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U. S. DEPARTMENT OF LABOR

BUREAU OF LABOR STATISTICS
ROYAL M EEK ER, Commissioner

BULLETIN OF TH E UNITED STATES \
BU R E A U O F L A B O R S T A T I S T I C S /
WORKMEN’S

INSURANCE

AND

*

*

*

’

A T ^ O C ZA
IN U . £ O t :

COMPENSATION

SERIES

PROCEEDINGS OF THE FIFTH ANNUAL MEETING
OF THE

INTERNATIONAL ASSOCIATION
OF I N D U S T R I A L A C C I D E N T
BOARDS AND COMMISSIONS




HELD AT M AD ISO N , W IS.
SEPTEMBER 2 4 - 2 7 , 1918

O CTO BER , 1919

W ASHINGTON
GO VERNM ENT PRINTING O FFIC E
1919




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V

CONTENTS.
Page.
In tro d u ctio n ______________________________________________________________________

7-13

TUESDAY, SEPTEMBER 24, 1918—AFTERNOON SESSION.
I . Accident prevention.

Chairman, Fred M . W ilc o x , President, I . A . I. A . B. C.

Ohio’s plan o f reaching the employer through monthly statistical re­
ports :
Em ile E. W atson, actuary, Ohio Industrial Com mission___________14-16
W hat W isconsin is doing to prevent industrial accid en ts:
G. H. Ham brecht, chairman, W isconsin Industrial Commission___17-24
C alifornia’s accident prevention cam paign ;
John R. Brownell, superintendent o f safety, C alifornia Industrial
Accident Com mission____________________________________________ 25-28
W hat the New Y ork State Industrial Commission is doing to prevent
acciden ts:
James L. Gernon, first deputy commissioner, New Y ork State In­
dustrial Com mission_____________________________________________ 29-34
The vital im portance o f industrial-accident prevention in war tim e:
Victor T. Noonan, director o f safety, Ohio Industrial Commission__ 35, 36
W hat Pennsylvania is doing to prevent a ccid e n ts:
Robert D. Young, Pennsylvania Safety M an______________________ 37-40
W hat M assachusetts is doing to prevent accid en ts:
W illiam W . Kennard, chairman, M assachusetts Industrial A cci­
dent B o a r d ______________________________________________________ 41, 42
Accident prevention in industries in O ntario:
George A. Kingston, commissioner, W orkm en’s Compensation
Board o f Ontario...______________________________________________ 43,44
W hat industrial com m issions can do to prevent acciden ts:
-Sidney J. W illiams, manager, accident prevention division, Na­
tional Safety Council___________________________________________ _ 45-47
TUESDAY, SEPTEMBER 24, 1918-EVEN IN G SESSION.
II . Administrative problems.

Chairman, Charles S, Andrus, Illinois.

Statistics as an aid in administration :
W. H. Burhop, secretary, W isconsin Compensation Insurance
B oard____________________________________________________________ 48-53
H ow should permanent partial disability be com pensated:
John Mitchell, chairman, New York State Industrial Commission__54-59
" Arising out o f and in course o f employment ” :
George A. Kingston, commissioner. W orkm en’s Compensation
Board o f O ntario________________________________________________ 60-72
WEDNESDAY, SEPTEMBER 25, 1918—MORNING SESSION.
Business meeting.

Chairman, Fred M. W ilcox , President, I . A . I. A . B. C.

Report o f the secretary-treasurer______ ,______________________________ 73-83
Financial statem en t_______________________________________________ 81-83
Reports o f committees_________________________________________________ 83-106
Report o f committee on statistics and compensation insurance cost__83-106
Election o f officers___________________________________________________ 106
Resolutions__________________________*_____________ _____ ____________ 106-108




3

4

CONTENTS.
W E D N E S D A Y , S E P T E M B E R 25, 1918—A F T E R N O O N S E SSIO N .

V isits to Gisholt plant and other industrial establishments___________________________

Page.
jQ g

W E D N E S D A Y , S E P T E M B E R 25, 1918— E V E N I N G S E S S IO N .

I I I . Statistical session.

Chairman, H arry A . Mackey, Pennsylvania.

Am ount o f exposure as fundamental in accident stu d y :
Lucian W . Chaney, special agent, United States Bureau o f Labor
Statistics_______________________________________________________ 109-116
W hy tabulate noncompensated a ccid en ts:
L. W . Hatch, chief statistician, New Y ork State Industrial Com­
mission__________________________________________________________ 117-125
The use o f standard accident and compensation ta b les:
W . H. Burhop, secretary, W isconsin Compensation Insurance
B oa rd ___________________________________________________________ 126-132
T H U R S D A Y , S E P T E M B E R 26, 1918— M O R N I N G S E S S IO N .

I V . Medical session.

Chairman, Charles H . Lemon, M . D., Wisconsin.

Should medical service be lim ited in compensation c a s e s :
Charles H. Lemon, M. D., M ilwaukee, W is_______________________ 133-139
Better treatment fo r industrial accident ca se s:
M aj. P. B. Magnuson, Office o f the Surgeon General, W a r D epart­
ment, W ashington, D. C_______________________________________ 140-146
Surgical treatment to prevent and minimize permanent d isab ilities:
Francis D. Donogliue, M. D., m edical adviser, Industrial Accident
Board o f M assachusetts______________________________________ 147-151
Should m edical service be lim ited in compensation c a s e s :
Frederic M. W illiams, commissioner, Connecticut W orkm en’ s
Compensation Commission_____________________________________ 152,153
Should medical services be limited in compensation ca se s:
Raphael Lewy, M. D., chief medical examiner, New York State
154
Industrial C om m ission _________________________________________
T H U R S D A Y , S E P T E M B E R 26, 1918— A F T E R N O O N S E S S IO N .

Chairman, 0 . J. Fay, M. D., Iowa.

The compensation o f disability due to preexisting disease, aggravated
or accelerated by accident or in ju r y :
Meyer Lissner, member, C alifornia Industrial Accident Commis­
sion____________________________________________________________ 155-1S4
How medical questions are handled under the w orkm en’s compensa­
tion act in the State o f W ashington :
J. W. Brislaw n, Industrial Insurance Commissioner o f W ash­
ington___________________________________________________________ 185-188
H ow medical questions are handled under compensation act in Massa­
chusetts :
W illiam W . Kennard, chairman, Massachusetts Industrial A cci­
dent B o a r d _____________________________________________________ 189-191
H ow medical questions are handled under compensation law in New
York State:
W illiam C. Archer, deputy commissioner in charge o f New Y ork
State Bureau o f W orkm en’s Compensation____________________ 192-194
The need o f medical statistics for compensation pu rposes:
F. H. Thompson, M. D., ch ief medical examiner, Oregon Indus­
trial Accident Commission_____________________________________ 195,196




CONTENTS.

5

T H U R S D A Y , S E P T E M B E R 26, 1918—E V E N I N G S E S S IO N .

Chairman, F. D. Donoghue, M. D., Massachusetts.

Selection o f the physician under compensation la w s :
rage.
John W . Mowell, M. D., medical adviser to the Industrial Insur­
ance Commission o f the State o f W ashington and chairm an o f
the State M edical A id B oard_________________________________ 197-109
Selection o f the physician in compensation c a se s:
Raphael Lewy, M. D., chief medical examiner, New Y ork State In­
dustrial Com mission_____________________________________________
200
F R I D A Y , S E P T E M B E R 27 , 1918— M O R N I N G S E S S IO N .

Rehabilitation.

Chairman, Fred M. W ilcox , President, I. A . I. A . B. C.

H ow to deal with crippled w ork ers:
T. Norman Dean, statistician, W orkm en’s Compensation Board
o f O n tario____________________________________________________ 201-206
Conservation o f man pow er and rehabilitation o f the industrially d is­
abled :
Lieut. Col. H arry E. Mock, M. C_____________________________ 207-211
Problem o f the crippled man in in d u stry :
Carl Hookstadt, expert, United States Bureau o f Labor Statistics 212-224







BULLETIN OF THE

U. S. BUREAU OF LABOR STATISTICS.
no. 264.

WASHINGTON.

October. 1919.

PROCEEDINGS OF THE FIFTH ANNUAL MEETING OF THE INTER­
NATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS AND
COMMISSIONS, MADISON, WIS, SEPTEMBER 24-27, 1918.
[The present bulletin contains only those papers which were pre­
pared for the conference and submitted to the Bureau. No steno­
graphic report of the proceedings has been received by the Bureau
o f Labor Statistics for publication. The following introduction gives
a summary account o f the papers, discussions, and activities o f the
conference.]
IN T R O D U C T IO N .

The International Association o f Industrial Accident Boards and
Commissions held its fifth annual meeting September 24-27, 1918, at
Madison, Wis. Seventeen States, two Provinces of Canada, and five
Federal departments were represented. The last named included the
United States Bureau o f Labor Statistics, United States Employees’
Compensation Commission, Federal Board for Vocational Education,
Bureau o f Standards, and the Surgeon General’s Office o f the W ar
Department. An address of welcome was delivered by the Hon.
Emanuel L. Philipp, Governor of Wisconsin.
The discussion centered about five main subjects: Accident pre­
vention; methods o f compensating for partial disabilities; statistics
and statistical methods as an aid in efficient administration; medical
problems, including the method of selecting physicians; and the
problem o f rehabilitation and retraining.
In his presidential address, Mr. Fred M. W ilcox, o f the Wisconsin
Industrial Commission, emphasized the necessity o f greater uniform­
ity in compensation practices, especially as regards partial disa­
bility schedules. He also advocated unlimited medical and hospital
treatment, urged the adoption o f State compensation insurance, and
emphasized the importance o f closer personal supervision o f acci­
dent cases.




7

8

INTRODUCTION.

The opening session o f the convention was devoted to brief State
reports on important legislative and administrative developments
during the year. An important instance of effective cooperation
was given by Mr. J. L. Gernon, first deputy commissioner of the
New York State Industrial Commission. A great many of the small
employers subject to the compensation act in New York had not in­
sured in accordance with the law, and it had been practically im­
possible for the commission to canvass the entire State for violations
of this sort. Now one o f the duties o f the factory inspectors is to
inquire whether employers are insured under the compensation act.
Violations are reported to the compensation bureau and then prose­
cuted. Mr. F. W. Armstrong, of Nova Scotia, stated that 75 per
cent o f the troubles o f compensation commissions would be elimi­
nated if an exclusive State fund were substituted for private casualty
companies. He also advised strongly against payment of compensa­
tion benefits in lump sums, stating that 90 per cent o f such lump­
sum payments are actually wasted.
ACCIDENT PREVENTION*.

The entrance o f large numbers of women into war industries has
necessitated a change in the character o f accident prevention meth­
ods. Machines and processes not particularly hazardous Avhen men
are employed become so when such machines are operated by woman.
Even the mechanical safeguards themselves, installed primarily for
the protection of male employees, are a source of danger to women
workers. Another prolific source of accidents, as pointed out by
Mr. Gernon, o f New York, is the lack o f proper instruction in the
use or technique o f tools. The greater liability to accident of the
inexperienced or “ green ” employee is due not to his carelessness
but to his ignorance o f the proper methods of performing his work.
This unfamiliarity has become a very potent factor in view o f the
present large labor turnover and the employment of thousands o f
new and inexperienced workers.
Some o f the accident prevention methods found effective in the
various States were discussed at the conference. The more salient
features are shown in the following summaries of-the papers read.
Mr. Emile E. Watson, actuary o f the Industrial Commission o f
Ohio, presented the plan in effect in that State.
An account o f the safety work in Wisconsin was given by Mr.
G. H. Hambrecht, chairman of the Wisconsin Industrial Commis­
sion. One method o f interesting employers in inaugurating inten­
sive safety campaigns is to study the accident experience in *thfc®£ f
plants and furnish the deputies with this data. The compensation




INTRODUCTION.

9

law itself is an aid to the safety movement. When an injury is due
to failure o f an employer to comply with any safety order the com^
pensation o f the injured is increased 15 per cent, to be paid by the
employer himself, and when an injury is due to violation of an order
by the injured the employee’s compensation is reduced 15 per cent.
Accidents are carefully investigated on this basis, and the result has
been to create a demand for copies o f safety orders.
The safety department o f the Industrial Accident Commission o f
California, as outlined by Mr. J. E. Brownell, superintendent o f
safety, was organized in 1914 with a nucleus of safety engineers and
now consists o f 22 members. The chief mine inspector is paid
jointly by the Federal Government and the commission through an
arrangement with the Federal Bureau o f Mines, by wThich he is also
employed. The following accident prevention methods have been
found useful: Development of safety organizations among employ­
ers; preparation and distribution of safety rules and orders; mass
meetings and shop talks to employees; issuance of bulletins dealing
with special hazards in different industries; a safety museum; and the
publication o f a monthly safety news bulletin.
Particular emphasis upon the necessity of instructing inexperienced
employees in the use o f tools and methods w7as laid down by Mr. J. L.
Gernon, o f the New York State Industrial Commission. He further
stated that the inspection bureau is empowered to tag as unsafe
machines which are dangerous and unguarded, and this has proved
a most effective means of securing compliance with the orders issued.
Considerable success has been achieved by the bureau in the policy o f
requiring every inspector to report all installations of new machinery
where the machinery itself is dangerous and the manufacturer has
failed properly to safeguard it. When called to their attention the
makers o f the machinery have in every instance signified their inten­
tion to remedy the defects and have cooperated with the bureau in an
effort to make their machinery safe for the operator.
Mr. Victor T. Noonan, director of safety of Ohio, emphasized the
human element in accident prevention work. The war, he said, had
given the safety movement a much needed stimulus. Employers
and w orkmen alike must consider it their patriotic duty to do every­
thing possible to prevent accidents.
Mr. S. J. Williams, manager o f the accident prevention division
o f the National Safety Council, spoke of the need of uniform safety
standards. He stated that a proper balance between safeguarding
and education should be maintained in any safety campaign, since
evocation reduces accident frequency and safeguarding prevents
many o f the more serious accidents.




10

INTRODUCTION.

PARTIAL DISABILITY SCHEDULE.

The formulation o f an adequate and just compensation schedule
for partial disabilities is a problem which is still confronting every
State legislature and compensation commission. X o two schedules
are alike and none is adequate. This inadequacy is particularly
noticeable as to foot and leg injuries. As was pointed out by Mr.
Carl Hookstadt, o f the United States Bureau of Labor Statistics, in
every State compensation law the schedule provides smaller benefits
fo r the loss o f the lower limbs than for the loss o f the upper limbs.
Yet every investigation shows that from both the medical and eco­
nomic standpoint the loss o f the former are more severe than the
loss o f the latter.
On what basis permanent partial disability should be compensated
was discussed in a paper prepared by Mr. John Mitchell, chairman of
the Industrial Commission o f New York. He stated that in the ad­
ministration o f the NewT Y ork law consideration has been given to
the vocational element to m odify the rigidity of the statute, in no case,
however, diminishing the award on this account, but it might be
advisable to allow a definite increase of, say, 33 J per cent for voca­
tional reasons alone. Under an amendment to the New York law com­
pensation for permanent total disability is awarded in cases in wThich
the claimant loses a hand, arm, foot, leg, or eye, having previously
suffered the loss of one or more such members. The totality is no more
chargeable to the last accident than to the first. The proper way to
handle such a matter would seem to be to charge the present employer
with the result o f the last accident and to throw the combination re­
sult o f the totality upon the industry as a whole. This may be done
by adding a small additional rate upon each risk or by collecting, as
New York has done, in each death case in which there are no depend­
ents, a fixed sum o f $100, which contribution has been sufficient to
establish a fund to take care of the permanent total cases. This has
done away with the objection o f employers to employing or reemploying crippled or defective workmen.
The statutory method of providing for permanent partial disabili­
ties not included in the schedule is to pay two-thirds of' the difference
between the old and the new wages, but the administration difficulties
are numerous. The claimant may refuse to return to w ork; changed
industrial conditions may cause the claimant to earn more or less than
he earned at the time o f the accident; the claimant may experience
intermittent employment— sometimes employed and sometimes not.
The method followed in New York in such cases is to allow the work­
man and the employer (or his insurance carrier) to present theiJlselVes
before the commission with a proposition to adjudicate compensation
by a single payment commuting all future payments. More than




INTRODUCTION.

11

5,000 such cases a year are thus adjusted. The chief defects of such a
plan are (1) the danger of introducing the “ settlement,” so called, in
■which the obnoxious element o f the old plan may be perpetuated and
(2) the danger which always attends the giving o f compensation in a
lump sum against which is the general tendency of compensation laws.
The first objection is entirely avoided by the commission’s active in­
terest in every case. The second defect is overcome largely by ordering
partial payments o f the lump sum to be made periodically where
there is indication that it otherwise might be wasted.
STATISTICAXi METHODS.

Mr. W , H. Burhop, o f the Wisconsin Compensation Insurance
Board, discussed the standard accident and compensation tables used
by the industrial commission, and pointed out the importance o f
proper statistics as an aid in administration.
The paper o f Mr. L. W. Chaney, o f the United States Bureau o f
Labor Statistics, emphasized the need o f information as to exposure
in the determination o f relative industrial hazards. Accident rates
always have significance as disclosing prevalence^ while in the matter
of hazard the significance is slight in extended groups such as the
entire State, but steadily increases as it narrows to industries, de­
partments, and finally to occupations. Mr. Chaney also discussed
the several methods which may be adopted to ascertain the amount
o f exposure in any industry, the most accurate method being the uso
o f actual hours as recorded by time clocks.
Mr. L. W . Hatch, chief statistician o f the New York State Indus­
trial Commission, in his discussion o f noncompensable accidents stated
that while such accidents should be reported, very little could be
gained by tabulating them. The results obtained would not be com­
mensurate with the great labor and cost involved.
MEDICAL SERVICE.

The medical session proved to be one of the most spirited and.
interesting features o f the convention. A description of the medical
administration and practices in each State opened the session. Every
speaker emphasized the importance o f medical and surgical treat­
ment which was unlimited both as regards time and amount. Noth­
ing short o f this was held to be adequate. T oo great a tendency on
the part o f employers and insurance carriers to select cheap and in­
competent physicians was also pointed out. The practices o f many
o f the contract doctors were especially condemned b y Maj. P. B.
Magnuson, o f the Surgeon General’s Office, and by Dr. C. H. Lemon,
o f Milwaukee. On the other hand, as pointed out by Dr. J. W . Mowell,
o f the State Medical Aid Board o f Washington, selection of physicians
by employees results in selection of incompetents in a large proper-




12

INTRODUCTION.

tion o f cases. Supervision by State industrial commissions over tlie
selection of physicians was suggested as the best way out o f the diffi­
cult problem.
The invaluable aid medical advisers render to compensation com­
missions was generally recognized and emphasized. Not only do
they advise the commissioners on technical medical problems, but
they are especially qualified to select the impartial examining phy­
sicians. A valuable paper on how to prevent and minimize perma­
nent disabilities of the hand was read by Dr. F. D. Donoghue. The
long period o f disability resulting from hand injuries, Dr. Donoghue
stated, was due largely to neglect or improper treatment. Valuable
papers were also read by Mr. Meyer Lissner, of the California In­
dustrial Accident Commission, on preexisting disease aggravated
by accident, and by Mr. Geo. A. Kingston, o f the Ontario’ Workmen’s
Compensation Board, on the interpretation of injuries 64arising out
o f and in course of employment.”
r e h a b il it a t io n

.

A discussion of rehabilitation problems closed the convention.
Mr. T. N. Dean, statistician o f the Workmen’s Compensation Board
o f Ontario, spoke of the importance of rehabilitating industrial
cripples and stressed the desirability o f prompt action. Mr. Carl
Hookstadt, o f the United States Bureau o f Labor Statistics, outlined
the actual industrial problem, as disclosed by several investigations,
confronting workmen permanently injured in industry. He pointed
out that the present industrial handicap o f a workman who sustains
a major limb injury is a serious one. The period o f total disability
resulting from the injury is unnecessarily long. Only about onethird of the seriously crippled workers return to the same employer
and relatively few reenter the same occupation. The compensation
benefits are inadequate and practically no retraining has been done.
Mr. B. M. Little, former chairman o f the United States Employees’
Compensation Commission, outlined the history and progress of
Federal rehabilitation legislation as regards both military and indus­
trial cripples. He urged specifically that the association support the
pending Smith-Bankhead bill providing for the rehabilitation of
industrial cripples under the supervision and administration of the
Federal Board for Vocational Education. Resolutions were adopted
by the association approving the principle o f the Smith-Bankhead
bills and authorizing the president to appoint a committee to further
State and Federal legislation along lines outlined in the said bills.
BUSINESS

SESSION.

The following officers for the ensuing year were elected: President,
George A. Kingston, commissioner, Workmen’s Compensation Board
o f Ontario, Canada; vice president, W ill J. French, member of the




INTRODUCTION.

13

Industrial Accident Commission of California; secretary-treasurer,
Royal Meeker, United States Commissioner of Labor Statistics,
Washington, D. C. Reports were made by the secretary-treasurer,
by the committee on jurisdictional conflicts, and by the committee on
statistics and compensation insurance cost. Among the resolutions
adopted was one authorizing the executive committee to confer with
the executive committee of the Association of Government Labor
Officials o f the United States and Canada as to the advisability o f
the consolidation of the twTo organizations. The executive commit­
tee was authorized to cooperate with the Federal Bureau of Stand­
ards in formulating a uniform safety code, and to study the question
o f uniformity in State compensation laws.




TU ESD AY, SEPTE M BE R 2 i —A F T E R N O O N SESSION.
CHAIRMAN, FRED M . W ILCOX, PRESIDENT, I. A . I . A. B. C.

I. ACCIDENT PREVENTION,
O H IO ’ S P L A N O F R E A C H IN G T H E E M P L O Y E R T H R O U G H M O N T H L Y
S T A T IS T IC A L R E P O R T S .
B Y E M IL E E. W A T S O N , A C T U A R Y , O H IO

IN D U S T R IA L C O M M IS S IO N .

Our monthly statistical report plan comprises hut one phase o f a
broader plan, the great function o f which is intended to create that
condition which will bring about a maximum reduction in industrial
accidents in Ohio. W ith this statement in mind the initial part o f
this paper will be strictly confined to the subject assigned.
Statistically speaking, an industrial accident for actuarial needs is
inherently different from an industrial accident for accident preven­
tion needs. To serve actuarial needs, an industrial accident must
have a matured value. To possess a matured value, an important
percentage o f accidents require a considerable exposure o f time be­
yond the date on wThich the accident occurred. In consequence,
actuarial needs demand that statistical compilations for actuarial
purposes be made considerably beyond the date of the year for which
the compilation was made.
This delay, however, is violently destructive considered from the
viewpoint o f accident prevention needs. In the first place, it will
permit o f the prolonged continuance o f a destructive physical or
moral hazard constituting the direct source of a prolific number o f
accidents. In the second place, the tendency o f a corrective practice
ultimately to start operation independent of external action, means,
in a large percentage of cases, that the delay forced by actuarial
needs will find an entirely different set of conditions existing than
were present at the time o f the occurrence o f the accident, in the
event the attempt is made to use actuarial statistics for accident pre­
vention purposes.
To-day, when industries are so rapidly changing the nature, char­
acter, and finished product o f their operations, and on such a large
scale, this delay is incomparably more destructive than ever before.
Stated concisely, the proper conservation o f accident prevention
and actuarial statistical needs demands that industrial accidents be
reduced to two points o f control—one instantaneous, the other ulti­
mate ; the former being concurrent with the date of the reporting of
the occurrence o f the accident, the other concurrent with the date
14




O H IO 'S PLAN ---- EM ILE E. W ATSOK.

15

the accident lias reached its matured value. The latter will be of
great constructive value to the former, but the former will be of
no constructive value whatsoever to the latter.
In the foregoing an effort has been made to explain the conditions
which made the adopting of our monthly statistical reports a neces­
sity in order to reduce our problem to effective control. W e have
tried diligently to make this work {our monthly statistical reports)
a procedure as simple as possible. In its beginning we have taken
only a selected number o f risks. It is our plan to extend this selec­
tion gradually until ultimately it will be a service universal to every
employer o f the State.
I consider it premature at this time to attempt to place a valuation
upon this plan, though I have the profoundest confidence in the serv­
iceable and effective results it will obtain. The detailed procedure
o f carrying out the plan is as follows:
1. The industrial accidents o f each selected employer are analyzed
as o f the day the same are repQrted to the department, as to cause,
nature, and as far as possible, extent o f disability. They are coded,
thus being made ready for punching on the Hollerith cards.
2. These codes are then punched on the Hollerith cards.
3. A t the termination o f the month these accidents are sorted and
tabulated by their respective risks.
4. The results of these tabulations are then carried to the monthly
statistical report form.
5. Copies of these reports are placed in the hands of our safety
engineers, workshop and factory inspectors, and the employer.
Then correlating with the foregoing our merit-rating plan, wo
feel that we have completed a cycle which is ultimately going to go
far toward reducing the industrial accidents in Ohio to a*minimum.
Suffice it to say that the employers5 insurance is renewed every six
months. The employer is rated within his classification upon the
basis of the experience he has produced. On renewal, if the em­
ployer finds he is penalized over his neighboring or competing em­
ployer within the same classification, he is always disappointed by
reason o f two things: (1) The dollars and cents loss, represented not
only by the penalization but also by the additional fact that this
penalization in itself bars the employer receiving the same from any
participation in the annual refund premium; (2) injuring of his
pride, which is frequently the greatest cause of disappointment.
The Ohio employers are now conversant with the merit-rating sys­
tem of the Ohio State Insurance Plan, and, when they get together
and talk over the rates, it is a source of pride to every employer to be
abl^ to say that he is getting the preferred rate and participation in
the refund premium.




16

ACCIDENT PREVENTION.

THE UNIQUE CORRELATION EXISTING BETWEEN OTJR MONTHLY STATIS­
TICAL REPORTS AND M ERIT RATING SYSTEM.

In Ohio, there is. just one carrier o f workmen’s compensation in­
surance, viz, the Ohio State Insurance Plan. There is no switching
from one insurance carrier to another.
We have diligently developed the merit-rating system o f the Ohio
State Insurance Plan to the specific end o f creating that condition
which makes the prevention of every preventable accident the
convenient and businesslike thing for every subscriber to the
fund to accomplish, our aim being to make it just as economically
necessary for the employers to safeguard against the occurrence of
a preventable accident to just the same degree that he finds it eco­
nomically necessary to safeguard his raw material, machinery, equip­
ment, and finished product against injury or damage.
It is hardly fitting to enter upon an analysis of the foregoing
merit-rating system in this paper. The writer made such an analy­
sis in a paper read before the 1916 annual meeting o f this associa­
tion. Since then, this merit-rating system has undergone a consider­
able number of revisions, calculated to produce more effectively the
results just recited.




W H A T W IS C O N S IN

IS D O IN G TO P R E V E N T IN D U S T R IA L
A C C ID E N T S .

B Y G. H . H A M B R E C H T , C H A IR M A N , W IS C O N S IN

IN D U S T R IA L C O M M IS S IO N .

The Wisconsin Industrial Commission was organized seven years
ago. From the very first, in formulating and carrying out its safety
program, it has worked in the closest possible cooperation with the
representatives of labor and the manufacturers. In its effort to be
thoroughly efficient and practical in all of its requirements and
methods, it has sought to do nothing on its own responsibility, but
always to consult the interests concerned and, in cooperation with
them, to work out standards along the lines of experience and good
practice.
Every one o f the safety orders now in force has been drafted by
committees whose members are experts in the respective fields to
which the orders apply. The personnel of the committees is made
up o f representatives of the manufacturers and members appointed
by the Federation of Labor, and it is by such practical men as these
that the safety orders in every instance have been prepared and
discussed before being adopted as administrative orders by the com­
mission.
These special committees were continued after the orders were
adopted and are looked upon by the commission as permanent ad­
visory committees to which the commission may turn for expert
advice and technical information, and to which also may be referred
difficult questions involving interpretation of the orders and their
application under unusual circumstances.
From the very first, also, the commission has endeavored to be of
service to the manufacturers o f the State and their workmen by
placing before them the best information attainable regarding safe­
guards and methods of accident prevention. Throughout the entire
course o f development o f its safety work the commission has sought
to impress upon the employers and workmen the fact that safety is
neither philanthropy nor “ bunk,” but that it is a necessary feature of
industrial organization and that there can be no efficiency without
safety.
The field inspectors have been practical men who have sought to do
their work in a practical manner. In every case where a safeguard
has been ordered they have been prepared to show that there was a
real need for the guard. They have also been prepared to show the
1 2 4 2 4 7 °— 19------- 2




17

18

ACCIDENT PREVENTION.

employer how to install every guard tliey have ordered. Nothing
has been ordered in the way of safety devices unless it could be
shown that the device required was thoroughly practical.
This attitude on the part of the commission and the application
of these methods by its field deputies, together with the great amount
o f personal work done by the commissioners and inspectors in spread­
ing the gospel of safety, paved the way for the hearty cooperation
which the employers of Wisconsin have given to the State in its
accident-prevention campaign. Whatever success the safety move­
ment in Wisconsin has attained is due to this cooperation more than
to anything else.
T. GENERAL INSPECTION SERVICE.

The safety and sanitation department of the Industrial Commis­
sion conducts the general faetory-inspection service and several
specialized activities, such as building code administration, inspec­
tion o f steam boilers and refrigerating machinery, improvement of
industrial lighting and enforcement of the lighting orders, and
general fire prevention and inspection service.
The orders which have been adopted by the commission form the
basis upon which all inspections are made in places of employment
and public buildings in the State. These orders are as follows:
1. General safety orders, applicable to m achinery and conditions in all plants.
This group also includes a few special orders on paper m ills and w oodw orking
plants.
2. General sanitation orders.
3. Laundry safety orders.
4. Elevator safety code.
5. Boiler safety code.
6. Orders on existing buildings.
7. B u ild in g code.

8. Building-construction sa fety orders.
9. Electrical safety code.
10. Lighting orders.
11. Fire-protection orders.
12. Refrigerating-m achinery safety orders.
13. General orders on zinc miners.

The general factory-inspection service is conducted by a staff con­
sisting o f a chief safety engineer, an assistant, and eight field depu­
ties, each o f whom is assigned to a district. The duties o f the field
deputies are to inspect places o f employment for the purpose o f en­
forcing the orders of the commission. In addition to the enforce­
ment o f these orders^ the deputies are also charged with the duty of
enforcing the child-labor laws, enforcing laws regulating the hours
o f employment for women, investigating serious accidents, and mak­
ing any special investigations within their districts which may be




W H A T W ISCONSIN IS DOING-----G. H . HAM BRECHT.

19

necessary to facilitate the work o f other departments of the com­
mission.
The attention given to safety by the field deputies has always been
primarily educational in character. The commission lias never re­
garded that the work of the deputy w^as to enter a place for the pur­
pose o f finding points o f danger and recording them upon a certifi^cate o f inspection. On the contrary, the commission has required
that its representatives in the field may be men o f considerable ex­
perience, well equipped for their work, and capable o f giving prac­
tical suggestions not only in regard to safety o f equipment, but more
especially in regard to methods o f organizing and conducting safety
campaigns in individual plants. It has held that the deputies’ chief
function was to present safety work to the manufacturers and to the
workmen in such a way that they will become interested and will
appreciate its practical value from the standpoint o f efficiency. The
deputy has been required, so to speak, to “ sell safety ” to the em­
ployer, the superintendent, the foreman, and all down the line. The
inspector who found only half of the danger points in a factory
but who stirred up interest in safety among the men in the plant
and left the manufacturer with the right attitude toward the prob­
lem was considered successful. The deputy who found every exposed
set screw and every open gear and made a careful tabulation o f
every danger point in the place but who left the manufacturer indif­
ferent about safety was considered a failure.
During the years 1915, 1916, and 1917, there were 40,980 accidents
settled under compensation in this State. O f this number 7,789, or
19 per cent, were strictly machine accidents, such injuries as we may
assume could have been prevented by mechanical safeguards. This,
we believe, is just about as low a proportion o f machine accidents
as any State with an equal amount o f manufacturing is able to show.
The attention given to safeguarding in past years has borne fruit,
and the factories throughout the State have been brought up to a
high standard with respect to the safeguarding o f physical equip­
ment. Granted that the present improved conditions be maintained,
it is not probable that increased attention to safeguarding will cause
any notable effect in the reduction o f the present accident frequency
rate. I f by such increased attention we should be able to cut down
the machine accident rate 25 per cent, it would result in a decrease
of less than 5 per cent o f all accidents occurring annually. The
deputies therefore, while not neglecting the importance o f mechani­
cal safeguards, have found it advantageous to devote considerable
time to the work o f assisting employers in reviving and developing
safety organizations in their plants, and stimulating interest among
the foremen and workmen by practical talks on safety whenever in­
spections are made. Occasionally, special meetings are arranged, at




20

ACCIDENT PEE VEXTIO X.

which talks on unsafe practices are given in connection with slides
or moving pictures. Many such meetings have been held with
groups o f factory employees and with labor unions. -Also, the
deputies in their contact with manufacturers endeavor to interest
them in various phases o f industrial betterment work which are now
generally recognized as having an important relation to the acci­
dent rate; such, for example, are an adequate and up-to-date firstaid room, an employment department, improved sanitation, lunch
rooms, factory-training classes, instruction in English, etc. As a
means o f reaching the foreman and helping the manufacturer in­
terest him, the commission began in June o f this year to issue a
monthly safety magazine, which is sent to 5,000 foremen, at their
residence addresses. Employers are also urged to become affiliated
with the National Safety Council, and get the benefits which the
splendid service of this organization is able to offer them. The safety
educational service o f the commission is being gradually extended.
Needless to state, such cooperation is greatly appreciated by both
employer and employee.
A method which has been found very helpful in interesting the
manufacturer to inaugurate an intensive safety campaign in his
shop is to make a study o f the accident experience o f the plant and
place this in the hands o f the deputy. Employers are required by
law to report to the commission all accidents causing disabilities of
more than seven days. When a deputy is planning to get things
started in a particular factory he is given data taken from these
reports showing the number o f accidents in the plant within a given
period, the department in which they occur, their causes, the char­
acter o f the injuries, and the cost in compensation and medical ex­
pense. He is thus armed with facts which not only give him a
clear cut outline o f the problems which he wTill find in the plant,
but also enable him to put up a strong argument to the employer
on safety as an essential of business efficiency. Presenting an em­
ployer with a summary o f this kind has frequently had the effect o f
surprise and sometimes a shock. It never fails to make an impres­
sion. In many instances it has been the means o f convincing him
that it would be well to give closer attention to safety problems.
In several instances it has resulted in the employment of a safety
engineer on full time.
The Wisconsin compensation act has a unique provision to the
effect that when an injury is due to the failure o f an employer to
comply with any safety order o f the commission the compensation
o f the injured is to be increased 15 per cent. The additional com­
pensation must be paid by the employer and not by his insurance
carrier. By the same provision the workman is under obligation
to use the safety devices required by the orders, and if his injury




W H A T W ISCONSIN IS DOING— G. H . HAM BRECHT.

21

is clue to willful refusal to use such safeguards, liis compensation is
then decreased 15 per cent. It is one of the duties of the assistant
to the engineer to read all accident reports with a view toward select­
ing for investigation such accidents as appear to have been due to
violation o f the safety orders, following up the investigation and
reporting to the compensation department whether the employer or
the employee, as the case may be, should be held for the penalty.
The enforcement of this provision has helped greatly to create a de­
mand for copies o f the State safety orders, and to bring forcibly to
the attention o f the employer and employee.the necessity o f comply­
ing with the orders.
The safety department has been endeavoring to work in close
cooperation with the insurance companies and the Wisconsin Inspec­
tion and Eating Bureau, so that there will be as little confusion as
possible in the matter o f standards to be followed by the employer.
The deputies are familiar with the standards followed by these or­
ganizations and recommend to employers who are about to install
safeguards that they design guards which will conform to the
standard o f the rating bureau, in order that they may get the bene­
fit o f all possible rate reductions. An important step which has
been taken recently by the safety department o f the commission is
directed toward uniformity o f safety standards to be applied by the
State inspectors, compensation insurance companies, and the rating
bureau* Committees are now at work preparing uniform standards,
which will no doubt be readily accepted and put into effect, with the
result that confusion as to the requirements of these various agencies
will be cleared away.
During the past year the first industrial service conference given
under the auspices o f the Wisconsin Industrial Commission and the
Milwaukee Association o f Commerce was held in the city o f Mil­
waukee. The purpose of this conference was to bring home to the
manufacturers, industrial service workers, and others present the
most recent information and up-to-date thought on the subjects o f
safety, sanitation, employment, hours o f labor in their relation to
production, health conservation in industrial occupations, and other
important topics bearing on the general problems of securing effi­
ciency in production and improving the relationship between capital
and labor. The good results obtained from this conference are being
followed up by deputies of the safety and sanitation department,
who are assisting employers to establish the essential elements o f
industrial service work in plants wherever such aid is requested.
II. SPECIALIZED ACTIVITIES.
B u i l d i n g
c o d e
a d m i n i s t r a t i o n .— A State building code containing
the broad general requirements of fire protection, sanitation, and




22

ACCIDENT PREVENTION,

structural safety was made effective in Wisconsin in October, 1914,
The code affects all new construction and additions or alterations o f
structures erected prior to that date, and applies to all buildings, ex­
cept private residences, flat buildings for not more than two families,
buildings for agricultural purposes located outside of the corporate
limits o f a city or town, and purely temporary buildings, such as
sheds used in construction work.
The code is administered by two State building inspectors in co­
operation with local officials, chiefly city building inspectors, and the
chiefs o f local fire departments. The State inspector’s work con­
sists o f examination and approval o f plans submitted in advance o f
building, field inspection during construction, and final inspection
when a building is completed. The revised code, which is now being
printed, requires that plans and specifications o f the following build­
ings shall be submitted to the commission for approval before con­
tracts are let, or work is commenced:
Theaters and assembly h a lls ; schools, colleges, and a cad em ies; apartment
houses, hotels, and places o f detention ; factories, offices, and mercantile build­
ings, as fo llo w s :
(a ) All buiklings having floor or ro o f spans greater than SO fe e t;
(b ) A ll buildings which are m ore than tw o stories h igh ;
(c ) AH buildings which are tw o stories high and are m ore than 5,000 square
feet in area at the second floor level.

This branch o f the safety department also inspects and enforces
the orders on existing buildings and the orders relating to the safety
o f workmen engaged on construction work. The building depart­
ment from time to time has rendered service to a number o f munici­
palities in this State in drafting local building regulations and ordi­
nances relating to fire protection and fire prevention. Through the
examination o f plans the inspectors have frequently been able to
offer suggestions for improvement, often fo r lower cost than origi­
nally contemplated. Public addresses, newspaper articles, bulletins,
and educational leaflets have been utilized by the members o f this
department in giving publicity to the principles o f “ good building
and safety.
B o i l e r
i n s p e c t i o n *
— Nearly all o f the steam-boiler inspections in
the State are made by inspectors in the employ o f insurance com­
panies and municipalities. Only about 2 per cent o f the boiler
inspections are made directly by the State boiler inspector. The aims
in this work have teen to eliminate duplicate inspections and to pro­
vide for thorough and efficient inspection service by the insurance
companies and cities employing boiler inspectors. To accomplish
these objects the industrial commission, through its boiler com­
mittee, has adopted as part o f its boiler code provisions regulating
the inspection service conducted by private and municipal inspectors.




W H A T W ISC O XSIK IS DOI3TG---- G. H . HAM BRECH T.

23

The chief duties o f the State boiler inspector are to prescribe ex­
aminations and to issue certificates o f competency to inspectors in
the employ o f insurance companies and cities o f the first, second, and
third classes; to receive, examine, and file reports o f their inspec­
tions; and to inspect all steam boilers which are not insured, which
are not subject to municipal inspection, and which are not otherwise
exempt from State regulation.
In May o f this year a set of rules governing the installation and
operation o f refrigerating machinery, which had been prepared by
a special committee and discussed at a public hearing, were adopted
by the commission. The enforcement of these orders has been
made a part o f the duties o f the State boiler inspector.
I n d u s t r i a l l i g h t i n g .— The Industrial Commission o f Wisconsin was
perhaps the first State labor department to add an illuminating
engineer to its staff of deputies. The commission has long recog
nized the importance of good lighting as an aid in reducing acci­
dents and conserving eyesight, but it was not until the latter part
o f 1916 that it became possible to put an expert into the field to
assist the manufacturers in improving the lighting conditions in
their shops and factories. The results already accomplished have
been beneficial, not only to a large number o f workingmen, but em­
ployers also have gained thereby, because good lighting always
makes for efficiency and increased production as well as safety.
The principal duties of the illuminating engineer are as follow s:
1. Supervise lighting inspection in factories and all places o f employment.
2. Furnish plant managers inform ation regarding the best methods o f ob­
taining good industrial lighting.
3. Prepare bulletins to assist plant managers, engineers, architects, elec­
tricians, and others in conform ing w ith the State lighting orders.
4. Make lighting surveys and studies, to determine proper methods o f
lighting to be recommended by the industrial commission for different
industrial processes.
5. Supervise inspection o f electrical equipment for the purpose o f enforcing
the State electrical safety code.
6. Investigate accidents caused by electricity.
F i r e
p r e v e n t i o n
w o r k .— This branch of the safety department is
in charge of a superintendent o f fire prevention. Its functions may
be classified under the headings of fire prevention, fire protection,
building improvement, and education, as follow s:

A. Fire p reven tion :
1. Supervise inspection w ork o f all local fire departments, and receive and
examine their records and quarterly reports.
2. Receive complaints o f dangerous conditions, and make inspections to
enforce the State fire prevention orders.
3. Make original inspection o f conditions in 41 cities whose fire departments
are not continuing an adequate inspection service.




24

ACCIDENT PREVENTION.

A. Fire prevention— Concluded.
4. Issue orders to correct lire hazards.
3. To give special attention to the tire hazards existing in Hour mills, grain
elevators, wholesale houses, warehouses, and food repositories, and to
take necessary action to im prove conditions wherever this is found
necessary. D uring the past year 1,730 reports of such hazards have
been received and follow ed up, in cooperation w ith the State council
of defense.
B. F ire protection :
1. Assist local communities in organizing and reorganizing lire departments.
2. Investigate the adequacy o f local water and chem ical protection, equip­
ment, personnel, practice drills, proper housing, and care o f equip­
ment, etc.
C. Building im provem ent:
1. Offer assistance in securing better and safer construction.
2. Give advice regarding structural changes in order to make building
safer.
3. Regulate and isolate fire hazards in and around buildings.
4. Assist m unicipalities in fram ing local building codes and fire prevention
ordinances.
1). E d u cation :
1. Issue monthly bulletins for the press, lire chiefs, trades, schools, clubs,
civic bodies, etc.
2. Publish fire prevention day pamphlet.
3. Give public addresses at schools, clubs, commercial organizations, etc.
4. Issue fire prevention cards and posters.




CALIFORNIA’S ACCIDENT PREVENTION CAMPAIGN.
BY JOHN R. BROWNELL, SUPERINTENDENT OF SAFETY, CALIFORNIA INDUSTRIAL ACCI­
DENT COMMISSION.

The safety department of the Industrial Accident Commission of
the State o f California was organized early in the year 1914, with
a nucleus o f safety engineers, each of whom was a specialist in
some particular branch o f engineering, and included mechanical,
civil (construction), and electrical engineers. The department has
later been augmented by a force o f inspectors and is now as follow s:
Superintendent o f safety.
Tw o m echanical engineers.
T w o construction engineers (c iv il).
One electrical engineer.
T w o electrical inspectors.
One ch ief boiler inspector.
Three boiler inspectors.
One ch ief elevator inspector.
Four elevator inspectors.
Chief mine inspector.
Three deputy mine inspectors.
One first-aid instructor.

It should be stated that by arrangement with the Federal Bureau
o f Mines, the chief mine inspector is also employed by the Bureau of
Mines, his salary and traveling expenses being paid jointly by the
Government and the Industrial Accident Commission.
The 3Tear 1914 was spent largely in “ getting acquainted ” with the
employers and as far as possible with employees. Each safety engi­
neer was especially charged to try to interest employers in the
safety committee plan of accident prevention. Emphasis has there­
fore been laid upon the educational side o f the work.
The result has been gratifying, in that there are an increasing
number of employers who have developed their safety organizations
on a firm basis, with corresponding reductions in their accident fre­
quencies.
It is necessary that mechanical hazards be eliminated where pos­
sible, and hence the commission, exercising its power, has issued safety
orders and rules which now7 cover the following list o f subjects:
General; Mines; Woodworking; Laundries; Engines; Elevators;
Boilers; Air-pressure tanks; Trench construction; Window cleaning;
Electrical utilization; Logging and sawmills; General construction.




25

2G

ACCIDEKT PREVEI^TIOX.

These will soon be augmented by safety orders covering steam
shovels and locomotive cranes, safety rules for quarries, and safety
orders for electrical stations.
In the preparation of all safety rules and orders the plan was
adopted o f having an advisory committee meet with the commission’s
representatives and formulate a tentative draft, which was then
printed and given wide distribution to those who would be affected,
after which one or more public hearings were held, where opportunity
was given for full discussion*
Upon request, any of the tentative orders or rules were referred
back to the advisory committees, who passed finally upon such points
and submitted their recommendations to the commission. In prac­
tically all cases the committee recommendations were adopted by the
commission and put into effect on specified dates.
In the case of several of the safety orders and rules a fairly exhaus­
tive investigation in the field was first made by one or more of the
safety-department staff, and a preliminary draft drawn up as a basis
for discussion by the advisory committee. This proved o f exceptional
value in the preparation o f the logging and sawmill safety orders.
Mass meetings have been held by the commission in all the prin­
cipal cities of California, where illustrated talks were given on acci­
dent prevention. Numerous talks have also been given to groups o f
employees, where special stress has been laid upon the individual’s
responsibility as regards his own safety as well as in connection with
his part in preventing accidental injury to his fellow workmen.
From time to time various bulletins have been published dealing
with special hazards. Such a series comprised bulletins on the haz­
ards o f building construction. Cuts o f photographs were printed in
these bulletins in order to indicate clearly just what conditions needed
correcting. Other bulletins have dealt with boiler-room precautions
and with standard signals for woods donkey boilers.
In 1916 a u Safety Bear Club ” was organized among the miners
o f the State, and, in addition to wearing an appropriate celluloid but­
ton or badge indicating membership, each miner joining the club has
received carefully prepared letters sent to him individually in a sepa­
rate envelope. There are now over 8,000 members in the club, and
nine letters have been sent out to each member.
One o f the principal industries o f California is the manufacture
o f lumber. The giant redwood is found nowhere else, and the haz­
ards connected with the logging operations, as well as the handling
o f the huge logs at the sawmills, have been o f a special nature. Cali­
fornia also cuts millions o f feet o f white and sugar pine. A study
o f the principal causes of accidents in the lumber industry showed
that there was a large class which could be overcome only through
the personal caution o f the employee.




CALIFORNIANS CAMPAIGN---- J O H N R. BROWNELL.

27

As a result o f the cooperation of the California Redwood Associa­
tion and the California White and Sugar Pine Manufacturers’ As­
sociation, which cooperation extended financial aid, a set of eight
reels o f motion-picture films were taken and successfully produced
showing a series of experiences which were typical o f the hazards
to be overcome.
Mr, James C. Bennett, one of the safety engineers o f the safety
department o f the commission, prepared the scenario, and the actors
were all workmen at their actual tasks, or posed to show the results
o f observing the necessary precautions. The showing of the pictures
has been handled much the same as a circulating library, each o f the
eight separate reels dealing with practically a complete phase in
itself. The films were prepared during the latter part o f 1917, and
have been widely shown at various logging camps and sawmills o f
the State,
In January, 1917, the safety department issued its first number o f
“ California Safety News,” which has appeared as a monthly period­
ical o f 16 pages. W ith a few exceptions the articles have been writ­
ten by members o f the department. Illustrations have been freely
inserted and various phases of accident prevention have been treated.,
Through its corps o f safety engineers and inspectors the mechan­
ical hazards are being eliminated as rapidly as possible. The safety
orders and rules have become the recognized standards in all new
construction and in existing installations wherever practicable.
The basic principle of the workmen’s compensation, insurance, and
safety act under which the Industrial Accident Commission operates
stipulates that all safety requirements shall be reasonable, and hence
a broad and flexible interpretation is given.
The “ Star and club ” method of handling inspections has been
taboo from the inception of the safety department and a spirit,
rather, o f cooperation and service has been developed which has won
the unqualified support o f all concerned.
In the spring o f 1914 a safety museum was started by the com­
mission. It has grown to such proportions that approximately 3,000
square feet o f floor space is occupied with several hundred separate
exhibits o f safety devices. These are augmented by collections o f
photographs showing safeguarded conditions in California’s indus­
trial plants. There are also several exhibits of photographs from
other States. The museum is advantageously located on the ground
floor of the Underwood Building at 529 Market Street, San Fran­
cisco, and has often had a daily attendance of over 700 visitors. A
capable caretaker is in charge at all times to explain the operation of
any device or to indicate by photograph how various hazards have
been overcome.




28

ACCIDENT PREVENTION.

Several hundred lantern slides have been prepared and are on file
in the safety department for use in lectures by various members o f
the staff, besides being available to safety engineers and others who
desire to show them at industrial-plant committee meetings and
safety rallies.
With the vastly augmented shipbuilding program, the shipyards o f
California began to enlarge existing equipment, and a number o f new
companies came into the field. This has meant a corresponding in­
crease in an employment which presents probably the two most pro­
lific sources o f accidents, namely, (1) falling, flying, and rolling
materials, and (2) personal falls.
In April, 1918, the superintendent of safety of the commission
called a meeting o f safety engineers and inspectors o f the various
shipbuilding concerns o f the San Francisco Bay region. The meet­
ing proved successful in bringing together in a round-table discussion
those who were in closest touch with the work. Mr. C. E. Ealston,
Government safety engineer at Mare Island Navy Yard, attended,
find by his enthusiasm and practical ideas gave valuable impetus to
the spirit o f the meeting. Subsequent meetings have been held at
approximately monthly periods.
The shipyards at San Pedro, Long Beach, San Diego, and Eureka
are so widely separated geographically as to make it impracticable
for them to participate in the discussions, but through inspections by
our safety engineers they are kept posted on the best practices.
A letter has been sent to the Emergency Fleet Corporation,, asking
for their cooperation with the commission in taking motion pictures
o f shipyard hazards. The matter has been referred to Washington
for decision, and we are hopeful o f receiving a favorable answer to
the proposition.
The employment of labor in new fields, and especially the increas­
ing tendency for women to discharge the duties commonly performed
by men, has been a cause of more or less apprehension as to any sub­
stantial reduction in the accident frequency, Jbut it is none the less to
be conceded that where earnest accident-prevention propaganda is
carried on there will result correspondingly fewer accidental injuries
in our industries, and California is determined to clo her part in con
serving the man power o f the Nation.




W H A T T H E N E W Y O R K S T A T E IN D U S T R IA L C O M M IS S IO N IS
D O IN G T O P R E V E N T A C C ID E N T S .
BY JAMES Ii. GERNON, FIRST DEPUTY COMMISSIONER, NEW YORK STATE INDUSTRIAL
COMMISSION.

The Bureau o f Factory Inspection of the New York Department
o f Labor has, since July 1, 1915 (at which date the present indus­
trial commission was created), conducted a most vigorous campaign
to prevent industrial injuries and has accomplished very satisfac­
tory results in securing compliance with the large number o f orders
issued relating to sanitation, accident prevention, and fire protection.
New York State has within its borders 65.449 factories, employ­
ing 1,500,000 people. The industries are diversified— including prac­
tically every industry found in other States of the Union, many of
them in greater number than in any other State and some in such
large numbers that they present difficult problems peculiar to the
industry.
Many o f the larger industrial plants employ safety engineers, who
carry on very creditable safety campaigns and some excellent wel­
fare work. Nevertheless, there are many large establishments that
do not employ safety men nor have they properly organized safety
work in their plants. Many w7ho endeavor to carry on safety cam­
paigns fail in their effort, due to an inferior type of safety director.
In some instances where the director is competent, failure is due to
the management o f the establishment in not permitting the director
to spend sufficient money to install safeguards properly and organize
safe practices in a practical and efficient manner. Thus, it very
frequently happens that improper and impractical guarding has to
be discarded and orders issued by the inspection bureau to provide
adequate protection to the employees o f the establishment.
While many plants in our State are doing very creditable work
in their endeavors to prevent industrial injuries, it should be borne
in mind that many thousands of factories do nothing to organize
effective safety wTork—some because of lack of knowledge or indif­
ference, others because of their reluctance to spend money for the
installation of devices to protect the workers from injury. In many
establishments this policy is pursued, regardless of the fact, which is
now generally conceded, that the installation of safeguards, the
adoption of safe practices for the industry, and the instruction of
the employees regarding these practices are known to be a paying




29

30

ACCIDENT PREVENTION.

investment, even in the smallest plant. There are many small manu­
facturers to whom the cost of safety devices is a serious problem,
because of the financial condition of the business, and far too many
o f them believe that in paying a premium for compensation they
have protected themselves from financial loss, the cost of injuries
being shifted to the insurance carriers. They have no regard con­
cerning the injury or physical suffering which their employees may
experience.
In consideration of all these difficulties, the New York State In ­
spection Bureau has grappled with this important problem and has
been fairly successful in mastering the same. It should be borne
in mind that those responsible for the conduct of the large majority
of the manufacturing establishments know far too little o f the prac­
tical methods o f installing safeguards or conducting safe practices
in industry. They can not afford to hire a safety engineer and do
not seem competent to meet the problem in a practical w ay; therefore*
the State inspector must act as safety man in this large class o f
establishments. In this type o f establishment, and in those where
they readily install proper safeguards, the inspector must instruct
both the employer and the workman in a practical, up-to-date method
o f safeguarding and in the inauguration of a proper plan o f con­
ducting a campaign o f safe practices.
In the enforcement o f orders relative to safeguarding employees
from injury there are those who claim that all that is necessary to
induce manufacturers to install safeguards is proper cooperation
between the manufacturer and the State inspection bureau charged
with the enforcement o f the provisions o f the law. Such cooperation
is ideal; it is essential, but not always possible to secure. Experience
shows that without a policy o f insistence on compliance with the or­
ders issued, and without the power to prosecute violators of. the law
or authority to tag machinery unsafe, not much would be accom­
plished. A very large percentage o f the manufacturers in New Y ork
State are cooperating w'ith the inspection bureau. These manufac­
turers deserve great credit for the results accomplished by them in
making their plants as safe as possible. Their efforts will compare
very favorably with employers o f other States in their desire to
make their establishments as safe as possible, in order to protect the
employees from industrial injury.
A conservative estimate o f the cost for installing safeguards in
compliance with the orders issued in New York State for the past
three years will total an aggregate o f $530005000.
You will understand that the number of orders relative to accident
prevention does not include the number o f machines to be safe­
guarded. Our order may mean the guarding o f one machine, or it
may mean, as frequently happens, the guarding of hundreds o f ma­




WHAT M W

YORK STATE IS BOIXG-----J. L. GER3ST0X.

31

chines o f the same type. Nevertheless, far too many o f the establish­
ments must be forced to do what is reasonable and fair for the protec­
tion o f their employees will be shown in the tables o f prosecutions,
tagging, etc., accompanying this report.
In order to measure properly the results accomplished in New
York State, there is presented here the figures relative to orders
issued and compliances secured for the past five years:
O R D E R S A N D COMPLIANCES R E P O R T E D B Y THE. D IV ISIO N OF FACTORY IN SPE C TIO N
IN THE: STATE O F N E W Y O R K FROM OCTOBER 1, 19-13, TO JU N E 30, M g .
Orders and compliances relating to health and safety.
Sanitation.

Fiscal year ending—

Accident
prevention.

Fire
protection.

TotaL

Whole number
; of orders amt
compliances.

Sept- 3G, 1914.........
Sept. 3D*, 1915..........
June- 30, 1916t.,........
June 30-,1917...........
June 30,1918...........

; 74,359 4L<m 70, m
41,418 : 34,24? 50,742
>32,088 ' SI,.944 36,483
53,555 68,201 i 46,288
48*735 54,849 * 39,730

40,286 m > m
38,122 '■33,710=
41,634 : 13>433
: 9y6S4
47,47a 1 6*022-

; 58,947
27,378
: 22,69S
: 17,481
8>39T

m m

Compli­
Compli­
Compli­
Compli­
Orders. Compli­
ances. Orders. ances. Orders. ances. Orders. ances. OsdeiSv ances.
143,327
! 99,754
96,277
: 141,168
110,721

287,893 179,826
163,96S 135,697
>116,399 . 125,889
173,982 206,§25
135,703 ; 152,361

T o ta l............ 250,105 228,335 244,011 22&,am 168,1-54 134,908 662,279 2591,247 ■877, Ua »80Q, 3CS
1 For 9 months.
2 E x c lu siv e ^ f 16>132, 8,422, and 31,425 orders relating- respectively to sanitation, accident prevention,
and firejprotectioa, in? wmefr eases jurisdiction was. transferred- fey law to> N ew Y ode City departments,
or the illegal conditions ceased to e x ist by reason of modifications in th e Labor L aw and Industrial Code,
rem ovals, fires, or accompanying- eireumstaaeea aoeh as to-naaie th e original* orders Bta longernecessary
to be enforced b y th e Department o f Labor. These figures bring th e aggregate num ber of orders disposed
of in regard to sanitation, accident prevention, and fire protection up to , respectively, 244,567, 236,432, and
166,327, th u s leaving 5,638, 7,579, and 1,827 orders outstanding on July 1,1918, respectively, i a relation to
sanitation, accident prevention, and fire protection, making a total of 15,044 orders outstanding on
July 1,19-18, for these-three groups.
3 Exclusive o f62,108rorders in which jurisdiction was transferred by law to N ew Y ork City departm ents,
or the illegal conditions ceased b y reason of modifications in the Labor Law and Industrial Code, rem ovals,
fires, or accompanying circumstances such as to make the original orders no longer necessary to be enforced
b y the Department of Labor. These figures bring th e aggregate number of orders disposed of up to
862^506,leaviingate^afof 15,4^G®cfeES-©iiteta£Qding;o® July 1 , 19-18-., In d u d ed m th ese 15,439uncompMed with.
orders are 4,440 orders th a t were issued* in the m onth of June, 1918; and th e im possibility of securing
compliance w ith th e major portion- of these latter orders before July 1 is readily apparent.

