1926, to consider the question. Before the bureau met we tabu
lated the information which came to us in reply to these letters,
particularly as regards their attitude on 28 well-recognized types'
of risks or classifications which were being discriminated against.
O f the 28 classifications, 2 of the companies refused coverage to 20
of them. Three companies refused coverage to 19 of the classifica
tions. Another company rejected 13 of them and still other com
panies a lesser number. Some of the companies reported that they
had no prohibited list. The fact remains, however, that while they
may not set up any specifically prohibited list, in practical operation
of their affairs, they refuse insurance to a large number of risks and
classifications that are rightly entitled to coverage.
In all of the studies1which we had made up to that time and have
since made, it was apparent that the risks which they deemed un
satisfactory had proven so, largely for the reason that they rarely
or never audited the pay rolls and collected only the original mini
mum premium; and, secondly, that while risks generally were given
inspection service in a way to reduce accident hazard, they never
spend a dollar inspecting one of these so-called undesirable types.
W e have urged from the first their obligation to audit pay rolls
and give inspection service, and in that wray bring these risks or classi
fications up to a standard which would end the present contention.
Under the compensation insurance board law of Wisconsin all com
panies licensed to do business in the State are required to belong to
the bureau. So at this conference in December, 1926, I proposed that
all the insurance companies join in an agreement to pool the writing
of these prohibited classes and that the business be actually handled
by the manager of the bureau for their account. The bureau then
and now has its own inspectors and auditors available for use, and
since there would be no acquisition cost and not much overhead, with
DISCUSSION---- GENERAL
229
abundance of opportunity to do the inspecting and auditing which
is now being neglected, we felt certain that the experience would be
beneficial and at the same time we would be relieved from the diffi
culty of getting some company to insure these risks and keeping them
insured.
The insurance companies were represented at the above-mentioned
conference in full force, coming all the way from the East and the
West. They were unable to conceal the fact that their objection to
the pool plan was fear that it constituted the entering wedge for
a State-fund system. I assured them that I had no such thought
and that in my judgment one of the ways to avoid the necessity for
a State fund w7as to do something constructive in the matter of
coverage of these undesirable risks at a decent rate. While they re
fused the pool plan, they gave assurances at that time that they
would develop some way of handling the business. From that time
on to the present the question of what was to be done to reach the
issue has been much in evidence. There has been some liberalizing
of attitude on the part of certain companies, but on the whole the
situation is still bad.
Finally, on May 8, 1928, the governing committee of the bureau
adopted the following resolution :
Voted that it is the sens© of this meeting that a plan be adopted whereby the
so-called undesirable risks would be referred to the manager of the bureau for
definite assignment to individual companies in the State in proportion to their
premium writings, and that the manager circularize all the member companies
to determine which companies are prepared, to subscribe to such plan; further,
that the rating committee be empowered to fix rules and special rates where
necessary.
Then at the August, 1928, meeting of the bureau they adopted the
following resolution :
Voted that the general manager be authorized to advise the industrial com
mission that the plan designed to furnish coverage to the so-called undesirable
risks has progressed to the point where coverage will be extended, provided
notice is furnished to the general manager of the bureau, and that such notice
is accompanied with the proper deposit premium either in the form of a certified
check, currency, or money order.
Not less than 15 companies have already notified the manager of
the bureau that they wall accept business assigned to them pursuant
to the resolution.
Under date of September 18, 1928, Mr. Haydon, general manager
of the Wisconsin bureau, gave notice to his bureau members as
follows:
A meeting has been called to convene in the offices of the National Council, 151
Fifth Avenue, New York City, to commence at 10 o’clock a#. m., Friday, October
5, for the purpose of finally deciding upon rules governing the proposed plan to
extend coverage to so-called undesirable risks. It is taken for granted that all
companies that have signified their intention to subscribe to this plan will be
present with full power. In addition, it is urged that all other companies that
have not so signified their intention will endeavor to be present so that they
may have every opportunity to observe the rules as finally drawn, together with
the manner in which they will be administered, with the view of possible further
consideration of any negative action to which they may be committed. At the
same meeting a discussion will be invited to obtain a first-hand view of the
companies with respect to the proposed “ policy record ” which, formed the sub
ject matter of the circular letter of the Wisconsin Compensation Insurance
Board under date of September 1.
230
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
While the foregoing displays commendable interest in the subject
matter, there is no right to hope that the course which they are fol
lowing is going to provide material relief. They still take no steps
to remedy the fundamental reason why these risks have proven
unprofitable to them. Their plan still leaves an individual company
to struggle along with a small risk here and another one there and
no prospect of supervising, without tremendous overhead, the safety
of the risk and rarely, if ever, an intention to audit pay rolls or
collect a dollar beyond the minimum premium.
It is significant that the experience of the insurance company writ
ing the largest volume of business in this State, a company which
has a highly developed safety inspection program and sufficient busi
ness in every community to justify pay-roll audits of every risk, at
a moderate overhead, does not find the small risk especially
burdensome.
W e have 58 insurance companies licensed to transact compensation
insurance business in this State. Recently, we tabulated the compen
sation claims for the year 1927? not only by counties where the acci
dent occurred, but by the number of insurance companies involved
in, the claims for each county. This tabulation discloses the end to
which competition for business has carried the insurance companies—
business written by many of them in communities where the expense
of administration is bound to eat up the earned premium; with little
left for losses.
The small risk will cease to be a serious problem only when a plan
of underwriting, pay-roll auditing, safety inspection, and claim ad
justment is centralized and a volume of business thus brought to
gether which will make it possible for all of these factors to be not
only cared for, but cared for at a reasonable cost. In States depend
ing upon insurance companies for the coverage of these risks and
where there is a rating and inspection bureau, there is the choicest
opportunity for the insurance companies to solve the problem and
relieve the public and public administrative bodies from the danger
and the worry that is now present. I do not know how the situation
can be met in the State that has no rating and inspection bureau,
unless insurance companies are willing to develop some sort of a pool
and charge this pool organization in absolute good faith with the
doing of whatever is necessary to meet the problem. In our present
situation throughout the country the exclusive State-fund State is
to be congratulated upon its freedom from problems that beset sister
States who are dependent upon the voluntary action of private insur
ance companies.
Mr. L a u g h l i n . As I stated when I was presiding yesterday, the
personal contact between members of the different States has not been
what I think it should be, and I would like to make the suggestion
that the executive board for future meetings make some arrangement
whereby that personal contact will be better. W e meet here for the
purpose of exchanging ideas— that is our education— and I would like
to see a plan worked out in the future whereby some arrangements
can be made that different States meet together at luncheon, say; for
instance, the States that have the insurance fund could discuss their
States; the next day another group could meet and discuss all the
problems that affect their States. Our big problem to-day is medical
DISCUSSION---- GENERAL.
231
aid. I came here to find out how to solve the medical-aid problem,
but I haven’t got any information.
Mr. S t e w a r t . I second that motion; and in doing so I would like
to suggest that the program policy in an association of this kind might
very well perhaps be wiped out; that is to say, just make a list of
topics of problems which the States are up against and say, Here
boys, go to it. I wonder if that would not solve the question.
Mr. W e n z e l . May I make a suggestion along that line? I have
been secretary-treasurer of the State bar association for 9 or 10 years.
W e had the same problem there that we are having here; time was
taken up by reading of papers and we had no time for discussion. It
took me five years to put over the program but we have succeeded,
finally; we print, just as you do, the reports and addresses in advance.
W hy not send those out two weeks in advance of the meeting and then
come here and discuss the problems that are presented by those
papers? That is what we do in North Dakota in the State bar asso
ciation, and everybody likes it.
The C h a i r m a n . It has been moved and seconded that the executive
committee in arranging for the program and carrying out of the con
vention proceedings, formal and informal, take account of the need
of States to confer with one another.
[The motion was carried.]
Mr. K i n g s t o n . W e have been talking a good deal about surveys
this morning and we got a lot of good from the discussion, but I
think the thing we need a survey on is our association work— a survey
of ourselves.
I have felt, and I know that a number of the members have felt,
for a long time that we are not functioning as an association 100
per cent and there must be some way of improving that situation.
I do not know what it is, but we are in danger of getting into a rut.
I am afraid to some extent we have got into it, and we must get
out of it. The suggestion of the secretary is a good one. This idea
of coming here and having the program filled up by the reading of
papers, so far as they go, is good, but it is discussion that is helpful
rather than the reading of papers.
Now I have a feeling that we are not doing as much as we might
in the interim between sessions. I am wondering if we can not
make greater use of the facilities at our disposal. There is a monthly
bulletin being published by Mr. Stewart at Washington, copies of which
go out to a limited number, and I have often thought that we ought
to make that bulletin a clearing house for information. I did think
that we ought to have oifr own bulletin, an association bulletin, but
perhaps that will involve us in more expense than I feel like commit
ting the association to. This is the resolution which I am going to
submit, and which I hope the members will accept. It is given with
the idea of keeping our minds to some extent focused on our work
during the 361 days that we are not at the convention:
Resolved, That the executive committee be requested to consider how interest
might be maintained in the work of the association during the period between
annual sessions by the greater use of the compensation columns of the monthly
bulletin of the Bureau of Labor Statistics or by the inauguration of a special
association bulletin which might be used as a sort of clearing house for
informative papers and discussions of interest to our common work.
232
FIFTEENTH AN N U AL MEETING OF I. A. I. A. B. C.
I feel that if a little wise guidance is put on something of that sort
we can have a lot of interesting material put before us during the year,
and perhaps it may be the basis for discussion when we come together
in our annual conference. *
[A motion to adopt the resolution was made and seconded.]
Mr. S t e w a r t . I would suggest that you amend the resolution to
include instructions to the compensation commissioners of the va
rious States to answer the letters of the secretary during these 361
days.
[The motion to adopt the resolution was carried.]
The C h a i r m a n . N o w I w ill turn the meeting over to the president.
BUSINESS MEETING
Chairman, Andrew F. McBride, M. D., President I. A. I. A. B. C.
The P r e s i d e n t . W e are now ready for the report of the auditing
committee.
REPORT OF AUDITING COMMITTEE
The auditing committee met and checked over carefully the treasurer’s finan
cial report for the year intervening: between the Atlanta and Paterson meetings.
Receipts during the period totaled $4,692.33; balance and disbursements
$3,100.62; leaving a cash balance of $1,591.71. Vouchers for all disbursements,
with the exception of a few miscellaneous postage items, were audited and
checked with the report.
The investment securities of the association, consisting of $3,700 worth of
United States and Canadian Government bonds and local mortgage certificates,
purchased by the treasurer with the authorization of the executive committee,
are safely deposited in a box at the National Savings & Trust Co., Washington,
D. C., marked “ For delivery to Mr. Stewart’s successor in i;he office of treasurer
of [this] association.” Mr. Stewart has provided by will that in the event of
his death while in office the financial assets of this association be turned over
to his successor in the office of treasurer.
The accounts of the association are in excellent order, and your committee
feels that much credit and thanks is due to the treasurer for the efficient con
duct of the financial affairs of the association during the last year.
W i l l i a m J. M a g u ir e , Chairman.
F red M. W il c o x .
R o w e n a O. H a r r is o n .
F . M . W il l ia m s .
Mr. K i n g s t o n . I was going to suggest that it might be wise to ask
the executive committee to consider whether or not $1,000 more of
that $1,500 might not be invested in another permanent investment
fund.
Mr. S t e w a r t . That w ill be done o f c o u r s g ; we keep a b o u t $500 in
the bank.
The P r e s id e n t . W e will listen to the report of the committee on
resolutions.
REPORT OF THE COMMITTEE ON RESOLUTIONS
Resolved , That Bulletin of the United States Bureau of Labor Statistics No.
456 be, and the same is hereby, approved as the record of the proceedings of the
fourteenlja annual convention of the association held at Atlanta, Ga., September
27-29, 1927. [Adopted.]
Whereas this association has learned with great sorrow of the death of Mr.
