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U. S. DEPARTMENT OF LABOR
BUREAU OF LABOR STATISTICS
ROYAL MEEKER, Commissioner
BULLETIN OF THE UNITED STATES \
j
BUREAU OF LABOR STATISTICS J ............... L l O
WORKMEN’S
INSURANCE
AND
COMPENSATION
OAQ
SERIES
PROCEEDINGS OF THE FOURTH ANNUAL MEETING
O TH
F E
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 BOSTON, MASS., AUGUST 21-25, 1917
MARCH, 1919
WASHINGTON
GOVERNMENT PRINTING OFFICE
1919
C O N TE N TS.
TU E SD AY, A U G U S T 21, 1917—A FTER N O O N SESSION
.
I. Accident prevention.
Page.
Address of welcome, by Hon. Samuel W . McCall, governor of Massachu
setts........................................................................................................................... ..
9,10
President’s address, by Dudley M. Holman, president, International As
sociation of Industrial Accident Boards and Commissions......................... 11-15
Mechanical safeguards, by David S. Beyer, manager, safety engineering
department, Liberty Mutual Insurance Co.......................................................... 16-26
Shop safety committees, by Lew It. Palmer, chief inspector, Bureau of
Inspection of Pennsylvania....................................................................................... 27-29
Some showings from accident records, by Lucian W . Chaney, special
agent, United States Bureau of Labor Statistics.............................................. 30-37
Accident prevention, by Barney Cohen, director, Illinois Department of
L a b o r................................................................................................................................ 38-42
Discussion:
A. H . Young, director, American Museum of Safety...........................
43
Royal Meeker, United States Commissioner of Labor Statistics.. . 43-45
George A. Kingston, Commissioner, Workmen’s Compensation
Board of Ontario.......................................................................................... 43,44
Lucian W . Chaney, special agent, United States Bureau of Labor
Statistics........................................................................................................ 44, 50
Dudley M. Holman, president International Association of Indus
trial Accident Boards and Commissions............................................. 45,46
David S. Beyer, manager, safety engineering department, Liberty
Mutual Insurance Co.................................................................................. 46, 47
T. Norman Dean, statistician, Workmen’s Compensation Board
of Ontario.......................................................................................................
47
Carl Hookstadt, expert, United States Bureau of Labor Sta
tistics.................................................................................................................47,48
W ill J. French, member of the Industrial Accident Commission
of California....................................................................................................
48
James L. Gernon, of the New York Department of Labor................ 48,49
Dr. Joseph M. Burke, chief surgeon of the Seaboard Air Line
R ailw ay...........................................................................................................
49
A. W . Wright, vice chairman of the Workmen’s Compensation
Board of O ntario.......................................................................................... 49, 50
TUESDAY, AUGUST 21, 1917—EVENING SESSION.
II. How claims are handled, with special reference to lump-sum settlements.
Lump-sum settlements, by William C. Archer, deputy commissioner of
New York State Industrial Commission, in charge of Bureau of Work
men’s Compensation..................................................................................................... 53-58
3
4
CONTENTS.
II. How claims are handled, with special reference to lump-sum settlements— Concld. Page.
Lump-sum settlements, by C. II. Crownhart, formerly chairman of the
Industrial Commission of Wisconsin......................................................................
How claims are handled, with special reference to lump-sum settlements,
by Will J. French, member, Industrial Accident Commission of Cali
fornia .................................................................................................................................
Commutation of compensation awards under the Pennsylvania system, by
Harry A . Mackey, chairman, Workmen’s Compensation Board of Penn
sylvania.............................................................................................................................
Address by A . A. McDonald, chairman, State Industrial Commission of
Oklahoma..........................................................................................................................
Address by Miss Eunice G. Anderson, chief clerk, Workmen’s Compensa
tion Department of Wyoming...................................................................................
Discussion:
Charles S. Andrus, chairman, Industrial Board of Illinois..............
F. M. Wilcox, member of the Industrial Commission of Wisconsin.
Dr. John W . Mowell, medical adviser, Industrial Insurance Co.
of Washington................................................................................................
W ill J. French, member, Industrial Accident Commission of Cali
fornia.................................................................................................................
Lump-sum settlements, by J. M. Wilson, chairman, Industrial Insurance
Department of Washington (S tate)........................................................................
Discussion:
Charles S. Andrus, chairman, Industrial Board of Illinois..............
F. W . Armstrong, vice chairman, Workmen’s Compensation
Board of Nova Scotia..................................................................................
J. M. Wilson, chairman, Industrial Insurance Department of Wash
ington................................................................................................................
Charles H . Verrill, chief statistician, United States Employees’
Compensation Commission........................................................................
59-64
65-67
69-73
73, 74
74-77
75
76
76, 77 *
77
78-81
82-84
84-87
87,88
88, 89
W E D N E S D A Y , A U G U S T 22, 1917—M O R N I N G SESSION .
Business meeting:
Report of secretary-treasurer...... .................................................................................. 90-93
Remarks of Royal Meeker, United States Commissioner of Labor Statistics,
during discussion of constitution............................................................................. 93-96
Constitution of the International Association of Industrial Accident Boards
and Commissions........................................................................................................... 96-98
Report of the committee on statistics and compensation insurance cost... 98-116
W E D N E S D AY , A U G U S T 22, 1917—A F T E R N O O N SESSION .
III. Medical aspects of compensation insurance.
X-ray diagnosis as an aid to efficient administration of the workmen’s com
pensation act, by Arial W . George, M. D ......................................................... 118-122
Discussion:
F. D. Patterson, M. D ., chief, division of industrial hygiene, Penn
sylvania Department of Labor and Industry................................. 123-125
Raphael Lewy, M. D ,, chief medical examiner, New York State
Industrial Commission........................................................................... 125-130
F. W . Armstrong, vice chairman, Workmen’s Compensation Board
of Nova Scotia...............................................................................................
129
Joseph M. Burke, M. D ., chief surgeon, Seaboard Air Line Railway.
130
Timothy Leary, M. D ., medical examiner, Suffolk County, Mass. 130,131
CONTENTS.
5
,
W EDN ESDAY A U G U S T 22, 1917—EV E N IN G SESSION.
IV. Medical competence and hospital efficiency.
Pa^e.
Medical competence and hospital efficiency, by Francis D. Donoghue,
M. D ., medical adviser, Massachusetts Industrial Accident Board------132-138
The value of diagnosis in back lesions, by James Warren Sever, M. D.,
junior assistant surgeon, Children’s Hospital, Boston................................. 139-152
Reconstruction and the hospital, by F. J. Cotton, M. D ................................ 153-158
A review of industrial accident board cases examined at the Psychopathic
Hospital, by E. E. Southard, M. D ., pathologist, Massachusetts Commis
sion on Mental Diseases, and director of the Psychopathic Department
of the Boston State Hospital, and Sidney L. Pressey, Ph. D ., University
of Indiana.................................................................................................................... 150-170
T H U R S D A Y , A U G U S T 23, 1917—A F T E R N O O N SE S SIO N (L U N C H E O N ).
Massachusetts factory inspection, by Edwin Mulready, Commissioner of Labcr
of Massachusetts................................................................................................................. 171-173
Round-table discussion:
Dr. Frank E. Schubmehl, General Electric Co., Lynn, Mass.................. 174,177
Dr. I. M. Rubinow, director, Bureau of Social Statistics of New York. 174-179
Capt. William P. White, of the Associated Industries of Massachusetts 175,176
Dudley M. Holman, president, International Association of Industrial
Accident Boards and Commissions.............................................................. 176-179
Royal Meeker, United States Commissioner of Labor..................................
177
Lucian W . Chaney, special agent, United States Bureau of Labor
Statistics.................................................................................................................
178
George A. Kingston, commissioner, Workmen’s Compensation Board cf
Ontario..................................................................................................................
178
William M. Smith, chairman, Michigan Industrial Accident B eard.. 178,179
T H U R S D A Y , A U G U S T 23, 1917—E V E N IN G SESSION .
V. Accident problems.
Restoring the disabled to industry, by T. Norman Dean, statistician,
Workmen’s Compensation Board of Ontario....................................................180-188
Industrial safety through statistics, by Charles H . Verrill, statistician,
United States Employees’ Compensation Commission.................................189-191
Accident rates since 1914, by Dudley R. Kennedy, assistant to the president
of the Youngstown Sheet & Tube Co.................................................................... 192-207
Discussion:
George A . Kingston, commissioner, Workmen’s Compensaticn
Board of Ontario....................................................................................... 208, 210
Dudley R. Kennedy, assistant to the president o f the Youngstown
Sheet & Tube Co...................................................................................... 203-211
Dr. I. M. Rubinow, director, Bureau of Social Statistics of New
Y o r k ............................................................................................................ 208,211
Royal Meeker, United States Commissioner of Labor Statistics.. 203-212
E. H . Downey, special deputy, Insurance Department of Pennsyl
vania............................................................................................................. 209,210
Lucian W . Chaney, special agent, United States Bureau of Labcr
Statistics........................................................................................................
210
T. Norman Dean, statistician, Workmen’s Compensation Board of
Ontario...........................................................................................................
211
Shop lighting as a means of accident prevention, by C. W . Price, United
States Employees’ Compensation Committee.................................................. 213-216
Comparison of industrial with military casualties by I. M. Rubinow,
director, Bureau of Social Statistics, New York C ity..................................... 217-225
6
CONTENTS.
F R I D A Y , A U G U S T 2 4 , 1917— M O R N I N G S E S S I O N .
Business meeting:
Place of next meeting, and officers elected.............................................................
Page.
226
F R I D A Y , A U G U S T 24, 1917— A F T E R N O O N S E S S I O N .
VI. Needed changes in legislation.
Conflict between Federal and State jurisdictions in accident cases, b y A. J.
Pillsbury, chairman, Industrial Accident Commission of California___ 228-^42
Discussion:
W illiam M. Smith, chairman, Michigan Industrial Accident Board.
243
John Mitchell, chairman, New York State Industrial Commission 244-249
Capt. William P. White, Associated Industries of Massachusetts. 247-249
George A. Kingston, commissioner, Workmen’s Compensation
Board of Ontario................................... ............................................. 248, 249
W ill J. French, member, Industrial Accident Commission of Cali
fornia.........................................................................................................
249
Compensation for occupational diseases, b y R iley M. Little, chairman,
United States Employees7 Compensation Commission............................ 251-257
Discussion:
John B. Andrews, secretary, American Association for Labor Legis
lation..................................................................................................... 258,259
R . M. Little, chairman, United States Employees’ Compensation
Commission.......................................................................................... 258-261
William M. Smith, chairman, Michigan Industrial Accident
B oa rd ................................................................................................... 259,265
F. W. Armstrong, v ice chairman, Workmen’s Compensation Board
of Nova Scotia..................................................................................... 259, 266
A. W. Wright, vice chairman, Workmen’s Compensation Board of
Ontario.................................................................................................. 259-262
George A. Kingston, commissioner, Workmen’s Compensation
Board of Ontario................................................................................ 261-263
Capt. William P. White, Associated Industries of Massachusetts. 261, 266
W ill J. French, member, Industrial Accident Commission of
California.............................................................................................. 263-266
William Neill, assistant commissioner, Workmen’s Compensation
Board of Manitoba..................................................................................
267
Royal Meeker, United States Commissioner of Labor Statistics. . 267, 268
F R I D A Y , A U G U S T 24, 1917— E V E N I N G S E S S I O N .
VQ. Administrative problems.
Eye injuries, b y George A. Kingston, commissioner, Workmen’s Compen
sation Board of Ontario..................................................................................... 269-280
Discussion:
Dr. Francis D . Donoghue, medical adviser, Massachusetts Indus
trial Accident Board.......................................................................... 273-279
F. W. Armstrong, vice chairman, Workmen’s Compensation Board
of Nova Scotia.........................................................................................
273
Chester E. Gleason, member, Massachusetts Industrial A ccident
B o a rd .......................................................................................................
278
B. E. Kuechle, adjuster, Employers’ Mutual Liability Insurance
Co. of Wausau, W is............................................................................ 280, 281
Defects in the administration of compensation laws, b y Edward F. McSweeney, former member of Massachusetts Industrial Accident Board. 282-286
C O N TE N TS.
TII. Administration problems— Concluded.
7
Page.
Claim adjustments under workmen’s compensation, b y B. E. Kuechle,
adjuster, Employers’ Mutual Liability Insurance Co. of Wausau, W is.. . 287-290
Discussion:
A. A. McDonald, chairman, State Industrial Commission of
Oklahoma............................................................................................. 291-295
Dr. Francis D. Donoghue, medical adviser, Massachusetts Indus
trial Accident Board...........................................................................
294
A. W. Wright, vice chairman, Workmen’s Compensation Board of
Ontario...................................................................................................
295
Royal Meeker, United States Commissioner of Labor Statistics. . .
295
John M itchell, chairman of the New York State Industrial Com
mission.................................................................................................. 295-300
Resolutions.............................................................................................................. 300, 301
Discussion:
A. W . Wright, vice chairman, Workmen’s Compensation Board of
Ontario................................................................................................. 301-303
Appendix— List of delegates....................................................................................... 304-306
B U L L E T IN
U .
S .
B U R E A U
WHOLE NO. 248.
O F
O F
T H E
L A B O R
S T A T I S T I C S .
WASHINGTON.
MARCH, 1919.
PROCEEDINGS OF THE FOURTH AN U
N AL MEETING OF THE INTER
NATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT BOARDS AND
COMMISSIONS, BOSTON, MASS., AUGUST 21-25, 1917.
TUESDAY, AUGUST 21—AFTERNOON SESSION.
CHAIRMAN, DUDLEY M. HOLMAN, PRESIDENT, I. A. I. A. B. C.
I. ACCIDENT PREVENTION.
The Chairman. It gives me great pleasure this afternoon to in
troduce to you His Excellency Gov. McCall, who has shown a deep
interest in the workmen’s compensation act during his administration.
Under his administration added benefits have been given to the
worker; the Industrial Accident Board has been increased from
five to seven, thus obtaining for the injured worker more prompt and
efficient service. Gov. McCall in his first inaugural address not
only advocated very strongly added benefits to the workmen’s com
pensation act but was, I think, the first governor to suggest and ad
vocate to his legislature the passage of an old-age pension, and His
Excellency went even further than that, and suggested that invalid
ity insurance and unemployment insurance were pressing on the
heels of workmen’s compensation, and he appointed a commission to
study the entire subject of social insurance, which commission made
its report to our last legislature. Therefore, I take great pleasure
in introducing to the members of this International Association His
Excellency, Gov. Samuel W. McCall, of Massachusetts.
ADDRESS OF WELCOME.
B Y H O N . SAM UEL W . M ’ CALL, GOVERNOR OF M A SSA C H U SE T TS.
I am very glad to be here and to say a word of welcome to you.
I congratulate you that you have selected a man as the president
of this International Association who has had so much experience
in the administration of the workmen’s compensation act. I do not
9
10
ACCIDENT PREVENTION.
know how we compare in Massachusetts with the other States of the
Union, but our board has been making progress and has finally se
cured a procedure and a method of doing business which, I think,
is very admirable, and I only trust that the other States and the
Provinces of Canada are as well developed in that respect, if not
better. It is strange how we move along, how we feel our way along,
but I think perhaps the progress that comes from the groping ahead
instead of leaping ahead is better and more permanent. The oldfashioned shoemaker, for instance, was not exposed to any accidents
through the pursuit of his industry; possibly beyond hitting his
thumb instead of the shoe with the hammer, or something of that
sort, there was no liability to what might be called industrial acci
dents. But with the growth o f modern industrialism and with the
invention of these fast-flying machines which are in universal use
to-day industrial accidents became a settled thing—in spite of all
care on the part of the worker accidents will occur. And so the
industrial accident system is simply based upon this idea: that
accidents to workmen are a fair charge upon the industry, and
that it is most inhuman to permit a man who is injured, in an
accident to bear the whole burden of that injury alone. Now, the
application of this reasonable principle was resisted, but I am glad
to say that it has finally become almost universal, and the object
to-day is justly and fairly to administer the law; to find out just
what the accident is without minimizing or without exaggerating,
and in the giving out of the benefit, or rather in the distributing of
the benefit, to consider in proportion just the character of the acci
dent. Of course, the administration of any law is subject to abuse—
men may not get fair treatment; they may not get what they de
serve ; other men may sham; they may try to get more than they de
serve—but the permanency of this system of workmen’s compensa
tion will rest upon the honest and fair enforcement of the law. I
think we are getting that in Massachusetts; I believe and trust we
are getting it in the rest of the country.
So I am here just to say a word of welcome to the Commonwealth
of Massachusetts and to express my pleasure at seeing here the rep
resentatives from our different States and from the Provinces of
Canada.
P R E S ID E N T ’S A D D R E S S .
B Y DUDLEY M . H O L M A N , PRESIDENT, I. A . I . A. B. C.
It gives me great pleasure to extend to you a cordial welcome to
the Commonwealth of Massachusetts and to Boston, its capital city.
I give to you a genuine, hearty New England greeting, and trust
that you will not only profit by your attendance, but enjoy your stay,
and feel that you have been more than repaid for coming, some of
you, many thousand miles.
While our program is a working program, we have left a little
free time here and there, so that we can show you some of the historic
places, which perhaps you have never seen, but which are a part of
our national heritage.
Massachusetts was the earliest State to consider workmen’s com
pensation and one of the earliest to adopt it. Its interest in this
work grows as the beneficial results of this legislation make them
selves apparent.
Our association is international in its scope, and we have with us
not only representatives of the State and Federal Governments, but
of several of the Provinces of our nearest and dearest neighbor,
Canada. We, in this work at least, are one people. The imaginary
(line which separates us politically forms no barrier to the progress
of this great work, and hands are clasped across the border in earnest
desire further to extend the benefits of humanitarian legislation in
which we are engaged.
In preparing the program for this occasion the committee thought
best to deal exclusively with workmen’s compensation problems and
to divide them into three groups, arranging them in accordance with
what seemed to us the importance of each:
First. The accident prevention and health protection problem.
Second. The problem of human repair after the accident has taken,
place, so that the wage earner may be restored to active participation
in industrial life, fully reequipped for his old work if possible; if not,
for some work, and at the earliest possible moment consistent with
full recovery.
The third group is that of purely administrative problems—the
questions we all want answered—in order that we may have the
T
fullest and freest discussions, learning one from another the w ays in
T
which difficult or moot problems are being met and solved, and
endeavoring to arrive, if that be possible, at some uniformity in our
11
12
ACCIDENT PREVENTION.
way of solving them. With so many forms of compensation acts,
widely differing on material points, with almost no uniformity save
in the general scope and plan, this will not be possible in all cases,
but I think it will be in most cases.
I am glad to see so many of the units of our organization repre
sented here. It is a pleasure to see so many whom I have met and
known at other meetings and an added pleasure to meet so many
others who have come to us for the first time and who I know will
be given a hearty welcome by the older members.
I am, however, as are all of us who have been engaged in this work,
saddened with the remembrance that one of our honored members,
my immediate predecessor in office, the Hon. Wallace D. Yaple, has
been called from our earthly midst since last we met in his home
city, Columbus, Ohio. One of the pioneers in this work, he threw
himself heart and soul into it, with his tireless energy meeting the
big problems and solving them, leading us all in many ways, and he
studied night and day how best to meet and answer the questions
that constantly arise; a man who was loved by his fellows, whose
work lives after him, who took rank so high that we all looked up to
him and admired him. Called from us at a time when his guiding
hand was heeded and his advice was sought after from all quarters,
it seems to us incomprehensible, but it is not ours to question why
God, in His infinite wisdom, has taken him home and we must bow
in silent submission, realizing that He cloeth all things well, and
saying His will, not ours, be done.
It is a pleasure to me to again thank you for the honor you have
done us by assembling here, and I know that I but voice the senti
ments of the industrial accident board and the board of labor and
industries, both members of our organization, in saying to you that
we hope you will find yourselves repaid by coming and that this
meeting will be productive of real benefits not only in the discus
sions which are to follow, but in our getting together, in knowing
personally the men engaged in this work in the States and Provinces.
This will lead to a broader development of the principles of work
men’s compensation, and fit us to grapple with other and collateral
problems when they come before us, as they soon must, for all touch
upon the one great problem—that of the man and woman in indus
try, how we can best advance their interests, make their life’s work
more enjoyable through recognition of the principle that men and
women engaged in industry should be protected from the hazards
of that industry, should be guarded as to s&fety and health and
made more efficient by the greater care taken to make their work
places, not task rooms, not places to drag out the day under condi
tions that undermine thedr health and constitutions, but business
places wherein they, happy and contented in their labor, intelligent
ADDRESS OF TH E PRESIDENT OF TH E ASSOCIATION.
13
and well directed, are doing their share in building up industry,
developing our natural resources, standing as one man behind the
Government under which they live, giving the best that there is in
them, in order that they and their children may in the future not
only live in peace, but be accorded their rightful share in the pros
perity which peace brings.
Facing as the world faces to-day the great problem of the success
of democracy serious matters await our consideration. In the
program as prepared, imperfect as it is and handicapped as the com
mittee has been by reason of the conditions which exist, you will
see the wisdom of our placing first on the program accident preven
tion and health protection.
I doubt whether the general public understands fully the work
our boards are doing, or the extent and expense of this waste of
life and health in industry. In the Commonwealth of Massachusetts
during the fourth year of the act, there were 135,257 nonfatal and
463 fatal accidents reported. The number of benefit cases in that
same year reported by the insurance companies was 93,825* Of this
number 65,779 had medical service only and 23,819 had both com
pensation and medical service. Of the killed, in 239 cases there was
total dependency and in 53 cases partial dependency.
There was paid out in this fourth year $834,804.52 for medical
treatment and $3,252,146.97 for compensation, making a total of
$4,086,951.49 paid out in that year under the act. The average cost
last year per benefit case was $43.56.
In four years, in Massachusetts, there has been paid to injured
workmen and their dependents under the provisions of this act
$11,224,534.31 in the form of compensation and medical treatment.
The economic waste has been nearly three times that amount, so
that we can gain some idea of the enormous waste in industry in
this one State alone from accidents.
This will explain why we are desirous of checking this great and
largely unnecessary waste—over 50 per cent absolutely preventable.
Is it worth while to cut this waste in two ? Is it worth while to pre
vent one-half of this great suffering which these figures reveal?
Is it worth while to save over 200 lives annually? Is it necessary
to have trained workers on their jobs at this time and not to have them
absent because of preventable accidents when the workers in indus
try are just as essential as the men on the firing line at the front?
This association, if it can only drive home these facts into the
minds of the people and arouse them to the necessity for prompt and
effective action in accident prevention, will have done much to justify
its existence, and it is for this reason that in arranging this program
we have given the place of first importance to the work of accident
prevention.
14
ACCIDENT PREVENTION.
Frederick W. Loughran, M. D., medical adviser, New York State
Insurance Fund, makes the following statement:
I f w e w ere to stop fo r a moment to consider the cost o f sickness among the
w age earners o f this country, w e w ould be appalled at the stupendous total.
There are 30,000,000 w orkers in the United States whose average annual loss
through illness is about nine days each. This is equal to 739,736 years each
year, and as the average daily w age is estimated at $2.50, and the cost o f m edical
attention at $1 a day, the annual loss to these 30,000,000 w orkers w ould be over
$945,000,000. * * * The loss to the wrorker is not the only one in cu rred;
w e must take into consideration the one sustained by the employer, am ounting
to about $5 a day, or $1,350,000,000.
Should we not see that the working places are made healthful, sani
tary, well ventilated, and well lighted to stop this tremendous waste
consequent upon the breaking down in industry through surround
ings that induce fatigue, disease, and discomfort? Is it or is it not
worth while for our industrialists to consider these questions thought
fully when the remedy lies largely in their own hands ?
The greatest need to-day is man power. Man power means man
and woman power, and this spells equal opportunity to both men
and women, opportunity to render service. We all know that in
periods of stress when a great national or world need arises the women
respond with no less willingness to serve than the men, and the world
is witnessing to-day sights that were undreamed of three short years
ago. Wives, mothers, daughters, and sisters have gone into mills and
factories, into the fields, into banks and business houses, aiding in
every possible way.. It is therefore our duty to see that when they
step in to fill the gaps caused by the withdrawal for war service of
their husbands, sons, fathers, and brothers that they are given safe,
healthful, and cheerful places in which to work. They, because of
the unaccustomedness of their surroundings, of the entire change in
their lives, are more susceptible to accidents and disease than workers
life-trained in these same employments. That is why accidents have
doubled in all our industries during the past year and a half. There
must be something more than the perfunctory enforcement of labor
laws and safety laws. Conditions must be studied by men and women
qualified to investigate, suggest, and insist upon remedial action.
Our very existence as nations depends upon the ability not only to
mobilize our forces in industry, but to maintain the workers at the
height of their efficiency and protect them from the hazards of indus
try to the best of our ability.
I would suggest the appointment of a committee by this association
to do this work and to cooperate with our respective Governments in
every possible way, through existing agencies if there be such, if not,
to initiate such agencies in order that all may benefit thereby.
ADDRESS OF TH E PRESIDENT OF T H E ASSOCIATION.
15
The. workers must, when unfortunately they are injured, be given
the best medical attention in order that they may return to their tasks
at the earliest possible moment consistent with good recovery.
In the preparation of the program this thought has been constantly
in the minds of the committee, and hence we have devoted a large part
of the time of the convention to an attempt to show how the problem
is being met in Massachusetts, and what loyal and sympathetic co
operation we are securing from the medical fraternity, the labor or
ganizations, and the insurance carriers.
We all understand the importance of the administrative problems,
and I will not therefore take up the time o f this convention further.
I thank you again for your coming, many of you thousands of
miles, to help us in this work, and I extend to you as president of
your association, a cordial and heartfelt welcome to Massachusetts.
M E C H A N IC A L S A F E G U A R D S .
B Y DAVID S. BEYER, M ANAGER, SAFETY ENGINEERING DEPARTMENT, LIBERTY M U T U A L
IN SU R A N C E CO.1
There has been great progress in the development of standard
guards in this country during the past 10 years. When the safety
movement started there were no standards available, and it was
largely a matter of “ cut and try,” each plant endeavoring to work
out something that would stop the accidents and at the same time
permit the machines to be operated. Many plants put in cumbersome
guards of solid sheet metal, which were often inconveniently ar
ranged and which did not allow a view of the working parts of the
machine without taking off the guard. A foreman in a certain large
plant which was a pioneer in the safety movement was once heard to
remark that every machine in his department had been so covered
up with guards you had to take the lid off to see what kind of a ma
chine it was.
Guards have been developed which are made of expanded metal or
heavy wire fabric, thus enabling the workmen to see the machine
through the guard and to watch its operations without removing the
guard. This open construction also allows light to pass through the
guard, the machine or workroom not being darkened appreciably,
as may be the case with solid guards. Experience has shown that in
order to get the best results from a mechanical guard it is absolutely
necessary to have it conveniently arranged so that it will offer the
least possible interference with work around the machine, or the
guard will be found hidden away under a bench or it will find its
way in some mysterious manner to the scrap heap.
The proper time to apply mechanical guards is when machinery
is being constructed, and more attention is being given to this point
by the machinery builders every year. The designer, in getting up a
new machine, can apply the guards at a minimum expense and can
adapt them to the equipment in such a way as will not interfere with
the work. He is thus able readily to provide difficult forms of pro
tection that are almost impossible to work out satisfactorily after the
machine has been built and placed in operation.
1 F o r m e r ly M a s sa ch u se tts E m p lo y e e s ’ In s u ra n c e A s s o c ia tio n .
16
M ECH ANICAL SAFEGUARDS---- DAVID S. BEYER.
17
As an example of how such difficulties often appear to the plant
owner, a recent experience of one of our standardization committees
may be of interest. We visited a plant at the request of a commit
tee of mill owners, who represented an important manufacturing as
sociation. They felt, for various reasons, that the gears and some of
the other working parts of the machinery used in their industry could
not be guarded. The proprietor of the plant which we visited sin
T
gled out one gear in particular which he said it was absolutely im
possible to guard, since the gear had to be changed frequently and
any guard that could be installed would so interfere with the opera
tion of the machine as to be out of the question. He had spent some
minutes emphasizing this fact, when we looked at the next machine
and found the identical gear on it had been thoroughly protected by
the builder, and instead of interfering with the operation of the
machine the device was so simple that the employer had never even
noticed it was there.
Similar experiences have been repeated, in one form or another,
in many plants and industries. Machines which the owners or opera
tors felt at one time could not possibly be guarded without limiting
the output or interfering with the operation too greatly have been
satisfactorily protected, with the exercise of sufficient care and in
genuity, so that the guards not only do not interfere with the opera
tion, but in some cases even increase the output by enabling the op
erators to work more rapidly through the .added sense of security
which the guards give.
A mistake which has been made in probably hundreds of plants
all over the country in starting their safety campaign is that of
putting in guards which give only partial protection. In glancing
through a hundred or more accident reports recently, it was noted
that half a dozen of the accidents had occurred on machines which
were but partially guarded. The old form of constructing a gear
guard was to put a band around the face of the gear, which only
partly protected the mesh point, and employees cleaning or work
ing around the machine, feeling that the gear was guarded, were
likely to be even more careless than they would have otherwise been.
Many accidents have resulted from such forms of partial protec
tion and there is no doubt that a poor guard may be worse than no
guard at all.
Many plants have made the similar mistake of making their guards
too light and flimsy at the outset, and later being compelled to re
place them with heavier guards which would stand the wear and
tear. This is an expensive road to travel, but it seems to represent
a form of evolution that many plants have to go through, because
78532°— Bull. 248— 10------- 2
18
ACCIDENT PREVENTION.
t h e y c a n n o t b e m a d e t o r e a liz e th e im p o r t a n c e o f b u ild in g a c o m
p le t e a n d s u b s t a n t ia l g u a r d a t th e b e g in n in g .
S o m e s u ch m is ta k e w a s p e r h a p s u n a v o id a b le a t th e s ta r t, w h e n
th e r e w e r e n o d e fin it e s t a n d a r d s a v a ila b le .
T h a t c o n d it io n h a s
b e e n c h a n g e d , s o th e r e is n o w n o n e e d f o r a n y o n e w a s t in g t im e a n d
m o n e y o n g u a r d s th a t a re im p r o p e r ly c o n s tr u c te d a n d w ill n o t g iv e
t h e d e s i r e d r e s u lt s .
T h r o u g h th e s t a n d a r d iz a t io n c o m m itte e s o f th e n a t io n a l s a fe t y
o r g a n iz a t io n s , th e e n g in e e r in g s o c ie tie s , th e S ta te a n d G o v e r n m e n t
a u th o r itie s , a n d th e r a t in g b o a r d s o f th e c o m p e n s a t io n in s u r a n c e c o m
p a n ie s th e b e s t p r a c t ic e o f t h e l e a d in g c o n c e r n s is b e i n g c r y s t a lliz e d
in t o d e fin ite s ta n d a r d s th a t a r e b e in g a d o p t e d a ll o v e r th e c o u n t r y .
T h e s e s ta n d a r d s a r e r e a d ily a v a ila b le in p r in t e d f o r m f p r th e u se
o f a n y o n e w h o is in t e r e s te d i n t h e s u b je c t a n d n o a t t e m p t w il l b e
m a d e h e r e t o g o in t o a d e t a ile d d is c u s s io n o f th e c o n s t r u c t io n o r
a r r a n g e m e n t o f m e c h a n ic a l g u a r d s .
Value o f mechanical guards .— S o m e d i s c u s s i o n w i l l b e g i v e n , h o w
e v e r , o f a s u b je c t w h ic h is o f g r e a t im p o r t a n c e t o e v e r y o n e w o r k in g
o n t h e r e d u c t i o n o f i n d u s t r i a l i n j u r i e s , a n d t h a t is , “ W h a t i s t h e
v a lu e o f m e c h a n ic a l s a fe g u a r d s a s c o m p a r e d w it h o t h e r m e th o d s o f
a c c id e n t p r e v e n t io n ? ”
A t th e 1 916 m e e t in g o f th is a s s o c ia tio n M r . D u d le y M . H o lm a n
d e v o t e d a p a r t o f h is in t e r e s tin g p a p e r t o th is q u e s tio n , a n d in
c lu d e d s o m e s ta te m e n ts .o f p r o m in e n t s a fe t y m e n in d iffe r e n t p a r t s
o f th e c o u n tr y .
O n e o f th ese m e n w a s M r . M a rc u s A . D o w , g e n e r a l s a fe ty a g e n t
o f t h e N e w Y o r k C e n t r a l lin e s .
H e s t a t e d t h a t o n l y 9.G 5 p e r c e n t
o f t h e ir in ju r y ca ses w e r e “ d u e t o d e fe c t iv e e q u ip m e n t, c o n d it io n s ,
t o o ls , o r a p p lia n c e s , th e b a la n c e b e in g o f a c h a r a c te r w h ic h ca n o n ly
b e p r e v e n te d b y th e e x e r c is e o f g r e a te r c a re o n th e p a r t o f o n e o r m o r e
h u m a n in d iv id u a ls .”
A n o t h e r o f th e sta te m e n ts w a s m a d e b y M r . C h a r le s D . S c o t t ,
g e n e ra l m a n a g e r o f th e b u re a u o f s a fe ty o f th e C o m m o n w e a lth E d i
s o n C o ., C h ic a g o , a n d s im ila r c o n c e r n s , w h o s a id th a t a n a n a ly s is o f
a c c i d e n t r e p o r t s w h i c h h e h a d c o m p i l e d s h o w e d t h a t o n l y 1 4 .1 p e r
ce n t o f th e a c c id e n ts r e p o r t e d c o u ld b e a ttr ib u te d t o m e c h a n ic a l o r
p h y s i c a l c o n d i t i o n s a n d t h a t 8 5 .9 p e r c e n t w e r e c h a r g e a b l e t o t h e
h u m a n e le m e n t.
A n o t h e r sta tem en t w a s b y M r . R o b e r t J . Y o u n g , m a n a g e r o f th e
s a fe t y d e p a r t m e n t o f th e I l l i n o i s S te e l C o ., w h o s a id t h a t n o m o r e
t h a n 3 3^ p e r c e n t e f f i c i e n c y c a n b e g a i n e d b y g u a r d i n g m a c h i n e s ( i n
c lu d i n g t h e in c id e n t a l a d v e r t i s in g o f s a f e t y t h a t r e s u lt s f r o m i n s t a ll
i n g g u a r d s ) , a n d t h a t u s u a lly t h is e ffic ie n c y w o u ld f a l l b e l o w 2 5 p e r
cen t.
M ECH ANICAL SAFEGUARDS---- DAVID S. BEYER.
19
D a ta fr o m th e B r o w n & S h a r p e M a n u fa c tu r in g C o. s h o w e d th a t
f o r th e y e a r s 1905 t o 1 9 1 0 m e c h a n ic a l a c c id e n t s in t h e ir p la n ts r e p r e
s e n t e d 4 2 .7 p e r c e n t o f t h e t o t a l , b e i n g r e d u c e d t o 3 1 .5 p e r c e n t i n
1 9 1 1 , 2 3 p e r c e n t i n 1 9 1 2 , a n d 1 9 .2 p e r c e n t f o r e i g h t m o n t h s o f 1 9 1 3 .
A p p a r e n t ly m o s t o f th e se sta te m e n ts a re b a se d o n th e n u m b e r o f
m e c h a n ic a l a c c id e n t s c o m p a r e d t o th e t o t a l n u m b e r o f a ll a c c id e n ts ,
r a t h e r th a n o n t h e s e r io u s n e s s o f th e a c c id e n t s .
A s M r. H o lm a n
p o in t e d o u t , m a n y o f th e c o m p a n ie s w h o s e s ta tis tic s w e r e q u o te d
h a d b e e n c a r r y i n g o n s a fe t y w o r k f o r a n u m b e r o f y e a rs , a n d th e
f a c t th a t m u ch o f th e ir p h y s ic a l s a fe g u a r d in g h a d b een d o n e f o r a
l o n g tim e m u s t b e b o r n e in m in d in c o n s id e r in g th e ir a c c id e n t d a ta .
H o w e v e r , as a r e s u lt o f h is in v e s t ig a t io n M r . H o lm a n c o n c lu d e d t h a t
o n l y 15 t o 2 5 p e r c e n t o f i n d u s t r i a l a c c i d e n t s c a n b e p r e v e n t e d b y
s a fe g u a r d in g m a c h in e r y a n d o th e r d a n g e r p o in t s a n d th a t so m e 25 t o
65 p e r c e n t ca n b e p r e v e n te d b y e d u ca tio n , in c lu d in g s h o p -s a fe ty o r
g a n iz a t io n s , e tc.
A n u m b e r o f s im ila r s ta te m e n ts h a v e b e e n
made
f r o m tim e t o tim e b y o t h e r s a fe t y m e n , u s u a lly b e in g g iv e n la r g e ly as
m a tte r s o f o p in io n , w ith o u t a n y r e c o r d o f th e d a ta u p o n w h ic h th e y
are based.
T h is q u e s tio n h a s a m o st im p o r ta n t b e a r in g o n th e fu n d a m e n ta l
p r i n c i p l e s o f a c c id e n t p r e v e n t io n , s in c e its a n s w e r d e te r m in e s th e
# h o l e lin e o f a t t a c k in c a r r y i n g o n a s a f e t y c a m p a ig n . I f m e c h a n ic a l
s a f e g u a r d s w i l l p r e v e n t o n l y 15 p e r c e n t o f t h e t o t a l a c c id e n t h a z a r d ,
o b v io u s ly m e c h a n ic a l g u a r d s s h o u ld b e g iv e n m in o r c o n s id e r a t io n ,
a n d o u r c h ie f e ffo r ts s h o u ld b e c o n c e n t r a t e d o n th e p la c e w h e r e th e
m a j o r h a z a r d l ie s .
I f , o n th e c o n tr a r y , m e c h a n ic a l g u a r d in g w ill
p re v e n t 50 p e r cen t o f th e h a z a rd , it b eco m e s a m a tte r o f p r im a r y
im p o r ta n c e .
W i t h t h is p o i n t in m in d , a t h o r o u g h s t u d y o f th
e n t ir e s u b je c t h a s b e e n m a d e , w it h th e id e a o f d e t e r m in in g w h e t h e r
th e sta te m e n ts m e n tio n e d a b o v e a re f a i r l y r e p r e s e n ta tiv e o f c o n d i
t io n s in th e a v e ra g e m a n u fa c t u r in g S ta te .
I t w i l l b e n o t e d t h a t th e fir s t t w o s ta te m e n ts q u o t e d w e r e m a d e
i n c o n n e c t io n w it h r a ilr o a d a n d e le c t r ic lig h t a n d p o w e r c o m p a n ie s .
T h e s e in d u s tr ie s h a v e v e r y lit t le m a c h in e r y in c o m p a r is o n w it h th e
o r d i n a r y m a n u f a c t u r in g p la n t a n d s o m u c h o f t h e ir w o r k is o u t
s id e t h a t th e h u m a n e le m e n t is n e c e s s a r ily a d is p r o p o r t i o n a t e l y la r g e
fa cto r.
T h e o t h e r t w o s ta te m e n ts a r e f r o m m a n u fa c t u r in g p la n t s ,
a n d a re p r o b a b ly m u c h m o r e n e a r ly r e p r e s e n ta tiv e o f g e n e ra l c o n
d it io n s .
T h e y g iv e an a v e ra g e o f a b o u t 25 t o 30 p e r ce n t fo r m e
c h a n i c a l a c c i d e n t s , w i t h a m i n i m u m o f 4 2 .7 p e r c e n t f o r o n e p l a n t ,
p r e s u m a b ly a t th e b e g in n in g o f its a c c id e n t - p r e v e n t io n c a m p a ig n .
S in c e th e w o r k m e n ’s c o m p e n s a tio n a c ts h a v e b e e n p a s s e d c a r e f u lly
c o m p ile d a c c id e n t s ta tis tic s a re b e in g k e p t b y a n u m b e r o f S ta te s ,
ACCIDENT PREVENTION.
20
m a k in g a v a ila b le m u c h a d d it io n a l d a ta w h ic h t h r o w s in t e r e s tin g
lig h t o n t h is s u b je c t . F r o m th e se s o u r c e s th e f o l l o w i n g r e p r e s e n t a
t iv e r e c o r d s a re t a k e n :
A C C I D E N T S IN M A S S A C H U S E T T S , J U L Y 1, 1914, T O J U N E 30, 1915, C L A S S I F I E D B Y C A U S E .
[F r o m ann ual report of M assachusetts In du strial A c c id e n t B oa rd .]
Cause.
N onfatal.
Fatal.
T o ta l.
MECHANICAL ACCIDENTS.1
B e ltin g ......................................................................................................................................
C alenders.................................................................................................................................
C ran es............... ..
................. . . .
_ . .........................................................
D rills ........ -................................................................................................................................
E le v a to r s.................................................................................................................................
E n g in e s ....................................................................................................................................
E x tr a c to r s .......................................... ....................................................................................
E y e injuries: B e lt in g e m ery w heels, m nphine tools
G ears.........................................................................................................................................
H o is ts ........................................................................................................................................
L a th e s.......................................................................................................................................
Machinery peculiar t o special industries. . T '_ ................ ......................................
_
M illin g m a ch in e s.................................................................................................................
Planers. ........................ r ..........
P orta b le t o o ls ........................................................................................................................
P resses......................................................................................................................................
S a w s ........................................................................................................................................
Shafting (set screw s, e t c .) .................................................................................................
V eh icles (s e lf-p ro p e lle d )....................................................................................................
W o o d m old ers, shapers, e t c .............................................................................................
M iscella n eou s2 ......................................................................................................................
T o t a l.............................................................................................................................
P er cen t of grand t o ta l.......................................................................................................
1
1,034
137
325
481
941
180
32
4,373
1,086
644
869
8,676
256
99
66
1,407
1,410
664
991
623
1,360
1,039
137
328
481
967
182
32
4,373
1,087
654
869
8,688
256
99
70
1,408
1,412
667
1,005
623
1,361
84
22.7
25,654
27.1
25,738
27.1
4
11
1
973
102
136
40
3,339
451
782
1
345
161
2,261
1,529
8,831
12
1,516
30,974
702
186
3,581
9
4,066
1,007
1,051
3,507
3,667
5
3
26
2
1
10
12
4
1
2
3
14
NONMECHANICAL ACCIDENTS.!
A n im a ls ...............................................*...................................................................................
A s p h y x ia tio n an d d r o w n in g .........................................................................................
A ssa u lt an d fig h tin g ...........................................................................................................
B oiler e x p lo s io n .................................................................................
B u m s ........................................................................................................................................
E le c tr ic ity .............................................................................................................................
E m e r y w h e e ls......................................................................................................................
E n g in e s ..................................................................................................................................
E x c a v a t in g ... .
.....................................................................................................
E x p lo sio n s (oth er th an b o ile r s ).....................................................................................
E y e inju ries; C h em ical, gauge glasses, and m o lte n m e ta l............................
F a llin g m a te r ia l..................................................................................................
F a lls ..........................................................................................................................................
F o o lin g .....................................................................................................................................
G lass..........................................................................................................................................
H a n d la b o r .............................................................................................................................
H a rm fu l substan ces, irritant fluids, e t c ...................................................................
Illn ess........................................................................................................................................
In fe ctio n ..................................................................................................................................
In to x ica tio n ............................................................................................................................
N a ils ..........................................................................................................................................
R a ilroa d e q u ip m e n t...........................................................................................................
Street ra ilw a y s .................
. .
.....................................................................
V eh icles (oth er th a n s e lf-p ro p e lle d )..............................................................................
M iscella n eou s2 ......................................................................................................................
60
6
33
2
969
91
135
40
3,319
437
782
1
336
159
2,261
1,523
8,749
12
1,516
30,950
699
186
3,572
9
4,066
947
1,045
3,474
3,665
T o t a l...........................................................................................................................
P e r cen t of grand t o ta l.......................................................................................................
286
77.3
68,943
72.9
69,229
72.9
G rand to t a l.................................................................................................................
370
94,597
94,967
20
14
9
2
6
82
24
3
9
1 T h is grou p in g w as m a d e b y th e w riter.
2 M iscellaneous unclassified accid ents d iv id e d p ro rata b etw een m ech an ical an d n on m e ch a n ica l accid e n ts.
M ECH ANICAL SAFEGUARDS---- DAVID S. BEYER.
A C C ID E N T S IN N E W Y O R K
21
F O R Y E A R E N D IN G S E P T . 30, 1914, C L A S S I F I E D B Y C A U S E S .
[F ro m B u lle tin N o. 75 o l N ew Y o r k In du strial C o m m ission .]
F actories.
1
B u ild in g and
engineering.
~
T o ta l.
Cause.
F atal.
N onfatal.
Fatal.
N onfatal.
F atal.
N onfatal.
F atal.
N onfatal.
MECHANICAL ACCIDENTS.
164
13
51
112
3
5
2,148
126
162
23
24
4,743
2,259
16,557
228
17.9
10
2
34.4
2,940
12.9
209
34.6
23,559
26.7
114
613
157
64
30
71
126
46
2
35
9
11
3,283
8, 2 1 1
2 , 718
1,047
797
3,791
169
79
3
105
15
24
8,478
21,552
9,525
6 ,1 1 0
2,223
16,867
17
73.9
1,049
82.1
229
65.6
19,847
87.1
395
65.4
64,755
73.3
23
1,277
349
22,787
604
88,314
6
C on v ey in g and h o is t in g ...........
P ow er tra n sm ission ...................
W ork in g m a ch in e s.....................
44
20
19
2,431
2 ,1 2 0
15,840
T o ta l....................................
P er cen t of grand t o t a l.............
83
35.8
20,391
31.7
F alls of p e r s o n s ...........................
F a llin g ofw eigh ts and o b je cts.
H a n d to o ls .....................................
H eat an d e le c tr ic ity ..................
V eh icles an d an im als................
M iscella n eou s...............................
42
18
1
70
5
13
5,081
12,728
6,650
4,999
1,396
13,005
1
15
T o t a l ...................................
P er cen t of grand t o t a l.............
149
64.2
43,859
68.3
G rand t o t a l .......................
232
64,250
6
26.1
66
6
NONMECHANICAL ACCIDENTS.
1
A C C ID E N T S IN O R E G O N , 1914-15, S H O W I N G R E L A T I V E I M P O R T A N C E A S I N D I C A T E D
B Y T H E C O S T O F C O M P E N S A T IO N , A N D C L A S S I F I E D B Y C A U S E S .
[F rom First A n n u a l R e p o rt of O regon In du strial C om m ission .]
N u m b er of accid ents.
C om pen
sation.
Cause.
F atal.
N onfatal.
T ota l.
P er cen t
of tota l
cost.
MECHANICAL ACCIDENTS.
B oilers and steam p ip e s ......................................................
H oistin g an d co n v e y in g app aratu s................................
P ow er v e h ic le s ........................................................................
P rim e m ov ers (engines and m o t o r s )..............................
S a w s...........................................................................................
T ran sm ission a p p a ra tu s.....................................................
W ork in g m a ch in ery (oth er than sa w s).........................
M iscellane ou s...........................................................................
1
14
6
T o t a l...............................................................................
26
9
247
37
21
136
64
109
12
10
261
43
21
137
66
111
12
$2,996.65
56,078.41
20,052.40
1,561.31
21,596. 70
18,411.43
13,691.37
321.01
0.99
18.48
6.61
.51
7.12
6.07
4.51
.1 1
635
661
134,709.28
44.40
8
21,617.76
7.12
1
5
71
396
371
393
303
82
75
405
377
393
304
87
14,539.78
35,426.18
32,438.29
19,166.07
9,795.72
17,368.73
4.79
1 1 .6 8
10.69
6.32
3.23
5.72
1
214
268
214
269
5,633.35
12,724.26
1 .8 6
4.19
T o ta l...............................................................................
34
2,098
2,132
168,710.14
55.60
G rand to ta l...................................................................
60
2,733
2,793
303,419.42
1 0 0 .0 0
1
2
2
NONMECHANICAL ACCIDENTS.
D ro w n in g .................................................................................
E x p lo siv e s, fires, corrosive substances, and elec
tr ic ity .....................................................................................
F a llin g o b je cts ........................................................................
Falls of person s.......................................................................
H a n d t o o ls ...............................................................................
H a n d lin g m aterials an d o b je c ts .......................................
R o llin g o b je c t s .......................................................................
S trik in g against or b e in g stru ck b y ob jects, step
p in g on sharp o b je c ts .......................................................
M iscellaneous...........................................................................
8
4
9
6
I t w ill b e n o te d th a t in M a s s a ch u s e tts , m a c h in e r y a c cid e n ts w e r e
2 7 .1 p e r c e n t o f t h e t o t a l n u m b e r o f a c c i d e n t s r e p o r t e d f r o m a l l
causes.
I n N e w Y o r k t h e y w e r e 2 6 .7 p e r c e n t o f t h e t o t a l .
In O re
22
MECHANICAL, SAFEGUARDS---- DAYID S. BEYEE.
g o n t h e y w e r e 2 3 .7 p e r c e n t o f t h e t o t a l .
T h e s e fig u re s c o r r e s p o n d
c lo s e ly w it h th o s e g iv e n in a r e p o r t o f th e W is c o n s in I n d u s tr ia l C o m
m i s s i o n , w h e r e m a c h i n e r y c o n t r i b u t e d 2 5 .5 p e r c e n t o f a l l c o m p e n
s a b le a c c id e n t s in t h e S t a t e f o r t w o a n d o n e -h a l f y e a r s e n d in g D e c e m
b e r 31, 1914.
T h is d a ta c o v e rs su ch a w id e r a n g e o f e x p e r ie n c e th a t it w o u ld
se e m t o b e q u it e c o n c lu s iv e , a n d w e m a y a c c o r d in g l y d e c id e t h a t
m a c h in e r y c o n t r ib u t e s a b o u t 25 p e r c e n t o f a ll a c c id e n ts in th e a v e r
a g e in d u s t r ia l S t a t e a t th e p r e s e n t tim e .
H o w e v e r , t h e m e r e n u m b e r o f a c c id e n t s f r o m a g i v e n c a u s e is n o t
a s a t is fa c t o r y b a s is f o r d e t e r m in in g t h e s e r io u s n e s s o f t h a t c a u s e as
a n a c c id e n t r o d u c e r , s in c e in c o n s id e r in g o n ly t h e n u m b e r o f a c c i
p
d e n t s t h e s a m e w e i g h t is g i v e n t o a c u t fin g e r a s t o a f r a c t u r e d s k u ll.
F r o m th e s t a n d p o in t o f th e e m p lo y e r , th e in s u r a n c e c o m p a n y , o r th e
a c c id e n t b o a r d , th e a m o u n t o f tim e lo s t o r th e c o s t o f th e a c c id e n ts
g i v e s a m u c h b e t t e r b a s is f o r d e t e r m in in g t h e r e la t iv e s e r io u s n e s s o f
m e c h a n ic a l a c c id e n ts as c o m p a r e d w ith th o s e f r o m o t h e r ca u ses.
T h e d a ta g iv e n in m o s t o f th e S ta te r e p o r t s is n o t so a r r a n g e d as
t o s h o w th e c o s t o f m e c h a n ic a l a c cid e n ts , a p a r t fr o m o t h e r a c cid e n ts ;
fo r t u n a t e ly , h o w e v e r , t h is s e p a r a tio n h a s b e e n m a d e in t h e O r e g o n
d a t a , a n d w e fin d t h a t , w h e r e a s f r o m t h e s t a n d p o in t o f n u m b e r s m e
c h a n i c a l a c c i d e n t s w e r e o n l y 2 3 .7 p e r c e n t o f t h e t o t a l , t h e y c o n
t r i b u t e d 4 4 .4 p e r c e n t o f t h e t o t a l c o s t .
I n o th e r w o r d s , th e a v e ra g e
m e c h a n ic a l a c c id e n t c o s t a p p r o x im a t e ly tw ic e as m u c h as th e a v e r a g e
a c c id e n t f r o m a ll ca u se s.
W h i l e th e O r e g o n d a t a is c o m p a r a t iv e ly lim it e d , in c lu d in g o n l y
a b o u t t h r e e t h o u s a n d a c c id e n t s , a m o m e n t ’s t h o u g h t w i l l s h o w t h a t t h is
r e s u lt see m s e n t ir e ly r e a s o n a b le .
T h e n a tu re o f n o n m e c h a n ic a l a c c i
d e n t s is s u c h t h a t i n m o s t c a s e s t h e a m o u n t o f p o w e r i n v o l v e d is . v e r y
lim ite d .
T a k e f o r e x a m p le th e h a n d t o o l, w h ic h c o n t r ib u t e s a m a t e
r ia l p e r c e n ta g e o f a ll n o n m e c h a n ic a l a c c id e n ts .
T h e p o w e r o f su ch
t o o l s is s l i g h t w h e n c o m p a r e d w i t h t h a t o f a p o w e r - d r i v e n m a c h i n e ,
a n d t h e a v e r a g e i n j u r i e s c a u s e d b y h a n d t o o l s a r e a c c o r d i n g l y le s s
sev ere. T w o o f th e m o s t fr e q u e n t ca u se s o f n o n m e c h a n ic a l a c cid e n ts
a re f a l l i n g o b je c t s a n d fa l l s o f p e r s o n s ; in s u c h ca s e s t h e r e is a s in g le
s h o c k o f th e o b je c t o r p e r s o n s tr ik in g , a n d th e d a m a g e g e n e r a lly
ce a se s im m e d ia te ly .
W h e n a n y o n e is c a u g h t i n a m a c h i n e , h o w e v e r ,
t h e r e is u s u a lly a c o n t in u o u s a p p l i c a t i o n o f p o w e r a n d a c o r r e s p o n d
i n g in c r e a s e in th e d a m a g e d o n e , u n t il th e m a c h in e c a n b e s t o p p e d o r
t h e p e r s o n r e l e a s e d f r o m it .
I t w ill b e n o te d fr o m th e M a ssa ch u se tts d a ta , th a t w h ile h a n d la b o r
fu r n is h e d 33 p e r c e n t o f th e t o t a l n u m b e r o f a c cid e n ts , it w a s r e s p o n
s ib le f o r le s s t h a n 7 p e r c e n t o f th e fa t a lit ie s .
I n O r e g o n , h a n d t o o ls
f u r n i s h e d 1 4 p e r c e n t o f t h e t o t a l n u m b e r o f a c c i d e n t s a n d o n l y 6 .3 2
p e r cen t o f th e to ta l cost.
O n th e o th e r h a n d , w e fin d in th e W i s c o n
M ECH ANICAL SAFEGUARDS---- DAVID S. BEYER.
23
s i n d a t a t h a t m a c h i n e r y a c c i d e n t s , w h i l e c o n t r i b u t i n g o n l y 2 5 .5 p e r
c e n t o f t h e t o t a l n u m b e r o f a c c i d e n t s , w e r e r e s p o n s i b l e f o r 3 7 .7 p e r
c e n t o f a ll m a jo r p e r m a n e n t in ju r ie s , a n d 80 p e r c e n t o f a ll m in o r p e r
m a n e n t in j u r ie s .
T h e r e fo r e , w e w o u ld e x p e c t to fin d th a t th e a v e r a g e a c c id e n t fr o m
m a c h i n e r y is r e l a t i v e l y m u c h m o r e s e v e r e t h a n t h e a v e r a g e a c c i d e n t
fr o m o th e r ca u ses.
I n w e i g h i n g t h e v a lu e o f m e c h a n ic a l s a fe g u a r d s f o r p r e v e n t in g
in ju r ie s , a n o t h e r p o i n t w h ic h m u s t b e k e p t in m in d is t h i s : T h
v a l u e o f m e c h a n i c a l s a f e g u a r d s is n o t c o n f i n e d t o p r o t e c t i o n o f m a
c h in e r y .
T w o o f t h e v e r y im p o r t a n t ca u s e s o f a c c id e n t s in a n y lis t o f s t a
tis tic s a re ( 1 ) f a l l i n g o b je c t s a n d ( 2 ) f a l l s o f p e rs o n s .
T hese a cci
d e n ts a r e c la s s ifie d in t h e p r e c e d in g s t a t is t ic a l t a b le s a s “ n o n m e c h a n i
c a l ” a c cid e n ts , a n d y e t th e y a re la r g e ly p re v e n ta b le b y m e c h a n ic a l
m eans.
O n e o f t h e f i r s t t h i n g s t h e e x p e r i e n c e d s a fe t }^ e n g i n e e r l o o k s
a ft e r w h e n h e s ta r ts a n a c c id e n t -p r e v e n t io n c a m p a ig n is th e e r e c tio n
o f s u it a b le t o e b o a r d s o r b a r r ie r s a l o n g p la t f o r m s a n d s t o r a g e p la c e s
t o p r e v e n t o b je c t s f a llin g a n d th e c o n s t r u c t io n o f r a ilin g s a t s ta ir w a y s
a n d a lo n g o v e r h e a d p la t fo r m s , s c a ffo ld s , etc.
T h ese g u a rd s a re v ery
e ffe c t iv e in p r e v e n t in g fa lls o f o b je c ts o r p e rs o n s.
W h ile th e w r ite r
w a s d ic t a t in g h is n o te s f o r t h is p a p e r h e sa w a w in d o w c le a n e r s ta n d
in g o n th e o u ts id e o f a w in d o w s ill o n th e te n th s t o r y o f a n e a r -b y
b u il d in g , w it h o n l y t h e u n c e r t a in g r i p o f o n e h a n d o n th e w in d o w
le d g e b e tw e e n h im a n d a f a l l t o c e r ta in d e a th , w h ile h e w a s h e d th e
w in d o w w ith th e o t h e r h a n d .
T h e u se o f a s a fe t y b e lt in t h is c a se
w o u ld h a v e p r a c t ic a lly e lim in a t e d th e h a z a r d .
A n o t h e r t y p e o f a c c id e n t w h ic h is c o m m o n ly n o t c o n s id e r e d a s
m e c h a n ic a l, b u t w h ic h is la r g e ly p r e v e n ta b le b y m e c h a n ic a l g u a r d in g ,
i s t h a t o f e l e c t r i c a l s h o c k s , f la s h e s , a n d b u r n s .
T h e p r o te c tio n o
e le c t r ic a l e q u ip m e n t is u n d e r g o in g m u c h th e sa m e d e v e lo p m e n t s a s
th e g e a r h a z a r d p a s s e d t h r o u g h 10 y e a r s a g o .
W h ile it w a s p r a c
t i c a l ly im p o s s ib le t o b u y in c lo s e d s w itc h e s a n d fu s e b o x e s f o r e le c t r ic
c ir c u its u p t o 550 v o lt s a fe w y e a r s a g o , m a n y c o n c e r n s a re n o w b u ild
i n g s u ch e q u ip m e n t c o m p le t e ly in c lo s e d , s o th a t i t is p r a c t ic a lly im
p o s s ib le f o r a n y o n e t o c o m e in c o n t a c t w it h c u r r e n t -c a r r y in g p a r t s
w h ile t h e y a re liv e . I n a d d it io n t o th e e q u ip m e n t th a t is fu r n is h e d
b y th e m a k e r , i t is p o s s ib le t o r a il o f f a n d in c lo s e e x p o s e d e le c t r ic
p a r t s ju s t a s d a n g e r o u s m a c h in e p a r t s w o u ld b e in c lo s e d .
M e c h a n ic a l
m e a n s f o r g r o u n d in g e le c tr ic c ir c u its a n d o th e r e q u ip m e n t w h e n th e y
a r e b e i n g w o r k e d o n is a n o t h e r o f th e m o s t e ffe c t iv e m e a n s o f p r e
v e n t in g e le c t r ic a l in ju r ie s .
T h e s e a re p u r e ly m e ch a n ic a l fo r m s o f
p r o t e c t io n , a n d m e c h a n ic a l g u a r d in g is ju s t as im p o r t a n t h e re as it
is f o r m a c h in e h a z a r d s .
24
ACCIDENT PREVENTION'.
E v e n in th e c la s s ific a t io n “ h a n d l in g m a t e r ia ls ,” w h ic h m ig h t see m
a t fir s t g la n c e t o b e r e a c h e d o n ly b y s a fe t y e d u c a t io n , m e c h a n ic a l s a fe
g u a r d s p la y a n im p o r t a n t p a r t in th e p r e v e n t io n o f a c c id e n ts .
It
u s e d to b e c o m m o n p r a c t ic e , w h e n p ilin g u p p ip e , r o u n d ir o n b a r s ,
s h a ft in g , a n d s im ila r m a te r ia l, f o r th e w o r k m e n t o u se a b r ic k o r a n y
s tr a y p ie c e o f w o o d o r o t h e r o b je c t th a t h e c o u ld p ic k u p as a s to p t o
p r e v e n t th e m a te r ia l f r o m r o llin g .
A s a r e s u lt a c c id e n t s w e r e f r e
q u e n t, d u e t o th e p ile s c o lla p s in g w h e n th e y w e r e b e in g p u t u p o r
ta k en d ow n .
I n m a n y p la n t s a c c id e n ts o f th is k in d h a v e b e e n p r a c
t i c a l ly e lim in a t e d b y th e u s e o f p r o p e r ly c o n s t r u c t e d s u b s t a n t ia l m e ta l
s k id s o r b lo c k in g .
I n o n e d e p a r t m e n t o f a p la n t w h e r e s t r a in s f r o m
l i f t i n g w e r e fr e q u e n t t h is t r o u b le w a s d o n e a w a y w it h b y p r o v id i n g
lo w e r b e n ch e s , so th a t th e h e a v y s to c k n e e d n o t b e lif t e d s o h ig h . T h e
in s ta lla tio n o f m e c h a n ic a l h o is ts a n d tr u c k s f o r h a n d lin g m a te r ia l
h a s g r e a t ly r e d u c e d th e h a z a r d in o t h e r cases.
S im ila r ly , a c c id e n ts fr o m e x p lo s iv e a n d c o r r o s iv e su b s ta n ce s ca n b e
l a r g e ly g u a r d e d a g a in s t b y p r o p e r m e c h a n ic a l m e a n s f o r h a n d lin g
th e m a te r ia ls a n d p r o p e r b a r r ie r s a n d g u a r d s f o r l im it i n g th e e ffe c t
o f th e e x p lo s io n o r p r e v e n t in g t h e c o r r o s iv e s u b s ta n c e s f r o m s p la s h
in g a n d s t r ik in g th e o p e r a to r .