There were 877,945 orders issued and 800,389 compliances secured.
O f the remaining 77,547 orders, 6-2,108 constituted fire protection
orders in New York City, which were transferred to the New York
City fire department by reason o f modification of the Labor Law
placing the responsibility for compliance with these orders on the fire
department o f that city. This leaves 15,439 orders uncomplied with.
In this number are included 4,440 orders issued in the month o f June*
1918.
The table also shows the number o f orders issued and compliances
secured relative to health and safety, which include orders for sanita­
tion, accident prevention, and fire protection. A total of 662,270
orders were issued; 591,247 compliances were secured. It is evident
from these figures that there remain 15,044 orders o f this class
uncomplied with. In this number are included 3,514 orders issued in
the month o f June, 1918, compliance with which can not be expected
before July 1, 1918. There being but 15,439 orders o f all kinds out­




32

ACCIDENT PREVENTION.

standing shows tliat our compliances are nearly up to date, or as near
so as can be expected wlien the character o f the orders and the time
it will take to do the work are taken into consideration.
Under the provisions of section 81 o f the Labor Law, we are em­
powered to tag as unsafe all machines which are dangerous and un­
guarded. With this provision of law we have the most effective
means o f securing compliance with the orders issued. I f the orders
are not complied with at the time set forth in the notice o f orders, a
letter known as a “ Machinery tagging letter ” is forwarded, fixing a
definite date for compliance.
W e are in receipt o f a report from our inspector that you have failed to com­
ply with the orders o f the department, to w i t :
1. Properly guard belts and pulleys o f job presses.
This shows that you are m aintaining a hazardous condition in violation o f
section 81 o f the Labor L a w :
When in the opinion o f the commissioner o f labor a machine or any part
thereof is in a dangerous condition or is not properly guarded or is dangerously
placed, the use thereof shall be prohibited by the commissioner o f labor (State
Industrial Com m ission), and a notice to that effect shall be attached thereto.
Such notice shall not be removed except by an authorized representative o f the
Department o f Labor, nor until the machinery is made safe and the required
safeguards or safety appliances or devices are provided, and in the meantime
such unsafe or dangerous machinery shall not be used.
Unless the above orders are satisfactorily com plied w ith by August 20, 1918,
the department w ill cause the machinery to be tagged in accordance w ith the
provisions o f the Labor Law, thereby prohibiting the use o f such machinery until
the orders are fully complied w ith and the hazard removed.
Tours, truly,
Supervising In spector.

Should the order not be complied with at the time indicated in the
“ Machinery tagging letter,” the "unsafe tag is applied to the machine
and its use prevented.
UNSAFE.
By virtue o f the pow er conferred upon the Commissioner o f L abor in section
81 o*E the labor law, the use o f this pow er press is hereby prohibited until made
safe.
This notice must not be removed except by representative o f this department.
To In spectors:
This tag must be applied in all cases w here a machine or any part thereof—
(1 ) Is in a dangerous condition.
(2) Is dangerously placed.
(3) Is im properly guarded.
(4 ) Guard is removed.
(5) Term s o f our notice not com plied with within the tim e specified therein.
Return this tag w ith report to supervising inspector.
Removed by inspector on ---------- , 191-.
Name and address o f concern ---------- .
Rem arks ---------- .




33

W H A T N E W YORK STATE IS DOING-----J. L. GERNON.

Tliis has proved the most effective method of securing compliance
with the orders to safeguard machinery. We issue many o f these let­
ters and are compelled to apply the “ unsafe” tag in very few in­
stances, when compared with the number o f letters issued. In only
933 cases were the tags used in the fiscal year ended June 30, 1918,
which is small in number when compared with the 47,475 compliances
for aceident-prevention orders secured in the same period.
Following is a list of machines to which tags were attached:
Shafting and couplings, buffing, polishing and grinding wheels, drill presses,
saws o f all kinds, planer, jointers, and molding machines, corner staying ma­
chines, extractors, laundry machines, winder, calenders, and rolling machines,
belts and pullej-s, printing presses, punch presses, stamping and rivetting ma­
chines, gears, lathes, milling machines, mixers and kneaders, ruling machines,
lapping machines, reamer, and slotters.

The effectiveness of this system is proved by the small number of
prosecutions begun relative to accident prevention orders in compari­
son to the number of prosecutions for other classes of orders issued.
The following statement shows the number of prosecutions begun
during the year ending June 30, 1918:
A d m in istra tion _______________________________________________
S a n ita tion ____________________________________________________
Accident prevention___________________________________________
Fire protection_______________________________________________
C h ild re n ______________________________________________________
Women and male m in o rs_____________________________________
Day o f r e s t___________________________________________________
M isce lla n e o u s________________________________________________

7
502
52
230
433
191
257
137

T o t a l ___________________________________________________1,869

The 52 prosecutions for accident prevention, as shown in this table,
were in instances where the application of the “ unsafe ” tag would
not prevent the use of a machine. Their character is indicated in
the following table:
Prosecutions instituted in current year relative to accident prevention.
1.
2.
3.
4.

Elevators and hoistways_____________________________________ _13
M achinery (including vats, pans, e t c .)____________________ *_ 13
Stairs, platforms, pits, floors, etc. (including re p a irs)______ 13
Lighting to prevent accidents_______________________________ __13

The New York Department o f Labor realizes that the hazard in
industry is very great. In the fiscal year ended June 30, 1918, there
were 300,000 industrial accidents reported to the commission, result­
ing in 55,000 claims for compensation. The injuries cost approx­
imately $35,000,000 to $40,000,000, and the compensation awarded
will total approximately $14,500,000. This is an enormous economic
loss, regardless o f the suffering these injuries entail. They should
124247°— 19------ 3




34

ACCIDENT PPiEVEXTIOST.

be reduced to a minimum. When we measure the claims for com­
pensation with the number o f factories in the State, we find that
there are less than one for each factory. It should not be forgotten
that the injuries reported and those for which claims for compensa­
tion are made are not all sustained in factories. A t least half the
injuries occur in those industrial groups over which the inspection
bureau has no power to regulate or improve the hazardous condition.
The inspection bureau has been very successful in its policy o f
requiring every inspector to report all installations of new ma­
chinery installed since previous inspection, where the machine itself
is ^dangerous and the manufacturer of the machine has failed to
guard same properly. In each instanee a communication, giving in
detail the defects, is sent to the manufacturer o f the machine asking
that they be corrected. It is very gratifying to say that in every
instance the makers o f the machines have signified their intention to
remedy the-defects and have heartily cooperated with the bureau o f
inspection in an effort to make their machines safe for the operator.
We have completed special surveys o f the dyeing and cleaning,
textile, and chemical industries, the report o f the last two not being
published to date. We are conducting special surveys relative to
ventilation, which is a very essential but difficult problem in many
industries, especially those using poisonous or injurious gases, fumes,
or substances. When these surveys, investigations, and lists are com­
pleted, the industrial commission can establish standards on a
scientific and practical basis, and thus forge a few more links in the
already strong chain o f safe practices being enforced for the pro­
tection o f the industrial workers.
Never in the country’s history has so much depended on our in­
dustries, and most important are the workers in such industries.
The present world conflict will be decided in favor o f the nations
having the greatest man power. Never has a worker been valued so
highly. So in this campaign for safe practices in industry we only
do our share when we furnish our full measure of protection to the
workers in industry, so that they may contribute all their efficiency
and skill to the country’s cause.




T H E V IT A L

IM P O R T A N C E O F IN D U S T R IA L -A C C I B E N T
T IO N IN W A R T IM E .

PREVEN­

BY VICTOR C. NOONAN, DIRECTOR OF SAFETY, OHIO INDUSTRIAL COMMISSION.

A ll the industrial commissions and compensation boards of the
United States and Canada should at this meeting consider and
devise some plan to bring home to the employers and workingmen
o f the United States and Canada the very vital importance in these
war days o f conserving man power—in other words, of more thor­
oughly protecting human life and limb and reducing industrial acci­
dents to a minimum. It is now as clear as daylight to all who have
given any thought to accident prevention that at least 25 to 75 per
cent o f the accidents occurring in workshops and factories can be
eliminated. The splendid accident reduction experience o f the
United States Steel Corporation and o f thousands of individual
plants throughout the country has proved beyond the shadow o f a
doubt the great possibility o f preventing both fatal and nonfatal
accidents.
During the past year the department o f safety o f the Industrial
Commission o f Ohio has conducted a survey in about 500 o f the
larger industries of the State with a view to finding out definitely
what results were being obtained by organized businesslike safety
work. The survey shows that where accident prevention was a busi­
nesslike department, thoroughly organized, with workmen’s safety
committees, and where the number, causes, frequency, and cost of
accidents were carefully kept and accidents investigated, there was a
reduction of anywhere from 25 to 75 per cent in the number o f
accidents reported since these companies had commenced accident prevention work.
In spite of the good work that has been accomplished along safety
lines, much more can be done. I am glad to say that the war has
given the safety movement throughout the country a much-needed
stimulus. It has become apparent that for every soldier we send to
the trenches we must protect and safeguard at least 10 workers in
the factories. When one of these workers is killed or disabled by
industrial accidents the loss of that worker to the country, to my
way o f thinking, is ten times greater than if one o f the boys in the
trenches had been killed or disabled. Accident prevention, therefore,
should be a very important war activity; in fact, it should be one o f
our most important war activities. Employers and workmen alike




35

36

ACCIDENT PREVENTION.

iiiust consider it their highest patriotic duty to do everything pos­
sible to prevent accidents. Every fatal accident, every eye lost,
every hand or foot crushed or amputated— in a word, every accident
that occurs to a worker—is just as much o f a victory for Germany
as if those workers had been disabled by German guns. On the other
hand, every accident prevented is a glorious victory for the Stars
and Stripes. It is a victory also for better living, better citizenship,
and happier homes.
Industrial-accident prevention, therefore, gives us a great oppor­
tunity to make the industrial life o f our country a safer place to
wrork in. Industrial-accident prevention will not only teach men and
women to be more careful, but it will teach all the workers, as well
as employers, how to think. It will teach the workers to be more
industrious, more thrifty, more sober, and more upright. Industrialaccident prevention will also give all o f our people a higher appre­
ciation o f the value o f human life and limb, and surely in these
days, when life and limb are held so cheaply, that higher apprecia­
tion is sadly needed.
No organization or organizations can do more to promote indus­
trial-accident prevention than the industrial accident boards and
commissions o f the United States and Canada working as a body,
and also each State working individually.
In Ohio during the past four years considerable educational accident-prevention work has been accomplished: First, through meetings
o f employers, superintendents, and foremen; second, through meet­
ings o f employees; third, by safety exhibits; fourth, by safety motion
pictures illustrating the cause and prevention o f accidents reported
to the commission; fifth, by safety bulletins and other literature;
and, sixth, by a study o f the accident experience o f individual plants
or groups o f industries.




W H A T PENNSYLVANIA IS DOING TO PREVENT ACCIDENTS.
BY ROBERT D. YOUNG, PENNSYLVANIA SAFETY MAN.

It has been well said, “ Cooperation is to-day an accepted element
in any program of industrial or social improvement,” and the one
great question at present confronting those agencies having as their
purpose the conservation of life and limb in industry is the extension
o f this cooperative element, and we feel that the Pennsylvania De­
partment o f Labor and Industry has in the past few years put forth
splendid efforts along these lines, and, although accidents have con­
tinued to occur with alarming frequency, especially in 1916, 1917,
and 1918, due in part to the abnormal war conditions prevailing, we
are going on, confident that the pendulum will soon swing forward
and that this preliminary or ground work will be reflected in the
coming years in a material reduction of the injuries and deaths caused
by preventable accidents.
To elate, for 1918, both fatal and serious accidents in the industries
of Pennsylvania show a decrease over the same period for 1917, this
notwithstanding the increase in the number o f men employed this
year over last year. There is still, however, much to be done to bring
accidents down to a minimum, and to this end the Department o f
Labor and Industry is endeavoring to secure a more continuous co­
operation of the employer and employee.
The laws as enacted in Pennsylvania make mandatory the provid­
ing o f safeguards for machinery and for the protection of all hazards,
yet it is necessary, through educational endeavor, to impress the em­
ployees that such safeguards shall be used, and that every device or
instrument which may be approved as desirable or effective in the
prevention o f industrial accidents shall be likewise constantly and
conscientiously used.
As we are all aware, regardless of how well machinery may be
safeguarded or how processes may be changed to eliminate the
danger of injury, there still remains, as the most important and the
most difficult factor in the whole situation, the personal equation,
mostly the employees themselves, and our energy and attention as a
department has been directed to them—however, with the cooperation
and help o f the employer.




37

38

ACCIDENT PREVENTION.

As a solution to this aspect of tho problem we have been apply­
ing our best thought to the development of a system of industrialaccident-prevention education, realizing that if prompt or imme­
diate returns are to be had the industrial worker must be educated
and trained in safe practices—to understand thoroughly the hazard
o f his job and to perceive and avoid danger, not only to himself but
also to his fellow employee.
We shall indeed be remiss i f we do not lay plans for the education
of the industrial worker o f to-morrow, and it is to be hoped that
before long a comprehensive system of personal safety education will,
through the cooperation o f the school authorities and the Depart­
ment o f Labor and Industry, be devised which will be productive
o f the best possible results in that direction.
In our educational work the first point of attack is the employers
and the plant managements. Through personal interviews we en­
deavor to point out to them, both from the humane and the financial
side o f the proposition, the importance o f conserving their man
power. We are pleased to observe that, when attention is called to the
daily appalling waste through industrial accidents, to the physical
suffering o f the injured, and to the privations which follow an in­
jury to the wage earner, the sympathy of the employers and their
generous impulses have been stirred, resulting in their taking up the
work in an earnest, sincere manner. We are also pleased to state
that the majority of those establishments which have had the matter
called to their attention have organized for safety, which augurs
well for the success of accident prevention in Pennsylvania.
After we have interested the plant managements in the safety
work we assist them, if they desire, in the formation o f their accident-prevention campaign, and furnish gratis a series o f motionpicture exhibits and hold safety rallies, which help to keep the em­
ployees interested in the work. Already the department’s motionpieture films have been exhibited to thousands of our industrial
workers and their families throughout the State, and those pictures
have, no doubt, been productive of much good.
In addition to the safety films the department sends, without
charge, safetv posters and bulletins.
The success or failure o f an accident-prevention campaign m a
plant depends in a large measure upon the attitude o f the foremen
toward the movement, and consequently we consider it necessary to
impress them with their great responsibility in the protection o f the
workers under their supervision. T o accomplish this purpose, spe­
cial meetings for superintendents and foremen are held in the various
localities, at which forceful speakers drive home the safety lesson.




W H A T PEN N SYLVANIA IS DOING---- Pt. D. YOUNG.

39

Witliin recent weeks more than 40 such meetings were held by the
Western Pennsylvania Division of the National Safety Council, in
cooperation with the Department o f Labor and Industry, in Alle­
gheny and adjacent counties, attended by at least 4,000 superintend­
ents and foremen.
Meetings are frequently held during the lunch hour for the work­
men and are addressed by our inspectors. A ll this tends to keep the
matter of self-preservation constantly on the worker’s mind.
In addition to our factory inspectors, we have special accident in­
vestigators w7ho devote all their time to the investigation o f fatal
and serious accidents. These operate under the direction of the bureau
of safety.
Assuming that all accidents are preventable, a case is not con­
sidered closed or filed until there has been received by the depart­
ment positive evidence that something definite has been done to pre­
vent the recurrence of a similar accident, either from the employer
or from the accident investigator. Immediately upon the receipt of
a fatal-accident report, which by* law must be forwarded to the de­
partment within 24 hours after the accident occurs, the report is
forwarded to the investigator in whose district the accident hap­
pened. The investigator proceeds to the scene of the accident with
the least possible delay, thus enabling him to ascertain the cause of
the accident before the conditions are changed, and to issue instruc­
tions or recommendations for the prevention of another similar
accident. Upon the receipt of the investigator’s report of his in­
vestigation by the bureau of safety, the matter is taken up direct
b y the bureau with the company, and the importance o f prompt com­
pliance with the investigator’s recommendations is pointed out to
them. I f the company has a safety organization, a general outline
of how it is conducted, with a report of the number of accidents for
the previous two years, with the average number of employees, is re­
quested. I f the company has no safety organization, it is urged to
take up accident prevention wrork through this system, which our
experience has proved to be efficient. Through this method we are
enabled to ascertain just what the companies are doing to prevent acci­
dents.
To still further the cause of safety, the department is cooperating
writh the organized labor bodies of Pennsylvania in putting into effect
the resolution presented and adopted by the American Federation
of Labor in convention at Buffalo, 1ST. Y., Saturday, November 17,
1917.
Already a State labor safety committee has been appointed, and
safety committees are being appointed in all the local unions of the




40

ACCIDENT PREVENTION.

State, and, as we see it, through this means safety is but the entering
wedge whereby a better understanding can be developed between the
employer and the employee. With it must come a frank discussion
of one vital problem, the solution of which works for their mutual
benefit.
Having found that the cooperative plan really works for the good
of all in this one instance, does it not stand to reason that the circle
of application wTill grow, become larger and larger, until through
faith in each other the contending forces will be led out of the
wilderness of strife and misunderstanding into the promised land of
industrial peace— made a fact through a square deal for all?




W HAT

M A S S A C H U S E T T S IS

B Y W IL L IA M

D O IN G

TO

PREVENT

A C C ID E N T S .

W . K E X N A R D , C H A IR M A N , M A S S A C H U S E T T S IN D U S T R IA L A C CID EN T
BOARD.

At the present time the work of accident prevention per se in Massa­
chusetts is delegated, by an act of the legislature passed in 1916,
Acts of 1916, chapter 308, to a State commission known as the Board
o f Labor and Industries.
When the Massachusetts Industrial Accident Board was created
this work was placed with our board, and our earlier reports indicate
the scope and character of the work done. It was found, however,
that there was a duplication of work at many points with the work o f
the commission on labor and industries, and particularly was the
complaint made from the shop and factory owners that the constant
and repeated visits and investigations of inspectors from various
boards and commissions and the varying orders received were con­
fusing and disorganizing and that the situations created had become
highly burdensome. It should be understood that it was not these
two boards alone, but various other governmental agencies, National,
State, and local, which were contributors to the conditions com­
plained of. It was commonly stated by manufacturers, and with
some basis of justification, that hardly a day went by that they were
not inspected and directed by an agent from some board or other.
To help out this situation and to relieve the manufacturers so far
as accident prevention work was concerned, in 1913, by chapter 813
of the acts o f the legislature of that year, it was provided that the
Industrial Accident Board and the Board of Labor and Industries
should work in conjunction and cooperation in accident prevention
work. This was found to be so unsatisfactory that in 1916 the pres­
ent law, giving sole jurisdiction to the Board of Labor and Indus­
tries, was enacted; since which time the work of our board has been
confined to the broad consideration of the problems involved in acci­
dent prevention, rather than the actual detail.
Our statistical department still furnishes an excellent compilation
o f causes o f accidents gleaned from our reports, which makes a val­
uable basis for investigation. The Board o f Labor and Industries
has in our department one of its employees to whom is available our
reports o f injuries, which are made the basis of actual field investi-.
gation by the Board o f Labor and Industries.




41

42

ACCIDENT PREVENTION.

You may wonder that this work was permitted to be taken from the
control o f the board which would appear to be its proper administra­
tion. Our Board of Labor and Industries is, however, charged with
functions which make this work closely allied to its other functions,
viz, preservation o f health conditions, observance o f hours o f labor,
etc.
Moreover, the administration of the compensation law in Massa­
chusetts has been so established that our board finds itself with its
time fully occupied. Every case in which any dispute arises which
cannot be amicably settled between the parties comes ultimately before
a member o f our commission personally, first at a conference, and, if
not adjusted there, later at a formal hearing, always with an attor­
ney on one side, and ordinarily on both, and later, in case o f appeal,
before the full board, which sits one day each week to hear such cases.

When I call to your attention that last month there was reported
to our board 18,000 injuries to employees, you will perhaps better ap­
preciate why, speaking for my board, I do not report greater activi­
ties in our department along the lines of accident prevention.




A C C ID E N T P R E V E N T IO N
BY

GEORGE

A. K IN G S T O N ,

IN

C O M M IS S IO N E R ,

IN D U S T R IE S
WORKM EN’ S

IN

O N T A R IO .

C O M P E N S A T IO N

BOARD

OF

ONTARIO .

The Workmen’s Compensation Act o f Ontario differs from most
other acts in respect to the provision made for the prevention o f
accidents, and offers at the same time an inducement to the employers
to cooperate.
Under the Ontario act the employers in any particular class cov­
ered by the act may form an association for the purpose of establish­
ing rules and regulations for safety or accident prevention among
their employees. Such association must, o f course, represent a sub­
stantial majority of the industries in the class concerned. When
such rules and regulations are adopted by the association and ap­
proved by the workmen’s compensation board and the lieutenant
governor in council they become binding on all the manufacturers
in the class represented. The associations so formed appoint in­
spectors to visit the different plants of the employers for the purpose
o f recommending such mechanical improvements or safety devices
as may be considered important or necessary, encouraging and assist­
ing in the development o f safety work, and the formation of safety
committees in the shops, and generally in promoting the work o f
applying the “ ounce o f prevention.”
The Industrial Accident Prevention Association of Ontario, which
embraces the several associations formed under the act, with their
staff o f seven inspectors, made approximately 10,000 safety recom­
mendations last year. Each recommendation is followed up until a
report is received from the employer that the recommendation has
been satisfactorily disposed of. It is perhaps remarkable to note
that the association has been able to obtain cooperation from the
employers to such an extent that recommendations made are carried
out as stated below :
Ninety per cent are carried out, as first made, without question.
Five per cent require some suggestion as to how the recommenda­
tion may be carried out.
Five per cent require some further explanation or reason given,
or a second visit of the inspector.
A report o f each inspection, showing the recommendations made
and the disposition o f each, is filed with the workmen’s compensa-




43

44

ACCIDENT PREVENTION.

tion board, which enables the board at any time to check up in case
o f accident, first, to see if the accident is one that could have been
prevented, and, second, to find out the attitude o f the employer
toward accident prevention generally as applied to his plant.
Merit rating is a further inducement for the emplo}^er to cooperate
with the work of the safety inspector.
The policy o f the Accident Prevention Association is to act as
advisers on safety work and assist in every way in devising means
to apply mechanical devices or guards, where possible, and to assist
in the organization of shop safety committees, solicit subscriptions
for the bulletin service, and promote the use of safety warnings in
shops.
In selecting inspectors for the work mentioned men of practical
experience have been chosen, those who have had experience in the
particular classes represented by the association. These inspectors
meet frequently for the purpose of exchanging information and
to establish certain standards to enable them to work on a plan that
is uniform.
It is impossible, of course, to form any accurate judgment as to
the extent to which accidents may have been prevented. It is inter­
esting, however, to note the improved physical condition o f the
plants that have been under the supervision of these inspectors for
the last few years. Frequent requests are received from employers
for information and advice as to some plan they have under con­
sideration for accident prevention.




W HAT

IN D U S T R IA L

C O M M IS S IO N S

CAN

DO

TO

PREVENT

A C C ID E N T S .
B Y S ID N E Y J . W I L L I A M S , M A N A G E R , A C CID EN T PR E V EN TIO N D IV IS IO N , N A T IO N A L
SAFETY

C O U N C IL .

An essential to success in any safety campaign, whether State­
wide or in an individual plant, is a proper balance between safe­
guarding and education. Education will prevent a greater number
of accidents; safeguarding will prevent more serious accidents.
Education brings the greatest results for the least money, and is
therefore favored by the employer; safeguarding suggests laws, in­
spections, the “ big stick,” and has naturally been emphasized by
most governmental departments. Education without safeguarding
is not sincere; safeguarding without education is narrow. Either
one without the other can achieve only limited success.
The pendulum swings back and forth, but each oscillation brings
us closer to the golden mean. The employer who said a few years
ago that all accidents were due to carelessness, and that legislative
requirements were absurd and oppressive, was not entirely wrong;
many legislative requirements were absurd and oppressive. Now,
when State codes are framed by expert administrative bodies, guided
by the best advice obtainable, such objection is not heard so often
from the employer. Yet I know State departments in which the
chief executive is beyond reproach in his sincere desire to give his
people the best possible service, but where the arbitrary and unin­
telligent behavior of some of the field inspectors still gives em­
ployers just ground for complaint and prevents complete harmony
of feeling and action. There is only one thing to cI q wTith such in­
spectors if the department is to be made really efficient.
On the other hand^ State officers often have good reason for feel­
ing that a certain employer has introduced a safety organization in
his plant principally to cover up glaring defects in his mechanical
equipment. Such camouflage, which does not deserve the name of
safety education, is looked upon with disgust by every employer who
is doing honest safety work, and I believe that the number of em­
ployers in the first-mentioned class is growing smaller, or at least
the number who are doing honest work is rapidly increasing. This
tendency in the right direction is hastened by the growing realiza­
tion that in a plant of any considerable size the safety work can not
be left to a committee or a system of committees, but should be in
charge of an experienced full-time safety engineer. No safety engi­
neer with the most rudimentary idea of honesty will attempt to
conduct an educational campaign until he has at least made a start
in correcting physical hazards. Reflecting this attitude, the National




45

46

ACCIDENT PREVENTION.

Safety Council, which is essentially a cooperative organization of
employers, is giving increasing attention to mechanical safeguard­
ing and engineering revision. Of course, the council can not require
the observance of standards on the part of its members; but it can
cooperate with other national and State organizations, both public
and private, in wTorking out correct and reasonable standards, and
can encourage the important work of underwriters’ laboratories, in
testing and labeling safety devices.
The progressive States here represented have broken away from
the old idea of factory inspection based on legal authority sloneTand
have carried on extensive educational campaigns. But even aside
from the occasional ignorant and unteachable inspector of the old
school, to whom I have already paid my respects, few State depart­
ments, if any, have as yet made the fullest possible use of educational
methods. The employer requires education, as well as the employee,
and more can be accomplished in this way than by legal prosecutions.
One excellent way of educating the employer, which several States
are now using, is to confront him occasionally with a record of his
own accidents. There is no time when the average employer is quite
so ready to listen to suggestions from the department, as when he has
just had a serious accident—provided the subject is not approached
from the standpoint o f “ I told you so.” In the case of small estab­
lishments, the accident experience of the entire industry must be
used. I f the employer’s record shows a large preponderance of acci­
dents due to overcrowding, disorder, and carelessness, the State
should recommend not only a safety organization, but a safety engi­
neer, as the only remedy for such accidents. I question whether any
State has yet made the fullest possible use of such individual sta­
tistics.
It is generally agreed that the foreman can do more to help or
harm the safety movement in a shop than any one else in the or­
ganization. The State department can do much to educate the fore­
man. I believe that foremen’s meetings should, as a rule, be con­
ducted by the factory inspector himself, in connection with his regu­
lar inspections. To supplement this personal contact, some depart­
ments are also publishing a monthly magazine designed principally
for the foreman. This should preferably be sent to each foreman
individually at his home.
For educating the workman himself, the up-to-date department
will encourage the holding* o f safety meetings or safety rallies and
will furnish speakers. Some States also distribute posters for the
factory bulletin board. My opinion on this point was formed about
a year ago, when I was engineer for the Wisconsin commission. The
State department can not compete—at least it can not compete eco­
nomically—with the weekly bulletin service of the National Safety




W H A T INDUSTRIAL COMMISSIONS CAN DO---- S. J . W IL LIA M S.

47

Council, either in quality or quantity. It is true that free distribu­
tion by the State will reach many employers who are not members
o f the National Council. A bulletin which costs nothing, however, is
apt to be considered by the recipient as w^orth just about what it costs.
A safety bulletin put up carelessly, or in the wrong location, or left
for months until it becomes torn and dirty, is worse than no safety
bulletin at all. Most o f the Wisconsin inspectors agreed with me
in this, and thought that instead o f spending our money in gettingout second-class bulletins o f which a majority would go into the
waste basket, we might better encourage employers to join the Na­
tional Safety Council.
As I have already indicated, the formulation o f standards or codes
for safeguarding is peculiarly a governmental function, except in war
time, when it is peculiarly a State function. During the past five
years State industrial commissions have greatly advanced the science
and art o f formulating safety standards. How unfortunate it is, that
while new safety codes are continually being adopted, and old ones
revised, no serious effort has been made for uniformity! W e are
fond o f saying that an administrative commission can formulate such
a code much better than a legislature; yet the industrial codes thus
adopted in different States are as little uniform as the statutes on mar­
riage and divorce. The advantages of uniform safety standards in
the different States will surely be admitted without argument; and
I can not believe that the practical difficulties are insurmountable.
A serious effort for uniformity should be made without further delay.
In addition to all the .various State standards, there are already
several different standards o f a national character, such as the stand­
ards o f the schedule-rating committees o f the Federal Safety Engi­
neers, the United States Compensation Board, and (on certain sub­
jects) the American Society o f Mechanical Engineers. A move­
ment for uniformity might well be started by this association, with
the backing o f the Federal Bureau o f Labor Statistics and the Fed­
eral Bureau o f Standards, and I urge most seriously that you take
some action thereon at this meeting. This does not mean that every
State must pledge itself to throw away its own standards and adopt
others. It* simply means that the State and national departments
interested and other organizations such as the engineering societies,
the insurance companies, and the National Safety Council would
agree to get together and form a joint committee, the result o f whose
work might properly be termed a national standard; this national
standard would then serve as a guide for States adopting new codes,
and would naturally be given some weight when existing codes are
being revised. Complete uniformity is doubtless impossible, and per­
haps undesirable—but a measurable approach thereto can surely be
made.




T U E S D A Y , S E P T E M B E R 24— E V E N IN G S E S S IO N .
Chairman, Charles S. Andrus, Chairman, Industrial Commission of Illinois.

II. AD M IN ISTR ATIVE PROBLEMS.
S T A T IS T IC S A S A N A ID IN A D M IN IS T R A T IO N .
B Y W . H . B U R H O P , SE CRETARY, W IS C O N S IN

CO M PE N S A TIO N IN S U R A N C E BOARD.

Five years ago the statement could have properly been made that
administrative bodies of our States, dealing with compensation and
labor laws, have woefully failed in the field of accident and work­
men’s compensation statistics; that they have failed to realize the
value o f statistics as an aid to the proper discharge of their public
function. Unfortunately not all of our States even at this time fully
appreciate the value of an adequate statistical department; too many
still regard statistics as either unnecessaiy or simply as a record of
what has been done, and not as a guide for future work or future leg­
islation. True, it is possible to pay an injured man 200 weeks’ comjDensation for the loss o f an arm, if such* is specifically provided in the
compensation act without reference to statistics. Nor do we need sta­
tistics to establish a rule that a man engaged in the manufacture of
gunpowder shall not smoke a pipe. It is unnecessary to know how
many men have been killed or injured in order to determine that such
occupations as blasting, window cleaning, or deep diving are danger­
ous. We know, without referring to figures, that 120 weeks of com­
pensation, with a $10 weekly maximum, is utterly inadequate to com­
pensate for the loss of an eye. To present these facts of common rea­
son and knowledge is not the function o f a statistical department.
There are at least four fields in which adequate statistics should be
o f material assistance if not indispensable to administrative bodies.
They are accident prevention, administration o f compensation, regu­
lation of insurance rates, and proposals for further legislation.
In the first of these functions, accident prevention, the value of
statistical records has been more universally appreciated than in other
fields. Much could be said on this subject alone, but since this feature
wTill be discussed on various occasions during this convention I will
treat it very briefly.
Many of our States have done safety work for several decades or
more. Without question, the requirements o f safeguarding danger­
ous machinery has prevented some accidents w7hich would have oe48




STATISTICS AS AN AID— W . H . BTJRHOP.

49

curred without the guards. Nevertheless, most of our safety work
has not been based upon a statistical analysis of accidents, and with
the possible exception of the State of New York, I know of no State
which can show from accident figures what the fruit of safety work
has been. Many Commonwealths have a record o f the number of acci­
dents from year to year, but this figure is absolutely meaningless if
not correlated with the number of full-time workers exposed to in­
jury in the various industries. An increase of 20 per cent in the num­
ber of accidents may actually mean a decrease in the accident rate
based upon the number o f men employed, and, conversely, a reduction
of 20 per cent may really be an increase if the number of workers ex­
posed to injury has been decreased in a larger proportion. Taking all
industries o f the State, we have at present no information to compare
properly even the number of accidents from year to year.
To make an intelligent campaign for the prevention of accidents,
we must, first o f all, know how accidents occur. What means a detail
analysis o f the causes of accidents ? The use and benefit which a table
of causes of accidents presents to a safety department is in direct
proportion to the detail of the table with proper summaries of similar
causes. A statistician gives little information to the safety inquirer
when he tells him that 5,000 workmen were injured in falling from
elevations, or even that 500 injuries resulted from circular saws. He
adds value to his figures when he says that 200 men were injured by
fall from ladders or from scaffolds. But even such information is
wholly inadequate for the safety man., He must know in greater de­
tail the circumstances which produced the fall. He must have such
information as will enable him to determine how similar accidents
can be prevented. Falls from ladders may occur because o f a defec­
tive rung; the ladder may slip; it may tip over; or the workman may
fall because of carrying too heavy a burden. The mode of prevention
varies in each one of these various causes. Similarly with the falls
from scaffolds. The scaffold itself may fall because of defective con­
struction or faulty braces; absence of a rail may cause a fa ll; or over­
loading may cause a collapse. All these separate significant circum­
stances must be known to prescribe rules and emphasize their im­
portance.
This detail applies to machine accidents as well as nonmachine
accidents. I f we told the man on the street that in one year circular
saws in Wisconsin were responsible for 405 injuries, causing more
than seven-day disability, he at once would picture a man pushing
a board through a saw and striking his hand against the fast moving
tool. As a matter of fact this conclusion could apply to only 243,
or a little over one-half of the total injuries. O f the others, 29
men were injured because they attempted to clean the machine while
124247°— 19------ 4




50

ADMINISTRATIVE PROBLEMS.

it was in motion, 67 were struck by so-called 44throw backs,” 9 were
injured because their loose clothing was caught, 6 accidents occurred
because of oiling the machine, etc. This is the information which
is vital for accident prevention. We must know why and how the
injury occurred before we can intelligently suggest means of pre­
vention.
To measure the results of safety work we must have records o f
exposure. We should know not only the total number of men em­
ployed in the State, but these numbers should be analyzed by the
various industries. Only with this information, correlated with the
number of accidents, can we determine the rise or face of our accident
curve.
To a somewhat less degree, but of great' importance, are records
an aid to the man who must approve claim statements or award
compensation. This is especially true if permanent partial disabili­
ties are not compensated on the basis of a fixed schedule, but on
the basis of loss of earning power. In such cases the records o f past
judgments must serve as a future guide or no uniformity can result.
In order to picture the operations of compensation laws and deter­
mine the administrative efficienc}^, records should show the number
o f compensable accidents reported and compensated, classified as to
the nature o f injury, the claims which are settled automatically, and
those brought before the administration body, or carried through the
courts. The time required to dispose of a disputed claim is a test
o f efficiency. Claims which are rejected should be classified by
grounds o f rejection. Approval or denial of lump-sum statements
should be correlated with the reason for such action. The amount
o f indemnity and medical aid paid should be tabulated according
to the various classes of injuries. The cost of administration,
together with legal and all other costs of adjusting claims, is an
important item. Here, again, detail must be emphasized. The total
number of permanent injuries to the index finger is insufficient; such
injuries should be classified by joints at which amputations were
made or upon the basis of which the degree of permanent disability
was established. The importance of this detail will be apparent
when the cost o f future legislation is considered.
While most of these suggestions contemplate in a measure a picturization o f the application o f the compensation act, and an account­
ing o f the work o f the administrative body, statistics are often the
basis o f individual claim settlement. In Wisconsin a minor who is
permanently injured is compensated upon the basis o f what he could
have earned in his occupation, when he attained his majority. Under
these conditions, it is important to know what adults in his line o f
work are earning. In other words, we must have wage statistics




STATISTICS AS A K AID---- W . H . BURHOP.

51

showing the amount of wages paid to men over 21 years- of age in
the various industries.
As a further illustration of the use of statistics in the adjustment
o f claims, presume that a man who has sustained a hernia refuses
to submit to an operation. Without such an operation his disability
may be indefinite, while an operation would effect a rapid recovery
o f earning capacity. It would obviously be unfair to compel an
employer or his insurance companies to pay compensation indefinitely
under such circumstances. There could be no fairer way to adjust
such a claim than to allow compensation for the average period o f
disability for similar cases. In Wisconsin we know that the average
disability of 491 hernia cases is 41 days, and this offers a basis of
settlement.

The extent or degree of aid which statistics may offer in the aelministration of compensation must obviously depend upon the man­
ner in which compensation laws provide far claim adjustment. This
is a problem of the individual States, and their statistics should be
adjusted in accordance to their specific needs.
A discussion of statistics for the regulation of insurance rates may
be somewhat out of order because not all of the organizations here
represented have supervision over this feature. Unfortunately, some
States have no rate regulation laws whatever, or have no means of
enforcing them.
In no field o f insurance is rate regulation so necessary and so essen­
tial as in workmen’s compensation. The State is compelling its em­
ployers to purchase insurance and compels employees to accept what­
ever coverage their employers may legally secure. In other words,
the employer is forced by the State to carry insurance for the benefit
o f his employees, but those dependent for their compensation upon
the insurance carrier have no voice in the insurance contract* Having
made insurance compulsory, the State should in justice protect the
employer against excessive or unfair rate charges, and the employees
as well as the employer against companies on an inadequate rate
basis, which can lead only to insolvency and failure to pay compen­
sation claims.

Further than this, employers should pay into the loss fund a pre­
mium charge in proportion to their respective hazard. There should
be no discrimination between employers whose work presents a simi­
lar degree of hazard.
Some of our States now have on their statute books antidiscriminatory laws, but, because of lack of statistics, administrative bodies
themselves have no method of knowing if rates are. right or wrong,
fair or unfair, as to classes and employers. Supervision of insurance
means nothing whatever unless supervising officials secure the neces­




52

ADMINISTRATIVE PROBLEMS.

sary information upon which rates must be based. The proper source
for this information is the insurance carrier. All that is required is
a statement from each company showing the pay roll and clasified
losses for each industry class. The reports of the various companies
can then be combined into the total class experience for the State.
Much time could be given to the discussion o f this subject, but it is
here presented only for the thought of those States having no rate
regulatory laws or no means for enforcing such.
Compensation laws of our States have been passed without ade­
quate information regarding existing conditions or sufficient under­
standing o f the problems which such laws were intended to solve.
No more convincing proof o f this is needed than the fact that the
laws o f practically all the States are amended during every legisla­
tive session. The application o f the acts are extended and the scale
o f benefit is constantly revised upward. In order that such future
legislation may be based upon sound experience, it is imperative that
detailed records o f compensation and medical payments, classified
by nature o f disability, be maintained; also other statistics regarding
the scope or adequacy o f the acts.
We should be able to determine the extent to which our acts in­
demnify the actual wage loss. Only from such a tabulation can we
determine the adequacy o f the scale o f compensation. The actual
wage loss and medical cost compared with the actual benefit received
for the various classes o f injuries will picture the adequacy o f our
payments. In the wTage loss obviously should be included the wait­
ing period.
Such a tabulation, while o f great importance, does not tell the
entire story. I f possible, we should follow our injured men through
their lives and learn how large a loss of earning power has resulted
on account o f a permanent injury. Most of the States compensate
permanent injuries on the basis o f a fixed scale of benefits. These
scales are not based upon scientific information and are not designed
to compensate fully for the loss o f a member of the body. Even if
a scale giving full compensation were attempted, we would not know
how to construct it because we have not been farsighted enough to
study the actual results of the various permanent disabilities. Not
only are we ignorant o f the wage impairment of specific injuries,
but we do not even know, except as common sense may dictate, the
relative significance of the various kinds of injuries. In Wisconsin
the loss o f an arm at the shoulder is compensated by 20 weeks more
than the loss o f a leg at the knee. No information is available to
establish the relative loss o f earning power which these two disabili­
ties produce. It is to place a scale of compensation upon an ade­
quate and balanced basis that statistics of future wage loss are essen­
tial.




STATISTICS AS AN AID---- W . H . B U K H 0P .

53

Changes in the benefits o f a compensation law are largely compro­
mises between labor and capital. A proposal to reduce the waiting
period or increase the maximum is always met with much objection;
that the increased cost would be a crippling burden to industry.
Unless an analysis of the various kinds o f injuries with the respective
benefits is available it is impossible to determine in advance the in­
creased cost o f any amendment revising the scale upward. I f we
have a list of permanent partial disabilities with the cost for each
class and changes in the specific number o f weeks are proposed, it is
an easy matter to determine the result in cost of proposals. I f we
have a correlation o f the number and cost of cases with wages earned,
we can readily determine the effect o f a change in the maximum or
minimum provisions.
An amendment introduced during the 1917 session of the Wisconsin
Legislature provided that the fixed benefits o f the scale should be
intended to cover only the permanent disability and that the healing
period should be compensated for in addition. That is to say, the
proposal would have added the healing period to the schedule. To
determine the additional cost, all permanent injuries were tabulated
according to kind o f inquiry and duration of the healing period.
From the tabulation the Wisconsin commission was able to advise
the legislative committee o f the increased cost. So with all the other
legislative proposals. We need detailed experience of the past to
give intelligent advice on further legislation.
An abundance o f illustrations could be given to show the real need
o f statistics for administrative use. American labor boards must
realize more and more the value o f tabulated experience. Much
thought and time has been given to this subject by your committee
on uniform statistics and insurance cost. It is gratifying to note
that many o f the States are already endeavoring to meet the com­
mittee’s recommendatipns, partly for their own administrative needs
and partly to place American statistics on the so-mucli-needed uni­
form basis. The time will soon be at hand when an adequate statis­
tical department will be considered an absolute necessity by every
organization dealing with compensation and safety laws. Until such
time we can not hope to proceed upon a thoroughly scientific basis,
using our experience to indicate our errors and guiding us for future
improvements.




H O W SH O U LD PE R M A N E N T P A R T IA L D IS A B IL IT Y B E
COM PENSATED?
B Y JO H N

M IT C H E L L , C H A IR M A N , N E W

YORK

ST A TE IN D U S T R IA L C O M M IS S IO N .

Inasmuch as this is a convention in which various States are representedy the provisions o f the compensation law o f New York with
reference to the subject o f this paper will be taken as the basis of my
remarks. This is done also for the further reason that the present
New York statute contains certain amendments which are the out­
growth o f a considerable experience in compensation matters and
which have tended to perfect the requirements o f the law so that as it
now stands it is one o f the best laws in the country in respect to the
subdivision under discussion and approximates that which I believe
will have more or less permanence in compensation laws.
What remarks I shall have to make wTill be independent o f the con­
sideration o f certain general phases o f compensation laws, such as the
waiting period, percentage o f compensation allowance, the medical
question, and, independent also, o f any suggestions as to the number
o f weeks in the specific schedule, etc.* but will be confined strictly to
the subject itself.
The New York statute is as follows:

S. Permanent partial disability. In case of disability, partial in character
but permanent in quality, the compensation shall be 66§ per cent of the average
weekly wages and shall be paid to the employee for the period named in the
schedule, as. follows:
Thumb.—For the loss of a thumb, 60 weeks.
First finger.— For the loss of a first finger, commonly called index finger, 46
weeks.
Second finger.— For the loss of a second finger, 30 weeks.
Third finger.— For the loss of a third finger, 25 weeks.
Fourth finger.— For the loss of a fourth finger, commonly called the little
finger, 15 weeks.
Phalange of thumb or finger.— The loss of the first phalange of the thumb
or finger shall be considered to be equal to the loss of one-half of such
thumb or finger, and compensation shall be one-half of the amount above
specified. The loss of more than one phalange shall be considered as the
loss of the entire thumb or finger. Where the injury results in the loss of
more than one finger, compensation therefor may be awarded for the propor­
tionate loss of the use of the hand thereby occasioned: Provided, however, That
in no case shall the compensation awarded for more than one finger exceed the
amount provided in this schedule for the loss of a hand.
Great toe.— For the loss of a great toe, 88 weeks.
54




P E R M A N E N T P A R TIA L D ISA B IL ITY — J O H N

M IT C H E L L .

55

Other toes.— F or the loss of one o f the toes other than the great toe, 16
weeks.
Phalange o f toe.— The loss o f the first phalange o f any toe shall be con­
sidered to be equal to the loss o f one-half o f said toe, and the compensation
shall be one-half o f the amount specified. The loss o f more than one phalange
shall be considered as the loss o f the entire toe. W here the injury results
in the loss o f more than one toe compensation therefor may be awarded
fo r the proportionate loss o f the use o f the foot thereby occa sion ed: Provided,
how ever, That in no case shall the compensation awarded for more than one toe
exceed the amount provided in this schedule fo r the loss o f the foot.
Hand.— The loss o f a hand, 244 weeks.
Arm.— For the loss o f an arm, 312 weeks.
Foot.— For the loss o f a foot, 205 weeks.
Leg.— F or the loss o f a leg, 288 weeks.
Eye.— For the loss o f an eye, 128 weeks.
Loss o f use.— Permanent loss o f the use o f a hand, arm, foot, leg, eye,
thumb, finger, toe, or phalange shall be considered as the equivalent o f the loss
o f such hand, arm, foot, leg, eye, thumb, finger, toe, or phalange.
Partial loss and partial loss o f use.— F or the partial loss or the partial loss
o f the use o f a hand, arm, foot, leg, or eye compensation therefor may be
awarded fo r the proportionate loss or proportionate loss o f the use o f such
hand, arm, foot, leg, or eye.
Amputations.— Am putation between the elbow and the w rist shall be con­
sidered as the equivalent o f the loss o f a hand. Am putation between the
knee and the ankle shall be considered as the equivalent o f the loss o f a foot.
Amputation at or above the elbow shall be considered as the loss o f an arm.
Amputation at or above the knee shall be considered as the loss o f the leg.
The compensation for the foregoing specific injuries shall be in lieu o f all
other compensation, except the benefits provided in section 13 o f this chapter.
In case o f an injury resulting in serious fa cia l or head disfigurement the
commission may, in its discretion, make such award or compensation as it
may deem proper and equitable in view o f the nature o f the disfigurement,
but not to exceed $3,500.
Other cases.— In all other eases in this class o f disability the compensation
shall be 66§ per cent o f the difference between his average weekly wages and
his wage-earning capacity thereafter in the same employment or otherwise,
payable during the continuance o f such partial disability, but subject to recon­
sideration o f the degree o f such impairment by the commission on its own
motion or upon application o f any party in interest.
4. Tem porary partial disability.— In case o f tem porary partial disability,
except the particular cases mentioned in subdivision 3 o f this section, an injured
employee shall receive 66 § per cent o f the difference between his average weekly
wages and his wage-earning capacity thereafter in the same employment or
otherwise during the continuance o f such partial disability, but not to exceed
when combined with his decreased earnings the amount o f wages he was
receiving prior to the injury, and not to exceed in total the sum o f $3,500, except
as otherwise provided in this chapter.

(This paragraph is also incorporated as reference to it will be made
below.)
5.
and
eye,
tion

Lim itation.— The compensation payment under subdivisions 1, 2, and 4
under subdivision 3, except in case o f the loss o f a hand, arm, foot, leg, or
shall not exceed $15 per week nor be less than $5 per w eek ; the compensa­
payment under subdivision 3 in case o f the loss o f a hand, arm, foot, leg,




56

A D M IN IST R A TIV E PRO BLEM S.

or eye shall not exceed $20 per week nor be less than $5 a w e e k : Provided,
however, That i f the em ployee’s wages at the time o f injury are less than $5
per week he shall receive his full weekly wages.
6. Previous disability.— The fact that an employee has suffered previous dis­
ability or received compensation therefor shall not preclude him from com­
pensation for a later injury nor preclude compensation for death resulting
th erefrom ; but in determining compensation for the later injury or death his
average weekly wages shall be such sum as w ill reasonably represent his
earning capacity at the time o f the later in ju r y : Provided, how ever, That an
employee who is suffering from a previous disability shall not receive com­
pensation fo r a later in ju ry in excess o f the compensation allowed for such
in ju ry when considered by itself and not in conjunction with the previous
disability.
7. Permanent total disability after permanent partial disability.— I f an
employee who has previously incurred permanent partial disability through
the loss o f one hand, one arm, one foot, one leg, or one eye incurs permanent
total disability through the loss o f another member or organ, he shall be
paid, in addition to the compensation for permanent partial disability pro­
vided in this section and after the cessation o f the payments for the pre­
scribed period o f weeks, special additional compensation for the remainder o f
his life to the amount o f 66f per cent o f the average wTeekly wage earned by
him at the time the total permanent disability was incurred. Such additional
compensation shall be paid out o f a special fund created for such purpose in
the follow ing m a n n er: The insurance carrier shall pay to the State treasurer
fo r every case o f injury causing death in w hich there are no persons entitled
to compensation the sum o f $100. The State treasurer shall be the custodian
o f this special fund, and the commission shall direct the distribution thereof.

First, let me call your attention to the fact that the schedule herein
is a well-balanced schedule, and that relatively the economic value of
the various members seems to be properly stated. However, in the
administration of the lawT, we always have given consideration to
the vocational element to modify the rigidity o f the schedule. This
is recognizing the spirit of the law as well as the letter. I f I were
drafting a new' statute I should introduce an element o f discretion
on the part of the hearing tribunal, allowing an increase, say, up to
33J per cent for vocational reasons alone.
In the consideration of the vocational element the New York
commission has not diminished any award on such account, but has
been more liberal in its interpretation of the schedule in numerous
instances, o f course, being bound at all times by the statutory limi­
tations. There was a time when our statute compelled us to consider
any injury short o f loss of or loss of use of a member as a simple
disability case in which payments should be made covering the period
o f disability only; but, by the very necessary amendment the com­
mission now has power to make an award on proportionate loss of
use o f member. Indeed, even before such amendment, the commis­
sion followed this practice, which was not objected to in minor
cases, but which finally came to be seriously objected to in the more
expensive cases until a court decision prevented a continuance of the*




P E R M A N E N T PA R T IA L D ISA B IL ITY ---- J O H N

M IT C H E L L .

57

practice. To illustrate wliat hardship might result in the absence
o f such provision, I will cite a case in the New York jurisdiction.
It was one in which there had been an eye injury followed by an
operation for cataract with a result of loss o f binocular vision, co­
ordination o f vision of the two eyes being lacking. It was even true
that the claimant could see better at his work with his injured eye
covered with a patch; but inasmuch as, in the event of the subse­
quent loss of the uninjured eye, the injured eye would be useful if for
no other reason than to give a field of vision and enable the injured
person to get around, the court held that there was no loss of use of
eye. The case, therefore, was reduced to one of simple disability, in
which a few weeks’ compensation was paid while the injured eye was
healing; so that we have the situation of one who for vocational pur­
poses had lost one eye receiving less compensation for it than if he
had lost his little finger. Such an adjudication must rest in its last
analysis-upon the assumption that the injured eye will subsequently
be lost; whereas such instances are exceptionally rare. Such a statute
is not satisfactory either in its particular or in its general applica­
tion and, plainly, laws should be so drafted or amended as to allow
justice to be done in the circumstances.
It is manifestly a wise provision to give discretionary powers to
the hearing tribunal to make an award for the proportionate loss of
use of hand or foot or arm when certain portions of them are lost,
for not only is the part lost but likewise does its loss impair the gen­
eral utility of the member when considered as a whole.
There is justification also for granting compensation for certain
disfigurements, for they result in impaired earning capacity quite as
certainly as does the loss o f a member or part of a member.
It is a wise provision o f any law that gives to the claimant who is
willing to return to work, but who is 'compelled to accept a lower
wage because o f his disability and during his disability, two-thirds
of the difference between his old and new wage with certain maxi­
mum limitations. It tends to do away with malingering and en­
courages recovery; more than that, it is simple justice.
It is also proper to increase the maximum compensation in cases
o f the loss of a hand, arm, foot, leg, or eye, for the obvious reason
that these are such serious injuries, attended with such great loss and
inconvenience through life that they should be more amply compen­
sated. In this connection, I may say that we are not apt to err in
this respect, because the whole scheme of compensation is still well
within the limitation of justice.
New York did wisely in amending her law to give compensation
for permanent total disability in cases in which a claimant loses a
hand, arm, foot, leg, or eye, having previously suffered the loss of one
or more members. The totality is no more chargeable to the last acci­




58

/JD M IX IS T R A T IV E PROBLEM S.

dent than to the first, for it is the combination o f injuries which produces the totality. It is therefore unjust to charge the last employer
with totality, whereas it would be unjust to deprive the workman of
the benefit of his award for total disability. The proper rule, there­
fore, would seem to be to charge the present employer with the re­
sults o f the last accident and to throw the combination result o f to­
tality upon industry as a whole. This may be done by adding a small
additional rate upon every risk or, as New York has done it, by col­
lecting in each death case in which there are no dependents a fixed
sum o f $100, which contribution seems sufficient to establish a fund
to take care o f the permanent total cases. One splendid effect of
this amendment was to do away with the objection of employers to
employing or reemploying crippled or defective workmen. The
latter have a natural right to earn a livelihood. At the same time,
employers were somewhat justified in their precautions. Now, crip­
ples will be employed for what they are worth, and any objection to
employing them has its answering advantage. So, it turns out that
after the first fear is over, that cripples are being employed or, at
least, are not rejected because of any provisions of the compensation
law o f New York State.
Dismissing the specific schedule, let us turn to the other perma­
nent partial disabilities which are very numerous. I have in mind
those cases o f stiff elbows, arms that can not be fully elevated, wrists
that have lost their suppleness, ankylosed fingers, inverted or everted
feet, knees that have lost their flexion, etc. The statutory method of
paying compensation in such cases is to provide two-thirds of the
difference between the old wrage and the new. The administrative
difficulties are numerous:
Suppose the claimant refuses to return to vrork; here we have the
discussion thrown upon the theoretical plane, one party contending
that he is able to work, another that he is unable to work, and all
the time perhaps no job in sight. Manifestly, compensation prob­
lems are practical problems and methods of adjudication should
always be at hand and susceptible among other things of finality;
but who has the ability properly to determine the question?
Suppose industrial conditions change and the injured workman is
able to earn more money than he was earning at the time of the
accident; shall we say in justice that he should go through life with
a stiff arm without any compensation for it ?
Or suppose the industrial conditions change so that because of the
change alone he earns $8, whereas he might have earned $12 if con­
ditions had remained as they were at the time of his accident.
Shall the employer or the insurance carrier be compelled to increase
compensation for reasons quite apart from the employment or the
injury or its effect?




P E R M A N E N T P A R TIA L D ISA B IL ITY ---- J O H K

M IT C H E L L .

59

Or suppose conditions of intermittent employment in which the
injured workman is sometimes employed and sometimes not; is the
administrative bureau to be burdened with a rehearing of the case
upon all such occasions ? And, yet, if this be the method there is no
escape from the endless rehearings of cases which as the years go by
will aggregate a vast number.
The method followed in New York in such cases is to allow the
workman and the employer (or his insurance carrier) to present them­
selves before the commission with a proposition to adjudicate com­
pensation by a single payment commuting all future payments.
More than 5,000 cases a year are thus adjusted. Such a method
veritably forced itself upon the commission and there seems to be no
other satisfactory method o f adjudicating these cases. What are the
defects o f such a plan? Manifestly they are tw o: First, the danger
o f introducing the 46settlement,” so called, in which the obnoxious
element o f the old plan may be perpetuated. Second, the danger
which always attends the giving o f compensation in a lump sum
against which is the general tendency of all compensation laws.
W ith respect to the settlement feature this is entirely avoided by the
commission’s active interest in every such case. To guarantee ade­
quate compensation the practice in New York is for the commission
to pass an independent judgment on the matter regardless of the
amount agreed upon and if the latter be not as much or more than
the amount the commission thinks should be paid and received, the
proposal is not accepted and approved and the parties are urged to
raise the amount; otherwise, the case goes back upon the impaired
earning capacity basis.
W ith respect to allowing the payment in one lump sum this is
found to be a not undesirable element in this particular class o f
cases, but the commission should order its payment periodically
where there is indication that it otherwise might be wasted. From
this a general approval of lump-sum payments should not be in­
ferred, for as a rule the periodical payments effect the greater good
and it is wisdom to continue them; but in the particular class of cases
it is very often the only practical way o f meeting the situation.




“ A R IS IN G
BY

OUT OF AND

IN

C O U R S E O F E M P L O Y M E N T .”

GEO RG E A . K I N G S T O N , C O M M I S S I O N E R ,

W ORKMEN’S

C O M P E N S A T IO N

BOARD

OF

O N T A R IO .

Perhaps no expression made use of in compensation laws has been
the subject o f more consideration and discussion by administering
boards and law courts than that which constitutes the subject o f
this paper.
People sometimes say that the modern compensation law provides
for compensation in case of all work accidents regardless o f the ques­
tion o f negligence, and that probably is the general conception o f the
law, but in 39 out of the 48 jurisdictions on this continent (i. e.,
4 0 1 in the United States and 8 in Canada) where a workman’s com­
pensation law is in force there is ingrafted upon the more general
expression o f the law the provision that an accident to entitle a
workman to compensation must have happened in course o f and
must also have arisen out of his employment.
The eight jurisdictions whose laws do not include this expression
are Ohio, Pennsylvania, Texas, Washington, West Virginia, Wiscon­
sin, Wyoming, and the United States.
I will briefly state the expressions used in the laws of these States
in lieu o f the uniform wording o f the other laws in this respect:
O h i o .— “ A ll injuries not self-inflicted received in course of employ­
ment.”
P e n n s y l v a n i a .—“ Injury by accident in course of employment.”
T e x a s .— “ Personal injury sustained in course of employment.”
W a s h i n g t o n .— “ Personal injury whether received upon the premi­
ses or at the plant or in the course o f employment while aw^ay from
the establishment.”
W e s t
V i r g i n i a .—“ A ll personal injuries not the result o f willful
misconduct or intoxication o f employee or self-inflicted.”
W i s c o n s i n .—“ Personal injury while performing service growing
out o f and incidental to the employment, not intentionally self-in­
flicted.”
W y o m i n g .—“ Personal injuries as a result of employment and not
due to culpable negligence o f injured employee or to the willful act
o f a third person due to reasons personal to such employee or because
o f his employment.”
1 Including Alaska and the Federal Government.
€0




ARISIN G OUT OF E M P L O Y M E N T ---- GEORGE A. K IN G ST O N .