Charles H. Yerrill, of the United States Employees’ Compensation Commission,
and at one time secretary of this association, and
BUSINESS MEETING
233
Whereas Mr. Verrill was for many years one of the leading compensation
officials in the United States, and was willing at all times to assist newer officials
in giving them the benefit of his knowledge and experience, and was the much
esteemed friend of many members of the association: Therefore, be it
Resolved, That we, the delegates to the fifteenth annual meeting of the Inter
national Association of Industrial Accident Boards and Commissions, do hereby
record our deep regret that Charles H. Verrill has been taken from our midst;
and as a further indication of our sorrow and of the high esteem in which we
held him, be it
Resolved, That this resolution be spread upon the minutes of this convention,
a copy sent to the United States Employees’ Compensation Commission, and a
copy sent to the family of our departed member. [Adopted.l
Whereas this association has learned with much regret of the death of Mr.
Benjamin W. Kernan, who joined the association as an associate member just
prior to the Atlanta convention; therefore be it
Resolved, That we, the delegates to the fifteenth annual meeting of the Inter
national Association of Industrial Accident Boards and Commissions, do hereby
record our deep regret that Benjamin W. Kernan has been taken from our midst;
and as a further indication of our sorrow, be it
Resolved, That this resolution be spread upon the minutes of this convention,
and a copy sent to the family of our departed member. [Adopted.]
Resolved, That we express our appreciation for the many privileges and
courtesies extended to and enjoyed by this association and the members thereof
at the Fifteenth Annual Meeting of the International Association of Industrial
Accident Boards and Commissions held at Paterson, N. J., September 11-14, 1928.
Resolved further, That, the thanks of this association be extended to the
Hon. A. Harry Moore, Governor of the State of New Jersey, to the Hon. Wilmer A.
Cadmus, [acting] mayor of the city of Paterson, and to Hon. Andrew F. McBride',
M. D., commissioner of labor of the State of New Jersey and president of this
association, and his associates, the Hon. Chariest H. Weeks and the Hon. John
Roach, deputy commissioners of labor of the State of New Jersey, and to the
Hon. James R. Wilson, president of the Chamber of Commerce of the city of
Paterson, and to the personnel of the labor department and to the many other
citizens of said city, convention, and) State who have had part in providing for
our welfare, instruction and entertainment, and especially to the following mem
bers of the medical profession who contributed the unusually able and practical
papers to the literature of this association: Jack Blumberg, M. D .; S. Cosgrove,
M. D .; William M. Maver, M. D .; Stanley It. Woodruff, M. D .; G. Rutherford
O’Crowley, M. D .; Jonathan M. Wainwright, M. D .; John J. Moorhead, M. D .;
Charles A. Elsberg, M. D . ; and Abraham E. Jaffin, M, D. [Adopted.]
Resolved, That the thanks of this convention be extended to the Paterson
Automobile Trade Association for their courtesy in furnishing automobiles
for the motor tour to points of interest in northern New Jersey; and also* to
the press in Paterson for its kindly consideration and the publicity. [Adopted.]
F red * M. W il c o x ,
F. W . A rm stron g,
F. W. D u x b u r y ,
Committee on Resolutions.
[The following resolutions were heretofore adopted:]
Resolved, That the executive committee be, and it hereby is authorized and
empowered to take such action as such committee may determine with regard
to advising or assisting members or committees of State law-making' bodies in
relation to pending enactment or amendments of compensation and safety
laws, and to appoint committees or representatives of this association personally
to appear before legislative committees when request for such action has been
made, and to pay the necessary expenses of such committees or representatives.
Resolved, That the executive committee be requested to consider how interest
might be maintained in the work of the association during the period between
sessions by the greater use of the compensation columns of the monthly bulle
tin of the Bureau of Labor Statistics or by the inauguration of a special associa
tion bulletin which might be used as a sort of clearing house for informative
papers and discussions of interest to our common work.
[The report of the committee on nominations was presented and
adopted. The list of officers elected will be found on p. 235. Niagara
234
FIFTEENTH AN N U A L MEETING OF I. A. I. A. B. C.
Falls was chosen as the place of the next meeting, to be held August
19-22, 1929.
James A . Hamilton, the newly elected president, thanked the asso
ciation for the honor bestowed on the Empire State and asked for a
large attendance at the next meeting and for the cooperation of the
members of the association.]
N o te .— Early in 1929 Mr. James A. Hamilton left the position of industrial
commissioner of the Department of Labor of New York, and being no longer
connected with any active member organization of the International Associa
tion of Industrial Accident Boards and Commissions, under section 4 of
Article VII of the constitution it became necessary for the executive com
mittee to elect his successor as president. Commissioner Frances Perkins of
New York was duly elected and is now president of the association.
The executive committee has also voted to change the place and date of
holding the sixteenth annual convention to Buffalo', N. Y., October 8-11, 1929.
Doctor M cB r ide . Before we adjourn I want again to express my
sincere appreciation to the association for having made it possible
to have the fifteenth annual convention in the Slate of New Jersey.
I trust that every member of the association and every one of the
friends who made the journey to Paterson and likewise all who con
tributed to the success of this convention have felt repaid. W e are
deeply grateful to them and we trust that the convention has been
a success. I f merit counts for anything, it has been; if numbers
count for anything, it has been; if a broad general discussion of
topics counts for anything, it has been. It may be that we are get
ting into a rut, and that there might be adopted some new method
which would be conducive of greater good. That can, perhaps, be
safely left to the executive committee to give serious thought t o ; but
the thought occurred to me this morning that if we had problems pe
culiar to our jurisdictions we ought to get in touch with the president
of the association by mail, and, set forth, either to the members or
the chairman of the executive committee, problems particularly con
fronting us in our respective jurisdictions which we would like to
have considered at the next convention. Perhaps it might lead to a
round-table discussion of the problems that confront us and do away
with the rut we may be getting into.
In conclusion I want to assure the association of the deep gratitude
that New Jersey owes you for having come to our State,
[The convention adjourned sine die,]
Appendixes
Appendix A.— Officers and Members of Committees for 1928-29
President, James A. Hamilton, Industrial Commissioner of New York.
Vice president, Walter O. Stack, president Industrial Accident Board of
Delaware.
Secretary-treasurer , Ethelbert Stewart, United States Commissioner of Labor
Statistics.
EXECUTIVE CO M M ITTE E
James A. Hamilton, New York Department of Labor.
Walter O. Stack, Delaware Industrial Accident Board.
Ethelbert Stewart, United States Commissioner of Labor Statistics.
Andrew F. McBride, M. D., New Jersey Department of Labor.
Parke P. Deans, Virginia Department of Labor and Industry.
W. H. Horner, Pennsylvania Department of Labor and Industry.
William W . Kennard, Massachusetts Department of Labor and Industries.
William M. Scanlan, Illinois Department of Labor.
Victor A. Sinclair, Ontario Workmen’s Compensation Board.
C O M M IT TE E ON
ST A T IS T IC S
AND
CO M PE N SATIO N
IN S U R A N C E
COST
Chairman, L. W . Hatch, New York Department of Labor.
Secretary, Ethelbert Stewart, United States Commissioner of Labor Statistics.
Charles E. Baldwin, United States Assistant Commissioner of Labor Statistics.
Charles A. Caine, Utah Industrial Commission.
E. I. Evans, Ohio Department of Industrial Relations.
N. Fletcher, Manitoba Workmen’s Compensation Board.
O. A. Fried, Wisconsin Industrial Commission.
C. E. Gleason, Massachusetts Department of Industrial Accidents.
Sharpe Jones, Georgia Industrial Commission.
Miss B. C. Joseph, Maryland State Industrial Accident Commission.
George A. Kingston, Ontario Workmen’s Compensation Board.
William J. Maguire, Pennsylvania Department of Labor and Industries.
Mrs. F. L. Roblin, Oklahoma Industrial Commission.
R. M. Van Dorn, Washington Department of Labor and Industries.
S. W. Wilcox, Illinois Department of Labor.
M ED ICAL CO M M ITTE E
Chairman, Raphael Lewy, M. D., New York Department of Labor.
Vice chairman, Charles W. Roberts, M. D., associated with the Georgia Indus
trial Commission.
William J. Arlitz, M. D., associated with the New York Department of Labor.
Robert P. Bay, M. D., Maryland State Industrial Accident Commission.
Nelson M. Black, M. D., associated with the Wisconsin Industrial Commission.
H. H. Dorr, M. D., Ohio Department of Industrial Relations.
Harley J. Gunderson, M. D., Minnesota Industrial Commission.
Maurice Kahn, M. D., associated with the California, Industrial Accident
Commission.
M. D. Morrison, M. D., Nova Scotia, Workmen’s Compensation Board.
Ralph T. Richards, M. D., associated with the Utah Industrial Commission.
Charles J. Rowan, M. D., associated with the Iowa Workmen’s Compensation
Service.
3 1 5 7 3 °— 2 9 -----1 6
235
236
APPENDIX A
SA FE TY C O M M ITTE E
Chairman, John Roach, New Jersey Department of Labor.
L. W. Chaney, United States Bureau of Labor Statistics.
James L. Gernon, New York Department of Labor.
Thomas P. Kearns, Ohio Department of Industrial Relations.
R. McA. Keown, Wisconsin Industrial Commission.
R. B. Morley, associated with the Ontario* Workmen’s Compensation Board.
CO M M ITTE E ON IN V ESTIG A TIO N OF RESU LTS OF C O M PE N SATIO N AW A R D S
Chairman, Ethelbert Stewart, United States Commissioner of Labor Statistics.
Secretary, W. II. Horner, Pennsylvania Department of Labor and Industries.
Hiss R. O. Harrison, Maryland State Industrial Accident Commission.
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 tic le II .— Objects
Section 1. This association shall hold meetings once a year, or oftener, for
the purpose of bringing together the officials charged with the duty of adminis
tering 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 restora
tion to industry; ( d ) methods of computing industrial accident and sickness
insurance costs; ( e ) practices in administering compensation laws; (f) exten
sions and improvements in workmen’s compensation legislation; and (g) re
ports and tabulations of industrial accidents and illnesses.
Sec. 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, in
dustrial 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 in the Canadian Labor Gazette.
A r tic le III .— Membership
Section 1. Membership shall be of two grades— active and associate.
Sec. 2. Active membership .— Each State of the United States and each Prov
ince 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. 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.
Sec. 3. Associate membership .— Any organization or individual actively in
terested 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 discussion, but shall have no vote either on resolutions or for
the election of officers in the association.
A r tic le IV .— Representation
Section 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.
Sec. 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 tic le V .— A n n u a l dues
Section 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
237
238
APPENDIX B
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
annual dues out of their own pockets for the State.
Sec. 2. Associate members shall pay $10 per annum.
S ec . 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 tic le V I .— Meetings of the association
Section 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.
Sec. 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.
A r tic le
V II .— Officers
Section 1. Only officials having to do with the administration of a workmen’s
compensation law or bureau of labor may hold an office in this association,
except as hereinafter provided.
Sec. 2. The association shall have a president, vice president, and secretarytreasurer.
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 shall cease to be
connected with any agency entitled to active membership before the expiration
of his term, he may continue in office notwithstanding until the next annual
meeting; but if for any reason a vacancy occurs in the office of president, the
executive committee shall appoint his successor.
A r tic le V III. — Executive committee
Section 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
association 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 le I X .— Quorum
Section 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 tic le 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 committee,
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 W ho Attended the Fifteenth An
nual Meeting of the International Association of Industrial
Accident Boards and Commissions, Held at Paterson, N. J.,
September 11-14, 1928
Canada
Nova Scotia
F. W . Armstrong, vice chairman workmen’s compensation board, Halifax.
Ontario
George A. Kingston, commissioner workmen’s compensation board, Toronto.
R. B. Morley, general manager industrial accident prevention associations,
Toronto.
United States
Alabama
R. M. Thigpen, workmen’s compensation division, Montgomery.
Colorado
W. F. Mowry, referee industrial commission, Denver.
Connecticut
Albert J. Bailey, member board of compensation commissioners, Norwich. .
S. G. Bloomfield, New Haven.
Wessell Doherty, Hartford Accident Insurance Co., Hartford.
W illiam Earl, Hartford Accident Insurance Co., Hartford.
Albert L. Gray, M. D., Hartford.
George S. Hubbard, Scovill Manufacturing Co., Waterbury.
W. C. Jaimsen, Hartford Accident Insurance Co., Hartford.
W. H. Rutherford, Hartford Accident Insurance Co., Hartford.
F. M. Williams, chairman board of compensation commissioners, Waterbury.
Charles E. Williamson, member board of compensation commissioners,
Bridgeport.