F o r e x a m p le , in m a n y p la n t s th e o ld
w a y o f h a n d lin g a c id w a s t o d u m p it f r o m a c a r b o y , b y h a n d , in t o
a b i g c r o c k o r ta n k a n d th e n d ip th e a c id o u t w it h a p it c h e r a n d ca rry ,
it b y h a n d t o th e p o i n t w h e r e i t w a s u s e d .
T h e m a n w h o “ stu b b ed
h is to e ” w h ile h e w a s c a r r y in g a p it c h e r o f a c id w a s v e r y lia b le t o b e
w e a r in g a g la s s e y e w h e n h e c a m e b a c k f r o m t h e h o s p it a l.
T h is h a z
a r d h a s b e e n p r a c t ic a lly e lim in a te d in m a n y p la n t s b y th e u se o f
p r o p e r a c id p u m p s a n d m e c h a n ic a l m e a n s f o r p o u r in g a n d h a n d lin g
th e a c id f r o m a s a fe d is t a n c e .
T a k i n g th e s e t h r e e c la s s ific a t io n s f r o m t h e O r e g o n d a ta , n a m e ly ,
“ e x p l o s i v e s , fir e , c o r r o s i v e s u b s t a n c e s , a n d e l e c t r i c i t y ,” “ f a l l i n g o b
j e c t s , ” a n d “ f a l l s o f p e r s o n s , ” w e f i n d t h a t 2 7 .1 6 p e r c e n t o f t h e c o s t
o f a ll a c c id e n t s in th e S t a t e w e r e d e v e lo p e d f r o m th e s e h a z a r d s . I f
e v e n o n e -fo u r t h o f th e a c c id e n ts in th e se th r e e g r o u p s w e r e p r e v e n t
a b le b y m e c h a n ic a l s a fe g u a r d s , i t w o u ld s o m o d i f y th e t o t a l th a t
m o r e th a n 50 p e r c e n t o f th e a c c id e n t c o s t w o u ld b e p re v e n ta b le b y
m e c h a n ic a l g u a r d i n g a n d le s s t h a n 5 0 p e r c e n t b y o t h e r m e a n s .
T h e p e r c e n t a g e o f m e c h a n ic a l a c c id e n ts in O r e g o n w a s th e s m a lle s t
o f a n y o f th e f o u r S ta te s q u o t e d ; i f th e sa m e r a t io o f c o s t f o r m e
c h a n ic a l a c c id e n ts c o m p a r e d w it h a ll a c c id e n t s w e r e m a in ta in e d in
th e o th e r S ta te s, it w o u ld g iv e th e f o llo w in g im p o r ta n c e t o m e ch a n i
c a l a c cid e n ts in th e se S ta te s : W is c o n s in , 48 p e r c e n t ; N e w Y o r k , 50
p e r c e n t ; M a s s a c h u s e tts , 51 p e r cen t.
T h e s e r e s u lt s a r e f o r a c c id e n t s , c a u s e d b y m a c h in e r y o n l y , w it h o u t
i n c l u d i n g a n y o f t h e a c c i d e n t s f r o m f a l l s , f a l l i n g m a t e r i a l , e t c ., w h i c h
a r e a ls o p r e v e n t a b le b y m e c h a n ic a l g u a r d s .
M ECH ANICAL SAFEGUARDS---- DAVID S. BEYER.
25
W e m a y a c c o r d in g l y c o n c lu d e f r o m t h is s t u d y t h a t a c c id e n t s r e p
r e s e n t in g a t le a s t 5 0 p e r c e n t, f r o m t h e s t a n d p o in t o f s e r io u s n e s s , o f
a ll a c c id e n ts o c c u r r in g in a n a v e r a g e in d u s t r ia l S ta te , a re p r e v e n t
a b le b y m e c h a n ic a l g u a r d s . S in c e th e a b o v e a c c id e n t r e c o r d s in c lu d e
t h o s e f r o m m a n y in d u s t r ie s w h ic h h a v e l i t t l e m a c h in e r y , i t is a p p a r
e n t t h a t t h e r e la t iv e v a lu e o f th e m a c h in e a c c id e n t s w o u ld b e c o n s id
e r a b l y h i g h e r i n i n d u s t r i e s w h e r e m u c h m a c h i n e r y is u s e d .
I t is
r e a liz e d t h a t t h e c o m p le t e g u a r d i n g o f a ll m a c h in e s w il l n o t e lim in a t e
a ll m e c h a n ic a l a c c id e n t s ; n e ith e r w ill th e s a fe t y e d u c a tio n o f th e e m
p lo y e e s e lim in a te a ll n o n m e c h a n ic a l a c c id e n ts . T h e v a lu e o f m e c h a n
i c a l s a f e g u a r d s a n d t h a t o f s a f e t y e d u c a t i o n a r e s o i n t e r w o v e n t h a t i t is
v e r y d iffic u lt t o s a y w h e r e o n e le a v e s o f f a n d t h e o t h e r b e g in s .
It
se e m s c le a r , h o w e v e r , t h a t t h e in s t a lla t io n o f m e c h a n ic a l g u a r d s i s a t
le a s t e q u a lly im p o r t a n t w it h a ll th e o t h e r fo r m s o f a c c id e n t p r e
v e n tio n , in c lu d in g s a fe t y o r g a n iz a tio n s a n d e d u c a tio n a l w o r k .
S o m e c o n c lu s io n s w h ic h h a v e a n im p o r t a n t b e a r in g o n a c c id e n tp r e v e n t io n w o r k f o l l o w l o g i c a l l y f r o m t h is r e s u lt .
I f m e c h a n ic a l
s a fe g u a r d s w ill a c c o u n t f o r 50 p e r c e n t o f th e a c c id e n t p r o b le m , th e re
is a r e a l d a n g e r in u n d e r s t a t in g th e v a lu e o f s u c h g u a r d s , a n d o f
o v e r s t a t in g t h e v a lu e o f s o -c a lle d e d u c a t io n a l w o r k .
T h e i n s t a l l a t i o n o f m e c h a n i c a l g u a r d s is a n e x p e n s i v e m a t t e r ,
p a r t ic u la r ly in th e o ld e r p la n ts , s o m e o f w h ic h h a v e b e e n s p e n d in g
se v e ra l th o u s a n d d o lla r s a y e a r o n s a fe g u a r d s , f o r a n u m b e r o f
y e a r s . I f th e e m p lo y e r f e l t t h a t t h is w o u ld a ffe c t o n ly 15 p e r c e n t o f
h is h a z a r d h e m i g h t w e ll h e s it a t e t o m a k e th e l a r g e e x p e n d it u r e s
t h a t a r e n e c e s s a r y t h o r o u g h l y t o s a fe g u a r d h is p la n t .
O n t h e o t h e r h a n d , i t is a r e l a t i v e l y i n e x p e n s i v e m a t t e r t o o r g a n i z e
s a fe t y c o m m itte e s , p o s t u p s a fe t y s ig n s , p r o v id e b u lle t in s e r v ic e , a n d
a r r a n g e f o r s a fe t y t a lk s ; in o th e r w o r d s , to sta r t th e m o s t a p p r o v e d
s c h e d u le o f s a fe t y o r g a n iz a t io n a n d e d u c a tio n a l w o r k .
B u t th e
e m p l o y e r w h o t h i n k s t h a t a l o n e w i l l s o l v e h i s a c c i d e n t p r o b l e m is
d o o m e d to d is a p p o in tm e n t.
T h e i n s t a l l a t i o n o f e f f e c t i v e g u a r d s is
n o t o n ly n e ce s s a r y f o r th e p r e v e n t io n o f th e la r g e p e r c e n ta g e o f
m a c h in e a c c id e n ts , b u t i t p la y s a n im p o r t a n t p a r t in th e e d u c a t io n
o f th e e m p lo y e e s .
U n t il t h e y a r e g iv e n t h is v is ib le e v id e n c e o f th e
s in c e r it y o f t h e ir e m p lo y e r t h e y w il l n o t h a v e m u c h c o n fid e n c e in
th e s a fe t y c a m p a ig n o r g iv e it th e ir c o o p e r a tio n .
A fe w m o n th s a g o a n in s p e c t o r v is ite d a p la n t w h e re th e p r in c ip a l
s a fe t y e d u c a tio n a l m e th o d s m e n tio n e d a b o v e w e r e in f u ll s w in g a n d
h a d b e e n f o r s o m e tim e , y e t t h e a c c id e n t r a t e o f t h e p la n t w a s h ig h ,
a n d t h e r e w a s n o a p p r e c ia b le r e d u c t io n in it.
H e a sk e d to m e et th e
s a fe t y c o m m itte e , a n d in in t r o d u c in g h im t o th e c o m m itte e th e
s u p e r in te n d e n t t o o k o c c a s io n to r e m a r k th a t h e h a d b e e n d is a p
p o in t e d in th e w o r k o f th e c o m m it t e e ; th a t th e m e n d id n o t seem
t o ta k e th e in t e r e s t in it h e h a d h o p e d ; a n d t h a t t h e y w e r e n o t c o o p
26
ACCIDENT PREVENTION.
e r a t in g a s t h e y s h o u ld .
O n e o f th e m e n o n th e c o m m itte e s a id
“ D o you know w h y ? ”
T h e s u p e r in te n d e n t s a id , “ N o .”
The ma
r e p lie d , “ W e t h in k t h is is a ll b lu ff.
W e sta rted o u t m a k in g r e c
o m m e n d a tio n s , b u t w h e n e v e r th e y co s t a n y m o n e y w e sa w th a t th e y
w e re n o t c a r r ie d o u t, s o th a t th e w h o le t h in g lo o k s lik e a w a ste o f
t im e t o u s .”
F u r th e r in v e s tig a tio n s h o w e d th a t th e im p o r ta n c e o f s p e n d in g
m o n e y f o r t h e i n s t a l l a t i o n o f m e c h a n i c a l g u a r d s h a d n o t b e e n s u ffi
c ie n t ly r e a liz e d b y th e m a n a g e m e n t, a n d o n ly w h e n t h is p o in t w a s
c le a r e d u p w e r e t h e d e s ir e d r e s u lts s e c u r e d .
I n t h u s e m p h a s i z i n g t h e i m p o r t a n c e o f m e c h a n i c a l g u a r d i n g i t is
n o t in t e n d e d t o m in im iz e th e v a lu e o f s a fe t y e d u c a t io n a l w o r k
S p l e n d i d r e s u lt s a r e b e i n g s e c u r e d f r o m p r o p e r l y o r g a n i z e d s a f e t y
c o m m itte e s a n d o th e r m e a n s o f in te r e s tin g a n d s e c u r in g th e c o o p
e r a t i o n o f t h e w o r k m e n , a n d s u c h m e t h o d s a r e a b s o l u t e l y e s s e n t ia l
t o th e g r e a te s t su cce ss in a s a fe t y c a m p a ig n .
I n s o m e p la n t s , w h e r e
s a fe ty w o r k h a s b e e n u n d e r w a y f o r a n u m b e r o f y e a rs , th e m e c h a n i
c a l g u a r d in g h a s g o n e a b o u t as f a r as it ca n .
I n th e a v e ra g
p la n t, h o w e v e r , o f w h ic h th e r e a r e h u n d r e d s o f th o u s a n d s s c a tte r e d
t h r o u g h o u t o u r g r e a t i n d u s t r i a l c o u n t r y , m e c h a n i c a l g u a r d i n g is
s t ill a b i g p r o b le m , a n d i t w il l c o n tin u e t o b e , in s p it e o f o u r b e s t
e ffo r ts , f o r m a n y y e a r s to c o m e .
SH O P S A F E T Y C O M M IT T E E S.
B Y 2JEW E. PALMER,
CHIEF INSPECTOR,
BUREAU OF INSPECTION OF P E N N S Y L V A N IA .
A c c i d e n t p r e v e n t io n s y m b o liz e s th e in t e r e s t o f t h e A m e r ic a n p e o p le
in th e c o n s e r v a t io n o f h u m a n l i f e a n d lim b . N e v e r h a s a n a t io n a l
m o v e m e n t in b e h a lf o f h u m a n ity a r o u s e d t o a g r e a te r e x te n t th e m in d s
a n d e n e r g ie s o f o u r in d u s tr ia l m a n a g e m e n ts f o r th e b e tte rm e n t o f
in d u s t r ia l a n d s o c ia l c o n d itio n s .
T h e in d u s t r ia l w o r ld n o w r e a liz e s t h a t o n ly a s m a ll p e r c e n t a g e o f
a c c id e n ts a re n o t p re v e n ta b le b y p r e c a u tio n a r y m e a su res.
T lie m e a n s o f b r in g i n g a b o u t s a fe t y a re u n lim ite d . T h e y a re a ll
g o o d a n d h a v e th e ir e ffe ct. B u t y o u w ill a g re e th a t th e p u r p o s e o f
a l l i s t h e s a m e ; t h a t is , t o d r i v e h o m e t o t h e i n d i v i d u a l t h e c o r r e c t
id e a o f s a f e t y ; t o g a in h is c o o p e r a t io n a n d t o te a c h h im t o t h in k o f
th e w e l f a r e o f o t h e r s a s w e ll as h is o w n s a fe t y .
T h e b e s t m e t h o d f o r o b t a i n i n g t h e d e s i r e d r e s u l t is t h e p e r s o n a l
a p p e a l f o r s a f e t y , w h i c h m e t h o d is . i n o u r o p i n i o n , t o o f r e q u e n t l y
o v e r lo o k e d .
T h e i n d i v i d u a l is th e o b j e c t i v e p o i n t , a n d c o n s e q u e n t ly t h e a p p e a l
m u s t b e m a d e d ir e c t ly t o h im .
I t m a y b e th a t th e s u p e rin te n d e n t c a n n o t ta lk s e p a r a te ly t o e a c h
in d i v i d u a l in a la r g e p la n t , b u t h e c a n m a k e h is a p p e a l t o e a c h d e p a r t
m e n t h e a d , w h o in tu rn ca n t a lk t o th e fo r e m a n , a n d th e fo r e m a n
t o th e s h o p c o m m it t e e ; th u s s a fe t y w ill b e m a d e a v it a l, p e r s o n a l
m a tte r.
F o r o b t a in in g a n d tr a n s m it t in g k n o w le d g e p e r t a in in g to p e rs o n a l
w e lfa r e a n d s a fe ty , a n d s e c u r in g c o o p e r a t io n fr o m th e in d iv id u a l
e m p lo y e e s , s h o p s a f e t y c o m m it t e e s h a v e b e e n o r g a n iz e d w it h e x c e lle n t
r e s u lt s in m o s t o f t h e la r g e p la n t s , a n d t h e y m a y a ls o b e a d o p t e d
w it h a d v a n t a g e b y t h e s m a lle r p la n t s .
T h e s h o p s a fe t y c o m m itte e u n q u e s tio n a b ly a ffo r d s th e m o s t e ffe ctiv e
m e a n s f o r im p r e s s in g t h e in d iv id u a l e m p lo y e e w it h h is o w n r e s p o n
s i b i li t y , a n d f o r t e a c h in g th e e s s e n t ia l e le m e n t s in a c c id e n t -p r e v e n t io n
m e t h o d s , s t im u la t in g t h o u g h t fu ln e s s o n h is p a r t , a n d b r in g i n g t o h is
a tt e n t io n m a n y d e t a ils w h ic h m ig h t o th e r w is e p a s s u n n o t ic e d a n d
r e s u lt in p e r s o n a l in ju r y .
W i t h th e s e c o m m it t e e s , c o m p o s e d e n t ir e ly o f w o r k m e n , it is f o u n d
th a t s o m e tim e s th e m e n a re m o r e fr e e t o e x p r e s s th e ir id e a s w h e n n o t
h a n d ic a p p e d b y th e p re s e n ce o f th e b oss.
S o m e v e r y v a lu a b le s u g
g e s t io n s h a v e d e v e lo p e d in th e s e w o r k m e n ’s c o m m it t e e m e e t in g s t h a t
p e rh a p s m ig h t n e v e r h a v e c o m e to lig h t u n til a ft e r an a c cid e n t h a d
t h e r e n o t b e e n fu r n is h e d a n o p p o r t u n it y f o r th e se m e n t o t e ll t h e ir
27
28
ACCIDENT PREVENTION.
tr o u b le s a n d s u g g e s t t h r o u g h th is c o m m itte e th e ir p r e v e n t iv e m e th o d s .
T h e m a n k n o w s w h e r e a n d h o w h e ju s t m is s e d b e in g h u r t , a n d g e n
e r a lly k n o w s h o w s u c h a n a c c id e n t c a n b e a v o id e d .
H e know s he
s lip p e d o n t h e o i l y t r o ll e y o f N o . 15 c r a n e a n d o n l y t h e w ir e s o n th e
t r o lle y m o t o r s a v e d h im — h a d t h e y p u lle d o u t h e m ig h t n o t h a v e liv e d
t o te ll h o w it h a p p e n e d — a n d h e w o u ld s u g g e s t th a t e v e r y t r o lle y , as
w e ll as th e b r id g e o f e v e r y c ra n e , b e p r o v id e d w it h a w a lk a n d
h a n d r a il.
The shop committee also assists in securing uniform supervision
and in arousing active interest in accident prevention.
T h e m e m b e r s h ip o f th e s h o p s a fe t y c o m m it t e e s h o u ld c o n s is t o f
a t l e a s t t h r e e m e n f r o m t h e r a n k a n d f i le , a p p o i n t e d t o s e r v e f o r s h o r t
p e r io d s .
N u m e r o u s s u g g e s t i o n s o f v a l u e A vill r e s u l t f r o m t h e a c t i v i
t ie s o f t h e c o m m it t e e , b u t in o u r o p i n i o n t h e g r e a t e s t b e n e fits w i l l b e
d e r iv e d t h r o u g h th e g r a d u a l e d u c a tio n o f th e w o r k in g fo r c e , m a n b y
m a n o r g r o u p b y g r o u p , s e r v in g as m e m b e r s o n th e c o m m itte e .
It
is a w e ll- k n o w n f a c t t h a t w e b e c o m e m o r e f a m i l ia r w it h a s u b je c t
w h e n c a lle d u p o n t o d is c u s s i t o r t o m a k e s u g g e s t io n s r e g a r d i n g it.
A s th e s a y in g g o e s , “ T h e r e is n o im p r e s s io n w it h o u t e x p r e s s io n .”
T h e s h o p c o m m it t e e s h o u ld d e v o t e a t le a s t h a l f a d a y e a c h w e e k
t o a g e n e r a l in s p e c tio n o f th e ir d iv is io n o f th e p la n t, p r e f e r a b ly w o r k
in g tog eth er as a b o d y .
N o te s s h o u ld b e ta k e n a n d s u g g e s tio n s s u b
m itte d in w r it in g f o r th e c o n s id e r a tio n o f th e c e n tr a l c o m m itte e .
The most satisfactory way to conduct this work is to arouse the
interest and enthusiasm of the employees for the safety movement to
such an extent that they will carry on the work by themselves as far
as may be possible.
When handled in this way it has been found to be more effective
than when managed from the office. It is, of course, understood that
no plant safety organization can be a success unless the hearty sup
port of the management is back of the movement; or, in other words,
“ Safety must begin at the top.” The office or management must be
represented on the central committee in order to keep in close touch
with the work being done.
The number of men on the shop committee should be determined by
the size of the plant and the work at hand. It is a good idea to ap
point at least two members from each mill or department, and the
length of service should be such as to enable each member to become
familiar with the work.
As a general rule, it has been found that two or three months is
sufficient for any employee to serve on the committee, and the term
of service should be arranged so that too many new men will not be
on the committee at the same time.
T h e m e th o d o f r o t a t in g th e m e m b e r s h ip at r e g u la r in t e r v a ls as
s is ts m a t e r ia lly in i n c r e a s in g t h e e ffic ie n c y o f th e c o m m it t e e b y d e v e l
SHOP SAFETY COMMITTEES---- L E W R. PALMER.
29
oping a rivalry among the committeemen, who will endeavor to find
danger points overlooked by previous committeemen.
In plants where large numbers of foreigners are employed the
shop committees should include from time to time workmen who can
speak the various foreign languages.
Real, effective accident prevention work can be obtained only
through the cooperation of the entire committee, and every commit
teeman should be made to feel that he is on an equal footing with any
other committeeman, regardless of rank or position.
In addition to making inspections of the plant or departments the
shop committee should investigate all serious and fatal accidents that
occur within its division and submit recommendations for the pre
vention of a recurrence. The experience thus gained is valuable
to the workers, and when the cause of a serious accident is clearly
understood there will be less likelihood of a similar accident occur
ring in the same plant. All the suggestions or recommendations
of the shop committee should be referred, in writing, to the safety
engineer, if the plant organization includes one, and those recommen
dations involving important changes should be referred to the central
committee, which committee should issue orders for putting them
into effect. This method tends to prevent petty jealousies that might
at times arise among the men when orders for changes do not come
from some one in high authority.
It has been found advisable to provide a badge or button for the
members of the shop committees, not only to show their authority
when it is necessary to question or censure a man, or make sug
gestions as to his methods of performing his work, but also for the
educational value attached to the display of such badge or button,
as it tends to keep safety always before the workers.
After having served on the shop safety committee the workman
should be given to understand that he is a permanent member of the
plant safety organization, and that his safety work does not end with
his service as a committeeman.
We have attempted to point out in a general way the advantage of
the shop or workmen’s committee, and believe if this phase of ac
cident prevention work is consistently carried out the desired end will
be obtained—accidents will be prevented.
We firmly believe that our duty to our fellow man is more clear
to us to-day than ever before, and if we hold to the faith our efforts
will not be in vain.
There is much to do, there is much to w in ;
For the ages have taught their lo r e ;
But we clearer see what the right must be
Than ever man saw before.
SO M E S H O W IN G S FR O M A C C ID E N T R E C O R D S.
BY
LUCIAN
W.
C H AN EY,
SPECIAL
AGENT, UNITED STATES BUREAU OF LABOR
STATISTICS.
Since 1910 the United States Bureau of Labor Statistics has main
tained a nearly complete record of the accident experience of the
iron and steel industry. JBy experience is meant much more than
the record of the number of accidents pccurriiig. Such numerical
accumulation may serve a useful purpose, but what purpose it is
difficult to determine. The records used by the bureau have the
following elements o f completeness:
1. The amount o f employment with which the accidents are asso
ciated is known in very close approximation.
2. The amount o f disability is readily ascertainable.
S.
Tlie causes of accidents and the nature of injuries are illus
trated by a sufficient volume o f cases to permit some authoritative
showings.
The distinction of this body o f records does n£>t lie in "any par
ticular excellence in the elements which make it up, Its ujaique
character is due to the combination found in it and not present m
like degree in any other compilation, so far as can be discovered.
For example, in n other case known to the writer has it been pos
*>
sible to determine so closely the ideal employment base, namely, the
number of “ man hours” of labor with which each group of acci
dents was associated.
On account, therefore, of the varied and basic character o f the in
dustry and the quality of the records it should be possible to offer
some “ showings” o f value.
Parallel with the development of this association there has grown
up in mill and factory an organization whose purpose is the direct
study of the accident problem. Both the association and the safety
men may properly appeal to the constituted statistical authorities
with an insistent demand to be “ shown.”
In response to this entirely legitimate demand this paper under
takes to make such u showings” as the records warrant on four
points. These points are.: (1) Progress, {2) relative hazard, (3)
points of attack, and (4) possibilities.
PROGRESS.
Have the labors of industrial boards, the organizations of safety
men, the propaganda which has been undertaken, produced any
30
SOME SHOW INGS FROM ACCIDENT RECORDS---- L. W . C H A N E Y.
31
substantial results? Are industrial accidents any less numerous
or any less severe than formerly? Since modification in seriousness
is much the more important matter, the answer to the question of
progress will be given in terms of the severity rate.1
This rate is still sufficiently unfamiliar to require a brief state
ment concerning it. This is purposely couched in entirely general
terms with no attempt to present the details. The severity rate is
the rate (obtained by dividing the amount of employment, expressed
in terms of 300-day workers, into the time losses incident to the
accidents under consideration. It is necessary to transform cases of
death and permanent injury into time expressions by a system of
fixed allowances, such for example as 0,000 days for death, 4,000
days for loss of arm, and so on. The severity rate so formed is a
much more exact measure than the frequency rate could possibly
be of the relative hazard o f diverse industries and of the changes
o f hazard which occur from time to time.
In order to make satisfactory comparison of the accident occur
rence of different periods it is necessary to choose those of like in
dustrial activity. I f this is neglected, it is very likely that in periods
when industry is slowing up and rates are Jailing accordingly there
will be undue optimism, with equally undue discouragement over the
almost inevitable rise in rates which, unless there is some strong
countervailing influence, accompanies industrial revival.
In the period covered by the records to which attention will be
directed there are three years of high industrial tension, namely,
1907, 1910, and 1913. If, therefore, it is found that the later of
these years has somewhat constantly and substantially a lower
severity rate than the earlier, the conclusion of definite progress is
justified.
The severity rate for the entire iron and steel industry in 1910
was 15.9 days per 300-day worker. In 1913 it was 13.0 days, a de
cline of 18 per cent. In a special group of plants in which it was
possible to follow the record from 1907 the steps were the following:
1907, 21.6 days; 1910, 14.6 days; and 1913, 11.2 days. The decline
from 1907 to 1913 is 48 per cent.
These percentages of decline are much less than could be shown
by using the frequency rates but assuredly they give a truer picture
of the effect of accident-reduction effort in this industry. It must
be borne in mind that most of the figures hitherto presented have
been those of particular plants or companies who had been especiall}’
active and successful. The figures which are now offered give for
1 A s o r ig in a lly p re p a re d th e “ s e v e rity ra te s ” used in th is p a p e r w e re co m p u te d b y
u s in g th e s ca le d e v is e d f o r th e U n ited S ta tes B u rea u o f D a b o r S ta tis tic s b y th e a u t h o r o f
th e p a p er an d M r. H u gh S. H a n n a an d a p p lied in B u lle tin s 210 an d 234 .
In p re p a rin g
th e a r tic le fo r p u b lica tio n th e y h a v e been m od ified t o c o n fo r m to th e s ca le p ro p o s e d b y
th e C om m ittee on S ta tis tics in th e ir re p o r t fo u n d on p a ges 9 8 - 1 1G o f th is b u lle tin .
32
ACCIDENT PREVENTION.
the first time, with any approach to exactness, American experience
for a great manufacturing industry on a national scale.
So varied an industry as iron and steel can not safely be considered
as a unit only. The entire industry may appear as reasonably pro
gressive when important departments are sadly backward. To avoid
being misled by such a possibility, the principal departments will be
separately considered. The following table summarizes the facts:
SEVERITY RATES IN THE DEPARTMENTS OF THE IRON AND STEEL INDUSTRY—
ALL PLANTS, 1910 AND 1913; SPECIAL PLANTS, 1907, 1910, AND 1913.
A ll plants.
Special plants.
Department.
1910
1913
1907
1910
1913
Blast furnaces......................................................................
Open hearths........................................................................
H eavy rolling m ills.............................................................
Sheet m ills............................................................................
Fabricating shops...............................................................
Y a rd s.....................................................................................
2S.8
29.3
19.4
12 7
163
197
21.6
17.2
8.6
8.2
11.2
19.2
48.1
43.3
14.3
12.2
28.6
22.5
21.5
12.8
12.4
13.5
19.9
16.4
15 0
22 6
6 0
8 6
7.3
3 0
Entire industry.........................................................
15.9
13.0
21.6
14.6
11 2
Blast furnaces.—The severity rate for blast furnaces in general
was 28.8 days per 300-day worker in 1910, and 21.6 days in 1913. The
decline was 25 per-cent. In a representative group of furnaces the
rates were: 1907, 48.1 days; 1910, 21.5 days; 1913, 15.0 days. The de
cline from 1907 to 1913 was 64 per cent. It may be suggested that
these furnaces had abnormal rates in the early years. This is far
from being the case. There were many having even higher rates at
that time.
Open-hearth furnaces.—The open-hearth furnaces of the country
show a record as follows: 1910, 29.3 days; 1913, 17.2 days. The de
cline for the period was 41 per cent. Considering a special group of
plants over a longer period, the following severity rates appear: 1907,
43.3 days; 1910, 12.8 days; 1913, 22.6 days. The rise between 1910
and 1913 illustrates the effect frequently arising from increased indus
trial activity. From 1907 to 1913 the decline was 48 per cent.
Heavy rolling mills.—These mills roll directly from the ingot and
are almost completely mechanical in their operation. All mills re
corded had a rate of 19.4 days in 1910, and of 8.6 days in 1913. The
decline was 56 per cent. The special plants had rates as follows:
1907, 14.3 days; 1910, 12.4 days; 1913, 6.0 days. The decline from
1907 to 1913 was 58 per cent.
Sheet mills.—For all sheet mills the record is: 1910,12.7 days; 1913,
8.2 days. This is a decline of 35 per cent. For special plants: 1907,
12.2 days; 1910, 13.5 days; 1913, 8.6 days. These mills register a
decline from 1907 to 1913 of 36 per cent.
SOME SHOWINGS FROM ACCIDENT RECORDS---- L . W . C H A N E Y.
33
Fabricating shops.—These shops produce the girders and other
parts of bridges and in recent years are largely occupied with the
materials of steel buildings. All shops recorded show the following
rates: 1910, 16.3 days; 1913, 11.2 days. The amount of decline is 31
per cent. The special plants have: 1907, 28.6 days; 1910, 19.9 days;
1913, 7.3 days. The decline from 1907 to 1913 is 74 per cent.
Yards.—Under this heading is included transportation, which is so
large an item in the operation of a great industrial plant. In 1910
the severity rate was 19.7 days and in 1913 it was 19.2 days. The de
T
cline was only 3 per cent—an amount so small as to be of little signifi
cance. The record of the special plants is better. In 1907 they had a
rate of 22.5 days, in 1910 of 16.4 days, and in 1912 of 11.5 days. In
this comparison 1912 is used instead of 1913 because the later year is
the only one in which the department was entirely free from fatality
and the rate of 3.0 days for that year might be regarded as not
typical. The decline from 1907 to 1912 is 49 per cent.
It will be evident from the foregoing review that the “ showing ”
regarding progress is definite, constant, and pervasive.
RELATIVE HAZARD.
That different departments of industry have not the same degree
of danger is so evident as to require no proof. There has been real
need, however, of a method of measuring this difference. That such
measurement is not accomplished by comparing the frequency of
accident occurrence may be illustrated by noticing that when the
machine-building records were made up it appeared in numerous
instances that machine-building plants had a considerably greater
accident frequency than some of the better steel mills. No one
familiar with the two industries could for a moment suppose that
these rates represented the true relation in the matter of hazard.
Such observations as this led to further study along the line of the
elaborate presentation of time lost through temporary disability,
which was made in the first iron and steel report, and finally to the
system of severity rates now used by the bureau.
For purposes of comparison between the different branches of the
iron and steel industry, the experience of a period of years affords
the best basis. Individual years are subject to the special industrial
conditions which may prevail. The different departments may be
very unequally influenced by these conditions. In a period of years,
especially if it includes a reasonably varied set of conditions, the
unusual will be overcome and rates of a fairly typical character will
be obtained. Accordingly the five-year period 1910 to 1914 is used
in the following comparison of the different departments.
78532°— Bull. 248— 19------ 3
34
ACCIDENT PREVENTION.
Tlie highest rate, 94.2 days per 300-day worker, is found in the
erection of structural steel. This occupation has long been known
to be one of great hazard. It will be further discussed at a later
point. From this extraordinarily high rate there is a long drop to
that of the operation of ore docks—24.8 days. Between 15 and 30
days there is a group of the important departments, such, for ex
ample, as blast furnaces, 21.4 days; Bessemer steel works, 19.3 days;
open-hearth steel works, 19.5 days; coke ovens, 18.3 days; yards, 18.0
days.
Between 10 and 15 days there is another considerable group, in
cluding forge shops, 11.6 days; mechanical departments, 11.8 days;
heavy rolling mills, 11.0 days; plate mills, 11.9 days.
A few departments are below 10 days. They are: Rod mills, 8.7
days; sheet mills, 7.7 days; wire drawing, 9.5 days; tube mills, 6.6
days; crucible melting, 7.7 days.
These figures rank these departments in very close accord with the
anticipations of those best fitted to judge by reason of personal
familiarity with the various hazards. This strengthens confidence
that the rates are fairly typical, and therefore useful as points of
reference. The operator of a given type of mill may compare his
figures with these with confidence that they represent the experience
of his branch of the industry with a fairly close approach to accuracy.
The rates presented indicate a wide diversity among the depart
ments. One further point in this connection is worth noting. As
rates have declined in recent years the differences between the
departments have become steadily less. In 1910 the range was from
5.2 days per 300-day worker in tube mills to 31.3 days in Bessemer
steel works. In 1914 it was from 5.9 days in tube mills to 15.3 days in
blast furnaces. This somewhat unexpected drawing together of the
rates suggests that the greater natural hazard incident to some de
partments and occupations may be, in a very considerable measure,
overcome and nullified by the vigorous application of the right kind
of preventive measures.
POINTS OF ATTACK.
It will naturally occur to anyone considering the facts so far pre
sented that those departments exhibiting high rates are those calling
for the most serious attention. This natural inference is subject to
many limitations. For example, a low rate may reflect a small in
trinsic hazard which, because it is small, fails to attract the attention
which it deserves. Such a rate may accompany a degree of neglect
far greater than that disclosed by the higher rate of naturally more
dangerous occupations. It would be possible to specify instances
where natural freedom from hazard has operated to give a false sense
of security. The possibility of improvement not being keenly felt,
the effort which might have brought about improvement has not been
SOME SHOWINGS FROM ACCIDENT RECORDS---- L. W . C H AN EY.
35
forthcoming, and a whole industry has lagged far behind the position
which it should properly occupy. This statement is offered lest it be
supposed that, because the limits of this paper will make it necessary
to confine attention to a few cases of notably high rates, the depart
ments having lower rates do not call for improvement.
The erection of structural steel will be first considered. It may
be thought that the rate of 94.2 days is exceptional. It is to be
feared that it is—in the direction of being low. Personal knowledge
of the methods of operation of the firms whose figures are used is
convincing that they are conducted with greater regard for safety
precautions than is usual with building constructors in general. The
rate is probably below, rather than above, the average. It should be
noted that not only is the aggregate rate high but the elements of
which it is composed are.high—the death rate is high; permanent and
temporary disability are both excessive. Is this unavoidable or might
concentrated attack bring about an improved condition ? No' authori
tative answer can be given without further study. The facts on
record are not extensive enough to warrant any final conclusion.
There are a number of conditions which'make the control of acci
dent causes in structural work extremely difficult. Among them may
be mentioned:
1. There is nearly always a tendency to haste. Both owner and
contractor are desirous of completing the task at the earliest possible
moment.
2. The work must be done under temporary and extemporized con
ditions very different from the orderly conditions of manufacturing.
3. The migratory habit of building-construction firms makes such
organization as that which is possible with localized industry diffi
cult in an extreme degree.
More influential than any of these, in all probability, is a deepseated conviction that effort is useless. Building constructors are
ready to admit the.success of efforts in general industry but insist
that their situation is so different that no comparison is possible.
They have therefore stayed, in a measure, outside the circle of those
making active efforts toward accident prevention. It may, in view
of past experience, be strongly suspected that it is this honest belief
that there is little that can be done, rather than the inherent difficul
ties, which keeps structural work in such extreme and bad pre
eminence. Here, then, is a point of attack. The question of possible
improvement should be theoretically and experimentally studied, with
persistence and on a large scale. I f the present situation admits of
remedy it is nothing short of a scandal that the remedy should not be
found and applied.
The second point of attack to which attention is directed is the
transportation problem, listed under the head of yards. It has
36
ACCIDENT PREVENTION.
been noted earlier that this department shows a decline of only 3
per cent when 1913 is compared with 1910. So small a decline
means nothing. No improvement can be argued from it. That
improvement is possible is evident from the experience of the special
plants in which there w
^as, between the same years, a decline of 88
per cent. Such study as it has been possible to bestow indicates
that the internal transportation of the plants has not been brought
up to the standard now maintained by the railways. It is a matter
of no small cost and difficulty to do away with grade crossings,
provide automatic couplers, adequate clearances, proper signaling
apparatus, and a long list of other modifications necessary to insure
safety. When they are applied the death rate falls at once.
Many other points might be specified. These must serve to illus
trate the lines of effort which may be discovered by a study of the
records.
POSSIBILITIES.
Is it possible to eliminate serious and fatal accidents ? The answer
thus far given has been an unhesitating negative. It will not be
possible within the limits of this paper to give the body of facts
which apply to this question. These have been elaborated in the
Monthly Review of the Bureau of Labor Statistics for August, 1917.
All that can be done here is to present the gist of the argument and
some of the illustrations.
Studies of the changes in frequency rates which have come about
in recent years are perfectly convincing that appeal to the human
factor has often produced remarkable results in bringing about re
ductions in accident frequency. Take, for example, a group of mills
which have pressed with unusual force various forms of appeal to
the men. In this group of mills the frequency rate declined from
187.5 cases per 1,000 300-day workers in 1910 to 88.5 cases in 1913.
This is a notable result which has been considerably exceeded in the
experience of individual plants. This and other similar experience
proves beyond question that results can be reached through the
medium of educational efforts which appeal to the men. At the same
time it has been proved that this laboriously acquired carefulness is
easily dissipated. A sudden rush of business activity and the acci
dent frequency rate may soar, to the despair of the safety man in
charge. Human nature is not perfect and will not become so in our
generation. If, therefore, the elimination of serious accidents is to
be dependent principally upon the perfecting of human nature, such
elimination must remain an “ iridescent dream.”
By means of the severity rate it is possible to show whether the
reduction of serious accidents is dependent upon this human factor
with its unescapable defects. The answer of the records is perfectly
SOME SHOWINGS FROM ACCIDENT RECORDS---- L . W . CH AN EY.
37
clear. In the iron and steel industry the great successes in reducing
fatal and serious accidents have been due to what is termed “ engi
neering revision.” By this expression is meant the broadest possible
application of engineering skill to rendering industry safe.
To illustrate, in a typical group of blast furnaces 4 breakouts ” and
6
“ asphyxiating gas ” were the great causes of death in the early years.
From neither of these does the personal caution of the men afford
material protection if the conditions are such as to permit exposure.
These two contributed 56 per cent of the severity rate of 1906. By
1910 “ breakouts ” had disappeared, as a result of improved construc
tion, and the menace from “ gas ” had been so much reduced that its
part of the severity rate was insignificant. The change in severity
rate for “ hot substances,” which include “ breakouts,” was from 54.3
days in 1906 to 1.6 days in 1913, an absolute decline of 52.7 days, or
97 per cent. At the same time 6 handling tools and objects,” a cause
6
group particularly dependent on personal care, showed a clccline of
only 6.4 days.
Among the deaths occurring between 1905 and 1914 of which the
bureau has record, 372 have causes stated in sufficient detail to justify
conclusions regarding the relative importance of “ engineering revi
sion ” and personal care. Of these 372 cases, 212, or 57 per cent,
would probably have been prevented by the engineering changes
which were made after the deaths.
A study of a group of 72 deaths occurring in 1916 indicates that
58 per cent of them would, in all probability, have been prevented by
adequate engineering provisions.
It appears, therefore, that in certain important instances the prac
tical elimination of hazard has actually occurred. It appears further
that there is no limit assignable to the possibilities of greater strength,
better design, and general engineering improvement.
Why, in view of the facts, should any theoretical limit short of .
entire elimination be set for injuries causing death?
I f in practice the entire elimination of fatality be accepted as a
reasonable goal of endeavor, and an “ engineering revision,” thorough
bej^ond anything yet attempted, be accepted as the rational means of
attainment, great progress may be expected. The limits of accident
reduction through appeal to the human factor are in sight. I f a
satisfactory progress is to continue we must dig much more deeply
into the problem.
A conclusion that fatality may be largely eliminated is, if well
founded, of vast importance to every board and commission which
administers compensation. It means vast savings in compensation
costs and, more important, vast sayings of human misery.
These are the “ showings ” of the accident records.
A C C ID E N T P R E V E N T IO N .
BY BARNEY COHEX, DIRECTOR, ILLINOIS DEPARTMENT OF LABOR.
The scope of this topic and the time available for its discussion
make only a sketchy treatment possible. The subject of accident
prevention embraces a wide range of associated subjects and deals
with information included in statistics, industrial development, eco
nomics, engineering, medicine and surgery, psychology—or mind
study, as I prefer to call it—and other subjects.
This paper presents, following a few observations deduced from
late experience in organizing a new department, some of the simple
basic principles which govern accidents, with suggestions as to how
these may be made of use in the reduction of accident hazard.
In bringing some 11 divisions—formerly independent State de
partments—under one head, I have noted several principles which
have to do with the subject in hand. The new Civil Administrative
Code of Illinois, in force July 1, 1917, provides that six free employ
ment offices located throughout the State, the general advisory board
for the free employment offices, the division of labor statistics, the
division of factory inspection, and the division of industrial com
mission be brought under the supervision of the State department of
labor. x\ll of these divisions are under the control of the department
of labor, excepting only the industrial commission, over whose judi
cial decisions the department has no supervision.
In making this consolidation, one fact stands out sharp and clear:
The elementary—the A, B, C—needs are often the most difficult
ones to be provided for by legislation. We in Illinois have not yet
been able to secure, by legislation, two of the most vital yet simple
requirements of thorough accident prevention. The first require
ment is an accurate industrial census giving the names (or some
lesser designation) of employers, the number of employees, and
more or less comprehensive information, classified by occupations.
The second requirement is a simple method by which all accidents
are to be reported. Illinois has legislation—conflicting legislation,
in fact—on accident reporting, but no one simple method of report
ing is now required, the result being that many industrial accidents
do not come to the notice of the department.
So much for needed legislation in my own State. Leaving State
needs for general needs, I wish to ask, What constructive study has
been and is being made of the function of the accident in the scheme
o f things?
Who among us is making a study of the why of the accident as a
part of nature’s plan ? Here and there wholesale students of heredity
38
ACCIDENT PREVENTION---- BARNEY COHEN.
39
have given thought to this matter as one vitally affecting human life.
By “ wholesale students ” I mean those who consider all of the facts
of heredity—such men as Luther Burbank, for instance—instead of
that class of technicians known to us all who specialize on some micro
scopic part of a science to the exclusion of all other parts.
I f we consider the deductions of those writers and students who
view facts by the wholesale, it is evident that the accident, in uncivi
lized life, had a most important function. Its utility, evidently, in
the plan of a barbarous world, was to weed out the unfit. The acci
dent was a mere by-product of progress. In the harvest, in the chase,
and more particularly in warfare, accidents and casualties tended
to weed out the less skilled, the less wary, and what, for a better
term, we must call the unlucky. This tended to leave the fit, the
unfit having been eliminated. The individual—his sufferings or
death—did not matter so long as the race was benefited. Nature,
unhampered, invariably subordinates the good of the individual to
the good of the raec. The individual may die prematurely; those
living will be fit to continue the race.
Another inference is evident here. Nature, it is plain, placed the
instincts of daring, curiosity, enterprise and initiative, desire for
excitement, and similar moving motives, in man’s make-up that he
might continue to investigate and learn, though multitudes were to
lose their lives in obeying those impulses and instincts.
So dominating are instincts, so strongly do they persist in man
to-day, that when a ladle of molten metal spills in a foundry, curi
osity will often hold a workman to a dangerous spot, even when he
knows he is risking his life. Similarly, in the railway service, the
spirit of daring often leads a brakeman or engineer to “ take a
chance.” At the door of the primal instinct, therefore, is to be laid
the deeply rooted cause of many accidents. Impulse may, and often
does, run counter to safety. It is for the good of the race, such is evi
dently nature’s plan.
So
we have for a basic principle that nature does not count the
individual of value but does place a high valuation upon the race.
This is no newTthought, nor is it always confined in its application
to nonindustrial conditions. It is as true in our industrial age as it
was when man lived by the fruits he could gather and the beasts he
could kill. Nor is it a principle that has been limited in its con
sideration merely to the student of technical heredity or biology.
Maeterlinck, as an instance, in his “ Life of the Bee ” constantly re
fers to the cruelty of nature, her willingness to sacrifice not only
millions but an entire nation of individuals in one of her magnificent
experiments, and further voices the thought that perhaps even the
entire human race is being sacrificed to some form of gigantic experi
ment that we as individuals are not able to understand.
40
ACCIDENT PREVENTION.
Now, suppose we take this principle governing all life and apply
it specifically to present industrial conditions. Man assembles a
gigantic industry and in planning it figures on having as much of
the work of that industry as possible done by means of unskilled
labor. In order to utilize such unskilled labor two things are neces
sary: First, the processes must be divided as fine as possible, so that
routine, unthinking work will take the place of initiative and
thought. Second, the machine must replace the man as far as inven
tion and skill can bring this about. As a consequence the work of
both men and machines is reduced to the simplest elements and com
bination of elements.
Now, bearing in mind the principle that the subconscious mind,
rather than reason, controls the acts of the untrained man, and com
bining with this general principle the industrial principle that in
order to procure dividends it is necessary that much of the work
be performed by elementary processes, it is plainly to be seen that
the causes of industrial accidents root deep in principles which not
only are not being generally considered, but are not even suspected
by many who are considering the subject of industrial accidents.
What we do know is commonly deduced from observation of .what
occurs rather than from the knowledge of the principles governing
what does occur. For instance, either observation or a knowledge
of principles leads us to the same accurate conclusion that where you
place a large number of untrained men in the most highly specialized
surroundings, where a single, momentary departure from reasoning
acts means mutilation or death, that the accident quota is bound to
be large. Further, when you work these men long hours at monoto
nous employment, and simple employment is bound to be monoto
nous, so tiring their conscious minds to a point where they have only
their subconscious minds to regulate their movements, the hazard
from accident is still more greatly increased.
For the animal mind, roughly the same as our subconscious mind,
is not competent to deal with complicated conditions; the simplest
departure from ordinary conditions is sufficient to act as a bait or
trap for all except the shrewdest and most untiring animals that
live. And when the human being tires, when he becomes fatigued or
careless, he is obliged to trust his animal or subconscious mind to pro
tect him and keep him out of danger. Yet the dangers to which he is
subject are those of which the animal mind itself knows nothing—
they are dangers which can be combated only by the exercise of
reason governing unusual skill. This reasoning power and this skill
we do not find in the lower grades of labor.
Here it is that we come in contact with two opposing principles—
that of nature and that of humanity. The first principle, as stated,
ACCIDENT PREVENTION---- BARNEY COHEN.
41
is that nature does not care for the individual. The evident aims of
nature are the continuance of the race and bringing the race to a
high standard of perfection. The number of sacrifices that are made
in furthering this aim seems to have no consideration in nature’s
scheme of things. I f we take as a basic principle that nature does
not care, then we must oppose such principle with a second one—that
mankind must care.
Not only must mankind care, but man must show as great an initia
tive and intelligence in caring as nature does in her apparent wastage
of human material. More specifically, man must show as great an
interest in life protection and conservation as the manufacturer does
in production.
I f the same inventive skill which creates the machine were to
exercise one-tenth of such initiative and skill in devising a plan of
protecting the workmen about that machine, we would see the indus
trial hazard drop as rapidly as industrial production has increased.
I f we were to use the same degree of constructive thought to prevent
accidents as is used in the arrangement of a complicated battery of
machine tools that they may work together to produce a unified prod
uct, there would be practically no accidents other than those which
would come from causes which are beyond the control of mankind—
accidents which are truly accidents and not merely the result of the
lack of foresight and care.
If we in the study and consideration of industrial accidents can
go far back to the causes which bring them about, putting less reliance
T
upon correcting results and more stress on what the deep-set causes
are and then do away with or lessen those causes, the solution of acci
dent prevention will have been found. How difficult a matter this is
to arrange—how difficult it will be to cut down the toll of human life
which is so relentlessly taken by organized industry—can only be
realized when the profit angle of such a move is studied. For truly,
profit is the motive that moves the industrial world.
At the present time, in many cases, there is no particular money
motive for the large manufacturer in many lines to cut down his
hazard. He is protected so thoroughly by the traditions of the law,
by precedents established long before organized industry was even
dreamed of, that reward for him can hardly come in a change of the
law. “ Let society pay the damages—if any damages are paid,” is
sometimes the slogan of the selfish employer who looks to dividends
instead of to human brotherhood for his reward.
When, on the contrary, the law surely penalizes the business and
the business alone, for injury to the workingman, there will be a
strong motive for the employer to bring accident prevention to a
high state of perfection, and to cut down every possible accident on
the list to the minimum. Or, what is a still more remote possibility,
42
ACCIDENT PREVENTION.
when labor is of such value to the employer that its loss, aside from
some other penalty, becomes of vital interest to him, we have a motive
which immediately will act doubly to protect the life and limb of the
employee and the dividends of the employer. Finally, there is the
humanitarian principle that it is a duty for human beings to protect
their kind, even if it may cut down immediate dividends a trifle.
Now, for specific suggestions as to how it seems possible to further
the work of reducing accident hazard:
1. As a basis we should know, from accurate deductions made by
some biologist or sociologist, the exact place that the accident occu
pies in nature’s plan for progress, that we may oppose this with
man’s plan for caring for the injured and protecting others from
injury.
2. In asking legislation, we should attempt to secure, in every
State, the simple requirements necessary to procure a complete, accu
rate industrial census and accident reports. This, once secured, will
permit accurate deductions to be made, merely by comparing the
number of accidents with the number employed.
3. Similarly, accidents should be standardized by defining all pos
sible accidents, so that uniformity in both reporting and recording
will be possible.
4. Some provision should be made for uniform classification of
accidents as to real causes, rather than on the basis of results.
5. Financial incentive, as a motive, should be studied that it may
be possible to draft legislation to influence the employer, the em
ployee, and the public so as to act from the profit motive.
6. Somebody has to pay for every accident; let us take steps to
learn exactly who it is that pays.
7. “ Safety first ” campaigns should be standardized, improved, and
continued.
8. Engineering colleges and institutes should plan to include a
course in safety engineering in all engineering courses.
9. Manufacturers of safety devices should unite to take up particu
larly the selling end of their business, that safety devices may be
intelligent^ marketed.
10. Some provision should be made to instruct students of machine
design, shop foremen, and others in specific methods of accident pre
vention in connection with the design, placing, and control of
machinery.
11. Systematic distribution should be made of literature, dealing
with safety methods, particularly among employees who are subject
to hazard, those supervising such employees, and apprentices and
beginners in the hazardous trades and occupations.
12. Humanity as well as dividends should be appealed to in a sys
tematic attempt to “ make the world safe for industry.”
D IS C U S S IO N .
A. H . Young, director, American Museum of Safety. We know
that because of the safety work in many of the industries, there has
been a reduction in the death rate, but if we use a 9,000-day unit^
we are going to throw things out of all proportion and make an
abrupt change in our method of comparison. I have felt that our
rates are possibly wrong. We know how accidents occur and we
all know the same accidents cause different periods of disability.
Now, if we reduce our accidents by mechanical means, but give the
total number of fatal accidents a valuation 9,000 times greater than
an accident which disables a man one day, we are going to get a
result out of all proportion to the general run of accidents in blast
furnaces.
Dr. R oy a l M eeker, United States Commissioner of Labor Statis
tics. It’s the time lost that measures the economic effect of the acci
dent, isn’t it ?
Mr. Young. Looking at it from the standpoint of a safety man.
The only possible way for a safety man to achieve success is to
eliminate all accidents—that’s going to bring about a reduction of
injury.
Dr. Meeker. There are accident hazards which result in very
serious accidents, and it seems to me that that’s the point which needs
to be dealt with—that is what has brought about this study of
severit}T rates.
Mr. Young. Unquestionably; but we can go further, and sajr that
all accidents—we use that term generally; it is about 50 per cent—
are due to mechanical causes. We want to prevent accidents which
cause fatality and those that cause the great economic loss, but to
go on and say that all accidents, or 50 per cent of the problem of the
safety man, lie in the extension of mechanical guarding, that I am
not prepared to agree to. The same accident which may cause death
may easily cause no injury at all, may break a man’s arm, or may
admit of his being back at work within a day, and yet the safety
man wants to prevent that accident. You have to safeguard your
trains and prevent all parts from dropping—that’s the real problem
of the safety man. It is not just to find out what are the fatal
accidents and then to take those accidents and give them a value 9,000
times as great as injuries similarly caused.
George A. K ingston, commissioner. Workmen’s Compensation
Board of Ontario. I would like to ask Dr. Chaney if in compiling
48
44
ACCIDENT PREVENTION.
h is s e v e r it y r a te s h e ig n o r e s a lt o g e t h e r th e c o s t id e a . S u p p o s e d e a t h
o c c u r s fr o m a c e rta in a c c id e n t, a n d th e re h a p p e n to b e n o co sts, o n
a c co u n t, sa y , o f th e re b e in g n o d e p e n d e n c y — w o u ld y o u p r o v id e fu n d s
to m e et th e c o s t o f su ch a n a c c id e n t?
I n oth er w o rd s, u n d e r su ch
a s y s t e m o f r a t i n g w o u l d y o u c o n s i d e r t h a t e v e r y d e a t h is s u p p o s e d
t o co st so m u ch r e g a r d le s s o f th e a c tu a l c o n d it io n s ?
I ask th i
q u e s tio n b e c a u s e , s p e a k in g f r o m r e c o lle c t io n , I w o u ld s a y t h a t a b o u t
h a lf o u r fa t a l a c cid e n ts c o s t o u r a c c id e n t fu n d n o t m u c h m o r e th a n
fu n e r a l ex p en ses.
D r . C h a n e y . Y ou a r e g o i n g t o g e t a n o t h e r vof w h e q u e s t i o n
ie t
f r o m th e c o s t s id e .
T h e d i f f i c u l t y w i t h u s i n g c o s t is t h a t i t v a r i e s s o ;
n o t w o a c c i d e n t s a r e a l i k e a n d t h e n a n o t h e r c a u s e is t h a t w a g e s a r e
h ig h e r in s o m e ca ses.
M r . K ingston . T h a t is , y o u a r e g o i n g t o b a s e y o u r r a t e s o n y o u r
s e v e r ity e x p e r ie n c e r a th e r th a n c o s t e x p e r ie n c e ?
D r . C h a n e y . Y ou s a v e m o n e y ; t h a t ’ s a p e r f e c t l y f a i r a s s u m p t i o n .
A l l d e a th s d o n o t c o s t th e sa m e , b u t w h e n y o u a r e t r y i n g t o e s tim a te
th e r e la tiv e s t a n d in g o f in d u s t r ie s , y o u p u t a ll d e a th s o n th e s a m e
b a s is .
Dr. Meeker. All deaths do not cost the same in time. I would
like to say that the idea w as to get a unit basis. We tried to estimate
from the figures given to us by everybody what was the average term
of life of men who liad met with fatal accidents. I do not think the
estimate was a very accurate one, but we used the figures that we
got and we arrived at this result, of allowing 9,000 days as a fair
estimate of the time lost to that individual normally and to society
because he was wiped out in an industrial accident. That does not
mean that every individual has 9,000 days left for him to live at
the time he meets with a fatal industrial accident, but that was the
average life expectancy as near as we could get at it. Of course,
there are a great many criticisms that can be made of this severity
rate; it isn’t absolutely accurate. No method of estimating the
severity of accidents is absolutely accurate, but I am convinced that
the “ time lost ” method of measuring the severity of accidents is
immensely more accurate than simply the number. Frequency
rates put the man who gets his head busted on the same level with
the man who gets his thumb-nail busted. Both are accidents, but
there is a great difference in the results. Now, to take up Mr.
Young’s criticism, I think the hazards that are the most hazardous
are those that cause the most severe accidents. Suppose we have twp
accidents each caused by a sliver penetrating a workman’s foot. One
results in blood poisoning, which eliminates the man; the other re
sults in nothing at all—he doesn’t lose any time at all. The cause is
the same for both. Why should we make any difference in the
ACCIDENT PREVENTION---- DISCUSSION.
45
records of tlie two accidents? Simply because they result differ
ently—that is all. It will all come out in the wash. The indus
tries and occupations that kill most men and injure men most severely
are the more hazardous industries and occupations, and their more
hazardous character will be shown by their accident severity records.
It is a perfectly legitimate thing to count accidents according to
their results and not count all accidents as accidents regardless of
what they do to the individual.
[The chairman stated that he did not quite agree with Dr. Chaney
as to the per cent of accidents that can be prevented by the use of
safeguards. Eeferring to the extracts from his paper at tlie Colum
bus meeting, quoted by Mr. Beyer, he emphasized some of the state
ments there made, and also, as corroborative of his view, quoted
AY. H. Cameron, secretary of the National Safety Council, to the
effect that “ 75 per cent of the accident-prevention problem is the
elimination of unsafe practices and thoughtless methods ” ; G. M.
Cooper, in charge of the safety work of two of the United States
Steel Co.’s plants, who stated that in 42*of their plants not one acci
dent happened the previous year attributable to the absence of a
safeguard, although many machines, equipment, and buildings were
not adequately protected; Charles L. Close, of the United States
Steel Corporation, who stated that if his company was starting its
campaign over again it would not emphasize safeguards, but would
devote its attention almost entirely to education; and Magnus W.
Alexander, executive secretary of the Conference Board on Safety
and Sanitation, who said that five large plants, employing 30,009
persons, by the wholesale guarding of machine tools at great ex
pense, reduced machinery accidents to 12 per cent of the total, the
other 88 per cent being in no way connected with machinery, and
that at the most but about 25 per cent of all accidents would be
prevented by total safeguarding of all machines. He contended that
only a combination of safeguarding and education will solve the
accident problem, and while not underestimating the value of safe
guards said that they in themselves do not prevent accidents. As
illustrative of this point, he told of two accidents which had hap
pened in Massachusetts on a machine that was adequately safe
guarded. The first man who was injured was a Russian, who was
put to work on this machine within two weeks after he landed in
this country. He was shown by signs how to operate the machine,
by a man who did not speak his language. Had he been instructed
in his own language, he could have avoided the accident. Four
months afterwards another Russian, taught in exactly the same way,
was put to work on the same machine and suffered the same kind of
an accident, with the same result—loss of his left hand. The safety
46
ACCIDENT PREVENTION.
device on this machine was adequate to protect these men, but they
were not educated in the use of it.
Not only must the workmen be educated by personal instruction,
shop organization, stereopticon lectures, pay-envelope series, etc., but
also the employers and foremen must be educated to the necessity
of safeguarding the men. Mr. Holman also pointed out the value
of study of accident reports, and instanced cases in his State where
conditions disclosed by such a study were remedied by the intro
duction of precautionary measures and the accident rate greatly
reduced.]
Mr. Beyer. Mr. Holman spoke about the machine that was guarded,
on which the men were injured. The first question is, How was the
machine guarded? It is possible to guard a great many machines
defectively. In some places the man starts his machine and also
shuts it down; that’s the maximum scope of safeguarding in a great
many industries. In many industrial plants where safety engineers
are employed, where guards are used, and where knowledge of them
is enforced you will find the men have injuries*, but, on the other
hand, where you have the best form of safety and educational work
you have the men doing careless things and being injured just the
same. I know of a case in a plant where a man who had been there
several years was operating a machine and was operating it in a
dangerous way. He was a pieceworker, and to operate the machine
carefully he would lose time. The result was that his hand was cut
off ; that was due to the careless operation of the machine. Mechan
ical safeguards certainly will not give you 100 per cent efficiency;
neither will education. Most of the reports to which you refer, Mr.
Holman, are based on accident frequency; based on the number of
accidents rather than the seriousness of them.
[The chairman replied that he did not think so; that he had sent
letters to the men whose statements he had quoted, telling of the
results of his study of 350,000 accident reports, and asking if their
experience agreed therewith, and the replies were all corroborative,
the percentage of accidents prevented by mechanical safeguards
ranging from 10 to 25. The highest, 25 per cent, dealt with all
accidents coming under the observation of these men in the dif
ferent plants they represented, covering considerably over 1,000,000
employees, and the accidents that would have happened during the
years these men were there. Their belief, therefore, is based on their
own studies and experience.]
Mr. B e y e r . Twenty-five per cent is not the high'est. Forty-two
and a fraction was the most that was given for mechanical accidents.
None of these reports mentioned speak about any rating for serious
ness. The New York Central quoted 22 per cent from mechanical
ACCIDENT PRETENTION---- DISCUSSION.
47
causes. Our records show that 10 per cent were due to mechanical
causes. Now, of course, you will have a great many accidents, but
I think we have a very wide coverage that we can depend on. It
seems to me one of the most convincing things in Dr. Chaney’s paper
is that he bases his opinion on things so closely comparative on the
basis of cost, which shows that, regardless of the basis which you
use, if you have wide enough coverage it will be about the same.
T. Norman D ean, statistician, Workmen’s Compensation Board
of Ontario. In my mind’s eye I picture a protruding set screw and
a man working around that set screw; that is a potential accident
producing a potential death. You propose to measure the severity
of a death by 9,000 days. Is the set screw any more dangerous—
should we protect that set screw any more—because the man was
killed ? Is not the point of hazard a potential accident ?
Accident severity rates, as I understand them, are used to produce
comparisons of two trends of events from similar bases at the same
time. It is a matter of proportional relation. Can we not keep
proportions irrespective of what basis -we use—whether we are
highly accurate or entirely wrong—as long as we maintain the same
basis? I think that that is the purpose of accident severity rates.
It has nothing to do with the work of accident prevention except
to express the results of accidents which have happened in a given
time, for comparable purposes.
I would like to ask Dr. Chaney as to the total number of accidents
this experience takes into consideration. You say about 300,000,
with the mechanical portion about 15 per cent, analyzed on a basis
of seriousness, but if 50 per cent they are the same accidents abso
lutely, judged by end results, and it is a large enough number from
which to draw conclusions. I think most of the men in safety work
have accepted the proportion of 15 per cent on mechanical equip
ment, though the suggestion has just been made that it is much
higher. The question becomes, on this basis of reasoning, whether
it is better to pay the foreman or to pay the safety man, because
of the greater economic value of the preventive movement. When
gross results are shown, the men who have worked one way have
obtained good results and those who have worked another way get
good results also—both simply by getting busy and keeping at it.