61

U n it e d
S t a t e s . —“ Personal injury sustained while in the perform­
ance o f duty.”
It will be readily seen that in a number o f cases this expression
uArising out of and in course o f employment ” substantially modifies
the general principle that all work accidents are compensable, re­
gardless o f negligence or fault on the part of the workman.
These may be conveniently enumerated under the following head­
ings :
1. Street accidents.
2. Accidents while going to or from work.
3. Injuries due to scuffling, larking, or horseplay.
4. Accidents, as sometimes stated in legal textbooks, caused by
the act o f God or the country’s enemies.
5. Injuries arising out o f attempted robbery, fighting, assault,
murder, or suicide.
6. Disabilities due to frostbite or heat stroke.
7. Accidents occurring during moments o f leisure or while doing
something o f a personal nature or out of curiosity.
8. Camp accidents.
9.1 Accidents resulting in the aggravation of a preexisting diseased
condition, or extraordinary conditions amounting almost to accident,
resulting in disease, as e. g., pneumonia resulting from exposure.
10.1 Accidents due to disobedience o f rules.
11.1 Hernia, lumbago, and strain cases.
One could go on almost indefinitely classifying occurrences which
seem to fall outside the commonly accepted idea of “ work accident,”
but the above list comprises the great bulk of cases presenting prob-~
lems which administering boards and commissions are constantly
confronted with, and it is the purpose o f this paper to discuss some
o f the principles underlying the decisions in cases coming under these
headings.

STREET ACCIDENTS.

Prior to the decision o f the House of Lords in the case of Dennis v .
.White, June 14, 1917, there was a fairly well-settled line of decisions
in England in regard to street accidents, to the effect, briefly stated,
that if a workman is on the public highway on his master’s business
and becomes injured by accident due to ordinary street hazard, such
an injury is not compensable, because it could not be said that the
accident arose out o f his employment, or, in other words, as some of
the judges expressed it, it was due to a risk no greater than is run by
all members o f the public.
One of the leading cases in which this principle of law was ex­
pounded wTas the famous banana skin case, Sheldon v . Needham,
1 Consideration of decisions under this head is not included in this paper.




62

A D M IN IST R A T IV E PRO BLEM S.

7 B. W. C. C. 471> where an employer sent his servant to post a letter
at a box a few yards along the street. While performing this duty,
she slipped on a banana skin carelessly thrown on the sidewalk and
broke her leg. For the reasons stated above it was ultimately held
by the court o f appeals that the employer was not liable.
The New York Supreme Court, in the case o f Newman v . Newman,
took the same view, and the idea seems to have been accepted in
quite a number o f the other States.
It was held in another English case, Pierce v . Provident (1911),
4 B. W. C. C. 242, that in order to make the employer liable in the
case o f street accidents employment in the streets must be practically
continuous, as in the case of a canvasser or collector, the reason for
drawing the distinction being thus expressed by the master of the
rolls:
As the w ork requires him to spend the greater part o f the day on the streets
he would be, in the course o f his duties, beyond all doubt more exposed to the
risks o f the street than ordinary members o f the public.

The Scottish courts, however, held a different view. As one of the
judges put it:
The risk o f the road at the particular time was a risk incidental to the em­
ployment, and it was none the less a risk o f the employment because every
pedestrian on the road at that time ran the same risk, or because the workm an
was facing this risk fo r the first or perhaps the only time.

Very early in the administration of the law in Ontario, i. e., in
1915, the board was called upon to decide this identical question. A
man employed by one of the cartage agents in Toronto was sent to a
harness maker’s shop some few blocks away to get a horse collar
which had been left there for repairs, and on the way back slipped
on the sidewalk and broke his arm.
Our board, while entertaining the most profound respect for the
decision of the English courts, is not bound to follow them, and the
reasons as stated in the Sheldon case in regard to these street cases
did not appear to us to be sound. We finally decided to adopt the
view expressed by the Scottish courts and allowed the claim.

It was, you may be sure, quite interesting to note that the House •
of Lords a couple of years later in the case first above referred to,
Dennis v . White, 10 B. W. C. C. 280, discarded the theory or rule
previously laid down by the English court of appeal as applying to
this type of case and adopted the view expressed by the Scottish
courts.
The written judgment of Lord Chancellor Finlay in this case deals
very fully with all the prior decisions o f importance on this subject
and refers to the reasoning o f these earlier decisions as unsound and
antagonistic to the terms of the statute.




AR ISIN G OUT OF E M P L O Y M E N T — GEORGE A. K IN G ST O N .

63

I have had the opportunity o f reading the written opinion o f the
chairman o f the Nova Scotia board, Mr. Y. J. Patton, in the matter
o f the claims arising out o f the Halifax disaster o f December last.
The reasoning in the case o f Dennis v . White was adopted, and it
was held that claims in respect to killed or injured workmen in Hali­
fax on that occasion should be taken as coming under the provisions
o f the act, it being considered that the injury arose out o f the employ­
ment because, by reason of the nearness o f the city to the shipping
in the harbor where high explosives were handled, all workmen in
the city, whether engaged on the street, in the factory, or 011 the
piers, were specially exposed to that particular danger.
ACCIDENTS W HILE GOING- TO OR FROM WORK.

Somewhat closely related to the problem of compensation for in­
juries in street accidents is that as to accidents happening while go­
ing to or from work. It is, I think, fairly generally held that after a
workman leaves the employer’s premises on quitting work or before
he reaches the premises on going to work, he is not in the course o f
his employment, and an accident happening to him on the street dur­
ing these periods could not be said to arise out o f his employment.
The New York commission in one case went a step farther and
rejected the claim of an office employee, who on finishing her day’s
work took some o f her employer’s letters to deposit in the post office
and on the way was struck by a train. The reason stated for this
decision is 44that she was following the same route that she would
have followed if she had been going home without undertaking to
mail the letters and that she was exposed to no unusual hazard due
to the employment.” This sounds rather like the argument formerly
given effect to in England prior to the decision o f the House of Lords
in Dennis v . White above referred to. It seems to me such a case
should turn on whether or not she was in the performance o f her
duties. I f it was her duty to go to the post office on this message,
then for the* time being the hazard of the street was a hazard of her
employment and her duties for her employer were not ended till she
deposited the letters in the post office.
A number of cases ha\;e arisen where a workman is injured going
to or from work by means o f a conveyance provided by the employer.
The question to be determined in all such cases is, Was it an express
or implied term o f the contract o f service that the workman was to
be so carried to or from his work? It seems to be well-settled law
in England that if a workman is entitled either by express or implied
contract to travel in a conveyance provided by the employer he is in
the course o f his employment, and an accident while so traveling
would be held to have arisen out of the employment even though he




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A D M IN IST R A TIV E PROBLEM S.

is not on the employer’s time till the place of actual work is reached.
Both California and Massachusetts have held to this effect also in
cases reported from those States.
We had one case in which we allowed the claim of a workman who
was injured on the steps at the entrance to the building, part of which
was occupied by the employer. We held that in renting a room or
suite of rooms in a building the common entrance to the building
should be considered in this connection as part of the employer’s
premises, and the hazard of the steps was a hazard peculiar to the
employer’s premises.
The Supreme Court of Massachusetts held to the same effect in a
case which recently came before them, In re Sundine, 105 N. E. 433.

The following are a few additional cases of this class which have
come before the Ontario board:
Allowed—
W here the forem an o f a teaming company, when quitting w ork in evening at
sand pit, got on one o f his em ployer’s w agons to ride into town, jum ped off
wagon at his street intersection, and was hurt by passing auto.
W here a workm an employed by a railw ay at terminal yards about 4 miles out­
side the city was killed by train which he was about to board in the city to take
him to his work. Usual custom for railw ay to carry men to their w ork at this
point. Board considered case arose out o f employment though w orkm an’s time
did not actually start until arrival at work.
W here a man going to w ork in a lumber yard which adjoins railw ay tracks
w as killed by passing train as he was crossing the tracks to work. Considered
he had reached the ambit o f his employment.
W here a man on engineer’s staff going into a lumber camp from town— pay
started when he left town— broke through ice and drowned.
W here a car inspector who had evidently finished his day’s w ork threequarters o f an hour before usual quitting time came into town as per usual
custom by com pany’s train. Evidently jumped off or jerked off near station,
though no one saw accident. Body found alongside track.
W here a man employed by one o f the tenants o f a building entered the eleva­
tor in common use by all tenants o f the building, and, instead o f w aiting for
the operator, pulled the rope him self and was killed. Considered that the ele­
vator was part o f the premises rented and constituted one o f the hazards o f
the business.
W here a man employed by a cartage agent was out plow ing on a farm near
town for a customer. On way home from work horses ran away.
Not allotved—
W here a man had been told the night before to go down to get w ork at an
elevator in the morning. W hile on the way to work along railw ay track near
the place where he was to be employed, about 9.30 or 10 a. m., he was hurt by
train.
W here a man going from w ork in the woods instead o f taking the com pany’s
bush road came out on railw ay track and was killed by train.
W here a railw ay workm an on bridge w ork had been given a ticket home for
Christmas holidays and return. On returning he jumped off the train at about
the place where his w ork would be and was injured. This w ould have saved
him a walk back from the station o f about a mile.




ARISIN G OUT OF E M P L O Y M E N T ---- GEORGE A. K IN G ST O N .

W here a man w orking fo r a railw ay as section man, after quitting w ork in
evening, jumped on passing freight to go down the yard to where he had hung
his coat when starting w ork and w as injured.
W here a man having met w ith a certain in ju ry the day before asked leave
at 11 a. m. to go tw o or three blocks along street to an emergency hospital to
get injury dressed. This took him across railw ay tracks. On returning, find­
ing a train blocking the crossing, he attempted to climb through and got foot
cut off.
INJURIES DUE TO SCUFFLING, LARKING, OR HORSEPLAY.

There have been a variety of opinions expressed on this type of
.case both in England and on this continent.
It was held in the recent case (1916) of Parsons v . Somerset, 9
B. W. C. C. 532, that where a railway porter in the course o f his
employment met with an accident due to his getting on the foot­
board o f a car after the train started, not for any object o f his em­
ployment but purely for his own pleasure (larking with two young
ladies on the train), he was not entitled to compensation.
In another case, Wrigley v . Nasmythe, where a workman who went
for some purpose to a fellow workman in the shop, on parting tapped
his friend on the back with a rule, and received a push in return from
which he was injured, it was held by the court o f appeal that the
accident did not arise out of the employment.
Our board in Ontario has adopted the rule in these cases that if
the injured workman is an active,, participant in the scuffling or
horseplay he is not entitled to compensation, but if while going about
his duties he is the victim o f another’s prank, to which he is not in
the least a party, we do not deny him compensation.
I note the following cases from my records coming under this
heading:
Allowed—
W here a Chinaman employed in a factory was the innocent victim o f horse­
play— blown up by hose.
W here a man who had been teased by another workman suddenly turned in
revenge and hit an innocent party.
WThere a man about to punch the time clock w as hit from behind by another
workman. Injured man innocent o f any horseplay.
W here a man in line up for the time clock w as pushed out o f Une by another
workman, and to prevent him self from falling, as w ell as to save his place in
the line, he grabbed the workm an and his hand came in contact with a sharp
knife in the latter’s hand.
Not allowed—
W here, when a man splashed a little water over another workman, the latter
in trying to avoid the wrater turned suddenly and, having hose in his hand,
turned it on the man who first started the horseplay.
124247°— 19------- 5




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A D M IN IST R A T IV E PR O B L E M S.

INJURIES ARISING OUT OF AN ACT OJF GOD OR THE COUNTRY’S ENEMIES.

Under this heading about the only type o f case in which the
question has arisen is that due to lightning, but there have been a
few cases reported during the last two or three years in England
arising out o f bombardments by enemy ships or airplanes.
In regard to lightning, the State boards or courts are not by any
means uniform in their decisions and it can scarcely be said that there
is in this country anything like a well-settled opinion.
The Supreme Court o f Michigan recently held that a railway sec­
tion man, who sought shelter from a storm in an adjacent barn
which wras struck by lightning and who was injured, was not entitled
to compensation, basing this decision on the argument that the risk
was not different from the risk run by other members o f the com­
munity.
The Supreme Court o f Wisconsin also held that where a man work­
ing on a dam was killed by lightning, it was not a case for compensa­
tion.
The Supreme Court o f Minnesota, however, toot an opposite view
and allowed compensation to a workman who was injured by light­
ning while seeking shelter under a tree at the time o f a storm.
In those jurisdictions where only the first of the two conditions are
required— that is, injury by accident during the course o f employ­
ment, omitting “ arising out of, etc.”—there can, of course, be no
question, as an injury by lightning is certainly an accident and if
this injury takes place during the period o f work the condition is
complete. I should scarcely have thought that it could be argued
where a man goes into a building or under a tree to seek temporary
shelter from a storm, that he has therefore left the employment, yet
this point did arise in the supreme courts of both New York and
Minnesota, and it was held that thus temporarily seeking shelter was
not leaving the employment but rather was incidental to it.
The decisions in England in lightning cases turn on the question of
special risk. Thus, for example, a steeple jack repairing a flag pole
is considered to be specially exposed to the danger o f lightning;
likewise a man working on the top o f a high scaffold was considered
exposed to special danger and compensation was allowed. But where
a roadman engaged in his ordinary occupation on the highway was
struck by lightning, it was held that there was no special exposure to
the danger o f lightning and compensation was refused.
It amounts to practically this in England, that in all lightning
cases the claimant must prove by positive evidence that the circum­
stances o f the employment exposed the employee to a greater risk
than that run by persons not so employed or not so employed under
the same conditions.




A RISIN G O UT OF E M P L O Y M E N T -----GEORGE A. K IN G S T O N .

6 f

The bombardment cases in England turn on much the same point
as the lightning cases, viz, the question o f special risk or special ex­
posure due to the employment.
In this connection dicta by Lord Chancellor Finlay in the Dennis
v . White case above cited are o f interest.
He says:
In the case o f injury by bomb thrown from hostile aircraft, the fa ct that
workm an w as engaged on w ork on a building brilliantly lighted so as to attract
the notice o f enemy crew s might be most m aterial as show ing that the in ju ry
by the bomb was one which arises out o f the employment.

It was actually held in one case (Allcock v . Rogers, W . ST., Decem­
ber, 1917, p. 353) where a servant' in a hotel, whose duties were,
among other things, to polish the brass name or sign plate 011 the
outside o f the building, was injured by the explosion o f a bomb
dropped in the street a short distance away, that this did not arise
out o f the employment, or, in other words, that the workman was
not exposed to any special risk incident to his employment.
In the famous Hartlepool case (Cooper v . N. E. Ry. Co.) the
decision was similar. In that case an engineer, having left his
engine to seek shelter while the bombardment was on, ventured back
to open the injector in order to prevent damage to the fire box and
upon returning again to shelter was injured by a bomb. It was
held by the court o f appeal that this injury did not arise out o f his
employment. As a master of the rolls expressed it:
The claim ant must prove that he was exposed by the nature o f his employ­
ment to some special or peculiar risk beyond that o f other inhabitants o f
Hartlepool. The w hole town w as within range o f the guns and there w as no
evidence or suggestion that they w ere directed at any particular spot.
INJURIES DUE TO ATTEMPTED ROBBERY, FIGHTING, ASSAULT, MURDER,
OR SUICIDE.

I suppose every administering board has occasion frequently to
determine cases coming under this heading, and from all the reports
I have been able to read it seems quite a generally accepted principle
of law in every jurisdiction that where a workman in the discharge
o f his duty is assaulted either by another workman or by a stranger
in attempted robbery of the employer’s premises, compensation
should be allowed.
A border-line case, however, arose in Massachusetts and compensa­
tion was denied. In this case a night watchman wras shot by mistake
by officers pursuing burglars wt1io had committed robbery in the
neighborhood and were being pursued. There was no suggestion
that robbery o f the premises claimant was guarding was feared, and
he was not fired upon because o f his employment, but clearly through
mistake. The court held that the injury did not arise out of the
employment.




£8

A D M IN IST R A T IV E PRO BLEM S.

The Supreme Court of New Jersey also refused compensation in
the case of a delivery man and collector who wTas shot by an unknown
person for an unknown cause while in the performance of his duties.
There was no attempt at robbery, though claimant had money on
his person, and it was held that the shooting was not in any way
connected with the employment.
We had a rather unsual case in Ontario about a year ago which
is also close to the border line, but our board allowed the claim.
A night watchman was found dead in the morning, sitting in a chair
in the office o f his employer, shot through the head, apparently by
his own gun. There was nothing which would warrant the con­
clusion that it was a case o f suicide, but on the contrary it seemed
probable that he had been engaged in cleaning the gun, though there
w as no positive evidence as to this. It was a case in which the
board was obliged either to infer suicide or accidental discharge o f
the gun while cleaning it, and the latter inference seemed the proper
one.
It is equally well settled, I think, that where the assault which
results in the injury arises out o f a dispute or quarrel purely per­
sonal to the workman and not associated with his employment, com­
pensation should not be allowed.
The distinction may be thus illustrated: Where a foreman is
assaulted and injured while trying to compel a discharged workman
to leave the place of his former employment, I think that the claim
should be allowed. This was an actual case in California. On the
other hand, and this is a case from our own Province, a street-car
conductor in resenting what he considered a personal insult directed
at him by a soldier passenger abused the soldier rather badly. The
latter, upon going to his camp nearby, reported the affair to his
soldier companions, whereupon a number o f them returned, boarded
this conductor’s car as it was returning and beat him up, causing
severe personal injury. W e held that this was a purely personal
quarrel and that the injury thus sustained did not arise out of the
employment.
In another case which came before us, two workmen got into a
dispute over some material or tools required in connection with their
w ork and, wTords finally leading to blows, one of them was quite
seriously injured. This one appeared to be the least to blame o f the
two, yet he did actively participate in the scrap. We held that the
dispute was a purely personal one between these two men, and as
the interests of the employer were in no way involved or concerned
the injuries could not be said to have arisen out o f the employment.
We also rejected a claim in a case where a boy was found dead
at his place of work with a loop o f rope around his neck, as the
circumstances pointed to suicide rather than accident.




A R ISIN G OU T OF E M P L O Y M E N T — GEORGE A . K IN G S T O N .

69

INJURIES DUE TO EROSTBITE OR HEAT STROKE.

The cases coming under this heading turn upon the same considera­
tion as the lightning and bombardment cases above noted, viz, the
question of special exposure.
In the Warner v . Couchman case, decided by the House of Lords in
England in 1911, a baker whose duty was to drive a bread-delivery
cart was frost bitten in the hand. The county court judge held that
there was nothing in the employment which exposed him to more than
the ordinary risk o f cold to which every person working in the open
air was exposed on that day, and consequently the injury did not arise
out o f the employment. The House of Lords held that the decision o f
the county court judge on this question o f fact was final.

Important dicta by one of the appeal court judges, however, are
quoted in the House of Lords with favor as expressing the point of
view with which he says judges should approach cases of this kind:
W here w e deal w ith natural causes affecting a considerable area, such as
severe weather,-we are bound to consider whether the accident arose out o f the
employment or was merely a consequence o f the severity o f the weather to
which persons in the locality, whether so employed or not, were equally exposed.
I f it is the latter, it does not arise out o f the employment because the man is
not specially affected by the severity o f the weather by reason o f his employ­
ment.

In the case of Dennis v . White, above referred to, which leversecl
the old line of decisions in regard to street accidents, Lord Chancellor
Finlay, in referring to frostbite and sunstroke cases as distinguished
from ordinary street accidents, says:
In such cases it is material to show that the wTork involves special exposure
to the heat or cold. W here the risk is one shared by all men, whether in or ou t
o f the employment, in order to show that the accident arose out o f the employ­
ment, it must be established that special exposure to it is involved.

In regard to heat stroke, there are two English authorities in which
the principles governing these cases were fully considered— one in the
House of Lords in 1908 (The Ismay v . Williamson case) and the
other in the court o f appeal in 1914 (Maskery v . Lancashire). These
were both shipping cases. In the one a stoker was overcome with heat
while trimming the fires and in the other a young man not in the
best o f health who had shipped as an engineer on a vessel bound for
Singapore, while sailing in the southern part o f the Red Sea, was
overcome by heat and died.
In both cases the court held that death was due to accident arising
out o f the employment, and it did not affect the situation to say that
the man was not robust enough to stand the tropical heat. It was
sufficient to find that the work in the engine room or boiler room
exposed the workman to excessive heat, which was far greater than
that to which ordinary sailors whose duty does not take them into
the engine room were subjected.




70

A D M IN IST R A TIV E PRO BLEM S.

We had a ease o f frostbite in Ontario last winter which the board
allowed. A railway workman was sent out with an auxiliary crew
to clear a wreck— weather 30° below zero. He was put at the job of
flagging and was so engaged three or four hours, with the result that
his legs and feet were very badly frozen. Under these circumstances
it was considered accidental injury arising out of the employment.
ACCIDENTS OCCURRING DURING MOMENTS OF LEISURE OR W H IL E DOING
SOMETHING 03? A PERSONAL NATURE.

Cases coming under this heading are very numerous and their deci­
sion must necessarily turn on the particular circumstances in each
case. In England^ as well as in all the jurisdictions on this side
whose reports I have had the opportunity o f reading, there is quite a
latitude allowed workmen in respect to moments o f leisure during
the eourse o f employment. The crew o f a train, for example, waiting
at a switch to make a crossing; a sailor in a river boat waiting for the
tide; a machine operator waiting for material which he is dependent
on another workman to bring to him ; a trainman having a few hours
between arrival at terminal and departure on return journey—one
can easily imagine a variety o f cases o f this type, where the work­
man is clearly in the course o f his employment but for the time being
has no duties to perform for the employer.
T o quote M ilton: “ They also serve who only stand and wait.”
The question to be asked in every such case is, Did the workman oc­
cupy those moments of leisure reasonably, having regard to all the
circumstances ?
If, during such an interval of waiting, he meets with an accident
while engaged in some occupation or amusement which is unconnected
with his employment, or which adds to the risk to which he would
otherwise be subject, judges in the main agree that compensation
should not be allowed; but what one may reasonably do, o f a personal
nature and which is not in conflict with specific instructions, should
not be held as taking a man outside the scope o f his employment for
purposes o f compensation in the event o f accident while so occupied.
The following decisions am noted in this connection: The New Jer­
sey Supreme Court allowed a claim where a workman was killed
while crossing railway tracks near the plaee o f his employment to the
toilet in common use by workmen in the employer’s service. The
Supreme Court o f Massachusetts held that a compositor who went
out on the roof on a hot night for fresh air and was injured by mak­
ing a misstep was entitled to compensation. The California commis­
sion went so far as to hold that a .eook was entitled to compensation^
where he left the kitchen to smoke for a time on the adjoining porch,
and on attempting to return opened the wrong door and fell down­
stairs.




A R ISIN G OUT OF E M P LO lrM E N T ---- GEORGE A. KINGSTON.

71

There is one decision, however, reported from Iowa, which I think
is carrying this idea o f personal liberty at the expense o f the em­
ployer too far. In that case a workman was allowed compensation
who undertook to light his pipe while his hands were moist with
gasoline, with which he had been cleaning his clothing.
We have had a variety o f these personal and leisure-moment cases
before our board, quite a number o f them arising out o f accidents
occurring to workmen while remaining on the employer’s premises
during the luncheon hour.
I note among them the following:
Allowed—
W here a woman w orker boiled water fo r tea on a gas jet near her w ork and
it boiled over or was knocked over causing injury.
W here a boy, 14, w orking in a planing mill, being desirous o f fixing up a
small block o f w ood fo r his own use, took it to a saw to cut it to the desired
shape and got his thumb cut off.
W here a scavenger, w orking for city, found tw o electric bulbs in garbage
and out o f curiosity cracked them together and lost an eye.
W here a section man, who had gone into city on his speeder to get his pay
check, w as found dead on the track, evidently run down by train on w ay home.
W here a workm an being dusted off by another workman, by means o f air
hose, gets an internal charge and dies o f peritonitis.
W here a workman paid 50 cents a week extra to engage in fire drill for the
em ployers’ voluntary fire department w as injured w hile so drilling.
W here a boy employed on a vessel having some leisure time, while the vessel
is tied up at a certain w harf, in chasing a rat w hich appears on the w harf,
trips into the w ater and is drowned.
W here a laborer engaged in certain building w ork went into the shop or tool
house to take shelter from a storm, and w hile there undertook to sharpen a
fellow w orkm an’s chisel. W hen done, w ent to turn off switch, and w as electro­
cuted.
W here a man on quitting work went to boiler for a pail o f w ater with which
to wash, slipped, and scalded himself.
W here a man in a mill having a moment o f leisure went to another part o f
the plant to pay a small board bill to a fellow workman [and was in ju red].
Not allowed—
W here a man, seeing an adjoining machine idle and being curious to know
how it works, attempted to operate it and got his thumb cut off,
W here a workm an sleeping at noon hour on em ployer’s premises, took a lit
and rolled against a hot steam pipe.
W here a boy went out o f his way to grind his ja ck knife on a machine where
he had no business to be and was injured.
W here a man working on repairs on a ship, whose living quarters were on the
ship, left his boat in the evening to spend the evening visiting his brother on
another vessel alongside, owned by the same company, and was injured w hile
leaving this other vessel late at night.
W here a workm an taking a bath on em ployer’s premises (a cordite fa ctory)
fell against hot pipes. It was alleged that it was necessary to take a bath
every day in this w ork to keep in condition. Considered personal business.
W here a workm an brought a bottle o f ginger ale as part o f his lunch and in
opening it the stopper flew up and hit him in the eye.




72

A D M IN IST R A TIV E PROBLEM S.

W here a young man, after eating his lunch on the premises, climbed out on
the roof o f the building and, finding him self slipping, grabbed a w ire w ithin
his reach. This sagged w ith his weight, and then he grabbed another, thus
creating a circuit, and he w as electrocuted.
CAMP ACCIDENTS.

Owing to the extensive lumbering and mining operations carried
on in our Province, we are frequently called upon to deal with claims
coming under this heading.
I refer especially to such as may happen to a workman after work­
ing hours. It is well understood, of course, that in most of these
operations the men spend the whole of the 24 hours on what may be
termed the employer’s premises.
Practically the same principle is involved in this type o f case as in
the noon-hour accident cases above noted.
We allowed the claim o f one man in a river driving camp who
after supper went to his tent; while lying on his blanket on the floor
reading, another workman came in and accidentally stepped on
claimant’s hand, inflicting a wound which became septic, with quite
serious results. We considered that the accident, properly speaking,
arose out o f the employment.
We allowed another claim where a workman in walking from the
dining camp to the sleeping camp slipped on the ice and broke his
le g ; also another claim where a workman slipped on the steps o f the
cook house, where large building operations were going on for an
aviation camp.
In a border-line case, the claim was allowed where a workman was
hired to go to work on a boat next morning. He actually came on
board that night and slept on the boat, but was badly hurt next
morning before his duties actually began.
On the other hand, where a workman w^as injured by slipping on
an icy path leading from the works to his own house, which was on
employer’s premises, claim was disallowed.
It follows, o f course, that workmen injured on the employer’s
roads leading from the woods to the camp are considered in the
course o f their employment, and in a few cases claims have been al­
lowed for accidental injuries under such circumstances.
The California commission allowed a claim where a workman was
injured by falling from a log on the road while coming with others
into camp from the woods, but the decision seems to have been put
on the ground in that case that these men were allowed time to
return to camp from their place o f work.




W E D N E S D A Y , S E P T E M B E R 25— M O R N IN G S E S S IO N .
CH AIRM AN, FRED M . W IL C O X , W ISCONSIN.

BUSINESS MEETINGREPORT OF THE SECRETARY-TREASURER*
A t tlie Columbus meeting o f the International Association o f In­
dustrial Accident Boards and Commissions, held in April, 1916, I
offered to bring out the proceedings of the conference as a bulletin
o f the United States Bureau o f Labor Statistics, i f the association
so desired. The advantages o f having the, proceedings published
and distributed free o f charge by the Bureau o f Labor Statistics
were obvious and the offer was accepted by the association. A t the
same meeting, I, as United States Commissioner o f Labor Statistics,
was chosen secretary-tre^surer o f the International Association o f
Industrial Accident Boards and Commissions because of the great
advantage of having the publishing and distribution of the proceed­
ings in the hands o f the secretary and because, by vesting this office in
the United States Commissioner o f Labor Statistics, the association
secured the benefits not only o f publication free of expense, but of a
central national secretariat possessed o f great resources for acquir­
ing information useful to the accident boards and compensation com­
missions and o f the right to disseminate such information under the
United States Government frank. The reasons for placing the sec­
retaryship in the Bureau of Labor Statistics seemed to me sound at
that time and I think the changing o f conditions has brought out
more strongly the indispensableness o f having the office of secretary
o f the International Association o f Industrial Accident Boards and
Commissions located in Washington and vested with all the rights,
powers, and prestige o f a Federal bureau.
I accepted the secretaryship o f this association only because o f the
great importance o f improving legislation and administration in
this comparatively new field o f labor legislation relating to the
rights o f workers to compensation for injuries due to industrial
hazards. I feel that the association has been very greatly strength­
ened and benefited by this arrangement, in spite o f the fact that
my time has been more than occupied with duties more directly con­
nected with administering my Bureau, which obliged me to give but
scant attention to the affairs o f the association. The International
Association of Industrial Accident Boards and Commissions has,




73

74

BU SIN E SS M E E T IN G .

however, secured the services of a trained, experienced editorial
staff free of expense. It has secured the publication and distribution
of its proceedings without cost. The Bureau of Labor Statistics,
through its M o n t h l y L a b o r R e v i e w , has put at the disposal of the
accident boards and compensation commissions a vast deal of in­
formation which should be of the greatest practical utility to them.
In addition, many hundreds of letters have been written in answer
to specific inquiries or to keep the boards and commissions informed
of interesting and important matters. All these services rendered
to the assocation constitute such additional burdens upon me, my
secretary, and the editorial staff in the Bureau of Labor Statistics
that some new arrangement must be made for the future.
Some criticism was voiced at the Boston meeting because of the
lateness in the appearance o f the proceedings o f the Columbus con­
ference. As I explained at Boston, the papers and transcripts o f
the Columbus meeting were not received by me until five months
after the meeting was held. When they did reach me they were in
such inexcusably bad shape that it required endless correspondence
and months o f labor on the part o f the Bureau’s editors to put the
proceedings in printable form. By contrast, the proceedings o f the
Social Insurance Conference, held in Washington, D. C., December
5 to 9, 1916, which were reported by stenographers of my own staff,
were sent to the Government Printing Office January 9, 1917, one
month after the close o f the conference, while the proceedings o f
the Columbus conference, held in April preceding the 'Social Insur­
ance Conference, were sent to the Government Printing Office Octo­
ber 30, 1916, six months after the meeting. The difference in the
time between the dates o f meeting and the dates o f sending the bul­
letins to the printer represents the difference between good reporting
and bad reporting. Only one speaker at the Social Insurance Con­
ference failed to get his remarks to me in time to be included in
the proceedings. This delinquent was a noted surgeon. It has been
my experience that physicians and surgeons are the most notorious
malingerers and procrastinators to be found anywhere. I f they
have no better sense o f time value in the practice o f their profes­
sion than they evidence in meeting their obligations in the matter of
writing and correcting their addresses on medical and, surgical sub­
jects, their unfortunate patients have my profoundest sympathy.

No doubt the members of the association marvel that the proceed­
ings of the Boston meeting have not yet appeared. The reasons
for the delay in bringing out the proceedings of the Columbus meet­
ing apply in the present case, but the circumstances are even more
aggravating and are utterly inexcusable. Despite every effort on
my part, no papers have ever been received from Dr. J. W. Brick-




REPORT OP T H E SECRETARY-TREASU RE R.

fey, Dr. Timothy Leary, F. M. W ilcox, and F. J- Donahue, After
using up an amount o f time, stenographic skill, typewriter ribbon,
paper, and ink all out of-proportion to the value of the results
achieved, I did get, on A pril 4, 1918, papers from Dr. F. D. D0110ghue, Dr. J . W. Sever, Dr. E, E. Southard, and Dr. A . W . George.
By that time the congestion at the Government Printing Office had
become so great that it was utterly hopeless to get anything printed
this year except the most urgent war emergency matter. Some o f
the speakers did not take enough interest even in their own remarks
to give the courtesy o f a reply to my urgent appeals for their papers.
It is quite evident that the papers can’t be published unless they are
written and sent in.
I had almost as great trouble in getting most of the stenographic
transcripts of discussions. A fter months of delay, during which
time the stenographers apparently completely forgot the meaning
o f their notes, if they ever meant anything at all, I received jumbled
masses o f more or less meaningless words. The strain upon the
patience and nerves of the editors, to say nothing of the time in­
volved in dealing with such reportorial inefficiency, is awful. In
the end, I was obliged to cut out most o f the stenographic reports
o f the alleged sayings of speakers. In doing so I felt obliged to
sacrifice some good material.
I can better picture to you the seriousness o f this matter by an
illustration. Those o f you who were present at the luncheon served
in the Wefet Lynn plant of the General Electric Co. will remember
with pleasure the spontaneous discussion which followed. You will
recall that Dr. F. E. Schubmehl started things by condemning the
free choice o f physician by the injured workers. Dr. Rubinow at­
tacked this position and there followed a most animated and highly
profitable discussion. The stenographer who took this discussion
for some reason credited Dr. Rubinow with only a brief paragraph
and Dr. Schubmehl with even less. The remarks o f another speaker
who did not contribute anything noteworthy were for some reason
reported in extenso. The stenographic report o f this vitally im­
portant discussion was thus so misleading that I deemed it best to
cut out practically all o f it.
In many instances the remarks ascribed to speakers were confused
or meaningless and had to be eliminated. I make extended refer­
ence to the unsatisfactory reporting o f discussions not merely to ex­
plain difficulties and delays in publishing but chiefly to urge the
need for adequate reporting if discussions are to be printed at all,
I may add that a good deal o f discussion is not worth publishing.
Perhaps no further comment on this score is necessary. However,
I can not refrain from again saying that the proceedings of the meet-




76

BU SIN E SS M E E T IN G .

mgs can not be brought out promptly and in useful form unless
speakers and writers cooperate by sending in papers and corrected
manuscripts and proofs promptly to the one charged with the task
o f editing and publishing the proceedings. I f the meetings are
worth while they are worth reporting correctly and publishing
promptly and in usable form. I f they are not worth while, let us
discontinue them and dissolve the organization.
Regarding this F ifth Annual Meeting of the International Asso­
ciation o f Industrial Accident Boards and Commissions, it was my
intention to have all the papers printed and distributed in advance
o f the meeting. The overwhelming pressure o f emergency war work,
coupled with the setting forward o f the date of the meeting by two
weeks, has made it impossible to carry out my intentions fully. It
is encouraging that up to September 9, 18 papers out o f the 37 pro­
vided for on the program had been received by me. It is not so
encouraging when we consider that I had asked that papers, to­
gether with summaries, be submitted not later than August 15. Only
6 of the writers had prepared summaries or synopses of their papers
as requested. The 12 papers without summaries had to be gone
through carefully and summarized by the editors o f my Bureau.
The summaries were mimeographed and sent out on the 9th and 10th
o f September. No doubt some of the authors whose papers have
been summarized by the editors in the Bureau o f Labor Statistics
will feel dissatisfied with the summaries. O f course, it would have
been much more satisfactory if the papers could have b ^ n printed
in full before the meeting. A summary by the author is the next
best thing when the complete paper is not available. One reason
for asking the authors o f papers to submit summaries was to en­
able us to take care o f the papers by mimeographing the summaries
in case it should prove impossible for any reason to get the complete
papers printed in advance.
Coming now to a question o f even more immediate moment, I do
not see how the Bureau o f Labor Statistics can publish the proceed­
ings o f this present meeting. The appropriation for printing and
binding allotted to the Bureau has been cut from $76,000 to $35,000—
a sum which is inadequate to pay for the printing of the M o n t h l y
L a b o r R e v i e w alone for a year.
Even if my printing funds were
made sufficient and the papers and stenographic reports came in
promptly and in perfect shape for printing, it would still be very
difficult to manage the publication because of the overwhelming
pressure of work falling upon my Bureau and the congestion in the
Government Printing Office. It has been proposed in Congress that
all “ nonessential” printing be eliminated. We are all heartily in
favor of that plan, but our classification o f nonessential printing




REPORT OF T H E SECRETARY-TREASU RER.

77

would probably not coincide with that of Congress. In view o f these
facts it seems necessary that the association consider seriously
whether it is not possible to make some other arrangements for pub­
lication o f the complete proceedings. A summarization o f the pro­
ceedings will, of course, appear in the November number o f the
M o n t h l y L a b o r E e v i e w . . I f it shall be found impossible to provide
for the publication of the proceedings more surely and more speedily
than appears possible through the Bureau o f Labor Statistics, I shall
o f course use every effort to get them out. The situation is so un­
certain, however, that I desire to call the attention of the delegates
to the probable delay and even the possibility that the Bureau o f
Labor Statistics can get nothing published for the association. I
wish it distinctly understood that the Bureau o f Labor Statistics will
continue to send out useful information to all accident boards and
compensation commissions throughout the United States and Canada,
both through the columns o f the M o n t h l y L a b o r E e v i e w and by
letter. To make my Bureau as useful as possible to the members o f
this association and to labor officials generally, the boards and com­
missions must inform the Bureau o f Labor Statistics promptly o f any
interesting and important developments in compensation legislation
and administration.
The treasurer’s report on the finances of the International Asso­
ciation of Industrial Accident Boards and Commissions shows that
it is not y£t a solvent organization, although the membership dues
were doubled last year and the active paying memberships have in­
creased from 24 to 28—more than 16 per cent.
The 28 active paying members are:
The Industrial Accident Commission of California.
The Workmen’s Compensation Commission of Connecticut.
The Industrial Accident Boards o f Hawaii (counties o f Kauai,
Maui, Hawaii, and Honolulu).
The Workmen’s Compensation Service of Iowa.
The Industrial Commission of Illinois.

The Industrial Accident Commission of Maryland.
Industrial Accident Board of Massachusetts.
State Board of Labor and Industries of Massachusetts.
Industrial Accident Board o f Michigan.
Department of Labor and Industries of Minnesota.
Industrial Accident Board o f Montana.
Department o f Labor of New Jersey.
New York State Industrial Commission.Industrial Commission of Ohio.

Industrial Commission of Oklahoma.
Industrial Accident Commission of Oregon.




78

BU SIN E SS M E E T IN G .

Department o f Labor and Industiy o f Pennsylvania.
Industrial Accident Board o f Texas.
Industrial Commission o f Utah.
Industrial Insurance Department of Washington.
State Compensation Commissioner of West Virginia.
Industrial Commission o f Wisconsin.
Workmen’s Compensation Department o f Wyoming.
Workmen’s Compensation Board of British Columbia.
Workmen’s Compensation Board of Manitoba.
Workmen’s Compensation Board o f Nova Scotia.
Workmen’s Compensation Board o f Ontario.
Department of Public Works and Labor of Quebec.
The dues o f the 11 following active paying members, however,
have not yet been received for the fiscal year ending June 30, 1919:
The Industrial Commission o f Illinois.
State Board o f Labor and Industries of Massachusetts.
Industrial Accident Board of Michigan.
Department of Labor and Industries o f Minnesota.
Industrial Accident Board of Montana.
New York State Industrial Commission.
Industrial Commission of Oklahoma.
Industrial Accident Board o f Texas.
State Compensation Commissioner of West Virginia.
Workmen’s Compensation Board of British Columbia.
Workmen’s Compensation Board of Ontario.
You will recall that the United States Employees’ Compensation
Commission, the United States Bureau of Labor Statistics, and the
Department o f Labor o f Canada, while entitled to vote as active
members, are exempt from the payment of dues.
It will be noted that two Massachusetts boards belong to the associ­
ation, namely, the State Industrial Accident Board and the State
Board of Labor and Industries. Both these agencies are, of course,
interested in the purposes of our organization. This adds point to
my suggestion for the amalgamation of the International Associ­
ation of Industrial Accident Boards and Commissions and the Associ­
ation of Governmental Labor Officials of the United States and
Canada.

We also have four associate members paying $10 each.
members are:

These

Mr. William P. White, treasurer and general manager of the
Lowell Paper Tube Corporation, Lowell, Mass.
National Workmen’s Compensation Service Bureau, Newr York,
N. Y.
Mr. John T. Clarkson, general counsel, law department, United
Mine Workers, District No. 13, Albia, Iowa.
Workmen’s Relief Commission o f Porto Rico.




REPORT OF T H E SECRE TA R Y -T R E A SU R E R .

79

The last-named associate member has just joined the organization
and the annual dues have not yet been received.
It is very difficult to obtain the appropriations from State legis­
latures to pay the dues. The difficulty is greatly increased by the
fact that another organization exists, claiming jurisdiction over all
matters pertaining to labor, including the administration o f com­
pensation laws. I refer, o f course, to the Association o f Govern­
mental Labor Officials o f the United States and Canada. A State
legislature would be justified in thinking that there is no good rea­
son for the separate existence o f these two organizations. The
election o f the chairman o f the Industrial Commission o f Wisconsin
as the president o f the Association o f Governmental Labor Officials
o f the United States and Canada marks a new epoch in the history
o f that association and gives promise that the association will be­
come, as it should be, a most useful organization for the standardiza­
tion and improvement o f labor administration and labor legislation.
Because the Association o f Governmental Labor Officials gives evi­
dence o f better things and because the International Association of
Industrial Accident Boards and Commissions has become pretty
firmly established, it seems to me the time is ripe for an amalgama­
tion o f these two organizations. In Wisconsin, Ohio, and New
York the industrial commissions are charged with the administra­
tion o f all labor laws, including workmen’s compensation laws. In
all States it is vital to bring the administrators of the compensation
laws and the people generally to see the connection between prevent­
ing injuries and paying compensation for them. The amalgamation
should make it easier to get the State legislatures to make appropria­
tions for the support o f the amalgamated organization; it would
cut dowTn travel and other expenses and eliminate much loss o f time
and bother by substituting one meeting for two ; it would unify more
closely the labor-enforcing agencies in those States not having in­
dustrial commissions. The only possible disadvantage that I can
see is that the more backward States might gain control o f the
organization. Presumably the compensation States are more pro­
gressive than the noncompensation States. Some may argue that
amalgamation should not be considered until all States have com­
pensation laws. There are 38 States, two Territories, and seven
Provinces o f Canada with compensation laws, as against 10 States,
the District o f Columbia, and four Provinces o f Canada without
compensation laws. The argument then has little weight.
It would be necessary, o f course, to have separate sessions devoted
to the discussion of special compensation problems, including statis­
tics o f accidents for compensation purposes, medical, surgical, and




80

BU SIN E SS M E E T IN G .

hospital treatment, the retraining o f injured workers and their re­
employment in suitable occupations, as well as the problems con­
cerned with the hearing o f compensation cases and the granting and
handling o f compensation awards.
After the rather frank manner in which I have discussed the
delinquencies o f conference speakers, coupled with my statement re­
garding the printing fund of the Bureau o f Labor Statistics, it is
perhaps superfluous for me to announce that I am not a candidate
for reelection as secretary-treasurer.
I have been obliged to let
many things go undone which should have been attended to in the
interests o f the association and its several members, because o f
many other duties which could not be neglected or postponed. I f
the International Association of Industrial Accident Boards and
Commissions and the Association o f Governmental Labor Officials of
the United States and Canada are amalgamated, as I have suggested,
a secretary-treasurer is needed who can give not less than half his
time to the affairs o f the amalgamated association. It does not seem
possible that the association will be immediately able t'o maintain a
paid secretary with the necessary office force and pay for the publica­
tion of its proceedings as well. The proceedings o f the Columbus
meeting (Bulletin 210), consisting of 252 pages, cost the Bureau of
Labor Statistics a little over $1,700. This charge covered only the
cost o f composition and paper and did not pay for the large amount
of editorial and clerical work required to bring out the bulletin.
The same bulletin would now cost at least 20 per cent more, be­
cause o f the increase in prices and wages. The association should
face the situation and now decide whether steps should be taken to
establish a central office, financed by funds to be collected from mem­
bers, or whether it will continue to depend upon the rather inadequate
services and dilatory and uncertain publication facilities offered by
the Bureau o f Labor Statistics.
I submit an estimated budget for your consideration in case you
should decide that the former course is advisable.
B udget fo r Amalgamated Association.
F or secretary to association, including stenographic and clerical w ork— $2, 500
S ta tio n e r y _________________________________________________________________
75
F or p osta g e_______________________________________________________________
250
50
F or telegram s------------------------- -------------------------------------------------------------------Printing ,o f program s fo r annual meeting-----------------------------------------------50
Miscellaneous expenses connected with annual meeting________________
100
F or reporting proceed in g s________________________________________________
400
F or printing proceedings___________________________________________________ 3, 000




6, 425

REPORT OF T H E SECRETARY-TREASU RER.

81

FIN A N C IA L STATEM EN T.
B E C E IP T S .

1917.
Aug, 21. Balance on hand, including postage and telegraph fund o f
$3.48_________________________________________________________ $371. 09
21. For membership dues, 1917-18, Compensation B oard o f
M anitoba____________________________________________________
50.00
21. From sales at Boston meeting o f the report o f discussion be­
fore the British R oyal Society o f M edicine on toxic
jaundice observed in munition w orkers____________________
11.00
21. From John T. Clarkson, legal department, United Mine
W orkers o f Am erica, D istrict 13, Albia, Iow a, associate
membership dues, 1917-18___________________________________
10.00
Sept. 29. From W illiam P. W hite, o f the L ow ell Paper Tube Corpora­
tion, associate membership dues, 1917-18__________________
10.00
Oct.
4. From New Y ork State Industrial Commission for five copies
o f the report o f the discussion before the B ritish Royal
Society o f M edicine on toxic jaundice observed in muni­
tion w orkers________________________________________________
5. 00
6. From Mr. Albert W . W hitney, fo r associate membership dues,
1917-18, o f the National W orkm en’s Compensation Service
Bureau______________________________________________________
10.00
6. Membership dues for the fiscal year ending June 30, 1919—
W orkm en’s Compensation Board o f Connecticut___________
50.00
Nov. 15. From the Illinois Department o f Labor for three copies o f
the report o f the discussion before the British Royal So­
ciety o f Medicine on toxic jaundice observed in munition
w orkers_____________________________________________________
3.0 0
1918.
Jan. 1. Interest on bank deposit______________________________________
3.60
Membership dues for the fiscal year ending June 30, 1919:
Apr. 16. Massachusetts Industrial Accident B oard____________________
50.00
17. Maryland Industrial Accident Commission___________________
50. 00
23. Department o f Public W orks and Labor, Province o f Quebec50.00
May 15. Washington Industrial Insurance Department_______________
50. 00
25. W orkm en’s Compensation Departm ent o f W yom ing__________
50. 00
June 17. W orkm en’s Compensation Service o f Iow a_________________
50. 00
24. W orkm en’s Compensation Boards o f H aw aii (counties o f
K auai, Maui, H awaii, and H on olu lu )______________________
50.00
July 1. Interest on bank deposits_____________________________________
3. 92
Membership dues fo r .the fiscal year ending June 30, 1919:
8. Compensation Board o f M anitoba_____________________________
50. 00
26. W orkm en’s Compensation Board o f Nova Scotia_____________
50. 00
Aug. 3. Industrial Commission o f Utah______________________________
50. 00
50.00
17. W isconsin Industrial Commission_____________________________
21. Industrial Commission o f Ohio_______________________________
50.00
28. C alifornia Industrial Accident Commission___________________
50. 00
28. Oregon Industrial Accident Com mission______________________
50. 00
29. Pennsylvania Department o f L abor___________________________
50.00
T o t a l_____________________________________________________________ 1,277.61
124247°— 19-------6




B U S IN E S S M E E T I N G .

82

D IS B U R S E M E N T S ,

1917.
Aug. 21. Postage and telegraph fund (balance on h a n d )_______ ___ ___
$3.48
27. To Bay State R ailw ay Co. (special car to Lynn, Mass., to see
General Electric Co. plant) check to Dudley M. H olm an___
16.40
29. T o Dr. Cora B. Gross, for services as registrar, fourth
annual meeting, B oston _____________________________________
12.00
29. T o D udley M. Holman, conference expenses: Postage, $2.75;
signs and messenger, $ 2 ; typewriting, $2.25; messengers,
75 ce n ts; telephone calls, $ 1 J 0 ; telegrams, $1.56; luncheon
and suppers, B oy Scouts, $3.50_____________________________
14.31
29. Reporting meeting, August 21________________________________
20. 00
Sept. 7. T o Robert M iller & Co. (h iring o f flags and draping &ame,
fourth annual meeting, B o s to n )____________________________
5.00
26. To Charles G. Stott (In c .), 10,000 sheets o f -mimeographed
14.40
p a p e r ------ ------------------------------------------------------------------------------Dec. 12. F or transcripts o f stenographic reports, fourth annual meet­
ing, B o s to n __________________________________________________
35. 50
12 F or transcript o f stenographic report, fourth annual meet­
ing, B o s to n __________________________________________________
3. 50
12. F or transcript o f stenographic report, fourth annual meet­
ing, B o s to n __________________________________________________
-3.85
1918.
Jan. 7. T o Gibson Bros. (I n c .), for letterheads, envelopes, second
sheets ( alterations in letterheads)__________________________
30.00
Mar. 11. F or transcripts o f stenographic reports, fourth annual meet­
ing, B o s to n __________________________________________________
27.32
18. F or postage and telegraph fund______________________ _______
5. 00
23. For postage and telegraph fund______________________________
10. 00
Aug. 24. F or postage and telegraph fu nd_____________________________
10. 00
Sept. 16. F or printing programs, and alterations_____________________
20. 50
17. Cash on hand---------------------------------------------------------------------------- 1, 046. 35
T o t a l ____________________________________________ - ________________ 1, 277. 61
There is a postage fu n d balance amounting to $9.84.
When the accounts o f the International Association o f industrial Accident
Boards and Commissions w ere first turned over to me as seeretary-treasurer
&f the organization there w as some confusion net on ly as to the membership
o f the organization but also as to when the dues should be paid. Last M arch
it was found, after much inquiry, that o f all the boards am i commissions be­
longing to the association only six had paid any dues since January, 1917, tiie
m ajority o f these being new members. It %
was, therefore, thought both inad­
visable and im practicable to attempt to collect 4ues fo r 1917-18, when the
new constitution provided that the dues for the fiscal year ending June 30,
1919, should be paid between July 1, 1918, a-nd the annual meeting this fall.
Such attempt would have meant that every delinquent industrial a<?eident board
and commission would have had to be requested to pay dues fo r tw o years be­
tween last April and the annual meeting this fail. Moreover, the amount o f
•dues was increased by the new constitution from $25 to $50 and, previous to
the adoption o f the constitution, there was nothing to mdieate when the fiscal
year o f the association began. In view o f these conditions and also o f the fact
that there were enough funds in the treasury to carry the organization up to




REPORT OF T H E ;SEC&ETAliY-TREASURER.

m

Jane SO, 1918, it wsls decided that a ll dales paid after the last annual meeting
should be credited to the fiscal year ending June 39, 1919.
It w ill be noted that the Province o f Manitoba paid dues on August 21, 1917,
fo r the fiscal year 1917-18, and on July 8, 1918, for the fiscal year ending June
%30, £919. A s the <;oiai$>ensatiou aboard o f M anitoba is the only active member
that lias paid dues twice since the opening o f the last annual meeting (Aug.
21, 1917), it is recommended that duses paid by such board on Ju ly 8, 1918, be
credited to fe e fiscal year e&ding June SO, 1920.
Vouchers fo r annual dues have been received from both the New Y ork State
Industrial Com mission an d the New Jersey Departm ent o f Labor, but payment
has not yet been made.
It is highly desirable that dues fee paid at least a month in advance o f the
annual meeting, so that a complete statement o f the financial condition o f the
' association may be em bodied in the treasurer’s annual report too such meeting.
O t the §0 c e p e s o f the report o f the discussion before the British iioy a l
S ociety o f Medicine on to x ic jaundice observed in munition workers, w hich
w ere purchased in June, 1917, 26 have been sold.
Respectfully submitted.
R o y a l M eeker,

S

cc

retury- T r e m u r e r .

REPORTS OF COMMITTEES.
The committee on jurisdictional conflicts re|>orted progress and
was continued.
The committee on statistics and compensation insurance cost sub­
mitted its report which was adopted. The executive committee was
authorized to cooperate with the Federal Bureau of Standards in tha
formulation of a uniform safety code; also to study the question of
uniformity in State compensation laws. Following is the full re­
port of the committee on statistics and compensation insurance cost:

fEPOKT OFCOMMITTEE ONSTATISTICS AND COMPENSATION INSURANCE COST.
A t the annual meeting o f th is association a t Columbus in April, 1916, your
com m ittee subm itted standard classifications o f industries and accident causes
and o f industrial injuries by location and nature o f injury and extent o f dis­
ability. T h e com m ittee’s recommendations on these subjects w ere adopted by
the association and are gradually being put into use by the various State
boards and commissions. It is believed that a foundation has thus been laid
for uniform statistics o f industrial accidents. T his report o f the committee has
been printed in fu ll in Bulletin 201 o f the United States Bureau o f Labor Sta­
tistics.
A t the last annual meeting o f the association at Boston, in August, 1917, your
* committee submitted standard definitions for industrial accident uses, a stand­
ard scale o f weights designed to express the severity o f accidents in terms o f
days lost, and standard tables for the presentation o f accident and compensa­
tion statistics. This report was also adopted by the association and was
printed in the October, 1917, issue o f the M o n t h l y R e vie w o f the United States
Bureau o f Labor Statistics.
During the past year your committee, continuing its work, has held two
meetings, these meetings occupying some 10 sessions covering four days. The




84

B U SIN E SS M E E T IN G .

revision o f the classification o f accident causes has been the com m ittee’s ch ief
w ork during these meetings. D uring the two years since the original cause
classification was published by the committee it has been in use by all the
members o f the committee and by others. Naturally, this practical experience
had given rise to suggestions for changes and additions to the classifications.
Furthermore, experience had shown the need o f some agreed-upon rules o f
practice, in order that variations in interpretation o f the causes might not
develop so as to render results not fairly comparable and, therefore, seriously
im pair their usefulness. The committee believes that this experience has en­
abled it to im prove greatly the cause classification, and it submits this classifi­
cation as now revised, w ith its accompanying notes, with confidence that it
represents a m arked improvement on any cause classification hitherto published.
The committee in its meetings during the year has also made some minor
revision o f the classifications o f accident by location and nature o f injury and
extent o f disability. The revision o f these classifications has, however, been
in minor details, not in any way affecting the broad outline as published in
Bulletin 201.
The committee has given some consideration to a revision o f the industry
classification, but any extended revision o f this classification is so form idable
a task that the committee has, thus far, made only slight progress in that
work. The revision o f this classification has been attempted by an inform al
committee, made up o f several members o f your committee and representatives
o f the National W orkm en’s Compensation Service Bureau and others. T h is
inform al committee has held several meetings and has practically completed a
revision o f the industry classification, w hich it is expected w ill be subm itted
at a later date, for the consideration o f the com m ittee on statistics. It has been
the plan o f your committee that this w ork should be taken up at its next
meeting.
A t the last meeting o f the committee it discussed w ith F rederick L. H offm an,
chairm an o f the committee on statistics o f the National Safety Council, the
question o f the standardizing o f the methods used by individual establishments
fo r recording, classifying, and analyzing accidents to employees. It was agreed
that some standard form s and methods should be w orked out, i f practicable, so
that results may be properly tabulated and comparisons, statistically valid, may
be made. It w as agreed w ith Mr. Hoffman that the whole m atter should be the
subject o f conference w ith his committee at a future meeting. It is understood
that Dr. H offm an’s committee is recommending for adoption by the National
Safety Council the definitions and classifications o f your committee.
As recommended in the report submitted last year, it is believed that the
w ork o f this committee should be continuous. Experience in the several States
is constantly disclosing the need o f interchange o f views and experience and
o f the discussions which are only possible in meetings o f such a committee.
Progress in the standardization o f accident and compensation statistics w ill be
necessarily somewhat slow, but the need, which was evident when the com­
mittee was organized, that statistical methods be standardized to facilitate
comparisons and to aid the boards and commissions in adm inistrative w ork
becomes more and more pressing with the extension o f workm en’s compensa­
tion laws.
The revised classifications which the committee recommends fo r adoption
follow .




REPORT OF C O M M IT TE E ON STATISTICS.

C L A S S IF IC A T IO N

OF

A C C ID E N T

85.

CAU SES.

GENERAL CAUSE CLASSIFICATION.
I.
32.
m .
IV.
V.
VI.
VII.
V m .

IX .
X.
XI.

Machinery.
Vehicles (not including construction of),
Explosions, electricity, fires, and hot substances.
Poisonous and corrosive substances and occupational diseases.
Falls of persons.
Stepping on or striking against objects.
Falling objects— not being handled by injured,
Handling of objects.
Hand tools.
Animals.
Miscellaneous causes.
I. M A C H IN E R Y .

A . Prim e M overs.
1. Steam engines.
2. Gas or gasoline engines.
N o te . — Include all internal-combustion engines.
3. Electric motors and dynamos.
4. Compressed-air motors.
5. W ater motors.
6. Other prime movers.
B. Pow er-Transm ission Apparatus.
1. Shafts.
2. Shaft collars and couplings.
3. Set screws, keys, and- bolts.
4. Belts and pulleys.
5. Chains and sprockets.
6. Ropes, cables, and drums.
7. Cogs, cams, gears, and friction wheels.
N o te . — Accidents upon belts, pulleys, shafts, gears, or other driving
mechanism or parts thereof w hich form the connection between a ma­
chine and the prime mover or intermediate drive shall be charged to
transmission apparatus. This includes parts attached to the machine.
Accidents upon belts, pulleys, shafts, gears, or other driving mechanism,
or parts thereof which connect one part o f the machine w ith another
part o f the same machine, shall be charged to the machine.
C. Pow er-W orking M achinery.
N o te . — The committee believes that power-working machines should be
classified by industry, and that within each industry group the principal types
o f working machines should be grouped by operative hazard. The committee
recommends the use o f the list o f working machines prepared by the Bureau
o f Statistics and Inform ation o f the New Y ork Industrial Commission, in
cooperation w ith the National W orkm en’s Service Bureau.