Delaware
H. D. Carl, Hercules Powder Co., Wilmington.
C. W . Dickey, assistant manager E. I. du Pont de Nemours & Co., Wilmington.
G. H. Gehrmann, M. D., medical director E. I. du Pont de Nemours & Co.,
Wilmington.
A. Klaw, attorney E. I. du Pont de Nemours & Co., Wilmington.
F.
W. Krastel, safety supervisor E. I. du Pont de Nemours & Co., Wilmington.
Donald R. Morton, service manager E. I. du Pont de Nemours & Co., Wil
mington.
Emil J. Riderer, Atlas Powder Co., Wilmington.
John K. Schafer, jr., safety and fire protection division E. I. du Pont de
Nemours & CO., Wilmington.
Walter O. Stack, president industrial accident board, Wilmington.
239
240
APPENDIX C
District of Columbia
Charles E. Baldwin, assistant commissioner United States Bureau of Labor
Statistics.
J. J. Bloomfield, chemical engineer, United States Public Health Service.
Daniel F. Callahan, attorney United States Bureau of Labor Statistics.
Miss Agnes L. Peterson, assistant director United States Women’s Bureau.
Ethelbert Stewart, commissioner United States Bureau of Labor Statistics.
Miss Anice L. Whitney, economist United States Bureau of Labor Statistics.
Georgia,
Richard P. Lawson, deputy commissioner United States Employees’ Compen
sation Commission, Savannah.
Miss Elizabeth Ragland, assistant secretary industrial commission, Atlanta.
T. E. Whitaker, commissioner industrial commission, Atlanta.
Mrs. T. E. Whitaker.
Idaho
G. W. Suppiger, chairman industrial accident board, Boise.
Illinois
A. V. Becker, industrial commission, Chicago.
Thomas E. Cambridge, manager, industrial accident department, International
Harvester Co., Chicago.
William M. Scanlan, chairman industrial commission, Chicago.
Sidney W. Wilcox, chief bureau of statistics, department of labor, Chicago.
Iowa
Ralph Young, deputy commissioner workmen’s compensation service, Des
Moines.
Maine
Charles O. Beals, commissioner department of labor and industry, Augusta.
Donald D. Garcelon, chairman industrial accident commission, Augusta.
Willis B. Hall, associate legal member industrial accident commission,
Augusta.
Maryland
Thomas N. Bartlett, manager claim division, Maryland Casualty Co.,
Baltimore.
A. E. Brown, secretary State industrial accident commission, Baltimore.
Miss Rowena O. Harrison, director of claims State industrial accident com
mission, Baltimore.
A. D. Lasenby, M. D., chief surgeon Maryland Casualty Co., Baltimore.
Massachusetts
E. J. DuBoyce, American Mutual Insurance Co., Boston.
William W. Kennard, chairman department of industrial accidents, Boston.
John P. Meade, director of industrial safety department of labor and indus
tries, Boston.
Minnesota
F. A. Duxbury, chairman industrial commission, St. Paul.
Henry McColl, member industrial commission, St. Paul,
Ora E. Reaves, claims manager M. A. Hanna Co., Duluth.
New Je't'sey
Francis A. Abbott, factory inspector department of labor, Trenton.
Michael J. Angel, factory inspector department of labor, Trenton.
Maurice J. Angland, factory inspector department of labor, Paterson.
LIST OF PERSONS IN ATTENDANCE
241
W . J. Arlitz, M. D., surgeon D., L., & W . Railroad Co., Hoboken.
Hugh J. Arthur, special investigator department of labor, Trenton.
Frank W. Ash, M. D., St. Joseph’s Hospital, Paterson.
Maurice S. Avidan, M. D., medical advisor department of labor, Trenton.
J. F. Ball, casualty manager Federal Shipbuilding & Dry Dock Co., Kearny.
George O. Beavans, superintendent compensation Commercial Casualty Insur
ance Co., Newark.
C. C. Beggs, resident manager United States Casualty Co., Paterson.
G. L. Belcher, safety inspector Standard Oil Co. of New Jersey, Newark.
Harold C. Benjamin, M. D., Jersey City.
Carl H. Blatt, adjuster General Accident Insurance Co., Newark.
Jack Blumberg, M. D., General Hospital, Elizabeth.
Henry Booth, factory inspector department of labor, Trenton.
James O. Boyd, trial attorney Public Service Corporation, Newark.
Sidney Brooks, M. D., St. Joseph’s Hospital, Paterson.
Vincent P. Butler, M. D., Jersey City.
Hon. Wilmer A. Cadmus, acting mayor of Paterson.
Bernard S. Coleman, executive secretary, Hudson County Tuberculosis
League, Jersey City.
Harold S. Cooper, factory inspector department of labor, Trenton.
Charles E. Corbin, deputy commissioner of compensation department of labor,
Jersey City.
Joseph M. Crippen, claims manager Indemnity of North America, Newark.
William J. Crowley, factory inspector department of labor, Trenton.
R. S. Dalenz, New Jersey State Chamber of Commerce, Newark.
C. R. DeBow, superintendent Du Pont, S. P. D., Penns Grove.
L. G. Dibbell, superintendent Du Pont Co., P. L. Works, Pompton Lakes.
Patrick L. Diver, senior engineer Travelers Insurance Co., Newark.
John Diviny, factory inspector department of labor, Newton.
M. E. Dleuch, M. D., E. I. du Pont de Nemours & Co., Carneys Point.
R. E. Doran, M. D., Jersey City Hospital, Jersey City.
John J. Fitzgerald, secretary chamber of commerce, Paterson.
Miss Agnes Fitzpatrick, chief clerk department of labor, Trenton.
Frederick W. Flagge, M. D., Rockaway.
W. G. Franks, Eberhard Faber Rubber Co., Newark.
Emil Gallman, industrial manager chamber of commerce, Paterson.
Leo J. Gaul, factory inspector department of labor, Paterson.
Harry J. Goas, deputy commissioner of compensation department of labor,
Newark.
Leon L. Goolden, safety engineer Travelers Insurance Co., Newark.
Charles W. Greenfield, safety and protection engineer Du Pont Viscoloid Co.,
Arlington.
James A. T. Gribben, chief bureau of statistics and records, department of
labor, Trenton.
Crowell W. Haslett, factory inspector' department of labor, Trenton.
A. E. Haufman, M. D., pathologist, Paterson.
M. P. Heffron, industrial relations manager, New York Belting & Packing
Co., Passaic.
E. W . Heilig, secretary welfare committee, Public Service Corporation,
Major William A. Higgins, aide to governor, Trenton.
Newark.
John V. Hinchliffe, Hinchliffe Investing Co., Paterson.
S. H. Hinton, M. D., E. I. du Pont de Nemours & Co., Parlin.
Henry H. Hussmann, factory inspector department of labor, Union City.
H. Jacobsen, safety supervisor, E. I. du Pont de Nemours & Co., Newark.
Abraham E. Jaflin, M. D., City Hospital, Jersey City.
James C. Keeney, M. D., Newark.
Mae Cecil Kelley, R. N., rehabilitation commission, Patterson.
Raymond A. Kiefer, M. D., Patterson.
W. T. Kolter, adjuster Travelers Insurance Co., Newark.
M. Kumrnel, M. D., Newark.
Mrs. N. W. Lameire, department of labor, Paterson.
Henry F. Lohse, factory inspector department ol labor, Bloomfield.
Joseph F. Londrigan, M. D., medical director depa» tm<ent of labor, Jersey City.
Andrew F. McBride, M. D., commissioner of labov, Paterson.
Andrew F. McBride, jr., Pa tersou,
242
APPENDIX O
Clifford Mclntire, production manager E. I. du Pont de Nemours & Co.,
Newark.
William H. McKnight, Travelers Insurance Co., Newark.
J. P. Maloney, general field sales manager Pyrene Manufacturing Co., Newark.
C. C. Mann, M. D., plant physician Du Pont Viscoloid Co., Arlington.
James C. Matthews, placement clerk department of labor, Paterson.
William Wallace Maver, M. D., Christ Hospital, Jersey City.
Hon. A. Harry Moore, Governor of New Jersey, Trenton.
Laura W . Moore, factory inspector department of labor, Trenton.
Joseph R. Morrow, M. D., Bergen County Hospital, Ridgewood.
Francis S. Myers, M. D., medical director Globe Indemnity Co., Newark.
Robert E. Nevett, Western Electric Co. (Inc.), Kearny.
Leonard F. Nichols, assistant manager United States1Casualty Co., Paterson.
Mrs. Margaret O’Connell, factory inspector department of labor, Jersey City.
0. Rutherford O’Crowley, M. D., Newark.
James Phelps, safety director Pittsburgh Plate Glass Co., Newark.
Frank W. Pinneo, M. D., Essex County Medical Society, Newark.
Fred Preusch, claim auditor United States Casualty Co., Paterson.
Fred P. Rearwin, factory inspector department of labor, Trenton.
Frederic R. Reed, attorney Public Service Corporation, Newark.
L. R. Riss, claims manager General Accident Insurance Co., Newark.
Charles F. Riley, process server department of labor, Paterson.
John Roach, deputy commissioner department of labor, Trenton.
David Roskein, attorney, Newark.
Fred M. Rosseland, manager, Newark Safety Council, Newark.
Charles B. Russell, M. D., Paterson.
Ernest S. Schmid, special agent Tide Water Oil Co., Bayonne.
Howard Schrader, photographer department of labor, Trenton.
Augustine M. Schultz, M. D., medical director rehabilitation commission,
Paterson.
Joseph F. Scott, examining engineer department of labor, Trenton.
Mrs. Joseph F. Scott.
M. L. Sheppard, M. D., medical director Passaic County Tuberculosis Sani
tarium, Valley View.
Aaron Simon, M. D., Passaic.
Max Singer, M. D., Newark.
Morton Sittelman, M. D., Elizabeth.
Mrs. Nellie Rush Slayback, factory inspector department of labor, Trenton.
George J. Speidel, factory inspector department of labor, Trenton.
William Spickers, M. D., Paterson Barnet Hospital, Paterson.
Seth B. Sprague, M. D., Jersey City.
John J. Stahl, referee workmen’s compensation bureau, Jersey City.
William R. Stalter, safety supervisor N. W . Belting & Packing Co., Passaic.
William C. Stuart, M. D., department of labor, Jersey City.
William E. Stubbs, deputy commissioner department of labor, Trenton.
M. C. Sucoff, M. D., Barnet Hospital, Paterson.
James H. Tallon, factory inspector department of labor, Trenton.
Dr. G. E. Teurs, Paterson General Hospital, Paterson.
F. H. Todd, M. D., General Hospital, Paterson.
William Van Assen, factory inspector department of labor, Trenton.
Edward Walker, examining engineer department of labor, Trenton.
Charles A. Ward, chief electrical inspector, Paterson.
Stanley Warzala, Calco Chemical Co., Bound Brook.
Charles H. Weeks, deputy commissioner department of labor, Trenton.
Mrs. Charles H. Weeks.
W . E. Wentworth, Western Electric Co., Kearny.
W. E. F. Wentzien, inspector New Jersey Manufacturers Association, Trenton.
Robert Winters, safety engineer United States Metals Refining Co., Carteret.
John Wyckoff, manager Alexander Hamilton Hotel, Paterson.
H. R. Zelley, safety supervisor E. I. du Pont de Nemours & Co., Paulsboro.
New York
John B. Andrews, secretary American Association for Labor Legislation, New
York.
W . C. Bastian, M. D., Port Hospital, New York.
L. P. Botesford, M. D., E. I. du Pont de Nemours & Co., Newburgh.
LIST OF PERSONS IN' ATTENDANCE
243
W . F. Brennan, superintendent of engineering New York Indemnity Co., New
York.
Frank A.. Cardello, examiner United States Employees’ Compensation Com
mission, New York.
Ross I. Chamberlin, claim attorney Merchants Mutual Casualty Co., Buffalo,
Richard J. Cullen, member State industrial! board, department of labor, New
York.
Charles A. Elsberg, M. D., Columbia University, New York.
James A. Hamilton, industrial commissioner department of labor, New York.