C a rl Hookstadt, expert, United States Bureau of Labor Statistics.
If it is true that there is a definite line of demarcation between
serious and minor accidents, and if it is true that serious accidents
are caused by defective engineering or lack of safeguards, while the
minor accidents are caused by the ignorance or carelessness of the
worker, then it seems to me that the duty of safety engineers is clear
and definite; that is, for the prevention of serious and fatal accidents
48
ACCIDENT PREVENTION.
our attention should be centered upon engineering revision and
mechanical safeguarding, while education and organization should
be relied upon for the elimination of the minor accidents.
W i l l J. F ren ch , member of the Industrial Accident Commission
of California. Next week it will be six years since I was appointed
on the California commission. It has fallen to my board to have
charge of our safety department, and during that time there have
been 400,000 accidents that have come to the commission in Cali
fornia, and, consequently, we think we have some experience in this
connection. Our chairman has accurately expressed my belief as to
the situation, namely, that it is impossible to definitely say what
per cent of accidents can be prevented by mechanical safeguards.
In the first place, there are different industries in the different
(States, and in the next place, because of that fact, we are sometimes
unable to get exposure. The percentages of accidents prevented by
the use of mechanical safeguards that I have read of are from 10 to
75, and just what those figures mean is unknown. We should use the
two things, safeguards arid education, and I would not confine the
educational process to the employee, as is so frequently advised. W e
find employers who ought to know that proper lighting and good
water are just as important in preventing accidents as the educa
tion of the worker. Also, you have to take into consideration the
thousands of foreigners. Some of these men come to us without a
knowledge of the language, so that they have to be taught. There
fore, I heartily indorse Avhat Mr. Holman has said, and I believe
you can never arrive at any definite per cent of accidents that can
be prevented by the use of safeguards alone.
[Mr. James L. Gernon, of the New York Department of Labor,
thought that in considering this whole proposition too much statis
tics had been used and that the basis of our figures has not been right,
and doubted if any of the States have complete figures for a proper
calculation of all these accidents. He thought that some of the argu
ments used had been productive of harm, as the manufacturer in
many instances, not wanting to provide guards, would argue that
safeguards were no good, as the so-called authorities in the country
have said that only 25 per cent of the accidents can be prevented by
them, and fall back on a safety campaign, which in many cases was
not really a safety campaign, or a campaign of education. He agreed
with the chairman that both guards and education should be pro
vided, and emphasized the point that the guards must be of proper
design and properly installed, as the number of guards that are
inadequate is amazing. He admitted that in some plants it will be
quite a task to educate all their workmen along safety lines, as, for
instance, in one plant where, on account of the higher wages paid
ACCIDENT PREVENTION---- DISCUSSION,
49
in a munitions plant near by, a great many were leaving, and 2.500
men came and went in one month, but it should be done, as many
men know nothing about the hazard in the operation of the machines
until they are injured. As to the basis for figuring lost time in fatal
accidents, Mr. Gernon thought that the expectancy of life rather than
9,000 days should be used, as a man 20 years of age has a greater life
expectancy than a man 80 years of age, and said that when the labor
people in New York State organized they insisted all payments for
death should be based on the expectancy of life.]
Dr. Joseph M. Burke, chief surgeon of the Seaboard Air Line
Railway. In so far as my State is concerned, I regret to say that
we have no compensation law, but whether or not there is a com
pensation law existing in a State, education and safeguarding are
necessary. I know a little something about preventive hazards. In
one shop in the city of Portsmouth, Ya., accidents by getting chips
of steel into the eyes last year amounted alone to 40 per cent of all
the accidents that occurred in that shop. It was mentioned by one
of the gentlemen here that in a certain shop guards over the eyes
prevented many accidents. Under a workmen’s compensation law
we have to pay for such accidents. An accident may occur where a
person may lose the sight of an eye, and if that eye is not taken out
he may lose both eyes. Education in all branches and in all profes
sions, coupled with providing safeguards, is what is necessary for the
people in this country.
Mr. A. W. W r ig h t, vice chairman of the Workmen’s Compensation
Board of Ontario. I don’t think it is safe to trust to one or the other;
that is, to safeguarding of the machine or to education alone. They
must go hand in hand. But one thing you must bear in mind—that
you in the United States are suffering from industrial indigestion.
Something must be done if you are going to trust things to education
alone. We have a section in our act which provides for safety asso
ciations. That, I think, can be made very useful in the way of acci
dent prevention. The employers are behind the safety association
movement. Each association has its own inspector, appointed and
controlled by the association. Our board has nothing to say except
as to the question of salary. These inspectors can go into a factory
and say certain things are required. They can lay down certain
rules. They can’t enforce them, but they can come to our board and
say, “ We want such a rule enforced,” and if the board feels that it is
a proper rule it can enforce it as a law. About a week ago I had
occasion to go into one of our large establishments over in Canada—
we have a great many such over there, and we are glad to have them.
These people are very proud of their safety work; they had
78532°— Bull. 248— 19-------4
50
ACCIDEXT PREVENTION.
recently had a safety campaign in the shop, and there was a wonder
ful spirit existing amongst the men.
Dr. Chaney. I want to say, in the first place, that the figures
quoted by the president, I think, are exactly right They are based
on the frequency of accidents. So far as the frequency of accidents is
concerned, I think our form showed very plainly a little less than 25
per cent due to mechanical causes. I am. quite sure both Mr. Beyer
and myself will feel highly pleased and satisfied if what we have
had occasion to say here to-day leads to a very thorough research of
this whole problem. We ought not to be satisfied with the present
status; we ought not to be satisfied with the results which we have
secured in getting rid of serious and fatal injuries. We should study
our accidents; and unless we study our accidents on the severity basis,
r
I am afraid we will still be in the dark. My idea of protecting the
workman is to improve the conditions under which he works, and I
think that has been neglected.
T U E S D A Y , A U G U S T 21— E V E N IN G S E S S IO N .
CHAIRMAN. WM. M. SMITH, CHAIRMAN MICHIGAN INDUSTRIAL ACCIDENT BOARD.
II. HOW CLAIMS ARE HANDLED, WITH SPECIAL REFER
ENCE TO LUMP-SUM SETTLEMENTS.
Mr. H o l m a n . It gives me pleasure to introduce as the chairman of
this evening’s program Mr. William M. Smith, chairman of the
Michigan Industrial Accident Board.
The C h a i r m a n . Your president induced me to act as chairman, or
a sort of temporary toastmaster. I am entirely a new member and
don’t know much about compensation, having been only some seven
or eight months in the work. I learned much this afternoon about
accident prevention. My board has nothing to do with accident pre
vention, but I am sure it is a good thing for me to know and a
good thing for all boards to know. It strikes me, though, that most
of the industrial accident boards of this country have nothing to do
with the prevention of accidents, though, of course, they may exercise
a moral influence, and may recommend the use of this or that sort of
a thing to prevent accidents.
The program to-night, as I view it, comes somewhat closer to our
work, the subject being, 4 How claims are handled with special ref
4
erence to lump-sum settlements.” My experience with lump-sum set
tlements so far has been to deny them. I don’t think we should have
7
such a thing. Seriously speaking, this lump-sum settlement should
be granted in very fewTcases.
I don’t know why the speakers should be confined to lump-sum set
tlements entirely, as I am sure you all have a great many problems
confronting you about which you would like to take counsel of your
fellow members.
As I talk with other members and read the statutes of the States, I
find about as many rules regulating a given subject as there are
States in the Union. It seems to me that it might be a good thing to
have the laws governing workmen’s compensation somewhat uniform.
To illustrate : One State said, 6 We have all accidents reported, no
6
matter how small or trivial ” ; another State said,4 We have accidents
4
reported when they incapacitate the man for more than 24 hours” ;
still another, 4 We have accidents reported when they incapacitate
4
the man for seven days or more ” ; and so on. Is there any reason in
the world why rules should not be the same? I f an accident which
51
52
L U M P -S U M SETTLEMENT CLAIMS.
disables a man for 24 hours is reported in Michigan, it should be
reported in Maine; if all accidents are reported in New York, they
should be reported in New Jersey. It seems to me that this organiza
tion might do something along the lines of administrative work in
securing uniform workmen’s compensation laws. We have had five
or six years’ experience in this work. The lawT of the United States
s
have secured uniform legislation on half a dozen other important
subjects, and I believe workmen’s compensation is capable of uni
form legislation. I suppose lump-sum settlements should be gov
erned by the same rules in Texas as in Tennessee, but I don’t know
of any rule covering that subject, and have been unable to find any
rules laid down, except the facts surrounding the particular case and
the judgment of the industrial accident board in that State, which
experience usually shows to be wrong.
Mr. W. C. Archer, the first speaker on the program and the deputy
commissioner of the NewT York State Industrial Commission, is, I
am told, not here.
LUM P-SUM SETTLEM ENTS.
BY
W IL L IA M
C. A R C H E R ,
C O M M IS S IO N , IN
DEPUTY
C O M M I S S IO N E R
OF
NEW
YORK
STATE
IN D U S T R IA L
C H A R G E OF B U R E A U OF W O R K M E N ’ S C O M P E N S A T IO N .
[R e a d by F. M . W ilc o x , o f W is co n s in I n d u s tria l C o m m issio n .]
In addition to this paper on the subject of lump-sum settlements
it has been my intention to prepare a symposium giving expression
to the principles and practices obtaining in every American jurisdic
tion. Between one-third and one-half of the various accident
boards and commissions have responded to my request for informa
tion, and as soon as all have responded I shall forward the sympo
sium to the secretary, to be printed, if it is so ordered; and if not,
I shall endeavor to find a means of transmitting copies of the
symposium to all of you.
My paper is expressed somewhat in general terms, and yet it may
be accepted as indicating the practices prevailing in the bureau
under my care.
Workmen’s compensation for losses arising out of industrial acci
dents is in no sense a charity or a dole from the State. Neither is
it provided in lieu of the cost otherwise to be encountered in the
maintenance of eleemosynary institutions. And its source is not a
tax upon industry, for it is not a levy in support of government nor
is it an assessment to support an improvement of property for the
benefit of the public. It is not even a burden.
But, as the word signifies, it is payment over and above* ordinary
wages for losses sustained through the risks taken in hazardous em
ployment. In a sense it is a wage whose payment is contingent upon
loss from accident. The money for the purpose, through being
made a certain element in the calculation of the cost of production,
is collected as part of the selling price of finished goods or work.
It does not lay an added burden on industry after proper adjust
ments to new conditions take place, but really produces relief. Money
hitherto paid for indemnity contracts would almost effect full pay
ment of compensation awards and benefits. Then there are the at
tendant economies and incidental improvements of industrial rela
tions. All these much outweigh any estimate of compensation as
burden.
The State in its attempt to further social justice has compelled
the plan; has done it by the method of insurance, since single indus-
53
54
L U M P -S U M SETTLEM ENT CLAIMS.
tries do not alone develop the law of contingent losses; has regulated
it in commerce through rates varying as hazards vary, and among
workmen according to earning capacity, which reflects living condi
tions; and with conditions of hitherto unalleviated distress in mind
has sought to guard against unthrift in expenditure by means of
installments of payments throughout the entire period of disability
or dependency.
This has been said in support of three propositions:
First. Awards and benefits of compensation are the workmen’s
as of right, as things earned, paid for in advance by all, and
enjoyed by all, the better, be it said, in expectancy but perhaps with
more appreciation during disability.
Second. The State, which enacted the law, has the right, and it is
its duty, to safeguard its fulfillment and to realize its beneficent
provisions.
Third. The employers have especial rights through their duties
to their workmen and since they themselves are directly benefited
when the law is well administered.
Periodical payments during disability or dependency is the rule
of all compensation laws. The schedule of specific awards is no
exception to the rule, for schedules have been adopted for the sole
purpose of certainty and convenience in administration and under
the analogy o f the general law are contingent interests rather than
vested. It may be said, therefore, that lump sums are not favored
by the law. Nevertheless, as has been shown, awards are the
workmen’s as of right and may under certain conditions be made
in lump sums and still kept within the letter and the spirit of the law.
In fact, I should say that the single and only test is the good of
the recipient, which will always satisfy the interests of justice. I f
this may be effectuated by a lump-sum payment, the State will in
stantly be obliged as a matter of duty to grant it. In doing so it
need not be deterred through consideration of the probability of the
failure of its purpose, for if it exercises a wise precaution it will
have performed its duty.
For the State to go too far as overseer
or protector would be a violation of the workmen’s rights and a
wrongful use of its own powers.
Let us proceed to a consideration of the various kinds of cases in
their relation to lump-sum payments, and first to those in which
lump-sum payments may well be made. Where the awards are small
and the disability of definitely short duration, payments which may
become due after the award is granted may well be made in a single
payment. This for obvious reasons.
Where the claimants belong to a fine type of thrifty men who
would likely know no dependency even were there no compensation
benefits or who show other evidences of thrift, payments should be
LUMP-S-IJM SETTLEMENTS— W IL L IA M C. ARCHER.
55
made. In such cases the opportunity for a distinct betterment o:£
conditions is offered and should be encouraged.
In cases in which a reputable employer interests himself in the
w elf are of his injured workmen and seconds an application for a
t
lump-sum payment it may well be made. The attitude of the em
ployer is somewhat of a guaranty that he will see the matter through.
Where sentiment through sympathy would support a small busi
ness in a community in which the injured is known, a lump-sum
award should be granted.
Lump sums should be given to aliens who are nonresidents or who
are about to become nonresidents of the country. Every reason sup
ports this, for abroad the award is worth more, our own States will
have discharged their duties to the injured, and a more suitable
environment will likely be found in native scenes. There is justi
fication for discounting the present values of such claims.
Lump-sum payments should seldom be withheld when they go
to support children in school. Through education the disability may
be turned into a blessing. It may, however, be said that an educa
tion may be paid for in installments, but experience teaches that
the periodical benefits to children are too small for this purpose,
though when confined to a more limited period they prove sufficient.
In the granting of lump-sum awards administrators of the law
are bound to take cognizance, at least mentally, of the different
character] sties of various races. It is seldom indeed that the repre
sentatives of certain races will lose or w^aste their awards if made
in lump sums, but, rather, they will proceed to turn them into
increased benefits.
There is another class of cases in which lump sums are granted
which would not be guessed by those who merely read the law or
give but academic consideration to the question of compensation.
This class arises out of injuries which we call permanent-partial
and in which theoretically there is ability to do some work. The
law measures compensation in such cases by the impairment of earn
ing capacity. There are such cases, and hundreds of them, but
as a rule employees are totally disabled temporarily and when they
are able to work earn full wages. But if an employee has been in
jured, has recovered as far as he will ever recover, and has not se
cured employment, or if he has secured employment at the same
wage, has done so through the consideration of his former employer
who will not turn away a faithful employee, and yet with any
other employer could not receive so much wages, a commission in
such cases knows that it is either a question of continuing payment
upon an impaired earning capacity or of a purely theoretical con
sideration of what a man is able to earn when, in fact, he is.not earn
ing anything. Such cases afford peculiar difficulties and endless
56
L U M P -S U M SETTLEM ENT CLAIMS.
hearings and rehearings, with some show of ill will on the part of
insurance carriers who lose all sentiment in the matter and begin to
resist the claim, or a temptation to malingering, in which the claim
ant may seek to secure advantage out of doubt. So when claimant
and insurance carrier come before a commission with a prayer to
end the case by an award for a single amount, such amount being
suggested jointly by employer (or his representative) and employee,
a commission should not hesitate to make an award and close the case
if clearly in the interest of justice. A commission need not be a
party to any dickering as to amount, nor does it enforce its opinion
on either party. It simply approves if justice is furthered. It is
needless to add that this function should be exercised with great care.
Finally, in certain cases lump-sum awards are justified to prevent
malingering, and especially is this true in cases of neurosis. I f the
psychic element tends to prolong disability the quicker a case is
closed the better. There are also certain cases of real disability
accompanied by malingering to the extent only of overestimating
the disability. I should say in the interest of justice that such cases
are better closed.
There are cases in which lump-sum payments should seldom, if
ever, be made. Since all payments should be made only for definite
purposes it follows that payments to satisfy sentimental reasons
should never be made. Claimants often desire their money that they
may see it and count it and put it in the bank. Their application
should be 'denied. Some desire to loan it or to speculate with it.
This is not sufficient reason.
Drunkards, the diseased of certain types, the stupid and imbecile
should never be granted lump sums.
Lump-sum awards, except in very rare cases, should not be granted
when the injured is suffering a permanent total disability. In such
cases only when the periodical payments are too small to subsist
upon should serious consideration be given to the claimant’s appli
cation. Each such case should and undoubtedly will have very earn
est and special consideration. It is enough to say that such is needed.
Many applications are supported by the pleas of attorneys or next
friends. In the majority of these cases the suspicion is at once
aroused that the expectation of fees rather than the good of the
claimants is back of the application. Such claims should be denied.
Cases sometimes come on for lump-sum settlements at the instance
of the employer or carrier whose reasons may be found in a desire
to liquidate doubtful cases, to pull down reserves or to save expense
of further handling. These are not justifiable causes for granting
lump-sum payments.
In death cases where payments are contingent upon life or re
marriage or dependency or minority great caution should be exercised
L U M P -S U M SETTLEMENTS---- W IL L IA M C. ARCHER.
57
in the granting of lump sums. In some such cases the very terms
of the law itself would seem to prohibit. In cases of children who
would be helpless against the improvident use of commuted pay
ments, their interests should be safeguarded. For the same reason
lump sums should seldom be paid to the aged or infirm who have
no hope of support outside the compensation benefits.
I have spoken of cases in which payments may nearly always
be made and of cases in which they should seldom, if ever, be made.
For these and for all other cases the growing, if not paramount, im
portance of the question of compensation problems leads me to sug
gest that where the volume of compensation business is sufficiently
large to warrant it, and it is likely so in all States, that a unit
of organization be formed for the special consideration of lump-sum
payments. There are many applications for money with which to
purchase businesses, to pa}7debts, to embrace and encourage opportu
nities, and to satisfy desires seemingly springing from proper mo
tives. All such applications should be carefully examined and the
administrative department might even go so far as to make investiga
tions and pass critical judgment upon the proposed ventures as
viewed from every standpoint. Certainly the matter can not be
treated with haste or disregard without subverting the ends of jus
tice. This is a stern business and should be governed by a great deal
of practical hardheacledness. Necessity rather than enjoyment should
be a governing rule, and there should be evidenced on the part of the
claimant enough foresight and thrift to justify the department’s ac
tion, and it should be kept constantly in mind that the interest of
justice and the good of the claimant will in many instances justify
lump-sum awards. A consideration of this will fortify the depart
ment with the proper balance and patience to listen to the never-end
ing applications for money.
Finally, I want to speak of one or two dangers to be guarded
against and avoided. The first is the tendency toward the practice
of granting lump-sum awards in order to get rid of cases. This tend
ency should be curbed as entirely unworthy, and the importance
of the suggestion should not be overlooked for it denotes a real and
present danger everywhere. The compensation business is new. Its
volume has surprised the public, who are yet unaware of its real
magnitude. Many departments administering compensation laws
are starved and compelled to work under strain. To close cases by
lump-sum payments is a temptation and especially since this method
satisfies all parties concerned, at least temporarily. But it is one
thing to be tempted, another to fall; and we must not fall.
The greatest danger of all, however, is the danger of a single cor
rupt administration, which would in a wholesale manner commute
future installments of outstanding claims and in doing so effect dis
58
L U M P -S U M SETTLEM ENT CLAIM S.
counts in value. This would be the real calamity, for the injury
would be irreparable, the work of years brought to naught and it
would scandalize the State in its benevolent purposes in furthering
the great humane laws comprised in our various compensation
statutes.
Finally, let me conclude by saying that a discussion o f lump-sum
agreements by emphasis of the details involved might lead to the
hasty conclusion that such payments should be made in a relatively
large number of cases. The very opposite should be the rule, and,
the law, as has been said, generally looks with disfavor upon this
manner of determining claims.
The C h a i r m a n . Mr. C. H. Crownhart, the second speaker on the
program and formerly chairman of the Industrial Commission of
Wisconsin, is unable to be here, but he has prepared a paper on the
subject of lump-sum settlements, and in the absence of Mr. Crown
hart his paper will be read by his fellow member on the Industrial
Accident Board of Wisconsin, Mr. F. M. Wilcox.
[Mr. Wilcox read a letter from Mr. Crownhart, relative to his in
ability to be present.]
LUM P-SUM SETTLEMENTS.
B Y C.
H.
CROW NHART,
FORM ERLY
C H A IR M A N
OF I N D U S T R IA L
C O M M I S S IO N
OF
W IS C O N S IN .
{R e a d by F. M. W ilc o x , o f tlie In d u s tria l C om m issio n o f W is c o n s in .]
For the most part our compensation laws permit lump-sum settle
ments upon approval of the compensation boards or the courts.
However, the general policy of the laws is to treat compensation as
in lieu of wages, to be paid weekly or at other stated periods. Where
the law permits lump-sum settlements on approval of the adminis
tering agency, a great responsibility rests upon such agency.
At the beginning of the compensation systems in the United States,
New Jersey and Wisconsin, in 1911, were the first States to adopt
constitutional laws. Wisconsin adopted the board system of admin
istration, while New Jersey adopted the court system.
The old-line casualty insurance companies had advocated the
New Jersey system and condemned the Wisconsin system. This they
continued to do. Tons of literature were sent out from their New
York insurance bureau, representing the combination of old-line
companies dominating the liability-insurance field. Some of this
propaganda went out under its true colors; more of it went out
under deceptive titles. For instance, articles went out from a paid
attorney of the bureau under the title of 4 Former Commissioner
4
of Labor of New York.” None of these documents contained the
real reason for their preference of the New Jersey system over the
Wisconsin system.
In a speech in 1912 before the association of old-line casualty
company agents at White Sulphur Springs I made the statement that
the companies were short-changing the workpien in New Jersey. A
representative of the bureau promptly challenged my statement by
calling it an absolute falsehood. Not long afterwards the American
Association for Labor'Legislation published the result of an investi
gation made by it in New Jersey, establishing the fact beyond con
troversy that such companies were systematically fleecing the labor
ing men, and particularly the widows and orphans of laboring men
who had died as the result of their injuries. The New Jersey law
provided no adequate system of reporting accidents, no statistical
department, and no real supervision. The companies had a free field;
they continued their old common-law liability policy of getting the
best settlement possible from the ignorant and helpless. But they
59
60
L U M P -S U M SETTLEM ENT CLAIMS.
had, and still have, this advantage under compensation: Under com
mon-law liability there developed along with the claim adjuster
an equally conscienceless ambulance chaser, who frequently forced
the claim adjuster into a reasonable settlement or made his com
pany pay dearly in a court of law; but under the compensation
system the amounts to be paid were so small as to discourage the
ambulance chaser, leaving the field free to the oppressor of the poor
man. Any system that takes away the only protection the injured
man had against chicanery and fraud, and gives nothing in its place,
is a poor system, indeed, for the laboring man. Most of the States,
much to their credit, have followed the Wisconsin system or substi
tuted State insurance or added something in w^ay of protection under
the New Jersey system.
But a correct system does not end the abuses of unconscionable set
tlements. The laws must be administered by able, conscientious men,
with plenty of backbone. There is no room for a man with a weak
spine in working out compensation problems and in securing to the
injured workman or his dependents their due under the law.
The average claim adjuster works overtime, and while the officers
of the law sleep they make settlements that rob the poor. There is no
doubt that the injured man or his dependents prefer lump-sum
settlements. There is no doubt that they will discount their claim
liberally for cash in hand. They fear the intricacies of the law and
the law’s delays.
Compensation is a debt due the injured workman or his dependents.
The insurance company has the same obligation to pay it as though it
had borrowed money of the workman and given its note of hand.
And yet a company that boasts of its assets, its credit, and its honesty
has no hesitation in discounting its debt to injured workmen.
Now, I know this from experience, and every member of a board
supervising compensation payments knows it. Not all companies are
equally guilty. Some are fair and some others would be fair were it
not for their competitors.
Right here it becomes the bounden duty of the board to see that
there are no favorites and no slackers. I f supervision is adequate
every accident must be properly reported. It must be carefully
checked against compensation payments. Investigations must be fre
quently made, and any time a company is found to have overreached
an injured man it should be promptly brought to book and thereafter
its settlements should be scanned with greater care.
Lump-sum settlements give the insurance companies the greater
opportunity to take advantage of the injured man’s ignorance and
cupidity. Hence they are to be discouraged and allowed only in such
cases as the board can affirmatively say that such settlement is for the
best interest of the beneficia^.
L U M P -S U M SETTLEMENTS— C. H . CROWNHART.
61
In a prosecution against the insurance combine known as the Work
men’s Compensation Bureau, before the Wisconsin insurance commis
sion, for crooked practices in rate making, representatives of the
bureau testified that Wisconsin compensation insurance rates had
been increased over the true ratable proportion, or, as it is called, “ law
differential,” because of Wisconsin’s administration of the law.
What does that mean ? It means one of three things: Either they
were falsifying or the Wisconsin commission were forcing the com
panies to pay too much or other States were not compelling them to
pay enough. The fact is that the rates in Wisconsin were then and
are now higher than the law differential indicates and several States
are lower than the law differential requires.
I don’t believe for a minute that the companies have paid on the
average in Wisconsin more than the law requires. In fact, I know
they have not. But I do think the commission has watched all set
tlements with commendable strictness. I know that the board be
cause of this has made itself persona non grata with many of the
companies. I know that some of these companies have been politi
cally active in opposing members for reappointment, and I know
this is true also in other States. But I believe that any board mem
ber will feel better to go down with the knowledge that he has been
true to the interest of the work confided to him than to know that
he has yielded one jot or tittle to the strong and powerful in op
pressing the weak and helpless.
Another thing that tempts injured men to make improvident
lump-sum settlements is the delays allowed in making compensation
payments and in adjusting claims. There is probably not a State
under compen»ation where the law is fully and promptly enforced.
One reason for this is the great burden placed on administering
boards and appropriations insufficient to allow for adequate help.
But a greater reason in many cases is the knowledge of insurance
adjusters that delay works to their advantage by inducing favorable
settlements.
I believe it is quite rare for insurance companies to make a prac
tice of paying compensation as the law requires. They hold back
for one reason or another a considerable period of time. Usually
this is accomplished by retaining all authority to pass finally on
compensation at the home office, frequently thousands of miles from
the place of accident. Beports have to be made and often volumes
of correspondence follow before any payment is made, the insurance
company meanwhile protesting its anxiety to make speedy payment.
The compensation boards, have arduous duties to perform. They
are overburdened with work. They are beset with astute claim
agents and insurance attorneys who stand on technicalities. The
courts make troublesome decisions from failure to understand the
62
L U M P -S U M SETTLEMENT CLAIMS.
full intent and purpose of the law. But compensation boards should
realize that they are the protectors and administrators of a sacred
fund. To allow the poor and ignorant to be defrauded by the
capable and powerful is to make such boards part ice ps criminis.
The laboring man will have no special representative haunting the
corridors of your office. He will attempt no backdoor entrance to
your presence. He will have 110 high-salaried attorney to assist you
in finding the facts nor in construing the law. He will have 110
special representative to come on from the home office to give you
gratuitous advice. And finally this same man, when you have
served him faithfully and well, will often turn out to be an ungrate
ful and suspicious recipient of your efforts in his behalf. Such is
your lot; you have no flowery road of ease to travel; but good public
service is its own reward. As the courts say: You take vour office
cum onere.
'
I would not be understood as making any attack on insurance
companies. We accept them as they are, indeed, as they must be.
Their adjusters are often good men, and sometimes humane. But
the system of long-distance administration of insurance business is
built on office efficiency, on dollar saving, and on dividends. It has
no heart.
To illustrate some ©f the abuses under lump-sum settlements I
will cite a few actual cases out of very many that have come under
my observation.
1. On a hearing before the Wisconsin insurance commissioner
against an insurance company the chief examiner testified that the
company seldom, if ever, paid a claim on time, as the law provided.
It was shown that the company had a systematic policy of delaying
their payments through correspondence, often running up to 25 or
30 letters over a single claim.
2. The general counselor, for the State, of a company made a
lump-sum settlement with a minor for a schedule injury. He based
the settlement on the low wages—$1 per day—that the boy was re
r
ceiving instead of the probable wages that he would receive at 21,
as required by law. The injury resulted from failure to guard, and
the law provided a penalty of 15 per cent to be added to the com
pensation. This was not done. In checking the accident this was
disclosed and the settlement was not approved.
3. The general attorney of another company attempted a compro
mise with a widow for $2,500 in a case where $2,742 were due. He
justified his position on the ground that the claim was doubtful.
There were no doubts, except those that he conjured up to beat the
widow out of $242.
4. In another case the general attorney, for the State, of an in
surance company made a stipulation of settlement for $650 with a
L U M P -S U M SETTLEMENTS---- C. H . CBOW NHART.
63
man wlio l\ad lost an eye. This was a schedule injury, and tlie
amount due was $1,1*24.40. There was absolutely no dispute as to
the facts or the law. When criticized for attempting such a fraud
he claimed the right to make any settlement that he could get by
agreement.
5. In a case where a minor had a bad injury to the shoulder and
spine a lump-sum settlement was made on stipulation for $143.22,
and the settlement was confirmed by an award of the commission. It
subsequently appeared that the stipulation falsely recited that the
boy had recovered from his injury, whereas he was in fact badly
crippled. A new award was made for $1,665.96 in addition to the
amount that had been paid. This award was affirmed in the supreme
court.
6. A young man had his hand cut off at the wrist. It was a
schedule injury and there was absolutely no dispute as to the amount
to which he was entitled. A lump-sum settlement was made for $800,
whereas in fact he was entitled to $1,250.
7. A most interesting case was one where a man lost the sight
of an eye. It was a schedule injury, and the man had been advised
by the commission of the amount to which he was entitled. He
was a poor man and his wife was sick, and he needed money badly.
The State agent of the insurance company met the man in the office
of the commission, and after a conference with him he induced him
to agree to a settlement for $450. The commission refused to accept
the compromise and awarded the man about $900. The agent was
very bitter over the arbitrary action of the commission. He appealed
the case, and after much delay the award was confirmed.
The foregoing are merely illustrations. They could be extended
far beyond the scope of this paper.
There is another phase of lump-sum settlements that is worthy of
consideration. In the case of deceased workmen the widows almost
unanimously beg for lump-sum awards, and it is rare indeed that
their requests should be allowed. When they receive lump-sum settle
ments they make improvident investments or their friends and rela
tives borrow their money and forget to repay it. I think experience
demonstrates it is the wisest course to award widows compensation
payable at stated times extending over long periods of time.
In conclusion, I urge compensation boards to greater promptness
in disposing of the business before them. Delay in this regard is the
one outstanding fact that is leading to criticism of the administration
of compensation laws. Delays only add to the difficulties of the
boards. Many insurance companies want delay because it makes the
injured man more eager to settle his claim at a discount, but the
policy of the compensation laws is to get relief to the injured imme
diately and continually until he is paid in full.
64
L U M P -S U M SETTLEMENT CLAIMS.
It is only fair to say tliat some insurance companies are as anxious
for speedy disposition of cases tried before the boards as are the
workmen and are equally impatient of delay.
The C h a i r m a n . The next on the program is Mr. F. J. Donahue,
member of the Industrial Accident Board of Massachusetts.
[Mr. Donahue’s paper is not reproduced, as a copy was not received
for publication.]
The C h a i r m a n . The next on the program is Mr. Meyer Lissner
a member of the Industrial Accident Commission of the State of
California. I am informed that Mr. Lissner is not present, but w©
have with us to-night an associate of his on the board, Brother
French, of California, who has been on the board since its organiza
tion, and I am sure we would all be greatly interested to hear a dis
T
sertation on the work of his board, and I hope he will include in his
subject what accidents ought to be reported and who ought to report
them.
HOW CLAIMS ARE HANDLED, WITH SPECIAL REFERENCE TO
LUMP-SUM SETTLEMENTS.
BY W ILL J . FRENCH, MEMBER, INDUSTRIAL ACCIDENT COMMISSION OF CALIFORNIA.
In California about 1,000 formal hearings are heard by the indus
trial accident commission, out of each 60,000 industrial injuries.
In a large majority of the 59,000 injuries, compensation is paid
according to law by either the employer or the insurance carrier.
Insurance is not compulsory in California. When I use the word
“ compensation ” I include the hospital and medical benefit, which
commences at the time of injury and lasts as long as may be necessary.
Out of each 60,000 injuries, compensation in monetary form is paid
in only about 13,000 instances, because of the two weeks’ waiting
period, during which time recoveries occur in approximately 47,000
injuries out of the 60,000 used as a base.
Reports of each injury from employers, insurance carriers, and
doctors are furnished our statistical department. The injured man
is informed of his rights under the law. Care is taken to see to it
that, if no compensation is paid, the injured worker is impressed with
the necessity of filing an application for adjustment of claim within
the six months before the statute of limitations begins to operate.
There is rarely occasion to do this. The working people of the State
know their rights. Those of foreign birth have consular agents
alert to their interests. Fraternal and trade organizations are im
portant factors in advising injured workers.
The California statistical department finds out why compensation
is not paid by employers and insurance carriers if the reports show
derelictions of duty. This course has the effect of both protecting
the injured and causing those responsible for the payment of com
pensation to realize there is an ever-watchful eye.
Efficient secretaries are maintained in San Francisco and Los
Angeles who meet injured workers with grievances, or employers
or insurance agents who desire assistance in straightening out diffi
culties. Many a budding controversy is thus nipped and the parties
satisfied of the right procedure. When the issue is of a medical
character there is reference to the medical department, and arrange
ments are made for immediate examination or the injured man
is sent to an expert. Usually the report of the doctor terminates the
dispute. In several of the California cities are representatives of
78532°— Bull. 248— 19------ 5
65
66
L U M P -S U M SETTLEMENT CLAIMS.
the commission whose duties include the kind of work described
as performed by the secretaries.
I f it is found impossible to adjust a dispute by informal means,
an application for adjustment of claim is filed by the interested
party or parties. After due notice a hearing is held, presided over
by a commissioner or a referee. The commission has always taken
the position that hearings should be inexpensive to employers and
employees, and referees are sent to places far removed from the main
cities, for California is a State of magnificent distances. A stenog
rapher accompanies the referee. Usually the testimony is written
up. Sometimes the substance of the testimony is placed in the
record, in lieu of all that transpired, because the issue may be com
paratively unimportant or a settlement may be agreed to at the
hearing. The record goes to the decisions department, where it is
worked up for submission to the commissioners, a majority of whom
are required to render a decision.
A number of the controversies relate to permanent injuries. The
California law bases compensation for such injuries on the nature of
the injury or disfigurement, the occupation, and the age. The central
thought is that loss of earning power shall govern, for it is certain
workers are affected differently by injuries. One man with a lost
finger can soon resume his usual employment. Another man with a
similar loss will have to search for new work. Older men are given
more than younger men because of the increasing difficulty of finding
work as a man passes middle age, and also because a younger man
can more easily adjust himself to the changed condition. An elab
orate schedule for rating permanent disabilities has been prepared.
It covers all injuries or disfigurements, all occupations, and all ages,
Lump-sum settlements can be made only with the approval of the
commission. There are many applications in California for such
settlements. The policy of the commission is hardly ever to use the
power given to force lump-sum settlements, and to consider carefully
those presented for consideration. Rarely is a settlement approved
unless both parties agree to it. Occasionally a widow will want to
clear her home of indebtedness and save interest payments. I f a
proper showing is made, the employer or insurance carrier will be
instructed to make the payment. I f the sum is only a portion of the
compensation due, the payments are computed to allow 6 per cent
interest and taken from the end of the compensation period. This
enables the weekly payments to continue without interruption until
the full amount is paid.
The California statute provides that commutation may be ordered
u if it appears that such commutation is necessary for the protection
of the person entitled thereto, or for the best interest of either party,
or that it will avoid undue expense or hardship to either party, or
H O W CLAIMS ARE HANDLED---- W IL L J . FREN CH .
67
that the employer has sold or otherwise disposed of the greater part
of his assets, or is about to do so, or that the employer is not a resident
of this State.”
Slightly more than 10 per cent of the total amount of compensa
tion payable in any one year is paid in lump sums. The exact propor
tion is 11.9 per cent.
It has been found difficult to hare our busy secretaries investigate
applications for lump-sum settlements as thoroughly as the commis
sion desires. There is under consideration a proposition to engage
the services of a welfare worker to ascertain just what is behind an
application for a lump sum, see the parties and their references, make
sure any money awarded is expended as contemplated, and assist
those who venture into business enterprises. This welfare worker
can also aid permanently injured workers in their efforts to prepare
for new occupations, or guide them toward new work if there is a
disinclination to use to advantage the weeks during which there is
a fixed income.
The stronger insurance companies are inclined to favor lump sums
because of the 6 per cent discount. The weaker companies are, for
obvious reasons, less inclined to favor complete payments.
Occasionally compromises are approved by the commission because
of uncertainty as to the issue or issues and a belief that it is best for
all concerned to close the case. Traumatic-neurosis cases come within
this class.
Partial lump-sum payments are not uncommon in California.
Sickness, bills for living expenses, heavy funeral costs, and other
sources of expense are considered at times as warranting the action
of the commission.
The policy of one payment is not good, unless for the reasons here
outlined, and the California commission does its best to see that
the true compensation principle is maintained when lump sums are
requested.
The C h a i r m a n . I might say, in connection with the question of
reporting accidents, that in Michigan the plan has not proven satis
factory to us. Our statutes require the reporting of all accidents, as
the statutes of a number of the States do; though, as a matter of
practice in times past in Michigan, the employers and insurance com
panies have reported—that is, reported in detail and separately—.
only those accidents for which they believed compensation should be
paid. They have also sent in a sort of so-called weekly report of
all minor accidents, the disability from which was very mild, and
which did not run into the compensatory period. We have now seen
fit to put into operation a new plan, which took effect August 10.
We have amended the statute rules of the board so that we may
require reports separately on each and every accident by the em
68
L U M P -S U M S E T T L E M E N T C LA IM S.
ployer, and not by the insurance company, within 10 days after the
accident occurs. There is a penalty of $50 provided by law in case
any employer refuses to report any accident within 10 days. Under
the law, we have provided that every accident, no matter how small
or trivial it may seem, must be reported, and we hope to get a report
of each and every accident after August 10 within 10 days after it
occurs.
The waiting period, like that of many States, is 14 days, the em
ployee getting no compensation unless disabled for more than 14
days. The plan we are experimenting on provides that the employer
must make a second report on each and every accident on the 15th
day following the accident, the end of the waiting period. I f the
employee, during the 15 days, went back to work, was given a little
medical or surgical treatment, lost a little time—less than 14 days—
then on the 15th day it must be reported to the board on paper of a
certain color, so that the employees in the office immediately know
that the receipt of that report by our board means that the accident
that was reported previously is on its face a noncompensatory acci
dent. We then annex that report and, while no index is made of it,
it is filed alphabetically in the noncompensatory file, so that it can be
found if necessary. If, on the other hand, the accident disables the
employee so seriously that on the 15th day he is still disabled and
compensation should start, we require a second report on a paper of
another color, so that the employees in the office will know that the
receipt of that report means that the accident previously reported
has turned out to be a compensatory accident.
It is quite important to every industrial accident board to have
some proper and efficient method of classifying accidents, both com
pensatory and noncompensatory. The experience in Michigan under
the old plan has been poor. I f we were to require only the reporting
of accidents that disabled for the waiting period, we would have a
good deal of trouble. In some cases accidents that do not disable the
employees at all turn out to be most serious accidents, and later may
cause the employees’ death.
Personally, I can not figure out any way to make really effective
laws in that line, except to require the reporting of every accident, no
matter how small, to be followed up in some way by the board.
C O M M U T A T IO N O F C O M P E N S A T IO N A W A R D S U N D E R T H E
P E N N S Y L V A N IA S Y S T E M .
BY
HARRY
A.
M ACKEY,
C H A IR M A N
OF
W ORKM EN’S
C O M P E N S A T IO N
BOARD
OF
P E N N S Y L V A N IA .
[T h is
p a p e r w a s s u b m it t e d b a t n o t r e a d .]
It very frequently happens that either the employer or the em
ployee—or both—feels that it would be advantageous, under the cir
cumstances of a particular case, to have the continuing payments of
compensation commuted to present value and paid in a lump sum.
The present value is simply the amount which, put at interest at
5 per cent, compounded annually, would produce the weekly pay
ments in question. In practice the commutation is computed by
means of a table which shows the present value of $1 weekly, at 5
per cent compound interest for each number of weeks up to 20 years.
There are three sections of the Pennsylvania act of 1915 which
deal with the subject of commutation. The first is section 310, which
provides that “ the employer may at any time commute all future
installments of compensation payable to alien dependents, not resi
dents of the United States, by paying to such alien dependents the
then value thereof, calculated in accordance with the provisions of
section 316.”
Section 316 is as follows: 4 Compensation may at any time be
4
commuted by the board at its then value when discounted at 5 per
centum interest, with annual rests, disregarding the probability of the
beneficiary’s death, upon application of either party, with due notice
to the other, if it appear that such commutation will be for the best
interest of the employee or the dependents of the deceased employee,
and that it will avoid undue expense or undue hardship to either
party, or that such employee or dependent has removed or is about
to remove from the United States, or that the employer has sold
or otherwise disposed of the whole or a greater part of his business
or assets.”
Section 424, which is a part of the procedure article of our act,
provides: 4 I f any party shall desire the commutation of future in
4
stallments of compensation, he shall present a petition therefor to
the board. The board shall appoint a time and a place for hearing
the petition, and shall notify all parties in interest. Every such
petition shall be heard by the board, but the board may refer any
question of fact arising out of such petition to a referee, whose find
ings shall be final, unless upon petition the board shall, for cause
L U M P -S U M SE T T L E M E N T CLA IM S.
70
sliown, grant a hearing on the facts. The board shall fix a time and
place for the hearing, and shall notify all parties in interest.”
The Pennsylvania law, therefore, has given the absolute right to
the employer to commute to present value and pay in a lump sum
any award that may be due to the widow and dependent children
of an alien employee who is killed in the course of his employment
in this country, when such dependents are living abroad.
Another section of the act provides that such alien dependents
living in a foreign jurisdiction are entitled to two-thirds of the
compensation that would be due them were they living in this coun
try. This is for the purpose of equalizing money values, rather
than to discriminate against foreign dependents. Therefore, the act
recognizes the fact that it would be highly advantageous and eco
nomical, very frequently, for the employer to dispose of such ac
counts by payment in a lump sum.
We have recently ruled that the employers, under these circum
stances, have a right to do it of their own motion, without the neces
sity of petitioning the board for an order to do so. The vast num
ber of cases, however, that come before our board are filed in conse
quence of the procedure section 424, praying for the commutation in
the method suggested in section 316.
Our attitude as to these applications was defined some time ago in
an opinion by the writer, which, at the time of its filing, seemed to
be a very wise precedent to establish, and our experience since that
time has not impeached our judgment, but has rather reaffirmed it.
The opinion is as follows:
The case came before us in the form of a petition presented by Mary Stifura
asking that we commute certain continuing payments in present value in order
that the whole sum be paid to her at once.
The compensation which is now being paid to her is in consequence of an
agreement executed beween herself and the Pressed Steel Car Co. for herself
and three small children because of the fact that her husband was killed in
the course of his employment and while he was an employee of the defendant.
The important facts of the agreement are:
A ge o f children.
Daughter born February 13, 1911, will be 16 on February 13, 1927.
Son born April 20, 1912, will be 16 on April 20, 1928.
Daughter born December 26, 1915, will be 16 on December 26, 1931.
Terms of agreement.
300 weeks at $20 per week, 55 per cent__________________ $3, 300
262 weeks at $20 per week, 35 per cent__________________
1, 834
61 weeks at $20 per week, 25 per cent__________________
305
192 weeks at $20 per week. 15 per cent__________________
576
Total com pensation___________________________________
6, 015
C O M M U T A T IO N OF C O M P E N SA TIO N AW ARDS---- H . A. M A C K E Y .
71
In tliis case tlie widow has formed tlie opinion that although by this agree
ment she has been secured in substantial semimonthly payments until her
youngest child shall have reached the age of sixteen, to wit, December 26,
1931, that she prefers to have the future payments commuted to present value
and venture the whole sum in some uncertain undertaking.
It seems to the board that it will be well to protect her as against herself
by refusing her petition. These petitions for commutation come before us under
section 424 of the Workmen’s Compensation Act. It will only be in rare cases
that we can wisely exercise this discretion by granting such petition. It is a
great temptation to a widow or any beneficiary under this law to ask that
the compensation payments be commuted to present value and paid in a lump
sum. We think, however, in a great majority of these cases these petitions
are ill-advised and a real wrong would be done to tlie petitioners if we granted
their prayers.
The act has wisely provided for the payments of compensation to be made at
such times as the injured or the deceased would have received his pay, thereby
providing a certain, modest, but sufficient, sum at stated intervals so as to
relieve the dependent of real want.
In the majority of these cases the dependents have been unaccustomed to
the use of money in bulk and the sudden acquisition of a considerable sum
might readily lead to its unwise expenditure or to its unfortunate investment.
The widow might terminate her dependency by remarrying and then the money
Would probably be spent without regard to the rights or best interests of the
children.
As a general rule, we are opposed to granting such petitions to alien citizens
who are desirous of taking the money to foreign countries. Awards have been
made on the basis of their residence here. This same amount of money in a
foreign country would be worth more than it is here, hence the difference, in
the act, in the amount to be awarded to alien dependents, not that our legisla
ture intended to discriminate against this latter class, but it attempted to
equalize money values between foreign countries and ours.
We desire by this opinion to apprise the public that it will only be in the ex
ceptionally meritorious case that we will grant commutation.
In order to compute present values of continuing payments our
actuaries must have certain definite facts upon which calculations
can be made. It is very obvious that commutation can not be made
unless we have before us a definite number of weeks during which
the compensation is to run.
We have had before us many applications for commutation of
awards granted for partial disability. In many of these cases we
felt, in the language of the act, that had we the power to grant com
mutation that it would “ be for the best interest of the employee and
that it would avoid undue expense or undue hardship.” We have
not been able to grant commutation in such cases because of the un
certainty as to the number of weeks compensation would run. This
is best illustrated in a case which came before us in the form of peti
tion for commutation of compensation where one Caskantino Cesarino had been very badly injured in the course of his employment.
The compensation agreement had been promptly executed between
his employers and himself. The amount agreed upon was being
72
L U M P -S U M
S E T T L E M E N T C LA IM S.
paid each week. He applied for commutation in order that he might
take the present value of his payments in a lump sum and return to
Italy, where his money would purchase more for him than here and
where he could be surrounded by his relatives and friends. We
would have been very glad to have granted this petition had we had
the power. We nominated a disinterested physician to examine the
petitioner in order to ascertain whether or not w e could find him
^
permanently injured and base commutation upon 500 weeks. The
result was that we were informed that while he was apparently per
manently injured at the present time, nevertheless he might recover
in a w^eek, a month, or a year, and the apparent permanency of his
injury be alleviated to that extent so that his condition would be
reduced to partial disability. We therefore were compelled to de
cline compensation, and we voiced our embarrassment and the rea
sons for our declination as follows:
In the above case the board has extended every opportunity to the claimant to
establish a status whereby we could find some way of relieving his situation.
There is no question but that the claimant was seriously and perhaps perma
nently injured while engaged in the employ of the defendant. He is under
compensation at this time. We have had him examined by disinterested
experts, and while the seriousness of his present condition is not denied, never
theless no physician nor surgeon can say how long this condition will continue.
It may continue for the full 500 weeks, which would be the number of weeks
of compensation for permanent disability, or the symptoms may clear up in a
week, a month, or a year.
The claimant’s condition of total disability at the present time might be
reduced to partial disability within a short time by an unexpected recuperation;
therefore the board has no data upon which it can grant commutation.
In order that our statisticians or actuarial experts may be able to compute
present values from continuing payments there must be a definite and fixed term
during which such payments are to run, otherwise there can be no mathe
matical calculation. In the case of a lost member the act specifically schedules
the number of weeks during which the claimant shall be compensated so that
when we have that class of cases before us present values can be computed with
certainty, but in the case at bar we could not adopt one week nor five hundred
as a basis of commutation.
We find as a fact in this case that it would be for the best interests of the
claimant to have his compensation commuted to present value and to have it
paid to him in a lump sum. The man has apparently been rendered helpless.
He is in a strange country, removed from his friends, and his compensation is
not sufficient to maintain him.
Under the undisputed testimony, were we able to award his compensation
in a lump sum in present value he could return to his native land where he
would be surrounded by his own kin and where he could secure more comfort
at less cost.
But under the foregoing facts there can be no commutation in this case. -
Eighteen months’ experience under the Pennsylvania act has dem
onstrated the wisdom of the provision -which places commutation in
the discretion of the board. We have granted public hearings to
every applicant. We have been guided entirely by the thought that
L U M P -S U M
SE T TLE M E N TS---- A. A. M cD O N ALD .
73
very frequently generosity on our part would do the applicant a great
injustice, for it often happens that close examination discloses the
fact that the application w as ill-considered when presented, and that
T
if the whole amount of money were placed in the hands of the injured
man or the dependents of the deceased it would soon be dissipated,
and no real good would .follow. We have been very keen to grant
commutation when the object was to pay off a mortgage on a home
in which the widow and children are domiciled, or to assist an injured
young man to an education, or to purchase artificial limbs for the
maimed in order to render them more efficient in industry.
The board receives hearty and cheerful cooperation in this respect
at the hands of the employers, who have very readily acceded to the
suggestion to supervise the payment of these sums when commuta
tion is granted, to insure the injured or dependents of the killed
against imposition or dishonesty.
The C h a ir m a n . The gentleman from Texas on the program is not
present, I am informed, but Brother McDonald, from Oklahoma, is
present, and as Oklahoma is so near Texas, we will be glad to hear
what Brother McDonald has to say regarding lump-sum settlements
there.
Mr. A. A. M c D o n a l d , chairman State Industrial Commission of
Oklahoma. I have listened with great interest to this discussion of
lump-sum settlements, and I should judge there is not much difference
of opinion among us as to the proper method of handling them. I
will say that our commission in Oklahoma is theoretically opposed to
granting them but, like all other boards, we are frequently persuaded
against our will to do so. It is our practice, in cases like the loss of
a finger, where the dismemberment has not interfered with the earn
ing capacity of the injured man, to grant him a lump-sum settlement
in preference to paying it weekly. I f a man is paid $10 per week
in addition to his regular earnings, the chances are, by the time the
payments have ceased, he has formed some extravagant habits of
living. If it is given to him in a lump sum, he may make some good
use of it.
I doubt if we should ever grant lump-sum settlements for the loss
of an arm, though we have many cases in our State, especially among
employees on cotton gins, who are recruited for the season’s run from
among the farm labor of the State, and after losing an arm, desire
to purchase a farm as the only method known to them of making a
living. As a one-arm man can, to a certain extent, make a success
of farming, we have made many settlements of this class.
We are always willing, in the case of a minor or a real young man,
to make a partial lump-sum settlement where he desires to take a
business course a*nd try to learn something else to do.
74
L U M P -S U M
SE T T L E M E N T CLA IM S.
We had one case of a coal miner who had both a leg and an arm
cut off. He was 27 years old, married, and had two children and a
mother-in-law to support. He was entitled to $4,400 in 500 weekly
payments. We assumed that if we compelled him to take his weekly
payments of $8.57, his compensation would be over before he reached
his 40th j^ear, and his children who were only five or six years old
would not even then be self-supporting; so we granted him a lump
sum settlement. He went over to Arkansas and bought out a colddrinks stand, and as Arkansas is now bone dry he is doing pretty
well.
In regard to reporting accidents, in our State we require all acci
dents to be reported that result in calling the doctor and giving medi
cal attendance, or in loss of time, regardless of whether it runs, to
14 days or not. I think it is very essential, where any medical attend
ance is given, that the accident be reported. I f the doctor is not
called, it is immaterial whether it is reported or not. We, of course,
endeavor to ascertain the medical expense in each case, and we have
a form that the insurance carrier has to fill out and file, showing the
amount of the compensation and the medical attendance.
The C h a ir m a n . In the absence of our member from Nevada, who
is listed on the program, I shall call on Miss Anderson, who lives
pretty close to Nevada, and who I am told is practically the whole
thing in workmen’s compensation in Wyoming.
Miss E u n i c e G. A n d e r s o n , chief clerk, Workmen’s Compensation
Department of Wyoming. I think that our chairman of the evening
elaborated somewhat upon the position which I hold in connection
with the Wyoming act. However, the Legislature of Wyoming did
seem to think, when introducing the law in the State, that the several
departments, or some of the executives of the State and the office of
the treasurer of the State, did not have enough duties to x^erform;
and while it is purely a State law, a comx>ensator}^ law, yet its admin
istration has not been made a separate department, but is a dej>artment of the State treasurer’s office. Since I have been connected
with the treasury department for a number of years, it fell to m lot.
}^
to take charge of this special department.
I was asked by Dr. Meeker to tell something of the method of han
dling claims in Wyoming. First, the accident report is filed with
the clerk of the district in which the accident occurs, and the judge
of the district decides upon the extent of the accident and what
compensation shall be awarded. He has, of course, the j>rivilege of
emx>loying x^hysicians to give a report on the extent of the accident.
We have 7 district judges; we have 21 counties—a large State in
area, but not so large in population—perhaps some of you might be
interested in knowing that we have only about 150,000 peox>le in
COMPENSATION CLAIMS IN W YO M IN G — E. G. ANDERSON.
75
TVyoming, hardly enough to make up a city—so that the judges can
handle the claims very well. But we find that we do need inspectors;
that sometimes the injured workman is not, perhaps, given just the
attention that he would have if we had inspectors who had more time
and who were compensated for their services.
There is no compensation attached to the salary of the judges when
they were given additional duties. The only additional compensa
tion that was given was, of course, to the treasurer’s office for admin
istering the act, for salaries, and for supplies.
The accident reports—the employer’s report of the accident and
the employee’s report of the accident—are filed with the clerk of
the district when passed upon by the judge of the district. I f the
employee is granted compensation, an order of award is issued in
duplicate. One copy is sent to the office of the treasurer and one to
the State auditor. We then compare orders of award, and if all in
formation is given which we feel that we need in our office to make up
our report we pay the order of award.
The law does not provide that the treasurer may take exception
to these awards when granted by the judges, although we often feel
that we should have that privilege, as sometimes something in con
nection with the awards, from information given in the order, makes
us feel that it is scarcely just. But these are things which we shall
have to ask to have straightened out.
We have paid a great many lump sums, and perhaps more in pro
portion than other States would pay. It may have been a little
easier way and a shorter route to dispose of claims, taking care of
them as they are decided by the judges.
Mr. C h a r l e s S. A n d r u s , chairman. Industrial Board of Illinois.
Where do you get the fund to pay the bills?
Miss A n d e r s o n . We feel that our law is brief as compared with
most of the laws of the various States, and in some ways it does work
out very satisfactorily. The employer pays into the fund a flat rate.
When the law was first introduced, it provided for a rate of 2 per
cent. We do not have a graded schedule of rates. The fund grew
so rapidly and satisfactorily, and we had such a fine balance at the
end of two years, it was decided that the rate could be decreased.
Mr. A n d r u s . Do I u n d e r sta n d th a t it w a s 2 per cen t o f th e w e e k ly
pay r o ll?
Miss A n d e r s o n . T w o per cent of the certified copy of the monthly
pay roll. The copy is transmitted to the treasurer’s office each month,
together with the remittance of 2 per cent. It was changed to 1 - per
-1
cent last January, and this became effective April 1.
Mr. A n d r u s . Do I understand, Miss Anderson, that all dues are
the same?
76
L U M P -S U M S E T T L E M E N T CLA IM S.
Miss A n d e r s o n . When the orders of award are issued they are
charged to the employer, and we are required to keep an account with
each employer, and all his remittances are credited to his account,
and all orders of award are charged against his account as drawn.
There is also a State transfer account and we are allowed an appro
priation from the general fund each year, which we probably will
not need after this year, as the fund has now reached the figure that,
should we have a very bad mine accident, the fund would take care
of it. There could be a fatal accident, where all of the employees in
any one or more mines were killed, and yet our fund would take care
of it.
Coal mining is our principal industry, although the oil industry
is growing to be one of the principal ones. There are very great
opportunities to get rich in Wyoming, and many eastern people are
becoming interested, and we hope that many more will become in
terested, as there are many opportunities there. I have no doubt but
what more will become interested, as we have the greatest drawing
card—the fact that you may all get very rich if you come to
Wyoming.
Mr. W il c o x . I would like to ask whether or not you have jany
reserve set aside to take care of permanent disability extending over
a period of years.
Miss A n d e k s o n . No; we have not.
Mr. W il c o x . H ow do you know whether your fund is sufficient?
Miss A n d e r s o n . There is a limit to the amount that may be paid
in a continuing claim. The limit is, I think, $1,200; and then if it is
found that the accident has caused a permanent disability an
amended order of award is issued and paid in a lump sum, the
amount that has already been paid to the claimant being deducted.
Mr. W il c o x . Regarding the question of auditing of pay rolls, do
you have any system of checking pay rolls of employers ?
Miss A n d e r s o n . We check every pay roll from the companies, but
we may also request the State examiner at any time to make an ex
amination. We have not done that so far because we have had no
reason to feel we needed to do it.
Mr. W il c o x . Where an employee is paid a certain wage and has
his board, do you have this employer make his report in that way ?
Miss A n d e r s o n . We require them to report the total amount of
their pay roll as to what the wage would be.
Mr. W il c o x . What do you do with respect to board ?
Miss A n d e r s o n . We have never come to that point.
Dr. J o h n W. M o w e l l , medical adviser, Industrial Insurance Co.
of Washington. Is it purely within the discretion of the judge as to
CO M P E N SA TIO N CLA IM S IN W Y O M IN G -----E. G. AN DERSON.
77
the amounts for permanent or partial disability? Do they vary a
great deal?
Miss A n d e r s o n . Yes; they vary a great deal.
Dr. Mow e l l . With reference to the same kind of accident?
Miss A n d e r s o n . With reference to the same kind of accident, they
do not vary a great deal. The judges have the law to govern them
and they have the amount specified for the kind of accident.
Mr. F r e n c h . Is there any medical or surgical treatment in
Wyoming?
Miss A n d e r s o n . In the case of coal companies they provide hos
pital and physicians. In the case of small employers the injured
man must take care of that expense, though ofttimes the employer
does.
The C h a ir m a n . The next speaker on the program is Mr. J. M.
Wilson, chairman of the Industrial Insurance Department of the
State of Washington.
L U M P -S U M
B Y J. M .
W IL S O N , C H A IR M A N ,
SETTLEM EN TS.
INDUSTRIxlL IN SU R A N C E DEPARTMENT OF W A S H IN G
TON
(S T A T E ).
Before going into the question of lump-sum settlements I want to
say a word with reference to our method of handling claims.
I presume you all know that workmen’s compensation in Wash
ington is compulsory. Every employer in the State is obliged to
pay into the accident fund a certain percentage, based upon his pay
roll, graded according to the class. We have 48 classes throughout the
State, the rates running from 1J per cent to 10 per cent.
Our claims are handled in this way: The claimant himself must file
his claim for compensation, the employer must report the accident and
the surrounding circumstances, and the attending physician must
report the condition of the man as he finds him when called upon to
attend him. Those three papers constitute the claim before the de
partment. Until all three of those papers are in the file and properly
inspected and properly proven, no claim will be paid.
We have had some difficulty, though very little, in obtaining re
ports from employers in instances where the emplo3~er thought that
the accident was not of sufficient importance to render a report.
However, we have a provision in our laws which makes it a misde
meanor for any person to fail to give the required information to
the department. We have not been lax in enforcing this provision,
and one or two have been prosecuted, which has given warning, and
we are now having no difficulty along that line. When those three
papers are filed and the claim is completed, we then award to the
claimant compensation each month, if his period of disability should
extend over a month.
We have five outside officers; we have branch offices in Tacoma,
Seattle, Spokane, and Vancouver, and in those offices we have repre
sentatives of the department whose duty it is to investigate claims,
and in the Seattle office we have a certain day fixed when claimants are
met there by our chief adjuster in the field, who passes upon the in
juries of the individual and decides whether or not he should be ex
amined by a physician, or if he is able to return to work suggests a
settlement with him. No payment is made without two of the com
mittee passing on it. We find that that system works very well, and
with follow-up cards going out to the attending physician and to the
employer it enables us to keep a very close and accurate check upon
the expense of his partial disability.
78
L U M P -S U M
S E T T L E M E N T S---- J . M . W IL S O N .
79
Under tlxe Washington workmens compensation act two kinds of
lump-sum settlements are provided—one in the settlement of perma
nent partial disability claims; the other in cases of permanent total
disability. The former is mandatory; the latter is within the dis
cretion of the commission. There are nine permanent partial con
ditions expressly defined by the act for which lump-sum payments
are provided, as follows:
Loss of one leg amputated so near the hip that an artificial limb can
not be worn_____________________________________________________ $2 , 000
Loss of one leg at or above the knee so that an artificial limb can be
worn________________________________________________ _____________ 1 , 0150
Loss of one leg below the kne£_______________________________________ 1, 300
Loss of major arm at or above the elbow____________________________
1,900
Loss of the major hand at wrist____________________________________
1, 600
Loss of one eye by enucleation______________________________________ 1, 200
Loss of sight of one eye____________________________________________
000
Complete loss of hearing in both ears_______________________________
1 , 000
Complete loss of hearing in one ear_______ ___________________________
500
Compensation for any other permanent partial disability is in
the proportion which the extent of such other disability bears to
that permanent partial disability which most closely resembles and
approximates in degree of disability such other disability, but not
in any case to exceed the sum of $2,000. This maximum is as in
creased by amendment of 1917.