B U S I N E S S M E E T IN G *

m

The list follow s:
Power-working machines.
S t o n e , C l a y , a n d G l a s s P roducts M a c h i n e s .

030 Brick-m aking m achinery (not. otherwise classified).
031 .
B rick cut-off machines.
032
D ry pans.
033
M olding machines.
034
Pug mills.
040 Cement-making machinery ( s o l otherw ise classified).
Bag-filling machines (cross index, Barreling, etc., machines, under
> . F o o d ).-.
042
Cement-block machines.
043
Tube mills.
050 Glass-making m achinery (n ot otherwise classified).
051
Polishing wheels.
052
Presses.
053
Surface grinding machines.
060 Pottery-m aking machinery.
080 Stone crushers.
090 Stone-working machinery other than crushers (not otherw ise classified).
091
Drills.
Planers (cross index, M etal).

093

Saws.

094

Rubbing beds.
M e t a l - W o r k in g M a c h i n e s .

100
105
106
107
108
109
110
111
115
319
120

121
122
123
124
125
129
130
132
133
134
135
136
139

All other metal-working machines.
Abrasive wheels (emery, etc.).
Bending and straightening machines (revolving rolls, screw or clam p).
Corrugating rolls.
Crimping rolls.
Other metal rolls.
Other bending and straightening machines (n ot r olls).
B olt and nut, pipe-cutting, threading, and tapping machines.
Boring machines or mills (horizontal and vertical) (n ot otherwise clas­
sified.
D rills (drill presses), radial and upright or gooseneck.
Milling and gear-cutting machines (n ot otherwise classified).
Broaching machines.
Die sinkers.
Gear-cutting machines.
K ey seaters.
M illing machines.
Profilers.
Slotters.
Other or indefinite.
Hammers and forging machines (n ot otherwise classified).
Belt machines.
Drop hammers.
Forging hammers. ,
Scrap breakers.
Swaging machines.
Upsetting machines (not otherwise classified).
Other or indefinite.




REPORT OF C O M M IT T E E OS' ST A T IST IC S.

Lathes and automatic screw machines.
Lathes (not otherwise classified).
Screw machines.
Turret lathes.
Cleaning mills—tumblers or rumble
Molding machines (core, sand mixers, tamping, etc.) (not otherwise
classified).
Planers and shapers.
151
Planers.
152.
Shapers.
i5'5
Polishers and buffers.
156 Portable power tools (pneumatic and electric drills, hammers and
riveters).
Presses (power) (including punches).
157
Arbor presses.
158
Bulldozers.
159
Button presses.
160
Draw presses.
161
Embossing presses.
362
Punch, stamping, and trimming presses.
163
Punch and eyeletting machines.
164
Punches and riveting presses (not riveting hammers).
167
Other or indefinite.
368Presses (foot and hand operated—no mechanical power) (not otherwise
classified).
169
Button presses.
170 Rolling mills (including blooming mills).
171 Saws (not otherwise classified).
172
Band.
173
Circular.
174
Hack.
175
Scroll and jig.
176 Shears (not otherwise classified).
185 Welding and heat cutting machines.
186 Wire working machines (not otherwise classified).
190 Winding machines (armatures, etc.).
191
Cable-making machines (not otherwise classified).
195
Wire and tube drawing machines.
197
Presses—hydraulic, pneumatic, and screw.

140
141
142
145
146

W o od w o rkin g M a c h i n e s .

200All other woodworking machines (not otherwise classified).
205 Bending machines.
206 Boring machines and drills.
207 Cork working machines (not otherwise classified).
208
Band knife.
209
Cork board cutters, block cutters, etc.
210
Cork-slicing machines.
213 Lathes (not otherwise classified).
214
Spoke lathes.
215
Shoe last machines.
216
Button lathes (ivory, etc.).




88

BU SIN E SS M E E T IN G .

220

223
225
226
227
228
229
230
231
232
234
237
238
239
240
241
242
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
265
266
267
268
270
272
280

Mortising machines (not otherwise classified).
Chain mortisers.
Chisel mortisers.
Pocket and boring machines.
Tenoning, planing and molding machines (not otherwise classified).
Auto, blind slat (tenoner).
Edgers.
Jointers.
Matchers.
Molders.
Planers.
Stickers.
Tenoning machines.
Presses (not otherwise classified).
Clamping machines.
Box nailers.
Box board squeezers.
Door and blind clamps.
Hoop presses.
Sanding machines (not otherwise classified).
Belt (felloe and panel).
Disk.
Spindle and post.
Surface or drum.
Saws (band, scroll, or jig) (not otherwise classified).
Band.
Band resaw.
Jig or scroll.
Saws (circular and all other) (not otherwise classified).
Circular.
Gaining machine.
Gang circular.
Lath bolter.
Swing.
Dado.
Dovetailing.
Rabbetting.
Shapers (including special head cutters) (not otherwise classified).
Core box machines.
Shapers.
Variety machines.
Veneering machine (all kinds) (not otherwise classified).
Veneer machines.
Brush and broom-making machines (all kinds).

300
301
302
303
304
305
306
307

All other.
Buffing drums.
Other drums and paddle vats.
Fur-working machines.
Fleshing, shaving, and skiving machines.
Jacks— felting, glassing, rolling, etc.
Presses and baling machines.
Hair washing and drying machines.

221
222

L e a t h e r - W o r k in g M a c h in e s — T a n n e r ie s .




REPORT OF C O M M IT TE E ON STATISTICS.

308
309
310
311

Setting up (or setting out) machines.
Splitting machines.
Unhairing machines.
Extractors (centrifugal).
L e a t h e r -W o r k in g M a c h in e s — L e a t h e r P roducts .

320

A ll other.

330Cutting machines (not otherwise classified).
340Punching and pressing machines (not otherwise classified).
350 Sewing machines.
351 Buffing and scouring machines.
352 All other shoe-making machines.
P a per -M a k i n g M a c h i n e s .

360
All other.
305Barkers, chippers, splitters, and grinders, indefinite.
366
Barkers.
367
Chippers.
368
Grinders.
369
Splitters.
370 Beaters (including rag washers).
371 Screens.
Paper machines.
372
Other or indefinite.
373
Head box.
374
Apron.
375
Wire.
376
Suction roll.
377
Couch roll.
378
Dryers.
379
Calenders.
380
Doctors.
381 Bolls and winders.
382 Cutters and slitters.
383 Choppers.
384 Digestors.
P aper -P roducts M a c h i n e s .

386
All other (not otherwise classified).
3S7
Paper-cup machines.
388
Tube machines.
389
Twine-making machines.
390 Automatic box-making machines.
391 Covering machines.
392 Cutting and punching machines (not otherwise classified).
393
Die cutters.
394
Guillotines.
395
Paper cutters (hand).
396
Perforators.
397
Punches.
398
Rotary cutters.
399
Saws.
400
Shears.




90

B U SIN E SS M E E T IN G .

401 Doming and ending machines (not otherwise classified).
Doming machines.
402
Corrugating machines (not rolls).
408
* Ending machines.
404
406 Corner staying machines.
Bag and envelope making machines.
407
Paper finishing machines.
408
Embossing rolls or calendars (cross index, Itubber).
Embossing presses (cross index, Metal).
P r in t in g a n d B o o k b in d in g M a c h in e s .

420 Composing machines (type casting and trimining machines) (not otherwise
421
422
423
424
426
427
428
429
430
431
440
441
442
445
450

classified).
Linotypes.
Monotypes.
Type casters.
Gathering machines.
Presses (printing) (not otherwise classified).
Web newspaper presses.
Flat-bed cylinder presses.
Job platen presses.
Other printing presses.
Presses (binders) (not otherwise classified).
Sewing and stitching machines (not otherwis# classified).
Wire stitchers.
Wire staplers.
Other printing machines.
Other bookbinding machines.
T e x t il e M a c h i n e s .

460
461
462
469
470
471
472
473
475
476
477
478
479
485
486
487
489
490
491
492
493

All other (not otherwise classified).
Washers.
Driers.
Opening and cleaning machines (not otherwise classified).
Openers.
Pickers.
Rag pickers.
Willow.
Carding and combing machines (not otherwise classified).
Cards.
Combs.
Garnett machines.
Slubbers.
Spinning machines (not otherwise classified).
Jacks and mules.
Spinning frames.
Drawing frames.
Weaving machines (not otherwise classified).
Looms.
Wire-cloth looms.
Warpers.




REPORT OF C O M M IT TE E O K ST ATISTICS.

M

Dyeing, finishing, and printing machines (not otherwise classified).

501
Pile-cutting machines.
502
Shearing machines.
510 Braiding and knitting machines.
515 Rope-making machines.
520
530
540
545

Sewing machines (cross index, Leather products).
Cloth cutting and stamping machines (not otherwise classified).
Hat-making machines.
Coating and inlaying machines (linoleum, etc.; other coated fabrics).
Winders, doublers, and quitters.
L au n d r y M a c h in e s .

550 All other.
Extractors (cross index, Leather).

560 Ironing machines (not otherwise classified)#
561
Body ironers.
562
Flat work ironers.
563
Mangles.
570 Washing machines (rotary).
F ood P roducts M a c h i n e s .

All other.
Cleaning, preparing, and sorting machines (not otherwise classified).
Milling and grinding machines (not otherwise classified).
Mixing machines and mixing kettles (dough and chocolate miners, etc.).
Bough mixers.
Cookers (not mixers) and ovens (not otherwise classified).
Shaping and forming machines (not otherwise classified).
Cutting machines (not otherwise classified).
Coating and polishing pans (not otherwise classified).
Calenders (candy rolls, etc.) (not otherwise classified).
Crushers (ice crushers, etc.)
Barreling, bagging, packing, and wrapping machines (automatic or semi­
automatic).
640 Bottling machines.
645 Tobacco working "machines.
Stamping presses— power-operated (cross index* Metal).
Stamping presses—foot or hand-operated (cross index, Metal).
655 Bleaching and blanching machines.
660 Containers* washing and cleaning machines.

580
585
595
605
60S
610
615
620
625
630
635
636

F arm

670
671
672
673
674
675
676
677

All other.
Feed and ensilage cutting and shredding machines.

Harvesters.
Thrashers.
Hay presses and balers.
Shelling machines.
Cream separators.
Cotton gins.
E n g in e er in g

680
681

M a c h in e s .

All other.
Concrete mixers.
Rock drills.




and

C on tractin g M a c h in e s .

92

BU SIN E SS M E E T IN G .

683
684
685
686
687

Pile drivers.
Road rollers.
Grouting machines and cement guns.
Well drills.
Trench and ditch digging machines.
C h e m ic a l P ro d u c ts M a c h in e s — A cid s an d S alts .

690
691
692
693

All other.
Grinding machines (except abrasive wheels).
Agitating mixers, vats, and kettles (except paint and pony mixers).
Machinery of recovery, such as screens, sifters, filters, and extractors,
not centrifugal.
694 Furnaces, ovens, dryers, and evaporators, mechanically fed or operated.
Crushers (cross index, Stone crushers).
Calenders (cross index, Rubber).
Centrifugal extractors (cross index, Leather, tanneries).
C h e m i c a l -P roducts M a c h i n e s — S o aps , G r e a se s , O il s , a n d F e r tiliz er s .

700

All other.
Agitating mixers, vats, and kettles (except paint and pony mixers)
(cross index, Acids).
Soap-stamping presses—power-operated (cross index, Power presses, under
Metal).
Soap-stamping presses— hand and foot operated (cross index, Foot presses,
under Metal).
Soap grinders (cross index, Grinding machines, under Acids).
Barreling, bagging, packing, and wrapping machines— automatic or semi­
automatic (cross index, Food products).
Machinery of recovery, such as screens, sifters, filters, and extractors, not
centrifugal (cross index, Acids).

705

All other.
Grinding machines (cross index, Acids).
Mixers (except pony mixers) (cross index, Acids).
Tablet presses and pill machines (cross index, Shaping machines, under
Foot).
Pony mixers (cross index, Paint mixers).

C h e m i c a l -P roducts M a c h i n e s — D r ug s .

P a i n t s , V a r n i s h e s , D r y C olors , I n k s , a n d D y e s .

710

All other.
Agitating vats and kettles (except paint or pony mixers) (cross index,
Acids).
715 Pony or paint mixers.
Grinding machines (cross index, Acids).
Machinery of recovery, such as screens, sifters, filters, and extractors, not
centrifugal (cross index, Acids).
Furnaces and ovens, mechanically fed or operated (cross index, Acids).
Crushers (cross index, Stone crushers).
Calenders (cross index, Rubber).
Centrifugal extractors (cross index, Leather, tanneries).




REPORT OF C O M M IT TE E ON STATISTICS.

93

R ubber , C ellu lo id , C o m p o s it io n , P ear l , B o n e , a n d T ortoise S h e l l .

720
725
726
727
728

All others.
Calenders.
Tire and tube making machines*
Hose-making machines.
Rubber-band choppers and cutters.
Mixers, not of calender type (cross index, Pony mixers— paint).
Cutting and slitting machines (cross index, Paper making).

729

Tubing and hose-wrapping machines.

730

Tire-wrapping machines.
Tumblers (cross index, Cleaning mills, under M etal).

731

732
733
734

Presses—foot and hand operated (cross index, Metal).
Tubing machines.
Punching and pressing machines (press and dye type) (cross index,
Leather products).
Cutting and punching machines (guillotine type) (cross index, Paper
products).
Comb-cutting machines and ornament shapers.
Drills (button, etc.).
Grinding, washing, milling, and cracking machines.
M i n i n g a n d O re -R e f in in g M a c h i n e s .

735
744

Sackett machine (gypsum products).
All other.

745
748

Office machinery.
All othei\

M is c e l l a n e o u s .

D.

Machines Other than Working Machines.
1.
2.
3.
4.
5.
6.

Pumps.
Fans and blowers.
Turntables.
Compressors.
Automatic stokers.
All other.

E. Hoisting apparatus,

1. Elevators controlled (not construction elevators).
(a) Cable, breaking.
(&) Cable, unwinding.
(c) Cable, overwinding (car rising too high).
(tf) Cable, caught by.
( e ) Counterweight, struck by.
(/) Machinery, breaking.
(g) Machinery, caught in.
( h) Car, caught between floor and.
(i) Car, caught between shaft side and.
(j) Car, caught between gate and.
( k) Car, struck by, in pit.
(I) Caught between car and overhead equipment or top of shaft.
(m) Car, struck by, elsewhere.
(n) Car, sadden start or stop.
(o) Car, dumping.




{B U S IN E S S

H aiM ing A p p a r a tu s —^Continued.

1. Elevators controlled (not construction elevators)— Concluded.
( p) Car rising too high.
(q) Fall of person into shaft, from floor.
(r) Fall of person into shaft, from rear.
( s) Fall of person into car, from floor.
( t ) Objects falling down shaft, from floor.
(m) ‘Objects Jailing down shaft, from car.
(v) Objects falling from floor into -car.
(w) Catching of load or part;thereof between caiNaad-shaft,
(%) Gates, not otherwise classified.
(y) All other.
2. Elevators, automatic, and .dumb waiters.
3. Elevators, sidewalk.
4. Construction hoists .and^elevators (mot .derricks;).
( a) Cable, breaking.
.(&) Gable, unwinding.
(c) Cable, overwinding (car rising too high).
( d) Cable, caught .by.
(e) Counterweight, struck by.
( /) Machinery, breaking.
( g) Machinery, caught in.
(7i) Car, caught between floor and.
( i) Car, caught between shaft side and.
O') Car, caught between gate and.
( k) Car, struck by, in pit.
(I) Caught between car and overhead equipment or top of;Shaft.
(m) Car, struck by, elsewhere.
( n) Car, sudden start or stop.
(o) Car, dumping.
(p) Car rising too high.
( q) Fall of person into shaft, from floor.
(r) Fall of person into shaft, from car.
(s) Fall of person into car, from floor.
( t ) Objects falling down shaft from floor.
(u) Objects falling down shaft from car.
(v) Objects falling from floor into car.
(tv) Catching of load or part thereof between car and shaft.
(x) Gates, not otherwise classified.
(y) All other.
5. Mine cages, skips, and buckets.
N ote .— I n those cases w here m ines are im portant, sp ecial an a lysis o f
m ine-cage accidents should be made.

6. Cranes, locomotive.
(a) Car, striking person.
(b) Car, falling.
(c) Cable or chain, catching or striking person.
(d) Machinery, catching .person.
1 (e) Hook or sling, catching or striking person.
(f) Load, struck by, swinging.
(g) Load, struck by, lowering or raising.
(h) Load falling, broken cable.
(i ) Load falling, slipping cable.
(/) Load falling, breaking of hook.




REPORT OP COMMITS!KK ON ST ATISTICS.

t5

E. H oisting Apparatus— Concluded.
6. Cranes, locom otive— Concluded.
( k ) Load falling, slipping o f liook.
(I) Load falling, sling breaking.
(m ) Load falling, machinery breaking.
( n ) Load falling, hitch slipping.
(0 ) Load falling, failure o f current ^©n magnet.
(p ) O bjects falling from load.
(q ) Falls from crane or crane track (n ot in greetin g #r rig g in g ).
( r ) Other.
7. Cranes, other traveling.
(a ) Car, striking person.
(&) Car, falling.
(c ) Cable or chain, catching or striking persan.
( d ) M achinery, catching person.
(e ) H ook or sling, catching or striking person.
( f ) Load, struck by, swinging.
(g ) Load, struck by, low ering or raising.
(h ) Load falling, broken cable.
(£) Load falling, slipping cable.
( j ) Load falling, breaking o f hook.
(7c) Load falling, slipping <®f ik©@k.
(1) Load falling, sling breaking.
(m ) Load falling, m achinery breaking.
(ft) Load falling, hitch slipping.
(0 ) Load fallin g, failure o f etrrTent on magnet.
( p ).. Objects fallin g from load.
(q ) Falls from crane or crane track (n ot in erecting er digging),
(r ) Other.
8. Derricks and jib cranes.
(а ) D errick or crane, striking person.
(б ) D errick or crane, falling.
(c ) Cable or chain, catching person.
( d ) M achinery, catching person.
(e ) H ook or sling, catching person.
( f ) Boom swinging.
(g ) Boom breaking.
( h ) Load, struck by, swinging.
(1) Load, struck fey, low ering and raising.
■(j) Load falling, slipping cable.
(7c) Load failing, breaking hook.
(I) Load falling, sling breaking.
(m ) L oad falling, machinery breaking.
(ft) Load falling, hitch clipping.
(o ) Load falling, failu re o f curren t on magnet.
(p ) Load falling, not otherwise classified.
{ q) O bjects fallin g from load.
(r ) F alls from crane load.
(s ) Falls from crane cab, ear, o r track (not in erecting or riggin g).
(t ) Other.
9. W ood stackers.
10. Blocks and tackles, windlasses, capstans, and winches, not otherwise
classified.
11. H ay forks, derricks, and stackers.




96

B U SIN E SS M E E T IN G .

F . Conveyors.
1. Air hoists.
(a ) Objects falling from .
(b ) Caught in.
(c ) Struck by load.
2. Overhead trolleys.
{a ) Objects falling from .
(b ) Caught in.
(c ) Struck by load.
3. Belt and chain conveyors.
(a ) Objects falling from*
(b ) Caught in.
(c ) Struck by load.
4. Screen conveyors.
(a ) Objects falling from .
(&) Caught in.
(c ) Struck by load.
5. Bucket conveyors.
(a ) Objects falling from .
(&) Caught in.
(e) Struck by load.
6. Platform conveyors and escalators.
(a ) O bjects falling from.
(b ) Caught in.
(c ) Struck by load.
The committee recommends that machine accidents should be further classi­
fied by manner o f occurrence and part o f machine, as fo llo w s :
(a ) Manner o f occurrence, machine accidents.
(1 ) A djusting machine, tool, or work.
(2 ) Starting, stopping, or operating machine.
(3 ) Cleaning or oiling machine.
(4 ) Repairing machine.
(5 ) Breaking o f machine or work.
(6 ) Flying objects, striking operator.
(7 ) Flying objects, striking person oiher than operator.
(8 ) A ll other.
( b ) Part o f machine on which accident occurred.
(1 ) P oint o f operation.
N o te . — Point o f operation means that part o f machine at
which w ork is actually inserted and maintained during any
process o f form ing, cutting, shaping, or other operation.
(2 ) Belts.
N o te . — Accidents upon belts, pulleys, shafts, gears, or other
driving mechanism or parts thereof which form the con­
nection between a machine and the prime mover or inter­
mediate drive, shall be charged to transm ission apparatus.
This includes parts attached to the machine. Accidents upon
belts, pulleys, shafts, gears, or other driving mechanism, or
parts thereof, which connect one part o f the machine with
another part o f the same machine, shall be charged to the
machine.
(3 ) Cranks or eccentrics.
(4 ) Flywheels.




REPORT OF C O M M IT TE E ON STATISTICS.

97

(&) Part o f machine on w hich accident occurred— Concluded.
(5 ) Gears.
(6 ) Set screws, keys, and bolts.
(7 ) Counterweights.
G e n e r a l N o te . — The classification o f part o f machine and manner o f oc­
currence applies as well to prime movers and hoisting or conveying m ach in ery.
as to w orking machines.
II. VEHICLES (NOT INCLUDING CONSTRUCTION O F ).

A . Cars and Engines— Steam and E lectric Railivays.
1. Train wrecks.
(a ) Collisions.
(&) Derailments.
(c ) Car striking object on track w ithout derailing.
2. Falls from or in.
(a ) In getting on or off, in motion.
(&) In getting on or off, at rest.
(c ) W hile riding on, due to sudden start or stop.
{d ) W hile riding on, due to slipping or loss o f balance.
(e ) W hile riding on, contact with overhead structure.
( f ) W hile riding on, contact with side structure.
(g ) Falls, not otherwise classified.
3. Struck by or caught between.
(a ) W hile coupling or uncoupling.
(&) W hile switching.
( c ) W hile repairing cars or engines.
(d ) W hile repairing track.
( e ) W hile crossing track.
( f ) W hile standing or w alking on track.
4. Other causes.
(a ) Setting or releasing hand brakes.
(Exclude, falls due to.)
(b ) Objects falling from .
(N ot in loading or unloading.)
(c ) O bjects shifting on load.
( d ) A ll other.
B. M ine and Quarry Cars and M otors.
1. Collisions.
2. Derailments.
3. Falls from , due to sudden start or stop.
4. F alls from riding on tail chain.
5. Riding on, contact w ith roof.
6. Riding on, contact w ith rib or side structure.
7. Caught between, and overhead obstruction.
8. Struck by or caught between while coupling or switching.
9. Struck by, not otherwise classified.
10. Braking.
11. Spragging.
12. L iftin g or pushing car.
13. Caught or struck by rope or chain.
14. Caught by car or load in dumping.
15. Getting on or off car.
16. Struck or caught between, not otherwise classified.
N ote .— I n clud e h ere a n im a l d raw n m ine or q u a rry ca rs.
124247°— 19------- 7




98

B U SIN E SS M E E T IN G .

C. Plant, Trucks on Tracks.
1. Collisions.
2. Derailments.
3. Falls from , due to sudden start or stop.
4. Falls from riding on tail chain.
5. Riding on, contact w ith roof.
6. Riding on, contact w ith rib or side structure.
7. Caught between, and overhead obstruction.
8. Struck by or caught between, while coupling or switching.
9. Struck by, not otherwise classified.
10. Braking.
11. Spragging.
12. L ifting or pushing car.
13. Caught or struck by rope or chain.
14. Caught by car or load in dumping.
15. Getting on or off car.
16. Struck or caught between, not otherwise classified.
D . Autom obiles and Other P ow er V ehicles.
1. Collisions, skidding.
2. Collisions, breaking o f parts.
3. Collisions, all other.
4. Overturning, skidding.
5. Overturning, breaking o f parts.
6. Overturning, all other.
7. Struck by.
8. Collisions w ith cars or enginea
9. Cranking.
10. Engines, not otherwise classified.
11. Breaking o f car or part not resulting in collision o r overturning.
12. Falls from.
13. Objects falling from.
14. Objects shifting on load.
15. Mechanical unloading.
16. All other.
N o t e . — All collisions o f autom obiles should be classed under automobiles,
whether with other vehicles or w ith cars.
Accidents due to the engine in an automobile or other pow er vehicle should
be charged to the pow er vehicle.
Accidents due to testing gas or gasoline engines should be charged to
prime movers.
E. B icycles.
F. A irplanes.
G. Animal-drawn Vehicles ( not M ine o r Quarry C ars>.

1. Collisions with cars or engines.
2.
3.
4.
5.
6.
7.
8.
9.
30.

Collisions with other vehicles.
Collisions w ith stationary objects.
Overturning.
Whiffletrees.
Falls from.
Struck by.
Objects fallin g from (n ot in loading or u nloadin g}.
O bjects shifting on load.
Breaking o f parts*




REPORT OF C O M M IT T E E O K STATISTICS.

G. Animal-drawn Vehicles ( not Mine or Quarry (Jars) — Concluded.
11. Mechanical unloading.
12. All other.
N o t e . — All vehicle accidents due to runaways should be charged to
anim als ( X - A - 3 ) .
H. Animal-drawn Im plem ents ( not M ach inery).
I. W ater Craft.
1. Collisions w ith vessels.
2. Collisions with other objects.
3. Capsizing.
4. Hawsers and other ropes.
5. Falls from, or jum ping overboard.
6. Falls from , rigging.
7. Falls into, hatchway.
8. All other.
N o t e . — Accidents from machinery on w ater craft should be charged
to the specific machine.
J. All other Vehicles.
III. EXPLOSIONS, ELECTRICITY, FIRES, A N D HOT SUBSTANCES.

A . B oilers and Steam-pres sure Apparatus.
1. Steam boilers, explosions of.
2. Steam boilers, escaping steam and hot water.
3. Steam boilers, all other causes.
4. Steam pipes, explosions of.
5. Steam pipes, all other causes.
6. Steam and hot water gauges, explosions of.
7. Steam and hot water gauges, all other causes.
8. Economizers and superheaters, explosions of.
9. Economizers and superheaters, all other causes.
10. Other steam-pressure apparatus, explosions of.
11. Other steam-pressure apparatus, all other causes.
B . Explosions o f E xplosive Substances.
1. Explosives, m anufacturing and storing.
2. Explosives, transportation and handling.
3. Explosives, blasting.
(a ) Premature shot.
(&) Misfires or delayed shot.
( c ) W indy sh ot
(tf) Tamping.
( e ) All other.
4. Dust.
5. Gas.
6. Gasoline and other petroleum products.
7. A ll other.
C. Other Explosions.
1. Ammonia apparatus.
2. Other high-pressure apparatus.
3. All other.
N o t e . — Includes accidents due to bursting under pressure.
D. E lectricity.
E. Conflagrations.
N o te . — Give description o f individual conflagration or catastrophe.




100

BU SIN E SS M E E T IN G .

F . H ot Substances and Flames.
1. H ot water.
2. Asphalt, pitch, and tar.
3. Other hot liquids.
4. Molten metal, explosions of.
5. Molten metal at furnace or cupola.
6. Molten metal, pouring.
7. Molten metal or slag, all other.
8. Radiant heat from incandescent metal.
9. Metal not molten, handling of.
10. H ot surfaces, contact with.
11. Oxyacetylene or electric cutting and welding.
12. Flames, clothing.
13. Flames, all other.
14. All other hot objects.
IV.

POISONOUS AND CORROSIVE SUBSTANCES

AND OCCUPATIONAL

D ISEASES.

N ote.— In case o f occupational disease or industrial poisoning, it is desirable
to subdivide specifically so as to show each occupational disease or poisoning.
In the present state o f knowledge in regard to the subject it is not possible to
prepare a satisfactory code.1 It must be built up as various occupational
diseases and poisonings are reported and experience is accumulated. F or this
purpose it is especially desirable that detailed inform ation should be published
rather than general groups w hich w ill conceal the exact name o f the disease
or poison. The correlation o f this inform ation with industry and occupation is
also exceedingly important.
V . FALLS OF PERSONS.

A. From E levations.
1. Benches, boxes, chairs, and tables.
2. Bridges, dams, and docks (n ot in construction or dem olition).
3. Cranes, derricks, elevators, and hoists in erecting and rigging.
4. Elevated bins, pockets, and tanks.
N ote.— I nclude here falls from , but not falls into.
5. Buildings in construction or dem olition not elsewhere specified.
6. Floors, tem porary.
7. Ladders.
(a ) Breaking o f ladder or parts.
(&) Slipping, twisting, or fall o f ladder.
(c ) K nocked off ladder.
( d ) All other.
8. Scaffolds and stagings.
(a ) B reaking or slipping.
(&) Breaking o f tackle or support.
(c ) Tilting o f scaffold.
($ ) Tilting or falling o f loose plank.
(e ) Other.
9. Boilers, engines, and machines.
N ote.— Include platform s or w alkw ays on, but riot stairw ays lead­
ing thereto.
1A tentative code for occupational diseases which has been prepared by the W orkm en's
Compensation Service Bureau, 18 P ark Row, N ew York City, w ill be found to be helpful.




REPORT OF C O M M IT TE E ON STATISTICS.

101

A. From Elevations— Concluded.
10. Piles.
11. Poles and trees.
12. Roofs.
13. Runways, balconies, and platform s (not loading pla tform s).
14. Loading platforms.
15. Gangplanks.
16. Stairs and steps.
N ote.— Include all falls on stairs, steps, or landings.
17. Tram w ays and trestles.
18. W indow s and wall openings.
19. All other.
B. In to Excavations, Pits, and Shafts.
1. Bins and vats containing hot or corrosive substances.
2. Bins and vats, all other.
3. Floor openings (not elevator sh afts).
4. Manholes.
5. Excavations, not otherwise classified.
C. On Level.
1. Slipping.
2. Stumbling over fixed objects.
3. Stumbling over loose objects.
N ote.— I nclude here stepping on rolling objects.
4. All other.
N ote.— Strains due to near falls from slipping or stumbling, w ith­
out falling, should be placed under slipping or stumbling in this group.
V I. STEPPING ON OR STRIKING AGAIN ST OBJECTS.

A. Stepping on Objects.
1. Nails.
2. All other sharp objects.
N o te . — Stepping on rolling* objects should be charged to stumbling.
B. Striking against O bjects.
1. Nails.
2. Splinters or sharp projections from walls or structures.
3. Other fixed objects.
4. Fellow employee.
5. All other objects.
VII. FALLING OBJECTS— NOT BEING HANDLED BY INJURED.

A. Collapse o f—
•
1. Buildings and walls.
2. Piles (stacked, stored, or piled-up m aterial).
3. Scaffolds or staging.
4. Chutes, conveyors, and slides.
5. All other.
B. From Elevations.
1. Buildings not in course o f construction or demolition.
2. Bins and pockets.
3. Tram w ays and trestles.
4. Runways, balconies, and platform s.




102

BU SIN E SS M E E T IN G .

B. From Elevations— Concluded.
5. Racks and shelves.
6. Floor openings (not elevator sh a fts).
7. Chutes, conveyors, slides, and screens,
8. Machines and workbenches.
9. Piles (stacked, stored, or piled-up m aterial).
N ote.— E xclude accidents in piling or handling o f material,
10. Dumps— at mines and quarries.
11. Buildings in course o f construction or dem olition (not otherwise
classified).
12. Scaffolds and staging.
13. Tem porary floors.
14. Floor openings— in building construction.
15. Other elevations.
C. Trees.
1. Trees in felling (not otherwise classified).
N ote.— I nclude dead limbs and tops.
2. Trees lodged in felling.
N ote.— IncliTde trees and limbs struck by felled tree.
3. Trees, kickbacks of, in felling.
4. Spring poles— flybacks of.
5. Limbs, not in felling trees.
6. Trees, not in felling.
D. O bjects Tipping over {ex cep t V eh icles).
N ote.— E xclude objects which tip over while being handled.
E. In to Excavations.
1. Ditches and trenches.
2. Other excavations (not tunnels, mines, or qu arries).
F. Cave-ins ( not Mines or Q uarries).
1. Ditches and trenches.
2. Tunnels.
3. Other excavations.
G. In Tunnels.
B . In Mines and Quarries— In sid e.
N ote.— I nclude all accidents from failing objects in mines and quarries.
1. Coal, rock, and ore at the w orking face (n ot r o o f).
N ote.— I nclude rolls o f coal or rock, but exclude accidents in
stopes and all pillar robbing.
2. Coal, rock, and ore from pillars o r ribs (n ot r o o f).
N ote.— I nclude rolls o f coal or rock.
3. Coal, rock, and ore from or in underground chutes, manways, and bat­
teries.
N ote.— Include rushes o f coal, rock, or gob in same.
4. R o o f in working places (n ot stopes).
5. R o o f in entries.
6. Ore and rock in stopes (m etal m ines).
7. Tim bers (not in handling).
8. From surface into shaft.
9. From cage into shaft.
10. From or in underground bins.
11. Cave-in o f mine.
; 1?. All other.




REPORT OF C O M M IT TE E ON ST ATISTICS.
V III. HANDLING OF OBJECTS.

A.

H eavy Objects.
N ote.— E xclude handling o f objects by power appliances. Include objects
set in motion by the handling o f other objects.
1. Objects dropped.
N ote.— I nclude tipping over o f object handled.
2. Objects thrown.
3. Objects falling from load (w hile loading or unloading).
4. Objects falling, from pile (w hile piling or u npiling).
5. Caught between object handled and other object.
6. Strain in handling.
N ote.— Include only strains, hernias, etc., caused by excessive
weight o f object handled.
7. Handling (not otherwise classified).
B . Sharp or Rough O bjects.
N ote.— I nclude only injuries due to sharpness or roughness o f object han­
dled, not tools or machines. ,
1. Glass.
2. Protruding nails in objects handled.
3. Protruding wires.
4. Sheet metal and sheet-metal objects.
5. Slivers, wood.
6. Slivers, metal.
7. Castings.
8. Bones,
9. A lf other.
C. Hand Trucks, Carts, and W heelbarrow s.
1. Struck by truck handled by injured person.
2. Struck by truck handled by coworker.
3. Caught between truck and other object.
4. Object falling from (not ia loading or unloadin g).

5. Overturning.
6. All other.
IX . HAND TOOLS*

A.

In Hands o f In ju red W orker.
1. Glancing or slipping o f tool in use.
2. Breaking or coming apart o f tool.
3. Flying particles set in motion by tooL
(a ) Nails and spikes.
( b ) Metal chips.
(c ) Stone.
(d ) All other.
4. All other.
B . In Hands o f Fellow W orker.
1. Glancing or slipping o f toof fet use.
2. Breaking or com ing apart o f tool.
3. Flying particles set in motion by tooL
{a ) Nails and spikes.
(&) Metal chips.
(c ) Stone.
(d ) All other.
4. All other.
N ote.— Causes given show manner ©£ occurrence.
causes o f accidents may be listed.




Principal tools found as

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BU SIN E SS M E E T IN G .
X. A N IM A L S.

A. D ra ft Anim als.
1. K icks and stepped on.
2. Bites.
3. Runaways.
N ote.— I nclude all vehicle accidents due to runaways.
4. All other.
B. Other Animals.
N ote.— Specify any animals which may be especially important.
XI. MISCELLANEOUS CAUSES.

1. Flying particles (not otherwise classified).
N ote.— Chips, dust, sparks, and other particles set in m otion by w ork­
ing machines or tools are to be charged to the specific machine or tool.
The above number relates only to nonassigned flying particles.
2. Doors, windows, covers, and gates, exclusive o f elevators.
3. Drenching (n ot drow n in g).
4. H eat prostration and sunstroke.
5. Cold, including frostbites.
6. Lightning.
7. Violence o f coemployee.
8. Violence, all other.
9. W restling, sparring, and horseplay.
N ote.— Include all accidents directly attributable to horseplay, giving
description o f horseplay accidents.
10. Compressed air (not explosions).
11. All other.
Dr. E. H. D ow n ey, Chairman,
Special D epu ty, Insurance D epartm ent, H arrisburg, Pa.
L. W. H a tc h , Vice Chairman,
Chief Statistician, State Industrial Commission, A lbany, N. Y .
C h a r le s H. V e r r ill, S ecretary,
U. S. Em ployees' Compensation Commission, W ashington, D. C.
P. A. B roderick,
Statistician, Industrial A ccident Board, B oston , Mass.
W . H. B urhop ,
S ecretary, Compensation Insurance Board, Madison, Wis.
T. N. D ean ,

Statistician, W orkm en's Compensation Board, T oronto, Ontario, Canada.
H ugh S. H a n n a ,
U. S. Bureau o f Labor Statistics, W ashington, D. C.
C. B. H e n sle y ,
Statistician, California Industrial A ccident Commission, San Francisco, Calif.
Dr. R oyal M eeker ,
Commissioner, U. S. Bureau o f Labor Statistics, Washington, D. C.
E. E. W atson ,
A ctu a ry , Industrial Commission, Columbus, Ohio.




REPORT OF C O M M IT TE E ON STATISTICS.

105

CLASSIFICATION OF INDUSTRIAL ACCIDENTS BY LOCATION AND
NATURE OF INJURY AND EXTENT OF DISABILITY.
The committee recommends the follow in g changes:
The brief introductory statement under the title should be omitted.
MULTIPLE INJURIES.

The paragraph in regard to multiple injuries, page 84, should be transferred
to page 81, immediately following the main title:
“ In case o f an injury involving more than one location "or one nature o f injury, as specified above, as a rule the injury should be placed in that classi­
fication which indicates the most serious disability. I f one or more dismember­
ments are involved, each should be separately listed. I f the injury is a tem­
porary disability only, it may be charged to the general part o f the body, but if
it is a permanent disability the above rule should be strictly follow ed.”
I. LOCATION OF INJURY.
Under this heading the follow ing should be added:
“ N ote.— I f the injury extends ultim ately to a part o f the body other than
that first affected, charge to the m ajor part finally involved.’’
II. NATURE OF INJURY.
The classification should be amended to read as fo llo w s :
1. Bruises, contusions, and abrasions.
2. Burns and scalds.
3. Concussions.
4. Cuts, punctures, and lacerations.
5. Amputation, traumatic.
6. Dislocations.
7. Fractures.
8. Sprains and strains.
9. Asphyxiation.
10. Drowning.
11. All other.
N ote.— I n case o f infection, nature o f in ju ry should be correlated with the
infection. This is especially im portant in cases o f bruises, contusions, and
abrasions, burns and scalds, and cuts and lacerations.
III. EXTENT OF DISABILITY.
The classification should be amended to read as fo llo w s :
1. Fatal.
2. Permanent total disability— dismemberment.
3. Permanent total disability— other.




106
4.
5.
6.
7.
8.
9.
10.

BU SIN E SS M E E T IN G .

Permanent
Permanent
Permanent
Permanent
Permanent
Tem porary
Tem porary

partial disability— dismemberment.
partial disability— total loss o f use.
partial disability— impairment o f use.
partial disability— disfigurement.
partial disability— other.
total disability.
partial disability.
IV. DEGREE OF PABTIAL DISABILITY.

In the first line o f the note the w ord “ injuries ” should be changed to
“ disabilities.”

ELECTION OF OFFICERS.
The following officers for the ensuing year were elected: President,
George A. Kingston, commissioner, Workmen’s Compensation Board
o f Ontario, Canada; vice president, W ill J. French, member of the
Industrial Accident Commission o f California; secretary-treasurer,
Royal Meeker, United States Commissioner o f Labor Statistics,
Washington, D. C. The new executive committee consists o f Charles*
S. Andrus, chairman o f the Illinois Industrial Commission; F. W.
Armstrong, vice chairman of the Workmen’s Compensation Board of
Nova Scotia, together with the incoming officers and the outgoing
president o f the association, Mr. Fred M. Wilcox, member o f the
Wisconsin Industrial Commission. The next annual convention o f
the association will be held at Toronto, Canada, September 23-26,
1919.
RESOLUTIONS.
Resolutions relating to the business o f the Association were
adopted, o f which the following are the most significant:
1.
W e contemplate w ith much encouragement the development o f w orkm en’s
compensation and the accom panying growth o f the kindred movement for the
promotion o f safety among the hosts o f industrial w orkers w ithin a period
com paratively recent in the States and Provinces o f North Am erica. A better
day dawned in the industrial w orld when these most helpful agencies were
instituted among men. M indful o f continuing widespread mourning and heavy
sacrifice o f usefulness the steady reduction o f these grievous losses is a source
o f deep satisfaction. Conscious o f the im perfections o f the compensation service
we may well view with pride and gratification the more equitable and humane
consideration o f the unfortunate victim s o f industrial accident, the smaller
and less w asteful levies upon industrial enterprise and progress, and the con­
sequently more harmonious and mutually helpful relations between workmen
and employers through the introduction and development o f this important
system. In feeling our way along dim trails or untrodden paths it were strange
indeed if mistakes were not m anifest and improvement required, but the rec­
ord justifies indulgence o f the hope that we shall profit by these mistakes and
continue to more nearly approach ideal standards and irreproachable methods.
T o this end we pledge the highest endeavor o f ourselves and our several ju ris­
dictions. In this endeavor we crave the practical and sympathetic cooperation
o f good men and women everywhere.




RESOLUTIONS*

107

2. Tlie association desires to place on record Its sense o f appreciation o f the
services o f the United States Bureau o f Labor Statistics, and particularly the
Commissioner o f the Bureau, Dr. R oyal Meeker, for the invaluable services
rendered to the association during the past two years.
W e recognize that the services o f the Bureau are alm ost absolutely essential
to the continued successful carrying out o f the w ork o f this association and we
express the hope that the Bureau under the able adm inistration o f Dr. Meeker
w ill be able to continue heading up the secretarial branch o f the w ork for
w hich he has shown such excellent qualification.
3. In the opinion o f the association the executive committee should place at
the disposal o f the secretary a sum not exceeding $500 to be disbursed by him
and accounted for in the usual way, in paying for special clerical services re­
quired in the conduct o f the secretarial w ork o f the association.
4. The association desires to place on record its appreciation o f the courtesy
shown by the Gisholt Co., the North W estern Ordnance Co., and the Board o f
Commerce o f the City o f Madison in entertaining the members o f the conven­
tion on the occasion o f the fifth annual meeting. The strain o f sitting through
three sessions daily listening to addresses and participating in the discussion is
very trying, and the thoughtful courtesies thus extended afford both a necessary
relief and a very pleasant memory.
5. The association desires to bear testimony to the good offices and kindly
courtesies extended to the members o f the convention by the Industrial A cci­
dent Board o f W isconsin, as well as by the officers and members o f the staff,
on the occasion o f this fifth annual convention, and especially for the services
o f its reporters in taking a record o f the convention proceedings. W e feel
sure also that all the members here assembled w ill carry away a conception
o f an ideal city, which those o f us who did not know Madison before had not
hitherto entertained.
6. That w e desire to place on record our appreciation o f the action o f H is
H onor Gov. Philipp, o f this State o f W isconsin, in granting the association
the privilege o f holding its convention meeting in the rooms o f this magnificent
capitol b u ild in g ; also o f his courtesy in coming to address the convention, and
for his cordial w ords o f welcom e so amply seconded by many o f the citizens
o f this State during our short visit in Madison.
7. This association desires to commend in the strongest possible terms the
action o f our Government in prosecuting the w ar against Germany with the
greatest possible vigor.
W e recognize that we are fighting an enemy who has lost, if he ever pos­
sessed it, all sense o f what is right and honorable and decent in his relation
to other nations, whose only conception o f rule hitherto has been that o f brute
force, and who has been found guilty before the great forum o f civilization
o f every crime in the decalogue.
To bargain for peace with such an enemy under present conditions may be
likened to a man bargaining with a burglar who has stolen all he could get
hands on and ravished, if not murdered, the fam ily besides.
W e believe there can be only one way to deal with such an enemy, and we
note with the greatest possible satisfaction the fixed determination o f all the
allied Governments to prosecute the w ar until the enemy is driven back into his
own country, and those o f their rulers who are responsible for this world
catastrophe are made to suffer that punishment which their crim e against
humanity so ju stly deserves.




108

BU SIN E SS M E E T IN G .

Upon recommendation of the secretary that the I. A. I. A. B. C.
amalgamate with the Association of Government Labor Officials, the
following resolution was adopted:
R esolved , That the executive committee be authorized and instructed to confer
with the executive committee o f the Association o f Government Labor Officials
as to the advisability o f the consolidation o f the tw o organizations, and if in
the judgment o f said committees said consolidation seems to be advisable,
that a referendum vote by mail be taken o f the membership o f both said organi­
zations on the proposition o f consolidation. I f a m ajority o f the membership
o f each o f said organizations vote in favor o f consolidation the executive com­
mittee is further authorized to arrange w ith the executive committee o f the
labor officials for a join t meeting o f the tw o organizations in 1919 at which
time the proposed consolidation may be consummated.
W E D N E S D A Y

,

S E P T E M B E R

25 — A F T E R N O O N

S E S S IO N .

Visits -were made by the delegates to the Gisholt plant and other
industrial establishments in Madison.




W E D N E S D A Y ,

S E P T E M B E R

2 5 — E V E N IN G

S E S S IO N .

Chairman, Harry A . Hacker, Pennsylvania Workmen’s Compensation Board.

III. STA TISTIC AL SESSION.
AMOUNT OF EXPOSURE AS FUNDAMENTAL IN ACCIDENT STUDY.
BY LUCIAN W. CHANEY, SPECIAL AGENT, UNITED STATES BUREAU OF LABOR STATISTICS.

The mere enumeration o f accident cases has little meaning. Sup­
pose, for purposes o f illustration, that 40,000 accidents are recorded
in one State and 50,000 in another. The principal result o f such
records is to arouse curiosity and lead to further questioning.
There will emerge almost immediately the question “ How many
people in each State were exposed to the hazards which produced
the recorded accidents ? ” Unless some reasonably accurate answer
can be given no beginning can be made toward the interpretation o f
the accident figures. Suppose that inquiry develops that the first
o f these States has 200,000 industrial workers while the second has
300,000. The frequency rate per 1,000 exposed will be 200 for the
first State and 167 for the second. This reverses the quantitative
relation and manifestly gives some definite idea o f the accident con­
ditions in the two States as compared one with the other.
It should be admitted at once that in a group o f such varied char­
acter as the industrial population o f an entire State the significance
o f such rates for certain purposes is lessened by the fact that the
hazards are not shared equally. This condition is, however, always
present in greater or less degree. No two persons o f a given occu­
pation Ijave actually and precisely the same hazards.
Much confusion will be avoided if it be kept clearly in mind that
there are two quite distinct things disclosed by accident rates:
(1) Prevalence in the group under consideration; (2) degree o f
hazard incident to certain machines or processes.
To illustrate, the rates quoted above, 200 per 1,000 exposed in one
State and 167 in another, disclose, in proportion to the accuracy o f
the basic data, the prevalence o f accident among the workers of
one State as compared with the other. These rates do not justify
the conclusion that industry is conducted in a more hazardous man­
ner in the State having the higher rate. This could be determined
only by a process o f finding the exposure and the accident occurrence
for constantly narrowing industrial groups until occupational groups
are reached. Suppose that the exposure in both States o f those




109

110

ST A TIST IC A L SESSION.

operating latlies is determined and on relating this to lathe accidents
it is found that one State has a frequency of 67 per 1,000 exposures
while the other has a frequency o f 90. It would then be justifiable to
conclude that the hazard o f lathe operation in the second State was
higher than in the first.
Eates always have significance as disclosing prevalence. In the
matter o f hazard from particular machines or conditions, the signifi­
cance is slight in extended groups, such as an entire State, but stead­
ily increases as the determination is narrowed to industries, depart­
ments, and finally to occupations.
The point here emphasized is that in this whole process by which
conclusions are finally reached regarding hazard, the amount o f
exposure is a fundamental factor without knowledge and use o f which
no really intelligible results are possible.
Before offering further illustration, a word regarding the nomen­
clature o f the subject is pertinent* We have inherited from European
sources, where these matters were studied before we began, the use
o f full-time or 300-day worker as the standard expression for the
fundamental unit. In my judgment, there would be great gain if this
association would break away from this inheritance and boldly adopt
a terminology o f its own. I would adopt as the name of the funda­
mental unit the expression “ industrial unit.” I would define it as
“ the equivalent o f one man engaged in industry for 3,000 hours or
300 days of 10 hours ea ch / I would use this industrial unit under
various names in a great variety o f discussions. I f considering labor,
I would say, for example, that product was so much per 1,000 units
o f labor. I f accident was under discussion, the formula would be so
many cases per 1,000 units of exposure. I f labor turnover was the
subject, I would say so many separations per 1,000 units o f employ­
ment.
These different forms o f expression simply mark the different
aspects from which the industrial unit may be viewed. Nunferically,
in a given plant, the number o f units would be the same whether they
were designated as exposure, labor, or employment. The m odifying
words call attention to the particular phase o f the general subject
which is being considered.
The growing tendency to use “ amount o f exposure” in treating
accident data suggests that the matter deserves consideration from
a broader standpoint.
Further illustration o f the importance o f amount o f exposure will
be drawn from the experience o f the State o f Wisconsin. In 1917
the Federal bureau received from the Wisconsin Industrial Commis­
sion an elaborate classification o f accidents according to causes for
the year 1916. In comment upon this it was suggested that a single
year did not afford sufficient volume in the smaller divisions to give




“ A M O U N T OF EXPO SU RE ”

IN ACC ID E N T STU D Y — L . W . C H A N E Y .

H I

a fair statistical average and that it was highly desirable to apply the.
system o f time allowances accepted by this association in order that
severity rates might be computed.
Recently a compilation has come to hand covering a three-year
period and having a complete application o f the scheme of timet
allowances accepted by this association.
In response to request the commission has furnished a carefully
worked out approximation o f the amount o f exposure in the State
for those among whom the accidents occurred. It is desired to
show by combination o f these items o f information something fur­
ther regarding the value as a base of even an approximate determina­
tion o f the amount o f exposure. The calculation of rates for causes,
as is here done, is not altogether new but is still so unfamiliar that
a few introductory statements are justified.
In mortality studies the method o f splitting up a community death
rate by causes has long been used. A general rate of 14, for example?
in a certain city will be found to consist o f 5 for tuberculosis, 2 fo r
pneumonia, and 7 for other causes.
It may be urged that hazard o f a particular disease is common to
the entire population, while danger from a particular accident cause
is confined to a few. It is far from being the case that disease hazard
causing death is uniformly distributed. Some people go through
their days with no more danger from smallpox than from corn shred­
ders. In both cases rates give an idea o f the average prevalence o f
certain conditions in a population, part o f whom are exposed and
part are not.
Rate tables will shortly be published in the M o n t h l y L a b o r R e ­
v ie w
showing both frequency and severity rates for a condensed list
o f the causes shown in the Wisconsin compilation. These are divided
into two groups, according to the exposure available. First, there
will be a table presenting causes for the entire number of people who
are covered by the compensation act. Second, there will be a supple­
mentary tabte devoted to the section o f the industrial population
engaged in manufacture. In this latter will be shown the rates for
the different types of machines operated. On considering these tables
it is found in the first table that, excluding cases o f temporary disa­
bility o f seven days and less, the general frequency rate of the State
o f Wisconsin is 40.7 cases per 1,000. This rate is made up in part by
the following in the order o f frequency: Handling objects, 8.6 cases;
machinery, 7.7 cases; falls o f person, 5.4 cases; falling objects, 4.2
cases; hand tools, 3.1 cases; hot and corrosive substances, 2.1 cases;
cranes and hoists, 1.3 cases; wagons and carriages, 1.3 cases.
The point here made is that this series o f rates by which we gain
a just idea o f the prevalence o f certain types of accidents in Wiscon­




112

ST A TIST IC A L SESSION.

sin, considered as a unit, is wholly impossible without some sort o f
an approximation to the number o f 3,000-hour exposures. This may
be very crude and imperfect, but, however open to criticism it may
be on the score o f strict' accuracy, it forms the only means possible to
approach the intricate subject o f the statistical study o f accident
causes.
It is instructive to notice the severity rates for the same cause
groups, also arranged in the descending order o f severity. The
State o f Wisconsin shows a severity rate of 5.9 days per 3,000-hour
exposure. Machinery heads the list with 1.40 days, followed by falls
o f person, 0.77 day; falling objects, 0.76 day; handling objects,
0.45 day; wagons and carriages, 0.37 day; cranes and hoists, 0.32
d a y ; hot and corrosive substances, 0.14 day; hand tools, 0.06 day.
It will be observed immediately that the order is not the same for
severity as for frequency. Handling objects, which heads the list in
frequency, drops to fourth place in severity. From the standpoint
o f the present paper the significance of this lies in the fact that with­
out some common base to which these diverse elements o f number o f
cases and number o f days lost can be referred it is not possible to
secure any notion o f the true relation. When the common base of
3,000-hour exposures is applied, frequency and severity rates are
obtained which together answer more questions regarding accident
data and answer them more accurately than any statistical device
hitherto utilized.
The need o f analysis o f the exposure as determined for a whole
State into successively smaller elements may be illustrated by ex­
cerpts from the table devoted to rates for machines. During the
three years covered by the compilation the exposure for all workers
covered by the compensation act was 1,007,826 3,000-hour exposures.
In manufacturing there were 745,915 3,000-hour exposures.
When the entire industrial population is used as a base o f ref­
erence, the rate for machines used in manufacture is 7.5 cases per 1,000
exposures. When the consideration is narrowed to the#portion o f the
population engaged in manufacture, the rate increases to 10.2. The
first rate indicates the prevalence o f machine accidents among the
industrial population taken as a whole; the second, the prevalence
in the portion o f the population devoted to manufacture.
O f this rate the larger part is furnished by two sorts o f ma­
chines, namely, metal working, with 3.6 cases per 1,000 exposures,
and wood working, with 3.2 cases. These two groups of machines
also exceed in severity, having 1.11 days per exposure out of a total
o f 1.86 days.
These relatively high rates would at once suggest that such ma­
chines deserved extra attention to determine whether there were
not possible measures o f prevention applicable.




“ A M O U N T OF EXPO SURE ”

IN ACCID EN T STU D Y — L . W . C H A N E Y .

113

A fter presenting these illustrations in an effort to make clear how
important knowledge o f the amount o f exposure is to the proper
understanding of accident data, the question naturally arises regard­
ing the method o f securing the needed figure.
The simplest and most direct method is possible in those plants
where a time-clock system is in use. The time cards o f the em­
ployees record exactly the hour o f arrival and departure. The dif­
ference is the time at work, with as much exactness as it is possible
to determine.
Since where time is kept in this way it is very common to pay by
the hour, the time at work must be ascertained, and the addition o f
these amounts gives directly the production hours of the depart­
ment. In some cases where the clocks are used simply as a check
upon attendance, and their records are not employed in computing
wages— as, for example, where all wages are on a piecework basis—
some additional labor would be necessary to determine the total
hours. This figure has so many uses that concerns can well afford
this additional labor in order to have the means to compute labor
costs accurately.
The record o f total hours is convertible into an equivalent in terms
o f annual exposure by dividing it by 3,000.
The uniform use o f equivalents in terms of the 3,000-hour year
is strongly to be urged. It is very common to compute two sets o f
rates comparable among themselves but wholly incomparable with
each other. This has arisen from the natural tendency to compile
data monthly and annually. For monthly purposes the total hours
will be divided by 250, one-twelfth o f 3,000. Using the resulting
figures for a series of months gives, as stated, rates perfectly com­
parable with each other but requiring to be modified before they will
compare with annual rates. On the other hand, if the determination
o f equivalents is always on an annual basis the entire system o f rates
becomes comparable throughout with no need for modification.
This method o f procedure does produce figures for each month
which have a somewhat strange appearance. The total number on
the pay roll is usually the thing considered as indicating the activity
for a particular month. Division of the total hours for a month by
250 gives a figure sufficiently similar to the ordinary pay-roll total
to seem appropriate. The result o f division by 3,000 has no apparent
relation to the accustomed figure.
The difficulty arises from the fact that the introduction of the
time element into the situation is not yet a familiar one. It is recog­
nized easily enough that a man working 8 hours at a given task is
less exposed to its hazards than a man working 10 hours at an iden­
tical task. The feeling is strong, however, that “ a man’s a man for
124247°— 19-------8




114

S T A T IS T IC A L SESSION.

a 5 that ” and that the attempt to express him in equivalents for sta­
tistical purposes does not sufficiently respect his personality.
It is quite evident, however, that without this process of determin­
ing equivalents an even approximately exact presentation of the facts
is impossible. When a statistical equivalent is necessary that one
should be adopted which gives most directly the largest body of
comparable results.
In many plants the record of hours is not kept but that of days
worked is. In such a case it is often possible to determine a con­
stant for the average daily hours in the department. For example,
in a department in which there is some variation in hours it is found
that the average is 9J hours. I f in a given period 20,000 €lays of
work are done this will be approximately equal to 190,000 hours.
This divided by 3y000 will give the usual equivalent, in this case 63i
3,000-hour exposures.
In still other plants it may be necessary to resort to another device.
Suppose it is possible to obtain an average annual employment by
using a quarterly average’, or better still a monthly average. This
may then be multiplied by the number o f days during the year on
which the department was in operation. Such a procedure will give
a number o f “ man days,” which divided by 300 will give exposure
in the ordinary terms.
Finally there is the case where payments in wages and some in­
formation regarding wage rates are the only available items. Sup­
pose this to consist o f a single pay roll and the total wage payment
fo r the year. From the pay roll it is learned that in a given depart­
ment there were—
10
15
20
.30

men at
men,at
men at
men at

80
70
60
40

cents
cents
cents
cents

75

per
per
per
per

hmir___________________________ i.----------------------------- $8.
hour_______________________________________________ 10.
hour_________________________ ._____________________ 12.
hour_______________________________________________ 12.