L. W. Hatch, member State industrial board, department of labor, New York.
Mrs. L. W. Hatch.
C. J. Haugh, assistant actuary National Bureau of Casualty and Surety
Underwriters, New York.
F. J. Kavanagh, claim examiner United Stated Casualty Co., New York.
Victor E. Kennedy, assistant general claims manager Merchants Mutual Cas
ualty Co., Buffalo.
Charles A. Kilcommons, special agent Fidelity & Casualty Co., of New York,
New York.
Jerome G. Locke, deputy commissioner United States Employees’ Compensa
tion Commission, New York.
Frank O. Lowe, personnel manager E. I. du Pont de Nemours & Co.,
Newburgh.
George M. McAinsh, engineering manager American Mutual Liability Insur
ance Co., New York.
Miss Nellie D. McKeon, assistant to district manager, engineering department,
American Mutual Liability Insurance Co., New York.
Miss Marguerite Marsh, research secretary National Consumers League, New
York.
John Melville, boiler inspector New York Indemnity Co., New York.
John Moorhead, M. D., Post Graduate Medical College, New York.
Edward M. Nash, M. D., medical adviser State insurance fund, New York.
Nathaniel Newbauer, underwriter State insurance fund, New York.
E. B. Patton, director bureau of statistics, department of labor, New York.
Thomas A. Quinn, superintendent compensation claims, General Accident,
Fire and Life Assurance Corporation, New York.
L. D. Reed, director of service Du Pont Rayon Co., Buffalo.
George E. Sanford, General Electric Co., Schenectady,
Charles W. Scott, examiner Aetna Life Insurance Co., New York.
Elmer F. Sheets, assistant editor Chemical Markets, New York.
Walter J. Toner, chief examiner United States Employees’ Compensation Com
mission, New York.
Ethel H. Van Buskirk, American Association for Labor Legislation, New
York.
John A. Willard, claims examiner United States Employees’ Compensation
Commission, New York.
S. R. Woodruff, M. D., Post Graduate Medical College, New York,
Fred A. Zierlign, supervisor of compensation claims United States Casualty
Co., New York.
North Dakota
R. E. Wenzel, workmen’s compensation bureau, Bismarck.
Ohio
Carl C. Beasor, department of industrial relations, Columbus.
Francis T. Casey, field deputy, industrial commission, Columbus.
E. I. Evans, department of industrial relations, Columbus,
F. C. Kettring, The M. A. Hanna Co., Cleveland.
Rose Mark, convention reporter, Cleveland.
Oklahoma
Mrs. A. E. Bond, secretary, State industrial commission, Oklahoma City.
I. K. Huber, chief adjuster Empire Companies, Bartlesville.
L. B. Kyle, chairman State industrial commission, Oklahoma City.
244
APPENDIX O
Oregon
Sam Laughlin, chairman State industrial accident commission, Salem.
Pennsylvania
W . H. Horner, department of labor and industry, Harrisburg.
William J. Maguire, department of labor and industry, Harrisburg.
Raymond Scott, supervisor of compensation General Accident, Fire and Life
Assurance Corporation, Philadelphia.
Richard D. Trainer, safety engineer General Accident Insurance Co., Phila
delphia.
Jonathan M. Wainwright, M. D., Moses Taylor Hospital, Scranton.
Utah
Henry N. Hayes, member industrial commission, Salt Lake City.
Virginia
Parke P. Deans, commissioner industrial commission, Richmond.
Washington
William A. Marshall, deputy commissioner United States Employees’ Compen
sation Commission, Seattle.
W est Virginia
J. R. Hanley, actuary workmen’s compensation department, Charleston.
C. L. Heaberlin,, commissioner workmen’s compensation department, Charleston.
R. H. Walker, M. D., chief medical examiner workmen’s compensation de
partment, Charleston.
Wisconsin
Fred M. Wilcox, chairman Industrial Commission, Madison.
Wyoming
Charles B. Morgan, workmen’s compensation department, Cheyenne.
INDEX TO PROCEEDINGS OF INTERNATIONAL ASSOCIATION OF
INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS, 1928
SUBJECT INDEX
A
Abdominal carcinoma. Bui. 485, pp. 90-91.
Accident prevention :
Canada, safety work in (Morley). Bui. 485, pp. 157-161, 185-189.
Education (Kearns). Bui. 485, pp. 175-180, 159, 161, 185.
Industrial Accident Prevention Associations. Bui. 485, pp. 157-161.
International Labor Office. Bui. 485, p. 160.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 34, 35.
Mechanical safeguards. Bui. 485, pp. 2, 161, 162, 166, 175-176.
National Safety Council. Bui. 485, p. 9.
Progress in. Bui. 485, pp. 8—9.
Safety museum, New Jersey. Bui. 485, p. 2.
Small plants. Bui. 485, pp. 165, 217-218.
What accident prevention can do (Meade). Bui. 485, pp. 162-175, 186.
Workmen’s compensation, relation to. Bui. 485, pp. 5-6, 8, 9, 130-131, 157-158,
162, 164.
States and Provinces—
Canada. Bui. 485, pp. 157-161.
Delaware. Bui. 485, pp. 185-186.
Massachusetts. Bui. 485, pp. 163, 166-175, 186-187.
New Jersey. Bui. 485, pp. 2-3.
New York. Bui. 485, p. 190.
Ohio. Bui. 485, pp. 177-180.
Miscellaneous. Bui. 485, pp. 185-193.
(See also Accident statistics; Safety codes.)
Accident reporting. (See Claim procedure.)
Accidents, industrial:
Building trades. Bui. 485, pp. 167—169.
Falls. Bui. 485, p. 166.
States and Provinces—
Massachusetts. Bui. 485, pp. 164, 166, 167-169, 171-172.
New York. Bui. 485, pp. 5-6, 190.
Accident statistics :
Accident prevention, use in. Bui. 485, pp. 9, 161, 162, 163, 165, 177, 178.
Need for. Bui. 485, p. 8.
Standardization. Revision of plan of. Bui. 485, pp. 20^-22.
States and Provinces :
Massachusetts. Bui. 485, p. 171.
Ohio. Bui. 485, p. 178.
Acid poisoning. Bui. 485, pp. 128, 136-137.
Administration :
Cost. Bui. 485, pp. 17, 208, 210, 214-216.
Longshoremen’s and harbor workers' act. Bui. 485, pp. 27, 29-30.
States and Provinces—
Porto Rico. Bui. 485, p. 11.
Quebec. Bui. 485, p. 12.
Agricultural labor. Bui. 485, pp. 10, 223-224.
Alcohol. Bui. 485', p. 128.
American Engineering Standards Committee. (Name changed to American Standards
Association.)
American Petroleum Institute. Study of toxic gases. Bui. 485, p. 135.
American Standards Association. (Name changed from American Engineering Standards
Committee.) Safety codes. Bui. 485, pp. 14-15.
245
246
SUBJECT INDEX
Anilin. Bui. 485, p. 129.
Appeal, right of. Longshoremen’s and harbor workers’ act. Bui. 485, pp. 27, 30.
Arising out of and in course of employment. (See Out of and in course of employment.)
Arm, permanent disability rating of. Bui. 485, p. 122.
Arteriosclerosis. Bui. 485, p. 109.
Association of Governmental Labor Officials in the United States and Canada. (Name
changed to Association of Governmental Officials in Industry of the United States and
Canada.)
Association of Governmental Officials in Industry of the United States and Canada.
Attendance at conventions. Bui. 485, pp. 15-16.
Attorneys:
Pees. Bui. 485, pp. 29-30, 32.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 28, 29-30, 32.
Awards:
Follow up of. Bui. 485, pp. 22-23.
Liberality of. Bui. 485, p. 47.
Weekly maximum. Bui. 485, pp. 11, 12, 27, 190.
(See also Death benefits.)
B
Back conditions:
Fractures of the spine (Elsberg). Bui. 485, pp. 93-101, 108, 117, 118, 121.
Benefits, compensation. (See Awards; Permanent disabilities; Relative benefits.)
Benzol poisoning. Bui. 485, pp. 128, 129, 130, 133, 139, 142, 143, 14G, 147, 170.
Bone injuries :
Fractures of the tibia and fibula (Moorhead). Bui. 485, pp. 112—115, 118—120,
121-124.
Pelvis, fractures of (Cosgrove and Maver). Bui. 485, pp. 5jk- 62, 70, 72, 76—77.
Spine, fractures of (Elsberg). Bui. 485, pp. 93-101, 108, 117-118, 121.
Syphilis. Bui. 485, pp. 107, 108.
Tuberculosis.
Bui. 485, pp. 10G-107.
(See also Sarcoma.)
Brain:
Concussion of. Bill. 405, p. 54.
Tumors. Bui. 485, pp. 116, 120, 121.
Brass poisoning. Bui. 485, pp. 145, 146.
Breast, carcinoma of. Bui. 485, p. 90.
Bryant, Lewis T., death of. Bui. 485, p. 203.
€
Cancer:
Carcinoma (Wainwright). Bui. 485, pp. 86-93, 115-117, 120—121.
Trauma, single, relation to (Wainwright). Bui. 485, pp. 86-93, 115-117.
Miscellaneous. Bui. 485, pp. 108, 110, 120.
( See also Sarcoma; Tumors.)
Carbon monoxide gas. Bui. 485, pp. 130, 132-133.
Carcinoma. (See Cancer; Tumors.)
Casual workersi. Bui. 485, pp. 9^-10.
Chemistry, effect of, on occupational diseases (Bloomfield). Bui. 485, pp. 130-140.
i----------(Gehrmann). Bui. 485, pp. 125-129, 147.
----------(Patton). Bui. 485, pp. 180-182, 182-185.
Chiropractors. Bui. 485, pp. 118, 121.
Chorea. Bui. 485, p. 109.
Chromic acid. Bui. 485, pp. 128, 136-137.
Chronic disease. (See Preexisting disease.)
Claim procedure:
Accident reporting. Bui. 485, pp. 186-187.
Occupational disease reporting. Bui. 485, p. 171.
Coal. (See Mining.)
Colleges and universities. (See Schools and colleges.)
Committees. (See International Association of Industrial Accident Boards and Com
missions, convention, and standing committees: also committees under specific subjects.)
Comparative benefits, workmen’s compensation laws. (See Relative benefits.)
Contributory insurance, self-insurers’ association plan of. Bui. 485, p. 16.
Costs. (See Administration.)
SUBJECT INDEX
247
Coverage :
Agricultural labor. Bui. 485, pp. 10, 223-224.
Casual workers. Bui. 485, pp. 9-10.
Domestic workers. Bui. 485, p. 10.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 27, 30—31, 4*w
Occupational diseases. Bui. 485, pp. 148-156, 182
Small plants (Stewart). Bui. 485, pp. 217-224, 224-230.
States and Provinces—
Alberta. Bui. 485, p. 12.
California. Bui. 485, p. 16.
District of Columbia. Bui. 485, p. 11.
Ontario. Bui. 485, p. 39.
Philippines. Bui. 485, p. 11.
Porto Rico. Bui. 485, p. 11.
Quebec. Bui. 485, p. 12.
Uniform code. Bui. 485, p. 17.
Cyclone. Bui. 485, p. 42.
D
Deafness, traumatic labyrinthitis (Blumberg). Bui. 485, pp. 53-55, 7^-76.
Death benefits, Porto Rico. Bui. 485, p. 11.
Disability rating. (See Permanent disabilities.)
Diabetes. Bui. 485, pp. 102, 110.
Domestic workers. Bui. 485, p. 10.
Du Pont de Nemours & Co. Chemistry and occupational diseases (Gehrmann).
485, pp. 125-129, 147.
Dusts, industrial. Bui. 485, pp. 138-139, 142-143.
Bui.
E
Ear:
Fractures. Bui. 485, p. 55.
Traumatic labyrinthitis (Blumberg). Bui. 485, pp. 5S-55, 74--f6.
Education. (See Accident prevention; Schools and colleges.)
Epilepsy. Bui. 485, pp. 44, 109.
Epididymitis. Bui. 485, pp. 84, 85.
Extrahazardous industries, insuring of. Bui. 485, pp. 12, 48-49, 50, 220-223, 224.
Extraterritoriality, uniform code. Bui. 485, p. 17.