These maximums have been reduced to degrees representing $25
each, making the maximum permanent partial disability 80 degrees,
or $2,000,, and graduating downward on all lesser disabilities accord
ing to their relative comparison to the maximums fixed by law.
This rating has been sustained by the Supreme Court of the State
of Washington and the fixing of the relative degrees of disability
has been held to be within the discretion of the commission and not
reviewable by the courts. (Sinnes v. Daggett, 80 Wash. 673; Chal
mers v. Industrial Insurance Commission (Wash.), 162 Pac. 576.)
In case of death or permanent total disability the monthly pay
ments may be converted into a lump-sum payment, not in any case
to exceed $4,000. Such payments can be made only upon the appli
cation of the beneficiary and shall rest in the discretion of the depart
ment.
In every case of death or permanent total disability there is trans
ferred from the accident fund to the reserve fund of that class a sum
of money for the case equal to the estimated present cash value of
the monthly payments provided for it, calculated upon the basis of
annuity covering payments provided by the law for the case. Such
annuities are based upon tables prepared by the insurance commis
80
L U M P -S U M SE T T L E M E N T C LA IM S.
sioner of the State and calculated upon the standard mortality tables
with an interest assumption of 4 per cent per annum.
Under the law as originally passed there was set aside a sum cal
culated upon the theory that a monthly payment of $20 to a person
30 years of age is equal to a lump-sum payment according to the
expectancy of life as fixed by the American mortality table of $4,000,
but the total in no case could exceed $4,000. The experience of a
few years proved this plan to be inadequate. The theory was not
accurate as to figures and the limitation of $4,000 resulted in an
insufficient sum being set aside to care for some cases where the
expectancy of life was great. This condition was discovered about
one year ago and the present plan devised. The publication of this
fact resulted in the misleading inference that a shortage existed in
the department’s funds and this was in some instances colored to
infer that the shortage was due to fraud, whereas the only difficulty
was the inadequate provisions of the law itself.
The Washington commission, exercising the discretion vested in it
by law, has ruled that no lump-sum settlement on account of death
or total disability will be made to any beneficiary unless it clearly
appears that the same is necessary to prevent the loss of property by
mortgage foreclosure or other legal process. This ruling was made
after careful consideration of the interests of the beneficiary, together
with what is believed to be the plain intention of the law.
The fundamental principles of workmen’s compensation are: 1.
That the industry shall bear the cost of its accidents (not only the
breaking of its machinery and equipment, but the breaking of its
men) ; 2. That the injured workman shall receive sure and certain re
lief from the consequence of his injury, and his family and de
pendents shall be provided with sure and certain compensation for
the loss of the bread winner upon whom they were dependent; and
3. That the general public shall be relieved to that extent from the
burden of the care and maintenance of such person.
The Washington law provides that no money paid or payable
under the law prior to the issuance of the warrant therefor shall be
capable of being assigned, charged, or taken in execution or attached
or garnished, nor shall the same pass to any other person by opera
tion of law, showing clearly that the mone;/ so provided is for the
benefit of the beneficiary and no other. The law provides, in the
case of death or permanent total disability, a stated monthly allow
ance payable to the beneficiary until death, or, in case of a widow,
until remarriage.
We believe the legislature intended what it said, namely, that as
long as the beneficiaries live or remain unmarried they shall receive
from the industry, by and through the State, a fixed monthly allow
L U M P -S U M
SE T T L E M E N T S---- J . M . W IL S O N .
81
ance, and that such allowance shall not be jeopardized by being in
trusted to the injured workman or his beneficiaries, a large percent
age of whom are inexperienced in business affairs, unused to the
handling of considerable sums of money and easy prey of the
scheming, speculating sharks who constantly hover about the inex
perienced person with a little money. The commission says to these
beneficiaries, we will not turn this money over to you and permit
you to take a chance of unwise investment, worthless loans, or specu
lation ; this is a trust fund now in the hands of a competent trustee,
the State, which guarantees to you through life the amount the law
allows you.
We are sometimes asked why we pay a lump sum of $2,000 in case
of permanent partial disability and refuse to pay a lump sum in per
manent total disability cases, though the amount of the latter may in
some cases be no greater than the maximum permanent partial dis
ability allowance, or, as the claimants sometimes put i t : Why do you
trust us with a lump sum in the one instance and not in the other?
We answer: A claimant suffering a permanent partial disability has
only a certain degree of earning power left and is not in a dependent
condition, whereas the totally disabled person has no earning power
and is dependent upon the amount provided by law or the public
generally. I f he loses or dissipates his award he has nothing left and
becomes a charge upon society.
It is not always easy to say no to applicants for lump-sum settle
ments, as sometimes their arguments seem plausible and persuasive,
but in our judgment to grant these requests would be contrary to the
spirit and policy of the law and the proof of the wisdom of the ruling
is found in the fact that in many instances those who at first are dis
satisfied return after a period of years to thank us for the wisdom
exercised in their behalf.
78532°—Bull. 248—19------ 6
DISCUSSION.
The C h a ir m a n . We are sorry indeed to have some of those who
were given a place upon the program to-night for some reason or
other unable to be here. I know there are a great many here who
can aid us in the consideration of many perplexing questions that
come before us, and I call upon Mr. Andrus, of Illinois, to say a few
words.
Mr. A n d r u s . The discussion this evening has been very interesting
to me. I was very much interested in the talk this morning, but in
Illinois we are in the same position as Mr. Smith says he is. In
Michigan we do not have anything to do with accident prevention,
and that is the reason I have enjoyed the discussion to-night so much,
not in any way minimizing the excellent authority we heard thi?
morning.
I have been a member of the commission since the 1st of July,
nearly two months, so you may well imagine that I speak with a
good deal of authority. It has, however, been very interesting to
me to talk with the men here, discuss the laws of their States and
their methods of operation, and, if you feel the same as I do, perhaps
a little account of the lawTand procedure in Illinois will be of some
interest.
The first compensation act in Illinois was enacted in 1911, and the
enforcement of that was left to the courts. The provision of the law
was that each side should procure an arbitrator, and the county judge
should select the third, and they should make the award. An appeal
could be taken from, the award of these arbitrators to the district
court, and from there the procedure was the same as any other case—
they could go to the appellate court and to the supreme court. In
1913 the industrial board was created, and that name was changed
to the industrial commission this last year. The acts of 1913 pro
vided that appeals could be taken direct from the industrial board
to the supreme court. The act was further amended in 1915, and
the law specifically provided that appeals should go to the circuit
court.
We have seven arbitrators in Illinois, but the number was increased
by the last legislature to eight. I f an employee is injured and there
is no question about the compensation, it is paid, and the accident
report is sent in to the industrial commission. We do not approve
or deny the settlement: it is simply paid as a matter of course.
82
L U M P -S U M
S E T T L E M E N T S---- DISCUSSION.
83
Duplicate receipts are sent to the commission, and in case a disagree
ment exists the case is set for hearing before an arbitrator. When
the board was first created it followed the old system of having three
men to act as a board of arbitration, but we soon found that the third
man always made the decision, so that now the arbitrator hears the
case in the town where it originated.
Most of the business is in Chicago, and the only office is in Chicago.
The arbitrator hears the case and makes and files his decision, a copy
of which is sent to each party. Either party may have that award
revoked by the commission by filing a petition and filing transcripts
of the testimony. The board furnishes the reporter. Up to July 1
we hired the reporter; since then we have been doing the work by
contract. The testimony is written up and sent at once to the office.
In case the party desires to have the order revoked by the commission,
he must file transcripts of the testimony, for which he is compelled
to pay at 5 cents a hundred words. That amount is fixed by the
statutes. The case is then heard by a member of the board and taken
up in conference by the whole board or commission and a decision
is made. A majority of the commission, of course, governs the de
cision. Then the party may remove that case by appeal to the circuit
court. At this hearing before the commission or board either party
may introduce additional testimony, provided proper notice be given,
and the aggrieved party may remove the case (upon points of law,
but not upon facts) to the supreme court. Our supreme court has
handed down 50 decisions upon the act.
There are several difficulties that I have discovered as to which I
would like information. I remember in reading over the proceedings
of last year, some gentleman (I don’t remember his name) said that
the lawyer had been entirely eliminated in the practice in that State
(I do not remember the State, either). The question of attorneys
and attorneys’ fees has been the cause of some difficulty. Some one
asked as to how the attorney is going to get his fee when an award
is in a lump sum. I suppose the answer is that that is of no interest
to the board or commission. The practical result, however, is that if
he does not get his fee he will not take the next case.
The United Mine Workers is the strongest union in Illinois, It
has a legal department; it pays its principal counsel, who lives
in Springfield, $5,000 a year, and there are five other attorneys over
the State. They handle all the claims for miners absolutely free of
charge. Before this year they were allowed a small percentage of
5 per cent, I think, but now they receive nothing. I f you are going
to have an attorney for the employer and make no provision for an
attorney for the employee, you are going to have a great many claims
that will not be successfully prosecuted. I f that gentleman is here
84
L U M P -S U M S E T T L E M E N T CLA IM S.
when I get through, I would like to hear from him as to what the
plan is.
The question of lump-sum settlements is a very serious one in Illi
nois. The law makes no provision for an award of a lump sum—for
the loss of an eye, a certain number of weeks; for the loss of a finger,
a certain number of weeks, and so on. The commission may order a
lump-sum settlement only in death cases or permanent disability
when the finding of the board is not opposed by the other party. We
have several hundred claims filed every month. Most of them are
small, and it is a very difficult thing when everybody wants the
money in a lump sum. The lawyer can not see why his client should
not get his money if he wants it, and it is a very serious matter.
I have been very much interested in what I have heard here to-night
in regard to it.
Up to the 1st of July our board consisted of three members. We
have a provision in our laws that does not exist in any other State,
apparently. Our law provides for three members, one member to be
a person representing the employer under the act, another a person
representing the employee under the act, and the third a person
representing neither, and the provision is the same with five mem
bers, two for the employer, two for the employee, and the fifth man
who represents neither the employer nor the employee. It is not a
lawyers’ board. I find a great many of these boards are composed
mostly of lawyers. There is only one lawyer on our board, and that
w as when I was elected. In addition to the regular duties of the
T
board, the duties of the State board of arbitration, which was abol
ished in July, were imposed upon the industrial commission.
The C h a i r m a n . I would like to ask Mr. Armstrong to say a few
words to the meeting regarding the laws in Nova Scotia.
Mr. F. W. A r m s t r o n g , vice chairman, Workmen’s Compensation
Board of Nova Scotia. The difficulties spoken of to-night in regard to
workmen’s compensation by some previous speakers do not apply at
all to Nova Scotia. We have what some members of the accident
boards or commissions would call a kind of an ideal system. It is a
pure State fund of compulsory insurance. We are not bothered at
all with any casualty companies or liability companies of any kind.
This practically follows the line of Ohio and also of Washington.
Ontario and British Columbia practically follow the same lines as far
as a pure State fund is concerned. Many of the objections offered
and difficulties mentioned by the different members to-night dis
appear altogether when you have a board with power such as we have
in Nova Scotia. No doubt we and the legislature have profited by the
experience of other States and Provinces of the Dominion.
L U M P -S U M SE T T L E M E N T S---- DISCU SSION .
85
The act went into effect January 1, 1917, and, of course, it has only
been practically about eight months in existence^ but the record has
been what I would consider very satisfactory. Speaking for myself,
we expected we Avere going to strike some snags, but when they do not
amount to what we expected, we feel we are running along pretty
well.
The. question of reporting of accidents has been mentioned by the
chairman. We follow practically along the lines mentioned by
Brother Wilson. We require, however, perhaps a little different pro
cedure. According to the law, the employer is supposed to report
every accident where a man loses any time. We do not pay any com
T
pensation unless the man has been ill over a week. The act provides
that if a man is off five days he gets nothing. I f he is off seven or
eight days or two weeks, he gets his full two weeks; any part of a
week is eliminated. In that way we get a report of practically every
accident which happens in the Province, and you can understand
that in this way we should be able to keep first-class records of acci
dents in the different industries.
Mr. Andrus, chairman of the Illinois State board, has spoken
about the question of lawyers. This is the first time I have been
present at these meetings, but in Nova Scotia we have also eliminated
the lawyer. We do not have any dealings with them at all. Not
that we consider them bad, but we feel we can get along without
them.
Mr. A n d r u s . Do you have a lawyer on either side ?
Mr. A r m st r o n g . N o lawyer on either side. These reports come in
from the employers within three days. When the matter they re
port is sent in, blank reports are sent out to the workmen telling
each one a report has been made of the accident, asking him to fill
out papers and send to the board, and inclosing a surgeon’s report
to be filled out and returned with the papers. Then the claim is
ready for adjustment by the commission. The man is paid his
claim, and if he has any objections he writes to us and we give him
just as good a show as if he had a lawyer.
The C h a ir m a n . H ow many accidents are reported each month?
Mr. A r m st r o n g . Y ou can understand that in the starting of
a commission you will find some difficulty in getting these acci
dents reported as promptly as is desired. During the first six
months, however, we have had over 5,000 accidents reported. Some
of these filed had no claim and were not entitled to compensation.
Regarding the question of appeal, the commission has full power
in regard to questions of fact, but in regard to questions of law there
is an appeal to the supreme court. On questions of fact there is no
86
L U M P -S U M S E T T L E M E N T C LA IM S.
a p p e a l a t a ll. W e h a v e h a d v e r y lit t le t r o u b le in th e s e ttle m e n t o f
c la im s , a s w e h a v e t r ie d t o d e c id e th e s e q u e s tio n s s o t h a t th e e m
p lo y e r ca n n o t c o m e b a c k a n d s a y w e h a v e n o t d o n e th e r ig h t th in g ,
a n d n e ith e r c a n th e e m p lo y e e .
I t is a d iffic u lt m a t t e r t o d o t h i
a lw a y s , b u t w e h a v e s u cc e e d e d v e r y w e ll s o fa r .
I n r e g a r d t o lu m p -s u m s e ttle m e n ts , t h e r e d o e s n o t a p p e a r t o b e a n y
d iffe r e n c e o f o p in io n .
W e h a v e t o b e s h o w n in e v e r y case w h a
is t o b e d o n e w it h th e m o n e y . W e h a d a c a se o f a m a n w h o h a d h is
h a n d in ju r e d a n d w a s a w a rd e d $900.
T h e m a n w a s b a d ly in ju r e d
a n d h a d t o le a v e h is e m p lo y m e n t.
H e w a n te d th e m o n e y to s to c k
h is fa r m , w h ic h h e h a d l e f t t o g o t o w o r k in a m u n itio n s fa c t o r y .
H e w a n te d a b o u t $ 5 0 0 f o r th e sh e e p fa r m a n d w e g a v e h im $490.
W e d id n o t m a k e a n y b a r g a in w it h h im . W e t o l d h im , “ Y o u a r
e n t it le d t o $ 9 0 0 , a n d w e w i l l le t t h e o t h e r s t a n d in a b e y a n c e .” H e is
e n title d t o h is f u ll $ 9 0 0 w h e n h e h a s s h o w n th e b o a r d h e h a s m a d e
g o o d u se o f th a t m o n e y .
W e h a v e t o b e s h o w n th a t a lu m p -s u m
s e ttle m e n t is f o r th e b e s t in te r e s t o f th e a p p lic a n t .
W e d o n o t h a v e s o m e o f t h e d iffic u lt ie s m e n t io n e d b y s o m e o f t h e
o th e r m e m b ers to -n ig h t , b eca u se o u r a c t d o e s n o t p r o v id e f o r s o
m a n y w e e k s f o r t h e lo s s o f a n a r m o r a le g o r a n e y e . T h e m a n is
e n title d to s o m u ch a m o n th f o r life .
T h e b u lk o f o u r a sse ssm e n ts in N o v a S c o t ia is f r o m c o a l m in in g .
P r a c t i c a l l y o n e - h a l f o f o u r a s s e s s m e n ts is f r o m c o a l m in e s .
O ur
e s t i m a t e d a s s e s s m e n t s f o r t h i s y e a r w i l l a m o u n t t o a b o u t $ 8 0 0 ,0 0 0 ,
a n d n e a r l y $ 4 0 0 ,0 0 0 i s f r o m o u r c o a l m i n e s . U n f o r t u n a t e l y , a f e w
w e e k s a g o w e m e t w it h a s e r io u s a c cid e n t.
S ix t y -s e v e n m e n lo s t
t h e ir liv e s in a n e x p lo s io n .
W e h a v e p la c e d a p r e t t y h ig h ra te o n
o u r m in e s , a n d w e a r e a b le t o ta k e c a r e o f th e c a ta s tr o p h e w it h o u t
a n y in c r e a s e i n t h e 3 J p e r c e n t o n o u r m in e s .
M r . W i l s o n s p o k e o f t h e d i f f e r e n t c la s s e s i n W a s h i n g t o n . H e w i l l
a g r e e w it h m e , I t h in k , th a t i f h e h a d t h e m a k in g o f th e a c t o v e r
a g a i n h e w o u l d d e c r e a s e t h e n u m b e r o f c la s s e s .
I f h e re d u ce d th e
n u m b e r t o n in e h e w o u ld h a v e a v e r y m u c h e a s ie r a n d b e t t e r w o r k i n g
sy stem .
T h e C h a ir m a n . T h e r e i s o n e p r o v i s i o n i n y o u r l a w w h i c h i s v a s t l y
s u p e r io r t o a n y t h in g w e h a v e in th e S ta te s, a n d I a m s u re e v e r y b o d y
h e re w ill a g re e w it h m e.
I f y o u w ill e x p la in t o u s h o w it is d o n e
w e w il l a ll b e m u c h in te r e s te d .
H o w l o n g i s y o u r t e r m o f o f f ic e ?
M r . A rm strong. O n e o f t h e a d v a n t a g e s o f t h e B r i t i s h s y s t e m o f
g o v e r n m e n t , o r , r a th e r , o f a p p o in tm e n ts , is t h a t y o u a r e g iv e n a l i f e
a p p o in t m e n t f o r g o o d c o n d u c t , b u t t h e y h a v e p u t a w is e p r o v is io n
i n t h a t y o u m u s t r e tir e a t th e a g e o f 75.
A l t h o u g h I h a v e b e e n o n t h e b o a r d o f w o r k m e n ’s c o m p e n s a t io n
o n l y s in c e th e 1 st o f J a n u a r y , I h a v e b e e n a v e r y c lo s e o b s e r v e r a n d
L U M P -S U M S E T T L E M E N T S---- D ISCUSSIO N.
87
s tu d e n t in r e g a r d t o c o m p e n s a t io n la w s f o r s o m e y e a r s .
B y life
a p p o in tm e n ts w e g e t c le a r o f o n e o f th e fe a tu r e s in y o u r A m e r ic a n
la w w h ic h w o r k s a g a in s t t h e b e s t w o r k in g o f t h e c o m p e n s a t io n la w ,
a n d t h a t is t h e p o l it i c a l in flu e n c e .
A s I w a s t a lk in g w it h s o m e o f
th e m e m b e r s t o -n ig h t , i f y o u p u t a m a n in c h a r g e o f a b u s in e s s a n d
k e e p h im th e re f o r s ix y e a r s , a n d a t th e e n d o f th e s ix y e a r s t u r n h im
o ff , y o u a r e t u r n in g o f f a v a lu a b le a sse t.
I f h e c o u ld c o n tin u e o n f o r
so m e y e a r s h e w o u ld b e c o m e a m o r e v a lu a b le m a n .
I f y o u ta k e a
n e w m a n i n a t t h e e n d o f e v e r y s i x y e a r s a n d .t h e n t u r n h i m o f f y o u
a r e t r a in in g m e n a ll th e tim e .
T h e r e fo r e a g o o d d e a l c a n b e s a id
in f a v o r o f th e B r it is h s y s te m o f a p p o in tm e n ts f o r s o m e le n g t h o f
t im e .
M r . W il c o x . D o y o u g i v e m e d i c a l a i d i n N o v a S c o t i a ?
M r . A rm strong. W e g i v e n o m e d i c a l a i d a t a l l , b u t w e r e a l i z e t h a t
th a t is o n ly te m p o r a r y a n d e v e n tu a lly w e m u s t a d o p t th a t.
A t th e
t im e o u r a ct w a s p a ssed , w h ic h w e n t in t o e ffe c t th e 1 st o f J a n u a r y ,
th e y d id n o t h a v e m e d ic a l a id in O n ta r io , o r in a n y o f th e o th e r
P r o v in c e s , a n d w e th o u g h t w e w o u ld g o as f a r as O n t a r io d id
O n t a r i o a t t h e la s t s e s s io n o f t h e h o u s e p a s s e d a m e d i c a l - a i d p r o v i
s io n o f 3 0 d a y s , e ffe c tiv e th e 1st o f J u ly , 1917.
O u r c o m m is s io n
r e c o g n iz e s th e f a c t th a t e v e n t u a lly w e s h a ll h a v e t o a d o p t it, b u t w e
d o n o t w a n t t o f o r c e it, b e c a u s e w e f e e l i t is a m a t t e r f o r th e l e g is
la tu r e o r th e G o v e r n m e n t t o ta k e u p .
T h e C h a ir m a n . H a v e y o u m e t w i t h c o n s i d e r a b l e o p p o s i t i o n
a m o n g th e c o a l-m in e o w n e r s f o r a s s e s s in g 3^ p e r c e n t o n t h e p a y r o l l ?
M r . A rm strong. I m i g h t m e n t i o n t h a t t h e a r g u m e n t u s e d b y u s
in r e g a r d to th a t r a te w a s th a t o u r ra te s w e re b a s e d r a th e r a lo n g
th e W a s h in g t o n s y s te m o f r a tin g , a n d w h e r e w e u s e d a b a s ic r a te o f
3 J p e r c e n t, i f w e d id n o t r e q u ir e th a t m o n e y it w a s n o t n e c e s s a r y
f o r u s t o a ssess it.
T h e C h a ir m a n . W e h a v e h a d v e r y s t r o n g o p p o s i t i o n i n M i c h i g a n
a m o n g th e o w n e r s o f c o a l m in e s b e c a u s e o f th e a m o u n t o f m o n e y
p a id o u t.
O n e o w n e r c a r r ie d h is o w n r is k , a n d w it h a p a y r o ll o f
$ 2 ,0 0 0 ,0 0 0 l a s t y e a r t h e e x p e n d i t u r e f o r s u r g i c a l a n d m e d i c a l c o m
p e n s a t i o n t h e w h o l e y e a r w a s 1^ p e r c e n t o f t h e p a y r o l l .
I f our
m o s t h a z a r d o u s e m p l o y m e n t i n M i c h i g a n c a n g e t a l o n g w i t h 1^ p e r
ce n t o f th e ir p a y r o ll, I s h o u ld im a g in e y o u w o u ld m e e t w it h s t r o n g
o p p o s i t i o n i n C a n a d a w h e n y o u l e v y a 3-| p e r c e n t r a t e .
M r . W il s o n . Y ou u n d e r s t a n d t h a t u n d e r o u r a c t w e h a v e a b a s i c
r a te o f 3 p e r c e n t, a n d w e m a k e c a lls th e n as w e n e e d th e m o n e y .
In
s o m e in d u s t r ie s w e m a k e o n l y t w o c a lls a y e a r , a n d in m a n y o n l y
s ix c a lls a y e a r , w h ic h m a k e s o n ly o n e -h a lf o f th e b a s ic ra te .
L ast
y e a r w e h a d a v e r y d is a s t r o u s e x p lo s io n in o n e o f o u r m in e s , w h e r e
2 0 o r 3 0 p e o p le w e r e k ille d , a n d w e n o t o n l y m a d e t h e 12 c a lls , b u t
88
L U M P -S U M S E T T L E M E N T CLA IM S.
assessed 1 p e r cen t ex tra .
I n t h a t w a y , w h i l e w e h a v e a b a s i c rate^
w e m a k e c a lls as w e n e e d t h e m o n e y , a n d t h e in d u s t r y g e t s t h e b e n e fit
o f t h e ir c a r e f u l a d m in is t r a t io n .
T h a t is , i f t h e y a r e p r o d u c i n g le s s
a c c i d e n t s , t h e y p a y le s s m o n e y ; i f m o r e a c c i d e n t s , t h e y p a y m o r e
m oney.
W e h a v e ju s t r e c e n tly a d o p te d a m e r it r a t in g sy ste m
w h e re b y th e c o m m is s io n h a s p o w e r to in c re a s e ra te s w h e r e th e a c c i
d e n ts so w a r r a n t it o r t o r e d u c e th e r a te w h e r e v e r th e s h o w in g w a r
r a n t s r e d u c in g it.
T h e C h a ir m a n . W e h a v e w i t h u s t o - n i g h t M r . C h a r l e s H . V e r r i l l ,
o f th e U n it e d S ta te s C o m p e n s a t io n C o m m is s io n , a n d w e w o u ld lik e
t o h e a r f r o m h im f o r a f e w m in u te s .
M r . C h a r l e s H . V e r r il l , c h i e f s t a t i s t i c i a n , U n i t e d S t a t e s E m
p lo y e e s ’ C o m p e n s a t io n C o m m is s io n . T h e a c t p r o v i d i n g f o r th e c o m
p e n s a tio n o f e m p lo y e e s o f th e F e d e r a l G o v e r n m e n t p r i o r t o S e p te m b e r
7 la s t w a s v e r y in a d e q u a t e , c o v e r i n g s o m e t h in g le s s t h a n o n e - f o u r t h o f
a ll F e d e r a l e m p lo y e e s , a n d p r o v i d i n g a c u r io u s s c a le o f c o m p e n s a t io n .
D u r i n g d i s a b i l i t y e x t e n d i n g le s s t h a n 1 5 d a y s , n o c o m p e n s a t i o n w a s
p a id , b u t i f th e d is a b ilit y r a n b e y o n d 15 d a y s , th e e m p lo y e e d r e w h is
f u l l w a g e r ig h t f r o m th e fir s t d a y f o r a p e r io d n o t e x c e e d in g o n e
year.
T h e r e s u lt w a s n o t a t a ll s a t is fa c t o r y .
A n ew a ct w en t in to
e ffe c t o n th e 7 th o f S e p te m b e r la s t b r in g i n g u n d e r th e c o m p e n s a tio n
p r o v is io n a ll th e c iv il e m p lo y e e s o f th e F e c le r a l G o v e r n m e n t , p e r h a p s
s o m e t h i n g o v e r 4 0 0 ,0 0 0 .
T h is n ew a ct w a s b a se d o n th e p r in c ip le s
r e c o g n iz e d in m o s t o f th e S ta te a cts.
T h e w a i t i n g p e r i o d is t h r e e
d a y s , a n d t h e s c a le o f c o m p e n s a t io n is t w o - t h ir d s o f t h e ir w a g e ,
b u t n o t e x c e e d i n g i n a n y c a s e $ 6 6 .6 7 a m o n t h . T h e r e i s n o l i m i t t o
th e tim e d u r in g w h ic h c o m p e n s a t io n is p a y a b le in ca se o f p e r m a n e n t
d is a b ility .
T h e a d m in is t r a t io n o f t h is a c t w a s p la c e d in t h e h a n d s o f
a c o m m is s io n a p p o in t e d b y th e P r e s id e n t, e x c e p t in th e ca se o f e m
p lo y e e s o f th e P a n a m a C a n a l a n d o f th e A la s k a E n g in e e r in g C o m
m is s io n .
I n th e ca se o f th e se t w o s e r v ic e s th e a d m in is tr a tio n w a s
t r a n s fe r r e d t o th e im m e d ia te a d m in is tr a tiv e b o d y b y th e P r e s id e n t.
T h e p r o c e d u r e t h e r e is t h a t t h e s e a d m i n i s t r a t i v e b o d i e s p a y t h e c o m
p e n s a t io n d u e u n d e r th e a c t a n d th e a m o u n t p a id is r e im b u r s e d f r o m
th e c o m p e n s a tio n fu n d .
T h e c o m p e n s a tio n fu n d , I s h o u ld e x p la in ,
f r o m w h ic h a ll c o m p e n s a t io n is p a id is a n a p p r o p r i a t i o n d e s ig n a t e d
b y C o n g r e s s , a n d is a c o n t i n g e n t f u n d . T h e r e is n o q u e s t io n o f in s u r
a n ce , b e ca u se a ll e m p lo y e e s a r e e m p lo y e e s o f th e F e d e r a l G o v e r n
m e n t.
T h is a ct d iffe r s in s o m e s m a ll r e s p e c ts f r o m th e o th e r a ct.
I r e fe r p a r t ic u la r ly t o th e d e s c r ip t io n o f w h a t in ju r ie s a r e c o m p e n
sa ted .
T h e F e d e r a l a ct u ses th e te r m 6 p e rs o n a l in ju r y ,” f o llo w in g
4
th e p r e c e d e n t o f th e M a ssa ch u se tts a ct, a n d a lr e a d y a fe w ca ses o f
o c c u p a t i o n a l d is e a s e s h a v e b e e n c o m p e n s a t e d u n d e r t h i s l a w .
The
la w in its p h r a s in g h a s a n o th e r fe a tu r e .
W h e r e in m o s t o f th e S ta te
L U M P -S U M SE T T L E M E N T S---- DISCUSSION*
89
a c ts y o u h a v e th e r e q u ir e m e n t t h a t th e i n ju r y m u st b e in th e “ c o u r s e
o f e m p l o y m e n t , ’ 5i n t h i s F e d e r a l a c t t h e p h r a s i n g i s “ w h i l e i n t h e p e r
fo r m a n c e o f d u t y .”
T h e r e is p r a c t ic a lly n o p r e c e d e n t f o r th e in te r
p r e t a t io n o f th a t te r m , a n d it s t ill r e m a in s t o b e d e te r m in e d ju s t
w h a t th e s c o p e o f th e a c t is as d e te r m in e d b y t h e p h r a s in g .
T h e C h a ir m a n . W e h a v e d e r i v e d a g r e a t d e a l o f h e l p b y d i s
c u s s in g th e p r o p o s it io n s th a t t r o u b le u s.
I w is h th a t e v e r y o n e o f u s
w o u ld w r it e d o w n th e m a tte rs th a t tr o u b le u s m o s t e a ch d a y in th e
h o p e th a t w e m a y h a v e th e o p p o r tu n ity o f g e t t in g som e s o r t o f
c o u n se l fr o m ea ch o th e r d u r in g o u r sta y h ere. I d o n o t k n o w th a t
t h e r e is a n y t h in g m o r e t o s a y , a n d as th e h o u r is g e t t in g la t e , I w i l l
t u r n th e m e e t in g o v e r t o B r o t h e r H o lm a n .
M r . H o lm an . T h e h o u r is la te , b u t I w is h t o s a y t h a t w e h a v e
a c lin ic a t th e M a ssa ch u se tts G e n e r a l H o s p it a l in th e m o r n in g , a n d
I t h in k t h e m e m b e r s w o u ld b e v e r y m u c h in t e r e s te d i n s e e in g w h a t
t h e y h a v e t o o ffe r d o w n th e r e , s o as m a n y as p o s s ib le s h o u ld t r y
t o a tte n d th a t c lin ic .
I t is a t th e c o r n e r o f B lo s s o m a n d A lle n
S tre e ts, ju s t o v e r th e h ill.
Y o u w ill b e m et at th e g a te b y re p re se n
ta tiv e s o f th e h o s p ita l, a n d y o u w ill b e s h o w n th e w a y in w h ic h th e y
m a k e c e r ta in t y p e o f in v e s tig a t io n s , p a r t ic u la r ly in in ju r ie s t o th e
back.
Y o u w i l l a ls o b e t a k e n t h r o u g h t h e r o o m w h e r e t h e y h a v e a ll
k in d s o f m e c h a n ic a l a p p lia n c e s f o r m a s s a g in g , f o r t a k in g c e rta in
k in d s o f e x e r c is e , a n d r e s t o r in g fu n c t io n s b y th e u se o f th e m e c h a n ic a l
m assage.
T h e r e a r e o t h e r f e a t u r e s in . c o n n e c t i o n w i t h t h i s c l i n i c
th a t p e r h a p s m a y b e u s e fu l to so m e o f u s, b u t th a t w ill b e in s tr u c tiv e
to a ll o f u s, a n d I tr u s t th a t as m a n y a s p o s s ib le w ill b e p re s e n t.
W ED N ESD AY, A U G U S T 22 , 1917— M O R N IN G SESSION
(BUSINESS M E E T IN G ).
CHAIRMAN, DUDLEY M. HOLMAN, PRESIDENT, I. A. I. A. B. C.
REPORT OF THE SECRETARY-TREASURER.
RECEIPTS.
1916.
May 15,
19.
June 2.
12.
21.
22.
July 5.
21.
24.
Aug. 24.
28.
Sept. 21.
Oct. 10.
14.
26.
31.
Nov. 2.
8.
3.
6.
9.
11.
24.
Dec. 4.
Check of former secretary-treasurer covering balance on liand_
Dues of Industrial Commission of Ohio______________________
Dues of Oregon Industrial Accident Commission_____________
Dues of Maryland Industrial Accident Commission___________
Dues of Massachusetts Industrial Accident Board____________
Dues of Workmen’s Compensation Board of Ontario__________
Dues of Industrial Board of Illinois________________________ ___
For 100 copies of the Proceedings of the Second Annual Meet
ing, for State of Michigan Accident Fund__________________
Dues of Industrial Accident Commission of California_______
Dues of New York State Industrial Commission_____________
Dues of Texas Industrial Accident Board____________________
Dues of West Virginia Compensation Fund__________________
Dues of American Museum of Safety__________________________
From United States Steel Corporation for expenses of confer
ence on social insurance_____________________________________
From National Window Glass Workers for expenses of con
ference on social insurance__________________________________
From United Mine Workers of America for expenses of con
ference on social insurance__________________________________
Dues of New Jersey Department of Labor_____________________ #
From Brotherhood of Painters, Decorators, and Paper Hang
ers of America for expenses of conference on social insur
ance__________________________________________________________
From National Civic Federation for expenses of conference
on social insurance__________________________________________
From American Association for Labor Legislation for ex
penses of conference on social insurance____________________
From Equitable Life Assurance Society for expenses of con
ference on social insurance__________________________________
From International Association of Machinists for expenses
of conference on social insurance___________________________
Dues of Massachusetts Board of Labor and Industries_______
Dues of Workmen’s Compensation Commission of ConnecticutRegistration and membership fees for conference on social in
surance (in addition to above listed contributions) received
from Nov. 6 to Dec. 15, inclusive____________________________
90
$42. 77
25. 00
25. 00
25. 00
25. 00
25. 00
25. 00
25.00
25.00
25. 00
25.00
25. 00
25. 00
25. 00
25. 00
25. 00
25. 00
25.00
25, 00
25. 00
25. 00
25. 00
25. 00
25. 00
309. 00
REPORT OF T H E SECRE TARY-TREASU RE R.
Dec. — . Refund from National Society of the Daughters of the Ameri
can Revolution, after charges in connection with the use
of Continental Memorial Hall had been deducted from $100
deposit______________________________________________________
1917.
Jan. 1. Interest on bank deposit----------------------------------------------------------May 10. Dues of Pennsylvania Department of Labor and Industry____
June 14. Duplicate check from National Society of Daughters of the
American Revolution sent under impression that original
check No. 5484 had been mislaid and not presented for
payment_____________________________________________________
29. Dues of Workmen’s Compensation Board of Nova Scotia____
July 1. Interest on bank deposit______________________________________
8. For copy (including postage) of Report of Discussion before
the (British) Royal Society of Medicine on Toxic Jaundice
Observed in Munition Workers, for Compensation Fund of
West Virginia_______________________________________________
14. For copy (including postage) of above-mentioned report for
Workmen’s Compensation Board of Nova Scotia____________
18. For copy (including postage) of above-mentioned report for
Industrial Accident Board of Texas_______________________
23. For copy (including postage) of above-mentioned report for
Workmen’s Compensation Board of Manitoba______________
28. For postage on three copies of above-mentioned report, or
dered by Illinois Industrial Board__________________________
Aug. 11. For copy (including postage) of above-mentioned report for
Industrial Accident Commission of California_____________
13. For copy (including postage) of above-mentioned report for
Workmen’s Compensation Board of Ontario________________
14. For copy (including postage) of above-mentioned report for
Insurance Department of Washington (State)_____________
14. Annual dues of Insurance Department of Washington (State) _
14. Annual dues of Workmen’s Compensation Board of British
Columbia____________________________________________________
91
$2.75
1. 07
25. 00
2. 75
25. 00
8. 35
1. 05
1.12
1.12
1.12
. 36
1.12
1.12
1.12
25. 00
25. 00
T o tal_____________________________________________________________ 1,044.82
DISBURSEM ENTS.
1916.
May 25.
June 8.
22.
23.
July
1.
1.
1.
Sept. 5.
16.
Oct. 13.
27.
To Julia T. Buchanan, stenographer, for Columbus meeting__
To Lilley & Co., for badges for Columbus meeting__________
Postage, including rubber stamp, etc__________________________
Balance due Julia T. Buchanan, stenographer, Columbus
meeting_____________________________________________________
To Service Photo Co. (installation), Columbus meeting______
H. C. Wylie (lumber work, etc.), Columbus meeting_________
F. J. Heern Printing Co., printing expenses, Columbus
m eeting______________________________________________________
Stationery— 3,000 letterheads, 3,000 envelopes, and 3,000 sec
ond sheets___________________________________________________
Fund for postage, telegrams, etc______________________________
Fund for postage, telegrams, etc______________________________
Fund for postage, telegrams, etc______________________________
$67. 00
21. 60
3. 00
8. 00
20. 00
7. 80
36. 25
27. 50
5. 00
10. 00
10. 00
92
BU SIN E SS M E E T IN G 01’ T H E ASSOCIATIO N .
Nov. 28. For deposit to cover charges for use of Continental Memorial
Hall for conference on social insurance____________________ $100. OO
The following charges were made:
Cleaning and moving furniture________________ $6. 50
Manning building______________________________
7. 50
Electric light___________________________________ 7. 50
Heating auditorium___________________________ 6. 25
Operating vent fan____________________ ,________
2.00
Eight ushers____________________________________ 14. 00
Wear and tear____________ ______________________ 50. 00
Insurance______________________________________ 2. 50
M a id ___________________________________________ 1. 00
Dec. 4. To Judd & Detweiler, printing registration cards and tickets
for conference on social insurance___________________________
9. 00
5. For tin cash box for conference on social insurance__________
1. 00
9. To Gibson Bros. (Inc.), for printing 2,000 programs and
making alterations— for conference on social insurance___
53. 00
9. Badges for conference on social insurance____________________
1. 50
9. Miscellaneous expenses of committee on arrangements for
conference on social insurance (including signs, dating
stamps, tips to hotel employees, ink, receipt books, etc.) __
9. 20
9. To W . H. C. Mais, registration clerk for conference on social
insurance_______________________ - __________________________
12.00
9. To Leon Robbin for clerical and other services in connection
with conference on social insurance_______________________
10. 00
19. To E. B. Thompson, furnishing stereopticon and operator for
lecture at social-insurance conference______________________
7. 50
21. To Smith & Hulse for reporting night sessions (including
attendance of stenographer)_______________________________
138.75
21. To Bureau of Applied Economics for furnishing clerical assist
29.17
ance for conference on social insurance____________________
1917.
June 4, For 50 copies of the Report of the Discussion before the
(British) Royal Society of Medicine on Toxic Jaundice
Observed in Munitions Workers____________________________
49. 96
July 3. Fund for postage, telegrams,* etc______________________________
3.00
18. For postage____________________________________________________
1.09
18. Excess postage returned to Industrial Accident Board of
Texas_________________________________________________________
. 03
30. Postage on Report of Discussion before the (British) Royal
Society of Medicine on Toxic Jaundice Observed in Muni
tion Workers, sent to Illinois Industrial Board____________
. li
30. Excess postage returned to Illinois Industrial Board________
. 25
31. Check returned to National Society Daughters of American
Revolution (refund for duplicate check sent by mistake)__
2.75
Aug. 2. Fund for postage and telegrams_____________________________
5. 00
15. Fund for postage and telegrams, etc___________________________
5. 00
20. To Gibson Bros. (Inc.), for printing 800 programs and mak
ing alterations— for fourth annual meeting___________________
22. 75
20. Cash on hand__________________________________________________
367. 61
T o ta l
1, 044. 82
REPORT OF T H E SECRETARY-TREASU RER.
93
I wish to submit tbe following explanation in connection with certain financial
transactions which do not appear in the above statements of receipts and dis
bursements :
When I became seereta ry-treasurer of the I. A. I. A. B. C. I kept both my
personal account and my account as secretary-treasurer at the same bank. Two
checks for expenses of the Columbus meeting, one for $21.60, and the other
for $8, were, by mistake, paid from my personal deposit. I decided, therefore,
to keep my account as secretary-treasurer at another bank, the National Sav
ings & Trust Co. Owing to the fact that checks for the above amounts had
been drawn on my personal account, I found, when I went to transfer my
deposit as secretary-treasurer, that the balance credited to the association
was $108.72. I drew a check for this amount and then reimbursed myself for
the two checks that had, by mistake, been paid from my personal account,
depositing the actual balance of the association— $79.12— in the National Sav
ings & Trust Co.’s bank.
On August 24, 1916, 1 drew $50 from the bank for expenses in connection with
a meeting of the social insurance committee in New York. I afterwards found
it was unnecessary to charge up any expenses to the International Association of
Industrial Accident Boards and Commissions. I therefore redeposited this
amount on August 31, 1916.
There is a postage fund balance amounting to $3.48.
Eighteen copies of the Report of Discussion before the (British) Royal
Society of Medicine on Toxic Jaundice Observed in Munition Workers have been
ordered by different commissions and boards, but 11 have not yet been paid for.
Respectfully submitted.
R oyal M e eker , Secrctary-Treasurer.
[ T h e c o n s t i t u t i o n w a s t a k e n u p a n d d i s c u s s e d , a r t i c l e b y a r t ic le *
a n d in t h e c o u r s e o f th e d is c u s s io n t h e f o l l o w i n g s ta te m e n t a s t o th e
fin a n c e s o f th e a s s o c ia tio n w a s m a d e b y D r . M e e k e r , t h e s e c r e ta r y t r e a s u r e r :]
D r . M e e k e r . Y ou a r e a b a n k r u p t i n s t i t u t i o n . Y o u c o u l d n o t s u r
v iv e f o r o n e m in u te w it h o u t a s u b v e n tio n f r o m th e U n it e d S ta te s
G o v e r n m e n t in th e sh a p e o f th e p r in t in g o f y o u r p r o c e e d in g s a n d th e
d is t r ib u t in g o f th e m fr e e o f c o s t. I f I s h o u ld c h a r g e t o th e a s s o c ia
t io n th e p r i n t i n g b i ll f o r th e tim e s in c e I h a v e t a k e n c h a r g e o f y o u r
f i n a n c e s , i t w o u l d c e r t a i n l y a m o u n t t o n o t le s s t h a n $ 6 ,0 0 0 . T h a t i n
c lu d e s n o c h a r g e f o r e d it o r ia l w o r k , t h e e n o r m o u s a m o u n t o f e x p e r t
c le r ic a l w o r k , a n d s t e n o g r a p h ic w o r k .
Y o u a r e h e lp le s s t o fin a n c e
y o u r s e l f a s a g o i n g c o n c e r n . T h e o n l y w a y it c a n b e d o n e is in s o m e
s u ch w a y as it h a s b e e n d o n e in th e p a s t y e a r a n d a h a lf .
N ow , I
se n t o u t th is d r a f t o f th e c o n s t it u t io n v e r y l a r g e ly as a m e n ta l s tim u
lu s . I h o p e t h a t it h a s w o r k e d . I t h in k it h a s. I t h a s b e e n s u g g e s t e d
in som e q u a rte rs th a t th e w e a lth ie r S ta te s o u g h t t o m a k e a la r g e c o n
t r ib u t io n . E v e r y o n e w h o h a s h a d a n y t h in g t o d o w it h th e re s e rv e s
o f t h e a s s o c ia t io n h a s k n o w n a ll a l o n g t h a t it is a b a n k r u p t c o n c e r n ;
t h a t it d e p e n d e d o n c h a r ity . N o w , I w a n t t o ta k e it o u t o f th e r e a lm
o f c h a r it y p a tie n ts a n d p r o v id e s o m e m o r e s a t is fa c t o r y w a y .
I
94
B U SIN E SS
m e e t in g
of
th e
a s s o c ia t io n
.
d i d n ’t s e e m t o m e t h a t t h a t w a s a v e r y s a t i s f a c t o r y w a y o f c o n d u c t
i n g b u s in e s s , a n d t h e p r o p o s i t i o n w a s m a d e b y s o m e t h a t t h e r e o u g h t
t o b e a d iffe r e n c e in th e a sse ssm e n t t o th e d iffe r e n t S ta te s b e ca u se o f
t h e d iffe r e n c e s in th e a m o u n t o f w e a lt h a n d t h e n u m b e r o f a c c id e n t
ea ses, t h e im p o r t a n c e o f th e w o r k o f c o m p e n s a t io n c o m m is s io n s in
t h e d i f f e r e n t S t a t e s , e t c ., a n d I s e n t t h i s s u g g e s t i o n o u t a s a f e e l e r .
I t h in k i t h a s s t ir r e d p e o p le u p p r e t t y w e ll.
I t w a s th e o p in io n
o f t h e c o m m it t e e , w h e n t h e y m e t y e s t e r d a y , t h a t i t is u n d e s ir a b le
t o m a k e a h ig h e r c h a r g e t o th e w e a lth ie r S ta te s. A s to th e a m o u n t
y o u r e a l l y n e e d , y o u c a n ’t h o p e t o r a i s e i t . I h a v e m a d e o u t s e v e r a l
e s tim a te s o f e x p e n s e s , p u t t in g t h e m a s lo w a s I f e l t i t s a fe t o d o .
N o w , so m e p r o v is io n w ill h a v e t o b e m a d e f o r t r a v e lin g ex p e n se s a n d
t h e n e c e s s a r y c le r ic a l a s s is ta n ce , p r e p a r a t io n f o r a n n u a l m e e t in g s ,
e tc.
N o t h i n g h a s b e e n e x p e n d e d o n t h a t a c c o u n t a s y e t , b u t i t is
q u it e l ik e ly t h a t i t w il l b e n e c e s s a r y t o e x p e n d m o n e y f o r th a
pu rpose.
A t o ta l o f $ 8 6 2 w a s e x p e n d e d la s t y e a r.
T h is m ak es n o
p r o v is io n f o r th e e x p e rts b r o u g h t t o a d d re ss th e c o n fe re n c e . I f w e
i n c l u d e $ 5 0 0 f o r s u c h e x p e n s e s , t h a t w i l l i n c r e a s e i t t o $ 1 ,3 6 2 . I f y o u
p r o v id e f o r p r in t in g , o n th e lo w e s t r e a s o n a b le e s tim a te th e p r i n t i n g
o f y o u r a n n u a l p r o c e e d in g s , o n th e b a s is o f o n e m e e t in g a y e a r , c a n
n o t b e d o n e f o r l e s s t h a n $ 3 ,0 0 0 .
T h a t b r in g s th e e x p e n se s u p t o
$ 4 ,3 6 2 . T h e n , i f y o u d o a s w a s s u g g e s t e d a t t h e C o l u m b u s m e e t i n g ,
c o n d u c t a ll y o u r c o r r e s p o n d e n c e f r o m a c e n tr a l p o in t , c e n tr a l h e a d
q u a r te r s , y o u m u s t p r o v id e , I e s tim a te , a b o u t $ 2 0 0 f o r p o s t a g e a n d
m a i l i n g e x p e n s e s ; t h a t w i l l b r i n g i t u p t o $ 4 ,5 6 2 , a n d t h a t d o e s n o t
i n c lu d e e x p e r t e d it o r ia l w o r k . I t h in k a $ 5 0 m e m b e r s h ip f e e is h ig h
e n o u g h s o t h a t y o u c a n p r o d u c e t h e fin a n c e s w it h t h e s u b v e n t io n
fr o m th e F e d e ra l G o v e rn m e n t. T h e assessm en t o f $ 50 p e r m e m b er
o n th e b a s is o f th e p r e s e n t m e m b e r s h ip w o u ld g iv e u s s o m e th in g in
excess o f $862.
[ I n t h e f u r t h e r c o u r s e o f t h e d e b a t e th e q u e s t io n w a s r a is e d , “ W h a t
p u b lic a g e n c ie s a re e n t itle d t o a c tiv e m e m b e r s h ip ? ” a n d D r . M e e k e r
s p o k e a s f o l l o w s :]
D r . M eeker. A s I c o n c e i v e t h e j o b o f w o r k m e n ’ s c o m p e n s a t io n
b o a r d s a n d in d u s t r ia l a c c id e n t b o a r d s , it is f o u r f o l d , n o m a tte r w h a t
y o u r la w m a y p r e s c r ib e .
I t is y o u r b u s in e s s t o c u t d o w n a c c id e n t
ra tes, a n d y o u ca n d o it w h e th e r o r n o t y o u h a v e le g a l a u th o r iz a tio n
t o d o so. T h e r e is n o t h in g in th e la w s o f a n y S ta te th a t fo r b id s th e
c o m p e n s a t io n c o m m is s io n t o u s e its m o r a l s u a s io n w it h t h e e m p lo y e r s ,
w it h th e in s u r a n c e c o m p a n ie s , in o r d e r t o c u t d o w n a c c id e n t ra te s.
T h i s is t h e m o s t i m p o r t a n t f u n c t i o n t h a t s u c h a b o a r d c a n p e r f o r m .
W h e n th e g e n tle m e n a lle g e t h a t t h e ir c o m p e n s a t io n c o m m is s io n h a s
n o t h i n g t o d o w i t h a c c i d e n t p r e v e n t i o n , I t a k e is s u e w i t h t h e m . Y o u
h a v e e v e r y t h in g t o d o w it h a c c id e n t p r e v e n t io n .
I f y o u r la w p r o -
REPORT OF T H E SECRE TARY-TREASU RE R.
95
v id e s t h a t a b u r e a u o f la b o r s h a ll h a v e to d o w it h s a fe t y w o r k , i t is
t h e b u s in e s s o f y o u r c o m m is s io n t o m a k e c o n n e c t io n s w it h t h a t s a fe t y
o r g a n iz a t io n ju s t as s o o n as y o u p o s s ib ly c a n , in o r d e r t o r e d u c e y o u r
a c c id e n t r a te s . Y o u r n £ x t f u n c t io n , w h ic h i s a b s o lu t e ly n e c e s s a r y , is
th e r e s t o r a t io n a s q u ic k ly a n d a s c o m p le t e ly a s p o s s ib le o f th o s e m e n
d is a b le d t h r o u g h in d u s t r ia l m is h a p s . M u c h m o n e y c o u ld b e s a v e d
it see m s t o m e , b y s p e n d in g m o n e y m o r e lib e r a lly o n p r o p e r h o s p it a l
a n d s u r g ic a l tr e a tm e n t. Y o u s a w s o m e e v id e n c e s o f it t h is m o r n in g .
I h o p e y o u w ill see m o re . M a ssa c h u se tts d id n o t h a v e a n y a u t h o r iz a
t i o n t o d o th e w o r k sh e is d o i n g ; sh e ju s t s i m p ly d id it. T h e r e
• n o t h in g in h e r la w t h a t a b s o lu t e ly fo r b a d e t h e I n d u s t r ia l A c c i d e n
B o a r d o f M a s s a c h u s e tts fr o m r e h a b ilit a t in g th ese m e n as f u ll y a n d
a s q u ic k ly as p o s s ib le , a n d so sh e h a s d o n e it o n a s m a ll s c a le ; a m is e r
a b l y s m a l l s c a le , t o b e s u r e , b u t s h e h a s d o n e s o m e t h i n g . I t i s t h e b u s i
n e ss o f su ch b o a r d s a n d c o m m is s io n s to g e t b u s y ju s t as q u ic k ly a s th e y
c a n a l o n g t h i s l i n e o f w o r k . T h e t h i r d g r e a t f u n c t i o n is t o r e t r a i n
t h e s e m e n . T h a t i s j u s t w h a t w e a r e u p a g a i n s t . C a n a d a is d o i n
it . S h e is r e e d u c a t in g h e r m e n w h o h a v e b e e n w o u n d e d o r in ju r e d in
m i l it a r y s e r v ic e . I t is a p r e t t y h a z a r d o u s ta s k , t h is ta s k o f k i l l i n g t h e
G e r m a n s . T h e y a r e h a r d t o k ill. W e d o n ’t k n o w w h a t th e h a z a r d
a re th a t o u r b o y s w ill h a v e t o m eet o v e r th ere.
T h e c o m p e n s a t io n
c o m m is s io n s h a v e n o t b e g u n t h is w o r k o f r e h a b ilit a t io n . Y o u k n o w
w h a t th e a t t it u d e o f th e e m p lo y e r s h a s b e e n a n d w h a t it s t ill is in t h is
c o u n t r y . T h e r e a r e t h o u s a n d s o f m e n in t h is c o u n t r y w h o h a v e m e t
w it h s e r io u s in d u s t r ia l m is h a p s w h o c o u ld h a v e b e e n r e s to r e d t o f u l l
e a r n in g p o w e r , b u t h a v e b e e n a llo w e d to b e c o m e tra m p s , b e g g a r s
a n d p a u p e r s . I f a m a n lo s e s h is h a n d , h e is c o m p e n s a t e d f o r th e lo s s
o f a h a n d . H e is p a id a su m o f m o n e y — a g r o s s ly in a d e q u a t e a m o u n t
in m o s t in s ta n c e s e v e n f o r th e lo s s o f o n e h a n d . T h e d is a b ilit y th a t
m a n r e a lly s u ffe r s is in m a n y in s t a n c e s — in th e g r e a t m a jo r i t y o f i n
s t a n c e s — p e r m a n e n t t o t a l d is a b ilit y . Y o u k n o w it.
Y o u k n o w th a
a m a n c a n ’t g e t a g o o d j o b w h e n h e h a s b u t o n e h a n d . H e g o e s d o w n
a n d d o w n a n d d o w n . I ca n p o in t o u t h u n d r e d s o f ca ses w h e re th a
r e t r o g r e s s io n h a s ta k e n p la c e .
T h e m an goes d ow n and becom es a
b e g g a r in t h e g u t t e r u n le s s s o m e b o d y h a s d e c e n c y e n o u g h in h im t o
g o d o w n a n d p ic k h im u p , ta k e h o ld o f h im , a n d p u t h im in a p o s it io n
a n d k e e p h im th e re u n til h e ca n m a k e g o o d .
I t is t h e t h i r d g r e a
fu n c t io n o f th ese a c c id e n t b o a r d s a n d c o m m is s io n s t o r e e d u c a te th e s e
d is a b le d m e n a n d p u t th e m b a c k in in d u s t r y . T h a t is w h a t t h e y a r e
d o i n g in C a n a d a , a n d w e a ll w is h m o r e s t r e n g t h t o h e r , t h a t sh e m a y
d o m o r e t h o r o u g h l y t h e w o r k s h e i s e n g a g e d in . T h e f o u r t h f u n c t i o n
o f th e b u r e a u s a n d c o m m is s io n s is th e f u n c t io n o f p a y i n g o u t c o m
p e n s a t io n . I t is v a s t ly im p o r t a n t t h a t a m a n ’s f a m i l y b e k e p t f r o m
w a n t w h ile h e is b e in g r e s to r e d , in th e h o s p it a l o r o u t o f it, b u t it is
96
BU SIN E SS M E E T IN G OF T H E ASSOCIATIO N.
n o t a s im p o r t a n t as a n y o n e o f th e th r e e fu n c t io n s I h a v e m e n tio n e d .
I n d r a f t i n g t h a t c la u s e o f t h e c o n s t it u t io n w e w a n t e d t o g i v e r e p
r e s e n ta tio n t o th o s e f o u r fu n c t io n s , n o m a tte r w h o p e r f o r m s th e m .
I n o r d e r to k e e p th e m e m b e r s h ip lim it e d , I fe e l w e s h o u ld e x c lu d e a ll
S ta te s a n d P r o v in c e s w h o h a v e n o t m a n ife s t e d e n o u g h in te r e s t in
in d u s t r ia l a c c id e n t s t o e n a c t a c o m p e n s a t io n la w .
O n ce th ey h a v e
e n a c te d a c o m p e n s a t io n la w , th e n t h e y s h o u ld b e c o m e m e m b e r s . W h y
s h o u ld N e w J e r s e y b e k e p t o u t o f o u r m e e tin g s ?
W h y s h o u ld w e
m a k e it m o r e d iffic u lt f o r N e w J e r s e y b y e x c l u d i n g h e r f r o m o u r
m e e tin g ?
W h y s h o u ld w e e x c lu d e W y o m i n g ?
I t h i n k t h e r e is n o
e a r t h ly r e a s o n w h y M is s A n d e r s o n s h o u ld n o t b e c o m e p r e s id e n t o f th e
a s s o c i a t i o n . I d o n ’t k n o w a n y r e a s o n . M r . M i t c h e l l c a n , j u s t a s s o o n
a s T e n n e s s e e e n a c t s a c o m p e n s a t i o n l a w a n d n o s o o n e r . I d o n ’t s e e
w h y I l l in o i s s h o u ld n o t b e r e p r e s e n te d b y a d ir e c t o r o f la b o r . I t h in k
t h a t a n y b o d y w h o h a s t o d o w it h th e a d m in is t r a t io n o f a c c id e n t -p r e v e n t io n w o r k , f a c t o r y in s p e c t io n , o r w it h th e s u r g ic a l f u n c t io n o f
r e h a b ilita tio n o f m e n , p u t t in g th e m b a c k in to in d u s tr y , o r d o lin g o u t
c o m p e n s a t io n — I see n o r e a s o n w h y a n y b o d y in th e S ta te s a n d P r o v
in c e s e n g a g e d in s u ch w o r k s h o u ld b e d e p r iv e d o f f u l l a c t iv e m e m b e r
s h i p i n t h i s a s s o c i a t i o n a n d b e i n e l i g i b l e t o a n y o ff ic e o f t h i s a s s o c i a t i o n .
[ A f t e r f u l l d is c u s s io n th e c o n s t it u t io n o f th e a s s o c ia tio n w a s
a d o p t e d i n t h e f o l l o w i n g f o r m :]
CONSTITUTION OF THE INTERNATIONAL ASSOCIATION OF INDUS
TRIAL ACCIDENT BOARDS AND COMMISSIONS.
A rticle I.— This organization shall be known as the International Associa
tion of Industrial Accident Boards and Commissions.
A rticle II.— Objects.
S ection 1. This association shall hold meetings once a year or oftener for the
purpose of bringing together the officials charged with the duty of administering
the workmen’s compensation laws of the United States and Canada to consider
and, so far as possible, to agree on standardizing (a) ways of cutting down
accidents; ( b ) medical, surgical, and hospital treatment for injured workers;
(c) means for the reeducation of injured workmen and their restoration to
industry; ( d) methods of computing industrial accident and illness insurance
costs; ( e ) practices in administering compensation laws; ( /) extensions and
improvements in workmen’s compensation legislation; and ( g ) reports and
tabulations of industrial accidents and illnesses.
S ec . 2. The members of this association shall promptly inform the United
States Commissioner of Labor Statistics and the secretary of the Department
of Labor of Canada of any amendments to their compensation laws, changes in
membership of their administrative bodies, and all matters having to do with
industrial safety, industrial disabilities, and compensation, so that these changes
and occurrences may be noted in the Monthly Review of the United States
Bureau of Labor Statistics and the Canadian Labor Gazette.
C O N ST IT U T IO N OF T H E ASSO CIATION.
97
A rticle I I I . — Membership.
S ection 1. Membership shall be of two grades, active and associate.
S ec . 2. Active membership.— Each State of the United States and each Prov
ince of Canada having a workmen’s compensation law, the United States Em
ployees’ Compensation Commission, United States Bureau of Labor Statistics,
and the Department of Labor of Canada shall be entitled to active member
ship in this association. Only active members shall be entitled to vote through
their duly accredited delegates in attendance on meetings.
S ec . 3. Associate membership.— A n y o rg a n iza tion o r in d iv id u a l a ctiv e ly in ter
ested in a n y ph ase o f w ork m en ’s com pen sa tion o r s o cia l in su rance m a y be
a d m itted to a ssocia te m em bership in th is a s socia tion b y v ote o f th e e x ecu tiv e
com m ittee.
A ssocia te m em bers shall be en titled to a tten d a ll m eetings a nd
p a rticip a te in d iscu ssion s, b u t shall h ave n o v ote either on resolu tion s o r fo r
th e electio n o f officers in th e associa tion .
A rticle IV .— Representation.
S ection 1. E a ch a ctiv e m em ber o f this a ssocia tion shall h av e on e vote.
S ec . 2. E a ch a ctiv e m em ber m ay send as m an y delegates to the ann ual m eet
in g as th ey m ay think fit.
S ec . 3. A n y person in atten d a n ce at con feren ces o f th is a ssocia tion shall be
en title d to the p riv ileges o f the floor, s u b je ct to ea ch ru le as m ay b e adop ted
by th e associa tion .
A rticle V.— Annual clues.
S ection 1. Each active member shall pay annual dues of $50. The United
States Employees’ Compensation Commission, the United States Bureau of
Labor Statistics, and Department of Labor of Canada shall be exempt from the
payment of annual dues.
S ec . 2. Associate members shall pay $10 per annum.
S ec . 3. Annual dues are payable any time after July 1, which date shall be
the beginning of the fiscal year of the association; dues must be paid before
the annual meeting in order to entitle members to representation and the right
to vote in the meeting.
A rticle V I.— Meetings of the association.
S ection 1. An annual meeting shall be held at a time to be designated by the
association or by the executive committee. Special meetings may be called by
the executive committee. Notices for special meetings must be sent out at least
one month in advance of the date of said meetings.
S ec . 2. At all meetings of the association the majority vote cast by the active
members present and voting shall govern, except as provided in Article V I I I .
A rticle V I I .—
Officers.
S ection 1. Only officials having to do with the administration of a workmen’s
compensation law or bureau of labor may hold an office in this association,
except as hereinafter provided.