00
50
00
00

42.50

The total hourly earnings divided by 75, the total number o f men5
gives 57 cents as the average hourly rate. I f the annual payments
in the departments were $136,800, this divided by 57 cents would
give 240,000 hours as the total hours of employment. This divided
by 3,000 gives an annual exposure of 80.
Such a procedure gives a close approximation, provided there have
been no considerable wage fluctuations. The wage rates above are
the high rates now prevalent. I f wages were lower earlier in the
period it would be necessary to consider that fact and also the length
o f time during which the different rates prevailed.
To illustrate, assume in the department mentioned above three
wage periods in the course o f a year: (1) 3 months with 70 men and




“ A M O U N T OF EXPO SURE ”

IN ACCID EN T STU D Y ---- L . W . C H A N E Y .

115

hourly earnings o f $35; (2) six months with 80 men and hourly
earnings of $44; (3) 3 months with 75 men and hourly earnings of
$42.50.
In order to get a true average annual exposure it is necessary to
introduce the time factor. Multiplying the number in each group
of men by the time factors 3, 6, and 3, and adding the results gives
915. Treating hourly earnings in the same manner gives $496.50.
Dividing $496.50 by 915 gives 54 cents as the average hourly rate for
the year. Dividing this again into the annual payment of $136,800
gives 253,333 as the total hours worked. This divided by 3,000 gives
84 as the annual exposure instead o f 80 indicated when the figures
for the last three months were considered alone. .
By the application o f these methods it is nearly always possible
to secure a reasonable approximation to the exposure expressed in
terms o f 3.000 hours per year.
It may be objected that results are largely modified by the method
of procedure and that it is unsafe to combine those obtained by one
method with those derived in another way.
A number o f careful and extensive tests indicates that the final
rates which result from using these methods are not sufficiently
different to modify the conclusions derivable from them.
I f the volume of data is sufficient to be reasonably trustworthy,
the methods outlined above may be used in determining the basic
figure of exposure without hesitation, and those obtained by the
different methods may be combined.
To recapitulate the methods o f securing an approximate “ indus­
trial unit” as a base for all forms o f industrial study:
1. Use actual hours as recorded by time clocks. Reduce these to
a usable equivalent by dividing by 3,000.
2. When days of work are recorded determine the average length
in hours in each department. Multiply this by the number of
recorded days. Divide by 3,000.
3. When average employment and days in operation o f the de­
partments are available multiply these together and divide by 300.
4. When it is possible from one or more pay rolls to determine an
average hourly or daily rate this may be divided into the total wage
payments, giving total hours or days worked. These figures may
be divided by 3,000 or 300, respectively, to give the desired unit.
After determining exposure for one year by the methods here out­
lined or by a combination o f them it may be entirely feasible to
utilize constants o f increase or o f decrease for later years. An at­
tempt to describe fully the development o f such a scheme would
unduly prolong this paper. An illustration o f its employment is
found in the figures furnished by the Wisconsin commission in con­
nection with the compilation already used for illustrative purposes.




116

ST A TIST IC A L SESSION.

The procedure will be given in full in connection with the tables to
be issued in the M o n t h l y L a b o r R e v i e w .
It has been proposed by some to abandon entirely the attempt to
include the man in this consideration and confine attention to de­
termining relations between accident occurrence and pay roll. . This
proposition has the merit o f requiring as basic data items much more
readily obtained than is the amount o f exposure.
It introduces, however, so many elements o f uncertainty due to
the varying rates of payment and other variables that its satisfac­
tory application would, on the whole, be quite as difficult as the
method based on human exposure.
In the course of time it may be hoped that accident rates, both
frequency and severity, will become sufficiently familiar that the
nontechnical reader will have the same sort o f understanding of them
that he now has of mortality rates. It would be unfortunate just
as this condition is beginning to prevail to introduce a new method
probably but little, if any, more easily applied than the one now
in use.




W H Y TABULATE NONCOMPENSATED ACCIDENTS?
B Y L. W . H A T C H , C H IE F S T A T IS T IC IA N , N E W Y O R K ST A TE IN D U S T R IA L C O M M IS S IO N .

When I was asked to discuss at this meeting the question which is the
subject o f this paper nothing was said as to why this question should
be raised. Considering the tacit assumption that has all along been
made by this association and its committee on statistics that non­
compensated accidents are to be tabulated, the raising of the question
now may seem rather late or quite uncalled for. That assumption ap­
pears in the very first action o f this association concerning accident
statistics when, at the meeting in Chicago, in January, 1915, it
adopted a standard definition o f a “ tabulatable ” accident identical
with the previously established standard definition o f a “ reportable ”
accident, which latter included every accident causing loss of time
other than the remainder o f the day, turn, or shift on which the acci­
dent occurred.
But during the last three years we have learned much about acci­
dent statistics by experience, and one o f the things that some o f us
have had thus borne in upon us is the great amount of work involved
in producing adequate statistics o f accidents and the difficulty of se­
curing sufficient resources for such work. I venture to think that I
give the common situation of accident statisticians to-day when I say
that they are forced to a selection only from among various desirable
lines o f work. In a word, they have to do what they can and live in
hopes o f the rest sometime in the future.
Under such circumstances the accident statistician needs to know
certainly that any line o f work is sure to have its labor justified by the
value o f its results, and that need grows according to the amount o f
labor involved. Now, the tabulation o f noncompensated accidents is
always a heavy undertaking. In number they run to many times the
total o f compensated cases, five times as many in New York State, for
example, at the present rate o f reporting, with a total o f 250,000 per
year. Another consideration here is that, in the absence of follow-up
work for purely statistical purposes, reports o f noncompensated acci­
dents are more incomplete and defective than those o f compensated
cases. The necessity o f exact information for purposes of awarding
compensation automatically insures the necessary data for statistical
purposes on compensated cases, but for noncompensated accidents there
is not the same necessity. Hence, as part of the work required for




117

118

ST A TIST IC A L SESSION.

tabulation o f noncompensated accidents must be reckoned the task o f
securing full reports o f all the necessary data.
It is by no means out o f place, therefore, to raise our question, even
to the extent of asking whether the assumption that has all along
been made is well founded. I f we find no occasion to alter that as­
sumption, we may at least clarif}^ the grounds for it, and thereby
afford support for the efforts of statisticians to bring their work up
to the best standards.
In order to be concrete as well as most practical, it will be well to
take the word “ tabulate ” as meaning tabulate to the extent specified
in the standard tables recommended by your committee on statistics.1
That will mean tabulation by industry, cause, nature o f injury, ex­
tent of disability (time loss), medical aid, wage, sex, and age. Also
for present discussion by “ noncompensated ” is to be understood
“ tabulatable” accidents (under the definition o f the committee on
statistics) in which no compensation for wage loss is paid, whether
medical benefits be paid or not.
I think we shall arrive most convincingly at conclusions if we re­
call at the outset that any accident statistics, ta justify themselves,
must be o f distinct service for one of the following four purposes,
namely: (1) Determination of rates for compensation insurance, (2)
prevention o f accidents, (3) equitable and accurate administration of
compensation laws, and (4) measurement of current experience.
Considering the first o f these, the statistical information necessary
for determination of insurance rates comprises the amount o f com­
pensation or medical aid paid, or to be paid, together with pay-roll
exposure, tabulated by industry classifications. This at once indicates
that a noncompensated accident is of no significance for this purpose
except as medical aid may be paid in connection with it. But under
a compensation law requiring payment of medical aid the latter is an
indispensable item o f statistical information for the insurance carrier.
It is an item which appears, o f course, in connection with compen­
sated accidents, but tabulations o f it restricted to the latter class of
cases would be wholly inadequate. There may be set down, therefore,
as one tabulation of noncompensated accidents which is clearly neces­
sary, one to show medical aid paid in such cases.
But as already indicated, this is an item o f significance chiefly for
the determination of insurance premiums. F or this, what is neces­
sary is the same as in case of compensation paid, i. e., tabulations
showing amounts paid in comparison with pay-roll exposure by in­
dustry classifications. For such a tabulation, insurance carriers are
practically best, if not solely, able to secure the necessary data, these
1 References to the committee recommendations herein are to those in the report o f the
committee published in the M o n t h l y R e v i e w of the U . S. Bureau o f L ab o r Statistics
for October, 1917.




NO N CO M PEK SATEI> ACCID EN TS— L . W . H A T C H .

119

being automatically a part of their records. T o them, therefore, as
chiefly requiring this information and best able to prepare it, this
sort o f tabulation o f noncompensated accidents might very well be
left. Bear in mind that to propose to leave such tabulation of medi­
cal aid to carriers does not need to involve loss o f such information
to the public. To whatever extent is desirable carriers may and
should be required by the appropriate public authority— superin­
tendent o f insurance or industrial accident board—to furnish for
public information the results o f such tabulations.
Tabulations of medical aid are as a matter of fact not called for
by any of the standard tables recommended by your committee on
statistics except one, namely, Table 5. The last column o f that table
calls for amount of medical aid for each class of disability, and will
involve tabulation of noncompensated accidents for that item. This
table is designed mainly to afford the means of comparing cost o f
different schedules o f benefits in different States and is useful chiefly
from the insurance point of view. As an item in those benefits medi­
cal aid is o f course essential to afford complete results, and where
the data are available should be tabulated. A t the same time it may
be pointed out that where data as to medical aid are not available,
omission o f that item would not deprive Table 5 of its chief value,
which lies in its information as to compensation. This consideration
carries greater significance, from the fact that complete data as to
medical aid are not easily obtainable, owing not only to the great
number o f cases to be handled but also to a special difficulty growing
out of the fact that large employers frequently furnish medical aid
directly in plant hospitals or by plant physicians in amount exceed­
ing the requirements o f the law and without allocation o f cost to
each ease.
The most important tables recommended by the committee, tables
1 to 4, call fo r distribution o f accidents by industries, and by causes,
according to extent o f disability, and provide for a division o f tem­
porary disability cases into those with lost time o f over two weeks,
over one to two weeks, and one week or less. Table 5 calls also
for distribution of noncompensated accidents according to length
of time lost, by days. In any State where the waiting time is over
one week, the data for the time loss in noncompensated accidents called
for by these tables will involve much the largest amount o f labor
and difficulty o f any contemplated by the committee’s scheme. This
is because o f the fact previously pointed out, that this data is not
_ordinarily developed in the necessary records for making of awards
and payment o f compensation, and must be specially secured for
the purpose o f supplemental reports in the short-time disability
cases, which are most numerous o f all, amounting in New York State,




120

ST A TIST IC A L SESSION.

for example, to hundreds o f thousands in a year. Let us consider,
therefore, how far this labor is worth while.
I t is sometimes said that it is important to collect this data so
that when the question arises o f reducing waiting time in a statute
it may be possible to tell in advance what the effect will be as to
numbers of workers to be affected and amount of compensation to be
paid. Argument is sometimes made as though such information
were indispensable for the settlement o f the question o f whether
waiting time should or should not be reduced. But that idea may be
dismissed as being from the same cloth as the argument which fre­
quently cropped up when passage of the first compensation laws was
being discussed, it being contended at that time that it would never be
safe to pass any such law until it could be determined in advance just
what it would cost. Reduction o f waiting time, like enactment o f
compensation laws, is not a question o f cost but o f justice, and is being
settled on that principle without awaiting determination o f cost,
as witness such reduction in 1917 in no less than 9 out o f 31 States
having compensation laws before that time.
From the point of view of insurance rates, there is something to
be said for collecting the data in question in anticipation o f a reduc­
tion o f waiting time so as to afford more accurate early readjustment
o f rates. There are, however, two counterbalancing considerations
on this proposition. One is that the assumption that dependable
data for rate-making .purposes are possible in the absence o f com­
pensation requirements whose administration necessitates the re­
cording o f the data is open to question in the light o f comparisons
of statistics o f accident before and since the passage o f compensation
laws. The other is that there are now'a sufficient number of States1
having a waiting time o f one week or less to afford a very substan­
tial body of statistics o f time loss in short-time disability cases,
such as the committee table calls for in noncompensated cases in other
States, developed under the advantageous conditions attaching to
compensated cases. The more dependable data wThich should be
available in these States may be regarded, I am inclined to believe
(I am almost ready to prophesy that actually they will have to be
depended upon for the purpose), as sufficient for necessary advance
data for preliminary insurance rating purposes in a State about to
reduce wTaiting time under two weeks, at least sufficiently so as to
make it necessary to seek other reasons, if there be such, to justify the
cost and labor involved in ascertaining time loss in noncompensated
accidents.
1 In 1917 there were 15 such States, namely, Connecticut, Illinois, Indiana, Idaho,
Kansas, Minnesota, Nebraska, Nevada, Ohio, Oregon, Texas, Vermont, W ashington, W est
Virginia, and Wisconsin. Also the U. S. Employees’ Compensation law limits the w aiting
period to less than a week.




NO N C O M P E N SA TE D ACCID EN TS— L . W . H A T C H .

121

What has already been said indicates that we must turn to pur­
poses other than determination o f compensation insurance rates to
find reasons for including noncompensated accidents. So far as
light on the administration of compensation is concerned, in the
nature o f things it is statistics o f compensated cases only that will be
of service because the problems o f administration are those of de­
termining awards in accordance with the provisions of law. It is
then from the point of view of accident prevention, or of the related
one o f measurement o f increase or decrease in accidents, that the
value o f statistics o f noncompensated accidents is to be appraised.
More specifically it will be the value o f statistics of frequency and
severity by causes and industries, as called for in Tables 1 and 4
recommended by the committee, that chiefly must justify tabula­
tions o f noncompensated accidents. In many ways, as pointed out
in the last report o f the committee, these are the most important
tables in the entire list.
In order to determine how important it is that the data concerning
noncompensated cases called for by these tables should be included, as
well as those concerning compensated cases, it will be well to consider
just what questions it is to be expected that those tables shall answer.
I take it these are three, namely: (1) How do the hazards of differ­
ent industries compare? (2) How do the hazards from different
causes compare? (3) How does the hazard in a given industry or
from a given cause compare one year with another ?
Theoretically, at least, it would seem to be necessary to have a com­
plete measure of the hazard in question in order to answer any o f
these queries, and for that account would have to be taken of every
accidental injury it caused, no matter how trivial. But is such com­
pleteness o f measure so necessary for practical purposes which statis­
tics o f accidents can serve as to make it worth the great expense o f
securing it solely for that purpose, as in the case of noncompensated
accidents? More exactly the question is this: With the differences
in hazard which complete statistics o f compensated cases will afford
in hand (no one can for a moment question the need of having such
statistics), how likely is it that the addition of noncompensated cases,
i. e., those causing temporary disability of 14 days or less, would alter
the results sufficiently to change conclusions for practical purposes?
More concretely, if a safety inspector o f a mutual insurance company
in a single industry, for example, has before him full knowledge o f
the relative importance of the various hazards which lie must com­
bat, as measured by the compensable accidents which they cause, will
the addition of noncompensated cases to his statistics be likely to
show that he did not before properly distinguish between the greater
and lesser hazards? Or will a Stat'e safety engineer, with the dif­
ferences between industries as to hazard as shown by compensated




122

ST A TIST IC A L SESSION.

cases, be likely to have to revise his selection of industries for tlio
purpose o f devoting his attention to the more hazardous? Or, t o
cite one more example, will an industrial commission studying in­
crease or decrease of accidents in its jurisdiction be likely to find
conclusions from experience as to compensated accidents alone
greatfy at variance from that for all accidents ?
A little consideration will, I believe, compel one to answer these
questions in the negative. The first point to note is that, to a consid­
erable extent, relative frequency o f injuries, as between different
causes or industries, would not be greatly changed by the addition
o f noncompensated cases. It is true that the ratio o f more serious to
less serious cases is not constant under different causes or in different
industries, but the variation is not so great as to make distribution of
compensated cases (that is, deaths, permanent disabilities, and tem­
porary disabilities of over two weeks’ duration) wholly unreliable as
an index o f accident frequency.
In the second place, and this is the main consideration, for all
practical purposes accident frequency alone, to the extent that the
relation o f more to less serious cases is not constant, is o f small value
as an index o f hazard. Only when to the factor o f frequency is
added the factor o f severity o f injuries can we arrive at any reliable
index o f hazards. Now, when the severity element is considered, it is
almost entirely compensated accidents which are controlling in the
results. This is because o f the enormous difference in weight o f the
two classes o f cases when measured by severity. This is well illus­
trated by the schedule of weighting for severity recommended by the
committee on statistics. In that schedule a fatal accident is estimated
as equivalent to the loss o f 6,000 days’ time. In a State with a wait­
ing time o f one week, the average time loss in noncompensated acci­
dents is bound to be less than three days,1 but if taken at that amount
it will be seen that on the average it would take 2,000 noncompen­
sated cases to equal in importance one fatal case. Or, in such a
State, it would take 1,000 noncompensated cases to equal one hand
dismemberment, or 100 to balance one loss of finger. A similar com­
parison for a State with a waiting time o f two weeks, assuming the
average time loss of noncompensated cases at six days (an over­
estimate for the same reason as above indicated), indicates that one
death case would equal 1,000 noncompensated cases, one hand loss
would balance 500 noncompensated accidents, and one finger dis­
memberment would equal 50 noncompensated cases.
A third consideration bearing on the question is the general fact,
which should always be borne in mind in connection with accident
1 Three days would assume an even distribution of cases according to time loss from
one day to six days^ whereas it is w ell known that the number o f eases is greater in
shorter time grades.




N O N C O M P E N SA TE D A CCID EN TS— L . W . H A T C H ,

123

statistics, that small differences in results are o f doubtful significance.
This is because of the great variableness o f the units which make up
the aggregates of accident statistics. No two accidents are exactly
alike, so that there is always more or less variation in statistical
results which represents pure chance for the particular time or
place, instead o f what is typical or permanent for the hazard under
consideration. This is true both as to frequency of occurrence and
also as to severity o f resulting injuries, but to a greater degree for
the latter than for the former.
From general considerations such as the foregoing, and in the ab­
sence of a test thereof by a study of statistical material, which I
regret that I have not found time to make for this paper, I am not
disposed to press conclusions too far. I am, however, inclined at
present to the view that for most practical purposes which accident
statistics can serve, the tabulation o f noncompensated accidents is of
minor importance. Certainly it is of very minor importance as
compared with complete tabulation of compensated cases along the
lines laid down by the committee on statistics. Particularly it can
be urged that in any State where there is a choice between the two,
the securing o f data concerning exposure, necessary for computation
o f accident rates, should by all means be undertaken befox^e tabula­
tion of noncompensated accidents. I emphasize this especially be­
cause apparently not much progress has yet been made toward the
achievement o f accident rates by industrial accident boards or com­
missions, whereas such statistics are of the very greatest importance
from every point of view. The reason for the paucity of this mate­
rial undoubtedly is the fact that in most States the provisions of law
or circumstances o f administration are such as to make necessary
special collection o f data for that purpose in addition to that which
is automatically recorded in the administration o f compensation
laws, and the collection o f that data is a task o f many difficulties and
much labor. But it can not be urged too strongly that every State
should put the achievement of such data in the very first rank o f
importance in its program for accident statistics.
Another point, by way of contrast, may also be urged here; that
is, that if the inclusion o f noncompensated cases in the tabulations
must be at the cost o f less prompt publication of statistics o f com­
pensated cases to any considerable extent, then their inclusion might
well be subordinated to the prompter issuance o f the latter. My
observation is that thus far there is still much to be desired along this
line o f earlier information as to compensation experience in most
States.
Do not understand me as arguing against tabulation o f noncom­
pensated accidents in accordance with the committee’s scheme under
any and all circumstances. On the contrary, where a commission




124

ST A TIST IC A L SESSIOH.

can afford to do it, in addition to the other statistical work o f greater
importance, tabulations of noncompensated accidents should be un­
dertaken as being the ideal achievement in accident statistics. As­
suming that that is to be done, there is one further question o f rela­
tive values that I venture to add; that is, how far the ascertainment
o f time lost in each noncompensated case is necessary, when special
inquiry to secure that item would be required (as would be the case
to a large extent in most States). Doubt on this point is particu­
larly strong for a State where waiting time is only one week, for
in such case absence of exact time loss would not prevent prepara­
tion of the frequency data called for by the committee’s tables,
except to a slight extent, and that at the point o f least moment, in
Table 5, which would be an unimportant omission. Even in a State
with two weeks’ waiting time the frequency data called for by the
committee’s program would be short at the least important point,
by failure to secure time loss in each noncompensated case; that is,
only in Table 5, as in the case of one week’s waiting time, and in
columns 9 and 10 o f Table 1, and columns 7 and 8 o f Table 4. W ith­
out collection o f time loss in noncompensated cases, it would only be
necessary to combine the columns referred to in Tables 1 and 4, and
this would detract comparatively little from the value of those tables
for practical purposes.
More important would be the effect upon severity data o f failure
to secure time loss in each noncompensated accident when the latter
are to be tabulated, because the committee’s plan proposes to measure
severity in terms o f time loss. But even here there is an alternative
for which much can be said. That would be to give each noncompen­
sated temporary disability a uniform weight in number of days,
using for that purpose as close an estimated average as could be
made. I f this seems like an arbitrary and inaccurate expedient, it
can very positively be replied that it would be no more arbitrary,
and probably less inaccurate, than data for time loss in compensated
cases o f death and permanent disability computed according to the
committee’s schedule of weighting in Appendix C, because the esti­
mated average to be used for noncompensated cases would be one
necessarily within far closer-known limits (between one and six days
in a State with one week of waiting time or between 1 and 12 days
where there is two weeks waiting time) than those used for death
and permanent disabilities. Furthermore, the estimate for noncom­
pensated cases would aggregate but a fraction of that to be used for
deaths and permanent disabilities. However, since this is a proposal
to alter substantially the recommended plan o f the committee on sta­
tistics, the suggestion to substitute a uniform weighting for non­
compensated accidents, as an alternative to determination o f exact
time loss in such cases, should perhaps go first to that committee.




NONCOM PENSAT.ED ACCID EN TS— L . W . H A T C H .

125

The answer to the question, “ Why tabulate noncompensated acci­
dents ? ” then, is that such tabulation is necessary to afford complete
statistics of accident experience, but that their inclusion is not a mat­
ter o f first importance for most practical purposes of accident statis­
tics and should be held secondary in value to attainment of com­
plete and early statistics of compensated cases. It is frankly recog­
nized that this conclusion has been reached by an analysis largely on
a priori grounds, and is submitted subject to further discussion on
those grounds, or better still to verification by the more laborious
method of test by available statistics.




THE USE OF STANDARD ACCIDENT AND COMPENSATION TABLES.
BY

W.

H . BUEHOP,

SE CR ETA RY , W IS C O N S IN

C O M P E N S A T IO N

IN S U R A N C E

BOARD,

While the primary function o f this discussion is to illustrate the
use of the standard accident and compensation tables recommended
by the statistical committee of the International Association of In­
dustrial Accident Boards and Commissions, and to emphasize the
practical yalue which these tabulations present to administrative
bodies, it may not be too great a deviation to inject a brief resume
pertaining to the development and maintaining o f the records which
must form the foundation of the statistics involved.
While the committee has recommended detailed classifications of
causes of accidents, of industries, and of nature of injury, also stand­
ard definitions and even table forms, no recommendations have been
made regarding the procedure or manner in which the original re­
ports find their way into the finished table. This, obviously, is an
administrative question which presents a different problem in the
various States. The industrial size of the State, the kind of acci­
dents reported, the manner of claim settlement, and the jurisdiction
of the administrative body are some of the factors which will in­
fluence the statistical procedure. Furthermore, so far as uniformity
is concerned, the details of procedure are unimportant; our aim is
to erect certain tables in which the facts are based on standard, uni­
form definitions and classified uniformly according to adopted classi­
fication codes. The manner in which this is accomplished rests with
the individual State.
This discussion is not intended to present a model statistical plan,
but merely to cite as an illustration the procedure employed by the
Wisconsin Industrial Commission, and which was developed as the
needs demanded and the budget permitted.
Employers of Wisconsin report annually from 15,000 to 18,000
industrial compensable accidents, or accidents causing more than
seven days’ disability. To enable a statistical department to com­
pile and arrange this number o f individual reports into table form,
and do so with efficiency and accuracy compels the use of tabulating
machinery. The safety department must have accident statistics
to exercise properly its functions, and so the statistical department
is continually called upon to compile statistics showing the accidents
in certain industries, make comparisons for given periods, make
126




STANDARD A C C ID E N T , E T C ., TABLES— W . H . B U R H O P .

127

studies o f specific causes, and even to show the accident experience
o f an individual employer over a period o f years. No hand method
o f dealing with 50,000 injuries (the approximate number o f accidents
in Wisconsin during the past three years) would enable a department
to collate all this information and do so with the rapidity demanded.
With the possible exception o f the smallest industrial States, each
State would find this labor-saving machinery a well-paying invest­
ment, if not an absolute necessity to gather the information vital
to the best administration o f safety and compensation laws. This
feature is here mentioned because the plan under discussion is based
upon the use o f machinery.
Where an accident report is received record is at once made upon
an individual claim card. On this card all facts necessary to the
proper adjustment o f the claim are recorded. Space is available
to indicate future payments and final settlement of the case as in­
dicated by supplementary and final reports. Until the claim is set­
tled the card is filed in a case containing all open claims, or claims in
the course o f adjustment. This work is done by the claim depart­
ment, which is not a division o f the statistical department.
When the claim department has made its original record of the
injury, the report passes to the statistical department. The first
function o f this department is to codify the information ; that is,
to translate the various facts into code numbers. This interpreta­
tion o f the report is a highly important function and should not be
intrusted to one without a thorough understanding of the classifica­
tions and a reasonable familiarity with industrial processes.
Some of the information pertaining to the injury can be definitely
determined from the first report, while such facts as the duration o f
disability, the amount of compensation and medical aid, can not be
ascertained until disability has ceased. In many instances even the
ultimate nature o f the injury varies from that at first indicated.
For these reasons the statistical department can not complete the
card from the first report. Such items as the date o f the accident,
industry class, the employer’s file number, the accident number, the
age and wage o f the injured, the cause o f the accident, and the nature
o f the injury are punched on the card from the first report, and then
it is placed in an incomplete file arranged in order by file number.
Periodically, weekly when possible, the claim department transfers
to the statistical department all the claim cards o f those cases which
were settled finally during the period. These cards also contain the
employers file and accident number, so that the two record cards
can be brought together. The accident card is then completed and
placed in a different file ready for tabulation.
All the accident statistics collated by the Industrial Commission
are based upon closed cases, and injuries are charged to the period




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ST A TIST IC A L SESSION.

in which the final payment was made. While this creates a slight
error in a tabulation o f accidents for time periods, the practical ad­
vantage in thus handling the records is so great that the method
seems justified. The only discrepancy involved is that in case o f a
rapid rise in the number o f accidents, this rise would not be shown
until several months later. If, on the contrary, all accidents were
to be charged to the period in which they occurred, a final tabulation
for a certain year could not be made, or at least would have to be
corrected, for a period o f possibly 10 or 15 years.
Having thus completed the record cards, the statistical department
is able to tabulate desired information in a very short time. Spe­
cific illustrations o f information compiled for the use o f various
departments o f the commission will be given later.
The standard tables suggested and outlined by the committee do
not present a complete exhibit o f accident statistics; they merely
represent wThat the committee believes to be the most essential in­
formation, arranged so that the experience o f the States may be
combined. Some jurisdictions may not yet be able to meet even
these minimum recommendations, while others may desire more de­
tailed and varied tabulations.
The tables compiled by the Wisconsin Industrial Commission dur­
ing the past three years are, in general, more detailed than the pro­
posals o f the committee. This, however, does not prevent the W is­
consin experience from being compared with tables formulated ex­
actly in accordance with the standard, because the details can easily
be combined. Tables 1 and 3 o f the recommendations call for a
distribution o f kinds of injury by industries, also for exposure rates
and time loss due to various classes o f injuries. The permanent
partial disabilities are grouped into one column. The Wisconsin
commission prefers to itemize the permanent partial disabilities so
that the number of disabilities to the various parts o f the body can
be determined. Instead of grouping all such permanent disabilities
into one column, they are actually divided into 21 columns,
showing separately permanent disabilities to the arm above elbow,
airm below elbow, hand, thumb, one finger, etc., in accordance with
the list employed in the weighting system presented with the report
o f the committee to the 1917 convention and found on page 142 o f
the M o n t h l y R e v i e w of the United States Bureau o f Labor Sta­
tistics, issued in October, 1917. The commission has gone further
than this and has indicated for each class of permanent injuries
whether the member affected was amputated, or if not amputated,
whether the disability was determined to be over or under 50 per
cent allowed for amputation.




STANDARD A C C ID E N T , E T C ., TABLES---- W . H . B U R H O P .

129

Instead o f making two separate tables to show the nature of the
injury and the time loss, the commission has combined. Tables 1
and 3 o f the committee’s recommendations.
The only difficulty encountered in attempting to fully meet the
standard was found in determining accident rates. The commission
does not have a record of the number o f employees in the various
industry classifications, hence the rate per 1,000 full-time workers
could not be determined. The only other measure of exposure is
the pay roll. This must be secured from two sources, the insurance
reports showing the audited pay roll by classes (Schedule Z) and
the reports o f employers carrying their own risk by permission of
the commission. A slight discrepancy will be found in this com­
bination o f pay roll because the insurance reports are on a year-ofissue basis, while the reports of self-insured are on a caleridar-year
basis. The results, however, should be reasonably accurate.
Only with the aid of a table such as above discussed can the
relative hazard of industries be determined. The safety man is in
need o f this information; and, with a broad exposure, an excellent
check o f compensation insurance rates, which are also expressions
o f relative hazard, is secured.
From the viewpoint o f accident prevention, Table 4 of the
recommendations is by far the most important. In this table the
number and severity of accidents by causes is exhibited. As in the
table previously discussed, the severity o f the injury is shown by
groups. A ll permanent partial disabilities are added into one
column. While the relative time loss due to the various causes, that
is to say, the relative importance of the causes, is derived by apply­
ing the weighting scale to the nature o f the permanent injury, the
Wisconsin commission believes that it is of additional value to
show the permanent partial disabilities in detail. As in Table 1,
therefore, the extent o f the disability and the part o f the body af­
fected is presented; also if the injury resulted in amputation, or, if
not, then the degree o f disability.
The argument is consistently made that the number o f accidents
alone is no criterion o f the relative hazard o f the instrumentality
producing the injury, but that the severity or gravity o f the injury
as well must be known. While this viewpoint is not contradicted,
the number o f accidents, especially for some causes, is quite as im­
portant to the safety man as is the severity o f the injury. The nature
o f the injury is in a great many cases purely a matter of chance.
A stamping press which “ repeats ” is just as much o f a danger if
by repeating it amputates a worker’s finger, his hand, or if no injury
occurs whatever. I f the workman’s entire hand had been under the
124247°— 19-------9




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ST A TIST IC A L SESSION.

die when the repeating occurred, the loss of the entire hand would
have resulted. The fact that at that particular moment only his
finger was exposed, or no injury resulted, is only a chance occurrence
which does not minimize the hazard. The fact that a mason’s scaf­
fold is not properly guarded, and as a result a brick falling from
it strikes a helper below a glancing blow on the arm causing a slight
disability, presents just as serious a hazard as if a fatality had re­
sulted. It was only by chance that the brick did not strike the work­
man on the head and kill him. It is largely for this reason that the
commission believes in a detailed exhibit o f causes of accidents as
well as nature o f injury. A table giving such detail is the most im­
portant guide which statistics offer to accident prevention. To be
o f maximum utility, however, the causes must be given in con­
siderable detail, and the mode o f prevention must be emphasized.
It is not enough to know that an elevator fell, causing injury and
death. The important thing to know is why the elevator fell. A
different method of prevention exists for every different cause o f the
elevator falling. Likewise, it is insufficient information to know
that a scaffold fell, or that a workman fell from or with a ladder.
These facts alone tell nothing regarding the prevention o f similar
accidents. So far as possible a cause classification should show why
the accident happened, or, if this can not be done, a subsidiary classi­
fication o f manner o f occurrence should be employed.
Tabulations showing the manner o f occurrence have been employed
by the Wisconsin Industrial Commission for several years, especially
in making detailed studies o f particular causes. Such a presentation
should exhibit the injuries caused because o f the wearing o f loose
clothing, slippery or uneven floors, oiling or adjusting the machinery
while in motion, breaking machine parts, and other contributing
causes. Metal burns can be tabulated to show how many could have
been prevented by the wearing of proper shoes and leggings; eye
injuries due to grinding or chipping should be correlated with wearing
or not wearing of goggles; and likewise there can be many other com­
parisons o f similar nature. This is the real information needed to
conduct a safety campaign properly, and in no other branch o f
accident statistics has the commission emphasized detail so much as
in the causes o f accidents. The Wisconsin cause classification pre­
sents much greater detail than the committee code, but this can
readily be combined so that comparability is not destroyed.
Tables 5 to 13 o f the recommendation have been prepared by the
commission for about five years. Table 5 presents the injuries by
nature o f severity and compensation and medical cost. This table,
with Tables 6 and 7, not only pictures the results and adequacy




STANDARD A C C ID E N T , E T C ., TABLES-----W . H . B U R H O P .

131

o f the compensation act, but is an absolute necessity to determine
accurately the effect in cost of new legislation. Legislatures will
want to know such facts before they take action on bills offering
changes, and insurance companies must have this information to
increase or decrease their rates properly. With the aid o f these tables
the Wisconsin commission has been able to determine for the legis­
lature the cost changes very accurately; as a matter o f fact, in the
final draft o f the bill passed by the 1917 legislature, cost tables pre­
pared by the commission were employed as an important guide.
The tables discussed are the most important recommended by
the committee. This list, however, is far from exclusive, considering
the entire field of useful accident statistics. Many special studies
to throw light on particular problems can and should be made. Some
o f these have been previously referred to. Important causes such as
saws, emery wheels, stamping presses and the like are adapted to
more detailed analysis, having in mind always why the accident
occurred. For such studies the manner of occurrence classification is
useful.
A detailed exhibit o f the causes of accidents in the logging indus­
try has guided the commission and the logging operators in estab­
lishing a set of rules for the workmen. When an employer or a
workman is told that a certain number o f men have been injured
because they carried the saw or ax under their arms, a rule to always
carry these tools on their shoulders carries a great deal more weight.
Likewise orders and rules have been made for safety in the mining
industry, based upon experience indicated by accident statistics.
Square-headed jointers have been legally condemned because statis­
tics pictured their danger to the fingers and hands of workmen. The
use o f goggles in certain occupations has been made compulsory be­
cause statistics displayed the danger to the unprotected eye. Ele­
vator orders have been made and increased in the light o f tabulated
experience. Children have been prohibited from -working in certain
industries and on certain machinery because the tabulated experi­
ence o f the past has indicated the hazard to be too great. Safety rules
have been established in the building industry and were founded
largely upon statistics.
Using accident experience to still greater detail, exhibits are made
to show in detail the record of the larger employers. Such a table
is placed in the hands of the inspector prior to his visit to the re­
spective plant. With this information in hand he can be guided by
former experience in making his inspection; he can also emphasize
his arguments for safeguarding. Inspectors report this information
to be o f great aid and value.




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STA TIST IC A L SESSION.

For large employers, accident frequency is the main gauge o f the
effectiveness o f safety work. A current record o f the experience of
individual employers should be kept. A rise in the frequency curve
is an invitation for the State safety department to visit the plant.
Maintaining proper accident statistics is the accounting system of
safety work; it is just as necessary as a cost accounting system of
our largest industrial enterprises. True, we can talk safety without
facts, but it means groping in the dark, misdirected energy, and
lacks the punch of certainty and definiteness which distinguishes
serious and effective work from superficial propaganda.




T H U R S D A Y , S E P T E M B E R 26— M O R N I N G S E S S IO N .
CH AIRM AN, CHARLES H. LEMON, M. D., M IL W A U K E E , W IS.

IV. MEDICAL SESSION.
SHOULD MEDICAL SERVICE BE LIMITED IN COMPENSATION
CASES?
BY CHAS. H . LEMON, M . D., MILWAUKEE, W IS.

We know that in the past, prior to the establishment o f the work­
men’s compensation act, first-aid treatment was about all that the
vast majority of injured workmen received at the hands o f their em-.
ployer or the insurance carrier. Nobody cared very much whether
this first aid was the best that could be had or where it was given.
The employer in the large cities called an ambulance and the man
was removed from the premises; usually he was taken to a city hos­
pital where routine treatment was given by internes, or young men on
the staff, who were without experience.
Medical service should be rendered to an injured employee, first,
because it is humanitarian to do so, and educated public opinion de­
mands it; second, it should be rendered because it is important for
industry that the man shall be returned to his employment with the
least possible loss of working days.
The steam railroads in the past were pioneers in the manner o f
furnishing medical service to injured employees. We will not admit,
however, that their action was entirely unselfish. The medical profes­
sion was subsidized by free passes, and with the exception of isolated
cases in the large cities the free pass was about all that the average
railroad surgeon got for his services. This practice established a
low fee basis, and even the chief surgeons in the metropolitan cities
were greatly underpaid for the work they did. There was an allur­
ing fetich in the title “ railroad surgeon.”
W e must recognize as an entity what is known as educated public
opinion, and any treatment on the part o f the employer which seems
like indifference to the sufferings of our fellow men will result in a
public remonstrance which can not go unheeded.
The employer, therefore, should render medical service, not merely
because the law requires him to do so, but because public opinion de­
mands it.




133

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M ED ICAL SESSION.

The character of the medical service to be rendered may well receive
consideration at this time. It occurs to the writer that the best medi­
cal service that a community affords is none too good for an injured
employee. The limitations that the most experienced surgeon
must admit in the presence of a serious injury, particularly to the
bony skeleton, should place a burden upon the employer not easily
gotten rid of, and when I say employer I must include the insurance
carrier; for but comparatively few of the large number o f firms in
a commonwealth can afford to carry their own risk. The larger
companies will endeavor to employ men of known experience, because
experience has shown that where skillful first aid is given the ulti­
mate cost of the accident is reduced to the minimum and the injured
employee will suffer less permanent disability. Some o f the largest
institutions, however, are endeavoring to cut the cost for medical
service either by the employment o f full-time men, who are usually
without any personal experience excepting such as they have re­
ceived as internes in metropolitan hospitals, or who are without any
experience at all, and accept the position because tlje salary offered
gives them a certain livelihood.
The medical man o f large experience will seldom be found outside
o f the metropolitan cities. No criticism therefore should be made
o f plants of moderate size remote from the larger cities, which must
employ the surgical talent that is available in their communities. It
is unfortunately true that doctors as a class are self-opinionated and
with few exceptions are entirely satisfied with their own work. In
their opinion, results which are far from what might have been at­
tained are due to “ complications,” and this diagnosis covers a multi­
tude of sins.
We occasionally find a doctor living in a community remote from
the larger cities who recognizes his own limitations and seeks advice
from those of larger experience.
Criticism, however, is to be directed to the character o f the medi­
cal service offered by some insurance carriers, who are seeking to
take advantage of the cupidity o f the medical profession by em­
ploying so-called surgeons for the treatment o f injured employees,
whose one reason for employment is that their fees are low. It is
my observation that some o f the insurance carriers are hoping to
educate some of these men at their own expense in the hope that
in time they will become competent. It is my opinion that no man
is justified in doing major emergency surgery who has not had a
training in this class o f surgical work under a competent surgeon.
The experience of the insurance carriers is sufficiently large at this
time to have taught most of them that competent surgical service
is the most economical, and in the larger cities they are employing a
group o f men who have specialized in this class of work. For M il­




L IM IT A T IO N OF M ED ICAL SERVICE-----C. H . L E M O N , M . D .

135

waukee, I will say that the men who represent the insurance com­
panies are doing excellent work, and without exception they are
men who have had not only excellent hospital experience prior to
their entrance upon the field of surgery, but they counsel with each
other when cases of unusual character present themselves. Without
making a personal investigation into the individual cases that I have
in mind, I would infer that the services rendered are satisfactory
both to the injured employee and to the insurance carriers. Employ­
ment by large corporations and by insurance carriers o f trained
nurses for the routine minor injury is a practice to be commended,
because it is both economical and encourages the injured workman
with the small infection to seek aid ready at hand.
Legal gentlemen representing the insurance carriers have told me
that the difficulty with the medical profession is, it makes the after
treatment so expensive by what seems to be unnecessary repetition
o f dressings, that the medical profession has biought itself into
disrepute, and has forced the insurance carriers to seek other means
o f avoiding what appears to be an excessive charge-for the subse­
quent treatment o f the cases. It would seem that prudence on the
part of the medical profession would prompt a careful revision o f
the subsequent dressing problem, so that it would not become a
burden to the insurance carrier.
Medical service that is not continuous has never been popular
with the medical profession. In the personal relation, which is so
frequently established between the doctor and patient, it has always
been a difficult matter for a physician either to discharge a patient
or to be dismissed by him. Any plan of medical service which does
not give the physician an abundance o f time to cure the patient will
be at once unpopular with the great body of the profession.
Emergency surgery in the past has found few who were willing
to give the large amount of time necessary to the first treatment,
because the day following, in a large number of instances, the cases
passed out o f their hands. The cases were referred to the interne in
the metropolitan hospital and were prized by him because he had an
opportunity to demonstrate his personal ability. The interne had no
personal interest in the result to be attained and he certainly had no
responsibility; and experience shows that the victim paid dearly for
the experience he furnished to the young surgeon.
I f medical service is to be limited, no first-class surgeon could be
induced to undertake it. The large number of major accidents
occurring in industries cause injury to the bony skeleton. These in­
juries are notoriously slow in recovering. There are so many factors
which enter into the problem o f repair o f fractures o f bone, both
simple and compound, that few, even among the most experienced,
are able even to approximate the period that will be necessary for




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M E D IC A L SESSION.

complete recovery. There are also many accidents which occur dur­
ing operations, beyond the control o f the surgeon, arising out o f
the use o f materials commercially made and handed to the surgeon
at the operating table, which cause infection and complicate an other­
wise clean case, requiring many months to effect a cure.
I recently had a case o f osteomyelitis follow an operation for de~
layed union that was caused by the use o f kangaroo tendon; the
osteomyelitis occurring in the drill hole in the bone made for the
kangaroo tendon; others have had similar experiences.
I f surgery were like carpenter work we could always give a definite
prognosis as to the period o f recovery. The complications caused by
injury to the soft parts, such as the destruction ..of the nerves, throm­
bosis o f the blood vessels, laceration of the muscle and fascia tissue,
frequently can not be foreseen and are not infrequently entirely over­
looked when obscured by some other serious injury which must be
given priority o f treatment no matter what happens elsewhere in the
body.
Many times injuries occur which are not attended by danger to life j
but which require long periods o f treatment before recovery ensues.
I cite for an example the‘matter o f extensive burns o f the chest, the
back, and the extremities. Not only, in these cases, must these pri­
mary lesions be healed, but frequently extensive operations must
subsequently be performed to neutralize the effect o f the contracture
o f scar tissue. We are all familiar with infections arising from very
slight wounds of the fingers which require months to effect a healing.
In the hands o f the experienced the time will be shorter for the heal­
ing period, but frequently when first seen, so much destruction has
occurred and such important structures have become involved, that,
even with the most skillful attention, many months elapse before the
man is able to return to his work, and then with a seriously deformed
hand.
Injured employees are not willing to part with even small por­
tions o f their fingers in order to shorten the period o f convalescence.
Many crushing injuries involving the pulp at the extremities o f
the fingers, with no injury to the bony portion o f the finger, require
from six to ten weeks to heal by granulation. The amount o f tis­
sue that is built up is oftentimes amazing and unless much scar tis­
sue forms, the resulting wound is infinitely better than any ampu­
tation stump. I f we were permitted to make amputations freely in
such injuries to the hand, a two-weeks period in the larger number
o f cases would be all that is required.
As surgeons, we must conserve that which can be saved and in
the treatment of the cases we must ignore any question o f expense
to the employer or the insurance carrier when such question o f ex­




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137

pense involves the loss of any useful portion that remains of an
injured member.
No surgeon having regard for his reputation would be willing to
reduce a fracture, place the same in a plaster cast where possible
to do so, and then resign the case to another surgeon for subsequent
treatment. It leaves too great a loophole for the shifting of respon­
sibility as to the ultimate result of the case.
Injuries to the bony skeleton, particularly those involving the
spine, the pelvis, and the upper portion o f the thigh bone, recover
slowly, and can not be treated within a time-limit period. No sur­
geon should be asked to treat, without compensation, a patient after
a time period has expired. This practice in time would lead to ai
multiplication of fees for the period prior to the expiration of the
time limit and this practice is essentially dishonest.
There are cases which are hopeless from the beginning and these
cases obviously should not be treated excepting on a permanent, com-,
plete disability basis, excepting for a brief period subsequent to the
reception o f the injury, which would enable the attending surgeon
to have a competent consultation to assist him in arriving at such
a decision.
These cases, o f course, require prolonged hospital treatment, but
the provision of the law should be such that this factor would be
taken care o f in the amount set aside for the permanent total dis­
ability.
The time will probably never come when either the employer or
the insurance carrier will fully appreciate the fact that the primary
treatment o f an injury is the most important factor that they have
to deal with. The period necessary for healing must be measured by
the thoroughness o f the primary surgical treatment that follows the
accident. More can be done by a competent surgeon, experienced in
the treatment o f emergency surgery, in the few hours following the
accident, than the most skillful surgeon in the world can accomplish
in the week following. The prevention of infections in compound
wounds o f the joints and in compound fractures of the bones is a
possibility that has been frequently demonstrated; but in actual prac­
tice it is seldom effected because of a lack of skill on the part of those
who, for the greater part, are treating these wounds. The war
surgery o f four years has developed the fact that extensive lacer­
ated and contused wounds can be cleaned by the removal o f the
injured areas with the scissors or the knife and that these wounds
heal frequently by primary intention because o f a vigorous blood
supply that is capable of destroying infection that is not massive in
quantity. This fact has been known to the railroad surgeons for
many years and many cases could be cited to prove the fact.




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M ED ICAL SESSION.

It would seem the part o f prudence to employ, therefore, men ex­
perienced in this specialized class of surgery, rather than to pick up
the first man who happened on the job, because, in your excitement,
you thought the unconscious man was in danger o f dying and your
sense o f responsibility became lessened when a medical man o f even
the most limited attainments made his appearance upon the scene.
Is it not a fact with almost no exceptions that nothing is ever
done by the surgeon called to the scene o f an accident other than
what a bystander could do, that in any way determined the question
o f life or death, until the patient had been placed in a hospital,
where apparatus and materials are at hand to provide the proper
surgical treatment? I would not be understood to say that’ a surgeon
should not go to the scene of accident; an important artery might
be severed which, without prompt attention, would cause death; or
the patient might be electrocuted, and those present might be without
skill in the matter of resuscitation; or there might be severe pain
which would necessarily need a measure o f relief prior to the suf­
ferer’s transfer in an ambulance. It is the factor of uncertainty
which strikes terror to the heart of the lay person and which so fre­
quently brings to the injured physicians who are without the neces­
sary special training. Once in charge o f the case, they are loath to
give it up. The provision o f the statute which gives the employer
the right to call surgeons o f his selection is the saving clause which
has insured to workmen competent medical attendance. The em­
ployer will usually give to his men the best medical service the com­
munity affords, and experience has shown this to be the rule. The
medical man, therefore, should not be handicapped by a time limit.
He should give the best that he is capable of to the injured man, with
the sole idea of lessening the period that1the worker is taken from
his daily labor. He should be permitted to make as many operations
as are necessary and in reason to accomplish this result. These oper­
ations obviously can not be too close together, and I speak from ex­
perience when I say that the intelligent cooperation of the patient in
recognizing the necessity for subsequent operations and submitting to
them for his own good has been the most comforting experience of
my own personal- professional career. To hesitate to operate a sec­
ond time, or the third time, to correct something which at the time
o f the first operation was impossible to foresee, is to confess weak­
ness and lack o f ability to meet a definite situation. As surgery is
an art and not a trade and as the surgeon is at the mercy of the
idiosyncrasies o f his patient, there must, in the experience of all, come
cases which bring disappointment and which require further ad­
justment; but they should not bring discouragement to the surgeon
nor to the patient*.




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139

In short, the emergency surgeon should be given every facility
as to place, time, and assistance that will enable him, with a free
hand, to do for an injured employee that which would be impossible
under any other condition, not limiting him, either as to the expense
to be incurred or the time to be consumed for the accomplishment of
this humane object.
I may epitomize all that I have written by quoting the words o f
Mr. F. M. Wilcox o f the Wisconsin Industrial Commission in a per­
sonal communication on this matter:
“ Unlimited medical service should be provided. The relatively
liberal provisions of the Wisconsin act in this respect have insured
to injured men a much higher quality o f medical attention than they
ever had under the common law system or than they will ever get
under any compensation system which only makes a very meager
allowance, such as we have in some of the States. It is hard to
measure in dollars and cents the value o f proper medical treatment.
I f the injured man is left to select his own attendance his first
thought is to get it as cheaply as possible. Rarely would they get
hospital attendance, whereas, under the Wisconsin system, it is an
unusual thing for a man with any major injury to be denied it.”




BETTER TREATMENT FOR INDUSTRIAL ACCIDENT CASES.
BY MAJ. P. B.

M AGNUSON,

O F FIC E

OF

THE

SURGEON

GENERAL,

WAR

DEPARTM ENT,

W A S H I N G T O N , D. C.

Gentlemen: You have all had plenty of experience with doctors,
and most laymen look at doctors as M. D.’s and all M. D.’s are doc­
tors and all doctors are the same. I think the industrial commis­
sions have changed their minds about doctors. They have had ex­
perience— we have all had experience— with the young man who
has just come out o f college into industry.
I don’t know how much the layman is expected to know about the
different classifications o f the medical schools in this country. We
have a number o f classifications under the American Medical Asso­
ciation, the A-plus school— standing the highest—and the A, B-plus
and the B, and these are rated according to their faculty, their equip­
ment, their clinical facilities. Now, it makes a good deal o f differ­
ence to a man in his education as to what sort of contact he has had
during his student days— in the formative period. A man who has
gone to one o f the schools that we have in Chicago, which we call the
“ mill ” and which the State board o f licensers has been trying to put
out o f business for a good while, is not apt to have very high ideals
when he comes out o f school. He gets a job, usually, as a night sur­
geon at some large plant to help himself through school and when
he comes out, instead o f taking an interneship, he goes right into
industrial work nine times out o f ten. W hy does he go into indus­
trial work? Principally because, to the average corporation, the doc­
tor is a doctor. The president o f that corporation wouldn’t take that
man on as his own family physician, but it never occurs to him that
a cheap doctor is an expensive proposition.
I would like to tell something that happened to me when I first
went into industrial work. I had been with Dr. Murphy for several
years as his assistant, and, upon his advice, went over to the stock­
yards— along Halstead Street—to get a little more experience. I
went in to see the president o f one o f the large corporations over
there and asked him if he didn’t want a doctor.
“ No,” he said,“ We have got one doctor; we don’t need any more.”
I said, “ How much do you pay him ?”
He said, “ I don’t know, but I will find out,” so he called up the
claim agent. They were paying the doctor $75 a month. They were
being cheated, I think.
140




BETTER MEDICAL, T R E A T M E N T ---- M A J . P . B. MAGNTJSON.

141

He said, “ What do you want to do it fo r?”
I said, “ I want to do it on a fee basis.”
He said, 46How much will that cost?”
I said, “ It will cost you $2 for the first office visit and $1 for every
other one after that; $3 for the first call, and $2 for every one, after
that.”
He said, “ That will run over $75 a month.”
I said, “ I hope so, or I don’t want the job.”
After thinking it over—I had quite a conversation with him—I
asked him if he knew anything about his doctor. I said, “ Where did
he graduate from ?”
He said, “ I don’t know.”
“ What experience did he have before he came to you?”
“ I don’t know.”
I said, “ Do you know who he is?”
“ W ell,” he said, “ I know his name is so and so.”
“ W ell,” I said, “ Do you think it would save you any money if
you had surgical treatment which was a little better than you are
getting now ? ”
He said, “ I don’t know ; but I am willing to gamble with you. I
will pay you on a fee basis, and I will let the other fellow stay here
and pay him a salary, and the fellow that has the most business at
the end o f three months I will let have the job.” He added, “ You
are starting out with a handicap, because the boys know this other
fellow and they don’t know you.”
I said, “ Maybe that is no handicap; that may be an advantage.”
So we went to it. At. the end of 3 months I am glad to say
I had about 80 per cent of the business. A t the end of 6 months the
bill for that one company, on a fee basis, totaled six hundred
and some dollars—that same work the other fellow was doing
for $75. I sent the bill to the claim agent; he refused to O. K. it.
He sent it to the general manager and he refused to O. K. it.
He sent it up to the president. The president wrote me a letter
and told me that if I didn’t cut that bill down he was going to
get another doctor. It wasn’t very cheerful news for me, because I
just had a new boy in the family and I wanted to send him through
college some day, and I had very little other business besides that
railroad business. But the president of the company was Irish and
I knew he had to get about so much out of his system before I could
talk to him, so I went over and let him get it out on me. Finally
he ended up by saying he wasn’t going to pay that bill and wouldn’t
stand for it.
I said, “ Mr. Fitzgerald, you may never pay me another bill, but
you are going to pay that one all right. I f the chairman o f the




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M ED ICAL SESSION.

board o f directors came along here and said, *Mr. Fitzgerald, we
don’t think you earned your money last month and we are going
to let you go at' the end o f this month, and we are not going to pay
you last month’s salary,’ I suppose you are the man that would sit
down and say, ‘ That suits me.’ You would tear the roof off the
house and get your money, and that is just the way I feel about it.”
He said, “ Young fellow, if you have got anything like that to
say to me you go home and write it.”
I went home and wrote him a nice letter. I told him I wasn’t the
man he wanted if he wanted arms and legs cut off when there was
some chance o f saving them. I f he wanted fingers cut off when
there was some chance o f doing tendon sutures, nerve grafts, and
tendon transplantation I wanted him to get another man, because
my reputation was worth more to me than his money was; that
dressings cost money; that careful treatment cost money, but it
saved money. He sent me a draft in three days.
At the end o f the year this was the record: W e had had almost
10 per cent more accidents than we had had the year before; we had
had only one lawsuit filed as against thirty-one the year before.
There was a total saving of $20,000 in the claim department, and
the surgical department expense had been boosted almost $900.
Now, I am not telling that as recommending myself to you gentle­
men, because the Surgeon General is employing me now, and I don’t
need any outside jobs, but it does show, not only what careful medi­
cal treatment and surgical treatment will do, but what the treatment
o f employees will do. We put those men in private rooms and gave
them a night and a day nurse if they were very sick. We gave them
everything that money could buy to further their treatment. We
didn’t keep them in luxury, but we gave them everything that a man
who can pay for the best gets, and the results saved the money. Now,
that all leads up to the fact that the training o f a surgeon should be
brought to the attention of the employer as much as the training o f
his general manager. He should look into the training o f the surgeon
that he employs and the man’s character as carefully as he does the
general manager’s, because it pays in dollars and cents, and if we
are going to talk to a corporation head, we have got to talk in dollars
and cents and not in medical ethics, because he isn’t interested in
medical ethics; he is interested in dollars and cents saving at the end
o f the year. He thinks it is saving to have a contract surgeon. Now,
there are a good many good men who do work on a salary basis, but
most o f them will not do it—that is, especially in the large cities
where they have a large outside practice. There are a great many
good men who have started as contract surgeons, simply as a stepping
stone to work up, but those men leave it, because they can’t get ade­
quate compensation for their work from the corporation. The con­




BE TTER M E D IC A L T R E A T M E N T — M A J . P . B. M A G N U S 0 N .

143

tract surgeon, therefore, has fallen into disrepute, because, on an
average, he doesn’t measure up to men in civil practice who are doing
the best kind o f surgery. We have all got to look out for our own
welfare, and if we can make more money doing private practice, we
are going to do that, in preference to contract practice. The con­
tract surgeon is often careless; he gets a biased view. The claim
agent bothers the life out o f him to get a man back to work. He
sees a few men whom he can’t find anything the matter w ith; I think
we have all had experience with that class. Two classes come in that
are in absolute disparity to each other. One man says there is noth­
ing the matter with him; the other will come in and say there is
something the matter with him, and he will bring medical testimony
to substantiate it.
On one railroad we have adopted this policy. W e have a great
many men who exaggerate their symptoms, but not because they
are dishonest, because most men are not dishonest. In ten years o f
practice, a large part o f the time dealing with corporations and
their employees, I have found only one man that I thought was an
actual malingerer. I have found a good many that exaggerated their
symptoms, not because they were dishonest, but because, when a man
is injured, he stays around and thinks about his trouble, and he
exaggerates his pain because he has nothing else to think about. He
has a sore joint and it hurts him when he concentrates on it. These
people come into the office and they are inclined to be disgruntled
with the company surgeon, anyhow. I call these men off, after I
have made a careful examination, and say,“ John, I don’t think there
is half as much the matter with you as you think there is, and I am
willing to gamble with you on the subject. I will give you the name
o f five or ten men in Chicago, men of unimpeachable reputation. I
won’t address the letter. I will leave the heading blank and say,
‘ Dear Doctor: This will introduce to you John Smith, who is a
patient of mine. I would like to have your opinion upon his condition
and will guarantee any fee that you see fit to charge for a thorough
examination. W ill you please mail the report to me, or hand it to
Mr. Smith to bring to me.’ ” John Smith takes this letter. I f he
isn’t satisfied with one man, I say to him, “ Now, if this man savs
there is nothing the matter with you, will you agree to go back to
work? I f he says there is something the matter with you, I will
agree to pay the bill,” The company gives me the privilege of spend­
ing all the money on outside doctors that I see fit. I f the man is a
malingerer he knows his bluff is called; he can’t get out of that; that
is a perfectly fair proposition that he can’t side-step. Eight out o f
ten men will say, “ Well, doctor, if you think there isn’t anything the
matter with me I will go back and try it.” The other two will go
to the man, who is a reputable man, and have their examination and




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M E D IC A L SESSION.

be convinced, and will go back and try it, and I am proud to say that,
in almost ten years connection with two railroads, I have only been
on the witness stand three times, and two of those times were on
account of passengers— only one with employees. That sort of treat­
ment counts, as far as money is concerned, and money is the only
thing, as I say, that counts with the corporation. Until you can get
them interested in their men, you have got to hit them through their
pocketbooks first, and through their sentiments second.
The weighing of medical testimony as it comes before the indus­
trial board from the men who have examined a case and had it
under observation is sometimes a rather difficult thing. We haven’t
had exactly the experience o f the Wisconsin Commission, maybe
because Chicago abounds in men who will testify to anything, prob­
ably; we have had some bad medical situations in Chicago that we
have tried to get rid of. Nevertheless, we have had to deal with
men who would come in before the insurance companies or the em­
ployers and say that a man was able to go back to work, and just
as many men come in for the employee and say that he was disabled
for life— an absolute divergence of opinion. You can’t expect a
layman to weigh that medical testimony that involves a lot o f medical
terms, and sometimes a man’s own ignorance is clothed in many highsounding medical terms that mean nothing much to him and much
less to the layman. I f you can put that testimony before a man who
is impartial, he can eliminate the wheat from the chaff and give the
commission some sort of an idea o f what the facts are in the case.
We have tried, in Illinois, to put ourselves in a position so that the
employers and employees would have enough confidence in the
medical department and the industrial commission to eliminate all
expert testimony; to send their case to the commission and say,
“ You tell us how much this thing is worth in dollars and cents.”
Here is where the commission has the whip hand over the employer
and employee. Many cases are sent in to us where the treatment is
not complete. A man may have had an injury to his forearm; he
has a limitation of motion in the joint and the elbow and wrist.
Maybe he has had a splint clear down to the end of his fingers. That
all constitutes part o f the injury and a part o f the disability. I f the
• employer has employed a doctor who knows no better than to leave
a man in a splint from his shoulder to his fingers without taking it
off or giving any chance for the joint to move, then the employer
should be penalized for employing that sort of physician. They
have sent that case to the commission for settlement before the case
is complete. The commission has a right to send that case back.
W hy ? Treatment is not complete. The best result has not been ob­
tained and we make the employer continue paying compensation
until that treatment is complete. Now, in many cases, you will find




BETTER M ED ICAL T R E A T M E N T — M A J . P . B. M A G N U S O N .