F
Farm labor. [See Agricultural labor.)
Feet. Fractures of the tibia and fibula (Moorhead). Bui. 485, pp. 112-115, 11&-120,
121-124.
First aid. Bui. 485, pp. 171, 172-173, 186-187.
Fishing industry. Bui. 485, pp. 12, 48—49, 50.
Follow up and investigation of compensation awards, report of committee on. Bui. 485,
pp. 22-23.
Fractures:
Ear. Bui. 485, p. 55.
Female pelvis (Cosgrove and Maver). Bui. 485, pp. 55-62, 76-77.
----------- References to books on. Bui. 485, p. 62.
Spine (Elsberg). Bui. 485, pp. 93-101, 117-118, 121.
Tibia and fibula (Moorhead). Bui. 485, pp. 112-115, 118-120, 121-124.
Frostbite. Bui. 485, pp. 42, 44, 86-87.
G
Gases, poisonous. Bui. 485, pp. 130, 132-133, 135-136.
Gastrointestinal disturbance. Bui. 485, pp. 110, 134.
Graves’ disease. Bui. 485, p. 110.
H
Haemophilia. Bui. 485, p. %11.
Harbor workers. (See Longshoremen’s and harbor workers* act.)
Hazard. (See Extrahazardous industries.)
Head, injuries to. (See Brain; Ear.)
Health examinations, Bui. 485, pp. 102, 139, 144.
248
SUBJECT INDEX
Health hazards in industry (Bloomfield). Bui. 485, pp. 130—140.
(See also Chemistry, effect on occupational diseases.)
Health insurance. Bui. 485, p. 155.
Hearings. Bui. 485, pp. 29, 30, 31.
---------- Longshoremen’s and harbor workers’ act. Bui. 485, pp. 29-31.
Heart disease. Bui. 485, pp. 43, 44, 109—110.
Heat stroke. Bui. 485, pp. 42, 44.
Home conditions. Bui. 485, pp. 183-184.
Hysteria. Bui. 485, p. 108.
I
Industrial Accident Prevention Associations (Morley). Bui. 485, pp. 157-161.
Infection. Bui. 485, pp. 45-46, 65, 71, 72-73, 82, 171-173, 186-187.
Insurance, extrahazardous industries. Bui. 485, pp. 12, 48-49, 50, 220-223, 224.
---------- Small plants. Bui. 485, pp. 220-223, 224, 228-230.
Insurance carriers, longshoremen’s and harbor workers’ act. Bui. 485, pp. 37-40.
International Association of Industrial Accident Boards and Commissions:
Colleges and universities, cooperation with. Bui. 485, p. 2.1.
Committees. Appointment and report convention committees. Bui. 485, pp. 13,
232-233.
--------- - Standing. Bui. 485, pp. 198, 235-236.
---------- (See also committees under specific subjects.)
Constitution, draft of. Bui. 485, pp. 237-238.
Conventions—
Attendance at. Bui. 485, pp. 1-2, 7, 16.
Persons attending, list of. Bui. 485, pp. 239-244.
Program, copy of. Bui. 485, pp. iii-vi.
---------- Suggestions. Bui. 485, pp. 208-210, 224-225, 230-231.
Time and place of holding. Bui. 485, pp. ii, 233, 234.
Legislative activity of. Bui. 485, pp. 156, 190-202, 233.
Maintenance of interest in. Bui. 485, pp. 231-232, 233.
Membership, list of. Bui. 485, pp. 13-14.
Officers. Bui. 485, pp. ii, 234, 235.
President’s address. Bui. 485, pp. 6-12.
Proceedings—
Fifteenth annual convention, Paterson, N. J., September 11—14, 1928. Bui. 485.
Printing and distribution of bound copies. Bui. 485, p. 14.
Resolutions, report of committee. Bui. 485, pp. 232—233.
Secretary-treasurer, reports of. Bui. 485, pp. 13-20.
International Labor Office. Bui. 485, p. 160.
Interstate workers. Bui. 485, p. 10.
(See also Railroad workers.)
Intoxicants. Bui. 485, p. 128.
Investigation of results of compensation awards, report of committee on. Bui. 485, pp.
22-23.
Ivy poisoning. Bui. 485, p. 44.
J
Jurisdictional conflict:
Longshoremen’s and harbor workers’ act.
Nova Scotia. Bui. 485, pp, 35-36.
Bui. 485, pp. 3-, 48-52.
K
Kernan, Benjamin W., death of. Bui. 485, pp. 14, 233.
Kidney, traumatized (Woodruff). Bui. 485, pp. 62-69, 77-81.
L
Labyrinthitis, traumatic (Blumberg). Bill. 485, pp. 52-55, 74-76.
Lawyers. ( See Attorneys.)
Lead poisoning. Bui. 485, pp. 126-127, 130, 131-132, 139, 140-142, 143-144, 169.
Leg injuries :
Fractures of tibia and fibula (Moorhead). Bui. 485, pp. 112-115, 118-120, 121-124.
Permanent disability rating. Bui. 485, p. 122.
Legal aid :
Boston plan of. Bui. 485, p. 24.
Committee on. Bui. 485, pp. 24-25.
SUBJECT INDEX
249
Legislation, workmen's compensation :
Changes in. Bui. 485, pp. 10-12, 223-224.
International Association of Industrial Accident Boards and Commissions, legislative
activity of. Bui. 485, pp. 156, 190-202, 233.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 11, 12, 26-40, 48—52.
States and Provinces—
Alberta. Bui. 485, p. 12.
Connecticut. Bui. 485, p. 201.
District of Columbia. Bui. 485, pp. 10—11.
Massachusetts. Bui. 485, pp. 196, 197.
Minnesota. Bui. 485, pp. 154, 191, 201.
New Jersey. Bui. 485, p. 11.
New York. Bui. 485, p. 190.
Nova Scotia. Bui. 485, p. 12.
Ontario. Bui. 485, pp. 157—158.
Philippines. Bui. 485, p. 11.
Porto Rico. Bui. 485, p. 11.
Quebec. Bui. 485, p. 12.
Wisconsin. Bui. 485, p. 200.
Suggested changes in. Bui. 485, pp. 190-191, 223-224.
Uniformity. Bui. 485, pp. 9, 16-17, 205.
(See also Coverage; Extraterritoriality; Waiting period.)
Lightning. Bui. 485, pp. 40-44, 47, 48.
Longshoremen’s and harbor workers’ compensation act (Locke). Bui. 485, pp. 11, 12,
26-30, 30-40, 48-52.
M
Malaria. Bui. 485, pp. 110-111.
Malignant disease. (See Cancer; Tumors.)
Malingering. Bui. 485, pp. 77-78, 81-82.
Mechanical safeguards. (See Accident prevention; Safety codes.)
Medical efficiency. (See Physicians, competency of.)
Medical science as applied to workmen’s compensation and occupational diseases, fifth
international conference on. Bui. 485, p. 14.
Medical schools and colleges. (See Schools and colleges.)
Medical service. Bui. 485, pp. 10, 27.
Medical supervision of employees. (See Physical examinations.)
Meningitis. Bui. 485, p. 106.
Medicine, industrial, study of. Bui. 485, pp. 122—123, 145, 147.
Mental conditions :
Epilepsy. Bui. 485, pp. 44, 109.
Fractured pelvis. Bui. 485, pp. 76-77.
Mercury poisoning. Bui. 485, pp. 128, 130, 133-134.
Mining. Bui. 485, pp. 220-223, 224.
Moorhead, Doctor, books by. Bui. 485, p. 124.
N
National Association of Legal Aid Organizations, cooperation with. Bui. 485, pp. 24-25.
National Council on Compensation Insurance. Figures on relative benefits. Bui. 485,
pp. 210, 216.
National Safety Council:
Accident prevention work. Bui. 485, p. 9.
Study of benzol poisoning. Bui. 485, pp. 133, 139-140.
Nervous conditions :
Chorea. Bui. 485, p. 109.
Graves’ disease. Bui. 485. p. 110.
Hysteria. Bui. 485, p. 108.
Neuroses. Bui. 485, pp. 108, 109.
Noise. Bui. 485, pp. 74-75, 76.
Miscellaneous. Bui. 485, pp. 108-109, 110.
Neuritis. Bui. 485, pp. 169—170.
Neuroses. Bui. 485, pp. 108, 109.
Nitrobenzine. Bui. 485, p. 129.
Nitroglycerine. Bui. 485, p. 128.
Nitrous fume poisoning. Bui. 485, p. 126.
Noise, effect of. Bui. 485, pp. 74-75, 76.
250
SUBJECT INDEX
O
Occupational diseases:
Books on, references to. Bui. 485, p. 140.
Coverage. Bui. 485, pp. 10, 148-156, 182.
---------- Cost of. Bui. 485, pp. 149, 150, 154, 155.
Fifth International Conference of Medical Science as Applied to Workmen’s Compensa
tion and Occupational diseases. Bui. 485, p. 14.
Growth of, as result of changes in industry (Bloomfield). Bui. 485, pp. 130-140.
---------- (Gehrmann). Bui. 485, pp. 125—129, 147.
---------- (Patton). Bui. 485, pp. 180^182, 182-185.
Reporting of by physicians. Bui. 485, p. 171.
Prevention of. Bui. 485, pp. 178, 179, 188-189.
States and Provinces—
California. Bui. 485, pp. 149, 154.
Connecticut. Bui. 485, pp. 149.
Hawaii. Bui. 485, p. 154.
Illinois. Bui. 485, p. 154.
Massachusetts. Bui. 485, pp. 149, 154, 155, 169, 171.
Minnesota. Bui. 485, pp. 152, 154.
New Jersey. Bui. 485, pp. 149, 154.
New York. Bui. 485, pp. 149, 154, 182.
North Dakota. Bui. 485, p. 149, 154.
Ohio. Bui. 485, pp. 149, 150, 154, 178, 179.
Pennsylvania. Bui. 485, pp. 155-156.
Porto Rico. Bui. 485, p. 154.
United States. Bui. 485, p. 154.
Wisconsin. Bui. 485, pp. 148, 149, 150, 152, 154.
(See also diseases under specific names.)
Orchitis. Bui. 485, pp. 82, 84-85.
Out of and in course of employment. (See Cyclone; Epilepsy ; Frostbite; Gases; Heart
disease; Heat stroke; Infection; Ivy poisoning; Lightning; Noise; Occupational
diseases; Wasp sting; and Windstorm.
P
Paresis. Bui. 485, p. 108.
Pelvis, fractures of (Cosgrove and Maver.) Bui. 485, pp 55-62, 70, 72, 76-77.
Books on, references to. Bui. 485, p. 62.
Permanent disabilities. Bui. 485, pp. 112, 113, 119, 120, 121-124.
Physical examination. Bui. 485, pp. 102, 139, 144.
Physicians :
Competency of. Bui. 485, pp. 28, 122-123, 141, 144-145, 14T.
Industrial training of. Bui. 485, pp. 145, 147, 154.
Rating of disability. Bui. 485, pp. 122-124.
Preexisting conditions :
Books on, references to. Bui. 485, p. 111.
Chromic acid poisoning. Bui. 485, pp. 136-137.
Diabetes. Bui. 485, pp. 102, 110.
Orchitis. Bui. 485, pp. 84, 85.
Syphilis. Bui. 485, pp. 102, 107-108.
Traumatic accentuation of chronic disease (Jaffln). Bui. 485, pp. 101-112, 118, 121.
Tuberculosis. Bui. 485, pp. 102, 103-107, 138.
(See also Cancer; Tumors.)
President’s address (McBride). Bui. 485, pp. 6-12.
Procedure. (See Claim procedure.)
R
Radium poisoning. Bui. 485, pp. 134-135, 139, 147.
Railroad workers:
Attitude toward workmen’s compensation. Bui. 485, p. 52.
Compensation under Federal and State acts. Bui. 485, p. 52.
Rehabilitation. Bui. 485, pp. 10, 27.
Relative benefits under various laws, study of. Bui. 485, pp. 203-207, 207-217.
Remarriage of widows, American experience table. Bui. 485, p. 15.
SUBJECT INDEX
251
s
Sacroiliac injuries. Bui. 485, p. 119.
Safety codes. Bui. 485, pp. 14-15, 163.