S ec . 2. The association shall have a president, vice president, and secretarytreasurer.
S ec . 3. The president, vice president, and secretary-treasurer shall be elected
at the annual meeting of the association and shall assume office at the last
session of the annual meeting.
78532°— B u ll. 248— 19------- 7
98
B U SIN E SS M E E T IN G OF T H E ASSOCIATIO N.
Sec. 4. There shall be an executive committee of the association, which
shall consist of the president, vice president, the retiring president, secretarytreasurer, and two other members, elected by the association at the annual
meeting.
S ec . 5. The duties of the executive committee shall be to formulate programs
for all annual and other meetings and to make all needed arrangements for
such meetings; to pass upon applications for associate membership; to fill all
offices which may become vacant; and in general to conduct the affairs of the
association during the intervals between meetings.
S ec . 6. The president, the secretary-treasurer, and one other member of the
executive committee shall constitute a quorum of that committee.
S ec . 7. If. for any reason, an officer of this association shall cease to be con
nected with any agency entitled to active membership, before the expiration of
his term, he may continue in office notwithstanding until the next annual meet
ing; but if the president should resign the executive committee shall appoint
his successor, may reconsider the decision of the last annual conference as
to the next place of meeting, and may change the place of meeting if it is
deemed expedient.
A rticle
VIII.— Amendment.
This constitution or any clause thereof may be repealed or amended at any
regularly called meeting of the association. Notice of any such changes must be
read in open meeting on the first day of the conference, and all change of which
notice shall have thus been given shall be referred to a special committee, which
shall report thereon at the last business meeting of the conference. No change
in the constitution shall be made except by a two-thirds vote of the members
present and voting.
REPORT OF THE COMMITTEE ON STATISTICS AND COMPENSATION
INSURANCE COST.
At the last convention of this association your committee reported the com
pletion of standard classifications of industries, of accident causes, and of in
dustrial injuries by location and nature of injury and extent of disability. The
committee recommendations on these heads were officially adopted by the as
sociation and have been put into practical effect by several States. It is hoped
that the foundations have thereby been laid for uniform and intelligible sta
tistics of work: accidents.
During the past year your committee has held four meetings, comprising in
all some twelve sessions.1 The standard tables for the presentation of accident
1 These four meetings were held as follows :
Chicago, 111., May 31 and June 1, 1916. Those present at this meeting were E. H.
Downey, chairman; W. H. Burhop, F. C. Croxton, L. W. Hatch, Don L. Lescohier, C. H.
Y e rrill; and, by invitation, G. F. Michelbacher, of the National Workmen’s Compensation
Service Bureau.
Buffalo, N. Y., July 19, 1916. Those present were E. H. Downey, chairman ; W. H.
Burhop, F. C. Croxton, T. N. Dean, L. W. Hatch, Royal Meeker; and, by invitation, G. F.
Michelbacher, o f the National Workmen’s Compensation Service Bureau.
New York City, Nov. 3 and 4, 1916. Those present were E. H. Downey, chairman;
P. A. Broderick, T. N. Dean, L. W. Hatch, Royal Meeker, C. H. Y errill; and, by invita
tion, Louis I. Dublin, of the Metropolitan Life Insurance Co. ; Arne Fisher, of the Pru
dential Insurance C o.; and G. F. Michelbacher, of the National Workmen’s Compensation
Service Bureau.
Boston, Mass., April 18 and 19, 1917. Those present were E. H. Downey, chairman;
P. A. Broderick, W. H. Burhop, T. N. Dean, L. W. Hatch, Royal Meeker, C. H. Verrtll,
and E. E. Watson.
BEPORT OF T H E C O M M IT T E E ON ST A TIST IC S.
99
statistics, begun in February, 1916, were first taken up and completed. The
standard list of statistical definitions was next revised and extended. Lastly,
the committee has worked out a standard scale of weights designed to express
j;he severity of accidental injuries in terms of time loss.
The standard tables proposed by the committee are appended to this report,
and are designated by serial numbers and titles. These tables are intended
to bring out in convenient form and in due correlation the significant facts
of work accidents. Next to the use of standard classifications, nothing will
contribute so much to the value of statistical reports as uniform and effective
organization of material. Conversely, the lack of any standard organization
has detracted greatly from the usefulness of most statistical reports heretofore
published by the several States. In many cases essential information which was
available in the files of the board or commission is not disclosed by the pub
lished reports, because the statistician did not perceive the significance of the
facts in his possession. In other cases again it is necessary to wade through
hundreds of pages to obtain facts which can and should be so clearly set forth
that he who runs may read. A moderate number of standard tables, thor
oughly worked out, will present more information in far more accessible form
than is ordinarily contained in ten times the bulk of printed matter.
The standard tables proposed by your committee are so designed as to admit
of adaptation to the administrative needs and financial resources of different
jurisdictions. Thus, Table 1 substantially in the form proposed, should be
published by all jurisdictions. This lable will give the essential facts of
industrial accidents by industries. The exposures for this table are calcu
lated both in terms of pay roll and of number of full-time workers. It is
expected that the industries will be shown in such detail as the volume of
exposure and the financial resources of the particular commission will admit.
Table 2 is possible only for those jurisdictions in which injuries and dis
eases not attributable to accident are reported.
Table 3 is a combination of Tables 1 and 2. In most jurisdictions Table 1
will answer all purposes of Tables 1, 2, and 8. In those jurisdictions which
take account of injuries other than by accident, Table 3 will answer all pur
poses of Tables 1 and 2, provided that a separate list of injuries not due to
accident is published.
Table 4 exhibits the number and severity of injuries by causes. This is in
many respects the most important table of the entire list. It is particularly
desirable that in publishing this table the standard classification of accident
causes be adhered to.
Table 5 shows the compensation cost of injuries by severity of injury.
The table as drawn provides for the separation of benefits, but it is not par
ticularly essential to carry this separation further than a distinction between
compensation and medical aid. In other words, a table in which columns
5, 6, 7, and 8 were consolidated in one would answer all practical purposes.
Table 6 will be needed only in those jurisdictions which compensate for occu
pational diseases.
Tables 7 and 8 are alternative. It is recommended that where the infor
mation is available the degree of impairment of each specified member shall be
shown, but in those jurisdictions in which compensation is based upon loss of
earnings rather than impairment of the particular member Table 8 may be
given in lieu of Table 7.
Table 9 is intended to show the importance of infection as a cause of dis
ability and death. It seems especially desirable that this table should be
made in order to emphasize the possibilities $f reducing the duration of dis
abilities by efficient first aid and medical treatment
100
B U SIN E SS M E E T IN G OF T H E ASSO CIATION.
Table 10 is intended to show the character of injuries due to each particular
cause. It is especially desired to bring out the causes which are responsible for
the greater number of dislocations and fractures. Table 10, however, is less
important by far than table 4.
Table 11 is intended to show the character of injuries which result in death
and in permanent disability. It is particularly intended for the benefit of the
medical profession. Obviously medical attention ought to be centered upon
those injuries which are producing the greater number of serious disabilities.
Your committee has likewise devoted much time to the consideration of acci
dent severity, with a view to obtaining a standard measure of industrial haz
ard. Hitherto every attempt to compare the hazards of different industries,
or of the same industries at different times and places, has broken down
from sheer lack of any adequate basis of comparison. The mere number of
industrial accidents per thousand employees per annum—the ordinary defini
tion of accident rate—is not a measure of hazard, because it takes no account
o f accident severity. Heretofore, indeed, the acccident rates of different juris
dictions have been wholly incommensurate because of the immense disparity
in the definition of reportable accidents. The accident rates of the German Em
pire, e. g., are based only on the comparatively small number of accidents which
cause disability for more than 13 weeks, those of France are derived from
T
accidents which cause disability for more than four days, while Massachusetts
includes every accident reported, however trivial in character. Obviously, a
tenfold difference in accident rates, as between Massachusetts and Germany,
would indicate nothing as to relative hazard. This particular difficulty may,
of course, be overcome by general adoption of the standard definition of
“ tabulatable accident ” which your committee has already recommended.
But a more fundamental obstacle lies just behind. The immense majority of
tabulatable accidents cause only a few days’ disability, with no permanent
impairment of earning capacity. A single death w produce greater economic
’ill
loss to the victim’s family and to the community at large than many hundred
minor temporary disabilities. This difference would matter little for the pur
pose in hand if the number of deaths and of permanent injuries bore any
reasonably uniform relation to the number of tabulatable injuries. Unfor
tunately, however, the very reverse is the case. In some of the lighter ma
chine trades there may be a thousand tabulatable acccidents for one fatality,
whereas among coal miners, railway trainmen, lumbermen, and structural-iron
workers the proportion of fatal and serious injuries is many fold greater
than in industry as a whole. Accident rates, therefore, as ordinarily compiled
are worse than inaccurate; they are positively misleading.
Various attempts have been made to overcome this defect by publishing, not
one but several, accident rates for each industry. Thus German and Austrian
statistics show the whole number of accidents, the number of deaths, and the
number of permanent injuries per thousand full-time workmen. But perma
nent injuries again cover a wide range—from the loss of the tip of a little
finger to total paralysis of the body. And the several degrees of permanent
disability are most unevenly distributed among industrial employments. In
woodworking industries, for example, finger injuries predominate; in logging and
in coal mining there is an excessive number of permanent total disabilities. To
be at all significant the analysis of accident rates must be carried further. We
must know not merely the number of all permanent injuries, but the number
causing total incapacity and the number involving loss of hand, foot, eye, or
fingers. The moment such an analysis is made, however, the resultant accident
rates become too multiform far practical use. No mind can compare six
columns of figures at one time, Neither are the separate comparisons capable
REPORT OF T H E C O M M IT TE E ON STATISTICS.
101
of any intelligent summation. If the several rates happen to vary in the same
direction the meaning is sufficiently clear, but how if a decrease in fatalities
is accompanied by a marked increase in permanent and temporary disabilities?
What is wanted evidently is some common denominator in terms of which can
“ expressed the total volume of accidental injury per unit of exposure—a
be
single expression which shall combine the number with the severity of work
accidents.
In seeking for such a common denominator your committee early fixed upon
time loss as the most significant, stable, and convenient expression of the
economic cost of industrial accidents.1 Obviously, it is only the loss of time
due to accidents that is susceptible of satisfactory measurement. The physical
or physiological results can not be reduced to a common denominator and the
cost in terms of human suffering can neither be estimated nor expressed in
standard units. Obviously, again, the economic cost of accidents can not be
measured by the compensation paid. No one of our American acts even pur
ports to give full compensation for the worker’s immediate economic loss, and
no two of them agree in the scale of benefits assigned to particular injuries.
Compensation cost in industries of equal hazard accordingly fluctuates enor
mously from State to State and the aggregate cost in every jurisdiction
grossly understates the relative importance of permanent disabilities. Wage
loss likewise, even if it could be accurately obtained, is not a satisfactory
index of occupational hazard. Wages vary tremendously from occupation to
occupation and from time to time, insomuch that no constant relation can be
predicated between extent of disability on the one hand and wage loss upon
the other hand. The same wage loss per thousand employees per annum will
consequently not indicate the same hazard in different occupations or in dif
ferent communities. The computation of wage loss, moreover, presents nu
merous difficulties, more especially in the case of fatal and permanent injuries.
Shall it be assumed that the particular wage rates prevailing at the time of in
jury will continue throughout the working life of the injured? Shall the pros
p e ctiv e earn in gs o f an a p p ren tice be com pu ted fr o m his p resen t ea rn in gs or
from the wage which he would probably earn as a journeyman? Shall the
foregone earnings of 20 years be taken at face value or discounted for interest?
Time loss, on the contrary, is relatively definite and stable. It relates directly
1A system of assigning time losses for a computation of accident severity rates was
worked out by the U. S. Bureau of Labor Statistics in the early part of 1914,
and was applied in the preparation of a group of charts exhibited by the bureau at the
Panama-Pacific International Exposition. As first used, the time allowances, as fixed
by the Wisconsin workmen’s compensation act for specific injuries, were employed. Later,
these time allowances were changed, death being based on life expectancy and permanent
disabilities on the New York scale increased 50 per cent. This scale has since been
used by the bureau in two reports— one presenting the results o f a study o f
accidents and accident prevention in the machine-building industry, and the other, a
similar study, covering the iron and steel industry. The method employed has been
explained by the bureau in an article entitled “ A new method of computing accident
rates,” in the July, 1916, issue of the Monthly Review.
The computation of an accident severity rate by the use of time losses has occurred
to a number of other persons, independently. At the Third Annual Safety Congress of
the National Safety Council, held in Chicago, Oct. 13-15, 1914 (Proceedings, pp. 133,
134), Mr. Dudley R. Kennedy, of the Youngstown Sheet & Tube Co., made sugges
tions in regard to severity rates along the same line, and early in 1915 submitted to the
National Safety Council a plan somewhat similar to that adopted by the committee.
A scale of severity weighting was worked out by the Wisconsin Industrial Commission
in the latter part of 1914, and was applied to the accident statistics of that State in a
bulletin issued Aug. 1, 1915. So far as can be ascertained, the above are the only pub
lished tabulations or suggestions for the compilation of accident statistics classified on
the basis of time losses.
102
B U SIN E SS M E E T IN G OF T H E A S S O C IA T IO N
to the physiological results of accidental injury and is, by comparison with com
pensation cost or with wage loss, but little affected by the occupation of the
injured, the prevailing rate of wages, the scale of legal benefits, or the spirit of
courts and commissions, A month’s disability per employee per annum means
the same degree of occupational hazard, whether it occurs among lumbermen or
locomotive engineers, in the State of Washington or the principality of Wales,
in 1900 or in 1920. If, then, all injuries by accident can be reduced to this one
common denominator, we shall have what has heretofore been wanting—an
inde^ of industrial accident hazard.
In the attempt to express accident severity in terms of time loss temporary
disabilities present few problems. The duration of disability in these cases is
shown on the face of the record. The only conversion required by the proposed
plan is that from calendar to working days. Your committee having previously
recommended, on grounds set forth in an earlier report, that exposures be ex
pressed in man-years of 300 days each, it follows that the duration of disabili
ties should likewise be expressed in working days. It is therefore recommended
that the number of working days chargeable to temporary disabilities be uni
formly obtained by deducting one-seventh from the number of calendar days
intervening between the beginning of disability and the recovery therefrom.
Your committiee is not unmindful of the fact that the seven-day week prevails
in certain occupations and the five-and-a-half-day week in others. But it must
be remembered that time loss is here used as a measure of accident severity.
A disability of one calendar week represents the same severity of injury what
ever the length of the working day or the working week.
T
More complicated questions arise in the consideration of fatal accidents. The
governing principle, indeed, is easy of determination. Death entails a total
cessation of labor power and the resultant time loss is evidently the working
life expectancy of the individual concerned. It is in the detailed application
of this principle that difficulties are encountered. To the discredit of our gov
ernments be it said that no American records exist to show the average age at
w'hich industrial workers cease to be employable, or the number of productive
years which a wage earner of given age may reasonably anticipate. In the
absence of such records, your committee was forced to rely upon personal judg
ment, checked and guided by several special investigations.1 Working life
expectancy is a function of mortality and superannuation; it is less than life
expectancy by the interval between voluntary or enforced retirement from
gainful employment and death. It is well known, however, that the life expec
tancy of our industrial population is markedly below that experienced by life
insurance companies, while the evidence of accident statistics, as well as com
mon knowledge, goes to show that relatively few wageworkers maintain a foot
ing in industry beyond the age of 55. On the whole, it seems reasonable to
assume that working life expectancy, between ages 20 and 50, is about twothirds of the full life expectancy shown by the American Experience Table.
The compensation experience of a number of States indicates that the average
age of persons fatally injured by industrial accidents is approximately 33 years.
Your committee, accordingly, adopted 20 years, or 6,000 working days, as the
average severity weight of fatal accidents.
The question whether each fatal accident should receive a weight propor
tionate to the calculated working life expectancy of the individual involved was
1 Mr. G. F. Michelbacher constructed a very ingenious table of working life expectancies
from the ages of persons reported as injured by industrial accidents in California and
Ohio. His results, while admittedly not conclusive because of inadequate data, were of
special value to the committee. Collateral evidence, tending to support the committee’s
conclusions, will be found in the Invalidity Insurance Experience of the German Empire
and in the investigations of the British Parliamentary Committees on Old Age Pensions.
EEPORT OF T H E C O M M IT T E E OIff ST A TIST IC S.
103
considered at length. It is not doubted that significant differences exist in
the average ages of workmen in different industries, in different occupations
within the same industry, and in different communities within the same occu
pational lines. Nor is it disputable that more labor power is lost by the death
of a man at 2 0 than at 5 0 . But the age of the individual killed is, after all,
not particularly indicative as to the character of the hazard which produced
the injury. The proposed plan, moreover, is to be applied to industries by
States, and the number of fatalities in most industry-State subdivisions will be
small. Hence, if the severity weight were to vary with the age of the injured—
T
if a death at 2 0 , e. g., were to count for 1 0 ,0 0 0 days and a death at 5 0 for only
3 ,0 0 0 —the resultant severity rates would be distorted by merely chance devia
tions. Your committee, therefore, recommends that a uniform time-loss value
o f 6,000 days be assigned to each fatal accident.
The severity weight of permanent total disability was settled upon the prin
ciples just discussed. Permanent total disability, equally with death, entails
a time loss equivalent to the full working life expectancy of the person injured.
For the reasons above recounted, it was deemed best to use an average expec
tancy rather than the actual (calculated) expectancy of each individual.
Finally, it was resolved to recommend the same weight as for a death. Against
this course may be urged that a permanent total disability entails a greater
economic burden upon the sufferer's family and upon the community than a
death. WSre the question solely one of economic loss, permanent total disability
might reasonably be valued at the full working life expectancy and a death at,
say, two-thirds thereof. But the question is one of industrial hazard and not
merely one of economic loss. Surely it can not reasonably be said that an acci
dent which results in permanent total disability indicates a greater hazard
than an accident which results in death. No injury can be more severe—and
we are speaking of an accident severity—than a fatal injury. It so happens,
furthermore, that the average age of those who are permanently totally disabled
l5y accident is higher than that of persons who die from accidental injuries—
about 42 as against 33 years.1 The fact is that the natural powers of recupera
tion fail with advancing years, so that a given injury is more likely to cause
serious permanent disability in an older than in a younger man. The use of
actual working life expectancies would, on this account, give lower average
weights for permanent total disabilities than for deaths. Lastly, it is by no
means always true that a permanent total disability involves a net economic
burden. A man may be incapacitated for employment and still contribute
something to the family income. Taken all in all, therefore, your committee
recommends that permanent total disabilities, like deaths, be valued uniformly
at 6,000 working days each.
Permanent partial disabilities clearly ought to be rated in percentages of per
manent total disability. Precisely here, however, is the nub of all severity
rating, namely, the determination of the degree of permanent disability. It
might well be supposed by one not familiar with the situation that the precise
extent of disability, being a material fact in the fixation of compensation, would
invariably appear on the face of the records. Such, however, is nowhere the
case. In most American jurisdictions permanent disabilities are graded by a
legislative schedule which assigns so many weeks’ compensation to each enumer
ated physical injury. Even in those jurisdictions, *as California, Washington,
and Ontario, where no such schedule is established by law, the administrative
practice is not widely different. Almost everywhere compensation is determined
1 This difference is found in both American and European experience.
104
B U SIN E SS M E E T IN G OF T H E ASSOCIATIO N .
not by the actual impairment of earnings but by the loss or disability of specified
bodily members.1
Such being the run of facts in the record, the statistician is constrained to
follow the same course in the severity rating of permanent disabilities. He has
no choice but to rely upon the actual bodily impairments which the records dis
close as indicia of the extent of disability. Why not, then, rate these disabili
ties in accordance with the specific indemnity schedule, statutory or adminis
trative, of each particular jurisdiction? Because the numerous American sched
ules differ widely among themselves in both the absolute and the relative rating
of the same injuries; because certain jurisdictions have no official schedule,
and the official schedules of other jurisdictions omit many permanent injuries
of common occurrence; because, finally, no one of these schedules (unless it be
Ontario’s) attempts to give an adequate rating to permanent as compared with
temporary disabilities. The use of any one of these schedules would under
state the relative hazard of extrahazardous industries, while the use of all of
them together would produce severity rates as little capable of combination or
comparison as the official accident rates of Massachusetts and the German
Empire.
Your committee, in the course of itsi investigations, carefully compared all of
the American specific indemnity schedules as well as the French and German
adjudications, the Austrian official ratings, the scale of the Italian law, the
Russian scale, and the European scales of Imbert, Miller, Biihr, Thiem, and
Konen-Koln.2 It was found that none of the existing schedules is derived from
a statistical study of loss of earnings as the result of injury. The best of the
American schedules are based upon local investigations of limited scope or are
borrowed from European scales, which in turn represent averages of awards
in various countries more or less modified by medical or otherwise expert judg
ment.3 Your committee, after mature deliberation, was unable to recommend
any one of these scales in its entirety. It is the unanimous judgment of the
committee that the American schedules, without exception, underrate the mo*e
serious permanent injuries, such as loss of hand, leg, or eye, and that the
European scales overrate such minor injuries as the loss of fingers and toes.
These considerations appeared to warrant the construction of the composite
scale appended to this report.
The schedule recommended is less detailed than several of the extant lists,
but is believed to be sufficient for its purpose. In adjudging compensation it
is customary and proper to distinguish between the loss of an index and a
ring finger and between the loss of one phalanx and an entire digit. But these
refinements are quite unimportant for the calculation of accident severity rates
by industries or occupations. Permanent injuries to the fingers are very
numerous and they occur in an endless variety of combinations. In any con
siderable exposure, however, it will be found that the relative frequency of the
many specific finger injuries do not greatly vary, so that an average value for
all will give nearly the same aggregate time loss as a specific value for each.4
1 Massachusetts is a partial exception, as are also Pennsylvania and other States, as
respects nonenumerated injuries. Such exceptions, however, are rather de jure thar
de facto.
2 For a comparison of these scales, see Bulletin 203 of the United States Bureau of
Labor Statistics, p. 94 et seq%
3 See article entitled “ Determination of the consequences of industrial accidents in
Austria,” in Monthly Review of the United States Bureau of Labor Statistics, December,
1916, p. 731 et seq.
4 The average values recommended for permanent injuries to fingers, thumbs, and toes
were calculated from the very detailed statistics of the Industrial Commission of Wis
consin.
REPORT OF T H E C O M M IT TE E ON STATISTICS.
105
It will be observed that the scale recommended takes no account of occupa
tional differences. Your committee recognizes, of course, that the same physical
injury causes more serious disability for some occupations than for others, but
these differences are believed not to be significant from the standpoint of
accident severity or of industrial hazard. The committee scale is not intended
to serve as a basis for awarding compensation but as a standard for comparing
the severity of accidental injuries and the accident hazards of industrial
employments. The loss of a leg indicates an accident of the same severity
whether it befall a stevedore or an elevator operator, and the annual loss of
10 index fingers per thousand full-time workers points to the same degree of
hazard in one industry as another. In fine your committee concludes that the
severity of accidental injuries must be adjudged from their physiological effects
and that the average time loss produced by each physiological class of injuries
is the fairest common measure both of accident severity and of industrial
hazards.
To sum up, your committee recommends that a severity weight be assigned
to each industrial accident. In the case of a temporary disability this weight
is the actual duration of disablement in working days. For a death or a per
manent total disability the severity weight is the working life expectancy,
which is taken at the average value of 6,000 working-days. For a permanent
partial disability the weight is an aliquot part of 6,000 working-days, propor
tionate to the average degree of disability resulting from the particular bodily
impairment involved. The aggregate time loss so obtained, divided by the
number of 300-day workmen, is the accident severity rate, or time loss per
full-time workman. The time loss so obtained is a common denominator by
means of which the number and severity of accidents per unit of exposure are
combined in a single expression.
The severity rate aboye described would serve all the purposes of an index
number of occupational hazards. It would afford, for the first time, a common
basis for the comparison of accident experience from year to year, from in
dustry to industry, from establishment to establishment, and from State to
State.
It should prove a powerful stimulus to safety first by providing a con
crete test of results. Applied to compensation insurance, it would furnish,
what has hitherto been lacking, a statistical basis for both schedule and ex
perience rating.
No one will claim perfection for the scheme here proposed. Intelligent
opinions will differ on many of the points involved. The relative severity of
accidental injuries must always be a matter for experienced judgment rather
than mathematical calculation. For that very reason, however, the collective
judgment of competent statisticians is a safer guide than the opinion of the
best informed individual. Above all, the problem is one in which uniformity
is more important than meticulous accuracy. If the schedule of relative
weights is reasonable upon the whole, and is uniformly applied, the results
will be sufficiently accurate for all practical purposes.
Your committee has now completed the preliminary work of standardization
for which the committee was originally created. But accident statistics is
emphatically a living subject, and the whole field of compensation is so new
that two years’ time has brought forth many changes. Experience in the
several States already has developed the need of revision and extension in the
standard classifications heretofore adopted. Continuous development besides
will require continued interchange of views and experience. It is therefore
recommended that the committee on statistics and compensation insurance
cost be continued, with such changes in personnel as may be thought expedient.
106
B U SIN E SS M E E T IN G OF T H E ASSO CIATION .
APPENDIX A .---- STANDARD DEFIN ITIO NS ADOPTED B Y T H E COMMITTEE.
1. Tabulatable accidents, diseases, and injuries.—All accidents, diseases, and
injuries arising out of the employment and resulting in death, permanent dis
ability or in the loss of time other than the remainder of the day, shift, or turn
on which the injury was incurred should be classified as “ tabulatable accidents,
diseases, and injuries,” and a report of all such accidents, diseases and in
juries to some State or national authority should be required.
2. In publishing the statistics of accidents, diseases, and injuries, clear defi
nitions of the terms used in the tables should be given either in the tables,
in prefatory notes thereto, or in readily accessible text.
3. Reportable accidents, diseases, and injuries should include all tabulatable
accidents, diseases, and injuries, and all nontabulatable accidents, diseases, and
injuries which require any medical expenditure.
4. Compensable accidents, diseases, and injuries as used in any report in ac
cordance with the practice in the particular State, should be shown separately
and clearly defined.
5. Medical service.—Information in regard to medical service expenditures
should be given as fully as possible. If the statistics given cover only a part
of the cases dealt with under the law that fact should be made clear.
6. Permanent total disability.—To this group should be assigned every acci*
dent, disease, or injury which is designated by statute as permanent total dis
ability, or which permanently incapacitates the workman from performing any
work continuously in any gainful occupation.
7. Permanent partial disability.—To this group should be assigned every acci
dent, disease, or injury (less than permanent total disability) which results
in the loss of any member of the body or part thereof, or in the permanent
Impairment of any function of the body.
8. Accident frequency rates per 1,000 full-time workers.—Accident-frequency
rates should be expressed in terms of the number of accidents per 1,000 full-time
workers, i. e., workers employed 300 days of 10 hours each.1 The basis used
for the average number of men should be the actual number of man-hours for
the year; that is, the total working time for all employees of the establish
ment or the department for the year reduced to the number of hours required
for one man to do the same work. This should be taken from exact records
if such records are in existence. If this exact information is not available in
this form in the records, then an approximation should be computed by taking
the number of men at work (or enrolled) on a certain day of each month in the
year, and the average of these numbers multiplied by the number of hours
worked by the establishment for the year would be the number of man-hours
measuring the exposure to risk for the year.
9. Accident rates per $100,000 of audited pay-roll exposure.—Accident rates
should also be computed on the basis of $100,000 of pay roll. This information
should be published for all State Funds and for the entire jurisdiction where
practicable.
1 This is in accordance with the practice of Germany, Austria, and a number of other
European countries, and also in accordance with the recommendations o f a joint com
mittee of the Permanent International Committee on Social Insurance and the Inter
national Institute of Statistics. This method was used in Germany as early as 1 8 9 7 .
See Germany: Amtliche Nachrichten des Reichsversicherungsamts, 1 8 9 9 . Beiheft. I.
Teil, TJmfallstatistik fur das Jahr., 1 8 9 7 . Berlin, 1 8 9 9 , pp. 5 ff. See also Bulletin de
Tlnstitut International de Statistique, Vol. XV, pp. 54, 55. London, 1 9 0 6 . Idem, Vol.
X V III, Part II, p. 4 6 1 et seq. Paris, 1 9 0 9 .
107
REPORtf OF T H E C O M M IT T E E O N ST A TIST IC S.
10. Accident severity rates.—Accident severity should be expressed in terms
of days lost, computed in accordance with the table and explanations appended
hereto (Appendix C).
Severity rates should be expressed in terms of days lost per 300-day worker.
11. In computing the duration of temporary disabilities, the day of the acci*
dent should be counted as the first day.
APPENDIX B.---- STANDARD TABLES SUGGESTED B Y T H E COMMITTEE.
Table
1 .— F r e q u e n c y
of
A c c id e n t s , b y
D is a b il it y .
I n d u s t r ie s a n d
E x t e n t of
Number of tabulatable accidents.
Industries.*
1
Num
ber of
full
time
work
ers.
2
a For list
Pay
roll
expo
sure. Total. Deaths.
3
4
5
Per
manent
total
dis
abili
ties.
6
Rates.
Per Temporary disabili
ties.
manent
par
tial
Over
dis Over 2 1 to 2 Iweek
abili weeks. weeks. and
under.
ties.
7
8
9
Per
Per
1,000 $100,000
full of au
time dited
work
sr.
ers.
10
11
12
of industries see Bulletin 201 of the IT. S. Bureau of Labor Statistics.
N o t e .— T his tab le sh ou ld n ot include cases of n on accid en tal injuries a n d oc cu p ation al diseases, w hich
are to be in clu d ed in T a b le 2.
T able
2 .— F r e q u e n c y o f I n j u r i e s , b y I n d u s t r i e s a n d
D is a b il it y .
E x t e n t of
[This table should include all cases of injuries and occupational diseases not definitely assignable
to accidents.]
Number of tabulatable injuries.
Industries.a
1
Num
ber of
full
time
work
ers.
2
Pay
roll
expo
sure. Total. Deaths.
3
4
5
Per
manent
total
dis
abili
ties.
6
Rates.
Per Temporary disabili
ties.
manent
par
tial
Iweek
dis Over 2!
and
abili weeks* weeks. under.
ties.
7
8
| 9
Per
Per
1,000 $100,000
full of au
time dited
work Pay
ers.
roll.
10
11
1
1
a For list
of industries see Bulletin 201 of the U. S. Bureau of Labor Statistics.
12
B U SIN E SS M E E T IN G OF T H E ASSOCIATIO N.
108
T able 3.— Severity
op
I njuries , by I ndustries
D isability .
and
E xten t
Days lost due to—&
Industries.«
1
Num
ber
of
full
time
work
ers.
2
Pay
roll
ex
po Total
sure. days Deaths.
lost.
3
4
5
Permament
total
dis
abili
ties.
6
Rates.
Temporary
Per
disabilities.
ma
nent
par
tial Over Over
1
dis
1 to 2 week
2
abili weeks. weeks. and
ties.
under.
7
8
of
9
10
Days Days
lost lost per
per
1,000 $100,000
full of aud
time ited
ork- S .
ers.
11
12
a For list of industries see Bulletin 201 of the U. S. Bureau of Labor Statistics.
b Days lost should be expressed in terms of working-days. Calendar days can be converted into
working-days by multiplying by 6/7.
T a b l e 4.— C a u s e s of A c c id e n t s , b y E x t e n t of D i s a b il it y .
Causes.
1
2
3
4
5
6
7
8
Total.
9
Temporary disabilities.
Perma Perma
nent
nent
Deaths. total
partial
Over
1 week
disabil disabil Over
1 to 2
and
ities. j ities, 2 weeks. weeks.
under.
10
II
12
13
a Days lost should be expressed in terms of working-days. Calendar days can be converted into working -days by multiplying by 6/7.
N o t e .— This table should be
made for each industry schedule also and for all important groups.
Further analysis of causes of fatalities and permanent injuries is suggested. Analysis by location of injury is also suggested.
109
O STATISTICS.
N
[For full list of causes see Bulletin
201 of the U. S. Bureau of Labor
Statistics.]
15
COMMITTEE
Machinery:
Prime movers
Steam engines
Gas or gasoline engines
Etc.
14
O TE
F H
Total.
Temporary disabilities.
Perma Perma
nent
nent
partial
Deaths. total
Over
1 week
disabil disabil Over
1 to 2
and
ities.
ities. 2 weeks. weeks. under.
EEPOKT
Days lost due to—a
Number of tabulatable accidents.
110
B U S IN E S S M E E T IN G O F T H E
A S S O C IA T IO N .
T a b l e 5.— C o m p en sa t io n a n d M edical A id I n c u r b e d
A ccid e n ts , b y E x t e n t op D is a b il it y .
on
A ccount
of
Benefits paid and outstanding.
Compensation.
Injuries causing—
1
Deaths, with dependents
Deaths, without dependents
Permanent total disabilities:
Loss of both eyes
Loss of both arms
Loss of both hands
Loss of both legs
Loss of both feet
Paralysis of both arms or legs
Loss of mental faculties
Other permanent total disability
Totalpermanent total disabilities
Permanent partial'disabilities:
Dismemberments
Loss of arm
Loss of hand
Loss of thumb
Loss of index finger
Loss of middle finger
Loss of ring finger
Loss of little finger
Loss of thumb and 1 or more fingers
Loss of 2 or more fingers
Loss of 1 phalanx of thumb
Loss of phalanx of index finger
Loss of phalanx of middle finger
Loss of phalanx of ring finger
Loss of phalanx of little finger
Loss o f fingers with injuries to
other fingers
Loss of 1 leg
Loss of toes
Loss of 1 eye
Loss of 1 eye with injury to the
other
Other permanent partial disabilities
Total permanent partial disa
bilities
Temporary disabilities: &
1 day
2 days
3 days, etc., up to 14 days
Over 2 to 3 weeks
Over 3 to 4 weeks
Over 4 to 5 weeks
Over 5 to 6 weeks
Over 6 to 7 weeks
Over 7 to 8 weeks
Over 8 to 9 weeks
Over 9 to 10 weeks
Over 10 to 11 weeks
Over 11 to 12 weeks
Over 12 to 13 weeks
Over 13 to 26 weeks
Over 26 to 39 weeks
Over 39 to 52 weeks
Over 52 weeks
Total temporary disabilities
Grand total
Per Per Tem
Num
Aver
ma ma
ber
Death nent nent po Med
age
Total amount and
of
rary
total par disa ical.
cases. amount. per
fu
tial
case. neral.® disa disa bili
bili bili
ties. ties. ties.
2
3
4
5
6
7
8
9
[Nc)TE.— Th e action; of the commtittee iin reg{ird to
t:
Table3 5 p r o v i ded for the use o:f a “ S andardLlist ” of per
mane>nt Total disabHHties based on t he “ S tandar<il acci1
similar “ standa rdlist ” of diismemdent t a b le ” a:nd for a s
berments undL permsrnent pa:rtialdiisabilities.
er
*bie7 <
7 eontahis no list of
The “ Standard acc)ident U
permanent total disat>ilities bilit onb7 a list; of di:smemj
berments. T he list Of permantent to tal disiabilitie;s here
n
giveEl is take> from some olt the i
State !
Laws. These
stancLard lists have not yet been prepared.]
a Form of notes to be used whenever applicable, e. g.r including----- cases of funeral benefits amounting
to $-----. Not reported in ----- cases.
6 In this table the duration of temporary disabilities should be expressed in calendar days, as the table
is not intended for weighting purposes.
REPORT OF T H E
C O M M IT T E E
ON
Ill
S T A T IS T IC S .
T able 6.— Compensation and M edical A id I ncurred on A ccount
O ccupational D ise a se s , b y E x t e n t o f D isability .
of
Benefits paid and outstanding.
Compensation.
Occupational diseases causing—
1
Aver
Per Per
Total
ma Tem
age
cases. Total amount Death ma nent po Med
amount. per
and nent par rary ical.
total tial disa
fucase.
neral.o disa disa bili
bili bili
ties. ties. ties.
2 ,
3
4
5
6
7
8
9
Deaths, with; dependents
Deaths, without dependents
Permanent total disabilities
Permanent partial disabilities involv
ing specified percentage of impair
ment:
20 and under
21 to 40
41 to 60
61 to 80
81 and over
Total permanent partial disa
bilities
Temporary disabilities: &
1 day
2 days
3 days, etc., up to 14 days
Over 2 to 3 weeks
Over 3 to 4 weeks
Over 4 to-5 weeks
Over 5 to 6 weeks
Over 6 to 7 weeks
Over 7 to 8 weeks
Over 8 to 9 weeks
Over 9 to 10 weeks
Over 10 to 11 weeks
Over 11 to 12 weeks
Over 12 to 13 weeks
Over 13 to 26 weeks
Over 26 to 39 weeks
Over 39 to 52 weeks
Over 52 weeks
Total temporary disabilities
Grand total
a Form of notes to be used whenever applicable, e. g., including----- cases of funeral benefits amounting
to $-----, not reported in ----- cases.
6 In this table the duration of temporary disabilities should be expressed in calendar days, as the table
is not intended for weighting purposes.
BU SIN E SS M E E T IN G OF T H E ASSOCIATIO N .
112
T able 7.— P erm anent Partial D isabilities ,
P ercentage of I mpairment
by
of
L ocation
M em ber .
of
I njury
and
Number of cases (not dismemberments)
involving specified percentage of im
pairment of member.
Total
cases.
Location of injury, a
1
20 and
under.
21 to
40.
41 to
60.
61 to
80.
3
4
5
Num
ber of
dismem81 and berover. ments.
6
2
7
8
a For classification of location of injury for use in the stub of this table, see Bulletin 201 of the U. S.
Bureau of Labor Statistics.
T able 8.— P erm anent D isabilities , by P ercentage
E arning Capacity .
Location of
injury.*
1
of
I mpairment
41
51
71
31
61
81
21
91
11
10
per per per per per per per per per
per cent cent cent cent cent cent cent cent cent
Total cent and and and and and and and and and
cases. and under under under under under under under under under
un
50
60
70
80
90
100
20
30
40
der. per per per per per per per per per
cent. cent. cent. cent. cent. cent. cent. cent. cent.
2
3
4
5
6
7
8
9
10
11
12
of
Total
disa
bil
ity.
13
aFor classification of location of injury for use in this table, see Bulletin 201 of the U. S. Bureau of Labor
Statistics.
113
REPORT OF T H E C O M M IT TE E ON STATISTICS.
T able 9.— I nfected I njuries , b y N ature of I njury
R esulting D isability .
E xtent
and
of
Cuts,
punc
Burns Con tures, Dis Frac Sprains All
Total. Bruises. and
cus and loca
and
scalds. sions. lac tions. tures. strains. other.
era
tions.
1
3
2
4
5
G
7
8
9
10
Total injuries
Total infected injuries
Infected injuries result
ing in—
Deaths
Total loss of—
Ey8
Arm
Hand
leg
Foot
Fingers
Toes
Other members
Permanent impair
ment of—
Eye
Arm
Hand
Leg
Foot
Fingers
Toes
Other members
Temporary disabili
ties—
Number
Days lost«
Average dura
tion
Total benefits, including
medical, hospital, etc.
.
a In this table the duration of temporary disabilities should be expressed in calendar days, as the
table is not intended for weighting purposes.
T able 1 0 - -N a tu r e
Cause of accident.
1
of
In ju ry,
by
Ca u s e .
Cuts,
punc
All
In
Burns Con tures, Dis Frac Sprains other Total fected
and
inju
cus and loca
Bruises. and
scalds. sions. lac tions. tures. strains. inju ries. inju
ries.
ries.
era
tions.
2
3
4
6
5
7
8
9
10
11
Machinery:
Prime movers
Steam engines
Gas or gasoline
engines
Electric motors
and dynamos
Etc.
N o t e . —For
classification of causes, see Bulletin
78532°— B u ll. 248— 19------- 8
2 01
of
th e
United States Bureau of Labor Statistics.
BU SIN E SS M E E T IN G OF T H E ASSO CIATION .
114
T able
11.—A c c id en ts ,
Nature and location of
injury.®
N a t u r e a n d L ocation
of D is a b il it y .
op
I n ju r y
and
E xten t
Number of permanent
disabilities (not dis
Temporary
memberments) involv
Total ing specified percent Num disabilities.
ber
per
age of impairment of
of
ma
member.
Total Deaths. nent
discases.
memdis
berabili 20
ties. and 21 41 61 81 ments. Num Aver
age
to
to and
to
un
ber. dura
tion.?)
der. 40. 60. 80. over.
2
1
A.
B.
C.
D.
by
4
3
5
7
6
8
9
10
11
12
Dislocations
Fractures
Burns
See other
a For classification of location of injury for use in the stub of this table, see Bulletin 201 of the U. S. Bureau
of Labor Statistics.
&In this table the duration of temporary disabilities should be expressed in calendar days, as the table
Is riot intended for weighting purposes.
Note.—Degree of impairment of member or degree of permanent incapacity may be used in this table
according to the practice prevailing in the particular State.
T a b le 12.— S e x
and
W ages
of
I n ju red .
Females.
Males.
Weekly wages. «
1
Total
cases. Total
males. Deaths.
2
3
4
Per
ma
nent
total
disa
bili
ties.
Per
ma
nent
par
tial
disa
bili
ties.
5
6
Per Per
Tem
ma ma
po Total
nent nent
rary
fe Deaths. total par
tial
disa males.
disa disa
bili
bili bili
ties.
ties. ties.
7
8
9
10
11
Tem
po
rary
disa
bili
ties.
12
Under $4.00
$4.00 and under
$5.00
$5.00 and under
$6.00
Etc.
$28.00 and under
$29.00
$29.00 and under
$30.00
$30.00 and over
Total
(a) For this table use the calculated wages upon which compensation awards are based, irrespective of
maximum or minimum limits.
Note.—This table should be made for all industries combined and for important industry schedules.
(Average weekly wages for the first and last groups would be useful for actuaries.)
REPORT OF T H E C O M M IT T E E ON ST A TIST IC S.
T able
13.— S e x
and
A ge
of
I n ju red.
Males.
Age.
1
Per
ma
Total Total
nent
cases. males. Deaths. total
disa
bili
ties.
2
3
4
5
115
Females.
Per
ma
nent
par
tial
disa
bili
ties.
Per Per Tem
Tem
ma ma
po Total
nent nent po
rary fe Deaths. total par rary
disa males.
tial
disa disa disa
bili
bili
bili bili ties.
ties.
ties. ties.
6
8
9
10
11
12
G ive ages b y
years, using age
at time of acci
dent.
N o t e .— This table should be made for all industries combined and for important industry schedules.
APPENDIX
C.---- SCALE OF TIME LOSSES FOR W EIGH TING INDUSTRIAL ACCIDENT D ISA
BILITIES SO AS TO SHOW SEVERITY OF ACCIDENTS.
Nature of injury.
Death...........................................................................................
Permanent total disability.........................................................
Arm above elbow, dismemberment............................................
Arm at or below elbow, dismemberment..................................
Hand, dismemberment...............................................................
Thumb, any permanent disability of.........................................
Any one finger, any permanent disability of..............................
Two fingers, any permanent disability of...................................
Three fingers, any permanent disability of.................................
Four fingers, any permanent disability of..................................
Thumb and one finger, any permanent disability of..................
Thumb and two fingers, any permanent disability of................
Thumb and three fingers, any permanent disability of.............
Thumb and four fingers, any permanent disability of...............
Leg above knee, dismemberment...............................................
Leg at or below knee, dismemberment......................................
Foot, dismemberment................................................................
Great toe or any two or more toes, any permanent disability of
One toe, other than great toe, any permanent disability of.......
One eye, loss of sight...................................................................
Both eyes, loss of sight................ ..............................................
One ear, loss of hearing...............................................................
Both ears, loss of hearing............................................................
Degree of
disability
in per cent
of
permanent
total
disability.
Days lost.
6,000
6,000
4.500
3,600
3.000
600
300
750
1,200
1,800
1,200
1.500
2.000
2.400
4.500
3.000
2.400
300
’T soo
6.000
600
3,000
(1 ) In ju r ie s n ot in v o lv in g am p u tation shou ld be ra ted as a p rop ortion o f the
w eigh t a ssign ed to the en tire loss o f the m em ber in volved, in a ccord a n ce w ith
the degree o f im pairm ent.
(2 ) T h e w eig h tin g fo r im pairm en t o f fu n ctio n o f any m em ber shou ld be such
p ercen ta ge o f th e w eig h tin g f o r dism em berm ent as m ay be determ ined b y th e
116
B U SIN E SS M E E T IN G OF T H E ASSOCIATIO N.
a d ju d ica tin g a u th ority in fix in g the com p en sa tion fo r such im pa irm en t— i. e., i f
lo s s o f an arm is com pen sa ted b y 240 w eek s’ in dem n ity, then an im pa irm en t o f
the arm f o r w h ich 160 w eek s’ com pen sa tion w a s p a id shou ld ra te a s tw o-th ird s
o f the lc>s o f th e arm in the a b ove scale.
(3 ) H e rn ia shou ld be in clu d ed on ly as a tem p ora ry d isa b ility on the ba sis
o f the a ctu a l tim e lost.
(4 ) F o r the w e ig h tin g o f tem p ora ry d isa b ilities the a ctu a l d u ra tion o f dis
a b ility in ca len d a r d a ys less on e-seventh shou ld b e used.
E. H . D o w n e y , Chairman,
Special Deputy, Pennsylvania Insurance Department, Harrisburg, Pa.
P. A . B roderick ,
Assistant Secretary, Massachusetts Industrial Accident Board, Boston, Mass.
W . H . B urhop,
Member, Compensation Insurance Board of Wisconsin, Madison, Wis.
F . C. C roxton ,
Vice Chairman, Ohio Branch of Council of National Defense, Columbus, Ohio.
T. N. D e a n ,
Statistician, Workmen's Compensation Board of Ontario, Toronto, Ontario.
L. W . H a t c h ,
Chief Statistician, Bureau of Statistics and Information, New York State Indus
trial Commission, Albany, N. T.
D on L. L e sco h ier ,
Formerly Statistician of the Minnesota Department of Labor and Industries,
St. Paul, Minn.
R o y a l M eeker ,
Commissioner of Labor Statistics, Washington, D. C.
C h a r l e s H . V errill ,
Chief Statistician, United States Employees ’ Compensation Commission, Wash
ington, D. C.
E. E. W a t so n ,
Chief Actuary, Industrial Commission of Ohio, Columbus, Ohio.
WEDNESDAY, AUGUST 22—AFTERNOON SESSION.
CHAIRMAN, RAPHAEL LEWY, M. D., CHIEF MEDICAL EXAMINER, NEW YORK STATE
INDUSTRIAL COMMISSION.
IXL MEDICAL ASPECTS OF COMPENSATION INSURANCE.
[In response to a vote taken in the morning, the president ap
pointed the following committee to bring in a report on the officers
of the association for next year and also as to the proposed place
and time of meeting: Mr. Wilson, Mr. Andrus, Mr. French; and the
following committee on resolutions: Dr. Meeker, Mr. Smith of Michi
gan, Mr. Andrus of Illinois, Mr. Armstrong, and Mr. Wilson.]
The C h a irm a n . Before calling the medical session to order I would
suggest, with your permission, that the discussion of the various
subjects begin after the conclusion of the papers, so that the
gentlemen may all take part in the discussion; and, as chairman, I
should also like the privilege of taking part in the discussion, and if
the time allows I have something that I should like to say to you.
I think the time has arrived when we not only need to speak as to
the compensation of visible injuries, so called—visible, palpable de
fects—but I believe the internal, pathological condition is beginning
to be a big factor in the so-called measuring term—the dormant con
ditions, the predisposing conditions, and those things which are
accentuated by injuries. I believe that it is time we turn our thoughts
and minds to this all-important subject and see what can be done.
[A paper on “ The value of the exact knowledge imparted by
autopsy findings in clearing up fatal industrial accidents ” was read
by Timothy Leary, M. D., medical examiner, Suffolk County, but is
omitted, as it has been impossible to obtain a copy.]
117
X-RAY DIAGNOSIS AS AN AID TO EFFICIENT ADMINISTRATION OF
THE WORKMEN’S COMPENSATION ACT.
BY ARIAL W. GEORGE, M. D.
I have been asked to say a few words in regard to the use of the
X ray in industrial accident cases, and its value in the practice of the
workmen’s compensation law.
It has been proved in the majority of cases that the use of the
X ray gives a better knowledge or comprehension of the various in
juries to the various parts of the body in industrial accident cases
than does the ordinary clinical examination of civil or hospital prac
tice. This has become so obvious that the better class hospitals
throughout the State have equipped themselves with adequate X-ray
departments and have made X-ray examinations an integral part of
the hospital routine to such an extent that an examination by X ray
is made in practically every case where a pathological condition
is suspected, whether it be a case of injury to the bony skeleton, or
some disease that may attack the lungs, or an infection or obstruc
tion of the gastrointestinal tract, or disease of the accessory sinuses of
the head, or new growth of the brain.
Very little progress, or at least exact progress, can be made without
the use of the X ray. Fortunately for employer and employee, we
have in this State a medical adviser who may be fairly called the
father of medical reconstruction of the injured, and who from the
very start of the practice of the act has insisted, in spite of criticism,
on liberal examinations by X ray of accident cases. It has been my
privilege to have been the impartial referee on a large majority o f
the Massachusetts board cases needing X-ray diagnosis, and it has
been apparent from the beginning that the success of this act in this
State must be attributed first of all to the efficiency of the medical
men, aided by the very general use of the X ray.
Naturally in the beginning the cost was a factor, and it was against
this perhaps more than against its systematic employment that
objections were made, but we were able to overcome this objection
by making the fee very little more than the average hospital would
charge, at substantially only the net cost, at the same time giving
the individual attention to the workman that he was deserving of and
would be entitled to in civil practice.
The use of the X ray in individual cases necessarily plays two very
important parts, according to its employment in the early or late
118
X -R A Y DIAGNOSIS AS A N AID— A . W . GEORGE, M . D.
119
stages of any injury. We are sadly wanting in its early employ
ment; that is, the early X-ray examination of every individual
case, first, as an essential aid to diagnosis, and, second, as a necessary
aid to proper and prompt treatment of these traumatic cases.
When for various reasons there has been no early X-ray examina
tion, and permanent disability apparently develops, then an X-ray
examination is made before the case is decided definitely as one per
manently disabled. The latter practice has become common and has
led to very excellent results in the reconstruction of individuals
thought hopeless invalids.
In the early days the insurance companies were not as familiar
with the value of the X ray as they are to-day. We have seen the
time when the insurance company would neglect to have an X-ray
examination of a fracture on account of cost, preferring that the
medical man treat the injury for the two-week period, trusting to his
unaided skill and that of nature to heal the fracture successfully, but
it was very soon found in practice that the accepted treatment of in
juries, without the guide of the X ray, did not always give the most
perfect functional results, no matter how many modern appliances,
in the shape of ingeniously contrived splints, etc., were employed.
Even now the insurance companies, who bear the brunt of this act,
are not quite prepared to say to their medical consultants—whether
they be special examiners or physicians called by the individual—
have X-ray examination early in every accident case.
What would be the value of such a procedure? It may be some
what idyllic and not practical, owing primarily to expense, but
what would be the outcome? Let me take as an example a man in
an administrative position who slipped, fell, and injured his hand.
It was a trivial accident and caused only a little annoyance at the
time. He expected the swelling would go down in a few days and
that he would have good use of his hand, and so practically ignored
the accident. Ten days later the hand was still swollen, function
was delayed or inhibited, and it became a source of annoyance and
wonder to him as to just what had happened. He then submitted to
X-ray examination and was found to have a fracture of the scaphoid
bone of the hand. We know from a medical and surgical point of
view that, for some reason, unless a fractured scaphoid heals imme
diately, it is not likely to heal, and becomes an irritation and even
tually leads to a disability which may be of considerable importance.
I f this man had had prompt medical treatment, with the knowledge
that there was a* fracture, in from 8 to 14 days his hand would have
been healed, the function would have been restored, and he would
have forgotten the incident. As it is, he is extremely fortunate if
he has good function of his hand, and more than fortunate if
120
M ED ICAL ASPECTS OF C O M P E N SA TIO N IN SU R A N C E .
eventually he does not have to have a surgical operation to remove
one of the fragments.
I f this had been an industrial accident case and in a routine way
the insurance company had insisted on immediate X-ray examina
tion, it is perfectly obvious that it would have saved a considerable
number of weeks’ compensation, and not only compensation but
the economic loss to the employer of his employee, provided the ex
amination was made by a competent Roentgenologist.
This is happening time and again, and if an estimate in dollars
and cents could be given to you of the loss of the workman’s time,
plus the compensation that he receives, it would astound you.
It is often the simple injuries that give the most distressing and
permanent results, because it is the wrist, the elbow, the shoulder,
the knee, and the ankle joint that are commonly injured, and as
these are the parts that come into play in the performance of man
ual labor, it becomes perfectly apparent that these are the parts
of the human body that we must protect, just as you protect your
mechanical appliances in your shops.
The injuries to the joints themselves, fractures especially, no mat
ter how slight, are the injuries that may give rise t*o the permanent
and difficult end results, and a delay in diagnosis and treatment
sometimes means that it is impossible by future surgical procedure
to return the joints to their original usefulness. Take, for example,
a fracture at the wrist joint, which is so common. I f there is a
slight amount of impaction and this impaction is allowed to heal
and becomes firm in its union, the functional result is permanently
destroyed to a greater or less extent, and no amount of surgical
procedure in the future will relieve this lack of function.
Even unrecognized fractures of the fingers, or those poorly cor
rected at the time of the injury by surgery, as simple as they may
seem, destroy the perfect usefulness of the hand, but if recognized
promptly from demonstration on the X-ray plate, the only excuse
then in the evidence will be of poor judgment pf the surgeon or lack
of training, because, after all, with the X ray as a positive factor
in the study of the injury, it becomes then only a mechanical pro
cedure to reduce the parts that are fractured, and, fortunately,
nature does not demand that the approximation be as it was previous
to the injury, but, as we see so commonly, even a marked deformity
will sometimes in individual cases give permanently good functional
results.
Injuries to the chest have been a source of annoyance when the
problem of resultant tuberculosis arises. The medical adviser of this
board could report numerous cases of tuberculosis that have been
claimed to have developed after injuries to the chest. We would have
been certain of one fact if the injured workman had been examined
X -R A Y DIAGNOSIS AS AN AID---- A. W . GEORGE, M . D.
121
within a few days after his injury, i. e., of the condition of the lungs
at that time, which would have been definite and positive, and no
future claim could have been made unjustly either way when the
question came up as to whether tuberculosis that had not theretofore
given marked clinical symptoms existed at the time of the injury or
was due to such injury or to change of occupation. The X-ray record
of the patient’s chest pathology would be at hand to help in adjusting
the claim.
Injuries to the spine have become more common than we hitherto
thought possible, and although perhaps the results of knowing that
there is a definite injury to the vertebrae may not help in the ultimate
treatment, there are some cases which, if found to have permanent
injuries to the bones of the spine, can be relieved of immediate symp
toms, and we can prevent, by surgical methods, the developing of
future symptoms. Hardly a case can I recall that has been examined
immediately after the injury—more commonly it is the following
week or month or months, with possibly increasing clinical symptoms,
and when examined by the X ray when the question of continued
compensation arises, definite serious disturbance of the bones is found.
Then it is almost always too late to do more than correct it by ap
pliances.
As to injuries of the head in which claim of fracture is made, in
a large percentage of these cases no fracture exists. I f such a case
were examined early perhaps treatment* could be instituted, in which
case the secondary results of this accident would not appear in the
case, because after all is said and done a great many times the useful
ness of the individual is lost if he even thinks he has a serious injury,
and if he thinks of it long enough it becomes just as serious as regards
his usefulness to his employer as if he had an injury. This we see so
commonly in the court cases tried against corporations, and, inci
dentally, it has only been within the last year or two that the corpo
rations have realized this, perhaps more definitely than have the in
surance companies, and have insisted that they have X rays of the
alleged injury.
In my own experience case after case has been found to be normal,
and yet in the routine of legal procedure such patients would recover
not only for the liability and for the suffering but for claimed per
manent injuries of a nature which never actually existed.
The time must come, gentlemen, and it must be for the individual
State board to decide how soon, when, in central locations, all cases
must be examined immediately after the injury, and whether it
becomes a great expense at first or not, the end results will, if you
consider no other factor than the usefulness of the individual to his
employer, soon become apparent, and this procedure of early and con
stant examinations will change the yearly statistics of cases being car
122
M ED ICAL ASPECTS OF C O M P E N SA TIO N IN S U R A N C E .
ried on compensation, and if carried out for one year by the Massa
chusetts board, of which we are all very proud, will show a very real
saving in dollars and cents in the compensation given to the indi
vidual, besides his early return to work and his usefulness to his
employer.
One of the objections to the change in the law recently passed by
our legislature—allowing the workman his choice of physician—is
fundamental to this whole discussion—that the average general
practitioner who is taking care of the individual workman is very
often, for some unknown reason, loath to ask for early X ray; per
haps because he does not know that the insurance companies want it
or will allow it—with the result that to-day hundreds of cases from
the records could be shown to you of deplorable results of improper
treatment which at the present time can not be corrected by surgical
means.
The X-ray man can at least do this, he can be the buffer or adviser
between the family physician and the insurance company, advising
the physician of his first faulty treatment and the insurance com
pany of the need of special consultation on the case.
No matter which way this subject is presented the fact remains
undeniable that this board has to practice in this State, and that no
matter how it compares with other States it will never reach the
acme of perfection until there is a definite arrangement by which
every individual workman, no matter how prolonged or how severe
is his injury, can have thorough X-ray examination by a competent
X-ray man. This must be insisted upon, and it must be done in the
early hours of the injury. I f the present system of impartial ex
amination is outgrown, a very simple plan could be worked out by
which a complete X-ray equipment could be operated in central
locations, all the insurance companies paying their proportional
amount of the expense of the operation of this department, and I
am sure that its success would be so apparent in a very short time
that the Roentgenologist would be as necessary to accident boards
as the invaluable services of a medical adviser.
[At this point a paper on “ The influence of alcohol in the pro
longation of disability in industrial cases; how can it be minimized?”
was read by J. W. Brickley, M. D., and one on “ What constitutes
adequate medical service in compensation cases,” was read by W.
Irving Clark, M. D., of the Norton Co., Worcester, Mass., but are not
reproduced as copies were not submitted for publication.]
DISCUSSION.
F. D. P a t t e r s o n , M. D., chief, division of industrial hygiene,
Pennsylvania Department of Labor and Industry. We should all
thoroughly realize how grave and serious a menace to this country
are the present casualties of modern industry. I picked up a paper
the other day and I saw featured there the fact that England had
lost in killed, wounded, and captured some 40,000 men in a month.
Why, it pales into insignificance compared with the killed, injured,
and maimed in the ranks of American industry throughout our con
tinent. We, one and all, should give very serious thought to this prob
lem and ask our fellow practitioners in medicine who are in charge
of medical schools in our country to give special thought to the
education that is now being given to the men who are going to take
our place in the fighting ranks of industrial practice. It seems to me
from my experience in Pennsylvania that the average medical stu
dent has far more knowledge of the symptoms of some obscure dis
ease than he has of the common industrial poisons that are being
handled every day in some of our factories. So, too, it seems to me
that he is much better qualified to tell you some one. two, or three
ways of amputating a hip joint than to point out to you how to clean
a wound that has occurred to a man laboring in industry. Here he
is as much at sea as some mariner in a boat without the aid of a
compass, and so I feel that the medical profession should take stock
of those who hold the degree of M. D.
I believe, from my experience in the State of Pennsylvania, that
we have an average of a thousand disability accidents a day, 10 of
which are fatal, and that one of the most important things that we
can have is competent medical attendance immediately after a man
receives an injury; and, furthermore, that the sooner that man is
enabled to get back into that plant and some kind of work—I don’t
say the position for which he was hired and at which he has been
injured, but getting back into the plant, even if he does nothing but
sit at the gate all day long—I contend it’s a thousand times better
than standing with one foot on the rail at the bottom of a bar. The
most serious case, I believe, is the case of unreported accidental in
jury. The man who meets with an apparently trivial injury and who
appoints himself a committee of one to treat himself, either by the
use of the cobweb or the chew of tobacco, is the man who places him
self in a most dangerous position.
123
124
M E D ICAL ASPECTS OF C O M P E N SA TIO N IN S U R A N C E .
Now, in regard to the subject of alcohol, I have hopes that we
may get some help out of Congress, but, unlike my good friend, Dr.
Meeker, I haven’t much faith in Congress, though I hope we may get
some help from them. I fully realize that it is no more possible to
stop drinking by the mere enactment of law than it is to control
accidents by the same method, and I say by that same process you can
make drinking different, but you can’t make it unpopular. Educa
tion is the solution of the problem, and we will have to educate the
foremen and the workmen, the men that are laboring in the indus
tries. Alcohol is a poison, and it doesn’t take any professor of
physiology to convince me of that.
A word on the subject of X rays. I hope that I may live to see the
time in this country when every accident board in every State and
Territory of our Union will adopt the use of the X ray, not only that
we may have an adequate knowledge as to just what the pathological
condition is which the doctor is called upon to treat, but so that w&
may have a more valuable record. The man who is incompetent to
treat fractures ought not to be allowed within 50 miles of them. The*
compensation system has come, it seems to me, as the result of a
feeling on the part of organized and unorganized labor that they
were sick and tired of those three old bugbears, the common-law de
fenses of assumption of risk, contributory negligence, and negligence
of a fellow servant, standing between a man who has been injured
in the performance of his work and the recovery of compensation,
and furthermore has come as the result of a demand on the part of
the progressive lawyers and the progressive manufacturers, because
they were sick and tired of the freedom with which juries disregarded
these defenses. The State has a keen interest in the unfortunate man
or woman who meets with an industrial accident, and is also keenly
interested in seeing that that man or woman is returned to productive
labor at the earliest possible moment. It is a question in my mind as
to whether or not in a great many of the industries we have not too
much first aid by incompetent people, and as to how far first aid
should be allowed to go—whether or not a wound properly cleansed*
in the absence of antiseptics, by a competent man will not be a great
deal better than improperly cleansed by a man who believes he is.
competent and who puts on all the antiseptics he can find in the fac
tory. I hope to live to see the investigation which is about to be
begun, at the request of the Surgeon General of the Army, by the
United States Public Health Service and a committee of the Associa
tion of Industrial Physicians and Surgeons into this question of first
aid completed, and I believe out of that investigation there will un
doubtedly come some great truths which have been obscured by the
incompetent first aid that has been rendered during previous years.