145

that the employer will say, “ We don’t know what to do with this
case. Our doctors say that the treatment is complete,” and then we
say to them, “ Well, we advise you to get some doctors who know
more.” With constant repeating of that sort o f performance, the
employers and the insurance companies are gradually coming to the
conclusion that it is a bad practice to send a case in before the treat­
ment is complete and the best result attained, because they simply
make it cost themselves a lot more than it otherwise would.
Now, in the hopes o f getting some line on them, when I. went down
to the surgeon general’s office a year ago, we started to ask various
commissions and various employers what became o f their serious
accident and o f their permanent disability cases; how medical treat­
ment' was furnished and what wjere the results. We couldn’t get any
information otherwise, as the statistics in this country are worth very
little. We would like to be able to talk in dollars and cents to the
employer, and to show him the difference saved in compensation by
the supplying o f expert surgical treatment and poor surgical treat­
ment ; and, to that end, I have here a rough surgical report to be filled
in by the commission on every case, in order to trace our accident
cases down and find out what the dollars and cents saving is per case
in certain classes of injuries. The thing reads like this: Loca­
tion of injury—head, arm, etc.; nature of injury— fracture, sprain,
etc.; extent and degree o f disability, in per cent, functional and
occupational. Now, a man may have a functional disability o f
50 per cent; for instance, if he has had a fracture of the forearm
and he has 50 per cent o f motion in that forearm in this direction
(indicating), he has a 50-per cent functional disability, so to speak,
because he has half his rotation; but supposing he is working at a
job where he has to have his hand in this position (indicating), he
hasn’t that 50 per cent that he needs, so his occupational disability
is considerably more than 50 per cent. It makes a lot of difference
in a man’s earning capacity. “ What kind o f medical treatment was
administered—washing, salve, dressing, iodine, etc.—to give us an
idea o f what the man got immediately after he was hurt ? How soon
was this applied after the accident? How many days, weeks, or
months under treatment? By whom furnished— employer, insurer,
or employee ? ” Those questions are asked with the idea o f giving us
some information. For instance, we have an infection o f the hand.
We can average the infections of the hand; extent of disability;
what length of disability they were; what the percentage of dis­
ability was after the injury, and how long the treatment lasted.
a Qualifications o f doctor in attendance; age, school, number o f years
in practice; special training; interneship; assistant to surgeons, etc.”
I f we get that information we can say to a company, “ Last year
124247°— 19------ 10




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M ED ICAL SESSION.

cases treated by men who rate as class A - l men cost in compensation
$350 for certain classes o f injuries, on an average. Cases treated by
class B men cost $850 per case. The medical treatment paid for
class A men cost $75 more per case than the medical treatment paid
class B men. Therefore, you have a saving o f $400 or $500 per case.”
That is the only way, I believe, we are ever going to be able to talk
to these m en; and the only way we can get valuable statistics on the
value o f decent medical treatment is by every commission in this
country following up their cases in this way.
Now, at the bottom o f this slip we have a paragraph which takes
up the vocational phases o f permanent disability or permanent par­
tial disability; previous occupation of injured employee; number of
years employed at that occupation; previous vocation and training
o f employee; is patient able to return to his former occupation;
could patient be taught new trade if supplied with opportunity;
would employer find a new job for him or teach him a new one at
liis own plant; attitude of employee— would he take a new job if he
got it; would he undergo training for a new job?
That means that the States will have to do in the future what the
Army is planning to do for its crippled soldiers. Because a man
has lost two legs is no reason why he should be a pauper the
rest o f his life and dependent upon St'ate charity. The States of
this country have got to furnish for their crippled industrial in­
dividuals just what the Army is going to furnish the crippled soldier,
because it costs every State a large amount o f money every year to
keep and support the injured man who is out o f employment, not
because that man isn’t capable o f doing anything, but because that
man isn’t capable of learning a new trade without some incentive.
There is a bill before Congress now— House bill No. 12880—which
provides for the promotion o f vocational rehabilitation o f persons
disabled in industry and otherwise, and for their return to safe em­
ployment. That is a plan that contemplates that the Government will
pay dollar for dollar—for every dollar that the State invests in voca­
tional reeducation of industrial accidents the Government will put
a dollar to it for that purpose, and the vocational board in Wash­
ington will have charge o f that work.
We have a plan in Illinois to put the whole regime in a State
hospital. I haven’t time to explain that, because I have run over
my time now. It is an idealistic plan, maybe, but it has got to come,
because we have got to supply decent medical and surgical treat­
ment for the industrial cripple as well as for the Army cripple. I f
we don’t we are going to be swamped in this country with our mil­
lion accidents a year.




S U R G IC A L T R E A T M E N T T O P R E V E N T A N D M IN IM IZ E P E R M A N E N T
D IS A B IL IT IE S .
BY

F R A N C IS D. D O N O G H U E , M . D ., M E D IC A L A D V IS E R , IN D U S T R IA L A C C ID E N T BOARD OF
M ASSACH USETTS.

A study made by my friend, Carl Hookstadt, under the direction
o f the Department o f Labor (“ What Becomes of Men in Industry,”
M o n t h l y L a b o r R e v i e w , July, 1918), emphasizes the facts that
proper surgical treatment could prevent and minimize permanent
disabilities and that it is inseparably connected with adequate super­
vising authority and responsible direction of the injured man as
a man.
Our thanks should be due to the Hon. William B. Wilson, Secre­
tary o f Labor, who, through Dr. Royal Meeker, has made possible
this timely contribution to our knowledge of end results.
Compensation laws have now been in existence in this country for
six or seven years and a large mass of experience must teach us
many lessons if we have time to take stock. Six years of experience
in the administration of workmen’s compensation laws must be
thoroughly convincing to everyone who has had to do with them
that the best kind of medical treatment is the cheapest. This point
can not admit of argument.
Getting the treatment to the man or getting the man to the treat­
ment is a thing over which the industrial accident boards do not
have sufficient control.
In my own State the treatment is given under the direction o f 24
insurance companies, each handling the case in its own particular
way, the accident board acting only when bad results have occurred
or good results have not been obtained.
In general terms, the speed with which employees may be re­
turned to work in surgical cases will depend upon the men and the
system under which such cases are handled. Cases should not be
sent to institutions which lack the methods o f making proper diag­
noses or which lack the surgeons qualified to render the particular
treatment; and the accident boards should have the power to regu­
late the institutions to which these cases are sent.
The system which obtains in Massachusetts of sending cases to
the open ward o f hospitals endowed or maintained for charitable
purposes is not a good one, and the treatment of industrial cases in
hospital out-patient departments should not be permitted unless
special arrangements are made so that a properly qualified surgeon
shall actually carry out the treatment.
T o quote you cases to show how men suffer from inadequate medi­
cal and hospital services would be to repeat in more or less detail




147

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M ED ICAL SESSION.

all I have said since I became medical adviser of the Massachusetts
Industrial Accident Board.
As the cases that come to our board are those showing poor results,
our viewpoint is apt to be distorted because we do not see the thou­
sands of cases in which adequate service has been rendered, so that
the men have been properly restored economically.
Adequate surgical treatment to prevent and minimize permanent
disabilities is the same kind of treatment which will minimize the
loss resulting from the less serious forms o f injuries. The perma­
nent disabilities represented by the amputation of an arm or a leg
or by the loss of an eye are evident and occupy attention out o f
proportion to their relative value in industrial injuries.
Less intrusive upon the eye of a claim adjuster and making a less
insistent appeal to the administrators of the compensation acts are
injuries to the hand.
Rather than discuss in abstract terms, as I think I have before,
the whole surgical field, I am going to take up briefly one group o f
cases and endeavor to focus your attention upon them. These are
cases of injuries to the hand.
My interest has been stimulated by the successful work of Dr*
William E. Browne, o f Boston, who has in some cases acted as an
impartial examiner for the Industrial Accident Board.
Do we fully realize the value o f the full capacity o f the hand?
Injuries to the hand vary in severity from simple contractures to
hands which are clawlike in appearance. The two great causes which
result in these deformities are first, sepsis, and secondly, fractures.
A great many cases of sepsis occur as the result of too many sutures
placed too tightly in some small skin wound. These cases are found
most frequently in large relief stations, where, young, conscientious,
but over-enthusiastic internes strive assiduously for a fine-looking
wound. It may seem strange, but nevertheless it is a fact, that out o f
a very large series of crippled hands a large percentage of them was
attributable to faulty application o f sutures. Nearly all the skin
wounds with which one meets in industrial accidents may be attended
to by careful application of perforated adhesive plaster with a
sterile dressing and, most important, a splint. On the whole, these
cases do better with dry dressings, probably because the subcuticular
tissues are made better culture media as a result of long-continued
and frequent soaking in various solutions. It has been my expe­
rience that, when it is possible, it is best to apply water running from
a faucet, both hot and cold, and then to squeeze out the water from
the dressing and cover it with a Turkish towel.
A poorly set, a nonrecognized, or a slipped fracture o f a meta­
carpal bone will cause a greater period of disability than a poorly




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149

treated Colle’s fracture. The average length of disability from an
impacted fracture of the lower end of the radius is six to eight weeks.
W hy? Because the lower end of the radius is almost a fixed object,
and an ordinary flannel bandage will serve at times to give a man a
fairly good wrist. This is very well proven by the fact that many
men treated with liniment and a flannel bandage for supposed
sprain o f the wrist get back to work in six to eight weeks’ time,
although they really had Colle’s fracture. On the other hand, the
metacarpal bone is a long curved bone with about the same curve
in it that we find in the normal femur. On the flexor surface o f this
bone we find three tendons; on the dorsal surface, one tendon; t’o
these groups of tendons the lumbarical muscles are attached; and
lastly the interossei muscles are attached to the metacarpal bone, so
that in the palm of the hand there is a complex anatomical situation
with its basic principle the metacarpal bone. I f the metacarpal
bone is improperly set, or not set at all, it throws out of normal
wTorking order seven muscles, which in turn cause the other muscles
o f the hand to remain quiet, in order to avoid pain; and here, with
reference to fractures of the metacarpal bone, is the starting point
of many crippled hands which require serious and skilled operative
interference in order to prevent them becoming permanent disabili­
ties. In the fingers themselves, where compound fractures o f the
phalanges or simple fractures in poor position are found, interference
with the action of the flexor or extensor tendons may result, causing
a long-continued disability and, not infrequently, resulting in ampu­
tation. It has been my experience that removal through careful dis­
section of the smaller fragment of a fractured phalange (when in
poor nonworking condition) gives the man a working hand much
better than any other way. This removal of pieces of fractured
phalange must be done without any injury whatsoever to the synovial
sheath of the flexor tendon.
There are many rules which one might lay down with reference
to the treatment of fractures o f the small bones o f the hand. But
in the treatment of these fractures the one greatest thing to bear in
mind is that these bones serve as levers for the movement o f the
tendons, and that interference with the plane of the bone will cause
interference with the movement o f the tendons. The greater the
disturbance o f the bone the greater the disturbance in the tendon;
the greater the amount o f pain in the hand the longer the man’s
period o f disability.
With reference to the soft tissues as a whole in the forearm and
hand it is difficult to say a great deal or to say anything which will
mean very much to anybody. For example, if a man has pain in the
index finger o f his right hand can that pain be due to abnormal
position o f structures in the little finger o f the hand ? I f a man has




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M E D IC A L SESSION.

flexor and extensor tendons, which in themselves are all right, why
should he not have normal flexion and extension in the distal pha­
langes o f his fingers? This brings up the lumbarical muscles ques­
tion. A man with a thumb and an index and a little finger can do
almost as much with such a hand as a man with all fingers present.
When tendons have sloughed in the palm o f the hand they may be
very well replaced by facia lata and good results may be obtained,
but in order to get a good result it is necessary to make a quick and
careful dissection o f the parts into which the graft is to be placed:
and if' you place a graft in a finger in an anatomically correct posi­
tion, making allowances for the movements of the finger and for the
amount of contracture in the graft you put in, you will restore the
greater percentage o f crippled fingers.
Every man is not qualified to operate upon the hand. Surgeons
o f great experience in abdominal and chest operations or in the
treatment o f fractures are flat failures when it comes to doing plastic
operations upon the hand. These cases are so important that they
demand men who are fully qualified in the surgery o f the hand
itself. *
The treatment of the hand is not an orthopedic proposition in
the sense that orthopedic surgeons alone should be allowed to treat
it. It is a capital problem in major industrial surgery.
I would like to say one word here of the tendency o f the orthope­
dist, w ho is really a mechanician, to invade the surgical field by means
o f operations. Orthopedic surgery is still in a state o f transition, and
perhaps general surgery itself is in a period of transition, many gen­
eral surgeons coming to know that they are incapable o f carrying
out long-continued mechanical treatment; on the other hand, the
surgical training of the orthopedist is as a rule deficient and their
surgical sense is o f late development. They have not had experi­
ence in surgical clinics and have not been called upon to treat acute
surgical emergencies, the results of which have afterwards drifted
into their hands. It almost may be said that they lack general surgi­
cal diagnostic ability, although extremely keen to sense mechanical
conditions that a general surgeon constantly overlooks.
Orthopedic surgeons as a rule have drifted into surgery through
the chronic channel, and we should utilize them only in such cases
as they have proven their ability to handle properly. The orthope­
dist has taught the general surgeon much by his perseverance and
patience in the nonspectacular problems o f neglected surgical cases.
Orthopedic surgery during the war has developed wonderfully. Its
scope has been materially enlarged and from its vast experience great
good may be obtained for our industrial cripples.
Cases should be held under such control that all instructions o f
the surgeon can be made effective, and when the period o f active
treatment is over, i f the employee does not at once return to work*




SU RG ICAL T R E A T M E N T — FR A N C IS D. D O X O G H U E , M . D.

151

there should be a follow-up system to persuade the employee to
return.
Right here let me say that one of the greatest factors in prolonging
disability is in preparing the mind o f the injured workman for his
first plunge back into industry.
A fter a severe injury, if the man goes back to work for one day in
a week and is given his compensation for the full week without
deduction, and the second week he goes back for two days or three
days, finally, at the end o f the third or fourth week, he will have
reacquired confidence in his own capacity.
Serious injury undoubtedly shakes a man’s confidence in his ability
to do work until he again finds himself. The longer he is allowed to
drift the longer he remains unemployed, the longer he remains away
from treatment that will restore him, the further he falls in the
economic scale; and as he falls in the economic scale his sense o f
uncompensated injury may become a fixed idea, so that in addition
to the difficulty in remedying a mechanical condition we have to deal
with a mental condition no less trying.
The conception o f work which most men advised to return to work
have is based on previous experience, and they should not be made to
feel that they are being forced back to work before they are able to
work. To advise a non-English-speaking laborer, whose only occu­
pation has been the labor o f the pick and shovel, to take up light work
at reduced compensation is absurd. Something more is needed than
turning the employee loose with the advice that he should find some
light work. He has been working under the watchful eye o f the boss,
and his idea o f work is to keep up with his fellow workmen and pro­
duce all that' is required every day.
Under a proper system, working in conjunction with the physician,
hospital, or educational influence, persuasion may be necessary. It
may have to be applied not only to the employee but to the employer,
and to the immediate superior o f the employee, and, above all, to the
insurance adjuster i f he does not comprehend the problem and how it
should be managed.
Industrial accident boards should be keen to help in the replace­
ment work o f the wounded o f our great war. We should be alive to
the opportunity that is afforded to develop industrial surgeons
through the great opportunity o f concentrated work.
The improved methods developed for the treatment, cure, and re­
habilitation o f the crippled in the army of warfare should be made
available for the improved handling o f the injured or disabled in the
army o f industry.
Hand in hand with adequate medical and surgical diagnosis and
treatment must go a firm, direct, and controlling administrative
function.




SHOULD

MEDICAL

SERVICE BE LIMITED
CASES?

IN

COMPENSATION

BY FREDERIC M . WILLIAMS, COMMISSIONER, CONNECTICUT WORKMEN’ S COMPENSA­
TION COMMISSION.

My own opinion is that this question must be answered in the nega­
tive. The time has, happily, long since passed when the general
policy o f compensation legislation requires either apology or justifi­
cation. The ingenuity o f the bar has exhausted itself in efforts to
attack the constitutionality o f such legislation, either optional or
compulsory in character. The question can no longer be considered
an open one. The live questions for the consideration o f students
o f the subject are, however, now just as numerous, as intricate, and
as important as ever. W e must consider: 1st, what are the funda­
mental objects to be accomplished by such legislation? 2d, what is
the best method o f attaining the desired results? 3d, what is the
fair construction of the particular statute or part o f a statute under
consideration in a particular case? The last problem is our daily
routine.
The main benefit o f such a meeting as this is interchange o f ideas
as to the correct answers to the two preceding questions. From
several years o f study and practical experience my own conclusions
are: (a) The main object to be accomplished is the prevention of
industrial accidents. This can never be entirely brought about and,
therefore, in practice, our efforts are to make such accident's as few
as possible, (b) Given the victim of an industrial accident, the
most important factor o f the problem is the restoration o f such
victim to his proper niche in the industrial world with the least pos­
sible impairment o f earning power, (c) The actual payment o f
money for incapacity or loss of member, or function, while a vital
necessity, is really subordinate to the two fundamental objects.
Assuming these premises to be well founded it necessarily follows
that provisions o f these statutes commonly spoken of as statutory
aid, either medical or surgical, are o f prime importance.
Connecticut has, so far as I am aware, the most liberal mediealaid provisions o f any o f the States. The only other statute with
substantially the same features o f statutory aid without limit as to
time or amount is the Federal statute.
The ideas summarized above are in substance the same as expressed
by the writer in two recent cases, Olmsted v. Lamphier et al., on
152




L IM IT A T IO N OF M ED ICAL SERVICE---- F . M . W IL L IA M S .

153

appeal reserved for the advice of the supreme court of errors, and
Saddlemire v. American Bridge Co., appealed to the superior court.
In the Olmstead case the court has just handed down an opinion sus­
taining the commissioner and dismissing the appeal.. In the Saddle­
mire case the same result has followed; hence the ideas above ex­
pressed may be said, in substance, to represent the settled doctrine o f
Connecticut on this subject.
In the Olmsted case a principal point in issue was as to whether
the broad and general provisions o f section 7 o f our act, “ The em­
ployer as soon as he has knowledge of any such injury shall provide
a competent physician or surgeon to attend the injured employee, and
in addition shall furnish such medical and surgical* aid or hospital
service as such physician or surgeon shall deem reasonable or neces­
sary,” includes the price o f an artificial leg, made necessary by an
injury.
The court held that it did include such leg, saying among other
things that the term surgical aid “ is not limited to the personal
service o f the surgeon, but includes all the means and instrumentali­
ties used in surgery which will help effect a cure.”
Again the court says, “ Our act contemplates the furnishing o f all
the medical aud surgical aid that is reasonable and necessary. The
purpose o f this provision is to restore the injured employee to a
place in our industrial life as soon as possible by the use o f all
medical and surgical aid and hospital service which the ordinary
usages o f the modern science o f medicine and surgery furnish.
“ Humanity and economic necessity in this instance are in harmony
in working for the accomplishment of the individual and o f the
public welfare.”
When our act was first passed it had the ordinary provision for
statutory aid for a 30-day period, with the usual result—dissatis­
faction. An effort was made to increase the period, though probably
no one thought at first of more than a 60 or 90 day period. Most
injuries are relieved within a less time. WThen the legislature com­
mittee began to consider the proper period it at once saw what every
one who will view the problem with an open mind must see, that the
logical time to cut off medical or surgical treatment is when the
patient no longer needs it.
The result in our State is good. No effort has been made to make
any change.
It is probable that payments for statutory aid under our system
amount to a little more than the direct compensation payments, and
this is quite justifiable on the theory which, as above outlined, main­
tains in Connecticut.




SHOULD MEDICAL SERVICES BE LIMITED IN COMPENSATION
CASES?
BY RAPHAEL LEWY, M. D., CHIEF MEDICAL EXAMINER, NEW YORK STATE INDUSTRIAL
COMMISSION.

Medical service should not be limited in any respect in compensa­
tion cases, but should be continued until medical or surgical treat­
ment is no longer necessary. A limitation of time may be doing
a serious injustice to the claimant, as he may be unable to pay for
private medical services after the expiration of the legal time limit,
or he will look for the cheapest services, or he will have poor advice
in selecting medical treatment, and may perhaps not receive skillful
or diligent treatment. Also, there is no accurate or exact way of
estimating in advance how long the need for medical services may
continue. In a serious or protracted case, complications may occur
which will unexpectedly prolong the treatment necessary. Even
where the time limit is comparatively long, as 90 days or more, and
where, as in some States, provision is made for continuing medical
treatment, where notice is given, within a stated period in advance
o f the expiration o f the time limit, it is not always possible to deter­
mine whether further treatment will be necessary,
154




T H U R S D A Y

,

S E P T E M B E R

2 6 — A F T E R N O O N

S E S S IO N .

CHAIRM AN, €K J. FA Y , M. D., IOW A.

T H E C O M P E N S A T IO N O F D IS A B IL IT Y D U E T O P R E E X IS T IN G
D IS E A S E , A G G R A V A T E D O R A C C E L E R A T E D B Y A C C ID E N T O R
IN J U R Y .
BY MEYER LISSNER, MEMBER,. CALIFORNIA INDUSTRIAL ACCIDENT COMMISSION.

The doctor tells us that our subject may satisfactorily be discussed
only through familiarity with certain principles concerned with the
relationship o f disease to the body.
Primarily the new-born babe is sterile; that is, the skin covering
and the mucous lining o f the body are free from organisms of all
kinds, with perhaps the possible exception of inherited syphilis.
Within a few hours of the time o f birth this covering and lining o f
the body becomes the site of myriads of organisms, many of which
under favorable conditions may produce body infection. The battle
against the germ thus begins almost before the child has opened its
eyes, and,, in general, it may be said that an individual begins to die
at the moment of birth.
Many o f the organisms which, under favorable circumstances, met
with in the individual host, may produce disease, are found to
inhabit the mouth and air passages at practically all times. Ordi­
narily these organisms are held within certain limits by the normal
body functions. They gain admission to the body through diiferent
portals and then only when at the portals an opportunity for germ
activity is rendered possible through a local or general lowering o f
the body resistance. An excellent illustration o f this activity ap­
pears in the ordinary infection o f an incised finger. Nearly always
a finger heals following injury, by primary union, while occasionally
a severe infection results which may not only jeopardize but even
terminate the individual’s life.
The course o f a disease aggravated by trauma is dependent almost
altogether upon the ability o f the body to manufacture white blood
cells (scavengers). It is a fight between these scavengers and the
germs. In the event that blood cells are not sent to the site o f an
injury in sufficient numbers the germs gain the upper hand and pass
into the circulatory apparatus o f the body.
All this is quoted, not on a basis of personal knowledge, but be­
cause the doctor tells us these things and says it is necessary, in con­
sidering our subject, to bear them in mind in order to emphasize two




155

156

M ED ICAL SESSION.

conditions, namely: That infection is possible only when organisms
are present and body resistance is below par, the former condition
never being wanting, and the latter always possible.
These scientific facts would seem to indicate that the narrow ap­
plication o f the general rule that the employer takes the employee
subject to his physical condition at the time he enters the employment
has, in many instances, worked grave injustice to the employer, by
holding him liable for serious and in many cases total disability due
to slight aggravation o f preexisting disease. At first the California
Commission was inclined to apply the rule strictly against the em­
ployer, but latterly it has taken into consideration more fully the cir­
cumstance o f each case, and in cases o f chronic disease, when more
than a reasonable period has elapsed during which compensation has
been paid, where the injury was comparatively slight and the disease
the principal contributing factor to the disability, the commission
has ordered compensation payments discontinued.
In the amendment o f 1917, which became effective January 1,1918,
this practice of the commission was confirmed and written into the
law under the definition of the term “ injury,” as follow s:
Section 3 (4 ). The term “ injury ” as used in this act shall include any in ju ry
or disease arising out o f the employment. In case o f aggravation o f any dis­
ease existing prior to such injury, compensation shall be allowed only fo r such
proportion o f the disability due to the aggravation o f such prior disease as may
reasonably be attributed to the injury.

The section o f the act just quoted refers generally to the announced
subject o f this discussion— “ The compensation of disability due to
preexisting disease, aggravated or accelerated by accident or injury
but there is another aspect of this problem that must properly be
considered at the same time— the aggravation or exacerbation o f an
injury due to preexisting disease. A latent tuberculosis lighted up
and made active by a chest injury is an example o f the first class,
which comes strictly within the definition of our announced subject;
the case o f a lesion which is stubborn in healing, due to syphilitic
infection, is an example of an injury aggravated or exacerbated by
disease.
The more one has to do with the administration o f a compensation
act, the more one becomes impressed with the fact that while it is
easy to lay down a general rule, much latitude must be allowed,
and much discretion be exercised in the application of general rules
to particular cases; in other words, to a large extent, each case must
be decided on the basis o f its own particular facts, with the object
o f doing justice between employer and employee, keeping in mind
always the purposes and limitations o f compensation statutes; and
this observation applies with full force to the class o f cases we are
now discussing. Two men may die o f the same disease, in both cases




D ISA B IL ITY DUE TO PR E E XIST IN G DISEASE---- M . LIS SN E R .

157

death to some extent being superinduced by something done in the
course o f the employment, and yet in one case compensation be
allowed and in the other denied; for example, the California Com­
mission awarded a death benefit in the case o f a delivery man who
had a long standing aortic aneurysm, and who died o f a rupture of
the aneurysm caused by unusually heavy lifting and straining.
(Draper v. Anderson Lore & Co., 1 I. A. C. Dec. 132) • while in the
case o f a roofer who also died from the rupture of an aortic aneurysm,
but whose labors required no heavy exertion, the death benefit was
denied. (Anderson v. De Paoli, 4 I. A. C. Dec. 82.)
But while to a large extent each case must stand on its own bottom,
from repeated consideration of the same question there has de­
veloped a fairly definite threefold classification o f cases arising under
our general subject.
I. LATENT DISEASES LIGHTED UP BY INJURY.

In these cases ordinarily the whole disability is compensated, the
curable disease charged to the employment, and an award rendered
in case o f death.
Example : Latent tuberculosis lighted up by severe chest injury.
H . DISABILITY DITE MAINLY TO DISEASE BUT AGGRAVATED BY INJURY.

In these cases compensation is usually given only for the period
during which the aggravation of disease may reasonably be attributed
to the accident and then terminated.
Example: Chronic osteoarthritis aggravated by slight injury.
m . DISABILITY DUE TO INJURY AND PROLONGED BY PREEXISTING
DISEASE.

In these cases treatment of the disease as well as the injury is
ordered at the expense o f the employer; that is, the employer must
treat the disease in order to cure the injury. In exceptional cases
where the preexisting disease becomes the chief factor and prevents
the cure o f the injury, the compensation is sometimes terminated and
a permanent disability rating made.
Exam ple: Healing of fracture or wound delayed by syphilitic in­
fection.
The following discussion o f decisions o f the California Commis­
sion will illustrate the application of these principles:
SY P H IL IS.

The complication o f injuries through syphilitic infection has given
the California Commission a good deal o f concern.
At first the commission was disposed to deny compensation or
terminate liability whenever by Wassermann test, or otherwise, it




158

M E D IC A L SESSION.

was demonstrated that recovery was delayed through syphilitic in­
fection; and insurance carriers were not slow to take advantage of
this attitude on the part o f the commission, and to urge the termina­
tion o f disability payments in practically every case where a positive
Wassermann could be procured. Later on the commission, upon ad­
vice, came to regard it as a rather faulty view to hold syphilitic in­
fection responsible in most o f these cases. W e were informed on good
authority that the bone o f the syphilitic, the incised wound, and so
forth, usually heal without any evidence o f a luetic background; in
other words, syphilis is ordinarily not invited by a local site by
reason o f trauma.
It was several years after it began considering cases complicated
by syphilitic infection before the California Commission really found
its own mind upon the subject. In May, 1917, the case o f Peterson v.
Bristol Bay Packing Co., 4 I. A. C. Dec. 122, was decided. The
applicant was injured July, 1916, by an oven door falling on his
knee. The defendants, after giving treatment for several months,
petitioned for termination o f disability indemnity on the ground
that the synovitis was complicated by preexisting syphilis* pro­
longing the normal period o f recovery. It appeared, however, that
the syphilitic condition could be cured by appropriate antisyphilitic
treatment. The commission denied the petition to terminate dis­
ability indemnity and ordered treatment for the syphilis.
In deciding this case the commission said:
These disorders are so prevalent that if compensation were denied
wherever an injury is complicated by so-called 66specific ” disease, a
great many worthy people would be without compensation to tide
them over their period o f adversity, and, in so far, the law would
fail o f its purpose to prevent poverty arising out o f injury. * * *
Compensation is not alone for those who are without spot or blemish
but for all who work, and there are thousands working who are af­
flicted with serious maladies which will complicate any injury they
may suffer. Nevertheless, in most instances, their disability is proximately caused by their injury and not by their disease which, without
injury to precipitate it, might scarcely have troubled them during
the rest o f their natural lives. The commission distinguishes, how­
ever, between ordinary disability, prolonged by complications with
specific diseases, and those more serious disabilities which are proximately caused, not by the injury, but by the specific disease, such as
tabes dorsalis or paresis, or spontaneous fracture. In such cases the
injuries which may have been suffered were only incidents contribut­
ing to, and not the proximate cause of, the disability or death, and
therefore in such cases compensation will be allowed only in so far
as the injuries did themselves, apart from the specific diseases, cause
disability.
About the same time the commission outlined its policy in relation
to syphilis in the following circular:




D ISA B IL ITY DUE TO P R E E XIST IN G DISEASE-----M . L ISSN E R .

159

T h e P o l ic y of t h e I n d u s t r ia l A ccid en t C o m m is s io n i n R ela t io n to S y p h i l i s .

The policy here outlined is intended to serve as a guide and can not be con­
sidered as binding in all cases o f syphilitic infection.
A fter some years o f experience, the reading o f much m edical testimony, and
consultation w ith m edical authorities, the com m ission has reached the follow ­
ing conclusions in relation to syphilitic com plications w ith other injuries.
1. In cases o f ordinary fractures, contusions and bruises the existence o f a
syphilitic infection does not, commonly, com plicate the issue at all seriously and
does not result in any substantial prolongation o f disability. In such cases the
com plication o f syphilitic infection w ill be ignored.
2. But in cases where the syphilitic infection results in tabes dorsalis or
paresis it w ill be the policy o f the commission to lim it the liability to such
tem porary, or other, disability, as w ould probably have resulted from the injury
i f there had been no syphilitic infection, and fo r the reason that the diseases
above mentioned are constitutional and never the result o f injury, but always
consequent upon syphilitic infection.
It is the purpose o f this commission to hold the industry responsible for so
m uch o f disability as such industry can reasonably be held responsible for, but
there is no industry that should be held responsible for tabes dorsalis, paresis
or spontaneous fractu re o f the bone.
D

e c is io n s

.

SPO N TA NE O U S FRACTURE.

An interesting case, decided in March, 1915, was that o f a plasterer
who, while ascending a ladder to a scaffolding, accidentally struck the
shin o f his right leg against a brace, fracturing the tibia, for which
he received treatment. About 90 days thereafter, while on crutches,
stepping down some marble steps, he came down rather heavily upon
the other leg and fractured the tibia o f that one. On careful ex­
amination it was discovered that he was suffering from syphilis in its
tertiary stage. The commission held that it was a case o f spantaneous fracture for which industry could in no wise be responsible, and
ocmpensation was denied. (Spangler v. Philbin, 2 I. A. C. Dec. 170.)
A T R O P H Y OF O P T IC N E R V E .

In the most recent case before the commission involving syphilitic
infection, the applicant received a blow in the eye in the course o f
his employment sufficient to cause some swelling of the lids and red­
ness o f the conjunctiva and to cut very slightly the cornea. He suf­
fered great pain, was in bed 10 days and was found to have lost the
sight o f the eye. Expert medical examination showed that the
blindness was due to atrophy of the optic nerve caused by syphilitic
infection and tabes dorsalis. The commission held that such part of
the disability complained o f as was properly attributable to the in­
jury could not have lasted longer than one month, and that the re­
mainder must be charged to the disease for which the industry was
not responsible. (E --------- v. Weed, No. 5461, Aug. 21, 1918.)




160

M ED ICAL SESSION.
GONORRHEA.

The question usually arising under the compensation act is whether
a particular case of inflammation o f the eye, or o f an infected joint,
etc., is primarily caused by an injury, or results from gonorrheal in­
fection unaccompanied by trauma.
D

e c is io n s .

C O M P E N S A T IO N A W A R D E D .

A boy was thrown from a bicycle and struck heavily upon his hip.
The injury was followed by inflammation and extensive destruction
o f the bone. It was claimed by the insurance company that the dis­
ease was the result o f gonorrheal infection which had been contracted
some years before and that the alleged trauma played no part in its
development. The commission found the proof o f the fall to be
sufficient and awarded compensation, attributing the disability proximately to the fall. (Laning v. U. S. Casualty Co., 3 I. A. C. Dec,
127.)
C O M P E N S A T IO N D E N IE D .

A gas fitter bruised his knee while crawling under a house while
at work and extensive inflammation set in, resulting in destruction
o f the knee joint. It was claimed that the inflammation was purely
gonorrheal and the commission sustained this position. (Walker v.
Fidelity & Casualty Co., 2 I. A. C. Dec. 738.)
Compensation was claimed for an inflammation o f the eyeball
alleged to be due to laceration. The condition was found to be gonor­
rheal and compensation was denied upon the ground that the in­
flammation was not sufficiently connected with any injury. (Marvin
v. New Amsterdam Casualty Co., 2 I. A. C. Dec. 966.)
O ST E O A R TH R ITIS.

Osteoarthritis following trauma has been a very troublesome prob­
lem. There have been many cases where men have been seriously
and, in some cases, permanently disabled or crippled through what
one would class as a minor injury and which would not ordinarily
seriously disable a man over a long period o f time. Medical testi­
mony has been to the effect that these people have suffered from
osteoarthritis in the spine or other joints for varying periods before
the time o f injury, and the injury, while not in itself producing the
arthritis, has caused the condition to become active and progressive
in character. The medical profession has stated that many o f these
people would finally have become crippled independently o f accident.
In the large majority of cases, however, a positive opinion as to the




D ISA B IL ITY DUE TO P R E E XIST IN G DISEASE---- M . USSN ER.*

161

length o f time this would have taken has been impossible o f forma­
tion. Trauma, it is said, may change the course of the disease but
no two cases o f trauma would produce the same results. For these
reasons and others akin to them, it is impracticable, and would be
most unjust, to compensate all cases alike, and it’ is manifestly neces­
sary to exercise judgment on the merits o f each case.
The medical director o f the Industrial Accident Commission has
suggested that cases presenting osteoarthritis and producing dis­
ability complicated by trauma shall be divided arbitrarily into three
classes.
I. Those in which no symptoms o f osteoarthritis are developed in
the history o f the injured prior to the injury, and which do not show
characteristic lesions commonly known to cause osteoarthritis, such as
bad teeth, bad tonsils, chronic abscesses, urethritis, etc.
II. Those in which moderate symptoms o f osteoarthritis but no
crippling had been present before the injury or in which there are
conditions present which are known frequently to be the cause of
osteoarthritis.
III. Those who were suffering prior to the injury from deformity
and disability due to osteoarthritis in an advanced form.
For purposes of compensation the medical director recommends the
adoption o f the following scale:
( a )
That cases in class I may be considered as having 25 per cent
o f disability chargeable to osteoarthritis.
( h )
Cases in class I I may be considered as having 50 per cent o f
disability chargeable to osteoarthritis.
( c )
Cases in class I I I may be considered as having 75 per cent
of disability chargeable to osteoarthritis.
According to this scale, 25, 50, and 75 per cent o f the compensation
would be deducted, depending upon the degree o f the previously
existing osteoarthritis.
While the recommendation o f our medical director has not been
formally adopted by the commission, nevertheless in compensating
cases complicated by osteoarthritis it has been the policy o f the
commission to take into consideration the preexisting condition, and
to terminate liability at what seems in each case the point where it
would be unreasonable to charge the condition then existing to the
employment. In some cases this might be within a comparatively
short time after the accident, while in others compensation might be
allowed for a period o f as long as a year or m ore; and in some cases
a permanent disability rating might be made charging against the
employer such portion of the disability as would seem to be proper
under all o f the circumstances.
124247°-—10-------11




162

M E D IC A L SESSIG K.
D

e c is io n s

L A T E N T O S T E O A R T H R IT IS P R E C IP IT A T E D

.
BY

I N J U R Y ---- C O M P E N S A T I O N

D E N I M ).

A carpenter fell and strained his sacroiliac and lumbrosacral joint,
and he thereafter suffered a disability due in part to traumatic
neurosis, and in part to osteoarthritis, the cause o f which was latent
in his system before the injury and which might have developed at
any time but was actually precipitated by the injury. The commission
held that the osteoarthritis was not proximately caused by the em­
ploym ent or the injury, and that the applicant was entitled to com­
pensation based upon the disability due to the traumatic neurosis
only. (P orter v. Morse, 4 L A . C. Dec. 199.)
In the follow in g cases o f arthritis, limited awards o f compensation
were m ade:
E X A C E R B A T IO N T H R O U G H I N F E C T I O N .

A n employee, with chronic arthritis o f the finger joints and
Dupuytren’s contraction o f the palm, suffered a slight injury to one
o f his fingers, which became infected. The infection and injury were
treated fo r several weeks and he was restored to his condition prior to
the injury. This was held to be the lim it o f the em ployer’s liability.
(Landrath ^..Mountain Copper Co., 4 I. A . C. Dec. 112.)
E X A C E R B A T IO N

THROUGH

S P R A IN .

A piano tuner, while holding a piano on edge, sustained a sprain
to his back, hip, and left leg. Notwithstanding pain he continued
w orking fo r two weeks, after which he was disabled by reason o f a
condition which was diagnosed as osteoarthritis. A t the end o f six
weeks, this disability had disappeared and he returned to work.
The commission found, in effect, that, although the applicant was
disabled by exacerbation o f a previously existing condition o f osteo­
arthritis, nevertheless, the disability was precipitated by the injury.
I t was therefore held that the applicant’s disability was proxim ately
caused by the injury and he was accordingly awarded compensation
fo r the period o f the disability. (Thom as v. Eilers, £ I. A . C.
Dec. 212.)
L IG H T IN G

UP

O F C H R O N IC

C O N D IT IO N .

A pplicant sustained a strain to the back from the slipping o f a
wrench which he was using underneath a cart. There immediately
follow ed a disabling condition o f oesteoarthritis o f the spine. The
commission found that since no symptoms o f the disease had shown
themselves previous to the accident, although a chronic arthritis had




D ISA B IL ITY DUE TO P R E E X IST IN G DISEASE— M . L IS SN E R .

163

probably already begun, and the disability was precipitated by the
accident, the accident was the proxim ate cause o f the disability. A
continuing award in favor o f the applicant was made. However,
when the applicant had received compensation fo r the better part o f
three years, the commission found that any disability sustained by
him after that time was not proxim ately caused by the injury, and
an order was made terminating indemnity payments. (Turner v.
Santa Cruz, 2 I. A . C. Dec. 917.)
C H R O N IC

C O N D IT IO N , B U T

NO

P R E V IO U S

D I S A B I L I T Y ---- C O M P E N S A T I O N

IN

FULL.

A painter injured his foot through the giving way o f a staging on
which he was working. The blow caused no fracture, but a disability
ensued which was diagnosed as osteoarthritis. The evidence showed
that the applicant, who was 63 years old, had had chronic osteoarth­
ritis and arteriosclerosis fo r a considerable time before the injury,
which, however, were causing him no disability prior thereto. The
medical testimony showed that the injury set up an inflammation
which lighted up the quiescent arthritic condition. The commission
held that the whole disability suffered by the applicant was proxi­
mately caused by the injury and was compensable. (W illiam son v.
Shell Co., 4 I. A . C. Dec. 222.)
H E A R T D ISE A SE .

Many cases are found in which an employee with a previously
diseased heart receives an injury, follow ed shortly by death from
heart trouble. In those cases it is usually held that where the death
occurs within a reasonably short period o f time from the injury, so
that it may be said that the shock o f the injury caused the final
overloading o f the heart which brought about its collapse, compen­
sation should be allowed. Where, however, the lapse o f time be­
tween the injury and death is such that the patient has had oppor­
tunity to overcome the immediate shock o f the injury, and death
from subsequent heart disease occurred about as it would have oc­
curred before long had there been no injury, compensation should
be denied.
Difficult questions o f fact frequently arise as to whether the heart
was in abnormal condition before the injury and whether the break­
ing down o f the heart was effected by the alleged injury.
D

e c is io n s

C O M P E N S A T IO N

.

AW ARDED.

Applicant suffered a severe and sudden strain when the entire
weight o f a 300-pound crate o f blackboards was thrown upon him
while it was being unloaded from a wagon. He immediately quit




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M ED ICAL SESSION.

work, and was found to have acute dilatation o f the heart. Medical
opinion differed as to whether or not applicant had any heart
trouble before the accident, but it was definitely established that
before the accident he was able to work, play ball, etc., and was to
all intents and purposes a well man, and that, i f he did have any
prior heart weakness, the accident was by far the m ajor factor in
causing the disability. F ull compensation was therefore granted
fo r the disability. (W elch v. W eber, 2 I. A . C. Dec. 681.)
A n application fo r disability indemnity was first brought by the
injured man and an application fo r a death benefit was subse­
quently brought by the widow. Bolster, while picking cherries, fell
si distance o f 15 feet, fracturing two ribs. Previous to the accident
he had shown some symptoms o f heart weakness, such as slight
shortness o f breath, but his work had not been interfered with.
Since the accident his heart trouble had been severe and he had
been unabl^ to work. The commission decided that the fall had in­
creased the trouble, that one-third o f the trouble should be attributed
to the original condition and two-thirds to the fall, and he was
given a rating fo r a permanent partial disability based on this con­
clusion. A few months thereafter the man died from the heart
trouble, and his widow was allowed a death benefit. (Bolster v.
California Mountain Fruit Co., No. 4923 [not reported].)
C O M P E N S A T IO N D E N IE D .

A 69-year-ola tailor fell 10 feet downstairs, severely shaking him
up and hurting his right knee and spraining his left ankle. H e was
much perturbed, believing he had narrowly escaped death. H e ap­
parently recovered, but nine days after the injury suffered a severe
attack o f angina pectoris, and died o f chronic heart trouble four
weeks from the injury. It appeared from the post-mortem examina­
tion that* the heart was in such a condition that death might have
come at any time without the fall. The commission held that the
fa ll might have hastened the death, but that this was not enough to
ju stify charging the employment with an entire death benefit.
(W aldm an v. Hermann, 1 I. A . C. Dec., Part I I , 82.)
A man 74 years old, w orking on the pavement in a street, had his
shovel knocked out o f his hand by an automobile, the handle strik­
ing him in the side and knocking the breath out o f him, causing him
to sit down to regain his composure before returning to work. H e
worked ten days, when he became ill, and continued so for about six
weeks, when he died. The autopsy showed that he died o f adherent
pericarditis, and that he had chronic m yocarditis; and the evidence
was that he died prim arily o f inanition o f a decline o f physical
powers rendering his system unable to resist the long existing heart




D ISA B IL ITY DUE TO P R E E XIST IN G DISEASE— M . LIS SN E R .

165

troubles; and that i f the accident had any relation at all to the death,
it was at most a trivial and inconsequential one, and could not be
looked upon as the proximate cause o f death. (Farrish v. Nugent,
1 I. A. C. Dec., Part II, 98.)
A stevedore, who had previously appeared to be strong and well,
was struck in the side by a case o f leather while steadying the freight
goin g down into the hold o f a vessel, and was knocked onto an auto­
mobile near by. H e worked on fo r about three weeks, then because o f
a bad cold and general weakness went to a physician who found him
in a bad state o f health with faulty heart action and a fatty tumor.
H e reached the conclusion that these were caused by the injury
sustained and applied fo r compensation, but the commission held
that the slight injury had no causal connection with his trouble,
which had been developing and had been brought to his attention by
the injury sustained. (Lynn v. Pacific Coast S. S. Co. 1 I. A . C.
Dec. 635.)
A car repairer on entering defendant’s employ was found to have
a slight cardiac enlargement'. W hile in their employ he was struck
in the abdomen by a timber, which incapacitated him fo r a few
hours only. Later while at work under a car he suffered a severe
pain in the abdomen, presumably from a wrench sustained while
using a hammer, and about a month afterwards went to a hospital,
where the pain and other abdominal symptoms disappeared; but he
experienced general debility and shortness o f breath, became anemic,
showed symptoms o f chronic heart lesion, and some months later
died. A n autopsy showed a serious dilation o f the heart, vegetations
on the valves, adhesions and an enlargement o f the lymphatic glands.
There was no evidence o f any trauma. The testimony showed that
the dilatation which caused the death was predisposed by some sys­
temic disease and that all o f his symptoms could be explained by
such disease. (Newell v. Pacific Electric Railw ay Co., 3 I. A . C.
Dec. 442.)
A pplicant while opening a bundle o f laundry smelled an offensive
gas, became dizzy and faint, and was unable to continue work.
Three days afterwards she had an irregular heart, and during the
follow in g month had heart murmur and rapid pulse, the symptoms
being those o f a heart that had been failing fo r some tim e; finally
there was manifested a m ild acute heart' failure. H eld, that the con­
dition was merely a step in the advancement o f a preexisting disease
o f the heart, possibly precipitated by the exertions in m oving the
bundles o f laundry.
(Bennett v. San Bernardino Laundry Co.,
3 I. A. C. Dec. 229.)
S.
C. B ollinger, by the overturning o f an automobile, received a
Colie’s fracture and bruises about the chest. H e rode fo r several
hours thereafter and that evening an examination o f his heart showed




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MEDICAL, SESSION.

that compensation o f the heart was good. N o trouble with the heart
appeared until the fourth day, when he suffered an attack o f de­
compensation. H e received treatment at a hospital fo r the heart
condition, which steadily improved. On the tenth day after the in­
jury he suddenly died. F or some time previous to the accident the
deceased had been suffering from endocarditis, and had had several
attacks o f broken compensation. The autopsy showed that the cause
o f death was this same heart condition, which is frequently the cause
o f sudden death, and that death wrould inevitably have occurred
suddenly and m ight have occurred at any time on slight exertion or
without any injury. In view o f the seriousness o f the preexisting
condition and the relative slightness o f the injury, a death benefit
was denied. (B ollinger v. Pacific Chemical Co., 5 I. A. C. Dec. 14.)
A R T ER IO SC L ER O SIS

(IN C L U D IN G

CEREBRO

H E M O R R H A G E ).

Arteriosclerosis as a disease, commonly known as hardening o f
the arteries, is produced either by chronic ailments o f various sorts
or occurs naturally in later life. A s far as known, it is never d i­
rectly produced by trauma, but may be aggravated by it. Such
aggravation consists either in the increase o f the symptoms due to
the disease, caused by weakening o f the body through serious injury,
or from a rupture o f a hardened artery, particularly in the head,
causing cerebro hemorrhage or apoplexy.
D

e c is io n s

C O M P E N S A T IO N

.

AW ARDED.

A n employee sustained a fall with a severe sprain o f the ankle
and recovery was thereafter prolonged by reason o f a condition o f
general arterial disease. The commission awarded compensation
fo r full duration o f disability due to the injured ankle without dimi­
nution by reason* o f its prolongation by the disease. (D abila v.
Aetna L ife Insurance Co., 1 I. A. C. Dec. 239.)
A n employee, 63 years o f age, employed in an undertaking parlor
aided in liftin g a 500-pound steel casket and immediately became in­
disposed. A fte r a few days he was taken seriously ill with paralysis
o f one side, which the attending physician attributed to a rupture
o f the blood vessel in the brain caused immediately by the heavy lift­
ing, but ultimately by a condition o f arteriosclerosis. Compensation
was awarded upon the ground that the liftin g was the proximate
cause. (Jones v. R oyal Idem nity Co., 1 I. A . C. Dec. 252.)




D ISA B IL ITY DUE TO P R E E X IST IN G DISEASE-----M . LISSN E R .

167

A night watchman, 67 years o f age, suffering from pyuria and a
marked degree o f arteriosclerosis, was assaulted by highwaymen and
sustained various head injuries which thereafter w holly disabled him
from labor, practically rendering him insane. The commission found
that the disability was proxim ately brought about by the injury and
awarded compensation. (F rohn v. State Compensation Insurance
Fund et al., 3 I. A . C. Dec. 274.)
C O M P E N S A T IO N D E N IE D .

A n employee suffering from a marked degree o f arteriosclerosis
sustained a slight laceration on his shin, which later became gan­
grened and necessitated amputation o f the leg. The medical testi­
mony showed that where gangrene arises from an infected wound,
it develops in the immediate vicinity o f the wound, but where the
gangrene develops from arteriosclerosis generally, it invariably com ­
mences in the toes. As the wound in this case was not infected and
the gangrene started in the toes, it was held that the amputation was
necessitated solely by natural causes and no compensation was allowed
for it. (B row n v. State Compensation Insurance Fund, 3 I. A . C.
Dec. 190.)
A pplicant was rem oving some packages o f stationery, which
weighed about 48 pounds each, from a low truck which was stand­
ing about tw o feet from the ground, when he became dizzy, after­
wards complained o f pain in his head, and feeling sick was taken
home and died soon after. T he autopsy surgeon testified that the
man died o f cerebral hemorrhage from rupture o f the m iddle me­
ningeal artery, right side, due to general arteriosclerosis. Aw ard
denied. (Mathewson v. United Railroads, No. 5442 [not reported].)
V A R IC O SE V E IN S A N D ULCERS.

Many workmen suffer from varicose veins, which condition is prac­
tically always due to natural causes and*not to trauma, and which
affects their earning power and exposes them unduly to various
sequelae, such as varicose ulcers, etc. The question has never been
presented to the commission o f whether varicose veins can be caused
by injury. The question usually arises as to whether the employer
should be freed from liability fo r disability follow ing a trauma,
where disability is in part due to trauma and in part due to the
prior varicose condition. Here our commission has follow ed the
policy o f allowing compensation wherever the disability is to a con­
siderable extent attributable to trauma, without regard to the pre­
disposing factor. W here, however, the normal skin has been changed
by prior varicose ulcers to a very friable tissue which is likely to
break out in ulcers on sustaining the slightest blow or scratch, or




168

M ED ICAL SESSION;

even without any trauma at all, the commission has found the contri­
bution o f the later trauma to be so small in proportion to that o f the
predisposing condition as to warrant a complete denial o f com­
pensation.
D
V A R IC O S E

e c is io n s

.

U L C E R S ---- C O M P E N S A T IO N

ALLOW ED.

A n employee was hired to work as a laborer, and claimed that
certain ulcers from which he had recently been suffering were caused
by scratches and abrasions which were received by him while at
work. The evidence showed that he had received the abrasions
claimed, and that they had ulcerated, but further showed that he
was troubled with varicose veins and had other ulcers before in
other places. Compensation was awarded as it was not shown that
the ulcers in question developed on the site o f any prior ulcers.
(M cM ullen v. Standard Oil Co., 1 I. A . C. Dec. 169.)
A n employee bruised his leg and the bruised area subsequently
broke down into an ulcer, the duration o f which was greatly ex­
tended by a condition o f varicose veins. Compensation was allowed
fo r the full period o f disability as it was not shown that the varicose
condition attributed in any way to the original form ation o f the
ulcers. (H offm an v. M aryland Casualty Co., 2 I. A . C. Dec. 183.)
V A R IC O S E U L C E R S ---- C O M P E N S A T I O N

D EN IED .

The applicant sustained an injury to one leg causing a varicose
ulcer. Such ulcers had been repeated and virulent leaving only scar
tissue upon the shins o f the injured workman, so that the slightest
abrasion o f the skin, which in a normal person would have amounted
to nothing, resulted in protracted and stubborn ulcers. Compensa­
tion was denied, as the original injury, in the absence o f prior ulcers,
would not have lasted beyond the waiting period. (K een v. Western
Indemnity Co., 2 I. A . C. Dec. 524.)
V A R IC O C E L E .

A teamster was kicked by one o f his horses, receiving a glancing
blow in the groin. H e was able to return to work within three or
four weeks, but claimed an operation fo r the radical cure o f vari­
cocele. The commission found that while ordinarily this condition
comes from gradual development, and not by trauma, the circum ­
stances o f the injury led it to find in his favor, attributing the con­
dition to the accident. (M itchell v. McNab & Smith, 1 I. A. C. Dec.
116.)




DISABILITY DUE TO PREEXISTING DISEASE— M . LISSNER.

169

TUBER CULOSIS.

This commission has taken several occasions to emphasize the
truth that it was not the intent o f the legislature, when it substi­
tuted the term “ in ju r y 55 fo r that o f “ accident ” in amending the act,
to transform the law into a sickness insurance scheme. The act
affords compensation fo r injuries, but not fo r sickness unless proximately caused by injuries.
Compensation is wholly a charge against the employer and the
industry which the employer follows, whereas sickness insurance,
wherever it obtains, is borne only partially by the employer, and i f
this commission were to be a party to the transform ing o f a compen­
sation law into a sickness insurance law, great injustice would result
to employers and to the industries in which they are engaged.
The change from the w ord “ accident ” to u injury ” in the amended
law, brings within the purview o f such law certain diseases known
as occupational or industrial diseases, but tuberculosis has no recog­
nized status as an occupational disease. There are no known occu­
pations, unless it be certain form s o f m ining or nursing tuberculosis
patients, which to any great degree result in inflicting tuberculosis
upon those who follow such occupations. This is not saying that
tuberculosis may not in certain very exceptional cases be the product
o f an injury, although it would be extremely difficult, in most cases,
affirmatively to establish a proximal connection between an injury
and a resulting tubercular condition.
D

e c is io n s

.

In the follow in g cases o f tuberculosis, compensation was allowed:
A C C E L E R A T IO N T H R O U G H

CHEST IN J U R Y .

Disability from tuberculosis has been compensated by the commis­
sion where a chest injury (striking chest on wheel o f wagon) caused
traumatic pneumonia, which was follow ed by active tuberculosis
which the evidence showed was probably present before but might
never have troubled the employee in the absence o f the injury.
(Huffm an v. Escondido Eochdale Co., 3 I. A . C. Dec. 207.)
A severe chest blow and the inhalation o f acid fumes while recover­
ing from the injury, held to have lighted up a preexisting infection
and the whole disability compensable. (Cuthbertson v. Hercules
Powder Co., No. 5492, June 19, 1918 [not reported].)
A C C E L E R A T IO N

THROUGH

S T R A IN .

The commission found that strain occurred in holding back sacks
o f flour from falling as the employee was piling same, which set into
activity a pulmonary tuberculosis which theretofore had been in a




170

M E D IC A L SESSION",

condition o f quiescence and equilibrium. A pplicant reported off,
felt badly fo r four or five days, had a pulmonary hemorrhage, and
has been ill with lung trouble ever since. A continuing award was
made in favor o f applicant. (Botterell v. Splivado, No. 3887,
June 13, 1917.)
A C C E L E R A T IO N T H R O U G H A N E S T H E T I C .

The employee sustained a hernia fo r which he underwent an oper­
ation in September, 1917. F ollow in g the operation, however, he
developed pulmonary tuberculosis, which resulted in his death in
October, 1917. The evidence showed that the deceased had had a
latent tuberculosis, which was lighted up and became active as a
result o f the ether anesthetic given at the operation and the depres­
sion and confinement subsequent thereto. The commission held, on
expert testimony, that the tubercular pneumonia which caused death
was proxim ately due to the operation, and that therefore the death
was proxim ately caused by, and arose out of, the employment, and
was compensable.
(C ox v. California Southern R ailroad Co., 5
I. A . C. Dec. 10.)
T U B E R C U L O S IS I N

T E S T IC L E .

W here employee had had no active tuberculosis for three years
prior to injury and then a blow on the testicle centralizes the infec­
tion there compensation was allowed (Stone v. F. L. Smith Co., 3
I. A . C. Dec. 365), but denied under similar circumstances in Ben­
jamin v. Pacific, 3 I. A . C. Dec. 419.
In the follow in g cases compensation was denied:
H E M O R R H A G E F R O M S L IG H T E X E R T IO N .

A deliveryman sustained a hemorrhage from the lungs in crank­
ing an automobile, follow ed by fou r weeks’ disability. The commis­
sion held that cranking caused exertion no more severe than was
usual in such act and that the hemorrhage arose from a tuberculous
condition o f the lungs which was such as to render a hemorrhage
possible and likely upon a slight or no exertion; that therefore the
hemorrhage and the consequent disability did not arise out o f and
were not proxim ately caused by said employment. (Broem m er v.
P eople’s Baking Co., No. 4799, Jan. 10, 1918.)
A C C E L E R A T IO N F R O M E X P O S U R E .