Safety devices. (See Accident prevention ; Safety codes.)
Safety museum, New Jersey. Bui. 485, p. 2.
Safety work. (See Accident prevention.)
Sanitation. Bui. 485, pp. 173-174.
Sarcoma. Bui. 485, pp. 87, 88, 92, 120-121.
(See also Cancer; Tumors.)
Schools and colleges:
Accident prevention. Bui. 485, p. 185.
Cooperation with. Bui. 485, p. 23.
Industrial medicine, study of. Bui. 485, pp. 122-123, 145, 147.
Self-insurers’ association plan to make workers contribute to premium. Bui. 485, p. 16.
Silicosis. Bui. 485, pp. 133, 145.
Skin diseases. Bui. 485, pp. 86-87, 89-90.
Small plant and workmen’s compensation coverage (Stewart). Bui. 485, pp. 217-224,
224-230.
Spine, fractures of (Elsberg). Bui. 485, pp. 93—101, 108, 117—118, 121.
Spray coating. Bui. 485, pp. 127—128, 133, 139—140.
Standardization.
(See Accident statistics; Legislation.)
State fund. Longshoremen’s and harbor workers’ act. Bui. 485, pp. 37—40.
Statistics and compensation insurance cost, report of committee on. Bui. 485, pp. 20-22*
Syphilis. Bui. 485, pp. 102, 107-108.
T
Tabes. Bui. 485, p. 108.
Tetryl. Bui. 485, p. 128.
Tornado. Bui. 485, p. 42.
Trauma :
Accentuation of chronic disease (Jaffin). Bui. 485, pp. 101-111, 118, 121.
Carcinoma, relation to (Wainwright). Bui. 485, pp. 86-93, 115-117.
Kidney injuries (Woodruff). Bui. 485, pp. 62-69, 77-81.
Labyrinthitis (Blumberg). Bui. 485, pp. 52-55, 74-76.
Urethra injuries (O’Crowley). Bui. 485, pp. 69-74, 81-85.
(See also Back injuries; Fractures ; Preexisting conditions.)
Tuberculosis. Bui. 485, pp. 102, 103-107, 138.
Tumors. Bui. 485, pp. 65, 88, 92, 108, 116, 120, 121.
U
Uniformity. (See Legislation.)
United States Bureau of Mines. Study of toxic gases. Bui. 485, p. 135.
United States Public Health Service :
Benzol hazard, study of. Bui. 485, p. 133.
Chromic poisoning, study of. Bui. 485, p. 137.
Committee on occupational diseases. Bui. 485, pp. 150-151.
Dusty trades, study of. Bui. 485, p. 138.
Lead poisoning. Bui. 485, p. 141.
Toxic gases, study of. Bui. 485, p. 135.
Urethra, injuries! to (O’Crowley). Bui. 485, pp. 69-74,. 81-85.
Universities. (See Schools and colleges.)
V
Verrill, Charles H., death of.
Bui. 485, pp. 14, 232-233.
W
Wages, longshoremen’s and harbor workers’. Bui. 485, pp. 33-34, 35, 36.
Waiting period :
Longshoremen’s and harbor workers’ act. Bui. 485, p. 27.
New York. Bui. 485, p. 190.
Wasp sting. Bui. 485, p. 47.
Weekly maximum. Bui. 485, pp. 11, 12, 27, 190.
Welcome, address o f:
(Cadmus). Bui. 485, pp. 4-5.
(Moore). Bui. 485, pp. 2-4.
Response (Hamilton). Bui. 485, pp. 5-6.
3 1 5 7 3 ° — 29-----17
SUBJECT INDEX
252
Widows, remarriage of. (,SVe Remarriage of widows.)
Windstorms. Bui. 485, p. 42.
Workers’ contribution to insurance premium. Bui. 485, p. 16.
Workmen’s compensation :
Definition. Bui. 485, p. 209.
Fifth international conference, medical science and wo?'kmen’s compensation and
occupational diseases. Bui. 485, p. 14.
Purpose of. Bui. 485, 7-8, 28, 181, 206, 207, 211, 219.
Responsibility for payment. Bui. 485, p. 16.
Workers’ contribution to insurance premium. Bui. 485, p. 16.
(See also Accident prevention.)
World War, malignant disease. Bui. 485, p. ST.
X
X ray, use of.
Bui. 485, pp. 60, 93—94, 96, 99, 100, 112.
Y
Yaple, Wallace D., death of.
Bui. 485, p. 202.
NAME INDEX
A
Arlitz, Dr. W. J. (New Jersey) :
Foot injuries. Bui. 485, pp. 111—112.
Kidney injuries. Bui. 485, pp. 78-79, 81.
Traumatic labyrinthitis. Bui. 485, p. 75.
Armstrong, F. W. (Nova Scotia) :
Legislative activity, International Association of Industrial Accident Boards artl
Commissions. Bui. 485, p. 200.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 35-36.
Andrews, John B. (New York) :
Railway employees. Bui. 485;,' p. 52.
Longshoremen’s and harbor workers’ act. Bui. 485, p. 40.
Avidan, Dr. Maurice S. (New Jersey) :
Carcinoma. Bui. 485, p. 115.
Competency of physicians. Bui. 485, pp. 122-123.
Foot and leg injuries. Bui. 485, p. 119.
Permanent disability ratings. Bui. 485, p. 122.
B
Baldwin, Charles E. (Washington, D. C.). Legislative activity, International Associa
tion of Industrial Accident Boards and Commissions. Bui. 485, p. 198.
Beasor, Carl C. (Ohio). Education. Bui. 485, p. 185.
Bloomfield, J. J. (Washington, D. C.). Health hazards in industry. Bui. 485, pp.
130-140.
Blumberg, Dr. Jack (New Jersey). Traumatic labyrinthitis. Bui. 485, pp. 53-55, 76.
Bradway, John S. (Pennsylvania). Report of Committee on Legal Aid. Bui. 485,
pp. 24-25.
C
Cadmus, Wilmer A. (New Jersey). Welcome. Bui. 485, pp. 4-5.
Coleman, Bernard S. (New Jersey). Occupational diseases. Bui. 485, pp. 150-151.
Cosgrove, Dr. Samuel Allison (New Jersey). Fractured female pelvis. Bui. 485,
pp. 55-62.
D
Deans, Parke P. (Virginia). Small boats and longshoremen’s and harbor workers’ act.
Bui. 485, pp. 48-49, 50-51.
Duxbury, F. A. (Minnesota) :
Infection. Bui. 485, pp. 46, 47.
Legislative activity, International Association of Industrial Accident Boards and Com
missions. Bui. 485, pp. 190-191, 193, 194-195, 196, 197-198, 201-202.
Lightning. Bui. 485, pp. 40-42, 43.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 38, 39, 49—50, 51, 52.
Relative benefits. Bui. 485, pp. 203-207, 208, 210.
E
Elsberg, Dr. Charles A. (New York) :
Brain tumors. Bui. 485, pp. 116, 121.
Fractures of the spine and their treatment.
Bui. 485, pp. 93—101, 121.
F
Flagge, Dr. Frederick W. (New Jersey).
Spinal fractures.
Bui. 485, p. 117.
G
Gehrmann, Dr. G. II. (Delaware).
125-129.
Chemistry and occupational diseases.
Bui. 485, pp.
253
254
NAME
IN D E X
II
Hall, Willis B. (Maine). Infection. Bui. 485, p. 46.
Hamilton, James A. (New York). Response to welcome. Bui. 485, pp. 5-6.
Harrison, Miss R. O. (Maryland). Report, Committee on Investigation of Compensation
Awards. Bui. 485,'pp. 22-23.
Hatch, L. W. (New York) :
Accident statistics, revision of plan of. Bui. 485, pp. 20—22.
Administrative costs. Bui. 485, pp. 214-215.
Legislative activity, International Association of Industrial Accident Boards and Com
missions. Bui. 485, p. 192.
Relative benefits. Bui. 485, pp. 215-216.
Report, Committee on Statistics and Costs. Bui. 485, pp. 20--22.
Wages, longshore labor. Bui. 485, pp. 33-34.
Heaberlin, C. L. (West Virginia) :
Legislative activity, International Association of Industrial Accident Boards and
Commissions. Bui. 485, pp. 198—199, 201.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 37, 39.
Horner, W. H. (Pennsylvania) :
Committee on Legal Aid, Report of. Bui. 485, pp. 24-25.
Heart failure. Bui. 485, p. 44.
Infection. Bui. 485, p. 45.
Lightning. Bui. 485', pp. 43-44.
Huber, I. K. (Oklahoma). Benzol poisoning. Bui. 485, p. 147.
J
Jaffin, Dr. Abraham E. (New Jersey).
485, pp. 101-112, 121.
Traumatic accentuation cf chronic disease.
Bui.
Iv
Kearns, Thomas P. (Ohio). Safety Education. Bui. 485, pp. 175-180.
Kennard, William W. (Massachusetts) :
Legislative activities, International Association of Industrial Accident Boards and
Commissions. Bui. 485, pp. 196—197.
Relative benefits. Bui. 485, pp. 210-212, 217.
Occupational diseases. Bui. 485, p. 155.
Kingston, George A. (Ontario):
Coverage. Bui. 485, p. 39.
Deafness. Bui. 485, p. 75.
International Association of Industrial Accident Boards ar d Commissions, mainte
nance of interest in. Bui. 485, pp. 231-232.
Kidney, loss of. Bui. 485, pp. 78, 80.
Legislative activity, International Association of Industrial Accident Boards and
Commissions. Bui. 485, p. 195.
Lightning. Bui. 485, p. 40.
Malignant disease. Bui. 485, p. 116.
Orchitis. Bui. 485, p. 82.
Out of and in course of employment. Bui. 485, pp. 44, 45, 46, 47.
Relative benefits. Bui. 485, pp. 212-214, 216.
Klaw, A. (Delaware). Longshoremen’s and harbor workers’ act. Bui. 485, pp. 33, 38-39.
Kyle, L. B. (Oklahoma). Legislative activity, International Association of Industrial
Accident Boards and Commissions. Bui. 485, p. 199.
L
Laughlin, Sam (Oregon). Convention program. Bui. 485, p. 230.
Locke, Jerome G. (New York). Longshoremen’s and harbor workers’ act.
26-30, 31, 32, 33, 34, 36, 37-38, 49.
Londrigan, Dr. Joseph F. (New Jersey) :
Foot and leg injuries. Bui. 485, pp. 119-120.
Malignant diseases. Bui. 485, pp. 116-117.
Spinal fractures. Bui. 485, p. 118.
M
McBride, Dr. Andrew S. (New Jersey) :
Attendance at conventions. Bui. 485, pp. 1-2.
Competency of physicians. Bui. 485, p. 123.
Bui. 485, pp.
NAME INDEX
255
McBride, Dr. Andrew S. (New Jersey)— Continued.
Correspondence relative to administrative problems. Bui. 485, p. 234.
Disability ratings. Bui. 485, pp. 123-124.
Lawyers’ fees. Bui. 485, p. 32.
Lightning. Bui. 485, p. 47.
Occupational diseases. Bui. 485, p. 150.
Presidential address. Bui. 485, pp. 6-12.
Wasp sting. Bui. 485, pp. 47, 48.
Maguire, William J. (Pennsylvania) :
Accident prevention. Bui. 485, p. 186.
Legislative activity, International Association of Industrial Accident Boards and
Commissions. Bui. 485, p. 191.
Occupational diseases. Bui. 485, pp. 155-156.
Marshall, William A. (Washington). Longhsoremen’s and harbor workers’ act. Bui. 485,
pp. 35, 39, 40.
Maver, Dr. William Wallace (New Jersey). Fractured female pelvis. Bui. 485, pp.
55-62, 76—77.
Meade, John P. (Massachusetts) :
Occupational diseases. Bui. 485, pp. 142—144.
Physical examinations. Bui. 485, p. 144.
What accident prevention can do. Bui. 485, pp. 162-175, 186-187.
Moore, Gov. A. Harry (New Jersey). Welcome. Bui. 485, pp. 2-4.
Moorhead, Dr. John J. (New York) :
Book by. Bui. 485, p. 124.
Fractures of the tibia and fibula Bui 485, pp 112—115, 121
Malignant disease. Bui. 485, p. 116.