M ED ICAL ASPECTS, E T C .---- D ISCUSSIO N.
125
In conclusion, it has been my experience that hospital records and
f&ctory records, valuable as they are to a certain extent, do not go far
enough, and I . trust that the compensation boards of this country
will eventually require that records be kept so that they will show, in
the first place, the personal-injury cases. I divide all cases coming to
the factory physician or the hospital into three classes: First, personal-injury cases; second, those cases of disease which are depend
ent upon the occupation of the man or woman; and, third, those cases
of disease which are not dependent and not connected in any manner
at all with the occupation. I am convinced that when the records are
kept in that way we will be able to get some real accurate statistics,
which at present we sadly lack in this country. I will be glad to
send to anyone who is interested the proceedings of the conference of
physicians which has been held at Harrisburg, and in which you will
find in detail what constitutes reasonable medical services. In con
clusion, I want to leave with you the thought that if America is to
win the struggle upon which we are now engaged it is going to be won
by our men at the front in France and by our men and women here in
the trenches of labor in America, and we owe it as a duty to our
country, as loyal Americans, to do everything we possibly can to pre
vent our men and women in industry from being injured and to see
that those who have the misfortune to fall by the industrial wayside
shall fall into the hands of competent physicians who will give them
proper care and restore them to their employers’ service at the earliest
possible moment.
D r . D o n o g h u e . May I insist that the chairman take part in the dis
cussion now ?
The C h a ir m a n . In referring to the paper on alcoholism, the gen
tleman dwelt on the toxic effect due to the injection of alcohol. Of
the pathology of the change in the system, the effect in arterioscle
rosis, the effect on the muscles of the heart, and the complicating
kidney changes, we have no conception; but this much we may know,
and it is important for us to know it : There are many people who are
addicted to alcohol who do not show any of the manifestations
of an alcoholic. Such a person, up to the time of an injury, may be a
very useful working man, but the injury becomes the actuating factor
in a condition of that kind to cause delirium tremens. You take, for
instance, a man who goes to work on a certain morning. He has
drank nothing and he did not drink for a few days before; he was
not intoxicated. He meets with a fracture of his leg and he is re
moved to the hospital. The fracture is set, his leg is immobilized, and
24 hours later he develops delirium tremens. That case is compen
sable, no question about it; it always has been compensable in New
York. If, although he drinks alcohol at a certain time, he can fulfill
126
M ED ICAL ASPECTS OF C O M P E N SA TIO N IN S U R A N C E .
his duty, be is a useful man in the community; you may not associate
with him socially—he may not be a good associate—but he is a useful
man, and the accident is the actuating factor in his permanent dis
ability- The very factor that predisposes to his delirium tremens,
perhaps with ultimate death, may be a factor in prolonging the stage
of disability and the consequent defective healing due to lowered
vitality-—
that’s as old as medicine. Even then he must be com
pensated.
As to the paper on pathology which has been read,, where the work
of the pathologist comes in, as regards the compensation law, in
making a diagnosis is this: Let us say that there is a differential
diagnosis to be made between a hemorrhage, extra dural hemorrhage
between the skull and the outside lining of the brain, and apoplexy—
let us say that a man worked and suddenly fell down and in his fall
he hit himself, but, to make the case more complicated., he died at once,
and therefore there was no change. Some teachers will tell you that a
traumatic hemorrhage is most often the consequence of a fall, or of
the closing of the middle meningeal artery where apoplexy or hemor
rhage of the cerebra occur, most often affecting the ventricles, and
so sclerotic changes, and so forth, take place—that’s a differential
diagnosis. There is the importance of autopsy findings.
I heard the doctor speak of a miliary tuberculosis. It is a wellknown fact all over the world that 50 per cent of people have tuber
culosis without any evidence of it, and that in those few cases where
autopsies have been made tubercular conditions have been found.
Now, for instance, take the man who inhales nitrate and who has a
]atent tuberculosis. As a consequence of this inhalation he gets a
cold, ail inflammation of the windpipe, or acute bronchitis. I f active
tuberculosis sets in he is surely entitled to compensation, although he
previously had latent tuberculosis. Take a man who has dormant
tuberculosis; he doesn’t cough, doesn’t raise, and doesn’t know that
he has it. He is a perfectly healthy man. It is the inhalation that
causes the acute condition. It was interesting to me to hear the
doctor say that to cause a systemic infection in some animals you have
to cause a fracture—fracture the leg. The experiments spoken of
were done 15 years ago by Wassermann. He simply wanted to cause
an artificial lowered vitality. That very same thing could have
occurred in a human being. You don’t need to break a man’s leg to
cause an infection. I f there is an infection in the body in an inactive
state, give it time and it will develop; that is, where you may have a
latent infection. I remember very well the first case that was reported
by Murphy, o f Chicago; it was an infection in consequence o f an
abscess. The son of a doctor fell and suddenly developed a tem
perature. Everybody saw him and nobody knew what was the mat
ter with him until they X rayed him, when they found a focus in his
M ED ICAL ASPECTS, E TC .— D ISCU SSIO N .
127
femur, an abscess in consequence of a dormant infection in his jaw.
That was the actuating condition—the fall. I f this were the case
o f a workman, if you found an infection in his jaw, wouldn’t he be
entitled to compensation ? That is the important thing, the differen
tiation between conditions that predispose and conditions that pre
exist, conditions that in their preexisting state are dormant, harmless
to the individual, but are actuated by something that causes you to
give him his compensation, and of right.
As to the X ray, I recall having seen doctors set fractures and
make very wonderful diagnoses preceding the X ray, but we must
all admit that the X ray is one of the most necessary and one of the
most important things and a godsend to medicine and surgery. But
the X-ray man must translate his own picture. I want his diagnosis
On the picture—never mind what the surgeon said. I don’t want him
to ask me: “ What was the matter?” He has the picture and he must
translate what he finds.
The doctor spoke of a fracture of the scaphoid bone. There have
been fractures that before the X ray have never been diagnosed, and
that is one of the fractures. Although men like Stimpson, of New
York, have described those fractures, they never could confirm their
description. Stimpson was a genius in that work. But I take excep
tion to the statement that if a fracture of the scaphoid is replaced
immediately the individual will be well in 10 days.
Now, whether you use in'first-aid treatment tincture of iodine, a
sublimate solution, or a carbolic-acid solution, I believe the first-aid
treatment which is successful is treatment and careful handling of
the tissues and the proper application to and immobilization of the
part involved. I was astonished at having seen a noted surgeon use
nothing on his hands but alcohol, and use nothing on the abdomen
but alcohol, and use nothing but dry sponges, and see him go into the
abdomen with both hands and do whatever was necessary, and during
eight months’ time not have one case of infection; but he was a
master. I believe the important thing in first-aid treatment is not
to mutilate more than is necessary and then to give the parts a
chance to heal naturally, unless there are distinct indications to the
contrary at the time. I f I were to be asked what is a good antiseptic
or a good aseptic, I may tell you frankly that in an experience of
over 20 years I have used nothing but sublimate. I mean that I use
nothing but solutions of bichloride of mercury—corrosive sublimate.
My grain is 1 to 2,000, about. I have used it as a packing; I have
inserted gauze saturated with it in wounds. I have used it as a
drain; I have inserted loose pieces of gauze to take away discharges
from a wound; and if I were to be asked whether I would change it,
I should say it has been good enough up to the present. Is iodine
128
M ED ICAL ASPECTS OF C O M P E N SA TIO N IN S U R A N C E .
good ? I f the other has been good enough up to the present, I don’t
need any better. That would be about as logical an argument as I
could give. You may say, “ Don’t you get sublimate irritations?”
Yes; I have had. But.I believe iodine is so well thought of because
it is so easy of application—you don’t have to make any solutions,
Its effect must be good, otherwise it would not be used,
Having spoken on first aid, I wish to say something on internal
medicine, and the first disease I wish to speak of is syphilis, which is
a very important factor in your compensation occupations. There
are any number of cases of syphilis on record which show absolutely
no evidences whatever—no chronic evidences. The individual does
not complain; has no physical signs of the disease; and you may
examine his blood and find no reaction there. This individual is a
very useful worker in whatever capacity he is employed. He is
slightly injured on a bone, which in the ordinary being and the
healthy man would cause a very slight injury which might last a day
or so. This man who is injured goes along and works, and four
weeks after he develops an enlargement of this bone, which may be
considered a good many things until he comes under the supervision
of a careful doctor, who makes the diagnosis of a gumma—an en
largement of a bone, not exactly painful. It does not break down,
and as the doctor goes into the man’s history he establishes that he
had syphilis. This man requires a long treatment; he is disabled.
Is he to be compensated? Absolutely. That this syphilitic man is
working is not his fault. He has been perfectly well—apparently
well—and a very useful man to all intents and purposes. He meets
with an injury in his vocation. Unfortunately his predisposition to
disease makes him a very expensive workman, but he is entitled to
compensation.
There is another set of cases. These are the persons who continu
ally complain of headaches, and who say, “ As I stoop down I get
dizzy and fall,” but they never fall. “ When I come home at night—
my head goes worse at night.” You give one of these persons a
thorough examination, from a neuropathological point of view, and
he has not one organic sign of a nerve lesion; has perfectly normal
reaction of the pupils; normal reaction of the knees; no Ehomberg;
not too much sensation; no loss of sensation. Still, he is disabled.
But he has no resisting power; he is not able to stand the shock the
ordinary man would stand; in which case the emotional shock and its
consequences must be considered.
I would, like to say something on heart lesions. I f you consider
that there is such a thing as normal senile changes which come in
old age, you must readily understand that the man of 50 years of age
when he is injured is an additional risk as regards prolonged com
M ED ICAL ASPECTS, E TC .— D ISCUSSIO N.
129
pensation and as regards premature death in consequence of his age
and condition. It is a peculiar thing that the very man who is
injured may have that very morning done the most laborious work.
He carried and shoveled and lifted, and his fellow workmen might
say: u John wasn’t sick this morning; I worked with him so long.”
This man lifts something in the afternoon; he is not disabled im
mediately ; works that afternoon; goes home, and says, “ I have an
awful pain in my back” ; and since then he has been disabled. When
you examine him, you find a distinct myocardial change; you find a
very slow pulse; the heart sounds are muffled; they are not distinct*
You take his blood pressure, and it is low, and he is sick, and he
proves to you that it was only two weeks since he was able to work,
and so he was. Now, what caused it? What happened to this man?
I f he had an acute dilatation of his heart he should have been dis
abled at once, under our conception of acute dilatation. He could
not have had an acute dilatation. He had a bad heart muscle, but
he should have compensation, as his heart was strong enough to
make up for that bad heart muscle until that heavy lift; and that lift,
while it would not have knocked out 10,000 other men, knocked him
out because that diseased muscle could not recuperate. I advise
my commission to compensate these cases. I believe the most im
portant thing for any commission to consider in the compensation
of these cases is the most logical and comprehensive thing. How is
it that this very sick man was able to work until that date if he is
so sick to-day and is disabled? I believe that is more important
than our diagnoses.
Mr. A r m st r o n g . What do you call the accident in that case?
The C h a ir m a n . The physical exertion—excessive lifting.
Mr. A r m st r o n g . The lift would not be the accident.
The C h a ir m a n . Why not, if the lift was too heavy ?
Mr. A r m st r o n g . I should think it was the strain and consequence.
The C h a ir m a n . What caused the strain? I just wish to say one
more thing on injuries to the back in conjunction with what we saw
this morning. I do believe that the chief medical examiner of
the Massachusetts board is to be congratulated. I think we saw this
morning one of the finest institutions in the world, and when I say
this I see before me some very large institutions in Europe. I think
we saw one of the best-equipped institutions in the world this morn
ing. There was one thing which appealed very much to me, and that
was the kindness with which the patients are treated. That is a very
important factor. We saw a room equipped with mechanical appli
ances which I think is as perfect as anything can be in that line. I
don’t mean to go on record to say that conditions can not be im
78532°— B u ll. 248—19-------9
130
MEDICAL ASPECTS OF COMPENSATION INSURANCE.
p r o v e d , n e ith e r d o I w a n t t o g o o n r e c o r d as s a y in g t h a t im p r o v e d
c o n d it io n s a re p e r f e c t c o n d it io n s . W e ll, n o w , as t o th e b a c k in ju r ie s ,
in o u r p r o fe s s io n t h e y h a v e ta k e n u p so m e te r m s lik e lu m b a g o a n d
n e u r i t i s , a n d s o f o r t h , a n d l a t e l y t h e y h a v e c o m e f o r w a r d w^ith s o m e
t h in g n e w w h ic h m e a n s a s e p a r a tio n o f th e jo i n t b e tw e e n th e s a c r u m
a n d th e h ip b o n e . W e h a v e som e m e n w h o d o th a t k in d o f w o r k —
m e n w h o h a v e l e a r n e d i t a n d w h o k n o w h o w t o d o it . O u r r e s u l t s
are n o t v e ry g o o d .
W h a t w e h a v e n o t ic e d fr o m m a n ip u la t io n i
t h i s : A t th e t im e w h e n t h e p a t ie n t is d is c h a r g e d f r o m h is t r e a t m e n t
th e m a n ip u la t io n in th e jo in t is f a i r l y g o o d .
A ft e r a fe w w eek
w e h a v e n o t ic e d th a t th e m a n ip u la tio n w a s n o t a s g o o d ; th a t th e
m o b ilit y b e c a m e le sse n e d .
W h e t h e r t h is w a s b e c a u s e th e m a n d id
n o t u se h is jo i n t , w h ic h h a d b e e n a r t ific ia lly u s e d b y t h e m a c h in e ,
I d o n o t k n o w , b u t w e h a v e o b s e r v e d th is c o n d it io n so fr e q u e n t ly th a t
w e d o n o t n o w s e ttle o u r ca se s s o e a r ly a ft e r t h e p a t ie n t is d is
c h a r g e d fr o m th e m e c h a n ic a l tre a tm e n t. W e w a it a n d see w h a t w ill
o c c u r w ith in a fe w m o n th s w it h o u t tre a tm e n t.
J oseph M. B urke , M . D . , c h i e f s u r g e o n , S e a b o a r d A i r L i n e R a i l w a y .
I w is h t o s a y t h a t I h a v e e n jo y e d a ll o f th e p a p e r s p r e s e n te d h e r e t h is
a fte r n o o n . I w a s s o m e w h a t a m a z e d a t s o m e o f th e sta te m e n ts m a d e
b y o u r w o r t h y c h a ir m a n . A s t o s o m e o f th e m , I a g r e e w it h h im e n
t ir e ly ; as t o o th e r s , I d o n o t. O f co u r s e , f r o m a r a ilr o a d s ta n d p o in t,
w e f e e l t h a t w h e r e a m a n h a s b y h is o w n w i l l c o n t r a c t e d s y p h i li s , a n d
r e c e iv e d a n in ju r y , t h a t t h e r e is r e a s o n f o r s o m e l it i g a t i o n , b u t 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 la w s I e x p e c t p r o b a b ly w e a re r e s p o n
s ib le . H o w e v e r , th e p a p e r p r e s e n te d b y D r . L e a r y I f o l l o w e d c a r e
f u l l y , a n d I s a w n o t h in g in h is p a p e r b u t w h a t w a s p la i n e n o u g h f o r
a n y la y m a n t o u n d e r s t a n d ; it w a s a b s o lu te ly c o r r e c t .
T h e X -r a y
p a p e r s , as w e ll as th e p ic tu r e s p re s e n te d b y o u r A r m y d o c t o r , w e r e
e x c e lle n t . O f c o u r s e , w e a ll k n o w t h a t t h e X r a y is a g r e a t b o o n ;
i n f a c t , w e c o u l d n o t d o w it h o u t it. W e a ls o k n o w t h a t t h e X r a y
d o e s a g r e a t d e a l o f h a r m . S o m e tim e s y o u w il l g e t a p ic t u r e w h ic h is
a b s o lu t e ly a d v e r s e t o th e tr u th . A n o t h e r X - r a y m a n c o m e s a lo n g a n d
ta k e s a p ic t u r e in a d iffe r e n t m a n n e r ; h e w ill s h o w a d iffe r e n t f a c t o r ;
h e w il l s h o w s o m e t h in g a ll w r o n g . F o r th e m e d ic a l m a n t h e X r a y is
a g r e a t t h in g .
T im o th y L eary , M . D . , m e d i c a l e x a m i n e r , S u f f o l k C o u n t y , M a s s .
F ir s t , w it h r e fe r e n c e t o th e t h e o r y o f m a k in g d ia g n o s e s in a u t o p s ie s :
W e a r e a ll h u m a n ; m e d ic in e is n o t a n e x a c t s c ie n c e . I t h in k , w it h m y
e x p e r ie n c e , th a t 2 t o 3 p e r c e n t w o u ld b e a la r g e m a x im u m f o r th e cases
in w h ic h a s a t is fa c t o r y d ia g n o s is w a s n o t o b ta in a b le a t t h e a u t o p s y
t a b le . T h a t is a s i t s h o u ld b e ; w e h a v e m a t e r ia l w h e r e w e c a n t a k e
c a r e o f it. T h e g e n t le m a n m a d e a s t a t e m e n t t h a t t h e m i d d l e m e n in
g e a l a r t e r y w a s th e a r t e r y u s u a lly r u p t u r e d . A s a fa c t , th a t is n o t
MEDICAL ASPECTS, ETC.— DISCUSSION.
131
tru e . T h e p e r c e n t o f m id d le m e n in g e a l in ju r ie s , o f t r a u m a tic i n ju
r ie s t o t h e h e a d , th e b r a in , is v e r y s m a ll.
A s a m a tte r o f fa c t,
s h o u ld s a y t h a t a t le a s t 8 0 p e r c e n t o f t h e c a s e s w h e r e th e h e m o r r h a g e
o c c u r s a re d u e t o tra u m a tis m o f th e p ia o r th e s u r fa c e o f th e b r a in
r a th e r th a n th e m e n in g e a l p ro c e s s .
A s ta te m e n t w a s m a d e w it h r e fe r e n c e t o th e ca u se o f m ilia r y tu b e r
c u lo s is . T h i s w a s n o t a c a se o f t u b e r c u lo s is o f th e lu n g s f r o m th e in
h a la t io n o f n it r a t e .
I t h o u g h t I e x p la in e d th a t in g r e a t d e ta i
M il i a r y t u b e r c u lo s is is a d iffe r e n t s t o r y ; y o u a re d e a lin g w it h a
c lo s e d p r o c e s s w h ic h is n o t i n c o n t a c t w it h b r o n c h it is . I t is a s e p a
r a t e t h in g w h ic h c a n n o t a r is e f r o m t r a u m a t is m o r a s t h e r e s u lt o f i r r i
t a tio n . A s a m a t te r o f fa c t , th is m a n w a s a n e n g in e e r in a p la n t, e m
p lo y e d a t a c o n s id e r a b le d is ta n c e f r o m th e b u ild in g s w h e r e th e
n it r a t e fu m e s w e r e p r o d u c e d , a n d w h ile th e c la im w a s m a d e w e fo u n d
h e g o t n o e x p o s u r e w h a te v e r t o th e m . O n a lc o h o lis m I w o u ld lik e to
s a y , a s t h e r e s u lt o f a v e r y w id e e x p e r ie n c e , t h a t t h e id e a t h a t a l c o h o l
is m ca u se s a r te r io s c le r o s is o u g h t t o b e c o r r e c te d . I h a v e d e a lt w it h s e v
e r a l t h o u s a n d a u t o p s ie s , in m a n y o f w h ic h ca s e s — a la r g e p e r c e n t —
a lc o h o l p la y e d a p a rt.
T h e c la im t h a t a lc o h o lis m is a n im p o r t a n t
f a c t o r in a r t e r io s c le r o s is is a m is t a k e n o n e . W e h a v e c o m e t o r e c o g
n iz e th e im p o r t a n c e o f s y p h ilis in t h is r e la tio n , a n d I b e lie v e th a t
a lc o h o lis m is o f m in o r im p o r t a n c e . I t is o f m in o r im p o r t a n c e in th e
p r o d u c t io n o f c h r o n ic n e p h r it i s ; q u ite a v e r y im p o r t a n t f a c t o r in th e
p r o d u c t i o n o f a c u t e n e p h r i t i s . Y o u c h a n g e t h e c h a r a c t e r o f t h e a lc o ~
h o i a n d y o u w il l c h a n g e t h e r e s u lt s o f a lc o h o lis m . W e u s e d t o g e t
c ir r h o s is o f th e liv e r a s a c o m m o n th in g . F r a n k ly , c ir r h o s is o f th e
l i v e r is b e c o m i n g u n u s u a l ; t o - d a y t h e m a n d ie s a s t h e r e s u lt o f a c u t e
a lc o h o lis m . T h a t ’s w h e r e t h e a lc o h o lis m p la y e d a n im p o r t a n t p a r t.
I d o n o t th in k th a t a lc o h o l s h o u ld b e p la c e d as th e ca u se o f th in g s
w h e r e i t is n o t r e s p o n s ib le .
W E D N E S D A Y , A U G U S T 22— E V E N IN G S E SSIO N .
CHAIRMAN, F. D. PATTERSON, M. D., CHIEF, DIVISION OF INDUSTRIAL HYGIENE,
PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY.
IY . M E D IC A L C O M P E T E N C E A N D H O S P IT A L E F F IC IE N C Y .
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
BY, FRANCIS D. DONOGHUE, M. D., MEDICAL ADVISER OF THE
M ASSACHUSETTS
INDUSTRIAL ACCIDENT BOARD.
C o m p e te n t m e d ic a l s e r v ic e s m u s t b e th e b a c k b o n e o f p r o p e r c o m
p e n s a t io n .
A t th e r is k o f r e p e a t in g p e r h a p s s o m e t h in g s th a t I h a v e s a id b e f o r e ,
I w il l e n d e a v o r t o s p e a k o n h o s p it a l e ffic ie n c y a n d m e d ic a l c o m p e t e n c e .
M a n y p e o p le m ig h t s u g g e s t th a t it w o u ld b e b e tte r t o s p e a k o f m e d ic a l
in c o m p e t e n c e a n d h o s p it a l in e ffic ie n c y , b u t w e s h o u ld lo o k a t t h e
b r ig h t s id e o f t h e s h ie ld a n d a s m u c h e ffic ie n c y a s w e h a v e o n t h e s i d e
o f t h e s h ie ld t o w a r d u s, a n d n o t l o o k f o r g lo o m .
P e r h a p s in th e b e
g in n in g a c o n s id e r a t io n o f th e m e d ic a l a sp e cts o f th e w o r k m e n ’s c o m
p e n s a tio n la w f r o m th e s t a n d p o in t o f a m e d ic a l a d v is e r m a y b
tim e ly .
I n th e fir s t p la c e , i t is in c o n c e iv a b le t o m y m in d h o w a b o a r d a d m in
is t e r in g a n a c c id e n t o r i n ju r y la w c a n g e t a lo n g w it h o u t m e d ic a l a d
v ic e .
I k n o w th a t m e n c a n a c q u ir e w is d o m .
I k n o w th a t m en h a v e
a c q u ir e d g r e a t w is d o m , b u t t o k n o w m e d ic in e a n d its a p p lic a t io n t o
t h e t h in g s o f in d u s t r y w it h o u t a t e c h n ic a l t r a in i n g is a b s o lu t e ly i m
p o s s ib le .
I n th e b e g in n in g w e h a d as lit t le p r o v is io n f o r m e d ic a l a d v ic e in
o u r la w as m o s t S ta te s.
T h e b o a r d in ca se o f a d is p u t e c o u ld p ic k it s
im p a r t ia l e x a m in e r s .
I t c o u ld p a s s u p o n t h e r e a s o n a b le n e s s o
p h y s ic ia n s ’ fe e s ; it c o u ld p a s s u p o n th e a d e q u a c y o f h o s p it a l tr e a t
m e n t, a ll a f t e r t h e r e s u lt s w e r e a t t a in e d .
T h e tim e th e b o a r d s h o u ld
h a v e c o n t r o l, s h o u ld h a v e it s fin g e r in th e p ie , is b e f o r e th e r e s u lts a r e
a t t a i n e d , e s p e c i a l l y t h e b a d r e s u lt s ,
N o t h a v in g a n y p r o v is io n in th e la w , it is a d v is a b le to ta k e th e
a d v ic e o f a v e r y d is tin g u is h e d R e p u b lic a n o f th e S ta te o f T e x a s , w h o
o n c e s a id , “ W h a t a re w e h e r e f o r ? ”
W e a re h e re to g e t o u t o f th e la w
a ll t h a t is in i t f o r t h e i n ju r e d w o r k m a n , a n d in g e t t in g o u t a ll t h a t i s
i n i t f o r t h e w o r k m a n , w e g e t o u t a l l t h a t is i n i t f o r t h e e m p l o y e r o f
la b o r a n d t h e b e s t f o r th e c o m m u n it y . I f it is a p o o r la w , a g o o d c o m
m is s io n o u g h t t o s tr e tc h i t t o th e c r a c k in g p o in t .
I f it is a g o o d la w
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MEDICAL COMPETENCE— FRANCIS D. D0N0GHUE, M . D.
133
w i t h a p o o r c o m m is s io n , it w i l l h a v e a p o o r r e s u lt.
T h e a p p lic a tio n
o f c o m m o n se n se t o t h e la w is a n e c e s s a r y a n d d e s ir a b le t h in g a n d th e
c o m m is s io n e r s a n d la w s w h ic h a re b u r d e n e d w it h le g a l p re c e d e n ts a n d
th e d e c is io n s o f th e H o u s e o f L o r d s w ill n o t a c c o m p lis h n e a r ly a s
m u c h f o r th e r e h a b ilita tio n o f th e in ju r e d w o r k e r as th e c o m m is s io n
w h ic h h a s in m in d th a t m e r e ly p a y in g th e m a n is n e v e r a d e q u a te c o m
p e n s a t io n a n d t h a t h e is o n ly p r o p e r ly c o m p e n s a t e d w h e n h e is r e
s to r e d t o h is p r o p e r p la c e in th e c o m m u n it y .
I n th e a b se n ce o f a n y d ir e c t p r o h ib it io n in th e la w w e s h o u ld g o th e
lim it in c u r e a n d r e h a b ilit a t io n . I n M a s s a c h u s e tts , in th e a b se n ce o f
a la w g iv in g th e a c c id e n t b o a r d su ch p o w e r , w e h a v e e n d e a v o r e d t o
b u ild u p th r o u g h a sy stem o f im p a r tia l e x a m in a tio n s a n d b y a s tu d y
o f h o s p it a l r e s u lts in c a s e s w h i c h c o m e b e f o r e th e b o a r d a p r o c e d u r e ,
w h ic h h a s le d fir s t t o e x a m in a t io n s o f ca s e s b y e x p e r t s in th e p a r t ic u la r
d is a b ilit y c la im e d a n d s e c o n d a r ily t o tre a tm e n t.
I t w o u ld m a n i
fe s t ly b e a jo k e t o r e f e r a n a r t h r it ic s p in e o r a n o b s c u r e b a c k i n ju r y
t o a g e n e r a l p r a c t it io n e r w h o s e t r e a t m e n t c o n s is t s o f s y m p a t h y a n d
lin im e n t s . O u r i m p a r t ia l e x a m in e r s e x a m in e d o n t h e b a s is n o t o n l y
as t o w h e t h e r th e m a n w a s s t ill d is a b le d w h e n th e ca se a r r iv e d , b u t
a ls o as t o w h e th e r th e ca se h a d b e e n p r o p e r ly tr e a te d b e f o r e it
a r r iv e d , w h e th e r it h a d b e e n p r o p e r ly d ia g n o s e d , a n d , i f s t ill d is
a b le d , w h e th e r it c o u ld b e c u r e d . T h e p r o o f o f th e p u d d i n g is th e
e a tin g , a n d o u r m e n , o u r im p a r t ia l e x a m in e r s , b e g a n t o m a k e g o o d
o n w h a t th e y s a id c o u ld a n d s h o u ld b e d o n e , a n d th e in s u r a n c e
c o m p a n ie s g l a d l y s t o o d f o r it.
W it h th e in c r e a s in g p a y m e n ts f o r m e d ic a l a n d h o s p it a l e x p e n s e s
a n d c o m p e n s a t io n , th e a g e n ts o f s o m e in s u r a n c e c o m p a n ie s a r e b e
c o m i n g p r o n e t o s e iz e u p o n s o m e h e l p f u l p o i n t i n d ia g n o s is o r t r e a t
m e n t t o “ b la c k h a n d ” a n in ju r e d e m p lo y e e w it h a le g it im a t e c la im .
B e c a u s e a m a n is s u ffe r in g f r o m a n u n u n it e d f r a c t u r e r e c e iv e d in h is
e m p lo y m e n t , a n d a W a s s e r m a n n is s u g g e s t e d , w h ic h m a y e v e n b e p o s i
t iv e , t h a t s h o u ld n o t b e a r e a s o n f o r in t im id a t io n , o r , w o r s e , m is r e p
r e s e n t a t io n a s t o h is r ig h t s .
T h e o b je c t io n to im p a r t ia l e x a m in e r s b e in g p a id b y th e in s u r a n c e
c o m p a n ie s f o r th e tr e a tm e n t o f ca ses, u n d e r a n a g r e e m e n t b e tw e e n a ll
p a r t i e s a t a c o n f e r e n c e , is t o m y m i n d o v e r b a l a n c e d b y t h e p o s i t i v e
g o o d t h a t c o m e s f r o m th e r e h a b ilit a t io n o f t h e m a n a n d h is r e s t o r a
t io n t o h is p la c e as a p r o d u c t iv e m e m b e r o f th e c o m m u n it y .
T h e v a r io u s f o r m s u n d e r w h ic h th e c o m p e n s a tio n a ct is a d m in is
te r e d m a k e it n e ce ssa ry f o r y o u t o ta k e th e p r in c ip le s a n d a p p ly th e m
a s b e s t y o u c a n in t h e v a r io u s p la c e s . T h e m e d ic a l p r o f e s s i o n a s a
w h o le d id n o t in th e b e g in n in g g r a s p th e im p o r t a n c e o f th e m o v e m e n t
wT i c h w a s i n s t i t u t e d . M e n h e r e a n d t h e r e p i c k e d o u t t h e e s s e n c e o f
h
th e la w a n d e n d e a v o r e d t o p u t i t in t o e ffe ct.
134
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
C a n m e d ic a l c o m p e te n c e b e o b ta in e d th r o u g h a fr e e c h o ic e o f
p h y s ic ia n s o r c a n it b e o b t a in e d u n d e r c o m p e t e n t s p e c ia lis ts ’ w o r t ?
Y o u h e a r d t h is a f t e r n o o n o f t h e r e s u lt s o b t a in e d in a c c id e n t w o r k
b y D r . C la r k . I f w e h a d e n o u g h D r . C la r k s t o g o a r o u n d , th e p r o b le m
w o u ld b e s o lv e d , b u t w e m u s t ta k e a n d w e m u s t u t iliz e th e in s tr u m e n ts
a n d in s t it u t io n s w e h a v e a t h a n d , b e c a u s e th e r e is n o t e n o u g h m o n e y
o r tim e t o fu r n is h im m e d ia t e ly w h a t w e a c t u a lly n e e d .
T h e o ld e r
m e n d o n o t m a k e th e e ffo r t t o g r a s p th e s a lie n t p o in t s th a t a re n e c e s s a r y
in th e tr e a t m e n t a n d r e h a b ilit a t io n o f t h e w o r k m a n o r in th e s e ttle m e n t
o f h is c la im . T h e w o r k o f th e m id d le g r o u p , th e f a m i l y d o c t o r s , so
c a lle d , w h o m e e t th e ir p a tie n ts fa c e t o fa c e , is lim it e d , b u t th e y ca n d o
m o s t o f th e o r d in a r y a c c id e n t w o r k , i f y o u c o n s id e r th a t o f th e ca ses
w it h w h ic h w e h a v e t o d e a l th e t r iv ia l f o r m th e g r e a te r p e r c e n ta g e .
T h e r e s h o u ld b e s o m e d ir e c t m e t h o d b y w h ic h th e g e n e r a l m a n , w h o is
a g o o d , h o n e s t, c o n s c ie n t io u s m a n , c o u ld b e s u p p lie d w it h th e t h in g s h e
n e e d s t o r e m e d y h is d e fic ie n c y .
I n o th e r w o r d s , th e r e s h o u ld b e tr a in e d
c o n s u lta n ts a v a ila b le , u n d e r s o m e f o r m o f th e a d m in is t r a t io n , a n d
t h e r e s h o u l d b e i n s t i t u t i o n s f o r d i a g n o s i s a n d f o r c h e c k i n g u p r e s u lt s .
T h o s e a r e e s s e n t ia l w it h t h a t t y p e o f m a n a n d p e r h a p s w it h a ll m e n .
S h a ll w e d u p lic a te h o s p it a ls b y h a v in g th e in s u r a n c e c o m p a n y o r
e m p lo y e r s o f la b o r a g a in t a x e d f o r o th e r in s titu tio n s ?
A s has been
p o i n t e d o u t b y D r . C o d m a n , t h e r e i s a l r e a d y i n M a s s a c 200s,-e t t s $
hu
0 0 0 ,0 0 0 i n v e s t e d i n p l a n t s f o r t h e p u r p o s e o f c u r e . I n a d d i t i o n t o
t h is in v e s tm e n t th e r e a r e t h ir t y - o d d m illio n s a y e a r a p p r o p r ia t e d o r
g iv e n f o r th e tr e a tm e n t o f th e s ic k .
I s th a t t w o h u n d r e d m illio n s
p r o p e r ly h a n d le d ?
I s th a t t h ir t y o r t h ir t y -s ix m illio n s p r o p e r ly
e x p e n d e d ? W h o k n o w s ? A n d i s th e r e a n y w a y t o c h e c k it u p b e fo r e
w e d u p lic a t e th e s e in s t it u t io n s and. s p e n d a n o t h e r t w e n t y o r t h ir t y
m illio n s in t r y in g t o a r r iv e a t p e r fe c t io n ?
A g a i n , th is le a d s t o th e in t e r e s tin g q u e s tio n , S h o u ld c h a r ita b le
fu n d s b e u se d f o r in d u s tr ia l w o r k e r s w h o c a r r y in s u r a n c e s u p p o s e d
t o p a y f o r m e d ic a l tre a tm e n t a n d ca re ?
T h e s m a ll h o s p it a l, o f c o u r s e , h a s la c k o f e q u ip m e n t. I t h a s a n a r
r o w -m in d e d s ta ff, a s a r u le .
T h e y d o n ’t le t a n y b o d y in a n d t h e y
r e s is t a n y b o d y w it h a n id e a .
W e h a d a ca se in th e a c c id e n t b o a r d in w h ic h a m a n h a d b e e n
t r e a te d in a h o s p it a l a n d in g e n e r a l th e d ia g n o s is m a d e w a s th a t h e
h a d a n o p e r a t iv e c o n d it io n in c o n n e c t io n w it h a C h a r c o t jo in t . I sen t
a n im p a r t ia l e x a m in e r t o F a ll R iv e r t o see th e m a n , a n d o u r im p a r t ia l
e x a m in e r s a id t h a t th e m a n c o u ld b e r e lie v e d b y a b r a c e o f a s im p le
c h a r a c te r a p p lie d t o th e le g , a n d th a t it w a s n o t a “ C h a r c o t .”
The
im p a r t ia l e x a m in e r w a s c a lle d u p o n t o m a k e g o o d , a n d h e m a d e a
b r a c e a n d th e m a n w a s la r g e ly r e lie v e d o f h is s y m p t o m s a n d g o t a b o u t
o n h is f e e t ; b u t th e d a y a ft e r th e h e a r in g in w h ic h t h a t w a s d e te r
m in e d th e s o c ia l-s e r v ic e w o r k e r o f th a t h o s p it a l w e n t t o th e m a n a n d
MEDICAL COMPETENCE— FRANCIS D. DONOGHUE, M . D.
135
s a id th a t h e m u s t c o m e in f o r a n o p e r a t io n o r h e c o u ld n o t c o m e t o
th e h o s p it a l a t a ll f o r a n y p u r p o s e , a n d th a t w a s a h o s p it a l th a
w a s s u p p lie d b y th e in s u r a n c e c o m p a n y . H e r e w a s a ca se in w h ic h
c o m p e te n t m e d ic a l a u th o r ity d e c id e d h e c o u ld b e c u re d , th e b o a r d
s a id h e c o u ld b e c u r e d , a n d th e h o s p it a l s a id , “ Y o u b e o p e r a t e d o n o r
y o u d o n ’ t g e t a n y ‘t r e a t m e n t o f a n y k i n d . ”
S m a ll h o s p it a ls a n d g e n e r a l h o s p it a ls a ls o h a v e a d is a d v a n t a g e in
t h a t th e m e n w h o h a v e b e e n tr e a t e d b y p r iv a t e p r a c t it io n e r s w h o a re
o b lig e d t o g o in to th e h o s p it a l a re g iv e n n o t o n ly th e u o n ce o v e r ,” b u t
t h e o n c e , t w ic e , a n d t h r e e tim e s o v e r .
W h a tev e r h as been d on e fo r
th e m , t o th e m in d o f th e in te r n e , h a s b e e n w r o n g , a n d b e tw e e n w h a t
th e m a n w a s t o ld b y h is a t t e n d in g p h y s ic ia n a n d w h a t h e is t o l d b y
w h a t is k n o w n a s th e “ p u p ” in th e h o s p it a l, h is m in d is s o m e w h a t
u p set.
S h a ll w e p e r m it o r h a v e w e g o t t o p e r m it th a t, a n d f o r h o w lo n g ?
I n ju r e d w o r k m e n d o fa ll d o w n b e tw e e n th e g e n e ra l p r a c t it io n e r a n d
th e h o s p ita l w h ic h w ill n o t g iv e u s a d e q u a te tre a tm e n t.
T h e n th e re a re a fe w la r g e h o s p it a ls , a n d in t h is S ta te t h e y a re
good.
T h e y w ill b e b e tte r a n d w ill d o b e tte r w o r k as tim e g o e s o n
w h e n th e w o r k m a n is ta k e n in t o t h e ir c o n fid e n c e m o r e a n d e x p la n a
t io n s m a d e t o h im o f th e w h y s a n d w h e r e fo r e s o f th e tr e a tm e n t, a n d
w h e n h e i s u r g e d t o g o b a c k t o wT r k h e w i l l f e e l t h a t h e i s n o t b e i n g
o
u r g e d t o g o b a c k t o w o r k f r o m a s e lfis h s t a n d p o i n t w it h o u t r e g a r d
t o h is o w n p h y s ic a l w e lfa r e .
D r . C la r k h a s su g g e ste d th a t m en g o
b a c k t o w o r k , b u t u n d e r m e d ic a l s u p e r v is io n ; th a t a m a n s h o u ld b e
p r o v id e d t o w h o m th e in ju r e d m a n m a y t u r n w it h h is t r ia ls a n d t r i b
u la t io n s , w h o w ill e x p la in t o h im th e m e a n in g o f th e t h in g s th a
m a y h a p p e n t o h im a ft e r h e r e tu r n s , d is p la y a lit t le h u m a n in te r e s t;
a n d i f th e c o m p a n y h o s p it a ls d o th a t, as th e y d o in W o r c e s t e r a n d
in L y n n a n d as th e y d o in s o m e m e a s u r e in B o s to n , th e o ld fe e lin g
t h a t th e e m p lo y e r is a n e n e m y o f th e w o r k m a n w ill d is a p p e a r a n d
h e w ill co o p e ra te .
A s t u d y o f h o s p it a l r e s u lts s h o w e d t h a t h o s p it a ls a r e d is t i n c t l y
u n d e r m a n n e d in p r a c t ic a l ly e v e r y in s ta n c e .
I n o n e o f th e la r g e s
h o s p it a ls in th e C o m m o n w e a lth , t h r o u g h th e a c tio n o f th e b o a r d b y
p r e s s u r e b tit w it h o u t la w , t h a t h o s p it a l r e d u c e d th e n u m b e r o f b e d s
t o e a ch v is it in g s u r g e o n f r o m 9 2 t o 5 0 ; a n d 50 b e d s t o a m a n g i v in g
p a r t tim e is a lto g e th e r t o o m a n y , in m y o p in io n , e v e n t o -d a y .
The
p e o p le w h o k n o w m o s t a b o u t h o s p ita ls h a v e v e r y lit t le to s a y a b o u t
th em .
T h e p e r s o n w h o s h o u ld k n o w m o s t a b o u t h o s p it a l n e e d s a n d
t h e e ffic ie n c y o f t h e h o s p it a l is t h e d o c t o r , a n d t h e d o c t o r is s e ld o m
o n e o f th e tr u s te e s , a n d , i f h e is o n e , h e is v e r y o f t e n m o r e c o n c e r n e d
w i t h o t h e r t h in g s t h a n h o s p it a l e ffic ie n c y .
I n th e p r o g r a m t o -d a y y o u w e r e g iv e n a v is it t o th e M a ssa ch u se tts
G e n e r a l H o s p it a l, o n e o f o u r la r g e s t a n d o ld e s t in s titu tio n s .
Y ou
136
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
sa w m a n y th in g s th e re .
Y o u sa w a -g r e a t p la n t.
T h e r e is lit t le in
t h a t fa m o u s Z a n d e r r o o m , so im p r e s s iv e t o y o u a n d m e , w h ic h c a n
n o t b e d u p lic a t e d f o r s m a ll c o s t. T h e p r in c ip le in v o lv e d in e v e r y
o n e o f th o s e m o tio n s c a n b e m a d e o p e r a t iv e w it h a d is c a r d e d b ic y c le ,
a n o l d l a d d e ra, f e w s t r i p s o f p l a s t e r , a w h e e l t i e d o n t o t h e w a l l , a n o l d
r o c k i n g h o r s e , e t c ., i f y o u h a v e s o m e b o d y t o p u t b r a i n s i n t o i t .
The
fin e s t in s t it u t io n is n o t a s u b s t it u t e f o r m e d i c a l c o m p e t e n c e , a n d y o u
p e o p le w h o c o m e f r o m p la c e s w h e r e i t is d iffic u lt t o g e t th e s e e x p e n
s iv e e q u ip m e n ts n e e d n o t b e d is c o u r a g e d , b e ca u s e th e se c a n b e d u p li
c a te d a t v e r y s m a ll c o s t— a lm o s t n o co st.
T h e b la c k s m ith s h o p ,
w h ic h y o u s e ld o m t h in k o f in c o n n e c tio n w it h a h o s p it a l, is a r a r e
t h in g in a h o s p ita l, a n d m o s t d o c t o r s w h o p r e s c r ib e b r a c e s a n d m e
c h a n ic a l t h in g s s e ld o m ta k e th e t r o u b le t o g o in t o th e b la c k s m ith
s h o p . V e r y o ft e n th e y d o n o t k n o w i f th e se a p p lia n c e s a re p r o p e r ly
m a d e , b u t k i c k i f a b r a c e i s in e ffic ie n t.
Y o u fu r t h e r sa w th e p la c e
w h e r e th e o r t h o p e d ic m e n g o in t o th e b la c k s m ith s h o p b r a c e -m a k in g
d e p a r t m e n t a n d le a r n h o w t o fit b r a c e s .
T h e “ lo w - b a c k ” q u e s t io n i s o n e w h i c h e v e r y b o d y h a s d iffic u lt y
w ith , a n d th e q u e s tio n a ro s e t h is a ft e r n o o n a b o u t a h e a r t ca se.
The
q u e s t io n o f t e n a r is e s a b o u t a b a c k c a s e , a n d s o m e t im e s i t is d iffic u lt
to d e c id e w h e th e r a c o n d it io n is an a c c id e n t o r a n in ju r y .
M assa
c h u s e tts h a s a p e r s o n a l-in ju r y la w , a n d u n d e r t h a t la w p e r s o n a l in
j u r y m e a n s a n y i n j u r y w h i c h a r is e s o u t o f t h e e m p l o y m e n t .
The
la w h a s b e e n c o n s tr u e d lib e r a lly , a n d a n o ld b a c k , e s p e c ia lly w h e r e
it h a s a r th r itis , o r o ld -fa s h io n e d r h e u m a tis m , t h a t b a c k w h e n i t is
s t r a in e d — a n d i t m a y b e s t r a in e d b y a v e r y t r iv ia l h a p p e n in g — is a n
e x t r e m e ly d iffic u lt t h in g t o c u r e u n le s s a d e q u a t e m e d ic a l a t t e n t io n is
g iv e n ; a n d m o s t o f th e se ca ses, in m y e x p e r ie n c e , e x c e p t w it h s o m e
p e o p le f r o m w a r m c lim a t e s , d u r in g c o ld m o n t h s , c a n b e c u r e d , a t a
v e r y m u c h le s s c o s t t h a n t h e c o s t o f a h e a r in g b e f o r e t h e a c c id e n t
b o a r d , b y b r a ce s a n d s u p p o r t iv e m e a su re, b e a r in g in m in d th e p a
t ie n t ’s f o o d , r e g im e , m e th o d o f l iv in g — a n d h e re m u s t b e t a u g h t th e
n e e d as to th e k in d s o f f o o d a n d th e e lim in a tio n o f f o o d , in a d d it io n
to lo c a l m easu res.
T h e tim e m a y co m e th a t in in d u s tr ia l ce n te rs
h o s p ita ls w ill b e p r o v id e d f o r t e c h n ic a l in d u s t r ia l ca ses.
I do not
b e lie v e th a t t h a t is n e ce s s a r y t o -d a y .
I b e lie v e th a t th e t h in g th a t is
m o r e n e ce s s a r y , as in d ic a t e d t h is a ft e r n o o n , a n d w h ic h I in d ic a t e d
la s t y e a r a t C o lu m b u s , is t h a t i t w o u ld b e a t im e a n d m o n e y s a v in g
t h in g i f a m a n w it h a lo w c o m p e n s a t io n r a te , w it h a f a m i l y d e p e n d
i n g u p o n h im , s h o u ld b e ta k e n o u t a n d p u t o n a n in d u s t r ia l fa r m a n d
a llo w e d t o w o r k o u t h is t r o u b le s t o a g r e a te r d e g r e e o f c o m f o r t , r a t h e r
th a n to h a v e th e in s u r a n c e c o m p a n y p a y h im m o n e y in d e fin it e ly
w h ile h e is s u r r o u n d e d b y c o n d it io n s t h a t o b t a in in c e r t a in p a r t s o f
o u r g r e a t c it ie s .
MEDICAL COMPETENCE---- FRANCIS D. DONOGHUE, M . D.
137
T h e n e x t t h i n g t h a t I h a v e i n m i n d o n t h e q u e s t i o n o f h o s p i t a l effi
c ie n c y is th e r e h a b ilit a t io n o f w o r k m e n , w h ic h h a s ta k e n o n a n e w
s ig n ific a n c e .
I f w e h a d a p r o p e r s y s te m in t h is c o u n t r y o f w o r k
m e n ’s c o m p e n s a t io n a d m in is t r a t io n in a ll t h e S ta te s , t h e r e w o u ld n o t
n o w b e th e fe v e r is h e ffo r t t o p r o v id e r e c o n s tr u c tio n h o s p it a ls f o r th e
w o u n d e d th a t are to com e.
D r . P a tte r s o n th is a ft e r n o o n s a id t h a t
w e h a d ju s t as m a n y w o u n d e d e v e r y d a y in th e U n it e d S ta te s a s
w ill p r o b a b ly b e in E u r o p e , a n d w e h a v e n o a d e q u a te c e n t r a liz e d
sy ste m o f ta k in g c a re o f th ese m en .
T h e M a ssa ch u se tts L e g is la tu r e
a u t h o r iz e d in v e s t ig a t io n a s t o h o w t o r e h a b ilit a t e th e in ju r e d w o r k
m e n , a n d th is in v e s t ig a t io n w a s t u r n e d o v e r to th e S ta te b o a r d o f
e d u c a tio n .
T h e y r e p o r t e d a b i l l t o t h e l e g i s l a t u r e c a l l i n g f o r $ 1 5 ,0 0 0
f o r s o c ia l s e r v ic e w o r k e r s , b u t n o d o c t o r a n d n o n u rse . I t h in k t h a t
sp e a k s f o r its e lf.
I w a s in C a lif o r n ia la s t w e e k , a n d I c a lle d o n M r . P ills b u r y , t h e
c h a ir m a n o f th e C a lif o r n ia c o m m is s io n , a n d h e t o ld m e th a t in C a li
fo r n ia t h e y f o u n d th e r e w e r e h o s p it a ls a n d h o s p ita ls , a n d a t th e la s t
le g is la t u r e h e in d ic a t e d a f e w o f h is id e a s a l o n g t h is lin e , w o r k i n g
f o r a c h a n g e in th e la w .
“ T h e r e h a v e b e e n h o s p ita ls th a t w e re h o s
p it a ls in n a m e o n ly , b u t in fa c t w e r e m e re b u n k h o u se s, r o u g h a n d
u n s a n it a r y a n d in c o n v e n ie n t , a n d w it h a m e d ic a l s t a ff t h a t c o n s is t e d
e i t h e r o f s o m e y o u t h w h o h a d j u s t g o t h i s ‘ s h i n g l e ’ o r s o m e o ld ,,
b r o k e n -d o w n p r a c t it io n e r w h o h a d n o t g o tte n a n y w h e re .
W ith th e
h o p e o f p u t t in g a n e n d t o t h is c o n d it io n , th e le g is la tu r e , in s e c tio n
10
o f th e n e w a ct, g a v e th e c o m m is s io n p o w e r to in s p e c t a n d d e te r m in e
th e a d e q u a c y o f h o s p ita ls a n d h o s p ita l fa c ilit ie s s u p p lie d b y e m
p lo y e r s o r b y m u tu a l a s s o c ia tio n s o f e m p lo y e e s f o r th e tre a tm e n t o f
in ju r ie s c o m in g w it h in th e p r o v is io n s o f th e a ct.
E v e r y h o s p it a l
s u p p lie d b y e m p lo y e r s o r m u tu a l a s s o c ia tio n s o f e m p lo y e e s m u s t
m a k e r e p o r t s f r o m tim e to tim e to th e c o m m is s io n , o n d e m a n d , g iv
i n g a c c o u n t o f t h e ir r e c e ip t s a n d d is b u r s e m e n t s a n d s e r v ic e s r e n
d e r e d t o o r f o r e m p lo y e e s , a n d i f in th e ju d g m e n t o f th e c o m m is s io n
t h e s e r v ic e s o r e q u ip m e n t o f a n y s u c h h o s p it a l is in a d e q u a t e t o m e e t
t h e r e a s o n a b le r e q u ir e m e n t s o f m e d ic a l tr e a t m e n t c o n t e m p la t e d b y
th e a ct th e c o m m is s io n m a y , a ft e r n o tic e a n d a n o p p o r t u n it y t o b e
h e a r d , d e c la r e su ch fa c ilit ie s t o b e in a d e q u a te , a n d t h e r e a fte r in ju r e d
e m p lo y e e s o f § u c h e m p l o y e r m a y p r o c u r e t r e a t m e n t e ls e w h e r e , a n d
t h e r e a s o n a b le c o s t t h e r e o f s h a ll b e a c h a r g e a g a in s t s u c h e m p l o y e r ;
b u t i f , a ft e r fin d in g b y th e c o m m is s io n o f a c o n d it io n o f in a d e q u a c y ,
th e in s t it u t io n s h a ll b e p u t in a d e q u a te c o n d it io n , w it h a n a d e q u a te
m e d ic a l s ta ff, t h e fo r m e r f in d in g m a y b e m o d ifie d o r r e s c in d e d a n d
th e h o s p it a l b e r e in s t a te d in g o o d s t a n d in g .
“ I t is w o r t h y o f n o t i n g t h a t n o p a r t o f a n y c o n t r i b u t i o n p a i d b y
th e e m p lo y e e s o r d e d u c te d f r o m t h e ir w a g e s f o r th e m a in te n a n c e o f
138
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
s u c h h o s p it a l fa c ilit ie s s h a ll b e d e v o t e d t o th e p a y m e n t o f a n y p o r
t io n o f th e c o s t o f p r o v id i n g c o m p e n s a t io n p r e s c r ib e d b y th e a ct.
I t w i l l b e l a w f u l t o a sse ss e m p lo y e e s f o r s ic k b e n e fit s , b u t t h e e m
p l o y e r m u s t h im s e l f c o n t r ib u t e e n o u g h t o t h e f u n d , a t le a s t, t o p a y
f o r th e c a r e o f a ll t h o s e w h o a r e in ju r e d in h is s e r v ic e .”
T h a t is th e la w o f C a l if o r n i a . T h a t o u g h t t o b e t h e la w in e v e r y
S ta te , a n d i f , a s D r . B r ic k l e y in d ic a t e d in r e g a r d t o c a is s o n w o r k
e r s , w e s tr u c k b e f o r e th e e ffe c t, e v e r y w h e r e th e n u m b e r a n d ca u se s
o f a c cid e n ts w o u ld b e r e d u c e d .
I w a n t t o sa y ju s t o n e w o r d b e fo r e I p o in t o u t a fe w c o n c r e te
cases.
I t h in k w e s h o u ld n o t e n c o u r a g e t h e e s t a b lis h m e n t o f r e c o n
s t r u c t io n h o s p it a ls e x c e p t in c o n n e c t io n w it h s o m e in s t it u t io n a lr e a d y
o r g a n iz e d .
W e h a v e p o o r h o s p it a ls e n o u g h .
W e have unde
m a n n e d h o s p it a ls e n o u g h .
W e h a v e h o s p ita ls w it h in a d e q u a te
fa c ilit ie s f o r tre a tm e n t.
T h e m o n e y t h a t is e x p e n d e d f o r w a r w o r k ,
i f e x p e n d e d ju d ic io u s ly , a n d i f th e g r o u n d h a s b ee n p r o p e r ly b r o k e n
b y th e a c c id e n t b o a r d s , ca n b e e x p e n d e d t o g r e a te r a d v a n ta g e th a n
n o w a n d b e a lo n g th e lin e o f p e r f e c t in g th e in s titu tio n s w e a lr e a d y
h a v e b y p r o v id in g th e m w it h p r o p e r e q u ip m e n t f o r c o n d it io n s u n d e r
w a r o r p ea ce.
W e h a v e p o w e r p la n t s , a d m in is t r a t iv e b u ild in g s
w a r d s , o u t -p a t ie n t d e p a rtm e n ts .
H a v e y o u a n o r th o p e d ic d e p a rt
m e n t in y o u r h o s p it a l?
H a v e y o u a b la c k s m ith s h o p ?
I s n ’t
c h e a p e r t o p a y f o r th e e s ta b lis h m e n t o f a n o r t h o p e d ic d e p a r t m e n t
a n d a b la c k s m it h s h o p t h a n i t is t o g o o u t a n d b u il d a n e w b u il d in g
w it h u n d e r g r o u n d c o n n e c tio n s ?
T h e fr e e d o m o f c h o ic e s h o u ld n o t ta k e in a ll th e p a th s t h a t w e r e
in d ic a te d t o -d a y b y D r . P a tte rs o n .
I t s h o u ld in d ic a t e o n ly th e p a t h
o f r ig h te o u s n e s s , a n d a c c id e n t w o r k m u s t b e c a r r ie d o u t b y m e n w h o
h a v e s o m e t h in g e ls e in m i n d t h a n w h a t is i n it fin a n c ia lly .
T h e m en
in M a s s a c h u s e tts a p p r e c ia t e th a t th e y o w e a d u t y g r e a te r th a n th e
m oney.
T h e y h a v e a c c e p te d r e d u c t io n s in fe e s a n d th e h o s p it a ls
h a v e c o n t r ib u t e d t h e ir s e r v ic e s a t le s s t h a n c o s t t o t h e e n d t h a t t h e
w h o le c o m m u n it y m i g h t b e n e fit , a s t h e l e s s o n o f m e d i c a l e ffic ie n c y
t h a t c a n b e r e a liz e d u n d e r th e a ct, w it h th e o p p o r t u n it y t o m e a s
u r e th e t im e t h a t i t ta k e s t o c u r e , w i l l h a v e a d e t e r m in in g in flu e n c e
u p o n a n y fo r m o f s o c ia l a n d h e a lth le g is la t io n th a t is t o co m e , a n d
u n t il t h e c o m p e n s a t io n la w is p r o p e r ly o r ie n t e d , u n t il t h e h o s p it a l
u n its a r e p r o p e r ly s y s te m a tiz e d a n d o r g a n iz e d , i t is f o l l y t o t h in k o f
th e d u p lic a t io n o f e ffo r t a n d u t iliz a t io n o f m illio n s o f d o lla r s m o r e
in h e a lth in s u r a n c e w it h o u t s ta n d a r d iz a t io n .
W e h a v e th e w a y n o w ,
w e h a v e th e m a c h in e r y , a n d w e k n o w w h a t o u g h t t o b e d o n e .
The
a d v o c a t e s o f h e a lt h in s u r a n c e , w h ic h is b o u n d t o c o m e in t im e a n d
o u g h t t o c o m e in tim e , a t t h is s ta g e s h o u ld w o r k f o r s t a n d a r d iz in g
o f h o s p it a ls , th e m e a s u r in g o f t h e ir o u t p u t , n o t in th e c o s t p e r d a y
o f m ilk , v e g e t a b le s , a n d d r e s s in g s , b u t b y h o w m a n y d a y s i t ta k e s t o
p u t a m an back to w ork .
[ D r . D o n o g h u e t h e n s h o w e d s o m e s lid e s .]
THE VALU E
O F D IA G N O S IS IN B A C K L E S IO N S .
B Y JAM ES WARREN SEVER, M . D., JUNIOR ASSISTA N T SURGEON, CHILDREN’ S HOSPITAL,
BOSTON * CONSULTING ORTHOPEDIC
,
SURGEON, CAMBRIDGE H O S P IT A L ;
ORTHOPEDIC
SURGEON, W A LTH A M HOSPITAL.
T h e t it le o f m y p a p e r is a b i t m is le a d in g a n d s h o u ld r e a d “ T h e
n e c e s s it y o f a c o r r e c t d ia g n o s is in b a c k le s io n s .”
T h e r e is n o q u e s
t i o n in a n y o n e ’s m in d a s t o t h e n e c e s s it y o r v a lu e o f a d ia g n o s is in
a n y c a s e , b u t i t is e s s e n t i a l t h a t s u c h a d i a g n o s i s b e a s c o r r e c t a s
p o s s ib le , n o t o n ly t o e n a b le th e m e d ic a l m a n t o t r e a t i t p r o p e r ly b u t
a ls o t o fu r n is h th e c o m p e n s a t io n b o a r d a n d in s u r a n c e c o m p a n y w it h
c o r r e c t in f o r m a t io n o n w h ic h t o b a s e t h e ir fin d in g s .
F o r se v e ra l y e a rs n o w it h a s b e e n m y g o o d fo r tu n e , as an im p a r
t ia l e x a m in e r f o r th e M a ssa ch u se tts I n d u s tr ia l A c c id e n t B o a r d , to
h a v e seen m a n y ca ses w it h s tiff a n d p a in fu l b a ck s.
T hese have
o r ig i n a l l y b e e n se n t to m e f o r e x a m in a tio n a n d d ia g n o s is in th e
c o u r s e o f s o m e d i s p u t e a s r e g a r d s t h e i n d i v i d u a l ’s d i s a b i l i t y , w h i c h
o f c o u r s e in v o lv e s h is b e in g e n title d t o c o m p e n s a tio n .
I t h a s b e e n a g r e a t s u r p r is e to m e t o fin d th a t a la r g e n u m b e r
o f th e se ca ses s h o w e d fr a c t u r e s o f o n e o r m o r e v e rteb rse— s o -c a lle d
c r u s h fr a c t u r e s — w h ic h h a d w h o lly e s c a p e d n o t ic e , a n d t h e r e fo r e
tre a tm en t.
M a n y o f th e se in d iv id u a ls h a d g o n e f o r p e r io d s o f tim e
v a r y in g f r o m s e v e r a l w e e k s t o e v e n a y e a r w it h n o d ia g n o s is a n d n o
tre a tm en t.
I t h a s seem ed t o m e th a t t o b r in g su ch a c o n d it io n t o
y o u r a t te n tio n w a s w e ll w o r t h w h ile , e v e n i f i t d o e s r e fle c t s o m e w h a t
o n h o s p ita ls a n d th e m e d ic a l p r o fe s s io n .
F i r s t a n d la s t, it a ll c o m e s
d o w n t o a n a d e q u a te c h e c k in g u p o f th e p a t ie n t ’ s c o m p la in t , b y c a r e
f u l m e th o d s o f e x a m in a tio n , in c lu d in g th e X r a y , as w e ll as c a r e fu l
c o n s id e r a t io n o f th e h is t o r y o f th e a c c id e n t.
P r a c t i c a l l y a ll o f th e s e p e r s is t e n t b a c k d is a b ilit ie s o f t h e s e v e r e r
t y p e a r e t h e r e s u l t o f f a l l s — f10o m o 6 0 f e e t — a n d c a r e f u l q u e s
r t
t io n in g w il l b r in g o u t c e r ta in m e c h a n ic a l fe a tu r e s in r e g a r d t o th e
p o s i t i o n o f t h e p a t i e n t ’s b o d y a t t h e t i m e o f i m p a c t w h i c h m a y g o
a lo n g w a y t o w a r d m a k in g a c o r r e c t d ia g n o s is .
S im p le b a c k s tr a in s f r o m l i f t i n g a n d b e n d in g a r e g e n e r a lly o f
s h o r t d u r a t io n a n d d o n o t le a d t o d is p u te , f o r th e p e r io d s o f d is a
b ilit y are sh ort.