W here an employee, suffering from a cold or grip, was exposed for
several days to dampness and receives a slight blow in the back, caus­
in g no disability at the time, and fou r days later suffered a hemor-




D ISA B IL ITY DUE T O 'P R E E X IS T IN G DISEASE-----M . L IS SN E R .

171

rliage o f the lungs and was found to be suffering from tuberculosis
o f considerable standing, it was held that the tuberculosis was not
proxim ately caused by the employment, and an award was denied.
(Coates v . Elsinore, 3 I. A . C. Dec. 269.)
T U B E R C U L O S IS O F S P I N E .

Compensation was denied where a conductor, in jum ping from a
train in the usual manner in the course o f his employment, precipi­
tates a tuberculous condition o f the spine resulting in disabling ab­
scesses. (Agezelow ^.,Mt. Tamalpais etc. Ry., 3 I. A . C. Dec. 169.)
ST R E E T S W E E P E R I N H A L I N G D U S T .

Compensation was denied a street sweeper who had been so engaged
fo r 10 years, and fo r 2 or 3 years had suffered from asthma,
when he was found to have been suffering from tuberculosis o f the
lungs. It appeared that street sweepers were no more subject to the
disease than any other members o f the public, and that while the
inhalation o f street dust m ight predispose one to the disease, the
inhalation o f large numbers o f the germs would not produce in fec­
tion. (Lopez v. City o f San D iego, 3 I. A . C. Dec. 497.)
H O S P IT A L O RDERLY.

A n emergency hospital orderly who came in contact with tubercu­
losis patients nearly every day was denied compensation fo r such
disease. (B loom v. City and County o f San Francisco, No. 5261,
Mar. 29, 1918 [not reported].)
P A R T IA L C O M P E N S A T IO N I N

C H R O N I C C ASE.

The applicant was injured by falling off a hand car, the wheels
striking him and rolling him over upon the rails and between the
ties, causing severe injury. T he medical evidence disclosed the fact
that applicant had long been a sufferer from a slow tubercular proc­
ess in the lung. The commission found that the disability, from
which applicant suffered as the result o f the accident, terminated
about three months thereafter, and that whatever disability existed
after that date was caused by a tubercular condition remotely and
not proxim ately referable to the injury and therefore not com ­
pensable. (M asich v. N. W . P. R. R%
. Co., 2 I. A . C. Dec. 539.)
PN EU M O N IA.

Responsibility fo r pneumonia presents many different topics. F or
obvious reasons, it is almost never claimed that a prior pneumonia
is accelerated by a subsequent trauma occurring in the course o f the




172

M E D IC A L SESSION.

employment. The questions most frequently presented are usually,
when pneumonia is said to have a traumatic origin, and when not.
D

e c is io n s

.

In the follow in g cases compensation has been awarded for dis­
ability or death produced by pneum onia:
A n employee was knocked from a w harf and inhaled salt water
into the lungs, causing pneumonia due partly to the irritation o f the
lungs and partly to alcoholism.
(Sm ith v. Pacific Surety Co.,
1 I. A . C. Dec. 197.)
Compensation was granted where pneumonia follow ed an opera­
tion fo r amputation o f the finger, being prim arily produced by the
effect o f the anesthetic and the surgical shock. (Favero v. City o f
Richm ond, 1 I. A . C. Dec. 225.)
H ypostatic pneumonia resulting from confinement in bed follow ­
in g a fracture. (M ajeau v. Em ployers’ Liability, 2 I. A . C. Dec. 443.)
Pleuropneumonia follow ed exposure to stormy weather while being
taken from the scene o f an accident to a hospital, the original injury
being to the hand. (D ecorm ier v. Western Indem nity Co., 2 I. A . C.
Dec. 756.)
Lobar pneumonia resulted in death 5 days after sustaining a back
injury, the employee showing hemorrhage o f the lungs a day after
the accident and before the pneumonia developed. (A iello v. F idelity
& Casualty Co., 3 I. A . C. Dec. 533.)
Lobar pneumonia developed the day after receipt o f a chest in­
ju ry and was held to have been caused by it. (Cledou v. Pacific
Casualty Co., 3 I. A . C. Dec. 233.)
In the follow in g cases compensation was denied upon the ground
that the alleged trauma was not the proximate cause o f the pneu­
monia :
Deceased died from lobar pneumonia about one month after his
injury (hernia) while confined to a hospital follow in g an operation
fo r the cure o f his hernia. (H olt v. Swayne & H oyt, 1 1. A . C. Dec.
655.)
Lobar pneumonia developed under such circumstances that it was
shown to have been in existence before the alleged trauma. (Dennis
v. Western Indem nity Co., 3 I. A . C. Dec. 463.)
A dredger man, whose w ork exposed him to frequent wetting, con­
tracted pneumonia, but no definite exposure was shown to be the
cause thereof. (D onnelly v . Ocean Accident & Guarantee Co., 3 I.
A . C. Dec. 393.)
A stevedore storing frozen meats in a refrigerator room on a ship
developed lobar pneumonia, no particular trauma being alleged.
(H oefer v. London Guarantee & A ccident Co., 3 I. A . C. Dec. 194.)




D ISA B IL ITY DUE TO PK E E X IST IN G DISEASE— M . LISSN EK .

173

IN T E S T IN A L D ISEASES.

In considering abdominal cases the commission has said: “ W e
think the industry chargeable with the consequences o f all accidents
grow ing out o f the industry, but it is not properly chargeable with
results that have Only a coincidental relation to such accidents, and
are not proxim ately caused by them.”
I t must be admitted that by com paring digests o f some o f these
decisions, the awards o f the commission will not always seem to be
consistent, but these cases well illustrate the suggestion heretofore
made that each o f them must be decided on the basis o f its own facts.
D

e c is io n s .

P E R IT O N IT IS F R O M R U P T U R E OF D U O D E N A L U L C E R .

W here an employee lifted, out o f its bed in the ground, a stone
weighing 250 pounds, and by reason o f the strain sustained a fatal
peritonitis due to perforations o f a chronic duodenal ulcer, although
ultimately the wall o f the duodenum m ight have given way entirely
as a result o f the ulcerous process, held, the injury and death were
proxim ately caused by the strain sustained in the employment.
(W hite v. County o f Los Angeles, 3 I. A . C. Dec. 83.)
A teamster was kicked at but not hit by a mule. He had been
out o f condition for a few days and had complained o f stomach
trouble and indigestion, but directly after the incident with the
mule he was seized with severe pain and forced to quit work, and
two days later the symptoms becoming alarming he was taken to a
hospital, operated on and found to be suffering from peritonitis
caused by perforations o f a duodenal ulcer. I t was claimed that the
perforation was caused by the strain o f avoiding the kick o f the
mule. The commission held that the strain complained o f was a
mere incident and not the cause o f the perforation, which w^ould un­
questionably have taken place in the immediate future had there
been no unusual strain at all experienced. Compensation was denied.
(A llen v. Southwestern Surety Insurance Co., 1 I. A . C. Dec. 67.)
A n employee, through a strain, sustained a slight perforation o f a
preexisting duodenal ulcer. H e was given hospital treatment and
warned that i f he left the hospital his condition would probably
prove fatal, but that i f he would continue treatment he would prob­
ably recover. H e nevertheless returned to his home and thereafter
suffered another perforation which caused peritonitis, from which
he died. The commission held that the refusal to continue medical
treatment' was unreasonable within the meaning o f section 16 ( e) o f
the act and proxim ately caused his death, and the defendants were
discharged from liability. (Stanway v. San Joaquin, 4 I. A . C. Dec«
373.)




174

M E D IC A L SESSION.
R U P T U R E O F P A N C R E A T IC

CYST.

A laborer fell from a bean cutter and ruptured a pancreatic cyst
which he had had fo r some time, but which medical testimony showed
might at some indefinite time have ruptured or might have been ab­
sorbed and never ruptured. I t was held that, under the rule that the
employer took the employee subject to the condition in which he
found him, the whole disability was proxim ately caused by and arose
out o f the employment. (Rategan v. Bates, 4 I. A . C. Dec. 78.)
S E P T IC E M IA F R O M G A L L S T O N E S .

A carpenter fell about fou r feet upon some sand and was so jarred
as to loosen some inflammatory products o f a prior attack o f gall
stones. H e died o f general septicemia and the commission held that
the evidence was insufficient to establish that the fall was the proxi­
mate cause o f the death. (L in d v. Anderson, 4 I. A . C. Dec. 103.)
G A S T R O IN T E S T IN A L T R O U B L E .

A laborer 56 years o f age who had fo r several years done the same
kind o f work as that which he was doing at the time o f his injury
sustained a strain which caused no disability at the time, and he con­
tinued w orking fo r five days and then sustained another similar
strain which was follow ed by a disabling gastrointestinal trouble
due to a preexisting abdominal weakness o f considerable standing,
which would have produced such ailment at any time on the suffer­
ing o f such strains. I t was held that only such disability as was
reasonably attributable to the injury was compensable; that such dis­
ability could not reasonably be said to extend beyond six months from
injury, and an award was made accordingly. (K ibler v. State Com­
pensation Ins. Fund, 4 I. A . C. Dec. 361.)
C O L IT IS .

Infection in the hand, resulting in the serious illness o f a street
sweeper and lowering his power to resist the lighting up o f a dormant
colitis, was held to be the proximate cause o f death from the latter.
A w ard fo r full death benefit was made. (Mtirais v. City o f San Jose,
3 I. A . C. Dec. 141.)
H E R N IA .

One o f my earliest impressions, as an industrial accident commis­
sioner, was that o f surprise at the number o f cases involving hernia
that came up fo r consideration. A t that time, about three years ago,
the policy o f the commission in hernia cases was quite strict. A n ap­
plicant had to make out a pretty clear case o f no previous trouble or
disability before receiving an award. There was a disposition in some




D ISA B IL ITY DUE TO PB& EXISTIN G DISEASE---- M . LIS SN E R .

175

cases, known as “ border-line cases,” when physicians testified to
operative findings indicating a preexisting chronic condition, to hold
the employer^ fo r the cost o f the operation, but refuse compensation
during the treatment and recovery. In a recent case the commission
decided that when an employer assumed the responsibility o f the
operation, he had to see the employee through the period o f treat­
ment and recovery and pay compensation in full until the employee
was able to return to w o r k ; and in my opinion this is as it should be.
I feel that we are justified in requiring the employer to “ fish or cut
bait.” H e may submit the case to the commission i f he wishes to
deny liability, but i f he voluntarily opens a man up he should p rop ­
erly see him through the period o f convalescence.
T

he

P

o l ic y

or

the

I

n d u s t r ia l
to

A

H

c c id e n t

C o m m is s io n

in

R e l a t io n

e r n ia .

The policy outlined is intended to serve as a guide and can not be
considered as binding in all hernia cases.
1. The issue o f predisposition to hernia is regarded as unimportant.
2. A ny hernia, whether complete or incomplete, resulting from
strain or wrench or other industrial injury, is compensable.
3. A chronic hernia, i f injured or aggravated by injury, is not
ordinarily compensable.
4. A n incomplete hernia, that is merely incipient, subsequently
completed through an independent injury, w ill ordinarily be com ­
pensable.
5. In hernia cases it is not necessary that the evidence must show
an immediate collapse or disability on the part o f the injured person.
There should, however, be p ro o f o f pain or discom fort accompanying
the alleged injury sufficient, at least, to cause pause and complaint,
with corroboration, i f possible.
6. A moderate permanent disability indemnity will be allowed fo r
hernia in those cases where operation fo r the radical cure o f the same
is fo r any reason not advisable and the commission w ill be disposed
to approve any reasonable compromise and settlement between the
parties in such cases.
7. In all cases o f hernia in which the commission shall find the
injury remediable by operation the applicant w ill be awarded such
operation as a part o f the medical, surgical, and hospital treatment
to which he is entitled to cure and relieve him from the effects o f
the injury. The expense thereof must be paid by his employer or
insurance carrier. I f the operation is not offered to the applicant
he may secure it, charging the reasonable expense thereof to the em­
ployer or insurance carrier. In all such cases the applicant w ill be
denied further compensation i f he refuses either to accept or secure
operative relief.




176

M E D IC A L SESSION.
N E P H R IT IS (B R IG H T ’S D IS E A S E ).

In a few cases compensation has been claimed directly fo r an ex­
acerbation by trauma o f preexisting nephritis. Such cases coming
before the commission are:
A n employee suffering from a m ild chronic B right’s disease over­
heated himself when fighting a fire upon the em ployer’s premises
and the disease returned with increased severity. It was held that
the resulting disability was mainly due to the preexisting disease and
not to the injury, and compensation was denied. (Stenburg v.
O liver Salt Co., 3 I. A . C. Dec. 295.)
It was claimed that a laborer in a chemical works sustained an
exacerbation due to constant inhaling o f sulphuric acid fumes. The
commission found that the asthmatic touch was due to this cause
but nephritis was not exacerbated thereby. (Costain v. Frankfort
General Ins. Co., I. A . C. Dec. 334.)
The question most frequently arises as to whether nephritis may

be proximately caused by an injury.
An employee suffered a fall from a trestle and was exposed to
severe climatic conditions of cold and wet while lying injured before
being gotten into a house. He died 10 days later from acute ne­
phritis which under the circumstances the commission found was
caused by the injury. (Gale v. U. S. Fidelity & Casualty Co.* 3
I. A. C. Dec. 363.)
Compensation was denied where acute B right’s disease developed
5 days after the fall, upon the ground that there was no evidence o f
physical injury to the kidneys at the time o f the fall, and that acute
B righ t’s disease is probably never traumatic in origin. (H usvick v.
Simms & Chandler, 1 I. A . C. Dec. 266.)
A death benefit was awarded where an employee received a blister
upon his heel while at work and the blister became infected, causing
death. The medical testimony showed that the infection resulted
in poisoning the blood stream, culminating in the breaking down o f
the kidneys. (Sheadon v. R ed R iver Lumber Co., 1 I. A . C. Dec.
640.)
LUMBAGO,

In general it may be said that lumbago is a condition occurring
from natural causes and not caused by injury. The difficulty usually
arises in determining whether a particular employee suffering from
a painful back is suffering from lumbago, coming on naturally, or
from various traumatic conditions, which might be either sacroiliac
slip, bruised muscles, strained ligaments, or osteoarthritis condition
o f the lower spine.
A n employee claimed that he strained his back while at work. It
was held that the pain in the back was due to lumbago and not to a




D ISA B IL ITY DUE TO P R E E X IST IN G DISEASE-----M . L IS S N E R .

177

wrench received while at work and compensation was denied.
son v. Pacific Casualty Co., 1 I. A . C. Dec. 178.)

(G ib­

D IA B E T E S .

No cases have been found in which it is claimed that an old dia­
betes was accelerated by a later injury. The question usually pre­
sented is whether diabetes can be produced by trauma.
D

e c is io n s

.

A boiler maker was struck in the abdomen by a piece o f iron, in­
capacitating him fo r only a few minutes, and about three weeks later
was found suffering from tonsilitis and shortly afterwards from dia­
betes. It was held that the evidence was insufficient to show that the
diabetes was produced by injury. (W illiam s v. State Compensation
Insurance Fund, 4 I. A . C. Dec. 202.)
A n employee was w orking upon a scaffolding at the time it col­
lapsed, causing him to sustain a heavy fall with a fracture o f sev­
eral ribs and injuries to the head. In subsequent medical examina­
tions a diabetic condition was discovered which it was claimed was
caused by the injury. The commission found that such condition was
proximately produced by the injury and directed the furnishing o f
medical treatment for its relief. (Wareham v. Royal Indemnity Co.,
decided Aug. 24, 1918, and not yet reported.)
M E N IN G IT IS.

No case has been found where prior meningitis was accelerated
or aggravated by subsequent trauma. The question, which usually
is decided in the negative, is whether the disability or death from
meningitis may be said to be proxim ately caused by an injury occur­
ring about the time o f the onset.
D

e c is io n s

.

In the follow in g cases compensation was denied:
A n employee sustained the loss o f a toe by accident, the wound
apparently healing, and some months later suffered a series o f boils,
the infection o f these boils subsequently penetrating the blood
stream and causing death from meningitis. H eld, the original in­
jury was not established as the proximate cause o f the terminal dis­
ease and death. (Stephens v. Em ployers’ Liability Assurance Cor­
poration, 2 I. A . C. Dec. 178.)
It was held that death from meningitis was not shown to have
been caused by injury occurring in the course o f and arising out o f
the employment, where the only evidence was that the deceased in124247°—19------ 12




178

M ED ICAL SESSION.

advertently scratched a pim ple on her face with her finger nail while
at work, and that the pim ple became infected, causing death from
meningitis, there being no evidence to show that she was working,
in infectious or poisonous materials. (Cannon v. Pacific Telephone
&> Telegraph Co., 3 I. A . C. Dec. 214.)
W here a carpenter fell from a scaffold and injured his back but
continued to work fo r nine months, though com plaining o f pain, and
thereafter was taken ill from cerebrospinal meningitis, the evidence
failed to show, in view o f the short period o f incubation o f the germ,
that death was due to the fall. (B row n v. City o f Los Angeles, 3 I.
A . C. Dec. 468.)
A N T E R IO R P O L IO M Y E L IT IS

(IN F A N T IL E P A R A L Y S IS ).

But one case o f this disease appears in our records.
Deceased, a motor truck driver, while liftin g a 3,000 pound trans­
form er by means o f a crowbar fo r the purpose o f putting rollers
under it, suffered a severe pain in his back which he ascribed to
wrenching caused by lifting. The pain in the back continued and
the follow in g day additional pain developed in his side and abdomen.
Shortly afterward he became paralyzed, and died six days after the
injury. The autopsy showed no evidence o f traumatism in the back,
but disclosed conditions o f the spine which showed that death was
caused by anterior poliom yelitis, and compensation was denied upon
the ground that the evidence failed to show any connection between
the liftin g and the onset or development o f the disease. (M cIntosh
v. B oyal Indem nity Co., 3 I. A. C. Dec. 178.)
SARCOMA.

Our commission has had to consider an unusually interesting series
o f cases involving sarcoma, which gave us a great deal o f concern and
necessitated much reading o f learned medical briefs before the com­
mission discovered how little the doctors really knew about the
etiology o f this truly terrible disease. The commission finally came
unanimously to the conclusion that it was justified in holding with
those medical authorities who claim that trauma is a causative, or at
least' predisposing, factor in these cases, and made awards in favor
o f the applicants in four cases o f sarcoma, which curiously enough
came before the commission fo r consideration at about the same time.
D

SARCOM A I N

e c is io n s

.

H A N D FROM H A M M E R BLOW .

A blacksmith struck the back o f his left hand with a hammer,
and a lump immediately appeared at the site o f the blow, which




D ISA B IL ITY DUE TO P R E E X IST IN G DISEASE---- M . LISSN E R .

179

was thereafter diagnosed as a rapidly grow ing sarcoma. It appeared
that a toy cannon had exploded in the blacksmith’s hand several
years before, but he had^ujffered no disability. X -ra y pictures taken
o f the sarcoma revealed the presence therein o f particles o f metal.
The medical testimony was inconclusive as to whether the sarcoma
originated at the time o f the explosion and then remained in a
quiescent state and was lighted up by the blow on the hand, or
whether it originated at the time o f the blow. Held, that the evi­
dence was sufficient to show by a reasonable preponderance o f likeli­
hood that the sarcoma was caused by the blow. Eleven months after
the injury the arm was amputated at the shoulder. It is now (S ep­
tember, 1918) a year since the operation and the injured seems to
be in good health. (R oyal Indemnity Co. v. Becker, 4 I. A . C.
Dec. 148.)
S A R C O M A F R O M S L IG H T A N K L E B R U IS E .

A salesman bruised his ankle by striking it against the street curb
in getting out o f an automobile. The ankle immediately swelled
and became painful. Twelve days after the accident an incision was
made, and X -ra y pictures taken showed a condition o f sarcoma with
rarefaction o f the bone. A fte r several operations fo r the purpose
o f removing the tumorous growth, about three months after the acci­
dent the leg was amputated, but the sarcoma continued to develop,
resulting in metastasis which caused death eight months after the
accident. A w ard was made fo r the fu ll death benefit. (Schneider
v. Norton Bros., 4 I. A . C* Dec. 382.)
S A R C O M A O F C L A V IC L E .

A n employee, who had worked steadily fo r years, fell a short dis­
tance from a platform on which he was working and struck the
point o f his left shoulder. A lump appeared on the inner third o f the
left collar bone, which he claimed he noticed immediately after his
injury, and which, five weeks later, was decided by physicians to be
a sarcoma o f slow progression. A lthough the medical testimony was
both hypothetical and conflicting, it was held that there was a reason­
able preponderance o f likelihood that the disability due to the sarcoma
was proximately caused by the injury, and an award for compen­
sation and necessary medical treatment was made in favor o f the
applicant. This case was taken to the appellate court and later on
to the supreme court and the award affirmed by both higher tribunals.
(V illa v. Santa Ana Sugar Co., 4 I. A . C. Dec. 147.)
This man fell about 12 feet and struck on his right arm and
shoulder; was in the hospital about tw o months. X -ra y plates taken




180

MEDICAL- SESSION.

about two months after the accident showed evidence o f sarcoma o f
the articular surface o f scapula neck and acromion process, and outer
end o f clavicle^ all being involved. X -ra y j^iates taken at the time o f
the injury showed the same to a lesser degree. The arm was ampu­
tated at the shoulder. A w ard made in favor o f applicant. (Farley v.
Hughes, No. 3426, M ay 24, 1917.)
IN S A N IT Y .

T o many this is the most fascinating medical question presented
in compensation practice and frequently the most obscure. The
.situation is complicated by the existence o f various distinct types
o f mental derangement, each o f which depends upon different princi­
ples. In many cases, as in paresis, the distinction between aggra­
vation and preexisting condition and proximate cause o f insanity
becomes lost, and these two issues become inextricably intermingled.
The follow in g cases com ing before our commission are classified ac­
cording to types o f insanity:
A. M

a n ia c a l

T

ype,

H

y s t e r ic a l

or

D

e p r e s s iv e .

An employee lost his finger while w orking on an oil well, and
three days later became mentally deranged, being noisy, maniacal,
and manifested hysterical symptoms and other abnormalities. H e
had been mentally unbalanced five years before fo r a period o f 10
months, but w^as at the time o f the accident normal. There was no
prior history o f venereal or other constitutional disease. I t was
held that his insanity was precipitated and proximately caused by
his injury, the commission stating as follow s in its opinion: “ In
the case before the commission we see a healthy and apparently a
normal workman suddenly suffer an accidental injury which takes
him from the ranks o f producing labor and renders him helpless,
incapable, and a charge upon his fam ily. The chain o f events from
the instant he was injured to the time-he became mentally deranged
is unbroken. W e can not see and we can not say that any new act
intervened originating the applicant’s mental condition. The testi­
mony and investigations we have made convince us to the contrary
(H ayes v. Standard Oil Co., 1 I. A . C. Dec. 219.)
A n employee was present and witnessed an accident which caused
the death o f two o f his fellow employees. H e became unbalanced
immediately, suffering from mental and emotional shock and excite­
ment. His mental condition was diagnosed as a previous hysteria
with maniacal manifestations in the earlier stages, and compensation
was allowed. (R e ic h v. City o f Im perial, 1 I. A. C. Dec. 337.)




D ISA B IL ITY DUE TO PR E E XIST IN G DISEASE---- M . LIS SN E R .

181

A n employee sustained a double hernia due to injury and was later
operated upon fo r its cure. Nine days after, he commenced to show
signs o f restlessness and nervousness which later developed into a
violent mania* H e was removed to a State insane hospital and died
there about 5 months later. It was claimed that the insanity and
subsequent death were caused by the shock o f the accident and o f the
operation or o f the anesthetic employed. The preponderance o f
medical testimony showed that death was probably due to an acute
condition contracted in the insane hospital and not directly to the
insanity, and further that the lapse o f time from the accident and
operation to the first manifestation o f insane symptoms was such
as to prevent the shock o f the accident and operation from having
upset his mental equilibrium. Compensation was accordingly allowed
only fo r the disability due to the hernia and physical disability
follow ing the operation. (K ato v. Guardian Casualty Co., 8 I. A . C.
Dec. 333.)
B.

P a r e s is .

A n employee fell from the top o f a straw stack 20 feet to the
ground, the fall causing a slight concussion o f the brain. H e was
sent to a hospital fo r 17 days and then returned to his home. U pon
arriving home he complained o f paralysis and other symptoms and
becoming worse was sent to the hospital for the insane, where his
condition was diagnosed as paresis, or general paralysis, this con­
dition being o f syphilitic origin. The commission found that the
effect o f the accident upon his mental balance was not sufficient to
constitute the proximate cause o f the development o f the insanity,
and denied compensation except fo r the immediate physical conse­
quence o f the fall. (Hanson v. Frankfort General Insurance Co.,
2 I. A . C. Dec. 767.)
A pplicant, employed as a farm laborer, while driving a team under
a projecting roof, struck his head on a rafter and was knocked to
the ground. A few days later he began to develop symptoms diag­
nosed as traumatic neurasthenia. I t was also found that he was
suffering from syphilitic infection, latent before the injury and
probably lighted up thereby. A n award was made for a temporary
partial disability. Later on it was shown that the physiological and
anatomical effects o f the injury had totally disappeared, that the
then existing symptoms were due entirely to the syphilitic infection
and were those o f the pseudoneurasthenia complex characteristic
o f the period antecedent to true leuetic paresis, due entirely to the
syphilitic infection and not to the injury. The defendants were
accordingly discharged. (Christensen v. Bra vender, 3 I. A . C. Dec.
527.)




182

M E D IC A L SESSION.
C. T

r a u m a t ic

I

n s a n it y .

T his class o f cases occurs where an employee has sustained athead
injury, principally where the skull is fractured, causing damage to
the brain which produces insanity. In this case the right to compen­
sation is clear i f the medical testimony sufficiently connects the dam­
age with the mental derangement.
A laundry-wagon driver was kicked by his horse, sustaining a
fractured skull. H e was unconscious fo r several weeks afterwards
and slowly recovered, returning to w ork in about three months.
Nearly a year after his accident he had seizures o f some sort, prob­
ably epileptic, although he had never been subject to epileptic fits or
seizures before the accident. F o r some time before the seizures he
had noted occasional dizzy spells and during the remainder o f his
life, which was nearly a year after the first seizure, he had other
seizures o f less violence. D uring the last few months his intelligence
became affected and he was unable to continue at work. 'H is case
was diagnosed by several neurologists as one o f m ajor hysteria and
traumatic neurosis, without any organic brain injury, but one expert
neurologist gave it as his opinion that the employee was suffering
from definite brain injury, traumatic epilepsy, and the probable be­
ginning o f dementia. The employee died from acute appendicitis,
and upon autopsy, necrosed portions o f the brain were found suffi­
cient to account fo r his symptoms. The commission allowed tem po­
rary total indemnity up to the time o f his death, terminating com­
pensation at that time as the death was not due to the injury. (B ald­
w in v. Western Indem nity Co., Sept. 14, 1917 [not reported].)
A lineman in the employment o f an electrical railway company
fell from the top o f a line wagon to the street, fracturing his skull.
H e remained unconscious fo r a time and later was able to be about.
X -r a y examination about six months later showed a pronounced
thickening o f the inner table o f the skull, about certain sutures. H e
complained principally, after the immediate effects o f the accident
had subsided, o f sleeplessness and occasional violent outburst o f
temper without apparent reason, maniacal spells, but not sufficiently
definite to enable the condition to be classed as a maniacal or depres­
sive type. H e also had a suggestion o f petit mal epilepsy. Compen­
sation was awarded fo r insanity produced by a head injury and con­
cussion o f the brain. Some time after the award the employee was
committed to the insane hospital. (Stultz v. Oakland San Fran­
cisco Terminal Railways, Mar. 12, 1918 [not reported].)
DISLOCATED SEM ILUNAR C ARTILAGE.

There is a certain type o f knee injury, known as a dislocated
semilunar cartilage, whose recurrent effects cause embarrassment




D ISA B IL ITY DUE TO P R E E X IST IN G DISEASE— M . LISSN E R .

183

to industrial accident boards. The first time trouble is noted by the
injured employee is usually when he strains his knee suddenly,
causing a dislocation o f this cartilage, im pinging in the knee joint,
and causing severe pain and disability fo r some weeks. Thereafter
the disability w ill gradually pass away and he w ill return to work,
but forever afterwards, uliless operated upon, he remains subject to
a recurrence. A n y slight strain thereafter w ill cause a new disloca­
tion o f the weakened joint, and indeed such dislocation is even found
to occur at recurrent intervals without any trauma whatsoever.
Each time the cartilage slips again disability w ill be produced for
some days or weeks.
W ith respect to the first occurrence, i f produced by trauma, the
case is clear. The problem arises with later displacements, particu­
larly where the man is w orking fo r other employers. Should the
second displacement be charged to the new employer, or are all sub­
sequent displacements proximately a result o f the original weak­
ening o f the joint and to be charged to the first employer, or should
the employee go uncompensated fo r later displacements?
Our commission in the cases o f R aggio v. R oyal Indem nity Co.,
3 I. A . C. Dec. 319, Em ployers’ L iability Assurance Corporation v.
R aggio, 3 I. A . C. Dec. 324, and Salyer v. Sperry Flour Co., 3 I. A.
C. Dec. 321, laid down the follow in g tests:
(1) The employer in whose service the first dislocation o f the
knee cartilage occurs is liable fo r compensation for the temporary
condition produced.
(2) The employer in whose em p loy m en ts second dislocation o f
the cartilage occurs, without evidence o f specific trauma at the time,
is not liable for any disability ensuing, as the condition is merely a
recurrence o f the fact o f the first dislocation.
(3) W here evidence o f trauma at the time o f the second slipping
o f the cartilage is clear and convincing, compensation will be awarded
against the second employer, but only in such cases.
(4 ) The only cure fo r the situation is an operation, but such
operation should not, by reason o f the dangers attending it, be
forced upon the injured employee as a condition precedent to receiv­
ing compensation fo r his injury. The expense o f the operation
should be borne by the first employer.
(5) W here an operation is advised by competent surgeons, the
first employer should be required to tender it, leaving the injured
man free to elect whether or not to submit himself to it. I f he
declines the operation, the employer should be discharged from all
further liability after the immediate temporary disability is passed
and not be held liable fo r future recurrences.




184

M ED ICAL SESSION.
DISEASES AND IN D U STRIA L INJURIES.

F ollow ing is an analysis o f the commission’s disposition o f claims
arising out o f 118 cases o f diseases and industrial injuries, from
January 1, 1917, to June 30, 1918:

Diseases.

Claims
Claims
denied
granted
by com­ by com­
mission. mission.
1

Arthritis . . . . . . . . . .
D o.....................
Carcinoma..............
Gonorrhea..............
Heart trouble..."__
D o.....................
Hemorrhoids..........
Hernia of appendix.
H ydrocele...............
Meningitis. . . __
Orchitis. . . . . . . . . __
Paralysis.................
D o...........„........
P n e u m o n ia ...........
Do
................
Rheum atism . . . . __
D o.....................
Sarcoma...............
Sacroiliac s lip ........
Syphilis__. . . ____
Do
.......
T enosynovitis... . . .
Tuberculosis.. . . . . .
D o.....................
Varicocele . . . . . . __
D o.....................
Varicose ulcer.........
Varicose veins.........

15

Total.............

60




2
2
1
1
3
4
3
4
6
5
1
10
2

Statute
of limi­
tations
inter­
fered.

2
1
1

Remarks.

N ot due to employment.
Insufficient evidence to establish claim.
'N o t in course of employment.

1
2
2

N ot due to employment.
N ot in course of employm ent nor result of injury.
N ot result of injury.

7

N ot due to employment.

1
1

N ot caused by employment.
Do.

2

N ot due to employm ent.

6

Insufficient evidence and not result of injury.
Do.

9

7
10

1

1
1

1
1
1
55

N ot due to employment.
N o t due to injury or employment.
Evidence insufficient.
Disability not result of injury.
Do.

3

H O W M E D IC A L Q U E S T IO N S A R E H A N D L E D U N D E R T H E W O R K ­
M E N ’ S C O M P E N S A T IO N A C T IN T H E S T A T E O F W A S H IN G T O N .
BY J. W . BRISLAWN, INDUSTRIAL INSURANCE COMMISSIONER OF WASHINGTON.

M edical problems arising under the W ashington plan o f work­
men’s compensation are handled through the medical department o f
the Industrial Insurance Commission. The Industrial Insurance Com­
mission, which administers the workmen’s compensation act, consists
o f three members appointed by the governor. The medical depart­
ment o f the Industrial Insurance Commission consists o f a chief medi­
cal adviser and an assistant medical adviser, appointed by the com ­
mission, who devote all o f their time to the work.
Under our law each claim for compensation is based on three re­
ports to the com m ission: r (1) The workman’s claim ; (2) the em­
ployer’s report; (3) the report o f the attending physician. Every
physician in the State o f W ashington attending an injured work­
man is required to make a report o f the case to the industrial insur­
ance commission. Blank form s fo r this report are furnished every
regularly licensed physician in the State. The rules o f the commis­
sion require the attending physician to make the report within a
reasonable time. Thus each practicing physician who gives medical
attention to injured workmen becomes in a sense an assistant to the
medical department o f the commission. The attending physician
may be called upon by the commission, or its medical department, fo r
other and additional inform ation than that required in the first re­
port. The attending physician is required to report the condition
o f the injured workman during each month o f his disability. In
every case the report o f the attending physician is submitted to our
medical department fo r approval or rejection o f the claim from a
medical point o f view. The action o f the medical department is not
final and conclusive so far as the fate o f a particular claim is con­
cerned, but is always subject to final action by the commission. In
border line cases, where the medical profession is in doubt as to
whether or not the claimant’s condition has resulted from his injury,
the commission is prone to give the benefit o f the doubt to the
claimant.

Special medical examiners are appointed by the commission to ex­
amine such claimants as are too far distant from the office of the
commission at Olympia to make it possible for them to report there




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MEDICAL, SESSIOIT.

fo r special examination. Specialists in nervous diseases, eye and
ear specialists, and specialists in bone work are appointed by the
commission from time to time to examine such claimants as we are
unable to have examined by our own department, or whose cases
require a more thorough examination than the ordinary practitioner
is prepared to make. Wasserman reactions and tuberculin tests are
made for the commission in the laboratory maintained by the State
Department o f Public Health. W e may also appoint a special ex­
aminer outside o f the State to examine any claimant who has re­
moved from our State before his case has been finally closed. W hen
we find an examiner who writes a good special report, and whose
findings are reasonably reliable, we try to use him in all our cases
in his locality, fo r the reason that this means uniform ity in the
handling o f cases, and after having done this work for us fo r some
time he usually becomes more skilled and gives us more definite in­
form ation on which to rate the cases.
Under the law, as amended by the legislature o f 1917, the com­
mission pays the traveling expenses o f any claimant ordered up for
special medical examination. This enables us to bring many more
claimants to our Olym pia office fo r examination than heretofore and
has resulted in much more satisfactory settlements in difficult or dis­
puted cases than it was possible to make prior to the amendment o f
the law. This has greatly increased the work o f our medical de­
partment but the results amply ju stify the increased labor.
A s an adjunct to our medical department we have two or three
claim adjusters who have been trained for the work but who are not
physicians. These men cover the entire State and meet the claim ­
ants at convenient places, settling such claims as can be settled with­
out special medical examination. Their reports— adjustments— are
forw arded to the medical department o f the commission and either
approved fo r final settlement o f the claim or the claimant is then
ordered to appear before a physician fo r medical examination.
P rior to 1917 the Industrial Insurance Commission was charged
with the duty o f supervising the medical and hospital treatment o f
injured workmen, to the extent o f seeing that such treatment was
suitable and wholesome. In 1917 the law was amended, and there
w^as created a State medical aid department, o f which the chief medi­
cal adviser o f the Industrial Insurance Commission was made, ex
officio, a member and chairman o f the b o a rd ; two other members, one
an employer and the other a representative o f labor, were to be ap|)ointed by the governor. This board, known as the “ State medical
aid board ” is now charged with the duty o f supervising medical and
hospital treatment o f injured workmen.
The medical aid act provides two plans under which injured work­
men may receive medical and hospital treatment, the first being




M ED ICAL Q U ESTIO N S, IN W A S H IN G T O N — J . W . B R IS L A W N .

187

known as the 64 State plan,” under which plan funds contributed by
the workmen and the employers o f the State are paid into the State
medical aid fu n d ; the workman chooses his own physician and his
own hospital; the employer furnishes transportation for the injured
workman to the place o f treatment, and the medical bills, hospital
bills, and drug bills are paid out o f the State fund upon approval o f
such bills by the State medical aid board certified to the industrial
insurance commission, which commission orders the payments made.
The other plan provided is the “ contract p la n ” under which the
employer, with the consent o f not less than 50 per cent o f his work­
men, may enter into a contract fo r medical and hospital care o f such
men as are injured, in which case only 10 per cent o f the amount
paid by the workmen and the employed so contracting is paid into
the State medical aid fund, the remaining 90 per cent being paid to
the doctor or hospital holding such contract. In either case, however,
whether under the State plan or the contract plan, the State medical
aid board has supervision o f the treatment. This ties the whole sub­
ject o f medical and hospital treatment o f injured workmen to the
medical department o f the industrial insurance commission.
The Industrial Insurance Commission has the power, under the law,
to prescribe rules and regulations concerning reports o f physicians
and to require claimants to submit to medical examinations from time
to time, and in conjunction with the medical aid board, to determine
whether or not the treatment that injured workmen are receiving is
suitable and wholesome. It is enabled to do this to its own satisfac­
tion and to the benefit o f the injured workman by reason o f having
constantly the services o f its medical department. A ctin g under the
advice o f its medical adviser the commission adopted rules concern­
ing hernia cases. TJnder the hernia rules i f an operation is advisable
and w ill relieve the condition, the commission orders the operation.
I f the claimant refuses to be operated on all payments are suspended
until he does submit to an operation. The same is true concerning
operations fo r almost any industrial injury where relief may be
obtained by a reasonable operation.
W hile new problems are constantly occurring it is worthy o f note
that hundreds o f injuries are similar in character, will yield to simi­
lar treatment, and will result in about the same degree o f temporary
or permanent disability, as the case may be. Careful observation o f
such cases by our medical department enables us to determine a reas­
onable duration o f time loss and to rate such disabilities as result
from like cases in a reasonably uniform manner. W e find many
injuries occurring that are not classified in the act and that result in
no definite permanent partial disability, such as when an amputation
follow s an injury. I refer to such injuries as fractures o f the skull
where no operation is required or where a depression o f the outer




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M ED ICAL SESSION.

table may occur. W here the final outcome is doubtful we endeavor
to rate such resulting disabilities in the light o f the experience that
the department has had and in conform ity with a uniform schedule.
It might be proper to say that under the W ashington act, as ad­
ministered by the commission, we attempt to settle our medical prob­
lems according to the best medical advice that we can obtain. W e
believe that by having the services o f our own medical men, supple­
mented by such further advice and consultation as they desire, or as
the commission may require, we get fairly uniform results and ad­
minister the law as equitably between the injured workman and the
employer who pays the bills as it is possible to do.
I t should be remembered, however, that many o f the injured work­
men are never seen by our chief medical adviser, or his assistant, and,
therefore, their skill and knowledge o f such matters is put to the
most severe test in determining the condition o f the claimant and
the degree o f his disability from the report o f attending physician
or special examiner. W e feel, however, that this can be determined
more accurately by having a department w orking in conjunction with
the Industrial Insurance Commission than it could be i f we were
solely dependent upon the attending physician or special examiner
fo r medical advice in each case.




H O W M E D IC A L Q U E S T IO N S A R E H A N D L E D U N D E R C O M P E N S A ­
T IO N A C T IN M A S S A C H U S E T T S .
BY

WILLIAM

W.

KENNARD,

CHAIRMAN,

MASSACHUSETTS

INDUSTRIAL

ACCIDENT

BOARD.

The compensation act o f Massachusetts, Part V , section 9, provides
that the Industrial Accident Board may appoint a medical adviser.
This act went into effect in 1914, since which time the office o f medical
adviser to our board has been most ably and efficiently filled by Dr*
Francis D. Donoghue, o f Boston. In his department are handled in
the first instance the medical questions which arise in any given case.
Under our act, “ A fter an employee has received an injury, and from
time to time thereafter during the continuance o f his disability he
shall, i f so requested by the association or subscriber, submit himself to
an examination by a physician or surgeon authorized to practice medi­
cine under the laws o f the Commonwealth, furnished and paid fo r by
the association or subscriber. The employee^ shall have the right to
have a physician provided and paid fo r by himself present at the
examination. I f he refuses to submit himself fo r the examination,
or in any way obstructs the same, his right to compensation shall be
suspended, and his compensation during the period o f suspension
may be forfeited.”
Under another section o f the act it is provided that “ The Indus­
trial Accident B oard or any member thereof may appoint a duly
qualified impartial physician to examine the injured employee and
to report. The fee fo r this service shall be $5 and traveling expenses,
but the board may allow additional reasonable amounts in extraordi­
nary cases, and the association shall reimburse the board for the
amount so paid. The report o f the physician shall be admissible as
evidence in any proceeding before the Industrial Accident Board or a
committee o f arbitration, provided that the employee and insurer
have seasonably been furnished with copies thereof.”

In practice the Industrial Accident Board of Massachusetts avails
itself, in almost every disputed case, of the provisions of the latter
section; that is, an impartial examination is made and an impartial
reports is filed. This may be done as a result of a conference; it may
be done as a result of the suggestion of the medical adviser in con­
sultation with the member of the board who has had to do with the
case; it may be done during a conference or hearing, or if the result
of a conference or hearing is such that in the opinion of the sitting




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M E D IC A L SESSION.

member he will be aided and assisted in a just determination o f the
question before him by a report from some impartial examiner.
In all other respects medical questions which come before the
board are handled as in a court o f law. Both parties, the employee
and the insurer, can present at the hearing the testimony o f attend­
ing physicians, hospital records, or experts, and such evidence is
received in the same way and manner as all other evidence having to
4 o with the proving or disproving o f the claimant’s case. In prac­
tice, as may be imagined, the report o f an impartial examiner is
entitled to and receives great weight in the ordinary case. The im­
partial examiner is chosen, and the case sent to him because he is a
specialist in the particular line o f work which is presented by the
particular case which he examines. These impartial physicians have
been picked out with the advice of, and after consultation with, our
medical department, in various parts o f the Commonwealth. Their
reports, as are indicated by the statute, are made in w riting along
certain prescribed lines tending to best meet the needs o f a hearing.
In many cases it is deemed advisable on the part o f the sitting mem­
ber, or more often by one o f the parties, to submit both the written
report and the oral testimony o f the impartial examiner. In the
latter case the party desiring his presence makes a request o f our
board, and the impartial examiner, i f it is the judgment o f the board
that such evidence is properly asked for, is then requested through
the medical department to be present at the hearing. A t this time
he is subject to examination by either o f the parties on matters perti­
nent to the case. A t no stage o f the proceedings, up to the time he
takes the witness stand, is the impartial examiner permitted to be
interrogated by either party to the controversy, it being the pur­
pose o f the act, which purpose we believe has been accomplished, to
make him all that the term u impartial ” implies.
In addition to the impartial physicians located throughout the
State, each day there is in attendance at the board rooms a ph}7sician
who can be, and is, called upon to examine cases inform ally fo r
guidance in conference matters, and form ally with a written report
to be used fo r hearing purposes. A s w ill be noted, from the statute,
the expense o f the impartial physician, both fo r examination and
testifying, is made a charge against the insurer, but his fee is not
paid direct by the insurer, but an account is rendered by our medical
department to the insurer which pays the money into the Common­
wealth and the Commonwealth, through the treasurer’s department,
disburses it in accordance with the accounts rendex^ed to him by our
medical department. Since December 1, 1917, the beginning o f our
fiscal year, to September 1, 1918, a period o f 10 months, there has
been so paid fo r impartial examinations the sum o f $18,889.62, an
average o f about $1,550 a month.




M E D IC A L Q U E STIO N S, IN M A SSA C H U SE TT S---- W M , W . K E N N A R D .

191

It should perhaps be stated at this point, if it should not have come
earlier in these remarks, that when the parties are not able to get
together themselves, or at an inform al conference, that under the
Massachusetts law, a form al hearing is held, at which both parties
are ordinarily represented by counsel, and testimony is taken and
received in accordance with regular court procedure and also in ac­
cordance with the ordinary rules o f evidence prevailing in any
court trial, with the result that some cases will run for two or three
days, the time being given up entirely to medical testimony from
various experts presented by both parties. The provision o f the
statute quoted with reference to examination o f the injured man by
the insurer, makes it possible fo r the insurer to go fully into the
medical side o f the case with his experts. The employee, generally
unable to pay the expense o f high priced expert testimony, is, through
the system o f impartial examination, amply protected in his rights,
the impartial examiner being, as before stated, a man especially
skilled with the problems o f the particular class o f cases o f which the
subject case is a part, and ordinarily a man who, by reason o f that
fact, is amply able to present his views upon the witness stand when
called upon to do so.
I haven’t attempted in these few remarks to go into the question o f
medical treatment and all the other aspects o f the medical prob­
lem, having in mind, upon an examination o f the program, that to
do so would be going beyond the scope o f our question, encroaching
upon the ground which w ill be covered by other papers.




H O W M E D IC A L Q U E S T IO N S A R E H A N D L E D U N D E R C O M P E N S A ­
T IO N L A W IN N E W Y O R K S T A T E .
BY WILLIAM C. ARCHER, DEPUTY COMMISSIONER IN CHARGE OF NEW YORK STATE
BUREAU OF WORKMEN’ S COMPENSATION.

W hat are medical questions?
Does the question refer to the organization o f the medical division
within the bureau or department? Or does it refer to the selection
o f physicians and the method o f treatment with such attendant ques­
tions as who shall provide the treatment, etc.? Or does it refer in
a larger sense to the relation o f the medical question to the whole
matter o f workmen’s compensation? These all stand up in plain
view when the subject o f these remarks is announced.
But the program o f this session when read with the entire medical
program would seem to lim it the medical question to the first refer­
ence above and I may say perhaps the least interesting.
In the New Y ork jurisdiction there is a large claims office in New
Y ork City to which is attached the principal office o f the medical
division and where is stationed our chief medical examiner. There
are also claims offices in four other cities. In New Y ork there is the
equivalent o f 12 fu ll daily sessions a week engaged in hearing
claims. In the other cities there is one fu ll day’s hearing a week with
numerous other cases heard on notice. Each o f these latter cities is
also the center o f a circuit which is visited periodically by deputy
commissioners who hear cases. Each o f the latter at each place o f
hearing has available medical advice.
The medical division is in charge o f a chief medical examiner
whose duties embrace the follow in g : T o examine claimants; to be
present at hearings where medical testimony is taken, either as an
examiner o f medical witnesses, as medical counsel to the sitting com­
missioners, or as witness whose opinions are subject to cross-exam­
ination ; to review cases and to make written reports on the medical
phases thereof; to be present at conferences o f physicians in the
examination o f claim ants; and to outline and control the work o f his
medical and clerical staff.
W ith never-ending hearings the medical office in New Y ork City
is a busy p lace; for, as soon as it appears to the sitting commissioner
that a medical report is desirable, the proceedings are interrupted
and the claimant is sent at once to the medical division fo r an exam­
ination. In the course o f a few minutes the case is returned with
a complete report, whereupon it is again called and disposed of.
192




M ED ICAL Q U E ST IO N S, IN N E W Y ORK STATE---- W . C. ARCH ER.

:

193

That this is an advantageous arrangement goes without saying.
I t enables us quickly to dispose o f a large number o f cases and
greatly to diminish the time consumed in the disposition o f the case.
It also permits o f numerous adjournments in a given case and the
ability o f the bureau to follow it from week to week or month to
month, keeping in close and accurate touch with it. O f course, it
is recognized that a large city and cheap transportation make this
.possible. But the practice in effect is quite the same in the smaller
cities where an available physician is always at hand. There is also
the element o f impartiality, which is recognized by all parties, our
medical division being guided only by a sense o f truth and justice
and not interested fo r or against either claimant or insurance com­
pany. O f course, prim ary requisites on the part o f the medical di­
vision are ability and fairness.
In New Y ork City alone 15,000 examinations were made last year.
T his gives an idea o f the amount o f work done. Every report is
recorded and made easy o f access through a card system o f filing.
A copy o f the report is also filed with the other papers in the case
and thus made easily accessible to the claim examiners or sitting
commissioner. In New Y ork, besides the cases which are noticed
fo r public hearing, there are many cases in which compensation is
paid and received by employers and claimants and which are certified
to the commission on join t reports o f agreements. The law requires
that these agreements shall provide full statutory compensation and
makes it a duty o f the commission to investigate the cases to see that
agreements have been made strictly according to law. T o aid in this
investigation, notices are sent to claimants to present themselves for
medical examination i f they lack knowledge o f the terms o f the law
or fo r any other reason they are doubtful that they have received
adequate compensation. This brings thousands o f claimants to the
office o f the commission and most o f them go through the medical
division, where they are examined and reported on in the manner
outlined above. This safeguards the enforcement o f the provisions
o f the law and again demonstrates the utility o f a well organized
medical division.
It is also the function o f the medical division to make arrangements
fo r all specialists’ examinations such as neurologists, oculists, etc.
The insurance carriers invariably pay fo r such examinations but the
examiner is selected by the medical division independent o f the
knowledge o f any party in interest.
This, in brief, is the manner in which medical questions are han­
dled in New York.
There are a number o f great problems in compensation matters
such as extent o f coverage, manner o f insurance, benefits, rates, ad1242470—19------13




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M ED ICAL SESSION.

ministration, including problems o f organization and finality in the
disposition o f claims, accident prevention, and the medical question.
The last has its relative importance, which is always large. Injured
workmen should have voluntary recourse to a clinic o f undoubted
skill and ability; they should be induced by every proper incentive
to submit themselves immediately after injury to adequate treat­
m ent; their cases should immediately come under the attention o f
the State, and be held there until a permanent determination o f the
disability is arrived a t ; they should have this medical attention with­
out cost to them other than the great underlying cost whose prom i­
nent share they are indirectly paying. Thfe State should also be able
to command directly the testimony o f the physicians under a plan in
which the physicians would not be tempted to be witnesses except for
the truth.
In addition to this, the administrative commission should have at
its command ar thoroughly equipped staff o f physicians, and in this
connection it is safe to say that every State in the Union should have
at its service a larger staff than it is now able to command. The
physicians com posing the staff should be o f such well recognized
ability that they m ight well be the final arbiters o f all medical ques­
tions raised.
So much, in brief, on a phase o f the compensation question with­
out lim it in importance or interest.




THE NEED OF MEDICAL STATISTICS FOR COMPENSATION
PURPOSES.
BY F. H . THOMPSON, M . D., CHIEF MEDICAL EXAMINER, OREGON INDUSTRIAL ACCIDENT
COMMISSION.

N o compensation board has a complete organization without a
statistical department, as such inform ation as is gained from the
gathering and presentation o f statistical data is essential fo r effective
service. Compensation statistics have tw o important functions:
First, such statistics give definite inform ation as to the method o f
treatment offering the most uniform success to the industrial sur­
geon. F or instance, it has been shown that in ununited fractures
autogenous bone g ra ft causes early union with no latent aftereffects,
the least amount o f callus (in excess), and no later operation, such
as is the case with the use o f plates, nails, etc., which must be re­
moved. Femur fractures vary according ta location, character, and
extent o f soft tissue trauma. Only by reviewing the records o f hun­
dreds o f cases has treatment o f this bone been so perfected that the
injured workman can have the benefit o f real scientific care, with
the expectation that the ultimate result w ill be satisfactory and the
amount o f shortening the minimum. The insuring to an injured
workman o f the best surgical care is made possible only by carefully
compiled statistics, from a study o f which adequate conclusions can
be drawn.
As regards the care o f wounds or any other abnormal condition,
statistics are just as valuable. To-day a palmar or tendonitis abcess
would not be poulticed and allowed to “ head ” while infection was
traveling up the arm, doing irreparable damage and menacing life.
The infected area would be drained at such a point as would leave
the least disability from scar tissue form ation and adhesions.
Real surgical science has, like every other science, grown by slow
process o f profiting by mistakes and o f perfecting technique along
lines that have proven successful. Case histories, which are statistics
o f the best sort, have been kept— the only means by which progress
is possible.
Second, statistical computation enables the accident board to ar­
rive more accurately at the relative hazard o f any occupation. This
is o f the utmost importance in properly estimating liability, fixing
adequate rates to cover the hazard, and estimating the proper time




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M E D IC A L SESSION.

loss. It is especially important as to the fixing o f rates, as it would
be obviously unfair to have one arbitrary rate that would apply to
all types o f hazardous work. It would be impossible to arrive at
an equitable rate without knowing the hazard o f the particular
industry, which can be ascertained only from accurate statistics.
I t has been found that the accident experience o f steel-ship yards
is greater in frequency, but less in severity, than in wTooden-ship
yards, and that it is higher in loggin g than in commercial transfer
wTork. So by proper com pilation o f actual accident experience ac­
cident boards are enabled to arrive at definite, equitable rates for
the various industries and at the same time to so grade the rate as
to cover the liability o f the hazard.
This one point should be borne in mind, however, that in study­
ing statistics fo r the estimation o f time loss due to any given type
o f accident, the model averages are the averages ordinarily made
and should be the standard. F or instance, in nine cases o f fracture
o f the tibia one case may be unusually severe and give a disability
period o f nine months; one may be slight, with a temporary total
time loss o f one m onth; five may last practically three months;
one may last four months, and one five months. Evidently for these
figures three is the mode, and should be taken as the ordinary
time loss in estimating liability, instead o f the average secured by
adding and by dividing by the number o f cases, which would give
3 f months time loss per case, a period which would be too long.
F or these reasons statistics are vitally necessary for industrial,
surgical, and compensation purposes.




T H U R S D A Y , S E P T E M B E R 26— E V E N IN G S E S S IO N .
CHAIRMAN, F. D. DONOGHUE, M. D., MASSACHUSETTS.

S E L E C T IO N O F T H E P H Y S IC IA N U N D E R C O M P E N S A T IO N L A W S .
BY JOHN W. MOWELL, M. D., MEDICAL ADVISER TO THE INDUSTRIAL INSURANCE COM­
MISSION OF THE STATE OF WASHINGTON AND CHAIRMAN OF THE STATE MEDICAL
AID BOARD.

The selection o f a physician under compensation laws depends
largely upon the law itself; so what I have to say will be from the
standpoint o f the compensation law o f the State o f W ashington
and it resolves itself into the follow in g :
First. The free choice o f physician by the injured workman.
Second. The selection o f a physician by the employer, after se­
curing the consent o f his workmen to contract for their care.
Third. The selection o f the physician fo r special work, by the
industrial insurance commission through the medical aid board.
Under what is knowTn in our State as the “ State plan” the law
grants the workman the privilege o f selecting his own physician in
case o f injury, provided he resides within a reasonable distance from
the injured workman. W hile this plan seems quite equitable and
it appears to be the natural thing to do, it has a good many short­
comings. F or instance, to the isolated workman who is employed
in a locality where there are only one or two physicians, free choice
means little, and the injured workman has to accept the services o f
the first physician he can obtain. However, in the larger cities where
there is a great number o f physicians we find that some o f the work­
men make a wise choice, while quite a large per cent o f them, fo r
some reason or other, select a physician who is not very well equipped
fo r the work at hand.
W e often find that a workman who has received a serious fracture
w ill select a physician who knows little about fractures; also a man
who receives an injury to his eyes may go to an ordinary practitioner
fo r treatment until the serious nature o f the case makes it necessary
to transfer him to an eye specialist, whom he should have consulted
in the first instance. This occurs more or less with reference to all
kinds o f injuries. W e have seen numerous times, and once within
the last month, a workman who had received a Colie’s fracture, that
had never been badly displaced, but had been treated by a long an­
terior and posterior splint extending over the fingers. The splints




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M E D IC A L SESSION.

were retained tw o months. This man was past middle age, and not
only his arm but his entire hand was so disabled that it was practi­
cally useless, due not to the fracture but to the manner in which it
was handled. H is condition is such that he w ill have a practically
useless arm and hand the rest o f his life.
W e have also seen numerous P o tt’s fractures that were treated by
physicians who were not well up in handling this particular frac­
ture, and did not appreciate the final results that are so apt to fo l­
low. The claimants are disabled from lack o f proper alignment and
left in a seriously crippled condition.
Since surgeons learn largely from experience in handling these
cases, the surgeon who handles few may entirely fail to appreciate
the condition that he is dealing with and trust too much to chance,
and after it is too late to remedy the condition he finds that he has
been quite shortsighted.
T o my mind the principal thing that can be said in favor o f free
choice o f physician by the injured workman is the effect that it has
on his mind, that is, the feeling that he is getting what he wants.
Under the contract plan we have a good deal o f the same condi­
tions to contend with, since in isolated districts it is impossible to
keep a physician in the locality under the “ Free choice plan,” so same
physician, and very often the man with very little experience, locates
in the district and contracts with the employer fo r the care o f his
workmen, on a monthly payment basis, so that he may be able to
maintain himself in that location. H e proceeds to handle everything
that may follow , to the m isfortune o f the workmen, and gets his ex­
perience, sometimes, at the expense o f the workmen and employer.
I f he is a close observer his work w ill improve, as it is largely along
one line.
In the larger industrial centers some o f the contract men are very
efficient “ business getters ” and obtain their contracts largely from
enterprise in that direction. They must, however, give service equal
to any that can be given in the district, or they are not able to retain
their contracts. This they do either by becoming quite efficient
themselves or by associating themselves with some surgeon who is well
equipped to do the work. The medical aid board also has this check
with reference to contract work, that it must be satisfied that the
surgeon who is taking the contract is able to give the men as good
service as they can get in that locality. The same rule holds good in
the isolated districts.
There is one unfortunate feature o f the contract plan that has given
and is at present givin g the State medical aid board considerable
trouble. It is the com m ercializing o f the contract plan by nonmedi­
cal men who form a hospital association and then go to the employer




SELECTIO N OF P H Y S IC IA N ---- J O H N W . MO W E L L , M . D.