Spinal fractures. Bui. 485, p. 117.
Morley, R. B. (Ontario). Safety work in Canada. Bui. 485, pp. 157-161, 189.
Mowry, W. F. (Colorado). Legislative activity, International Association of Industrial
Accident Boards and Commissions. Bui. 485, pp. 192-193.
N
Nash, Dr. Edward M. (New York) :
Orchitis. Bui. 485, p. 85.
Urethra injuries. Bui. 485, p. 79.
O
O’Crowley, Dr. C. Rutherford (New Jersey) :
Orchitis. Bui. 485, pp. 84-85.
Traumatized kidney. Bui. 485, p. 77.
Traumatized urethra. Bui. 485, pp. 69t-74, 83—85.
P
Patton, E. B. (New York).
Occupational diseases.
Bui. 485, pp. 180-182.
R
Roach, John (New Jersey) :
Benzol poisoning. Bui. 485, p. 142.
Brass poisoning. Bui. 485, p. 146.
Lead poisoning. Bui. 485, pp. 141—142.
S
Sanford, George E. (.New York). Accident prevention work, Bui. 485, pp. 189-190.
Scanlan, William M. (Illinois) :
Awards, liberality of. Bui. 485, p. 47.
Court decisions. Bui. 485, p. 47.
Infection. Bui. 485, p. 45.
Slayback, Mrs. Nellie Rush (New Jersey). Occupational diseases. Bui. 485, pp. 146,
182-183, 184.
Spiekers, Dr. William (New Jersey). Urethra, injuries to. Bui. 485, p. 82.
Stack, Walter O. (Delaware) :
Accident prevention. Bui. 485, pp. 185-186.
Lawyers’ fees. Bui. 485, p. 32.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 39—40, 50, 51.
Out of and in course of employment. Bui. 485, pp. 44, 45.
256
NAM E INDEX
Stewart, Ethelbert (Washington, D. C.) :
Administrative costs. Bui. 485, pp. 207—208, 210, 214.
Competency of physicians. Bui. 485, p. 147.
First aid. Bui. 485, pp. 187-188.
Industrial physicians, training of. Bui. 485, pp. 147, 154.
International Association of Industrial Accident Boards' and Commissions!.
tion program. Bui. 485, p. 231.
---------- Maintenance of interest in. Bui. 485, p. 232.
------ —1 Reports of secretary-treasurer. Bui. 485, pp., 13—20.
Lead poisoning. Bui. 485, pp. 140-141.
Longshoremen’s and harbor workers’ act. Bui. 485, pp. 30, 31, 48.
Noise. Bui. 485, pp. 74-75.
Occupational diseases. Bui. 485, pp. 147, 154, 183-184, 184-185, 188.
Preexisting disease. Bui. 485, p. 118.
Radium poisoning. Bui. 485, p. 147.
Small plants. Bui. 485, pp. 217-224, 227.
Conven
T
Thigpen, R. M. (Alabama). Legislative activity, International Association of Industrial
Accident Boards and Commissions. Bui. 485, p. 198.
W
Wainwright, Dr. Jonathan M. (Pennsylvania) :
Malignant disease. Bui. 485, pp. 86-93, 120-121.
Spinal fracture. Bui. 485, p. 117.
Traumatic surgery. Bui. 485, p. 118.
Warzala, Stanley (New Jersey). Occupational diseases. Bui. 485, pp. 188—189.
Wenzel, R. E. (North Dakota) :
Convention program. Bui. 485, p. 231.
Infection. Bui. 485, p. 46.
Lacquer poisoning. Bui. 485, p. 129.
Legislative activity, International Association of Industrial Accident Boards and
Commissions. Bui. 485, pp. 191-192, 195-196, 199, 214.
Out of and in course of employment. Bui. 485, p. 42.
Relative benefits. Bui. 485, p. 210.
Small plants. Bui. 485. pp. 224-227.
Wilcox, Fred M. (Wisconsin) :
Administrative costs. Bui. 485, pp. 208, 210.
Disability ratings. Bui. 485, p. 122.
Epilepsy. Bui. 485, pp. 44, 45.
General Bryant. Bui. 485, p. 203.
Hearings. Bui. 485, p. 31.
Heart failure. Bui. 485, p. 44.
Infection. Bui. 485, pp. 45, 46.
International Association of Industrial Accident Boards and Commissions. Conven
tion program. Bui. 485, pp. 208-210.
---------- Legislative activity. Bui. 485, pp. 199, 200.
Judge Yaple. Bui. 485, p. 202.
Lightning. Bui. 485, pp. 42r-43.
Occupational diseases. Bui. 485, pp. 147—150, 153—154.
Out of and in course of employment. Bui. 485, pp. 42-^43, 45, 46, 47, 48.
Relative benefits. Bui. 485, pp. 209, 216, 217.
Small plants. Bui. 485, pp. 227-230.
Williams, Frederic M. (Connecticut) :
Chiropractors. Bui. 485, p. 118.
Ear injuries. Bui. 485, p. 74.
Fractured pelvis. Bui. 485, pp. 76, 77.
Kidney, loss of. Bui. 485, p. 80.
Legislative activity, International Association of Industrial Accident Boards and
Commissions. Bui. 485, pp. 195„ 201.
Malignant disease. Bui. 485, p. 115.
Moorhead, book by. Bui. 485, p. 124.
Occupational diseases. Bui. 485, pp. 144-146.
Woodruff, Dr. Stanley R. (New York) :
Traumatized kidney. Bui. 485, pp. 62-69, 79, 80-81.
Urethra injuries. Bui. 485, p. 82.
LIST OF BULLETINS OF THE BUREAU OF LABOR STATISTICS
The follow ing is a list o f all bulletins o f th e Bureau o f Labor S tatistics
p u blish ed since July, 1912, except that in th e case o f bulletins giving th e
results o f periodic surveys o f th e bureau on ly th e latest bulletin on any on e
su b jec t is here listed
A co m p lete list o f th e reports and bulletins issued prior to July, 1912, as
well as th e bulletins p u blish ed since that date, will be furnished on appli
cation . B ulletins m arked th u s
are o u t o f p r in t
.
(*)
.
Conciliation and Arbitration (including strikes and lockouts).
•No. 124. Conciliation and arbitration in the building trades of Greater New York. [1913.]
*No. 133. Report of the industrial council of the British Board of Trade on its inquiry into industrial
agreements. [1913.]
No. 139. Michigan copper district strike. [1914.]
No. 144. Industrial court of the cloak, suit, and skirt industry of New York City. [1914.]
No. 145. Conciliation, arbitration, and sanitation in the dress and waist industry of New York City.
[1914.]
*No. 191. Collective bargaining in the anthracite coal industry. [1916.]
•No. 198. Collective agreements in the men’s clothing industry. [1916.]
No. 233. Operation of the industrial disputes investigation act of Canada. [1918.]
No. 255. Joint industrial councils in Great Britain. [1919.]
No. 283. History of the Shipbuilding Labor Adjustment Board, 1917 to 1919.
No. 287. National War Labor Board: History of its formation, activities, etc. [1921.]
No. 303. Use of Federal power in settlement of railway labor disputes. [1922.]
No. 341. Trade agreement in the silk-ribbon industry of New York City. [1923.]
No. 402. Collective bargaining by actors. [1926.]
No. 468. Trade agreements, 1927.
No. 481. Joint industrial control in the book and job printing industry. [1928.
Cooperation.
No. 313. Consumers’ cooperative societies in the United States in 1920.
N o. 314. Cooperative credit societies in America and in foreign countries.
[1922.]
No. 437. Cooperative movement in the United States in 1925 (other than agricultural).
Employment and Unemployment.
*No.
No.
*No.
*No.
No.
109.
172.
183.
195.
196.
*No. 202.
No. 206.
No. 227.
No. 235.
*No. 241.
No. 247.
No. 310.
No. 409.
Statistics of unemployment and the work of employment offices [inthe United States]. [1913.]
Unemployment in New York City, N. Y. [1915.]
Regularity of employment in the women’s ready-to-wear garment industries. [1915.]
Unemployment in the United States. [1916.]
Proceedings of Employment Managers’ Conference held at Minneapolis, Minn., January 19
and 20, 1916.
Proceedings of the conference of Employment Managers’ Association of Boston, Mass., held
May 10, 1916.
The British system of labor exchanges. [1916.]
Proceedings of the Employment Managers’ Conference, Philadelphia, Pa., April 2 and 3,1917.
Employment system of the Lake Carriers’ Association. [1918.]
Public employment offices in the United States. [1918.]
Proceedings of Employment Managers’ Conference, Rochester, N. Y., May 9-11,1918.
Industrial unemployment: A statistical study of its extent and causes. [1922.]
Unemployment in Columbus, Ohio, 1921 to 1925.
Foreign Labor Laws.
*No. 142. Administration of labor laws and factory inspection in certain European countries. [1914.]
Housing.
*No. 158.
No. 263.
No. 295.
No. 469.
Government aid to home owning and housing of working people in foreign countries. [1914.]
Housing by employers in the United States. [1920.]
Building operations in representative cities in 1920.
Building permits in the principal cities of the United States in [1921 to] 1927.
[I]
Industrial Accidents and Hygiene.
*No. 104. Lead poisoning in potteries, tile works, and porcelain enameled sanitary ware factories.
[1912.]
No. 120. Hygiene of the painters’ trade. [1913.]
*No. 127. Dangers to workers from dusts and fumes, and methods of protection. [1913.]
*No. 141. Lead poisoning in the smelting and refining of lead. [1914.]
*No. 157. Industrial accident statistics. [1915.]
*No. 165. Lead poisoning in the manufacture of storage batteries. [1914.]
*No. 179. Industrial poisons used in the rubber indusiry. [1915.]
No. 188. Report of British departmental committee on the danger in the use of lead in the painting of
buildings. [1916.]
*No. 201. Report of committee on statistics and compensation insurance cost of the International
Association of Industrial Accident Boards and Commissions. [1916.]
*No. 207. Causes of death by occupation. [1917.]
*No. 209. Hygiene of the printing trades. [1917.]
*No. 219. Industrial poisons used or produced in the manufacture of explosives. [1917.]
No. 221. Hours, fatigue, and health in British munition factories. [1917.]
No. 230. Industrial efficiency and fatigue in British munition factories. [1917.]
*No. 231. Mortality from respiratory diseases in dusty trades (inorganic dusts). [1918.]
*No. 234. Safety movement in the iron and steel industry, 1907 to 1917.
No. 236. Effects of the air hammer on the hands of stonecutters. [1918.]
No. 249. Industrial health and efficiency. Final report of British Health of Munition Workers* Com
mittee. [1919.]
*No. 251. Preventable death in the cotton-manufacturing industry. [191).]
No. 256. Accidents and accident prevention in machine building. [1919 ]
No. 267. Anthrax as an occupational disease. [1920.]
No. 276. Standardization of industrial accident statistics. [1920.]
No. 280. Industrial poisoning in making coal-tar dyes and dye intermediates. [1921.]
No. 291. Carbon-monoxide poisoning. [1921.]
No. 293. The problem of dust phthisis in the granite-stone industry. [1922.]
No. 298. Causes and prevention of accidents in the iron and steel industry, 1910-1919.
No. 306. Occupation hazards and diagnostic signs: A guide to impairments to be looked for in
hazardous occupations. [1922.]
No. 339. Statistics of industrial accidents in the United States. [1923.]
No. 392. Survey of hygenic conditions in the printing trades. [1925.]
No. 405. Phosphorus necrosis in the manufacture of fireworks and in the preparation of phosphorus.
[1926.]
No. 425.
No. 426.
No. 427.
No. 428.
Record of industrial accidents in the United States to 1925.
Deaths from lead poisoning. [1927.]
Health survey of the printing trades, 1922 to 1925.
Proceedings of the Industrial Accident Prevention Conference, held at Washington, D. C.,
July 14-16, 1926.
No. 460. A new test for industrial lead poisoning. [1928.]
No. 466. Settlement for accidents to American seamen. [1928.]
Industrial Relations and Labor Conditions.
No. 237.
No. 340.
No. 349.
No. 361.
No. 380.
No. 383.
No. 384.
No. 399.
No. 483.