T h i s p a p e r , th e n , w ill b e l a r g e ly a d is c u s s io n o f
th e q u e s tio n o f d ia g n o s is in ca se s o f c o m p r e s s io n fr a c t u r e o f t h e
139
140
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
s p in e , a n d , t h e r e fo r e , b e f o r e g o i n g fu r t h e r it w ill b e n e c e s s a r y t o
g o i n t o d e t a il s o m e w h a t a s t o w h a t c o n s t it u t e s a c o m p r e s s io n f r a c
tu r e , its m e th o d o f p r o d u c t io n , th e n a tu r e o f th e a c c id e n t, d ia g n o s is ,
th e su b s e q u e n t c o u r s e , a n d th e q u e s tio n o f lo n g -c o n t in u e d o r p e r m a
n e n t d is a b ility .
D E F IN IT IO N OF COMPRESSION F R AC TU R E.
A c o m p r e s s io n f r a c t u r e o f a v e r te b r a is o n e w h e r e t h e b o d y o f
th e v e r te b r a is c r u s h e d o r fla tte n e d e v e n ly , o r m o r e o n o n e s id e t h a n
th e o th e r , d e p e n d in g o n th e d ir e c t io n o f th e a p p lic a t io n o f th e c ru s h
i n g fo r c e . A s a r u le it is m o r e c o m p r e s s e d o r c r u s h e d in th e a n t e r io r
p o r t io n th a n in th e p o s te r io r .
METHODS OF PRODUCTION.
C o m p r e s s io n fr a c t u r e s o f th e v e rteb ra e g e n e r a lly f o l l o w s e v e r e
v io le n c e , a p p lie d t h r o u g h th e l o n g a x is o f th e s p in e , o r w h ile th e
s p in e is f o r c i b l y fle x e d .
F a l l s o n t h e b u t t o c k s , s h o u ld e r s , o r b a c k ,
o r la n d in g o n th e fe e t f r o m a h e ig h t , c o m b in e d w it h f o r c i b l e fle x io n
o f th e s p in e , a re th e m o s t fr e q u e n t ca u se s.
N A T U R E OF ACCIDENT.
I n a n a n a ly s is o f th e c a se s w h ic h h a v e b e e n e x a m in e d b y m e th e
f o l l o w i n g a c c id e n t s c a u s e d c o m p r e s s io n fr a c t u r e s , e it h e r in o n e o r
m o r e v erteb ra e in t h e sa m e i n d i v i d u a l :
TABLE I.
(1) Fell 28 feet, landed on feet; second and third lumbar crushed, kyphos.
(2) Caught under electric car, back forcibly flexed; fifth lumbar crushed.
(3) FeU 50 feet from a tree, landed on back; second lumbar crushed, kyphos,
first to third lumbar.
(4) Jumped from burning building; fracture of fourth lumbar.
(5) Thrown from motor, landed on buttocks; fracture of fourth and fifth
lumbars.
(6) Struck on back by planks falling off roof; fracture of first and second
lumbars, kyphos.
(7) Fell 12 feet, landed on back; fracture of first lumbar.
(8) Fell 45 feet onto concrete floor; fracture of twelfth dorsal, first and
fourth lumbars.
(9) Walked out of second-story window in sleep, fell 15 feet; fracture of
twelfth dorsal, first and second lumbars, kyphos, twelfth dorsal, first
lumbar.
(10) Fell 30 feet, landed on buttocks; fracture of first lumbar.
(11) Ran over by heavy truck; fracture of transverse processes of fourth
lumbar vertebra.
(12) Fell 17 feet, landed on back; fracture of first lumbar, kyphos.
(13) Ran into second-hand Ford; fracture of fourth lumbar.
DIAGNOSIS IN BACK LESIONS---- J. W . SEVER, M . D.
141
(14) Fell 14 feet down elevator well, landed on buttocks; fracture of second
and third lumbars, kyphos.
(15) Fell with staging 50 feet; fracture of ninth, eleventh, and twelfth dorsal
and first lumbar, kyphos.
(16) Fell with staging 40 feet; fracture of twelfth dorsal, first lumbar.
(17) Fell 27 feet, landed on back; fracture of first lumbar, kyphos, first lmmbar.
(18) Fell with staging 40 feet, landed on feet; fracture of twelfth dorsal, first
and second lumbars, kyphos, twelfth dorsal.
(19) Fell 15 feet; fracture of first and second lumbars.
(20) Doubled up under wagon; fracture of first lumbar, kyphos.
(21) Fell 12 feet; fracture of first and second lumbars, kyphos.
(22) Fell 10 feet through hole in stairway; fracture of first lumbar, kyphos.
(23) Bag of flour fell on back; fracture of first lumbar, kyphos.
H e r e is c o n c r e t e e v id e n c e th a t f a l l s w i l l a n d d o c a u s e fr a c t u r e s o f
t h e s p in e , w it h o u t in m a n y c a s e s o t h e r s y m p t o m s th a n t h a t o f a la m e
a n d s tiff b a ck .
I t w ill b e n o t e d th a t a lm o s t tw ic e as m a n y fr a c t u r e s t o o k p la c e a t
th e le v e l o f th e fir s t lu m b a r v e r te b r a th a n a t a n y o t h e r lo c a t io n .
T h i s is p r o b a b ly d u e t o t h e f a c t t h a t t h e c e n t e r o f g r e a t e s t m o b i l i t y
o f th e s p in e is a t t h a t p o i n t , a n d a ls o t h a t i t is a n a r e a n o t v e r y
w e ll g u a r d e d , e x c e p t b y m u s c le s , w h ic h d o n o t o ff e r th e p r o t e c t i o n
t h a t is o ff e r e d t o t h e d o r s a l v e rteb ra e b y t h e r ib s .
(S e e T a b le I I .)
T A B L E II.
Location of fracture.
Ninth dorsal
Tenth dorsal
Eleventh dorsal.
Twelfth dorsal.
First lumbar
Second lumbar.
Third lumbar—
Fourth lumbar_.
Fifth lumbar__.
In d iv id u a l vertebrae a ffe cte d .
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _1
_
2
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _1
_
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _6
_
________________________________
14
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _8
_
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _2
_
____ JL_________________________
4
__________________________________
3
41
T h a t th e fr a c tu r e s a re n o t lim it e d t o o n e v e r te b r a in a n y s in g le
c a s e is e v id e n t f r o m t h e f a c t th a t o n l y 11 c a s e s o u t o f 2 3 s h o w e d
t h a t 1 v e r t e b r a a l o n e w a s i n j u r e d , 7 s h o w e d2 tvhea t e b r a e w e r e
r
fr a c t u r e d , 3 h a d 3 v e rteb ra e fr a c t u r e d , a n d 2 h a d 4 v e r t e b r a l b o d ie s
fr a c tu r e d .
C e r t a in ca s e s s h o w e d a d e f o r m i t y o f th e b a c k as a r e s u lt o f t h e
b o n y d e s tr u c tio n , k n o w n as a k y p h o s — a b a c k w a r d b o w i n g a t th e
p o in t o f fr a c t u r e , d u e t o a c o lla p s e o f t h e v e r t e b r a l b o d y .
Thi
k n u c k le o r k y p h o s is n o t a c o n s t a n t f a c t o r , b u t m a y r e s u lt f r o m t h e
fr a c t u r e o f o n e o r m o r e b o d ie s . I t is a d ia g n o s t ic p o i n t t o b e a r in
m in d , a n d m e a n s, o f c o u r s e , o n ly o n e t h in g , n a m e ly , d e s t r u c t io n o r
d i s t o r t i o n of t h e v e r t e b r a l b o d y .
A b 50 tp e r c e n t of t h e c a s e s
ou
s h o w e d t h is d e f o r m i t y , c o m i n g a p p a r e n t ly in t h o s e ca se s w h e r e t h e
142
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
fr a c t u r e w a s lo c a t e d n e a r th e d o r s o -lu m b a r ju n c t io n .
T he kyphos
m a y n o t m a k e its a p p e a r a n c e a t o n c e , f o l l o w i n g a n i n ju r y , b u t m a y
a p p e a r a n d in c r e a s e s o m e w h a t d u r in g th e c o n v a le s c e n t p e r io d w h e n
t h e i n d i v i d u a l is u p a n d a b o u t , e s p e c ia lly w h e n w it h o u t p r o p e r b a c k
su p p o rt.
SYMPTOMS.
T h e in te r e s tin g t h in g a b o u t th e se cases, a n d p r o b a b ly th e re a so n
w h y s o m a n y o f t h e m a r e n o t d ia g n o s e d a t fir s t, is t h a t t h e y c o m
p la in o n ly o f a s t iff a n d p a in fu l b a c k , g e n e r a lly w it h te n d e rn e s s o v e r
t h e s ite o f th e fr a c t u r e . V e r y fe w o f th e ca ses h a v e a n y s y m p t o m s
d u e t o n e r v e p r e s s u r e , a n d m a n ife s t e d as lo s s o f s e n s a tio n , o r p a r a l
y s is o f th e le g s , o r in c o n t in e n c e o f th e b la d d e r a n d r e c tu m , w h ic h
a r e a lw a y s seen in ca ses o f c o m p le t e fr a c t u r e o f th e b a c k , w h e r e th e
s p in a l c o r d is cru s h e d . T h is la c k o f n e r v e in v o lv e m e n t is p r o b a b ly
d u e t o th e f a c t th a t th e s p in a l c o r d e n d s a t a b o u t th e le v e l o f th e
fir s t lu m b a r v e r te b r a , th e p o in t o f g r e a te s t fr q u e n c y o f fr a c tu r e ,
a n d so e sca p e s in ju r y . C E d em a a n d h e m o r r h a g e a b o u t th e c o r d m a y
le a d to t e m p o r a r y p a r a ly s is f r o m p re s s u re , b u t th e s y m p to m s f r o m
t h is c o n d it io n u s u a lly s o o n c le a r u p .
P r a c t ic a ll y a ll c a se s c o m p la in o f a s tiff, la m e , a n d p a in f u l b a c k .
T h e y ca n n o t b e n d fr e e ly , a n d a re m o r e lim ite d in s id e b e n d in g th a n
in f o r w a r d b e n d in g .
W i t h o u t t r e a t m e n t — t h a t is , s u p p o r t t o t h e
s p in e — th e y g o a lo n g c o m p la in in g o f th e sa m e c o n d it io n s w it h o u t
r e lie f u n til th e fr a c t u r e is d is c o v e r e d .
T h e ir d is a b ilit y a t fir s t is
g e n e r a lly c o m p le te , b u t as tim e g o e s o n t h e y a r e a b le t o b e u p a n d
a b o u t, b u t n o t a b le t o d o h e a v y w o r k .
TABLE III.
Date of accident.
July, 1910................................................ .
Oct. 7,1914......................................................
June 24,1914....................................................
Feb. 18,1915....................................................
Mar. 28,1915....................................................
Apr. 2,1915......................................................
Apr. 28,1915.....................................................
Sept. 27,1915...................................................
July 31,1916.....................................................
Dec. 26,1916.................................................
Feb. 14,1914....................................................
Aug. 16,1915....................................................
Dec. 27,1915.....................................................
Nov. 26,1915....................................................
April 30,1916...................................................
July 31,1914.....................................................
Oct. 31,1912.................................................
Oct. 19,1915.....................................................
Sept. 24,1915...................................................
Nov. 6,1916......................................................
Diagnosis made by Treatment before
diagnosis.
X ray after—
5 months............... None...................... None.
6 months............... Back brace.........
Back brace.
1 year.................... B e lt for last 4
months...............
Do.
4 months................ None...................... Jacket.
....... do.................... ....... do.................... Back brace.
6 months............... ....... do....................
Do.
3 months............... ....... do..................... Brace.
At once................. ....... do..................... Bed.
4 months............... ....... do..................... Jacket and brace.
3 weeks.................. ....... do..................... Corset.
1 month................. ....... do..................... Belt.
At once................. ....... do..................... Jacket.
2 months............... Bed.................
Brace.
4 months............... None......................
3 months............... ....... do................... 2>
Brace.
At once.................. ....... do..................... Frame and jacket.
3 months...............
..do.............
Brace.
....... do....................
...d o.................... Jacket.
4 months...............
. . .do.................... (?)
3 months...............
.d o .....___
(?)
Average.................................................. 4 months...............
Treatment
after
diagnosis.
DIAGNOSIS IN BACK LESIONS— J. W , SEVEB, M . D.
143
I t m ig h t b e o f in t e r e s t t o y o u t o le a r n t h a t a n a n a ly s is o f 17 o f
th e ca ses s h o w e d th a t n o d ia g n o s is w a s m a d e o f th e fr a c t u r e a t an
a v e r a g e o f fo u r m o n th s fr o m d a te o f th e a c c id e n t.
S e v e r a l cases
w e n t fiv e a n d s ix m o n th s , a n d o n e a y e a r , b e f o r e a d ia g n o s is w a s
m ade.
T h i s is n o t b e c a u s e t h e d i a g n o s i s i s a t a l l d i f f i c u l t t o m a k e ,
b u t s i m p ly b e c a u s e r e a s o n a b le a n d d u e c a r e is n o t u s e d in t h e e x a m i
n a t io n o f th e p a t ie n t . I t is c e r t a in ly s t r ik i n g a n d m a k e s o n e t h in k
t h a t th e s e e k e r a f t e r c o m p e n s a t io n is n o t a lw a y s in t h e w r o n g , o r t h a t
h is s y m p t o m s a re n o t a lw a y s so s u b je c t iv e t h a t t h e y ca n n o t b e
p in n e d d o w n t o s o m e a d e q u a te a n a to m ic a l d e fe c t.
(S e e T a b le I I I . )
I n r e g a r d to som e o f th e g r a v e r s y m p to m s a c c o m p a n y in g th ese
fr a c tu r e s , c e r ta in o f th e ca ses s h o w e d d e fin ite s ig n s o f in ju r y to th e
s p in a l c o r d , m a n ife s t e d b y lo s s o f s e n s a tio n in o n e o r b o t h le g s , n o t
c o m p le t e , a n d m o r e o r le s s p a r a ly s is , e it h e r e a r l y o r la te .
Som e o f
th e ca ses w h ic h s h o w e d e a r ly lo s s o f m u s c u la r p o w e r r e c o v e r e d
i t w h o lly , o th e r s h a v e s u ffe r e d p e r m a n e n t d a m a g e t o th e c o r d fr o m
p r e s s u r e o f th e in ju r e d verteb ra e, a n d w il l a lw a y s h a v e s o m e p a r
a ly s is o f th e le g s .
T w o o f th e w o r s t ca se s, w h ic h s h o w e d p a r a ly s is f r o m th e fir s t,
a r e r a th e r in t e r e s tin g .
O n e w a s tr e a te d f o r p le u r is y w it h e ffu s io n ,
o r r a th e r t o ld th a t h e h a d it b u t w a s n o t tre a te d , a n d n o e x a m in a tio n
o f h is b a c k w a s m a d e , a n d th e o t h e r w a s tr e a te d i n a h o s p it a l f o r
s e v e n w e e k s f o r h y s te r ia , m e a n w h ile s u ffe r in g f r o m u r in a r y r e
t e n tio n a n d p a r a ly s is o f b o t h le g s , a n d n o e x a m in a t io n w a s m a d e o f
h e r b a c k u n t il th e e n d o f t h a t tim e , w h e n a n X r a y w a s ta k e n , w h ic h
s h e w a s t o l d s h o w e d n o t h in g .
T h e tre a tm e n t, o f c o u r s e , in a ll th e se ca se s s h o u ld b e a d e q u a te
fix a t io n o f th e s p in e , in a p la s te r ja c k e t a t fir s t a n d la t e r b y m e a n s
o f a b a c k b ra ce . T h e w h o le p e r io d o f tre a tm e n t w ill p r o b a b ly c o v e r
a p e r io d o f s e v e r a l y e a r s . T h e q u e s tio n o f a n o p e r a t io n o n th e s p in e
d e s ig n e d t o fu r n is h s u p p o r t t o t h e c r u s h e d verteb ra e h a s b e e n c o n
s id e r e d , a n d I b e lie v e h a s b e e n d o n e in s o m e ca ses. T h e u s u a l t y p e
o f o p e r a t i o n is t h a t w h i c h u s e s a b o n e s p l i n t f r o m t h e t i b i a i n
s e r te d in t o t h e s p in o u s p ro c e s s e s .
T h is p ro ce d u re m a y sh o rte n th e
p e r io d o f c o n v a le s c e n c e s o m e w h a t, a n d m a y le a d e v e n tu a lly t o a
s o m e w h a t s t r o n g e r b a c k in c e r t a in ca ses. E n o u g h d a t a h a s n o t b e e n
c o lle c t e d , h o w e v e r , t o e n a b le m e t o sta te d e fin it e ly w h e th e r t h is
o p e r a t io n s h o u ld b e u se d as a r o u tin e in a ll cases.
A s th e c a llu s
fo r m s a b o u t t h e fr a c t u r e th e s p in e lo s e s it s r e s ilie n c e a n d b e c o m e s
s tiff, e s p e c ia lly t o s id e b e n d in g , b u t th e w ea k n ess a n d som e s o r e
n e s s p e r s is t, e s p e c ia lly a f t e r e x e r t io n , s u c h a s w a lk in g , b e n d in g , o r
lift in g .
I t is o b v io u s t h a t t h e s e i n d i v i d u a l s a r e t o t a l l y d is a b le
f r o m f u r t h e r h e a v y w o r k . T h e r e m a y b e e x c e p t io n s t o t h is s ta te
m e n t , b u t it is a g o o d r u le t o g o b y , t h a t o n c e a la b o r e r h a s h a d a
144
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
c o m p r e s s io n fr a c t u r e o f th e s p in e , h e h a d b e t t e r b e g in t o l o o k f o r
som e o th e r k in d o f a jo b . T h e s o o n e r h e g e ts lig h t w o r k th e b e tte r
it is f o r h im a n d f o r t h e in s u r a n c e c o m p a n y , a n d h e r e I m i g h t a d d
th a t th e s o o n e r th e in s u r a n c e c o m p a n y ta k e s a n in t e llig e n t in te re s t
in th e tr e a t m e n t o f th e se in d u s t r ia l a c c id e n t s , b y s e e in g t h a t fir s t
o f a l l a d i a g n o s i s is m a d e a n d t h e n p r o p e r a n d c o m p e t e n t a f t e r
tr e a t m e n t is c a r r ie d o u t , w it h a s fr e q u e n t m e d ic a l a t t e n t io n a s is
n e c e s s a r y th e b e t t e r it w ill b e f o r th e m a n d th e i n ju r e d p a r tie s .
T h is m a y seem t o b e a n a d d it io n t o th e a lr e a d y h e a v y m e d ic a l e x
p e n se t h e y a ll c la im th e y a re u n d e r , b u t s u ch a c o u r s e w o u ld s o o n
p a y f o r it s e lf a n d b e c o m e a p r o fit , i f p u t in th e p r o p e r h a n d s , as
e v e n tu a lly it w o u ld s h o w a m a r k e d r e d u c t io n in c o m p e n s a t io n a l
lo w a n c e s . M e n w o u ld g e t b a c k t o w o r k m u c h s o o n e r a n d w o u ld n o t
d r i f t a b o u t, a s m a n y d o n o w , w it h lit t le o r n o tre a tm e n t, a n d c o n
tin u e d in a b ilit y to w o r k b e ca u se o f th e ir la c k o f tre a tm e n t.
CASE HISTO R IES.
T h e fir s t 11 ca s e s in t h is s e r ie s h a v e b e e n r e p o r t e d in d e t a il in t w o
p r e v i o u s p u b l i c a t i o n s b y t h e a 1 t a no dr m a y b e c o n s u l t e d t h e r e .
u h
T h e rest o f th e ca ses w ill b e r e p o r te d in d e ta il h e re in th e o r d e r as
s h o w n in T a b le I .
J------- S------- (Case 12).
M a le .
F e ll 17 fe e t w h e n a la d d e r b ro k e , J u ly 31, 1916.
S een
N o v e m b e r 17, 1916. N o le g p a r a ly s is ; b la d d e r a n d re ctu m n o t in
v o lv e d . F o r fir s t t w o w e e k s a f t e r i n ju r y w a s t r e a t e d b y h a v i n g b a c k
s tr a p p e d . T h e n h a d h ig h fr e q u e n c y a p p lie d f o r “ n e u r it is ” f o r s e v
e r a l w e e k s w it h o u t b e n e fit .
N o fu r t h e r tre a tm e n t u n til N o v e m b e r ,
1916, w h e n b a c k w a s X r a y e d a n d a p la s te r ja c k e t a p p lie d w h ic h
w a s w o r n t h r e e wre e k s . H e c o m p l a i n s o f p a i n i n t h e b a c k , e s p e c i a l l y
o n s t o o p in g , a n d is u n a b le t o l i f t a n y t h in g .
W a s in b e d a t fir s
f o r th re e w eek s. F o llo w in g r e m o v a l o f ja c k e t w o r e a n a r r o w ca n v a s
b e lt a r o u n d h ip s .
E x a m i n a t i o n o f b a c k m a d2e, 1 9 1n7e s h o w s
Ju ,
th a t h e h a d a s m a ll k y p h o s in th e r e g io n o f th e t w e lft h d o r s a l a n d
fir s t lu m b a r v e rteb ra e. H e b e n d s f o r w a r d p r e t t y w e ll, b u t h is b a c k
is s t i f f in b e n d in g in o t h e r d ir e c t io n s . H i s n e r v o u s r e fle x e s a r e n o r
m a l, a n d h e h a s n o lo s s o f s e n s a tio n o v e r a n y s k in a rea s.
The X
r a y s h o w s a c o m p r e s s io n f r a c t u r e o f t h e b o d y o f th e fir s t lu m b a r
v erteb ra .
T h is m a n w a s la te r fitte d w ith a p r o p e r s p r in g b a c
b r a c e a n d w a s seen a g a in in A u g u s t , 1917, w h e n h e h a d im p r o v e d
s u ffic ie n t ly t o d o l i g h t w o r k . H i s b a c k s t ill g o t t ir e d a n d t h e k y p h o s
s t ill e x is te d . H i s d is a b il i t y o f c o u r s e is p e r m a n e n t .
1 Surgery, Gynecology, and Obstetrics, March, 1 9 1 6 ; Boston Medical and Surgical Jour
nal, Vol. CLXXIV, No. 17, April 27, 1916.
DIAGNOSIS IN BACK LESIONS---- J. W . SEVER, M. D.
145
H ------- H --------- (Case 13).
M a le ; a g e 47. S tr u c k in b a c k b y th e m u d g u a r d o f a m o to r c a r
a n d th ro w n a cross a g a ra g e.
H e w a s a b le t o g o h o m e a n d la t e r
h a d h is b a c k s t r a p p e d , w h ic h g a v e h im s o m e r e lie f. H a s p a in in t h e
b a c k a ll th e tim e , lo w d o w n , b u t i t d o e s n o t g o in t o le g s . N e v e r h a d
a n y p a r a ly s is o r lo s s o f s e n s a tio n .
T h e p a in d oes n o t k e e p h im
a w a k e , a n d h e c a n lie o n h is b a c k b e tte r th a n h e c a n o n h is s id e .
C o m fo r t a b le w h e n s it t in g d o w n b u t g o e s u p a n d d o w n s ta ir s o n ly
w it h d iffic u lt y .
B e e n u n a b le t o w o r k s in c e a c c id e n t th r e e w e e k s
ago.
E x a m i n a t i o n s h o w s t h a t h i s b a c k is t e n d e r a n d s e n s i t i v e i n t h e
m id d le lin e lo w d o w n . H e is s t iff in b e n d in g in a n y d ir e c t io n . T h e
s e n s a t i o n i s n o r m a l e x c e p t t h a t t h e r e is s o m e h y p e r s e s t h e s i a o v e r t h e
b u t t o c k s a n d u p p e r s a c r a l r e g io n . T h e k n e e je r k s a r e n o r m a l. A n
X r a y sh o w e d th a t th e re h a d b een a fr a c tu r e o f th e le ft-h a n d u p p e r
c o r n e r o f th e fift h lu m b a r v e rte b ra , a n d a p a r t ia l c ru s h o f th e r ig h t
s id e o f th e b o d y o f th e fo u r t h lu m b a r .
T h e r e w a s a ls o a s lig h
la t e r a l d is p la c e m e n t o f t h e w h o le s p in e a b o v e t h e f i f t h lu m b a r .
T h i s i n ju r y w a s t h e r e s u lt o f a d ir e c t v io le n c e , a n d w a s c o m p le t e ly
d is a b lin g as f a r as h is a b ilit y t o w o r k w e n t. A h e a v y c a n v a s c o r
s e t w a s m a d e f o r h i m , w h i c h h e h a s b e e n w e a r i n g n o w f7 r a b o u t
o
m o n t h s w i t h g r e a t r e l i e f . H e is a b l e t o d o m o s t o f h i s u s u a l w o r k
e x ce p t h e a v y liftin g .
H e h a s to w e a r th e c o r s e t n ig h t a n d d a y
a n d s till h a s a s tiff, a n d o c c a s io n a lly p a in fu l, b a c k .
H ------- M--------- (Case 1 4).
M a le ; a g e 44.
A c c id e n t F e b r u a r y 14, 1914.
E x a m in e d M a y 5
1917.
F e l l d o w n a n e le v a t o r w e ll a d is t a n c e o f a b o u t 15 f e e t a n d
la n d e d s it t in g d o w n . H e w a s ta k e n t o a h o s p it a l, w h e r e h e s ta y e d
a fe w h o u r s a n d h a d n o tr e a tm e n t, g o i n g h o m e la te r o n th e e le c t r ic
cars.
H e w a s in b e d f o r fiv e w e e k s , d u r in g w h ic h p e r i o d h is b a c k
w a s s t r a p p e d . H e n e v e r h a s h a d a n y p a r a ly s is o r lo s s o f s e n s a tio n .
F o r th e la s t y e a r o r so h e h a s w o r n a c a n v a s b e lt, w h ic h m a k e s h im
m o r e c o m fo r t a b le . H e c o m p la in s o f p a in a n d w e a k n e s s in th e b a c k ,
a n d t h in k s t h a t th e c o n d it io n is n o t b e t t e r t h a n a ft e r th e a c c id e n t .
T h e r e a r e s o m e d a y s w h e n h e i s f r e e f r o m p a i n , b u t wT e n h e h a s i t
h
i t is l o c a l i z e d i n t h e s m a l l o f t h e b a c k . H e is a b l e t o d o l i g h t f a r m
w o r k , b u t c a n n o t l i f t o r s a w w o o d , a n d h a s b e e n u n a b le t o g o b a c k
t o h is p r e v io u s o c c u p a t io n a s a m e a t c u tte r .
E x a m in a tio n sh o w s
th a t h e is a w e ll-d e v e lo p e d a n d n o u r is h e d m a n , w h o w a lk s n o r m a lly ,
a n d h a s a r a t h e r s h o r t , b r o a d b a c k . T h e r e is a s m a l l k y p h o s i n t h e
lu m b a r r e g io n a b o u t th e le v e l o f th e s e c o n d lu m b a r v e r te b r a .
H is
b a c k is n o t s t iff, a n d h e c a n b e n d f a i r l y w e ll in a ll d ir e c t io n s .
An
78532°—Bull. 248—19----- 10
146
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
X r a y sh ow s th a t h e h as h a d a cru sh fr a c tu r e o f th e se co n d a n d
t h ir d lu m b a r v e r te b r a l b o d ie s , th e s e c o n d b e in g c ru s h e d m o r e th a n
th e th ir d .
H e r e is a n in d i v i d u a l w h o h a s g o n e a b o u t f o r t h r e e a n d a h a l f
y e a r s w ith n o m o r e s u p p o r t th a n a lig h t c a n v a s b e lt p a r t ia lly t o
h o ld a fr a c t u r e o f t w o v e r te b r a l b o d ie s . H e h a s d o n e p r e t t y w e ll in
s p it e o f t h is , b u t s h o u ld h a v e h a d a ja c k e t o r b a c k b r a c e . W i t h b e t
t e r s u p p o r t h e w o u l d e v e n n o w b e a b l e t o d o m o r e w o r k . H e is , o f
c o u r s e , p e r m a n e n t ly d is a b le d .
j ------- b --------- W --------- (Case 1 5 ).
M a le ; a g e 44.
A c c id e n t A u g u s t 16, 1915.
E x a m in a tio n M a r c h
14, 1916.
T h i s m a n f e l l w it h a s t a g in g a d is t a n c e o f a b o u t 50 fe e t.
H e w a s m a d e u n c o n s cio u s a n d d o e s n o t k n o w h o w h e s tru ck .
H e w as
in a h o s p it a l f o r o v e r t h r e e w e e k s , w h e r e h e h a d a p la s te r ja c k e t
a p p lie d , w h ic h h e w o r e o n ly a w eek .
S in c e th e n h e h a s w o r n n o t h in g
t o s u p p o r t h is b a c k e x c e p t a n a r r o w c a n v a s b e lt.
H e w a s in a n oth er
h o s p it a l, a la r g e m e t r o p o lit a n o n e , f o r t w o w e e k s , s o m e tim e la te r ,
w h e re h e h a d n o tre a tm e n t, b u t h a d a n u m b e r o f X r a y s ta k en fo r
p u r p o s e s o f d ia g n o s is .
T h e fir s t w e e k f o l l o w i n g th e a c c id e n t h e h a d
t o b e c a th e te riz e d , b u t s in c e th e n h a s h a d g o o d c o n t r o l o v e r b la d d e r .
H e c o m p la in s o f w e a k n e s s in b o t h le g s , a n d b o t h le g s fe e l as i f th e y
w e r e a s le e p .
H e ca n n o t s ta n d w e ll w it h o u t s u p p o r t, a n d h a s
d o u b le to e d r o p .
E x a m i n a t i o n s h o w s t h a t h e w a l k s wri t h r a t h e r a n
a t a x ic g a it .
B o t h f e e t s h o w n o m u s c le p o w e r e x c e p t v e r y s lig h t in
to e fle x o r s a n d m o d e r a t e in g a s tr o c n e m iu s .
T h e o t h e r l e g m u s c le s
a re o f g o o d stre n g th .
D o u b le a n k le c lo n u s a n d k n e e je r k s m u c h e x a g
g e ra te d .
N o B a b in s k i.
S e n s a tio n t o p in p r i c k s o m e w h a t d im in is h e d
o v e r lo w e r t h ir d o f b o t h le g s .
T h e b a c k s h o w s a k y p h o s in th e r e g io n
o f th e n in t h a n d t e n th d o r s a l v e rte b ra e , n o t te n d e r .
T h e b a c k is s tiff
a n d h e c a n n o t b e n d e a s ily o n a c c o u n t o f lo s s o f c o n t r o l o f th e le g s .
A n X r a y s h o w s th a t th e n in th d o r s a l v e rte b ra is c ru s h e d r a th e r
e v e n ly a n d s y m m e t r ic a lly .
T h e te n th d o r s a l is a p p a r e n t ly u n in
ju r e d , th e e le v e n th a n d t w e l f t h d o r s a l a n d fir s t lu m b a r v e rte b ra )
a r e c r u s h e d , e s p e c ia lly th e t w e lft h d o r s a l, w h ic h is m a r k e d ly fla t
te n e d a n d d is p la c e d la t e r a lly .
I n th e lo w lu m b a r r e g io n th e in te r v e r t e b r a l s p a c e b e t w e e n t h e f o u r t h l u m b a r a n d f i f t h l u m b a r is p a r
t ia lly o b lite r a te d b u t n o fr a c t u r e ca n b e m a d e o u t.
T h is m a n o b v i
o u s ly h a s a p e r m a n e n t d is a b ility .
T h e c o r d i n j u r y is s l i g h t , c o n s i d e r
i n g th e n u m b e r o f verteb ra e in ju r e d .
T h e l a c k o f t r e a t m e n t is n o t
u n u s u a l, a n d h e w o u ld b e b e tte r w it h p r o p e r s u p p o r t .
H e w ill n ev e r
b e a b le t o d o m u c h o f a n y t h in g in t h e w a y o f w o r k , e x c e p t w h a t c a n
b e d o n e s it t in g d o w n .
DIAGNOSIS IK BACK LESIONS— J . W . SEVER, M . B.
147
C------- B--------- (Case 1 6).
M a le ; a g e 38.
A c c id e n t D e ce m b e r 27, 1915.
E x a m i n e1d* M a r c h .
1916.
T h is m a n f e l l a b o u t 40 fe e t w h e n a s t a g in g h e w a s o n c o l
la p se d .
H e w a s m a d e u n c o n s c i o u s a n d wT s t a k e n t o a n e a r - b y h o s
a
p it a l.
H e h a d n o t r o u b le w it h h is b la d d e r o r r e c t u m , a n d c o u ld m o v e
h is le g s f r o m th e fir s t, b u t s ta te d th a t it h u r t h im t o d o so.
H e sta ted
t h a t h e la n d e d o n h is fe e t w h e n h e f e l l a n d b e c a m e u n c o n s cio u s .
In
th e h o s p it a l h e h a d s o m e X r a y s ta k e n o f h is b a c k , w h ic h h e w a s t o ld
w a s u n in ju r e d a n d th a t th e X r a y s s h o w e d n o t h in g a b n o r m a l.
He
s ta y e d in b e d in th e h o s p it a l f o r a b o u t 3 0 d a y s a n d th e n w e n t h o m e .
H e h a d n o tr e a tm e n t f o r h is b a c k .
S in c e g o in g h o m e h e h a s b e e n
u p a n d a b o u t, a lt h o u g h h e h a s h a d t o u se a ca n e , o n a c c o u n t o f p a in
a n d s w e llin g in h is le g s .
H e h a s n o t b e e n a b le t o g o b a c k t o h is w o r k
a s a p la s t e r e r .
E x a m in a t io n s h o w e d th a t h is b a c k w a s v e r y s tiff a n d
ten d er.
T h e r e w a s a s lig h t k y p h o s in th e d o r s o -lu m b a r r e g io n .
The
k n e e je r k s w e r e in c r e a s e d a n d h e h a d a s lig h t a n k le c lo n u s o n th e r ig h t
a n d o n e m o re m a r k e d on th e le ft.
T h e s e n s a tio n w a s n o r m a l.
An
X r a y o f th e s p in e s h o w e d a c r u s h fr a c t u r e o f th e t w e lft h d o r s a l a n d
fir s t lu m b a r v e rte b ra e , w it h a q u e s t io n o f i n ju r y t o th e s e c o n d lu m b a r .
A t t h is tim e h e w a s w e a r in g n o s u p p o r t f o r th e b a c k a n d h a d n e v e r
h ad any.
T h is m a n w a s see n a g a in a y e a r la te r .
H e w a s s t ill u n a b le
t o w o r k , o n a c c o u n t o f p a in in th e b a c k .
H is le g s a re n o t s t r o n g a n d
h e h a s to w a lk w it h a ca n e , b u t c a n g e t a b o u t b e tte r th a n h e c o u ld a
year ago.
H e is n o w w e a r in g a c o r s e t w h ic h h e g o t t h r o u g h s o m e
m a g a z in e a d v e r t is e m e n t , in s p it e o f th e f a c t t h a t h e is a ls o r e c e iv in g
b a c k e x e r c is e s a t a la r g e o r t h o p e d ic c lin ic .
H is k n ee je r k s a re n o w
n o r m a l a n d th e a n k le c lo n u s h a s d is a p p e a r e d .
J -------- P---------- (Case 1 7 ).
M a le ; a g e 28. A c c id e n t N o v e m b e r 26, 1915. E x a m in a tio n M a r c h
29, 1916.
T h is m a n w a s w o r k in g o n a p ile d r iv e r w h e n h e f e ll 27
fe e t a n d in ju r e d h is b a c k .
H is fa ll w a s b rok en som ew h a t b y a cross
b a r w h ic h s tr u c k h im a c ro s s th e b a ck .
H e a ls o b r o k e h is l e f t l e g a t
t h e a n k le .
H e w a s ta k e n t o a h o s p it a l a n d a ca st w a s p u t o n th e
le g , b u t h e h a d n o e x a m in a t io n o r tr e a tm e n t f o r h is b a c k .
S in c e le a v
i n g th e h o s p it a l h e h a s b e e n a t h o m e u n a b le t o w o r k o n a c c o u n t o f
p a in in t h e b a c k a n d d is a b il i t y in t h e a n k le .
E x a m in a tio n o f th e
b a c k s h o w s t h a t it is v e r y fle x ib le .
T h e r e is a s m a ll k y p h o s o n s t a n d
i n g a t a b o u t th e e le v e n th d o r s a l v e r te b r a .
H i s n e r v o u s r e fle x e s a re
n o r m a l.
A n X r a y s h o w e d a f r a c t u r e o f la m in a o f th e fir s t lu m b a r
v e r t e b r a w it h d is p la c e m e n t d o w n w a r d o f th e d is t a l e n d s o f th e la m in a
a n d its a tta c h e d s p in o u s p r o c e s s .
T h is m a n ’s b a c k w a s n o t h is p r i n
c ip a l d iffic u lt y b u t i t is in t e r e s t in g t h a t h e n e v e r h a s h a d a n y t r e a t
m e n t f o r i and has been able t o get about w i t h o u t m u c h d i s c o m f o r t .
t
148
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
F------- G--------- (Case 18).
M a le ; a g ed 45.
A c c id e n t, A p r il 30, 1916.
E x a m in a tio n F e b r u a r y
T h is m a n fe ll a b o u t 40 fe e t w h e n a s c a ffo ld in g g a v e w a y .
H e la n d e d o n h is fe e t , a n d w a s t h e n b e n t f o r w a r d v io le n t ly , h is
k n e e s c o m i n g in f o r c i b l e c o n t a c t w it h h is r ib s .
H e w a s la id u p in
b e d a t h o m e f o r s ix w e e k s, n o t a b le t o g e t u p b e c a u s e o f p a in in
th e b a ck .
H e h a s n e v e r h a d a n y t r o u b le w it h h is b o w e ls o r d iffic u lty
in p a s s in g h is w a t e r .
H a s n e v e r h a d a n y lo s s o f p o w e r in h is le g s
o r lo s s o f s e n s a tio n .
S o m e tim e in J u ly , 1916, h e w e n t t o th
M a s s a c h u s e tts G e n e r a l H o s p it a l, w h e r e h e w a s fitte d w it h a b a c k
b r a c e , w h i c h h e h a s w o r n m o r e o r le s s e v e r s in c e .
T h is h a s g iv e n
h im s o m e c o m f o r t a n d r e l i e f f r o m p a in .
F o r th e la s t f o u r m o n th s
h e h a s b e e n h a v in g m a s s a g e a n d m a n ip u la t io n f o r h is b a c k b y h is
o w n p h y s ic ia n .
H e sta te d th a t h e w a s g e t t in g b e tte r s lo w ly , a n d
w a s a b le t o d o c h o r e s a r o u n d t h e h o u s e , b u t w a s n o t a b le t o g o b a c k
t o h is u s u a l w o r k a s a la b o r e r , o n a c c o u n t o f th e p e r s is t e n t p a in a n d
w ea k n ess in th e b a c k .
E x a m in a t io n s h o w e d th a t h is b a c k w a
fle x ib le t o f o r w a r d b e n d in g w it h o u t p a in , b u t th a t s id e b e n d in g w a s
s t iff a n d m u c h r e s t r ic t e d a n d c a u s e d p a in .
T h e r e w a s a s m a ll k y p h o s
in th e r e g io n o f th e s e c o n d lu m b a r v e rte b ra .
T h e le g s a n d n e rv o u s
r e fle x e s w e r e n o r m a l.
T h e X r a y s s h o w e d a se v e r e c o m p r e s s io n
f r a c t u r e o f th e fir s t l u m b a r v e r t e b r a , p o s s ib ly i n v o l v i n g a ls o t h e la s t
d o r s a l a n d th e s e c o n d lu m b a r.
T h e r e w a s c o n s id e r a b le c a llu s f o r m a
t i o n a b o u t t h e s ite o f t h e f r a c t u r e , w h ic h is n o t u n u s u a l a n d h a s b e e n
n o te d in som e o f th e ca se s p r e v io u s ly r e p o r te d .
T h is m a n w a
g e t t i n g f i x a t i o n b y m e a n s o f a b r a c e , w h i c h wT s w h a t h e n e e d e d ,
a
p a r t o f th e tim e , a n d th e n h e w a s g e t t in g fo r c i b l e m a n ip u la t io n e v e r y
d a y , w h i c h w a s wT a t h e d i d n o t n e e d .
h
R e s t a n d fix a tio n d o m o re
g o o d t h a n a c t iv e t r e a t m e n t a n d a r e s u re t o r e lie v e p a in .
10 , 1 9 1 7 .
T--------F --------- (Case 19).
A g e d 40.
A c c id e n t, J u ly 31, 1914 (lo n g s h o r e m a n ).
E x a m in a
tio n J a n u a r y 28, 1916.
T h is m a n f e l l 15 fe e t a n d la n d e d o n h i
le f t h a n d a n d h ip .
H e s u s ta in e d a fr a c t u r e d w r is t a n d in ju r e d h is
back .
H e w a s ta k e n t o a h o s p it a l, w h e re h e w a s k e p t o n a B r a d
f o r d fr a m e f o r a b o u t fiv e w e e k s a n d th e n w o r e a p la s t e r c a s t f o r
s ix w e e k s , s in c e w h e n h e h a s w o r n a c o r s e t.
H e sta ted th a t a
fi r s t , f o l l o w i n g t h e a c c i d e n t , h e c o u l d n o t m o v e h i s l e g s , a n d t h i s c o n
d it io n c o n tin u e d f o r a b o u t fo u r w eek s.
W h e t h e r th is w a s d u e t o
a c tu a l p a r a ly s is o r n o t I d o n o t k n o w .
A s h e h a d n o lo s s o f s e n sa
t io n a n d n o lo s s o f c o n t r o l o f th e b la d d e r o r r e c tu m , I q u e s tio n th e
e x is te n c e o f a c t u a l n e r v e i n ju r y .
H e h a s b e e n a b le t o d o n o w o r k
s in c e t h e a c c id e n t , a n d f e l t t h a t h e w a s n o t g e t t in g a n y b e t t e r , o r
h is b a c k a n y s t r o n g e r .
H e s ta te d t h a t th e b a c k g e ts la m e a n d s tiff,
DIAGNOSIS IN BACK LESIONS— J. W . SEVER, M . D.
149
a n d t h a t h e a lw a y s g e t s a b a c k a c h e w h ile s it t in g d o w n . H e is m o r e
c o m fo r t a b le l y i n g d o w n fla t o n h is b a c k .
E x a m in a t io n s h o w s th a t h e h a s a f a i r l y fle x ib le b a c k .
T h e m o v e -^
m e n ts w e r e r a th e r g u a r d e d .
T h ere w as n o k yph os.
H i s r e fle x e s
w e r e n o r m a l.
A n X r a y s h o w e d t h a t h e h a d s u s t a i n e d a c r u s h fr a c - 1
t u r e o f t h e fir s t a n d s e c o n d lu m b a r v e rte b rs e . T h e r ig h t s id e o f t h e
fir s t lu m b a r w a s b r o k e n , a n d th e s e c o n d lu m b a r w a s c r u s h e d d ow n ^
o n i t s e l f e v e n ly .
T h e r e w a s c o n s i d e r a b l e n e w b o n e d e p o s i1t e d a b o u t
t h e s e c o n d v e r t e b r a l b o d ie s , e s p e c ia lly o n t h e r i g h t s id e . ; T h i s m a n
h a s , o f c o u r s e , a p e r m a n e n t d is a b ilit y , w h ic h w ill p r e v e n t h im fr o m "
e v e r d o in g h is u su a l w o r k as a lo n g s h o r e m a n .
A n in te r e s tin g t h in g
a b o u t th e ca se fr o m th e p o in t o f v ie w o f d ia g n o s is w a s th a t p r e v io u s
X r a y s ta k e n s in c e h e l e f t th e h o s p it a l w e r e in t e r p r e t e d as s h o w in g
n o b o n e in ju r y .
D------- McC--------- (Case 2 0 ).
A g e , 51. T e a m s t e r .
A c c i d e n t , O c t o31, r 1912. E x a m i n a t i o n ,
be
M a y , 1916. T h i s m a n h a d t h e t r u e m e c h a n i c a l f a c t o r s i n h i s a c c i d e n t
to p r o d u c e t h e t y p i c a l f l e x i o n f r a c t u r e .
H e w a s ca u g h t u n d e r th e
f r o n t o f a n e m p t y te a m , a n d in a t t e m p t in g t o s t o p it p u t h is fe e t
a g a in s t th e f r o n t a x le a n d p u s h e d . T h e te a m w a s h e a v y a n d d o u b le d
h im u p as h e la y o n th e g r o u n d o n h is b a c k . H e w a s ta k e n t o a h o s
p it a l a n d k e p t o n a B r a d fo r d fr a m e f o r th re e w eek s. X r a y s ta k e n
a t t h a t tim e h e s ta te d s h o w e d n o a b n o r m a lit y . H e w a s d is c h a r g e d
f r o m t h e h o s p i t a l a t h i s o w n r e q u e s t N o v29, b e r
e m 1912. H e w a s
th e n tre a te d b y h is o w n p h y s ic ia n b y s t ic k in g -p la s t e r s t r a p p in g .
L a te r , e a r ly in
1913, h e h a d a b a c k b r a c e a p p l i e d , w h i c h h e h a s w o r n
s in c e a n d w h ic h h e s ta te d h e c o u ld n o t d o w it h o u t . H e h a s n e v e r h a d
a n y s ig n s o r s y m p to m s o f c o r d p re s su re . H e c o m p la in e d o f p a in a n d
so re n e ss in th e b a c k a n d c o n s e q u e n t in a b ilit y t o w o r k .
E x a m in a t io n s h o w e d th a t w h ile s ta n d in g h e w a s s o m e w h a t te n d e r
in th e d o r s o -lu m b a r r e g io n , a n d th a t t h e r e w a s a s lig h t k y p h o s w h ic h
c o u ld b e f e l t a t th e d o r s o -lu m b a r ju n c t io n . H e c o u ld b e n d f o r w a r d
f r e e l y , b u t c o u l d n o t b e n d v e r y w e ll t o th e s id e . A n X - r a y e x a m in a
t io n s h o w e d a fr a c t u r e o f t h e fir s t lu m b a r v e r t e b r a w it h a n o b lit e r a
t i o n o f t h e s p a c e b e t w e e n th e fir s t l u m b a r a n d t w e l f t h d o r s a l, w it h
s o m e c a llu s fo r m a t io n . T h is m a n w il l b e u n a b le t o d o h is u s u a l w o r k
a s a te a m s te r, a n d s h o u ld g e t s o m e s o r t o f l ig h t w o r k t o d o in s te a d
o f d r i f t i n g a b o u t d o i n g n o t h i n g , w h i c h is d e m o r a l i z i n g p h y s i c a l l y
a n d m o r a lly .
D------- C--------- (Case 2 1 ).
M a l e ; a g e 39. P l a s t e r e r . A c c i d e n t , O c t o15, r1915. E x a m i n a
,
be
t i o n , O c t o b e 30, 1916. T h i s m a n f e l l a d i s t a n c e 12 ff e e t o n t o s o m e
r
o
ston es. H e d o e s n o t k n o w h o w h e la n d e d . H e w a s ta k e n t o a h o s p it a l,
w h e r e h e s ta y e d n in e d a y s , b u t h a d n o tr e a tm e n t. A n X r a y o f h is
150
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
b a c k ta k e n th e re s h o w e d n o t h in g a b n o r m a l h e w a s to ld . A f t e r le a v
i n g th e fir s t h o s p it a l h e w e n t t o a n o th e r , w h e r e a n o th e r X r a y w a s
t a k e n a n d a p l a s t e r c a s t a p p l i e d t o h i s b a c k . T h i s h e w o10e a b o u t
r
m o n t h s . T h i s w a s f o l l o w e d b y a b a c k b r a c e w h ic h h e is s t ill w e a r in g .
H e h a s b e e n u n a b le t o d o a n y w o r k s in c e th e a c c id e n t o n a c c o u n t o f
p a in in th e b a c k a n d s o m e w e a k n e s s . H e is u n a b le t o g e t a b o u t w it h
o u t s o m e s o r t o f b a c k s u p p o r t , s u c h a s th e b a c k b r a c e g iv e s h im .
E x a m in a t io n s h o w s th a t t h e b a c k is r a th e r s t iff in b e n d in g . T h e r e
is a m o d e r a te k y p h o s in th e r e g io n o f th e d o r s o -lu m b a r ju n c t io n ,
i n v o l v i n g a p p a r e n t ly o n e o r t w o ve rteb ra e. H e s t a n d s w it h r a t h e r a
r o u n d e d b a c k , p r o t u b e r a n t a b d o m e n , a n d fla t c h e s t
H i s s e n s a tio n
a n d r e fle x e s a r e n o r m a l a n d a p p a r e n t ly a lw a y s h a v e b e e n .
A n oth er
ca se w it h t o t a l d is a b ilit y f o r h e a v y w o r k .
A n X r a y sh ow ed th a t
h e h a d s u s ta in e d a c o m p r e s s io n fr a c t u r e o f th e fir s t a n d s e c o n d lu m
b a r v erteb ra e.
T h e t w o b o d ie s a re ja m m e d t o g e t h e r , w it h a c o n s e
q u en t o b lite r a tio n o f th e in te r v e r te b r a l sp a ce .
W -------- C---------- (Case 2 2 ) .
M a le ; a g e 42. A c c id e n t, S e p te m b e r 24, 1915. E x a m in a tio n , F e b
ru a ry 26, 1916. T h is m a n s te p p e d th r o u g h a n in c o m p le te d s ta ir w a y
in t h e d a r k a n d f e l l a b o u t f e e t . H e l a n d e d o n h i s b a c k . H e w a s
10
t a k e n t o a l a r g e h o s p i t a l w h e r e *he s t a y e d f o u r h o u r s . W h i l e t h e r e
h is b a c k w a s X r a y e d a n d h e w a s t o ld th a t th e r e w a s n o t h in g th e m a t
ter. H is b a c k w a s s tr a p p e d a n d h e w e n t h o m e . H e w a s la id u p a t
h o m e , b u t n o t in b e d , f o r s e v e n w e e k s , a n d d id n o t g o b a c k t o w o r k
f o r t w o r e a s o n s , i. e1.,) (t h a t h i s b a c k h u r t h i m a2n) d t h( a t h e
c o u ld n o t g e t a n y t h in g t o d o . H e c o m p la in s o f p a in in th e b a c k n o w ,
l o c a l i z e d l o w d o w n i n t h e r e g i o n o f t h e s a c r u m . T h i s p a i n is b e t t e r
so m e d a y s th a n o n o th e rs. H e h a s so m e p a in a n d d is c o m fo r t w h e n
g e t t in g in a n d o u t o f a c h a ir .
E x a m in a tio n sh o w e d th a t h e c o u ld
b e n d h is b a c k w e ll f o r w a r d s a n d s id e w a y s . T h e r e w a s a s m a ll p r o
je c t io n b a c k w a r d o f th e s p in e in th e r e g io n o f th e d o r s o -lu m b a r
r e g io n , w h ic h w a s te n d e r.
X r a y s o f th e s p in e s h o w e d th a t th e re
w a s a fla t t e n in g a n d c r u s h in g o f th e b o d y o f th e fir s t lu m b a r v e r
te b r a , w it h s o m e c a llu s la id d o w n b e tw e e n it a n d th e t w e lft h d o r s a l
v e rte b ra a b o v e a n d th e s e c o n d lu m b a r b e lo w . T h e r e w a s a n o b lit e r a
t io n o f th e in t e r v e r t e b r a l s p a c e b e tw e e n th e fir s t a n d s e c o n d lu m b a r
verteb ra e.
T h is m a n h a d a n o t v e ry severe fa ll, fe w sy m p to m
f o llo w in g , e x c e p t b a c k a c h e , a n d e x p r e s s e s a w illin g n e s s t o g o t o
w o r k , y e t h e h a s h a d a fr a c t u r e o f o n e o f h is v e r te b r a l b o d ie s .
He
h a s a ls o b e e n w it h o u t * a n y r e a l t r e a t m e n t s in c e t h e a c c id e n t .
I be
lie v e t h a t m a n y o f t h e u n e x p la in e d b a c k a c h e s f o l l o w i n g f a lls a n d
in ju r ie s o f v a r io u s s o r ts , w h ic h h e r e t o fo r e h a v e b een c a lle d “ r a ilw a y
DIAGNOSIS IN BACK LESIONS— J. W . SEVER, M . D.
151
s p in e s ,” “ n e u r a s th e n ic s p in e s ,” a n d “ t r a u m a t ic s p i n e s ” m a y h a v e
w e ll b e e n fr a c t u r e s o f th e v e r te b r a l b o d ie s o f t h is t y p e . .
S------- A --------- (Case 2 3 ).
M a le ; a g e 29.
A c c i d e n t , N o v e m, b 1 9 1 6 .
6 er
E x a m in a tio n , J u ly
30, 1917. T h is m a n sta ted th a t a b a g o f flo u r fe ll fr o m a h e ig h t o n to
h is b a c k as h e w a s s t o o p in g o v e r . A f t e r th e a c c id e n t h e w a s ta k e n
t o a h o s p ita l, w h e re h is b a c k w a s s tr a p p e d , a n d h e w a s k e p t in b e d
f o r 17 d a y s , a t th e e n d o f w h ic h tim e a p la s te r ja c k e t w a s a p p lie d .
T h is h e w o r e f o r 32 d a y s. N o X ra y s w e re ta k e n th e re , b u t h e h a d
s o m e ta k e n in B o s to n in F e b r u a r y , 1917, w h ic h w e r e r e p o r t e d as
n e g a t iv e . H e h a s b e e n w it h o u t s u p p o r t t o h is b a c k s in c e t h e p la s t e r
cast w as rem oved .
H e c o m p la in s o f c o n s id e r a b le p a in a n d w e a k
n e ss in th e b a c k , m o r e m a r k e d w h e n w a lk in g a r o u n d a n d w h e n t r y
in g to l i f t a n y th in g th a n w h e n s it t in g o r ly in g d o w n .
E x a m i n a t i o n s h o w s t h a t h i s b a c k is f l e x i b l e t o a l l m o t i o n s , b u t
t h a t h e c o m p la in e d o f p a in in s id e b e n d in g .
T h ere w as a sm al
k y p h o s a t th e fir s t lu m b a r v e r t e b r a . T h e r e w a s n o e v id e n c e o f a n y
n e r v e in v o lv e m e n t. A n X r a y s h o w e d th a t h e h a d s u s ta in e d a c r u s h
f r a c t u r e o f th e fir s t lu m b a r v e r te b r a .
T h is m a n h a s a p e r m a n e n t d is a b ilit y w h ic h w ill p r e v e n t h im f r o m
d o in g a n y h e a v y w o r k in th e fu tu r e .
H e n eeds a su p p o rt o f som e
k i n d f o r h is b a c k , w h ic h w il l g i v e h im m o r e c o m f o r t t h a n h e n o w
e n jo y s .
N o w w h a t a re th e c o n c lu s io n s a r r iv e d a t fr o m a s tu d y o f a g r o u p
o f ca ses lik e th e s e ?
I n m y o w n m in d th e y a re as fo llo w s , n a m e ly ,
t h a t fir s t o f a ll th e n e c e s s ity a n d v a lu e o f a d ia g n o s is is d e m o n
s tr a te d ; a n d se c o n d th a t fe w cases g e t a c a r e fu l a n d a d eq u a te e x
a m in a t io n .
( 1 ) C o m p r e s s io n fr a c t u r e o f o n e o r m o r e v e rte b ra l b o d ie s a re n o t
u n c o m m o n fo llo w in g fa lls o n th e fe e t o r b a c k o r fo llo w in g th e d r o p
p i n g o f w e i g h t d i r e c t l y o n t o t h e f l e x e d s p in e .
( 2) T h e fr a c t u r e is g e n e r a lly t h e r e s u lt o f f o r c i b l e fle x io n o f th e
s p in e .
( 3 ) T h e r e u s u a l l y is n o n e r v e i n v o l v e m e n t o r c o r d p r e s s u r e .
( 4 ) T h e i n j u r y r e s u lt s in a w e a k , s t iff, a n d p a i n f u l b a c k .
( 5 ) T h e e x a m in a t io n o f a n y b a c k ca se, e s p e c ia lly f o l l o w i n g a n
i n j u r y , is a l w a y s i n c o m p l e t e w i t h o u t a g o o d X r a y .
( 6) T h e r e i s u s u a l l y a k y p h o s p r e s e n t , n o t a l w a y s a p p e a r i n g a t
on ce.
( 7 ) T h e d is a b il i t y f o r h e a v y w o r k is u s u a lly p e r m a n e n t .
( 8) T h a t i n s o f a r a s t h e m a j o r i t y o f c a s e s i s c o n c e r n e d , t h e y g o
u n r e c o g n iz e d as fr a c tu r e s o f th e v e rte b ra l b o d ie s b e ca u se o f in a d e
152
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
q u a te e x a m in a t io n a n d c o n s e q u e n tly c o n tin u e
d i s a b i l i t y , w h i c h is r e a l a n d n o t f e i g n e d .
(9 )
N o in d iv id u a l w h o c o m p la in s o f p a in ,
th e b a c k f o llo w in g a n in ju r y o r f a l l s h o u ld g o
a m in a tio n o f th e b a c k .
T o q u o te fr o m o n e o f m y p r e v io u s p a p e r s in
n o s i s i1
to
s u ffe r p a in
s o r e n e s s , o r s tiffn e s s
w ith o u t c a r e fu l e x
r e g a r d to th e p r o g
The bony repair is generally good in these lumbar cases, and although there
may be a persistent stiffness, the supporting function of the spine is generally
good, even in spite of a kyphos, which may tend to increase somewhat. Per
manent disability, so far as doing heavy laborious work goes, generally follows
such an injury, and as a rule a light back brace is needed for some time or
always to give comfort and stability. The prognosis as far as life is concerned
is generally excellent, provided no cord injury has occurred.
1Su rgery,
Gynecology, and Obstetrics, March, 1916.
and
R E C O N S T R U C T IO N A N D T H E H O S P IT A L .
BY F. J. COTTON, M. D.
B y r e c o n s tr u c tio n w e m e a n th a t b r a n c h o f s u rg e r y w h ic h m a k e s
p o s s ib le th e r e tu r n o f th e in ju r e d w o r k m a n t o h is w o r k , th a t c o n
c e rn s it s e lf w it h th e s a lv a g e o f th e w re ck s , th e m a k in g w h o le o f
p o te n tia l c r ip p le s .
O n l y o f la t e h a v e w e c o m e t o r e a liz e w h a t c a n a n d s h o u ld b e d o n e
in t h is d i r e c t i o n ; h o w d e fe c t iv e o u r s u r g e r y h a s b e e n in t h is r e g a r d ;
h o w la r g e ly it h a s c o n c e r n e d it s e lf w it h th e s e t t in g o f fr a c t u r e s a n d
th e h e a lin g o f w o u n d s , to th e n e g le c t o f a n y e ffe c t iv e in te r e s t in
r e s t o r in g n o r m a l fu n c tio n .
S o m e o f u s h a v e l o n g k n o w n t h is a n d h a v e p r e a c h e d , y e a r in a n d
y e a r o u t, t h a t th e h o s p it a ls s h o u ld ce a se to le t p a tie n ts b e c o m e p a r k b e n c h lo a fe r s a n d t r y h a r d e r to g e t th e m b a c k as u s e fu l m e m b e rs o f
th e c o m m u n it y .
S o c ia l s e r v ic e e ffo r ts h a v e d o n e s o m e t h in g t o e m p h a s iz e th e s itu a
t io n , b u t th e s o c ia l s e r v ic e ca n n o t d o th e w o r k w h ic h b e lo n g s t o
th e s u r g e o n , th e o r th o p e d is t, th e n e u r o lo g is t , a n d th e m a sseu se.
C o c lm a n ’s e ffic ie n c y c r u s a d e h a s o p e n e d o u r e y e s a b i t a ls o . T h e e x
c e lle n t p la n c a r r ie d o u t b y o u r a c c id e n t b o a r d , o f im p a r t ia l e x a m i
n a t io n s o f c a s e s th a t “ h a n g fir e ,” th e p la n o n w h ic h D r . D o n o g h u e
h a s p la c e d s u ch stress, h a s h e lp e d s till m o r e . A t la s t I t h in k a g o o d
m a n y p e o p le b e g in t o k n o w w h e r e w e s ta n d in t h is m a tte r .
I n t h is S t a t e w e h a v e h a d a w o r k m e n ’s c o m p e n s a t io n a c t f o r fiv e
y e a rs . F iv e y e a r s a g o I t h o u g h t I sa w a v e r y p r o m is in g fie ld f o r
p r o g r e s s a n d c o u ld see f o r th e fir s t tim e th e in te r e s t o f th e in ju r e d
m a n , o f th e e m p lo y e r o r in s u r e r , a n d o f th e d o c t o r a n d th e h o s p it a l
r u n n in g p a r a lle l, w it h e n o u g h m o n e y a ssu re d to m a k e t h in g s g o , a n d
e v e r y o n e in t e r e s t e d in g e t t i n g th e s a m e r e s u lt f o r t h is m o n e y , n a m e ly ,
th e e a r ly a n d c o m p le t e c u r e o f th e in ju r e d m a n w h e r e v e r p o s s ib le
a n d h is p r o m p t r e t u r n t o w o r k .
T h is w a s fiv e y e a r s a g o .
F i v e y e a r s is l o n g e n o u g h t o s h o w i n
s u lt s .
W h a t h ave w e to sh ow — w h a t p rog re ss m a d e?