199

and employees and by offering them some special inducement get
the signatures o f the workmen, giving their consent to the employer
to make a contract fo r their care. Then they secure the services o f a
surgeon and pay a small part o f the proceeds to him fo r the work
and keep the remainder. This has brought about a lot o f dissatisfac­
tion among the workmen and the physicians o f the State, causing
some agitation at the present time toward State hospitals for the care
o f workmen under the industrial act.
Under the head o f “ Selection o f surgeon fo r special work,” the
medical aid board requires, by rule, that where a contracting surgeon
is not able to do the work personally he must furnish the services
o f a specialist.
Under free choice o f physician the medical aid board, by rule,
reserves the right to transfer a man fo r treatment to a surgeon o f
its choice where it becomes evident that the injured workman is not
receiving the service that he should at the hands o f the physician o f
his choice. In m aking this selection the board is guided entirely by
its knowledge o f the various kinds o f work that the different sur­
geons o f the State are best fitted to do. This knowledge is based on
seven years* observation o f the work done by the physicians in the
State.
In conclusion, I would like to say. that fo r the ordinary accident
I feel that the workman should have “ free choice o f physician,”
but in more serious accidents it would be much better if he would
take the advice o f some one who is in a position to know what
physician is best equipped by experience or otherwise to treat the
particular condition from which he is suffering. In this way the
permanent partial disabilities resulting would be fewer and the
injured man would be left in better shape to take up a gainful oc­
cupation, fo r the disability awards, although as liberal as under any
compensation act, are not in keeping with what the workman loses.




SELECTION OF THE PHYSICIAN IN COMPENSATION CASES.
B Y R A P H A E L L E W Y , M . D ., C H IE F M E D IC A L E X A M IN E R , N E W Y O R K ST A T E IN D U S T R IA L
C O M M IS S IO N .

[This paper was submitted but not read.]

The selection o f the physician to treat workmen’s compensation
cases is a problem o f some moment, and one that must be regarded
from various points o f view. It is obvious, at the outset, that the se­
lection o f the physician by either party— the claimant or the insur­
ance carrier— is accompanied by both advantages and disadvantages.
I f the physician is selected by the insurance carrier, it may be pre­
sumed that the carrier is in a position to select a skilled attendant, w h o
will give the claimant adequate care, but it must also be remembered
that the carrier is vitally interested in shortening the period o f disa­
bility as greatly as possible. This may sometimes result in disad­
vantage to the injured person, as he may be pronounced cured or be­
yond need o f further attention, or beyond the possibility o f further
improvement, when he still honestly believes him self to be suffering
or not entirely cured.
I f the selection o f the physician is left to the injured person, it
must be remembered that there is the advantage that the claimant is
more likely t'o experience mental satisfaction by having his own
wTay. There is also the element o f so-called confidence in the physi­
cian o f his choice. I f he selects his own fam ily physician, however,
the doctor may not be specially qualified to treat injuries or com ­
plicated surgical sequelae, or i f the claimant selects some one else, he
may not be properly guided by good advice in his selection, and his
own experience in such matters is necessarily limited. There is also
the element o f human nature to be taken into consideration that
treatment may sometimes be unnecessarily prolonged, or that the
physician may tend to m agnify the claimant’s case.
Even i f we assume, as we should, that the claimant w ill honestly
select a competent physician who w ill adequately treat him and
relieve him o f his suffering and injury at the earliest possible m o­
ment, it should be understood that the commission shall have the
power to refer the claimant to another physician for more competent
or specialized treatment when it is apparent to the commission that
the claimant is no longer receiving skillful or careful treatment.
The ideal plan would be to leave the choice in the hands o f neither
carrier nor claimant, but entirely in the discretion o f the compensa­
tion commission, at the recommendation o f the medical department.
This plan may be presumed to be impartial, fair to both parties, en­
tirely disinterested, and to result, as a general rule, in the selection
o f competent medical assistance.
200




F R I D A Y , S E P T E M B E R 27— M O R N I N G S E S S IO N .
CH AIR M AN, FRED M. W IL C O X , PRESIDENT, I. A . I. A . B. C.

V, REHABILITATION.
H O W T O D E A L W IT H C R IP P L E D W O R K E R S .
B Y T . N O R M A N D EAN , S T A T IS T IC IA N , W O R K M E N ’ S C O M P E N S A T IO N BOARD OF O N T ARIO .

Terms, especially when used in m ajor premises, require somewhat
careful definition. W herefore, the follow in g : A “ w ork er” is one
who functions in society according as he uses the fu ll measure o f his
physical and mental capabilities; when he has lost some part o f those
capacities he becomes a cripple. The distinction between a handi­
capped and a crippled worker is that the handicapped man has lost
either actual or potential power, while the cripple has lost only actual
power— something which he already possessed. The limitation thus
placed in defining crippled workers so operates as to set apart those
whose power o f social functioning has been lessened by purely exo­
genous forces. These forces are disease, war, and accidents, accidents
being easily divisible into those the result o f the public hazard and
those the result o f industrial employment. Cripples also readily di­
vide into two main g rou p s: Those who are able to pursue their form er
occupations and those who are unable to do so. This is perhaps the
true measure o f incapacity from the social side, fo r i f a cripple can
engage in his prior occupation and successfully meet the competition
o f nondisabled workers he is able to produce as much or nearly as
much as formerly.
It does not seem possible to hazard an estimate o f the number o f
cripples, irrespective o f cause, in the United States, yet to convey
concretely the magnitude o f the problem an attempt has been made
to deduce, conservatively, the number o f industrial cripples. W ith ­
out delineating the bases and various assumptions made, or the in­
tricacies o f statistical calculation, the figure, shorn bald o f all quali­
fications, is 2,122,000, o f whom 600,000 have been so incapacitated as
to be rendered occupationally useless.
In philosophic definitions o f the State and its functions and o f
democracy from the Politicus o f Aristotle to the decision o f the
United States Supreme Court in Chisholm v. Georgia, throughout
the labyrinth o f metaphysical content, there runs the silver cord o f
national weal and individual well-being.




201

202

R E H A B IL IT A T IO N .

Every citizen is, as it were, a part o f the great economic machine
o f his country. I f he is an efficient part he is adding to the national
wealth and maintaining the social prosperity; i f he fails in his
efficiency he is a dead weight that the rest o f the Nation must carry
and hence lessens instead o f increasing the public resources. The sub­
traction o f the producing capacity o f half a m illion or so cripples is not
all; there is a further incubus on the Nation o f uncrippled producers
maintaining the crippled nonproducers. In a time o f national
stress, when all productive elements and agencies needs must be mar­
shalled, the pow er o f half a m illion is not inconsiderable. Further­
more, when the reconstruction o f peace inevitably follow s the de­
struction o f war there is an accentuated loss from war cripples.
The loss o f wages, and o f what wages will buy in necessities,
com fort, and satisfaction, inactivity, moral as well as industrial,
cheerlessness and hopelessness o f outlook and physical and mental
suffering o f the cripple and changed conditions o f his dependents*
are not conducive to individual well-being.
The pleas fo r the adequate care o f war cripples are not specious
arguments. Y et it would require an army o f over 48,000,000 con­
tinuously in contact with the enemy fo r a year, or o f four m illions
fo r ten years, to produce the number o f industrial cripples, unable
to engage in their form er occupations, alive at this instant in the
United States alone. Then apart from pure sentimentalism, i f war
cripples as cripples form a national problem how much more manifest
is the problem o f industrial cripples. Measured in national terms,
the question o f m ilitary cripples is dw arfed by the immensity o f
the question o f industrial cripples, and measured in individual terms,
the number o f industrial cripples is to the number o f war cripples
as the sands o f the seashore are to the ships that sail the depths, fo r
the future holds vistas o f industrial progress o f inconceivable magni­
tude and o f the total obliteration and elimination o f warfare. W ar,
in its terrible intensity has galvanized a materialistic w orld into some
consideration fo r human wastage. Even the unspeakable Turk and
the unutterable H un have been touched. Albeit the “ Beast that
walks like a man” has naught else than Hohenzollern aggrandizement
and Prussian megalomania as his propelling motives. The broken
wrecks returning from abroad have stirred the laggard national
heart to the pulsating beats o f democracy. The call o f heroic dead
comes sharp and clear.
To you with falling hands we throw the torch—
Be yours to hold it high.
I f ye break faith with us who die,
W e shall not sleep though poppies grow
In Flanders fields.

The torch of democracy—individual well-being and national weal.




H O W TO DEAL W I T H CRIPPLED W O RK ERS---- T. N . D EAN .

203

The problem, then, is the restoration o f the producing and earning
power o f cripples. The measure o f national weal is the producing
power o f the citizens; the measure o f individual well-being is, in
fact i f not in theory, the individual’s earning pow er; the one is the
natural concomitant o f the other.
The social movement specifically designated as conservation has
its appropriate place in ithe economic calendar. Conservation is the
development o f natural resources fo r the future, natural resources
consisting o f passive resources such as land, minerals, fisheries, and
waterpowers, and o f one active force, industrial man power, the
only agency through which passive resources can be transposed into
usable product. W ith conservation runs its twin brother, reclama­
tion— the utilizing o f waste. W ith all o f the passive resources and
with practically every product manufactured therefrom has come
the utilization o f waste. But the waste dumps o f industry still con­
tain the cripples o f industry “ unwept, unhonored, and unsung.”
Rehabilitation is the reclamation o f cripples— the converting o f the
now useless cripples into producers, thereby subserving the national
weal and individual well-being.
That rehabilitation is possible no longer implies consideration o f
theoretical probabilities. The experience o f Canada with war cripples
shows that it has been possible successfully to widen the field o f in­
dustrial reemployment to 176 different trades and occupations with­
out exhausting as yet all the opportunities. The net result is that
up to June 30, 1918, 4,612 soldiers so disabled as to require reeduca­
tion had been approved fo r courses o f vocational treatment. Even
before the war such schools as those at Charleroi, Brussels, and Tournai were doing excellent work with excellent results. Since war’s
advent the belligerent nations have earnestly and diligently prose­
cuted endeavor and the results have been astounding. In Canada,
one man with both legs off and one eye out has been taught silver
polishing, soldering, and gilding, and is in receipt o f a wage o f $75
monthly.
Canada is tending her war-disabled from clearing station to his
last hospital better than the wounded soldier has ever been tended
in any war. In special hospitals— orthopedic, phthisic, neurasthenic,
blind— the medical branch o f the Department o f Soldiers’ Civil R e­
establishment is restoring the torn flesh, solidifying nerve and lung,
and ameliorating other bodily and mental conditions, as well as the
most modern science can effect it. A n earned sympathy and human­
ity enwraps the man who fought. The department’s dietary branch
feeds him as no soldier was fed before, the commandant’s branch
provides the means fo r smoothing his personal difficulties; the ac­
counts branch plays its necessary p a rt; whilst the vocational branch




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R E H A B IL IT A T IO N .

retains him if, by reason o f his wounds, there is no return possible to
the way he made his living before enlisting.
Scientific rehabilitation, as the result o f war experience, connotes
adequate medical care, proper prothesis, functional reeducation, voca­
tional training, and system fo r employment— these form the physical
side; and, from the mental side, understanding o f psychothenia,
sympathetic counseling, patience, and tolerance. I t follow s as a mat­
ter o f course that in order to achieve the ends o f rehabilitation a
system o f pay or allowance must be provided fo r the cripples and
their dependents. The necessary adaptations o f these methods to in­
dustrial cripples constitutes the patent answer to the question, “ H ow
to deal with crippled workers.”
The jurisdictional differences must be noted. Under present sys­
tems or under present laws, it is impossible fo r a compensation board
to exercise -mandatory control o f the patient from time o f injury. I t
is possible, however, to eliminate the inefficient and unscrupulous medi­
cal practitioners. N or is it possible to require a patient to submit to
occupational therapy, but it is possible in large industrial centers to
make arrangements with hospitals so that occupational therapy be
made a part o f hospital regimen.
The first thing necessary to a plan o f rehabilitating industrial
cripples is the appointment o f a vocational officer, a man o f broad
sympathies and good judgment, one conversant alike with industrial
processes and human nature. On notification o f an accident likely
to result in serious permanent disability this officer should, i f pos­
sible, interview the injured man and his dependents, to provide
proper hospital accommodation and a living allowance for main­
tenance o f fam ily, so that the fear o f want could be eliminated from
the mind o f the patient, fo r it is the actual fear o f want, o f subse­
quent incapacitation and industrial uselessness that engenders psycho­
thenia, the poison that creeps into the mind suddenly shocked by
injury and then allowed to stagnate through long and forced idle­
ness, and psychothenia, even as neurosis, often disables more than
injury itself. A n y business or financial worries settled on the mind
o f the patient should be dissipated by sound advice so that surgical
recovery can be hastened. The patient should be visited often, his
prior occupational record should be studied, and his employer can­
vassed fo r suitable employment. The thought that any service
rendered is with the ultimate idea o f reducing compensation should
not be allowed to germinate. W hen convalescing time comes, a start
should be made toward suggesting new avenues o f employment
necessitated by in ju ry; that he can be self-supporting, that his power
to work can be restored should be the thoughts dominant in the
patient’s mind— this by the power o f suggestion. Naturally the




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205

m an’s desires should be consulted but he should be impressed gently
but firmly with the fact that he must compete with nondisabled
workers and so piloted into a sensible and practical occupation. He
should be advised further as to the most suitable type o f artificial
appliance. Em ployers within the jurisdiction should be canvassed for
suitable opportunities. I t is more than a belief that there is suitable
employment fo r every disabled man provided he be not insane and
that he retains some useful faculty. In point o f fact, experience and
such meager statistical data as are available demonstrate this a fact.
The actual introduction to the new trade should be in the shop or
existent institutions fo r rehabilitation and reeducation. I f fitted,
the man should receive further education— in night schools, social
service classes, technical schools or business colleges. Finally, when
. placed he should be further encouraged to “ carry on ” and sympa­
thetic tolerance should overbear his vagaries.
It is manifest that pay and allowances would be necessary. These
could be deducted from compensation without too greatly reducing
the amount and without fear o f overpayment.
Objections can be urged, it is true, against such a plan, that it is
academic in scope, paternalistic in conception, and socialistic in exe­
cution, that men w ill not submit, that employers w ill not provide em­
ployment, that the trade-unions would object, that it would cost too
much, that it is not practical.
Whether it be paternalistic, idealistic, socialistic, or academic is be­
side the point. The fundamental thing is that there is a problem, that
that problem requires solution, that it can be solved, and that’ it can be
solved only by action. A ll the writings or talkings can not restore
one cripple to service unless there be action. That the employers
w ill hire these men is a proved fact. Even as a matter o f business,
i f a cripple can compete and the employer, through compensation,
has already paid him a part o f wages, surely in return for 100 per
cent labor he is w illing to pay a minimum o f wages up to a reason­
able amount. That men w ill not submit is not shown to be true by
war experience, and even i f some o f the wastage can be reclaimed
something is done. Trade-unions w ill not object i f they understand
the fundamental conception o f rehabilitation, fo r to do so would
defeat some o f their own ends. The cost o f the scheme is not over­
whelming— the services o f one or at most two officers and the
incidental postage, office, and traveling expenses— for the number o f
cripples in any one jurisdiction in any one year is small.
In last analysis the argument against action in restoring cripples
to industrial usefulness, in view o f the necessity to provide fo r the
added risk by reason o f prior disability, is untenable. In the case
o f jurisdictions which refuse permanent total disability compensa­
tion to a substandard workman who has his remaining earning




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R E H A B IL IT A T IO N .

capacity seriously impaired or wiped out in the accident under con­
sideration, the conclusion can not be supported by the premises. A
careful calculation fo r a jurisdiction which provides for total dis­
ability regardless o f whether that disability was incurred in the
present or in a previous accident shows that the average rate per
hundred o f pay roll would be increased by less than one-third o f 1
cent in order to meet the added burden necessitated through a humane
consideration o f facts.
Furthermore, with Canada’s four years o f war cripples back in the
country, the problem o f prior disability in relation to subsequent
compensation has not become acute nor pressing to the Ontario com­
pensation board. Pennsylvania has a record o f 42,111 employment
openings in that State for its soldiers, sailors, and marines who may
return disabled by war service, and it is understood no question o f
increased compensation liability has become apparent.
A year ago it was urged that action in regard to industrial cripples
be taken. It was pointed out that the present system o f pensioning
was inadequate and highly artificial, that the whole economic theory
o f workmen’s compensation called fo r rehabilitation, that pensioning
instead o f being the only thing to be done was but the last o f five
equally important things. In the year since elapsed some 30,000
industrial cripples have been thrown on the Nation. T o-day the
problem and its solution are left, with the thought o f the old tentmaker—




The m oving Finger writes, and, having writ,
M oves on, nor all your Piety nor W it
Shall lure it back to cancel h alf a line,
Nor all your Tears wash out a W ord o f it.

C O N S E R V A T IO N O F M A N P O W E R A N D R E H A B IL IT A T IO N O F T H E
IN D U S T R IA L L Y D IS A B L E D .
B Y L IE U T . COL. H A E E Y E. M O C K , M . C.

[This paper was submitted but not read.]

Our Nation, follow in g the example o f the other warring nations,
has adopted a plan to physically reconstruct, functionally reeducate,
and completely rehabilitate all o f her disabled soldiers. Congress
in June, 1917, pledged this service by passing the W ar Eisk Insurance
Act. The necessity o f conserving our man power as well as the debt
which the Nation will owe these disabled soldiers makes such a pro­
gram obligatory.
B y physical reconstruction is meant the continued and complete
medical and surgical treatment until the greatest possible restora­
tion o f the disabled parts has been secured.
Functional reeducation consists o f various methods to restore func­
tion in a disabled part, or to train other members to new work, or
to teach the amputated cases the use o f artificial members. In other
words, it is com bining with 6ur surgical procedure, which aim at his
physical repair, certain other therapeutic measures which w ill help
the patient to functionally overcome his handicap.
These reeducational methods are:
1. Physiotherapy— massage, hydrotherapy, mechanical appliances,
gymnastics, games, etc.
2. Bedside occupations and, later, work in the curative w ork­
shops— so-called occupational therapy.
3. Mental training— individual and classroom work. This has
a psychotherapeutic value.
Rehabilitation, or the refitting o f the man to an independent
economic position in society, consists o f measures which are neither
medical nor surgical, but which can often begin during the course o f
his medical treatment.
Thus the work o f rehabilitation laps over into the hospital treat­
ment and in many cases continues fo r an indefinite time after the
work o f the medical officers has been completed.
In the m ajority o f cases the functional reeducation, especially the
occupational therapy, can be made so practicable that it will dove­
tail in with the rehabilitation work.
Therefore, while a portion o f this work must be conducted while
the man is under m ilitary control, and a portion must be carried
on after the man becomes a civilian, yet, as far as the man him self is




207

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R E H A B IL IT A T IO N .

concerned, it will be a gradual, unbroken reclamation to a useful
life whatever his handicap may be.
These are the plans fo r the disabled soldiers from the Arm y. But
no concrete, definite program has yet been conceived for the disabled
from the industrial army.
D uring the last decade a new specialty has developed in the
medical profession dealing with the human maintenance in in­
dustry. This does not refer to the old-time company physician whose
chief, and often only, duty consisted o f emergency treatment for the
injured. Rather industrial medicine and surgery includes every­
thing necessary fo r the complete supervision o f the health o f the
w orking force.
Human maintenance in industry consists in applying the general
principles o f medicine and surgery to a large group o f people as a
unit. W hile individuals receive special medical or surgical care
whenever needed, yet the chief purpose o f this specialty is prevention.
Prevention o f disease or accidents among the entire group o f em­
ployees; prevention o f undue loss o f time when injury or disease
assails an em ployee; prevention o f deformities and permanent dis­
abilities; prevention o f inefficiency on the job when traceable to some
physical condition. In fact, the prevention o f everything which
would tend to undermine the physical or mental welfare o f the
workers.
In order to accomplish this many o f our largest industries have
developed a staff o f capable physicians and surgeons who spend part,
or all, o f their time at the plant. Here, by being on the job— in the
front-line trench o f industry— they are not only in the strategic p o­
sition to study and apply every phase o f prevention, but also to
render immediate and proper medical and surgical care to every sick
or injured employee, which after all is only another form o f pre­
vention.
W e have succeeded in having this comprehensive system o f indus­
trial medicine and surgery adopted by many o f our larger employers.
T o-day approximately one-tenth o f the workers o f our Nation are
receiving the benefits, to a more or less degree, o f this system. There
still remains, however, many more large concerns, the small employer,
the householder with his domestic help, the farmer with his hired
men, and many others who have not considered it a duty to safeguard
the health and welfare o f those w orking fo r them.
W hen we consider that 40,000,000 people in the United States are
engaged in gainful occupations, we can then comprehend what the
adoption o f a Nation-wide program o f disease and accident preven­
tion would mean to the economic existence o f our country.
But in spite o f all our prevention methods we have, and will con­
tinue to have, the disabled employee in our midst. The man who




CO N SERVATION OF M A N PO W ER ---- L IE U T . COL. H . E. M O C K .

209

is no longer able to continue at heavy work because o f a damaged
heart or circulatory apparatus; the man who develops tuberculosis,
and, even though cured, is afraid to or advised against returning to
his form er work, or is rejected from one job after another because o f
his damaged lu n g ; the epileptic who, to safeguard the concern against
possible compensation, is fired as soon as his condition is know n; the
men with hernias, with flat feet, and many other anatomical condi­
tions that make them inefficient; as well as the armless and legless
and others seriously handicapped, the result o f injuries; all make
up our army o f disabled men. E very year adds to the total o f in­
competents who on account o f disease or accidents are prematurely
thrown into the scrap heap because their handicap prevents them
from continuing at their old occupations.
A few industries have salvaged these disabled and made them effi­
cient and independent. Some industries have given their disabled
employees easy jobs where they could make a living. But the very
softness o f the job robbed them o f all incentive, and the bitterness en­
gendered from dying ambition added to their incompetency, so that
many o f these drifted on into the scrap heap. Other concerns settled
with their disabled workman, when they were legally responsible, and
then dismissed him. Their disabled fo r whom they were morally
but not legally responsible were scrapped without a settlement.
These men, trained fo r certain occupations, who meet with perma­
nent handicaps, are the waste products o f our industrial life. T oo
often when reemployed they are ineffective because they are thrown
into the job without considering their physical fitness fo r it. Again,
they are given the positions o f watchman, flagman, messengers,
porters, and the like when, with proper training, their full mental
energy and remaining physical capacities could make them highly
efficient in much more useful vocations.
The most unfortunate group o f these disabled are those who cease
to be employed by the concern responsible for their disability. Other
employers are not interested in them— do not feel responsible fo r
them. They drift from one job to another, constantly dropping into
a lower scale, until finally they relinquish all effort to work. These
make up the loafers, the beggar on the corner, the shoe-string mer­
chant on the street, the poor physically handicapped and mentally
debased flotsam and jetsam o f our civilization.
The great lesson, therefore, which industrial medicine and surgery
can learn from the plans o f the M edical Department o f the A rm y to
reclaim the disabled soldier is the complete rehabilitation o f the dis­
abled from the industrial army.
These handicapped soldiers from industry must not only be physi­
cally cured, but they must be retrained fo r new work when their
124247°— 10------ 14




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R E H A B IL IT A T IO N .

disability prevents return to the old jo b ; they must be given suitable
employment in a position that affords them equal income and the op ­
portunity fo r initiative and advancement; adequate compensation
must be paid them fo r disabilities directly the result o f occupation,
without derogatory reaction upon their future opportunities; and
proper supervision must be maintained over them to see that their
rehabilitation is completed and so remains.
To-day, as a result o f our plans fo r the reclaim ing o f the w ar dis­
abled, the nation is awakening to its responsibility toward the civilian
disabled.
There is every reason to believe that before long Congress will
enact a law fo r the vocational rehabilitation o f the industrially dis­
abled just as it is now meeting the same question fo r the disabled
soldier.
It is conceded that the industries o f the country are as essential to
the winning o f the war as the m ilitary army. Many o f these indus­
tries, producing and transporting materials necessary to maintain­
ing our fighting forces, belong to the Federal Government. Others
are controlled by the Government. Still others are civilian. These
have built up a vast industrial army, many o f whose men are ex­
empted from draft because they are needed in this branch o f the
service. It has even been suggested that it may become necessary to
conscript labor fo r this army.
Production and other work in many o f these industries is slowed
up, due to {a) insanitary w orking conditions; (&) insanitary living
conditions; ( c) failure to select men fo r proper work— especially
from a physical standpoint; ( d ) inadequate medical and surgical
care; (e) failure to provide disease and accident prevention; ( / )
great labor turnover, resulting from many o f the above conditions;
(g) many accidents occur, the result o f em ploying green hands and
o f speeding up.
A s a war measure the Government must make every unit o f this
industrial army as efficient as possible. The health o f these men is o f
prim ary importance in accomplishing this. Some medical force o f
the Federal Government must take up this work. A s this is a m ili­
tary measure some existing governmental medical department is the
logical force to carry on such a human conservation policy, in those
industries directly operated for m ilitary production.
The duties o f the governmental medical officers assigned to these
m ilitary industries should be: (a) T o establish plant dispensaries.
(&) T o give immediate medical and surgical care. This would save
lives and man}^ subsequent complications and deformities, (c) T o
examine all applicants fo r work. 1. T o protect the old forces from
contagious diseases. 2. T o prevent men with disabilities from being
placed at work where they could not be efficient— thus to prevent




CONSERVATION OF M A N PO W ER---- L IE U T . COL. H . E. M O C K .

211

premature breakdown. 3. T o provide physical selection o f men and
women fo r work. ( d ) T o supervise health o f workers by medical
examinations. ( e) T o establish plant sanitation. ( / ) T o establish,
house sanitation, (g) T o provide fo r all kinds o f disease and acci­
dent prevention.
In Government controlled industries and civilian industries carry­
ing on any type o f m ilitary work this governmental medical depart­
ment could assign medical officers at once to act as health inspectors.
A precedent is established by certain departments o f the A rm y in
that inspectors are assigned to inspect the products o f an industry—
as inspectors o f shells in munition plants. Also, a medical officer
has been assigned to shipbuilding industries for this work at request
o f the Secretary o f W ar.
The duties o f these inspectors would be: (a) Inspect plants for
insanitary conditions tending to slow up production, and report on
same. ( b) Use influence to have these industries establish the above
health policy by using civilian doctors. This could be forced by the
Government by including certain clauses in contracts, by comman­
deering methods, etc.
Comprehensive plans fo r the reconstruction and otherwise reclaim­
ing o f the war disabled are being developed by the Federal Govern­
ment. Since the industrial army is equally serving the country this
reclamation work should be extended to include the disabled from
these military industries. Hundreds are being disabled every day.
Therefore reconstruction hospitals should be established at once
and work on the reclaiming o f the disabled from the industrial army
begun at once. Man power is at such a premium now that this policy
is essential to the winning o f the war. Federal and State govern­
ments should be held responsible for reclaiming their disabled.
A lso this reclamation work should be extended to those rejected
because o f disabilities from both the military and the industrial army.
A t present these are being thrown back into society as a discard with­
out the Government taking proper steps to reclaim this man power
so badly needed. It is an economic waste which an efficient war
policy demands should be conserved.
Man power will win this war, man power at the front over there,
and man power in the great’ industrial army— the second line o f de­
fense— over here. A s a Nation we are united in one great purpose—
our determination to win this war. Our every motive must be toward
this end.
Therefore every effort expended fo r the conservation o f human
life and the reclamation o f all human energy, in both the military
and industrial armies, will be o f the greatest aid in achieving this
victory.




PROBLEM OF THE CRIPPLED MAN IN INDUSTRY.
BY

CARL

HOOKSTADT,

EXPERT,

U N IT E D

STATES

B U R E A U OF LABOR

S T A T IS T I C S .

T he purposes o f this article are to outline the actual industrial prob­
lem, as disclosed by several intensive investigations, confronting
workmen permanently injured in industry; to analyze the causes o f
the various factors entering into the problem ; and to offer certain
remedial suggestions. The statements are based' chiefly upon a study
o f industrial cripples in Massachusetts, supplemented by similar in­
vestigations in California, W isconsin, New Y ork City, and Denmark.
The facts show the actual economic consequences o f permanent dis­
abilities under normal industrial conditions.
THE PROBLEM.

The economic problems resulting from permanent disabilities are
indicated by (1) length o f time totally disabled; (2) change o f occu­
pation and o f em ployer; (3) number unemployed; (4) reduction in
wages and earning capacity; (5) relative severity o f various types o f
injuries in different occupations and industries; and (6) the adequacy
o f present statutory compensation benefits as compared with probable
loss o f earning capacity.
Period of total disability.— The period o f total disability resulting
from the loss o f limbs is shown by the follow ing table. Loss o f a
member, as hereinafter used, means loss o f use or impairment o f
functions, as well as loss by severance or amputation.
P E R IO D OF TOTAL D IS A B IL IT Y R E SU LT IN G FROM LOSS OF LIM B, B Y T Y r E OF
IN JU R Y .
Average period of
total disability
in months.

Per cent of cases causing total
disability of 18 months or
over.

Type of injury.
Massa­
chusetts.

Califor­ Massa­
nia.
chusetts.

Califor­
nia.

Den­
mark.

Loss of—
Hand or arm .............................................................
Foot or leg..................................................................

13.4
24.8

12.7
13.4

26

59

28
42

55

T otal.......................................................................

15.9

13.0

33

33

28

19

The above figures are minimums. Many o f the injured men were
still disabled or unemployed at the time o f the investigation, and the
actual disability periods, therefore, are longer than the figures indi­
cate. The accidents investigated in California occurred later than
those in Massachusetts, which accounts in part for the shorter disa­
bility periods reported.
212




T H E C R IP rL E D M A N IN IN D U ST R Y ---- CARL H O OKSTADT.

213

Tw o important facts stand out. One is the greater severity o f the
fo o t and leg injuries over those o f the hand and arm, and the other
is the unexpectedly long period o f disability in all cases. One-third
o f the workers losing a hand or foot are disabled for 18 months or
over. The average length o f total disability fo r the lesser injuries is:
■Loss o f one eye, 4.8 m onths; o f one thumb, 2.4 m onths; one finger,
2.1 m onths; two or more fingers, 3.8 months. The relative severity
o f the several types o f permanent injuries is also shown by the pro­
portion o f cases o f each type o f injury in which disability terminates
within 5 months. These proportions a re: H and or arm, 21 per cent;
foot or leg, 13 per cent; eye, 67 per cent; thumb, 59 per cent; one
finger, 91 per cent; and two or more fingers, 76 per cent. The per­
centages for the loss o f limbs were based upon the combined data o f
Massachusetts and C alifornia; the percentages for the other injuries
were based upon C alifornia data alone.
In each type o f injury the seriousness o f the disability increases
with the age o f the workman. The average total disability fo r those
under 45 years and those 45 years or over is as fo llo w s: Loss o f one
limb, men under 45 years, 12.2 months; men 45 years or over, 20.3
m onths; loss o f one eye, men under 45, 4.4 m onths; men 45 or over,
6.5 months; loss o f one thumb, 4.1 and 4.6 months, respectively;
one finger, 2 and 2.7 m onths; two or more fingers, 3.4 and 5.1 months.
Here again the averages fo r the m ajor injuries are based upon the
combined Massachusetts and California data, whereas the lesser
injuries are fo r C alifornia alone.
Change of employer and occupation.— Opportunity for reemploy­
ment by the same employer varies inversely with the severity o f the
injury. O f those who lose a hand or foot less than 40 per cent (Mas­
sachusetts, 39 per cent; California, 37 per cent; W isconsin, 37 per
cent) return to the same employer. F o r other injuries the percent­
ages o f workmen returning to the same employer are as fo llo w s: Eye,
62 ; thumb, 56; one finger, 58; two or more fingers, 57.
A bility to return to the same occupation also decreases with the
severity o f the injury. O f those who lose a hand or foot less than
one-third return to the same occupation (Massachusetts, 10 per cent;
California, 33 per cent; W isconsin, 18 per cent; Denmark, 24.4 per
cent). F or other injuries the percentages in California are as fo l­
lows : Eye, 73; thumb, 68; one finger, 69; two or more fingers, 60.
A bout one-third o f the persons, therefore, sustaining a major in­
jury return to the same employer, and about one-fourth reenter the
same occupation, while in the case o f m inor injuries three-fifths re­
turn to the same employer and two-thirds follow the same occupa­
tion. O f the several types o f injuries the loss o f an eye has the least
effect upon the change o f occupation or employer.




214

R E H A B IL IT A T IO N .

The character o f the industry determines to a considerable extent
whether the injured man is reemployed in the same industry or by
the same employer. Machinery m anufacturing establishments show
a high percentage o f reemployment. This is due mainly to two rea­
sons: First, the employees are usually highly skilled, and because o f
this fact are more readily reem ployable; second, because o f the
nature o f the work employment fo r this type o f disabled man is either
already available or can be more easily created. On the other hand,
employers in the building construction or trucking business show a
low percentage o f reemployments. The character o f the work and
the small size o f the establishment account chiefly fo r the nonreem­
ployment in these industries.
The percentage o f those unemployed increases with the serious­
ness o f the injury. O f those who lost a lim b about one-fourth were
unemployed at the time o f the investigation (Massachusetts, 23 per
cent; California, 27 per cent; W isconsin, 16 per cent; New Y ork
City, 54 per cent). O f 45 eye-injury cases in California, 13 per cent
were unemployed. A m ong those suffering minor injuries the per cent
o f unemployment was small. In C alifornia, o f those losing one
finger, 2 per cent were unem ployed; o f those losing two or more
fingers, 5 per cent were unem ployed; and o f those losing a thumb,
hone was unemployed.
There was practically no difference between right-hand and lefthand injuries as regards length o f total disability and opportunity
fo r reemployment. This is due to the fact, as will be explained later,
that a crippled man’s greatest handicap is not his inability to per­
form work, but his inability to get a job.
A comparison, from the standpoint o f degree o f skill required, o f
occupations held by workmen before and after injury, shows that
a smaller number were engaged in skilled work after the injury than
before it. In Massachusetts, o f the injured workers losing a limb,
60 per cent were in skilled occupations before the injury, whereas
only 31 per cent were in skilled occupations after the injury. In
California the corresponding percentages were 61 before and 45 after
the injury. O f those sustaining minor injuries practically the same
per cent were in skilled occupations after the injury as there were
before.
Inability to speak English in many cases lessens the opportunity
fo r reemployment, although it is not possible to show this statisti­
cally, because o f incomplete and indefinite data. In a number o f
cases reported by the industrial accident board and by insurance
companies in Massachusetts this factor had a determining influence.
A bility to understand and speak English may not be o f vital im­
portance to a machine tender in a cotton mill, but it is essential to




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215

watchmen, messengers, and elevator operators, and it is occupations
o f this character that most o f the injured employees fill after their
injury.
Summarizing the above conclusions, it may be said that reem­
ployability o f crippled industrial workers varies directly with degree
o f occupational skill and ability to speak English, and inversely with
the severity o f the injury and the age o f the employee.
Change in wages and earning capacity.— The effect o f the injuries
upon earning capacity is difficult o f determination. Change in
earning capacity is indicated by the difference in the wages received
before and after injury, but this method o f comparison is entirely
misleading unless industrial conditions have remained stationary for
a sufficient length o f time. Another method is to compare the wages
o f crippled workers with those received by normal workers in the
same occupation; this method is faulty, however, in that it takes no
account o f change in occupation necessitated by the injury. The
best method o f measuring reduction o f earning capacity is to com­
pare the present wages o f fhe injured worker with the wages current
in the occupation in which he was injured.
In Massachusetts 48 per cent o f the injured workmen (hand and
foot cases) received less at the time they returned to work than they
received before the injury, 34 per cent received the same wages, and
18 per cent received a higher wage. In California the corresponding
percentages were 41, 33, and 26. In case o f the lesser injuries (eye,
thumb, and fingers) 17 per cent received less, 33 per cent received
the same, and 50 per cent received more.
Relative severity of upper and lower limb injuries.— I t may be
well to emphasize here that while from the medical and economic
standpoint the loss o f a foot or leg is more serious than the loss o f a
hand or arm, the compensation schedules o f every State are based
upon the theory that industrial workers who lose an upper limb suf­
fer a greater economic loss than those who lose a foot or a leg. Even
the committee on statistics o f the International Association o f In ­
dustrial A ccident Boards and Commissions seems to have adopted
this view in form ulating its severity rating schedule. The common,
and practically the only, argument in substantiation o f this belief is
that 66it stands to reason.” Y et an analysis o f the follow in g table,
giving the results o f fou r independent investigations, shows the con­
trary to be true.
There are tw o main reasons fo r this. In the first place the economic
severity o f foot and leg injuries is accentuated by the fact that a
preponderant number occur in industries in which the loss o f the
member is a practical bar to employment. A one-legged man is
effectively excluded from most o f the operations in the transporta­
tion, construction, lumbering, and m ining industries; it is in employ­




216

R E H A B IL IT A T IO N .

ment o f this character that three-fourths o f the foot and leg injuries
occur. In California 91 per cent o f the permanent fo o t and leg in­
juries occurred in nonmanufacturing industries and 60 per cent
occurred in transportation and construction. A n analysis o f the
permanent disability accidents in Massachusetts during the first four
years5operation o f the compensation act shows that 75 per cent o f the
hand and arm injuries occurred in m anufacturing industries and 25
per cent in nonmanufacturing industries, while the percentages as
regards foot and leg injuries were exactly reversed, being 25 in
m anufacturing and 75 in nonm anufacturing industries. Nearly all
o f the latter injuries occurred in the building trades, transportation,
and construction.
O rdinarily when one thinks o f the relative industrial usefulness o f
an upper and a lower limb one has in mind factory operations. A nd,
o f course, in operating a machine a one-legged man is less handi­
capped than a one-armed m a n ; but machine operators do not lose
their legs, they lose their hands and arms. In manufacturing indus­
tries in which the m ajority o f upper-limt) injuries occur, the injured
workman can often go back to the same employer or the same occupa­
tion. On the other hand, the industries dangerous to lower limbs are
the industries in which the use o f lower limbs is practically in­
dispensable. A larger proportion o f those who sustain foot and leg
injuries, therefore, must seek a new employer, and this fact affects
adversely their reem ployability (see table below ).
In the second place, the greatest industrial handicap heretofore
suffered by a crippled worker, as already noted, has not been his
inability to perform work, but his inability to get a job. Potential
ability to perform work is o f little use to a workman who by reason
o f his injury is prevented from seeking employment, or is not em­
ployed even i f he does find a prospective job.
The follow in g table shows the relative severity o f upper and lower
limb injuries as shown by fou r independent investigations:
R E L A T IV E SE V E R IT Y OF U P P E R A N D L O W E R LIMB IN JU R IE S AS SHO W N B Y VA R IO U S
INV ESTIG A TIO N S.

Place of investigation.

M assachusetts.....................................................
California ...........................................................
New York C ity...................................................
Denmark
......................................................

1 Ter cent reemployed by same employer.




Per cent of
Per cent reAverage pe­ cases in which
employed by
riod of total disability con­ Ter cent
same
employ­
disability in tinued for 18 unemployed.
er or in same
months.
months or
occupation.
more.
Hand
or
arm.

Foot
or
leg.

Hand
or
arm.

Foot
or
leg.

13.4
12.7

24.8
13.4

26
28

59
42

19

55

2

Hand
or
arm.

Foot
or
leg.

30
41
8

24
62
17

H and Foot
or
or
arm.
leg.
52
i 40

30
132

a 27

*1 6

Ter cent of persons reemployed in same occupations.

T H E CRIPPLED M A N IN IN D U ST R Y ---- CARL H O OK STAD T.

217'

It w ill be noted that in practically every case the loss o f a foot or a
leg is more serious than the loss o f a hand or an arm as regards length
o f total disability/, per cent o f persons reemployed by same employer
or in same occupation, and per cent o f persons remaining unem­
ployed after the injury.

Comparison of statutory benefits with probable loss of earning
capacity.— Adequacy o f compensation benefits should be earnestly
considered in conjunction wTith the whole rehabilitation and reemployment problem. In none o f the existing State compensation
laws is the scale o f benefits commensurate with the economic losses
sustained by reason o f industrial injuries. The benefits provided
under the most liberal law are not more than 50 per cent o f full
indemnity, and those provided under the least liberal law are not
over h alf that o f the most liberal. Some idea o f this inadequacy is
obtained by com paring the statutory benefits with the schedule o f
severity ratings o f industrial injuries formulated by the committee
on statistics o f the International Association o f Industrial Accident
Boards and Commissions. The purpose o f this schedule was to
obtain a more accurate measure o f industrial hazards and was not
intended as a basis o f compensation awards. Assuming, however,
that the schedule is a reasonable measure o f adequacy fo r compen­
sation payments, how do the compensation scales in our State laws
compare with this schedule? The follow ing table shows, fo r the
more important injuries, the severity ratings in terms o f number o f
weeks o f time lost as computed by the committee on statistics, the
number o f weeks o f compensation benefits usually provided in State
laws, and* the percentage the average time allowances o f all the
States is o f the severity schedule:
SE V E R IT Y RATING IN TIME LOST FROM EACH SPEC IFIE D IN JU R Y , A N D P E R C ENT
OF TH IS LOSS COM PENSATED B Y ST A T U T O R Y B E N E F IT S .

Injury.

D ea th .....................................................................................
Permanent total disability..................................................
Loss of—
A r m ................................................................................
Hand ...........................................................................
L e g ..................................................................................
Foot..................................................................................
E v e ..................................................................................
Thumb
.......................................................................
Index finger ..................................................................
Great to e................................. ........................................

Severity rat­
Number of
ings in time weeks for which
lost (in weeks), compensation
computed by is usually pay­
committee on
able unaer
statistics of
State compen­
I. A .L A .B .C .
sation laws.1

Per cent aver­
age time allow­
ance of Stale
laws is of com­
m ittee’s sever­
ity schedule.2

1,000
1,000

300
500

64

600-750
500
500-750
400
300
100
50
50

200
150
175
125
100
60
30
30

29
33
38
35
36
53
66
55

1 The number of weeks here given are those provided in the normal or model State compensation law.
2 These averages are computed from the arithmetical average of all the State laws having specific
schedules.




218

R E H A B IL IT A T IO N .

A s the table shows, the average statutory compensation provided
fo r the loss o f a hand, arm, foot, leg, or eye is approximately onethird o f the loss o f earning capacity caused by such injuries. M ore­
over, the adequacy o f the benefits provided decreases with the severity
o f the injury. The above percentages refer only* to time. W hen
the statutory wage percentages are applied, the percentages o f
adequacy are still further reduced. Furthermore, a just and ade­
quate compensation scale fo r permanent disabilities should take into
account not only the workman’s decreased earning capacity, but his
increased livin g expenses as well. I f the necessary expenditures o f a
one-legged man are greater than those o f a normal man, his net in­
come and consequently his real earning are doubly reduced.
ANALYSIS OF CAUSES*

From the foregoing facts it is quite clear that the present industrial
handicap o f the workman who sustains a m ajor injury is a serious one.
The period o f total disability resulting from the injury is unneces­
sarily long. Only about one-third o f the seriously crippled workers
return to the same employer, and relatively few reenter the same
occupation. The compensation benefits are inadequate, and prac­
tically no retraining has been done. A critical analysis o f the several
contributory causes shows that nearly all o f these causes have their
origin in, and are closely related to, the absence o f a central and
responsible supervising authority. The welfare o f our crippled men
has been nobody’s business. Closely connected with this irresponsi­
bility is the lack o f opportunity. The very fact that men a^e crippled
has closed the door o f opportunity against them. They are not
given a chance to show their worth or ability. Some o f the more
im portant o f these contributory causes, in the order in which they
would present themselves to the injured employees, are as fo llo w s :
1.
The injury produces a sense o f helplessness and uselessness.
The injured man’s self-reliance is temporarily destroyed and he feels
that he is “ done fo r ” fo r the remainder o f his life. Coupled with
this is a feeling o f resentment and bitterness toward society for his
injury. In many cases he refuses to cooperate and adopts an antago­
nistic attitude toward all efforts to help him. H is unfam iliarity
with his legal rights prevents him from distinguishing between those
who wish to help him and those who desire to exploit him. Usually
the_first person with whom he comes in contact follow ing his injury
is the insurance company adjuster, who often antagonizes him and
arouses his suspicions. The agent’s efforts to obtain the facts in the
case in order to ascertain whether and to what extent the company
is liable are interpreted as an attempt to take advantage o f him.
In many cases the agent is tactless, unsympathetic, and inclined to




T H E CRIPPLED M A N IN IN D U ST R Y — CARL H O O K STAD T.

219

take advantage o f the employee. A t the very time when the injured
man is in most need o f assistance and sympathetic advice he meets
with indifference and exploitation. This initial experience colors all
his subsequent acts and has an important effect upon his reaction
toward medical treatment, rehabilitation, and reemployment.
2. Another contributory cause is the inadequate medical service
furnished, both as to quantity and quality. From every viewpoint,
and especially from that o f social economy, unlimited medical and
surgical treatment, without cost to the employee, should be provided.
Here again the element o f distrust affects adversely the speedy
recovery o f the injured man. In many cases the employee is sus­
picious o f the service provided by the insurance carrier and is ex­
ploited by those in whom he has confidence and who speak his own
language. There is no one to take an intelligent interest in him
and to obtain his confidence. Furthermore, some races are pecul­
iarly sensitive to pain and refuse to undergo necessary operations
or other treatment recommended. Because o f this lack o f coopera­
tion the injury does not heal properly and disability is unnecessarily
prolonged, or made permanent.
3. A third contributory factor, correlated with the medical service,
is the lack o f rehabilitation hospitals fo r functional restoration.
Practically the only attempt at rehabilitation revealed by these
studies was the furnishing o f artificial hands or arms, and these were
supplied in only about one-half the cases. In many instances the
men refused to wear these appliances, either because they did not
fit or because they were unsightly and useless. No systematic in­
struction in the adjustment and use o f them was given.
4. Not only has there been very little reeducation and retraining o f
industrial cripples, but a large proportion have never been educated
or industrially trained at all. The task o f retraining our disabled
men brings into relief the great need for industrial education. H ow ­
ever, those who are most helpless and in need o f assistance are fo r ­
eigners, and consequently even an adequate industrial education
system would not solve the whole problem. But by no means all o f
the disabled would be subjects for retraining. V ery little could
probably be done with the old men— those who were already near
the end o f their industrial career at the time o f the injury. But an
intelligent readjustment o f industry and the interested cooperation
o f employers would take care o f most o f the remainder. Thousands
o f positions exist which a one-armed or one-legged man could fill as
successfully as a normal man. Obviously, however, it would not be
desirable to place all these injured men in such positions without
regard to age. F or example, men under 21 or 25 years o f age should
not spend the rest o f their lives operating elevators. Those most in




220

R E H A B IL IT A T IO N .

need and best adapted fo r reeducation are the young men. O f the
disabled men studied in Massachusetts, 12 per cent were under 21
years, 28 per cent were under 24, and 43 per cent were under 30.
F o r C alifornia the corresponding percentages are 9, 18, and 35.
M ost o f these could probably be benefited by reeducation and re­
training fo r suitable occupations.
5.
None o f the compensation States have established proper facili­
ties fo r the reemployment o f handicapped men. In Massachusetts
insurance companies must pay compensation fo r total disability until
the men are reemployed. Consequently, it is incumbent upon them
to*find employment, but they have not been very successful. Em ­
ployers refuse to employ these industrial cripples unless they were
injured in their own establishments. Even then, because o f the
character o f the industry, the size o f the establishment, the em­
ployee’s lack o f skill and ability to speak English, his possible adverse
effect upon plant output and processes o f production, and the risk
o f a second injury causing serious or total disability, many are not
reemployed. Few employers will employ handicapped men injured
in other establishments. They feel no moral responsibility in the
matter and do not want to be bothered with cripples, especially i f
plenty o f . normal workers can be had at low wages. On the other
hand, many employers do feel morally responsible fo r workmen
injured in their own establishments, and this despite the fact that’
their fu ll legal obligations have been met by the payment o f com­
pensation insurance premiums. However, moral responsibility,
though important, is not necessarily the sole determining motive in
reem ploying even their own injured men. A study o f the reemploy­
ment cases in Massachusetts discloses the fact that in many instances
the men taken back are old, faithful, and usually skilled employees
whose knowledge o f the business is an economic asset to the employer.
One reason frequently advanced fo r not em ploying handicapped
men is that such men constitute an extrahazardous risk. From the
accident-compensation standpoint, injuries sustained by physically
defective workmen are more serious than similar injuries sustained
by normal workers and the accident or insurance cost to employers
or insurance carriers would be increased. A s a matter o f fact,
however, this fact is probably largely psychological, fo r the number
o f such accidents as compared with the total is practically negligible.
N o figures are available showing the actual number o f second perma­
nent' injuries. However, a computation made by the Bureau o f
Labor Statistics from accident data furnished by the Industrial
Commission o f W isconsin shows that the annual number o f second
m ajor injuries would at the very most be not over four in the entire
State, that is, o f all the persons in the State o f W isconsin who had




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221

lost a hand, arm, foot, leg, or eye not more than fou r would suffer
the loss o f a second m ajor disability in any given year.
From the insurance standpoint, therefore, the employment o f
physically defective men would present no special problem. The
increased compensation cost, which, w ould be slight, could be taken
care o f by the necessary increase in insurance rates. But this does
not hold true as regards self-insured *employers, because in such
establishments there is a greater and more direct connection between
accidents and compensation costs, and because o f this connection
there is a decided tendency among self-insurers, through their
system o f physical examinations, to discriminate against handicapped
men.
This factor o f discrimination, therefore, whether based upon justi­
fiable grounds or not, does actually exist and must be met. Tw o
remedial measures suggest themselves. One is, the adoption o f the
New Y ork plan o f compensating fo r second injuries. Under the
compensation act o f this State the liability o f an employer fo r a
second m ajor disabling injury is limited to' the liability resulting
from that particular injury without reference to any prior disability.
Compensation fo r the remaining disability is paid out o f a special
fund, which could be charged to the industry as a whole. Since
July 1 o f this year the Industrial Commission o f Ohio has also put
this plan into effect in that State. Thus, from the compensation
viewpoint the extra hazard element inherent in a handicapped man
would be eliminated and one factor o f discrimination removed.
A second remedial measure would be the adoption o f a plan p ro­
viding that employers, before they are granted the privilege o f
carrying their own risk under the compensation act, must agree not
to discriminate against crippled men in the matter o f employment.
Such an agreement by employers is required by the compensation
board o f Pennsylvania.
6.
One o f the chief obstacles in the way o f a successful solution o f
the whole rehabilitation problem lies in the very nature o f our indus­
trial society. Reemployment is beyond the State’s present power.
Our industries are privately owned and consequently opportunities
fo r industrial employment are under the exclusive control o f private
employers. Em ployers therefore can not legally be compelled to
reemploy handicapped workers.
This question o f compulsory employment has been considered by
foreign countries in connection with the reemployment o f disabled
soldiers. In France employers who refuse to reemploy their propor­
tionate share o f m ilitary cripples are excluded from obtaining any
concession, m onopoly, or subsidy from the State. In Italy private
employers em ploying three or more persons must take back those




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R E H A B IL IT A T IO N ,

employees who had been with them one year i f they can do the same
work. The Paris conference o f May, 1917, went on record as fo llo w s :
It belongs to the legislature o f each allied country to decide whether or not
employers should be placed under obligation to employ disabled soldiers.
Meantime, the interallied conference holds that there is a m oral obligation
resting upon employers to employ disabled soldiers in a number proportional
to the im portance and personnel o f each industrial and com m ercial estab­
lishment.

This principle o f compulsion or constraint m ight conceivably be
applied to the employment o f industrial cripples. F or example, the
State compensation acts m ight be amended to provide that employers
having a certain number o f employees must pay additional compen­
sation to injured workmen i f they refuse to reemploy tl\ese men at
suitable jobs and at fair wages. Such a scheme m ight act as an
incentive for employers to make an intelligent study o f their estab­
lishments, with the result that positions could be found or created
which would be mutually beneficial.
7. But actual restoration to industry solves only h a lf o f the prob­
lem. It is important to know under what conditions injured workers
are reemployed. W hat wages should they receive, both absolutely
and in relation to normal workers ? W hat effect w ill their reem ploy­
ment have upon the displacement o f normal workers and upon the
integrity o f the organized labor movement? Those employers who
maintain sick-benefit funds, welfare plans, and the like seem more
inclined to reemploy and take care o f their injured workers than
other employers. On the other hand, they are extremely hostile to
labor organizations and would resent interference from this quarter.
It is the policy o f some o f the labor unions to look after their own
disabled men, but a large proportion o f injured workers are not mem­
bers o f labor organizations. The difficulties involved in these funda­
mental problems, though great, need not be insolvable, but they
require cooperation and careful study.
8. Another factor tending to prolong disability and prevent early
return to industry is the operation o f the lump-sum provision in many
o f the State compensation laws. A lump sum usually looks large and
inviting to the average employee. He may want to return to his
native country or to invest the proceeds in some small business
enterprise, though these reasons are frequently given merely as a
pretext to influence the industrial board. Often the employee is
afraid that his return to work would prejudice his rights under the
law. As a result the case drags on and on until for sheer relief a lump
sum is finally granted.
9. F or the reasons mentioned above the injured man remains dis­
abled and unemployed much longer than the circumstances warrant.
Accustomed to idleness and regular compensation payments he feels




T H E CRIPPLED M A N IN IN D U S T R Y — CARL H O O K STAD T.

223

progressively less inclined to resume work. H e gets into a rut,
adapts himself to a lower standard o f living, and loses his ambition
and initiative. H is idle time is frequently spent in saloons and other
lounging places, in which he finds cronies similarly situated. Here
he discusses his ailments, the seriousness o f which he is inclined to
exaggerate, and the effect o f which produces a psychosis which im ­
pairs his w ill power and accelerates his physical deterioration.
10.
A n analysis o f the foregoing contributory causes shows that
they are all closely related to, and the result o f, the lack o f an intelli­
gent and responsible supervision. The welfare o f our disabled men,
whether injured in m ilitary or civil life, is a social and public func­
tion. Accident prevention, compensation, insurance, medical treat­
ment, rehabilitation, reeducation, and reemployment are all com­
ponent parts o f this problem and should be under the supervision and
jurisdiction o f a single public body. D elegating to private agencies
the performance o f these social functions should no longer be toler­
ated. This is not intended as a criticism o f these private agencies.
They have developed largely because the State failed to grasp its
opportunity or shirked its responsibility; but the fact remains that
they have not been able to perform these social functions successfully.
REMEDIAL SUGGESTIONS.

A n examination o f the facts and. an analysis o f the contributory
causes prom pt the follow in g remedial suggestions:
1.
Compensation.— (a) The compensation scale o f benefits should
be materially increased to approximate the loss o f earning capacity.
(&) Benefits for permanent injuries causing dismemberment or muti­
lation should be fixed at a definite, though adequate, amount, graded
according to nature o f disability and age and occupation o f the em­
ployee, but not dependent upon employment in individual cases.
Injured employees should not be penalized fo r rehabilitating them­
selves. W hen the injured man knows that the amount o f his com­
pensation will not be affected by his early return to industry, disabil­
ity and unemployment w ill be materially decreased. ( c) In Massa­
chusetts compensation is paid fo r the loss o f a major member fo r
50 weeks, and also fo r total disability while disabled, and these pay­
ments run concurrently. This practice o f concurrent payments
should be abolished. The combined weekly amounts o f such pay­
ments in most cases exceed the employee’s wages. Employees are
often under the impression that the amount received will continue
indefinitely, and consequently have less desire to return to work.
(d) The present system o f granting lump sums should be abolished
or materially restricted fo r reasons already explained. ( e) E m ploy­
ers should be relieved o f the added risk involved in the employment
o f disabled workers.




224

R E H A B IL IT A T IO N .

2. M e d i c a l s e r v i c e . — ( a ) Adequate medical and surgical treatment,
including necessary appliances, should be furnished by the State.
(6) Orthopedic and rehabilitation hospitals should be established
and maintained by the State, utilizing present institutions wherever
possible.
3. R e e d u c a t i o n a n d r e t r a i n i n g .— There should be established voca­
tional training schools, with both day and night courses, which should
be closely correlated with the rehabilitation hospitals.
4. R e e m p l o y m e n t .— A survey o f the occupational opportunities in
the various industries o f the State should be made and the coopera­
tion of the employers and labor organizations should be enlisted.
Thousands o f positions exist or could be created which crippled
workers could fill as successfully as normal workmen were the prob­
lem carefully studied and an intelligent readjustment made. Par­
ticular care should be taken to eliminate the stigma o f charity. The
positions should be necessary and constructive in an industrial sense
in order that the handicapped man may feel himself an integral and
important part o f the economic world and thus maintain his selfrespect.
5. I n s u r a n c e .— In the field o f workmen’s compensation, competitive
insurance companies are wholly unsatisfactory. Either a monopo­
listic State insurance fund or an employers’ mutual association should
be substituted for the competitive casualty companies.
6. A d m i n i s t r a t i o n .— The entire administrative and supervisory
work should be under the jurisdiction of one central authority, pref­
erably the industrial accident commission. This commission should,
in case o f necessity, have power to coerce the employee as well as the
employer. Confidence, impartiality, and intelligent direction and
supervision are vital factors in the whole rehabilitation problem, and
these can best be obtained through public administration.
Mr. Ralph M. Little, former chairman of the United States Em­
ployees’ Compensation Commission, and now director of the Ameri­
can Museum o f Safety, called the attention of the conference to the
Smith-Bankhead bills (S. 4922 and H. R. 12880) providing for Fed­
eral and State cooperation in promoting the vocational rehabilitation
o f persons disabled in industry or otherwise and their return to civil
employment. He gave an address explaining the meaning and
objects o f the bills and urged that they receive the support o f the
association.
The following motion was passed by the convention:
M oved that this organization indorse the principle o f the Smith-Bankhead
bills (S. 4922 and H. R. 12880) and that the president o f this organization be
authorized and instructed to appoint a committee fo r the purpose o f furthering
legislation along that line.




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