Industrial unrest in Great Britain. [1917.]
Chinese migrations, with special reference to labor conditions. [1923.]
Industrial relations in the West Coast lumber industry. [192?..]
Labor relations in the Fairmont (W. Va.) bituminous-coal field. [1924.]
Postwar labor conditions in Germany. [1925.]
Works council movement in Germany. [1925.]
Labor conditions in the shoe industry in Massachusetts, 1920-1924.
Labor relations in the lace and lace-*curtain industries in the United States. [1925.]
Conditions in the shoe industry in Haverhill, Mass., 1928.
Labor Laws o f the United States (including decisions o f courts relating to labor).
No. 211.
No. 229.
No. 285.
No. 321.
No. 322.
No. 343.
No. 370.
No. 408.
No. 444.
No. 467.
No. 470.
Labor laws and their administration in the Pacific States. [1)17.]
Wage-payment legislation in the United States. [1917.]
Minimum-wage laws of the United States: Construction and operation. ri921.]
Labor laws that have been declared unconstitutional. [1922.]
Kansas Court of Industrial Relations. [1923.]
Laws providing for bureaus of labor statistics, etc. [1923.]
Labor laws of the United States, with decisions of courts relating thereto. 11925.]
Laws relating to payment of wages. [1926.]
Decisions of courts and opinions affecting labor, 1926.
Minimum wage legislation in various countries. [1928.]
Labor legislation of 1927.
[n]
Proceedings o f Annual Conventions o f the Association o f Governmental Labor Officials o f the United
States and Canada. (Name changed In 1928 to Association of Governmental Officials in Industry
of the United States and Canada.)
*No. 266.
No. 307.
No. 323.
No. 352.
*No. 389.
*No. 411.
No. 429.
No. 455.
No. 480.
Seventh, Seattle, Wash., July 12-15, 1920.
Eighth, New Orleans, La., May 2-6, 1921.
Ninth, Harrisburg, Pa., May 22-26, 1922.
Tenth, Richmond, Va., May 1-4, 1923.
Eleventh, Chicago, 111., May 19-23, 1924.
Twelfth, Salt Lake City, Utah, August 13-15, 1925.
Thirteenth, Columbus, Ohio, June 7-10, 1926.
Fourteenth, Paterson, N. J., May 31 to June 3, 1927.
Fifteenth, New Orleans, La., May 15-24, 1928.
Proceedings of Annual Meetings of the International Association of Industrial Accident Boards and
Commissions.
No. 210.
No. 248.
No. 264.
*No. 273.
No. 281.
No. 304.
No. 333.
No. 359.
No. 385.
No. 395.
No. 406.
No. 432.
No. 456.
Third, Columbus, Ohio, April 25-28, 1916.
Fourth, Boston, Mass., August 21-25, 1917.
Fifth, Madison, Wis., September 24-27, 1918.
Sixth, Toronto, Canada, September 23-26, 1919.
Seventh, San Francisco, Calif., September 20-24, 1920.
Eighth, Chicago, 111., September 19-23, 1921.
Ninth, Baltimore, Md., October 9-13, 1922.
Tenth, St. Paul, Minn., September 24-26, 1923.
Eleventh, Halifax, Nova Scotia, August 26-28, 1924.
Index to proceedings, 1914-1924.
Twelfth, Salt Lake City, Utah, August 17-20, 1925.
Thirteenth, Hartford, Conn., September 14r-17, 1926.
Fourteenth, Atlanta, Ga., September 27-29, 1927.
Proceedings o f Annual Meetings o f the International Association o f Public Employment Services.
No. 192. First, Chicago, December 19 and 20, 1913; Second, Indianapolis, September 24 and 25, 1914;
Third, Detroit, July 1 and 2, 1915.
No.. 220. Fourth, Buffalo, N. Y., July 20 and 21, 1916.
No. 311. Ninth, Buffalo, N. Y., September 7-9, 1921.
No. 337. Tenth, Washington, D. C., September 11-13, 1922.
No. 355. Eleventh, Toronto, Canada, September 4-7, 1923.
No. 400. Twelfth, Chicago, 111., May 19-23, 1924.
No. 414. Thirteenth, Rochester, N. Y., September 15-17, 1925.
No. 478. Fifteenth, Detroit, Mich., October 25-28, 1927.
Productivity o f Labor.
No. 356.
No. 360.
No. 407.
No. 412.
No. 441.
Productivity costs in the common-brick industry. [1924.]
Time and labor costs in manufacturing 100 pairs of shoes, 1923.
Labor cost of production and wages and hours of labor in the paper box-board industry. 11926.]
Wages, hours, and productivity in the pottery industry, 1925.
Productivity of labor in the glass industry. [1927.]
N o. 474. Productivity of labor in merchant blast furnaces.
[1928.]
No. 475. Productivity of labor in newspaper printing. [1928.]
Retail Prices and Cost o f Living.
*No. 121.
*No. 130.
No. 164.
No. 170.
No. 357.
No. 369.
No. 464.
Sugar prices, from refiner to consumer. [1913.]
Wheat and flour prices, from farmer to consumer. [1913.]
Butter prices, from producer to consumer. [1914.]
Foreign food prices as affected by the war. [1915.]
Cost of living in the United States. [1924.]
The use of cost-of-living figures in wage adjustments. [1925.]
Retail prices, 1890 to 1927.
Safety Codes.
*No. 331. Code of lighting: Factories, mills, and other work places.
No. 336. Safety code for the protection of industrial workers in foundries.
No. 350. Specifications of laboratory tests for approval of electric headlighting devices for motor
vehicles.
No. 351. Safety code for the construction, care, and use of ladders.
No. 375. Safety code for laundry machinery and operation.
No. 378. Safety code for woodworking plants.
No. 382. Code of lighting school buildings.
No. 410. Safety code for paper and pulp mills.
No. 430. Safety code for power presses and foot and hand presses.
No. 433. Safety codes for the prevention of dust explosions.
No. 436. Safety code for the use, care, and protection of abrasive wheels.
No 447. Safety code for rubber mills and calenders.
No. 451. Safety code for forging and hot-metal stamping.
No. 463, Safety code for mechanical power-transmission apparatus. First revision.
[m3
Vocational Workers’ Education.
*No. 159.
*No. 162.
No. 199.
No. 271.
No. 459.
Short-unit courses for wage earners, and a factory school experiment. [1915.]
Vocational education survey of Richmond, Va. [1915.]
Vocational education survey of Minneapolis, Minn. [1917.]
Adult working-class education in Great Britain and the United States. [1920.]
Apprenticeship in building construction. [1928.]
Wages and Hours o f Labor.
*No. 146. Wages and regularity of employment and standardization of piece rates in the d:
waist industry of New York City. [1914.]
♦No. 147. Wages and regularity of employment in the cloak, suit, and skirt industry. [1914.]
Wages
and hours of labor in the clothing and cigar industries, 1911 to 1913.
No. 161.
No. 163. Wages and hours of labor in the building and repairing of steam railroad cars, 1907 t<
♦No. 190. Wages and hours of labor in the cotton, woolen, and silk industries, 1907 to 1914.
No. 204. Street-railway employment in the United States. 11917.]
No. 225.
No. 265.
No. 297.
[1924.]
No. 356.
No. 358.
No. 360.
No. 365.
No. 394.
No. 407.
[1926.]
No. 412.
No. 413.
No. 416.
No. 435.
No. 438.
No. 442.
No. 443.
No. 446. Wages and hours of labor in cotton-goods manufacturing, 1910 to 1926.
No. 450.
No. 452.
No. 454.
No. 471.
bs and hours of labor in slaughtering and meat packing, 1927.
No. 472.
mscales of wages and hours of labor, 1927. Supplement to Bui. 457.
No. 476.
n scales of wages and hours of labor, May 15, 1928.
No. 482.
No. 484. Wages and hours of labor of common street labor, 1928.
Welfare Work.
*No. 123.
No. 222.
♦No. 250.
No. 458.
Employers’ welfare work. [1913.]
Welfare work in British munition factories. [1917.]
Welfare work for employees in industrial establishments in the United States. [1919.]
Health and recreation activities in industrial establishments, L926.
Wholesale Prices.
No. 284. Index numbers of wholesale prices in the United States and foreign countries. [1921.]
No. 440. Wholesale prices, 1890 to 1926.
No. 453. Revised index numbers of wholesale prices, 1923 to July, 1927.
No. 473. Wholesale prices 1913 to 1927.
Women and Children in Industry.
No. 116. Hours, earnings, and duration of employment of wage-earning women in selected industries
in the District of Columbia. [1913.]
*No. 117. Prohibition of night work of young persons. [1913.]
No. 118. Ten-hour maximum working-day for women and young persons. [1913.]
No. 119. Working hours of women in the pea canneries of Wisconsin. [1913.]
♦No. 122. Employment of women in power laundries in Milwaukee. [1913.]
No. 160. Hours, earnings, and conditions of labor of women in Indiana mercantile establishments and
garment factories. [1914.]
*No. 167. Minimum-wage legislation in the United States and foreign countries. [1915.]
•No. 175. Summary of the report on condition of woman and child wage earners in the United States.
[1915.]
♦No. 176. Effect of minimum-wage determinations in Oregon. [1915.]
♦No. 180. The boot and shoe industry in Massachusetts as a vocation for women. [1915.]
♦No. 182. Unemployment among women in department and other retail stores of Boston, Mass. [1916.]
No. 193. Dressmaking as a trade for women in Massachusetts. [1916.J
No. 215. Industrial experience of trade-school girls in Massachusetts. [1917.]
♦No. 217. Effect of workmen’s compensation laws in diminishing the necessity of industrial employ
ment of women and children. [1918.]
No. 223/. Employment of women and juveniles in Great Britain during the war. [1917.]
No. 253. Women in the lead industries. [1919.]
[IV]
Workmen’s Insurance and Compensation (including laws relating thereto).
*No. 101.
*No. 102.
No. 103.
No. 107.
*No. 155.
No. 212.
Care of tuberculous-wage earners in Germany. [1912.]
British national insurance act, 1911.
Sickness and accident insurance law of Switzerland. [1912.]
Law relating to insurance of salaried employees in Germany. [1913.]
Compensation for accidents to employees of the United States. [1914.]
Proceedings of the conference on social insurance called by the International Association of
Industrial Accident Boards and Commissions, Washington, D. C., December 5-9, 1916.
*No. 243. Workmen’s compensation legislation in the United States and foreign countries, 1917 and 1918.
No. 301. Comparison of workmen’s compensation insurance and administration. [1922.]
No. 312. National health insurance in Great Britain, 1911 to 1921.
No. 379. Comparison of workmen’s compensation laws of the United States as of January 1, 1925.
No. 423. Workmen’s compensation legislation of the United States and Canada as of July 1, 1926.
No. 477. Public-service retirement systems, United States and Europe. [1928.]
Miscellaneous Series.
*No. 174. Subject index of the publications of the United States Bureau of Labor Statistics up to May
1, 1915.
No. 208. Profit sharing in the United States. [1916.]
No. 242. Food situation in central Europe, 1917.
No. 254. International labor legislation and the society of nations. [1919.]
No. 268. Historical survey of international action affecting labor. [1920.]
No. 282. Mutual relief associations among Government employees in Washington, D. C. [1921.]
No. 299. Personnel research agencies: A guide to organized research in employment management,
industrial relations, training, and working conditions. [1921.]
No. 319. The Bureau of Labor Statistics: Its history, activities, and organization. [1922.]
No. 326. Methods of procuring and computing statistical information of the Bureau of Labor Statistics#
[1923.]
No. 342. International Seamen’s Union of America: A study of its history and problems. [1923.]
No. 346. Humanity in government. [1923.]
No. 372. Convict labor in 1923.
No. 386. Cost of American almshouses. [1925.]
No. 398. Growth of legal-aid work in the United States. [1926.]
No. 401. Family allowances in foreign countries. [1926.]
No. 420. Handbook of American trade-unions. [1926.]
No. 439. Handbook of labor statistics, 1924 to 1926.
No. 461. Labor organizations in Chile. [1928.]
No. 462. Park recreation areas in the United States. [1928.]
No. 465. Beneficial activities of American trade-unions. [1928]
'No. 479. Activities and functions of a State department of labor. [1928.]
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