I h a te t
s a y it, b u t w ith a c o n s id e r a b le o p p o r t u n it y to o b s e r v e fr o m v a r io u s
a n g le s I c a n n o t see a n y s u b s t a n t ia l p r o g r e s s , c e r t a in ly n e x t t o n o n e
in th e w o r k tu r n e d o u t b y th e h o s p it a ls th a t a re s u p p o s e d t o le a d
in m e d ic a l p r o g r e s s . N o w h e r e a n y e s s e n t ia l c h a n g e in t h e h a n d l in g
o f a c cid e n ts o r th e ir a ft e r ca re, n o p r o v is io n f o r c o n tin u ity o f o b s e r-
158
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MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
v a t io n o r r e s p o n s ib ilit y , n o s e r io u s a t te m p t t o m a k e i t p o s s ib le o r
w o r t h w h ile f o r b e t t e r m e n t o in t e r e s t a n d t r a in th e m s e lv e s t o d o
b e t t e r w o r k . W h y is t h i s s o ?
C e r ta in ly n o t b eca u se th e re are n o t
p le n t y o f g o o d m e n . C e r ta in ly n o t b eca u se w e d o n o t k n o w o r ca n
esr
n o t l e a r n h o w t o d o t h e w o r k . W i t h i n t 10e yl a a t s t h e r e s u l t s
h
o f fr a c tu r e s , f o r in s ta n c e , in p r iv a t e w o r k h a v e v a s tly im p r o v e d ;
b u r n s c a n b e h e a le d in h a l f th e o l d s c h e d u le , a n d la t e ly s e p s is h a s
b e c o m e c o n t r o lla b le t o a g r e a t e x te n t u n d e r th e C a r r e l-D a k in te c h n ic .
B u t t h is C a r r e l t e c h n ic , f o r e x a m p le , i s n o t f o l l o w e d in a n y o f o u r
c l i n i c s ; h a s h a r d ly b e e n t r ie d o u t, a t b e s t, in a n y k n o w n t o m e .
W h a t is w r o n g ?
S h e e r la c k o f in te r e s t a n d o f c o o p e r a tio n ,
t h in k , a la c k d u e t o v a r io u s c a u s e s , im p e r s o n a l r a t h e r th a n p e r s o n a l.
I n t h e .f i r s t p l a c e , t h e s p l i t t i n g u p o f t h e w o r k b e t w e e n v a r i o u s i n
s u r a n c e c o m p a n ie s m a k e s e f f e c t iv e c o o p e r a t io n d iffic u lt . I n t o o m a n y
in s t a n c e s o n e fin d s c o m p a n ie s w h o h o l d t h e ir a g e n t s d o w n t o o c lo s e ,
a g e n t s w h o th e m s e lv e s c a n see l it t le in th e a f f a ir b u t t h e im m e d ia t e
d o l la r p a id a n d w h o r e g a r d th e d o l la r p a id a s a c o m p a n y lo s s p u r e
a n d s im p le . O t h e r a g e n t s th e r e a r e w h o c a n see t h a t c o m p e n s a t io n
<ian b e s p e l l e d r e c o n s t r u c t i o n w i t h p r o f i t a l l a r o u n d .
T h e d iffic u lt y , th e n , is p a r t l y w it h t h e c o m p a n ie s as u n it s o f v a r y
in g q u a lit y ; b u t e v e n i f th e y w e r e a ll g o o d a n d b r o a d -m in d e d th e
v e r y n u m b e r o f t h e u n it s w o u ld m a k e c o o p e r a t io n d iffic u lt , a n d t h is
w o r k c a n o n l y b e d o n e w e l l , p r o b a b l y , o n a l a r g e s c a le i n b i g c l i n i c s .
T h e s e c o n d d iffic u lt y is w it h th e h o s p it a ls a n d t h e h o s p it a l s ta ffs .
H e r e w e ru n p r o m p t ly in t o th e d e fe c t s o f o u r h o s p it a l o r g a n iz a tio n .
T h e h o s p it a ls a r e in t h is c o m m u n it y p r i m a r il y c h a r it y h o s p ita ls .
T h e d o c t o r is s u p p o s e d t o d o h is w o r k p a r t l y a s a c h a r it y , p a r t l y f o r
th e t r a in in g a n d th e p r e s tig e w h ic h s h o u ld b r in g p r iv a t e p r a c tic e .
T h a t h e s h o u ld “ e p a i d f o r h is w o r k is n e v e r t h o u g h t o f , o r t h o u g h t
b
o f w ith h o r r o r .
N o w , so fa r as th e p r o p e r ca re o f in d u s tr ia l cases g o e s , a m a n m a y
p r a c t ic e it f o r y e a rs w it h o u t g lo r y , m a y tr a in h im s e lf v e r y t h o r
o u g h ly , b e c o m p e n s a te d n o t a t a ll f o r th e t r a in in g p e r io d , a n d so
f a r a s p r iv a t e p r a c t ic e is c o n c e r n e d in t h is lin e , h is c lie n t s a r e th e
c o m p a n i e s , h i s c o m p e n s a t i o n m e a g e r , e v e n w h e n h e g e t s p a i d a t a l l.
M o r e o v e r , e v e n in t r a i n i n g h im s e l f h e is h a n d ic a p p e d .
T h e h o s p it a ls n e v e r h a v e c a r e d f o r t h is s o r t o f w o r k p a r t i c u l a r l y —
s t o m a c h s u r g e r y , g y n e c o l o g i c a l w o r k , e t c ., a r e o b v i o u s l y m o r e s h o w y .
R e c o n s t r u c t io n w o r k c a lls f o r e x c e lle n t s u r g e r y in t h e e a r ly s ta g e ,
e x c e lle n t ju d g m e n t , a n d e la b o r a te s p e c ia l c a r e in th e w e e k s a n d
m o n th s th a t fo llo w .
T h e v i s i t in g s u r g e o n is n o t t o o d e e p ly in t e r e s te d in th e ca se , e v e n
i f h e o p e r a te s (a n d u s u a lly h e d o e s n ’t ) h im s e lf, o n ly t o se n d it to th e
o u t - p a t ie n t d e p a r t m e n t a n d lo s e t r a c k o f it.
K E C O N S T R U C T IO N A O T T H E H O S P I T A L — F . J . C O T T O N , M . D .
155
T h e o u t - p a t ie n t s u r g e o n is a p t t o r e c e iv e a c a s e h e d id n ’t t r e a t a t
th e sta rt, a n d t o fin d h im s e lf h a n d ic a p p e d , in a c r o w d e d c lin ic , b y
a b s o lu t e l a c k o f m e d ic a l a s s is ta n ts w it h a n y r e a l t r a in i n g a l o n g t h is
lin e , b y h a v i n g n o n e o f th e s p e c ia l e q u ip m e n t n e e d e d , a n d b y a
m a s s a g e d e p a r t m e n t n o t u n d e r h is c o n t r o l.
F o r h im th e r e is n e it h e r a n y p r o f it n o r c r e d it , n o r is th e r e a n y p r o
fe s s io n a l in te r e s t in d o i n g t h is w o r k u n d e r c ir c u m s t a n c e s t h a t m a k e
it a lm o s t im p o s s ib le t o d o it w e ll.
F e w m en p ersevere.
I s it a n y w o n d e r t h a t t h e a v e r a g e a b le m a n t u r n s h is b e s t a t t e n t io n
t o o t h e r b r a n c h e s le s s d e p e n d e n t o n s k ille d a s s is ta n c e , s h o w i n g r e
s u l t s m o r e i m m e d i a t e l y a n d m o r e i n l i n e w i t h w h a t is i n t e r e s t i n g
a n d lu c r a tiv e in o u ts id e p r a c t ic e ?
T h is s h o u ld n o t b e so , b u t it i s ;
a n d t h a t is w h a t w e m u s t u n d e r s t a n d .
U n d e r th e se c ir c u m s ta n c e s th e in ju r e d m a n g o e s t o a n a c c id e n t
r o o m o r r e lie f s ta tio n , is see n a n d a tte n d e d t o b y a y o u n g m a n w e ll
s c h o o le d b u t in e x p e r ie n c e d , is o p e r a t e d o n i f n e e d b e b y t h is m a n o r
a ju n io r v is it in g s u rg e o n , is tr a n s fe r r e d t o a w a r d in th e c a re o f
a n o th e r m a n , w h o tr a n s fe r s h im in tim e t o a y o u n g o u t-p a tie n t s u r
g e o n , n o t v e r y e x p e r ie n c e d , w h o g e ts s o m e d a ta , u s u a lly s k e tc h y , a n d
ta k e s c a r e o f th e ca se w ith a h u n d r e d o th e r s as b e s t h e ca n .
I s it p o s s ib le u n d e r s u c h a s y s t e m t o g e t r e a l r e s u lts ? I s it s t r a n g e
t h a t s m a l l t o w n h o s p i t a l s , n o t t o o w e l l e q u i p p e d , o f f ic e r e d b y s u r
g e o n s o f f a r le s s e x p e r ie n c e o r s k i l l in m a n y c a s e s — h o s p it a ls s m a ll
e n o u g h t o h a v e o n e m a n see t h e c a s e t h r o u g h — g e t r e s u lts o n t h e
a v e r a g e a b o u t as g o o d as th o s e o f o u r le a d in g in s titu t io n s ?
W h a t t h e r e s u lt s a r e o u r a c c id e n t b o a r d k n o w s .
I am g o in g to
c it e a s m a ll g r o u p o f ca ses th a t h a v e c o m e u n d e r m y a tte n tio n w it h in
10 d a y s .
1. B-- - - - .
M e d io t a r s a l fr a c t u r e lu x a t io n .
H a d an a tte m p te d
o p e n r e d u c tio n , w a s a llo w e d t o fid d le a lo n g w it h h o p e le s s a tte m p ts
t o b e tte r t h in g s b y m a s s a g e f o r n in e m o n th s .
R e c e n t ly h a d t o h a v e
a r e a l o p e r a t i o n , w h i c h s h o u l d h a v e b e e n d o n e a t fi r s t .
2. P - - - - - ; a g e 3 4 .
H i p fr a c t u r e — in tr a c a p s u la r .
I n h o s p it a l
seven w eek s.
S e n t o u t as s o lid .
S a y s th e o r d e r ly m a d e h im h e lp
b a th e h im s e lf a n d , as h e h a d o n ly s a n d -b a g p r o t e c t io n , th in k s h e
d a m a g e d h im s e lf.
A t a ll e v e n ts, a ft e r a y e a r h e n o w h a s a lo o s e
h i p , is a c r i p p l e , a n d a l w a y s w i l l b e , u n l e s s h e m a y b e h e l p e d b y a
s e r io u s o p e r a t io n e n t a ilin g s ix t o n in e m o n t h s o f c o n v a le s c e n c e .
T h is
m a n , a ft e r lo n g o u t-p a tie n t tre a tm e n t w it h m a s s a g e , w e n t t o a n o th e r
h o s p it a l w h e re th e c o n d it io n w a s r e c o g n iz e d , th e p r o p e r o p e r a t io n
p r o p o s e d , th en f o r som e rea son p o s tp o n e d .
S in c e th e n n o t h in g h a s
b e e n d o n e a t a l l.
3 # F — - - -; a g e 22 .
H a d h a n d s b u r n e d in h o t r o lls .
H o s p ita l
tr e a tm e n t, c ic a t r iz a t io n o f b o t h p a lm s w it h s u c h c o n t r a c tu r e as t o
m a k e b o t h h a n d s u s e le s s .
N o t h in g d o n e o r p r o p o s e d u n til h e w a s
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MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
e x a m in e d f o r th e b o a r d .
S in c e th e n , as a r e s u lt o f a p la s t ic o p e r a
t io n , h e h a s u s a b le , n e a r ly n o r m a l h a n d s .
4. G- - - - - ; a g e 2 6 . F r a c t u r e o f c a l c i s f r o m a f a l l .
T r e a t e d m e r e ly
in p la s t e r . N o t h i n g m o r e t h a n e x e r c is e s d o n e w h ile in t h e h o s p it a l.
M a n y m o n th s a ft e r w a s a c r ip p le , m a in ly b e ca u s e o f c o n ta c t o f th e
e x te r n a l m a lle o lu s w it h g r e a t m a sses o f b o n e o n th e o u t e r s id e o f th e
c a lc is . O p e r a t io n c le a r e d t h is a n d h e r e p o r t e d la s t w e e k , n o w w o r k
i n g s te a d ily as a c a r p e n te r .
5 . S- - - - - . M a n g l e b u r n , s e v e r e , o f b a c k a n d f r o n t o f r i g h t h a n d .
W e n t t o a r e li e f s t a t io n a n d w a s d r e s s e d a n d t u r n e d lo o s e .
T w o days
la te r h a d se v e r e c e llu lit is o f h a n d a n d a r m t o th e a x illa .
H ad had
n o t h in g d o n e sa v e th e o u tr a g e o u s o ld -t im e C a r r o n o il tre a tm en t.
0, T- - - - - .
S h o u ld e r in ju r y f r o m f a l l — p r o b a b le fr a c t u r e o f t u
b e r o s ity o f h u m eru s.
D e v e lo p e d a b u r s it is w it h a d h e s io n s , w a s o p
e r a t e d o n w it h o u t r e s u lt .
T h e n w a s tre a te d m a n y m o n th s w ith m a s
sage.
N o im p r o v e m e n t f o r th re e m o n th s — a rm p r a c t ic a lly fix e d a t
t h e s id e .
A n X r a y b y a n o t h e r s u r g e o n s h o w e d m a s s iv e b o n e f o r
m a t io n in t h e s h o r t m u s c le s a t th e s h o u ld e r , la t e r r e m o v e d b y o p e r a
tio n .
M o n t h s w e r e w a s t e d in u s e le s s m a s s a g e , w h ic h p r o p e r e x a m i
n a t io n a n d X r a y s w o u ld h a v e s h o w n t o b e h o p e le s s .
7 . C- - - - - ; m a n o f 5 5 . F o o t c r u s h e d w e l l b a c k t o w a r d t h e a n k l e .
C a r e fu l a m p u ta tio n d o n e , le a v in g th e h e e l— a p e r f e c t l y r e s p e c ta b le
b u t u t t e r ly u s e le s s o p e r a t io n , l e a v i n g a s t u m p o n w h i c h in t im e a m a n
c o u l d g e t a r o u n d t o t h e b a r b e r ’ s b u t o n w h i c h h e c o u l d n ’t w o r k . H a d
to h a v e a r e a m p u t a t io n t o g e t a s tu m p t o w h ic h a n a r t ific ia l l e g c o u ld
b e fitte d .
8. D i s l o c a t i o n a n d f r a c t u r e o f t h e a s t r a g a l u s — p e r f e c t l y r e p l a c e
a b le .
I s a w t h e p la t e s .
H a d th e a s tr a g a lu s r e m o v e d .
C a u se g iv e n ,
t h e s u r g e o n d i d n ’t w a n t t o c u t t e n d o n s — a p e r f e c t l y t r i f l i n g p r o
c e d u r e , i f p r o p e r ly d o n e . W i l l a lw a y s b e v e r y la m e .
9. F r a c t u r e d a n k le .
R e d u c e d b y h o u s e o f f ic e r — f a i r r e d u c t i o n o n l y .
H ea vy m an.
S e n t o u t a s o u t-p a tie n t.
W e n t t o s u r g e o n o u ts id e
S u p p o r t i n g a p p a r a tu s a n d c a r e f u l e x e r c is e s h a v e b r o u g h t th is m a n
t o n e a r n o r m a l e ffic ie n c y ; w it h o n ly th e o r ig in a l h o s p it a l c a r e h e
w o u ld h a v e b ee n a p e rm a n e n t c r ip p le .
T h e s e c a s e s s p e a k f o r t h e m s e lv e s — a c h a n c e c o ll e c t i o n , b u t I c o u l d
w is h t h e m le s s r e p r e s e n t a t iv e t h a n t h e y a r e o f t h e h o s p it a l s t a n d a r d .
T h e b la m e lie s n o t w it h a n y in d i v i d u a l .
T h e p r o b le m s im p ly h a s
n o t b e e n t a c k le d a t a ll— w e h a v e le t i t d r i f t .
T h e s e n in e ca se s s u ffe r e d in p a r t f r o m in c o m p e t e n t s u r g e r y — n o t ,
m in d y o u , b y p o o r s u rg e o n s b u t b y g o o d g e n e r a l s u r g e o n s w it h o u t th e
s p e c ia l c o m p e t e n c y n e e d e d f o r t h is w o r k ; t h e y s u ffe r e d f r o m b e in g
h a n d l e d b y h o u s e o f f ic e r s w h o s e e x p e r i e n c e i s n e c e s s a r i l y l i m i t e d ;
t h e y s u ffe r e d f r o m la c k o f s h o p fa c ilit ie s f o r a p p a r a tu s , f r o m la c k o f
RECONSTRUCTION AND THE HOSPITAL— F. J. COTTON, M. D.
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X r a y s , o r , r a t h e r , f a i l u r e t o u t iliz e th e m , b u t m o s t o f a ll t h e y s u f
f e r e d f r o m la c k o f r e s p o n s ib il it y , f r o m la c k o f o n e m a n t o see t h a t th e
c a s e w a s p r o p e r ly h a n d le d b y h im s e lf o r h is a s s is ta n ts a n d t o b e
r e s p o n s ib le f o r r e s u lts .
W e a r e n o t g o i n g t o g e t r e s u lt s in r e c o n s t r u c t io n s o l o n g a s t h in g s
a re so c h a o tic .
F o r a c a se o f a c u te a p p e n d ic it is o r g a lls to n e s o r a
b re a st ca n c e r th e p re s e n t sy stem d o e s fa ir ly w e l l ; f o r th e m a n w it h a
d e la y e d u n io n in a fr a c t u r e o r w it h a b a d b u r n , le t u s sa y , it d o e s n o t
w ork.
A n d y e t t h is w o r k c a n b e d o n e , a n d ca se s o f t h is s o r t a re b e i n g
h a n d le d in a ll t h e a r m ie s o f a ll t h e b e llig e r e n t s w it h m a r v e llo u s s u c
cess. D r . G o ld t h w a it is ju s t b a c k f r o m E n g la n d — it w a s h o p e d h e
c o u ld b e h e r e th is e v e n in g — w it h w o n d e r fu l s to r ie s o f th e E n g lis h
w ork.
F o r i n s t a n c e , o f 1 ,8 5 0 c a s e s o f t h i s c l a s s a t t h e S h e p h e r d s B u s h H o s p i t a l n e a r L o n d 1,000 w e r e r e t u r n e d t o t h e a r m y , 2 5 2 o f
on,
t h e m a s c la s s A m e n . A n d r e m e m b e r t h e s e w e r e n o t t h e c a s e s w i t h
s l ig h t w o u n d s , b u t t h e d is c a r d s s e n t h o m e w it h u s e le s s lim b s , m e n
w h o w o u ld h a v e b e e n c r ip p le s w it h o u t t h is s p e c ia l c a re .
C a n a d a is s a l v a g i n g a b o u t 7 0 p e r c e n t o f s u c h c a s e s , s e n d in g t h e m
b a c k t o in d u s try , i f n o t t o th e tre n ch es.
B u t s u c h w o r k r e q u ir e s c a r e f u l, o f t e n r a d i c a l a n d d a r i n g s u r g e r y ;
it r e q u ir e s u n r e m it t in g a f t e r c a r e , w it h s p e c ia l s u p p o r t in g a p p a r a t u s ,
a r r a n g e m e n ts f o r m a s s a g e a n d e x e r c is e s a n d e le c t r ic a l tr e a tm e n t,
s o m e tim e s th e fit t in g o f a n d e d u c a t io n in th e u se o f a r tific ia l lim b s o r
o t h e r p e r m a n e n t a p p lia n c e s — a n d a ll t h is m u s t b e d o n e o r s u p e r v is e d
b y s p e c ia lly t r a in e d a n d s p e c ia lly c o m p e te n t s u r g e o n s .
T h i s w o r k h a s b e e n c l a s s e d a s o r t h o p e d i c ; s o m e o f i t is , a n d s o m e
t im e s o r t h o p e d i c m e t h o d s a r e a p p l i e d t o c a s e s s c a r c e ly t o b e s o c la s s e d ,
b u t a v e r y la r g e s h a r e , p e r h a p s m o s t o f it, b e lo n g s t o w h a t h a s b e e n
c la s s e d a s g e n e r a l s u r g e r y o f a c c id e n t s a n d t h e ir r e s u lts , r a r e ly r e c o g
n iz e d as s p e c ia l w o r k .
P r o b a b l y t h is w o r k is d u e t o m e r g e w it h
o r th o p e d ic s .
W h a t e v e r w e c a ll it, th e w o r k in c iv il l i f e is a lm o s t
e x a c t ly th e w o r k w h ic h h a s b e e n so s u c c e s s fu lly d o n e in th is w a r .
H o w a r e w e t o s e c u r e lik e r e s u lt s in c iv il h o s p it a l s ?
O n ly in th e
sa m e w a y — b y c o n c e n t r a t in g ; b y r e c o g n iz in g th is w o r k as a s e p a r a te
p r o b le m ; b y u n d e r s ta n d in g th a t a g e n e r a l h o s p it a l ca n n o t h a n d le
t h is w o r k h e r e a n y m o r e t h a n a r e g u la r A r m y b a s e h o s p it a l c a n h a n d le
i t i n F r a n c e . ‘W e m u s t f o c u s — w e m u s t h a v e l a r g e i n s t i t u t i o n s o r
d e p a r tm e n ts in g e n e r a l in s titu tio n s p r e p a r e d in e q u ip m e n t a n d in
p e r s o n n e l t o d o th is w o r k .
W e m u st e d u ca te th e p u b lic t o r e ly o n s u ch d e p a rtm e n ts. W e m u st
e d u c a te th e e m p lo y e r a n d th e in s u r e r t o see th e e v e n tu a l e c o n o m y o f
d o i n g t h e ir s h a r e in th e fin a n c in g o f t h is w o r k ; m u s t m a k e t h e m
s e e t h a t i t is a w a s t e t o s t o p p a y i n g m e d i c a l c h a r g e s a t t h e l e g a l t w o -
158
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
w e e k lim it , a n d a n e c o n o m y t o see t o it th a t th e la te r w o r k , w h e th e r
i t in v o lv e s o n ly m a s s a g e o r a p p a r a t u s o r a ls o s u r g ic a l o p e r a
t io n s , is c a r r ie d o u t a n d c a r r ie d o u t as a c o n t in u o u s p a r t o f th e tr e a t
m e n t a fte r th e in ju r y , n o t a ft e r m o n th s o f fu t ile n e g le c t o r u n
s u it a b le tr e a tm e n t.
N e it h e r th e p r o b le m n o r it s s o lu t io n is n e w t o m e , b u t I h a v e
g r o w n a s p e s s im is tic a b o u t its s o lu t io n in p r a c t ic e as I w a s o p t i
m is tic fiv e y e a r s a g o .
N o w I th in k I see lig h t a h ea d .
A s y e t th
e x i s t i n g h o s p i t a l s h a v e n ’t w a k e d u p t o t h e p r o b l e m , a n d t h e i r l o s s e s
in s ta ff a n d p e r s o n n e l, o w in g t o th e w a r , h a v e b e e n s u ch as t o m a k e
e ffe c t iv e w o r k o f t h is s o r t a lm o s t im p o s s ib le ju s t n o w .
B u t t h e S u r g e o n G e n e r a l ’ s o ff ic e h a s w a k e d u p a n d i s v e r y b u s y .
E e c o n s t r u c t io n h o s p it a ls a re t o b e b u ilt a t v a r io u s p o in t s t h r o u g h
o u t th e c o u n t r y a n d a re to b e r u n o n a p la n v e r y lik e th e E n g lis h .
O n e is t o g o u p h e r e o n P a r k e r H i l l s h o r t ly . I ’m v e r y e n t h u s ia s t ic
a b o u t th is a n d fe e l su re t h a t w e a r e p r e s e n tly t o h a v e a s p e c ia l
h o s p it a l t o h a n d le th is w o r k o f r e c o n s t r u c t io n a s i t s h o u ld b e h a n d le d
a n d to serv e as a m o d e l p r o fe s s io n a lly .
D u r in g th e w a r th e c iv il p r o b le m w ill h a v e t o w a it, p r o b a b ly .
A f t e r th e w a r w e s h a ll h a v e a s t a n d a r d ; a n d I h o p e th a t m e a n s w ill
b e d e v is e d t o c o n tin u e a ll th e s p e c ia l w a r h o s p it a ls a n d t h e ir p r o f e s
s io n a l a n d a s s is ta n t s ta ffs t r a in e d t o t h is h ig h l y s p e c ia l w o r k , f o r th e
a v o id a n c e o f th e w a s ta g e , n o t th e n o f w a r , b u t o f p e a c e fu l in d u s tr y .
I t is f o r u s t o see t h a t t h is is d o n e .
[ A p a p e r o n “ H o s p i t a l e ffic ie n c y a n d th e e n d r e s u lt s y s te m ” w a s
r e a d b y D r . E . A . C o d m a n , b u t is n o t r e p r o d u c e d h e re a s n o c o p y w a s
r e c e iv e d f o r p u b lic a t io n .]
A REVIEW OF INDUSTRIAL ACCIDENT BOARD CASES EXAMINED
AT THE PSYCHOPATHIC HOSPITAL.
BY E. E. SOUTHARD, M . D., PATHOLOGIST, M ASSACHUSETTS COMMISSION ON MENTAL
DISEASES, AND DIRECTOR OF TH E PSYCHOPATHIC DEPARTMENT OF T H E BOSTON STATE
HOSPITAL, AND SIDNEY L. PRESSEY, P H . D., UNIVERSITY OF IN DIANA.
I a m th e m o r e g la d t o p re s e n t a r e v ie w o f in d u s tr ia l a c c id e n t
b o a r d ca ses e x a m in e d a t th e P s y c h o p a t h ic H o s p it a l b e c a u s e o f th e
b r e a d th a n d lib e r a lit y o f v ie w s h o w n b y th e p r o g r a m c o m m itte e o f
th e I n t e r n a t io n a l A s s o c ia t io n o f I n d u s tr ia l A c c id e n t B o a r d s a n d
C o m m is s io n s .
A s y o u a r e a w a r e , t h o s e o f u s w h o d e a l w i t h m e n t a l d is e a s e s ,
w h e t h e r p r a c t ic a lly o r t h e o r e t ic a lly , as a r u le fin d o u r s e lv e s b r o u g h t
i n t o m e d ic a l c o u n c ils , i f a t a ll, a t t h e e le v e n t h h o u r .
T h e la c
o f p r o g r e s s in th e p s y c h ia t r ic b r a n c h o f m e d icin e is d u e n o
e n tir e ly to th e c o m p le x it y o f th e t o p ic , b u t la r g e ly t o a ctu a l n e g le c t
o n th e p a r t o f th o s e w h o a re c o n c e r n e d a d m in is t r a t iv e ly , e ith e r in
m e d ic a l s c h o o ls o r in m e d ic a l in s t it u t e s , w it h th e d e v e lo p m e n t o f
d e p a r t m e n t s a n d t h e c h o i c e o f r e s e a r c h l in e s .
O f c o u r s e t h is n e g le c t is in i t s e l f p a r t l y d u e t o th e f e e li n g o f th e
c o m p le x it y o f th e t o p ic , a fe e lin g e n t ir e ly o u t o f p r o p o r t io n t o its a c t
u a l c o m p le x it y . B u t i f th e h e a d s o f m e d ic a l s c h o o ls a n d o f m e d ic a l
in s titu te s f o r re s e a r c h a re p r o n e to n e g le c t th e n e r v o u s s y s te m a n d
t h e m in d , it is n o t a t a ll t r u e o f s u c h c o m p a n ie s o f p r a c t ic a l m e n a s
a r e fo u n d in in d u s tr ia l a c c id e n t b o a r d s a n d c o m m is s io n s , t o sa y
n o t h in g o f th e p r a c t ic a l w o r k e r s in c o u r ts , s c h o o ls , a n d p r is o n s . W e
a r e ju s t n o w in th e p r o c e s s o f s e e in g h o w m u c h r e a l a t t e n t io n is
b e in g p a id t o p s y c h o lo g y a n d p s y c h ia t r y in th e A r m y , w h e r e it is
o f t e n m o r e e a s y t o p e r s u a d e t h e l i n e o f f ic e r s o f t h e v a | u e o f m e n t a l
e x a m i n a t i o n t h a n i t i s t o c o n v i n c e t h e e v e r y - d a y m e d i c a l o ff ic e r s .
P r o b a b ly , t h e r e fo r e , m y h e a re rs , in te re s te d in th e w h o le p r o b le m o f
in d u s t r ia l a c c id e n ts , w o u ld n o t a p p r e c ia t e h o w r e a lly h o n o r e d a
p s y c h ia t r is t f e e ls w h e n c a lle d u p o n t o s a y s o m e t h in g o f h is w o r k in
c o n n e c t io n w it h in d u s t r ia l a c c id e n ts . T w o s u c c e s s iv e c h ie fs o f s ta ff
a t th e P s y c h o p a t h ic H o s p it a l— D r . H . M . A d le r a n d D r . H . C . S o lo
m o n — h a v e b e e n in te re s te d in th e se p r o b le m s . T h e fo r m e r h a s p u b
l i s h e d a p a p e r o4nU n e m p l o y m e n t a n d p e r s o n a l i t y ” w h i c h t o u c h e s
4
v e r y in t im a t e ly th e in d u s t r ia l fie ld . I n t h a t p a p e r D r . A d le r c a lle d
a tte n tio n to th re e m a in re a so n s (fe e b le m in d e d n e s s , p a r a n o id c o n d i
t io n s , a n d p e r i o d i c e m o t io n a l d is e a s e s ) f o r d iffic u lt y i n in d u s t r ie s a s
159
160
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
r e l a t e d t o m e n t a l d i s e a s e a n d d.1e f e Ht o w m a n y i n d u s t r i a l a c c i
c
d e n t s a r e r e a l l y d u e t o p s y c h o p a t h i c c o n d i t i o n s i t is i m p o s s i b l e n o w
t o s a y , b u t i t is c le a r th a t o n e o f th e m a jo r g r o u p s in D r . A d l e r ’s
a n a ly s is , n a m e ly , th e fe e b le -m in d e d g r o u p o f w o r k m e n , m u s t b e r e
s p o n s ib le f o r a g o o d m a n y a c c id e n ts , d e s p ite th e fa c t th a t th e h ig h e r
g r a d e s o f fe e b le -m in d e d n e s s a r e e n t ir e ly c o n s is t e n t w it h g o o d r o u
tin e in d u s tr ia l w o r k f o r y e a r s a n d e v en d eca d es .
D r . A d l e r ’ s wT r k o n “ U n e m p l o y m e n t a n d p e r s o n a l i t y ” h a s b e e n
o
fo llo w e d b y a n o th e r c o m m u n ic a tio n f r o m th e P s y c h o p a t h ic H o s
p it a l o f in te r e s t t o t h o s e c o n c e r n e d i n in d u s t r y , n a m e ly , a p a p e r
o n “ T h e p s y c h o p a t h ic e m p lo y e e ,” w h ic h c a r r ie s th e s e id e a s fu r t h e r ,
a n d g iv e s s u m m a r ie s o f th e a c tu a l ca se s o n w h ic h m a n y o f o u r c o n
c lu s io n s w e r e fo u n d e d .
O f cou rse, as y o u are a w a re, a g o o d d ea l
o f o u r s o c ia l w o r k a t t h e h o s p it a l c o n s is t s i n t r y i n g t o fit p s y c h o
p a t h ic p e rs o n s in to s u ch e m p lo y m e n t th a t th e ir fa m ilie s ca n b e
r e a s o n a b ly w e ll s u p p o r te d .
T h is p r o c e s s o f fit t in g th e m e n ta lly
h a n d ic a p p e d in t o v a r io u s f o r m s o f in d u s t r y is o n e f r a u g h t w it h
d a n g e r s , b o t h f o r th e p s y c h o p a t h ic p e rs o n s so u tiliz e d a n d f o r th e ir
n e ig h b o r s in th e s h o p s , a n d t h e o w n e r s o f m a c h in e s a n d t o o l
u se d . A l l t h e s e e x p e r ie n c e s w il l , o f c o u r s e , b e o f v a lu e in o u r w o r k
o f c o m in g y e a r s in fit t in g m e n ta lly h a n d ic a p p e d e x -s o ld ie r s in t o
c iv il life .
I t a p p e a r s t o m e th a t, in p r a c t ic a l fie ld s lik e t h a t o f in d u s t r y in
a ll its a s p e c ts , p s y c h o lo g y a n d p s y c h ia t r y a r e c o m i n g i n t o t h e ir o w n .
W e s h a ll, in t h is c o u n t r y a t le a s t, w a it f o r a l o n g t im e b e f o r e a n
i n s t i t u t i o n i s d e v e l o p e d l i k e t h a t a t M i l a n , d e s c r i b e d b2y D e v o t o
in K o b e r a n d H a n s o n ’s w o r k o n D is e a s e s o f O c c u p a t io n a n d V o c a
t i o n a l H y g i e n e , w h e r e i n a l l k i n d s o f w o r k i n o c c u p a t i o n a l d is e a s e s ,
fr o m o u t-p a tie n t a n d w a r d w o r k o n th e o n e h a n d t o a u to p s y a n d
a n a t o m ic a l m u s e u m w o r k o n th e o th e r , c a n b e s tu d ie d .
I t has been
a g r e a t p le a s u r e t o m e , as d ir e c t o r o f th e P s y c h o p a t h ic D e p a r t m e n t
o f t h e B o s t o n S t a t e H o s p,3 ttao l e n c o u r a g e t h e u s e o f t h e w a r d s a n d
i
o u t -p a t ie n t d e p a r tm e n t o f th e h o s p it a l f o r su ch p u r p o s e s as th o s e f o r
w h ic h th e M ila n C lin ic w a s b u ilt.
D r . H . C . S o lo m o n a n d I f o u n d o u r s e lv e s g r e a t ly in t e r e s te d i n
in d u s t r ia l p r o b le m s u p o n th e o c c a s io n o f o u r g o in g o v e r th e e n tir e
lit e r a t u r e o f o c c u p a t io n n e u r o s e s f o r a s y s te m a tic c o n t r ib u t io n t o
t h e w o r k o f K o b e r a n d H a n s o n a b o v e m e n.4 i o n etd t h e c o n c l u s i o n
t A
1 A d le r , H . M . : “ U n em p loy m en t a n d p e r s o n a l it y : A s tu d y o f p s y c h o p a th ic ca s e s.”
M en ta l H yg ien e, V ol. I, N o. 1, J a n u a ry , 1917, pp. 1 6 -2 4 .
2 D e v o to , L . : “ T h e M ila n C lin ic f o r O c cu p a tio n a l D iseases : Its O rig in , p u rp o se s, an d
a c t iv itie s .” D is ea s es o f O c cu p a tio n a n d V o c a tio n a l H y g ie n e , b y K o b e r a n d H a n so n , 1 916,
pp. 7 6 5 -7 7 6 .
3 S ou th a rd , E. E . : A n n u a l R e p o rts o f the P s y c h o p a t h ic D e p a rtm e n t o f the B o sto n S ta te
H o s p ita l, 1 9 1 2 -1 9 1 6 .
4S o u th a rd a n d S olom on : “ O c cu p a tio n n e u ro se s .” D iseases o f O ccu p a tio n an d V o c a
tio n a l H yg ien e, by K o b e r a n d H a n son , 1916, p p. 2 7 0 -2 9 5 .
PSYCHOLOGICAL EXAMINATIONS---- E. E. SOUTHARD, M . D.
o f o u r s y s te m a tic r e v ie w
w r o te as fo llo w s :
of
“ O c c u p a tio n
n e u r o s e s ,”
161
in
1916, w e
A note should be made of a new and practical phase into which the occupa
tion neurosis question passes through the enactment of various workmen’s com
pensation acts. Problems of a most intricate nature come up in connection
with arbitration boards dealing with these questions. The whole topic of
simulation enters to obscure the issue. It is too early to speak of the prac
tical effect of these acts in this country. It is probable that the theory of
the condition will be greatly benefited by the careful expert examinations
which will be performed in these cases. We have already noted a tendency to
greater care in these examinations as a result of the work of a commission
like the Industrial Accident Board of Massachusetts.
I n t h is m e n t io n o f lo c a l c o n ta c ts o f th e P s y c h o p a t h ic H o s p i t a l
w it h th e fie ld o f in d u s t r y a n d in d u s t r ia l a c c id e n ts , I m u s t n o
f o r g e t t o m e n t io n th e w o r k o f D r . S o lo m o n in c o n n e c t io n w ith th e
e m p lo y m e n t o f s y p h ilit ic s .
I n a w o r k o n N e u r o s y p h ilis : M o d e r n
S y s te m a tic D ia g n o s is a n d T r e a tm e n t, 1 917, D r . S o lo m o n a n d I h a v e
d e v o t e d a s e c t io n t o m e d ic o le g a l-a n d -s o c ia l p r o b le m s , in w h ic h ca ses
90, 91, 92, 93, a n d 94 w e r e ca ses o f s y p h ilis o f th e n e r v o u s s y s te m ,
b r o u g h t t o o u r a tte n tio n th r o u g h th e w o r k o f th e in d u s tr ia l a c c i
d e n t b o a r.1 S o m e o f t h e s e c a s e s I s h a l l r e f e r t o b e l o w ; s o m e o f
d
th e m a re m e n tio n e d b y D r . P r e s s e y in th e p a p e r w h ic h I c o n c o m i
t a n t ly p re s e n t w ith m y o w n r e m a rk s.
T h e p o i n t I w i s h t o m a k e f o r t h e m o m e n t is , h o w e v e r , t h a t w i t h
th e m o d e r n tre a tm e n t o f s y p h ilis o f th e n e rv o u s s y s te m w e a re p la c in g
in th e c o m m u n ity a c e rta in n u m b e r o f p e r s o n s w h o fo r m e r ly w o u ld
h a v e s h o r t ly d ie d o r r e m a in e d p e r m a n e n t ly in c a p a c it a t e d .
T h ese
p e rs o n s a re, h o w e v e r , a p o te n tia l d a n g e r f r o m th e in d u s tr ia l s ta n d
p o in t , a n d th e m e n e n g a g e d in in d u s tr ia l a c c id e n t w o r k m u s t, I
b e lie v e , a t n o d is t a n t d a te , t a k e a c c o u n t o f t h is m a t t e r o f s y p h ilis in
e m p lo y e e s .
A lt h o u g h th e a m o u n t o f s y p h ilis in th e c o m m u n it y — I
sp e a k o f s y p h ilis in g e n e ra l, n o t o f s y p h ilis o f th e n e r v o u s sy s te m —
is p r o b a b l y b e l o 10 p e r c e n t , y e t i t m a y w e l l b e a q u e s t i o n w h e t h e r
w
t h e c o m m u n it y s y p h i li s d o e s n o t s t a n d a t a s u ffic ie n t ly h ig h p e r c e n t a g e
t o b e t a k e n a c c o u n t o f b y e m p lo y e r s . S u p p o s e , f o r e x a m p le , 1 m a n
in 2 0 a t t h e a g e o f 3 0 s h o u ld b e f o u n d a fflicte d w it h s y p h ilis , w o u ld
i t n o t e c o n o m i c a ll y p a y a n d b e t o e v e r y b o d y ’s in t e r e s t t o h a v e s u c h
tw e n t ie th m a n p ic k e d o u t b y b lo o d te st, so th a t h e s h o u ld e ith e r n o t
b e e m p lo y e d in in d u s t r y ( o r in c e r ta in fo r m s o f in d u s t r y ) o r s h o u ld b e
e m p lo y e d o n ly w h e n s p e c ia l tr e a t m e n t is g iv e n ?
I n s h o r t, w ith o u r
P s y c h o p a t h i c H o s p i t a l e x p e r ,2e nacne d i t m a y b e w i t h p r e j u d i c e
i
1 S ou th a rd an d S olom on : N eu ro s y p h ilis : M od ern S y s te m a tic D ia g n o sis an d T re a tm e n t.
M o n o g ra p h N o. 2 o f th e P s y c h o p a th ic H o s p ita l S eries, 1917.
2 S ou th a rd , E . E . : “ S ta tis tic a l n o te s on a series o f 6 ,0 0 0 W a sse rm a n n te sts f o r s y p h ilis
p e rfo rm e d in H a rv a rd N e u r o p a th o lo g ica l T e s tin g L a b o r a to r y .”
B o s to n M e d ica l a n d S u r
g ic a l J ou rn a l, V ol. C L X X , N o. 25, June 18, 1914, pp. 9 4 7 -9 5 0 .
78532°— Bull. 248— 19 ------ 11
162
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
f r o m s e e in g a g o o d m a n y w r e c k s f r o m s y p h ilis (1 5 p e r c e n t o f o u r
n e w p a t ie n t s a p p e a r s a fflic te d w it h s y p h i l i s ) , w e h a v e w o n d e r e d
w h e th e r e m p lo y e r s o f g r e a t g r o u p s o f m e n w o u ld n o t d o w e ll t o m a k e
r o u t in e W a s s e r m a n n te sts o f its p r o s p e c t iv e e m p lo y e e s .
O f course,
th e w o r k o f th e L i f e E x te n s io n I n s t it u t e m i g h t b e c it e d in t h is c o n
n e c tio n . I f a s y s te m o f g e n e r a l m e d ic a l e x a m in a tio n s a t s ta te d p e r io d s
w e re to b e set on fo o t , a c c o r d in g to p r o g r a m s p r o p o s e d b y th e L i f e
E x te n s io n I n s titu te , th e n th e m a tte r o f fin d in g s y p h ilis b y m e a n s o f
W a s s e r m a n n r e a c t io n - in - t h e - b lo o d s e r u m w o u ld n o t b e t h r o w n a s id e
as im p r a c tic a l.
I n th ese, as in m a n y o th e r m a tte r s , o u r p r o s p e c t iv e e x p e r ie n c e in
t h e w a r w il l d o u b t le s s y i e l d u s m a n y n e w p o i n t s o f v ie w a n d p r a c t ic a l
s o c ia l p r o c e d u r e s . S u c h a s s o cia tio n s as th e A s s o c ia t io n o f M e c h a n ic a l
E n g in e e r s a n d th e A s s o c ia t io n o f M in in g E n g in e e r s a re p la c in g o n
t h e ir p r o g r a m s f o r t h e ir a n n u a l m e e tin g s t h is se a so n q u e s tio n s c o n
c e r n in g th e p s y c h o p a t h ic fr a c t io n o f th e ir p r o b le m s . T h e m e c h a n ic a l
e n g i n e e r s a r e f i n d i n g t h a t t h e i r e n t i r e p r o b l e m is n o t o n e o f m a c h i n e s
a n d c o n s tr u c tio n , a n d th e m in in g e n g in e e r s a re fin d in g th a t th e ir
w h o l e p r o b l e m is n o t o n e o f s h a f t s i n k i n g o r e v e n o f t r a n s p o r t a t i o n .
T h e y a re fin d in g th a t th e p r o b le m s o f h u m a n c h a r a c te r , e s p e c ia lly
a s m o d i f i e d b y d is e a s e , a r e p r a c t i c a l p r o b l e m s i n m a n y o f t h e i r f i e l d s .
P s y c h o lo g i c a l c o n t r ib u t io n s t o e n g in e e r in g p r o g r a m s a r e n o w q u it e
th e o rd e r o f th e d a y .
T u r n in g t o th e r e v ie w o f m a te r ia l w h ic h I h a v e m a d e th e o c
c a s io n f o r th e s e b r o a d e r r e m a r k s , I s h a ll le a v e t o D r . P r e s s e y t h e
im p o r t a n t d e ta ils o f c e r ta in ca ses o n w h ic h h e b a s e d h is c o n c lu s io n s
a s t o r e lia b ilit y o f th e p s y c h o lo g i c a l e x a m in a t io n in d e a lin g w it h
ca se s o f in d u s tr ia l a c c id e n t. I h e re in s e r t D r . P r e s s e y ’s d a ta .
THE RELIABILITY OF THE PSYCHOLOGICAL EXAMINATION IN
DEALING WITH CASES OF INDUSTRIAL ACCIDENT.
O f th e p s y c h o t ic ca ses c o m in g b e fo r e th e in d u s tr ia l a c c id e n t b o a r d ,
a c o n s id e r a b le n u m b e r p re s e n t p r o b le m s w h ic h s u g g e s t m e n ta l m e a s
u re m e n t b y m e a n s o f p s y c h o lo g ic a l te sts as a n a id in d ia g n o s is o r
e s t im a t e o f a m o u n t o f i n ju r y . T h e r e is s o m e tim e s a s u s p ic io n t h a t
th e p a t ie n t m a y o r ig in a lly h a v e b e e n d e fe c t iv e m e n ta lly . W h e r e th e
p a t ie n t ’s o w n n e g le c t o r i n c a p a c i t y m a y h a v e b e e n a f a c t o r in th e
a c c id e n t s u ch a q u e s tio n is o f n o s m a ll im p o r t a n c e .
A som ew hat
s i m i l a r p r o b l e m a r is e s i f t h e r e i s s u s p i c i o n o f a p r i o r d e t e r i o r a t e d
c o n d it io n , d u e , p e r h a p s , t o a lc o h o lis m . I n o t h e r ca ses th e p s y c h o lo g i
c a l e x a m in a t io n m a y b e lo o k e d t o f o r h e lp in e s t im a t in g th e d e g r e e
o f in c a p a c it y r e s u ltin g f r o m th e in ju r y .
I n s u c h ca ses as th e se th e in t e r p r e t a t io n a n d p r o p e r e v a lu a t io n o f
t h e r e s u l t s o f t h e p s y c h o l o g i c a l e x a m i n a t i o n a r e u s u a l l y v e r y d if f i-
PSYCHOLOGICAL, EXAMINATIONS---- S. L. PRESSEY , PH. D.
163
c u lt . B u t n o t i n f r e q u e n t l y t h e s e r e s u lt s a r e o f n o s m a ll i m p o r t a n c e
f o r a n a d e q u a te u n d e r s t a n d in g o f th e ease. I t h a s t h e r e fo r e b ee n th e
p r a c t ic e a t th e P s y c h o p a t h ic H o s p it a l t o m a k e p s y c h o lo g ic a l e x a m i
n a tio n s o n as m a n y o f th e in d u s tr ia l a c c id e n t b o a r d ca ses as p o s s ib le ,
w it h a v ie w t o t h e a c c u m u la t in g o f d a t a f o r s p e c ia l s t u d y o f t h is
g r o u p o f p a t ie n t s .
T h e c a se s a re p a r t ic u la r ly in te r e s tin g , b e c a u s e
o f th e im m e d ia te p r a c t ic a l im p o r ta n c e o f th e fin d in g s ; le g a l c o n
s id e r a tio n s a r e in v o lv e d , q u e s tio n s o f r e c o m p e n s e f o r in ju r y , a n d th e
r e lia b ilit y o f th e m e th o d s e m p lo y e d f o r d ia g n o s is m u s t b e t h o r o u g h ly
c o n s id e r e d .
T h e c a s e o f --J- - - H - - - - - - -i s a n e x c e l l e n t e x a m p l e o f t h e p o s s i b l e
v a lu e o f a p s y c h o lo g i c a l e x a m in a t io n w h e r e t h e r e is a q u e s t io n o f o r
i g i n a l m e n ta l d e fe c t . T h e p a tie n t, a te a m s te r, h a d b e e n t h r o w n f r o m
a m o t o r t r u c k w h e n i t w a s s tr u c k b y a tr a in . T h e l e f t s id e o f t h e s k u ll
w a s fr a c t u r e d , s e v e r a l r ib s w e r e b r o k e n , a n d th e re w e r e n u m e ro u s
b r u is e s o n th e b o d y .
T h e p a t ie n t ’s h e a d w a s o p e r a t e d u p o n , h e w a s
in a d e lir iu m f o r s o m e t w o w e e k s, g r a d u a lly r e c o v e r e d , b u t h a s b e e n
u n a b le t o w o r k , e a s ily t ir e s , s h o w s s o m e m e m o r y d is t u r b a n c e s , is i r r i
ta b le , d e p r e s s e d .
H e h a s b e e n r e c e$8 i n g w e e k f r o m t h e i n s u r
iv a
a n c e c o m p a n y , a n d wT s s e n t t o t h e P s y c h o p a t h i c H o s p i t a l f o r d e t e r
a
m in a t io n as t o th e r e la tio n o f h is in c a p a c it y t o th e a c cid e n t.
T h e p r e v io u s h is t o r y s h o w s th a t th e p a t ie n t c o m p le t e d o n ly s ix
g r a d e s o f g r a m m a r s c h o o l— w a s t w o y e a rs in th e fift h g r a d e — a n d
h a d c o n s id e r a b le d iffic u lty in le a r n in g .
S in c e l e a v i n g s c h o o l a t 15
h e h a s w o r k e d , c le a n in g sc re e n s , in a m a c h in e s h o p , in a d y e h o u s e , a
r u b b e r m ill, a n d d r o v e a m ilk w a g o n f o r a y e a r.
H is w a g e s h a ve
v a r i e d f r o m$6 t o $ 12 a w e e k .
T h is h is t o r y n a t u r a lly s u g g e s te d th a t
th e p a tie n t m ig h t h a v e b e e n o r ig i n a l l y d e fe c t iv e m e n ta lly .
H is p re s
e n t in c a p a c it y c o u ld n o t, th e n , b e c o n s id e r e d d u e a lt o g e t h e r t o th e
in ju r y .
A p s y c h o lo g ic a l e x a m in a tio n w a s m a d e a n d g a v e a m e n ta l
a g e o f 1 5 .5 .
T h e s c a le r a t in g in t h is in s t a n c e m a y b e t a k e n a s d e c i s i v e in r u l i n g
o u t th e s u p p o s it io n o f o r ig in a l fe e b le -m in d e d n e s s .
I f th e p a t ie n t , in
s p ite o f th e a b n o r m a l m e n ta l c o n d it io n r e s u lt in g f r o m h is in ju r y , is
a b l e t o e a r n a m e n t a l a g e o f 1 5 .5 o n t h e t e s t s , i t i s i m p o s s i b l e t o s u p
p o s e h im m a r k e d ly b e lo w a v e r a g e in te llig e n c e p r e v io u s t o th e a c c i
d e n t.
W i t h s u c h a r a t in g n o fin e r a n a ly s is o f t h e e x a m in a t io n is
n e e d e d ; th e m e n ta l a g e a lo n e g iv e s th e in fo r m a t io n d e s ire d .
I n t h e c a s e o f L - - - - - - -C- --- , a m i l l w o r k e r , a g e d 3 5 , t h e p s y c h o l o g i
c a l e x a m in a tio n g a v e a d iffe r e n t in d ic a t io n , r e s u ltin g in a d ia g n o s is o f
d e m e n t ia p ra e e o x o n a f e e b le -m in d e d b a s is .
T h e p a t ie n t h a d b e e n
a w o r k e r in a c o t t o n m ill in L o w e ll a t $ 9 a w e e k a n d w a s s tr u c k b y
a fly in g s h u ttle w h ic h in ju r e d h e r b r e a s t a n d a rm .
S h e w a s g iv e n
c o m p e n s a t io n f o r f o u r w e e k s , b u t a t th e e n d o f th a t tim e a s s e r te d
th a t sh e w a s s t ill u n a b le t o w o r k .
A p s y c h o t ic c o n d it io n g r a d u a lly
164
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
d e v e lo p e d .
T h e p a t ie n t t o l d s to r ie s o f a tta c k s b y m y s te r io u s p e r
so n s h o o d e d in b la c k , o f i n ju r y b y a n e e d le w h ic h a d r e s s m a k e
s n a p p e d in to h e r e y e , c a u s in g a “ b r u is e d fe e lin g in h e r h e a d .
P r e v io u s h is t o r y w a s in d e fin it e as t o p r o g r e s s in s c h o o l, b u t t h e
s c h o o l in fo r m a t io n w a s e ith e r v e r y p o o r ly r e t a in e d o r la c k in g
K n o w l e d g e o f c u r r e n t e v e n t s w a s v e r y s l i g h t ; e c o n o m ic e ffic ie n c y
h a d a lw a y s b e e n lo w .
S h e w a s d e s c r ib e d as p r i o r to th e a c c id e n t a
'“ c r e d u l o u s , i g n o r a n t , s i m p l e - m i n d e d p e r s o n . ”
O r ig in a l m e n ta l d e
fe c t , as a n im p o r t a n t e le m e n t in th e ca se, w a s c le a r ly s u g g e s te d .
P s y c h o l o g i c a l e x a m i n a t i o n g a v e t h e p a t i e n t a m e n t a l9, a a e o f
g
c o e f f i c i e n t o f 0 . 5 5 ; t h a t is , h e r s h o w i n g w a s o n l y 5 5 p e r c e n t o f t h e
r a t in g o f th e a v e r a g e a d u lt.
F u r th e r , th e p e r fo r m a n c e o n th e d i f
f e r e n t te s ts w a s q u it e c o n s is t e n t ly a t t h is le v e l, t h e r e b e i n g lit t le
u ir r e g u la r it y .”
S in c e r a t in g b y th e tests w a s u n i f o r m l y a t a b o u t
th e le v e l w h ic h w o u ld b e e x p e c t e d f o r a c h ild o f o n ly 9 y e a r s ,
c o n c lu s io n th a t th e p a t ie n t h a d a lw a y s b e e n d e fe c t iv e m e n ta lly
seem ed w a rra n ted .
T h e im p o r ta n c e o f su ch a c o n c lu s io n as d e te r
m in in g th e r e la tio n o f th e a c c id e n t to th e p re s e n t m e n ta l c o n d it io n
is o b v io u s .
I f th e e x a m in a tio n h a d b ee n m a r k e d ly ir r e g u la r , th e a b o v e c o n c lu
s i o n w o u l d n o t h a v e b e e n j u s t i f i a b l e . T h e e x a m i n a t i-o - - -oJf- -M - - -n
C - - - - - - , a ls o s h o w i n g a m e n t a l a g e o f 9 , i s a n e x a m p l e o f s u c h i r r e g u
la r ity .
T h e m a n w a s a p la s te r e r , 60 y e a r s o f a g e , w h o h a d fa lle n
w h ile a t w o r k . T h e fin a l d ia g n o s is w a s K o r s a k o w ’s p s y c h o s is . A l
m o s t n o h is t o r y w a s o b ta in a b le .
A p s y c h o lo g ic a l e x a m in a tio n w a s
g i v e n . T h e “ m e n t a l a g e ” o b t a i n e d w a s 9 .7 . T h i s m e n t a l a g e b y i t s e l f
w o u ld s u g g e s t th a t th e p a tie n t m ig h t b e a m o r o n a d d ic t e d t o a lc o h o l.
B u t c lo s e r s t u d y o f th e e x a m in a t io n s h o w s a m a r k e d ir r e g u la r it y .
T h a t i s , M- - - - J - - - - - - - C - - - - - -f a i l s i n s o m e t e s t s w h i c h t h e a v e r a g e 9 y e a r -o ld c h ild d o e s w it h ease, a n d su cce e d s o n o th e r p r o b le m s w h ic h
e v e n a12 -y e a r - o l d c h i ld fin d s d iffic u lt. A m e t h o d h a s r e c e n t l y b e e n
w o r k e d o u t a t t h e h o s p 1 t fao lr t h e c a l c u l a t i o n o f t h i s “ i r r e g u l a r i t y , ”
i
a s it a p p e a r s in t h e p o i n t s c a le u s e d th e r e , in “ p o in t s .” T h e a v e r a g e
f e e b l e - m i n d e d c a s e s h o w s a n i r r e g u l a r i t y o f 1 7 “ p o i n t s . ”- - - - B u t M
J - - - - - C ;- - - - - -g i v e s a n i r r e g u l a r i t y o f 2 8 p o i n t s , o r s o m e 6 5 p e r c e n t
m o r e th a n th e a v e r a g e f o r th e p r im a r y a m e n ts.
W o r k w it h th
“ s u p p le m e n t a r y t e s t s ” (p u z z le s , b r i e f m e m o r y p a s s a g e s , le a r n in g
te s ts , a n d s o o n ) w a s a ls o ir r e g u la r .
T h e p a t ie n t f a i l e d , a f t e r fiv e
m in u te s ’ w o r k , t o c o m p le t e a s im p le p u z z le w h ic h th e a v e r a g e 9 -y e a r
m e n t a lit y p u t s t o g e t h e r 1 in in u te a n d 15 s e c o n d s . H e c o u ld g iv e
m
b a c k o n l y t h r e e d e t a ils o f a s im p le s t o r y , im m e d ia t e ly a f t e r r e a d in g ,
w h e re th e a v e ra g e c h ild r a t in g at th e sa m e m e n ta l a g e re m e m b e rs 9
d e t a ils .
1 S. L . P ressey : “ D is tin c tiv e fe a tu re s in th e p s y c h o lo g ic a l e x a m in a tio n o f d e m e n tia
prsecox an d c h ro n ic a lc o h o lic p a tie n ts .” J o u rn a l o f A b n o rm a l P s y c h o lo g y , J u ly , 1917.
PSYCHOLOGICAL EXAMINATIONS— S. L. PRESSEY, PH. D.
165
T o s a y in t h is c a se t h a t th e e x a m in a t io n s h o w s a u m e n t a l a g e ”
o f 9 is c le a r ly a b s u rd .
T h e e x a m in a t io n is a lt o g e t h e r d iffe r e n t in
th e m a k e -u p fr o m th a t g iv e n b y th e a v e r a g e m e n ta lity o f 9 y e a rs .
T h e “ c o e ffic ie n t o f in t e llig e n c e ” e x p r e s s e s t h e s ig n ific a n c e o f t h e
f in d i n g s m u c h b e t t e r . ----- J - - - - - - C - - - - - - o b t a in s a c o e ffic ie n t o f
M
0 .6 4 ; t h a t is , h e o b t a in s 6 4 p e r c e n t o f t h e s c o r e o f t h e a v e r a g e a d u lt .
T h e 28 p o in t s ir r e g u la r it y c le a r ly in d ic a t e th a t h e o b ta in s t h is 6 4 p e r
c e n t o f w h a t h e s h o u ld i f n o r m a l p r im a r ily b e c a u s e o f m e n ta l d is t u r b
a n ce . F r o m th e p s y c h o lo g ic a l e x a m in a tio n its e lf, th e r e fo r e , a n in d i
c a t io n c a n b e o b t a in e d as t o w h e t h e r t h e m e n t a l a g e r a t in g is r e lia b le .
I n t h is in s t a n c e it c le a r ly is n o t .
T h e e x a m in a tio n o f a n I t a lia n la b o r e r , s tr u c k o n th e h e a d b y a
p la n k w h ile w o r k in g in a se w e r, w a s u s e fu l c h ie fly in e m p h a s iz in g
a n d g i v i n g s o m e d e fin ite in d ic a t io n o f th e m a r k e d in c a p a c it y r e s u lt
in g f r o m th e a c cid e n t.
L it t le h is t o r y w a s o b ta in a b le , b u t p r e v io u s
t o th e a c c id e n t th e p a tie n t h a d b e e n a n a v e r a g e I t a lia n la b o r e r so
f a r a s c o u ld b e a s c e r t a in e d .
F o llo w in g th e in ju r y h e b eca m e d e
p re s s e d , ir r ita b le , c o u ld n o t w o r k , h a d v is u a l a n d o lf a c t o r y h a llu c i
n a t io n s — a t th e P s y c o p a t h ic H o s p it a l w a s d ia g n o s e d as a c a s e o f
t r a u m a t ic p s y c h o s is .
I n g iv in g th e p s y c h o lo g ic a l e x a m in a tio n th e
“ K n o x ” s c a le w a s u s e d , s i n c e t h i s i s e s p e c i a l l y a d a p t e d f o r w o r k w i t h
s u c h illit e r a t e fo r e ig n e r s .
T h e e x a m in a tio n g a v e a m e n ta l a g e o f 5 f.
T h e s h o w in g w a s
e x t r e m e ly ir r e g u la r , w it h fa ilu r e s in th e fo u r -y e a r g r o u p o f te sts
a n d a su cc e s s in th e 1 3 -y e a r g r o u p .
S o f a r a s e v id e n c e w e n t c o n
c e r n i n g t h e le v e l o f t h e p a t ie n t ’s m e n t a lit y p r i o r t o t h e a c c id e n t ,
t h e e x a m i n a t i o n w a s p l a i n l y u s e le s s .
B u t as a n in d ic a tio n o f th e
m a r k e d i n c a p a c i t y f o l l o w i n g t h e i n j u r y i t is o f d i s t i n c t s i g n i f i c a n c e .
I t is o f e s p e c i a l i n t e r e s t , s i n c e a s e c o n d e x a m i n a t i o n w a s m a d e f i v e
m o n t h s l a t e r w h i c h g a v e a m e n t a l a g e o f 7-g.
T h e p a t ie n t h a
im p r o v e d s lig h t ly , b u t s till s h o w e d m o s t o f th e p r e v io u s s y m p to m s
t o a c o n s id e r a b le d e g r e e .
T h e se c o n d r a tin g g a v e an e x p r e s s io n o f
b o t h th e se fa c ts .
T h e s e f o u r e x a m p le s w il l s e r v e t o illu s tr a te th e w a y s in w h ic h
p s y c h o lo g ic a l tests in t h e ir p r e s e n t s ta g e o f d e v e lo p m e n t m a y b e o f
u se in a n a ly z in g o r e s tim a tin g th e a m o u n t o f m e n ta l in c a p a c it y
d u e t o i n j u r y . R o u g h l y , i t m a y b e s a i d 1 t h a t m (e n t a l a g e a b o v e
)
12 m a y b e c o n s i d e r e d t o e x c l u d e t h e s u p p o s i t i o n o f a n o r i g i n a l f e e b l e
m i n d e d n e s s ; 2 )( a m e n t a l a g e b e l o 1w w i t h s l i g h t i r r e g u l a r i t y
1
w o u ld s u g g e s t su ch a fe e b le -m in d e d b a s is f o r th e p s y c h o s is o
n e u r o s is ; ( 3 ) a m a r k e d ir r e g u la r it y ( o v e r 2 p o in t s o n th e p o in
s c a le as fig u r e d b y t h e m e t h o d a t p r e s e n t in u se a t th e P s y c h o p a t h i c
H o s p it a l) w o u ld in d ic a t e th a t o th e r fa c t o r s th a n o r ig in a l m e n ta l
d e fe c t h a v e b r o u g h t a b o u t th e lo w r a t in g .
I n s u c h ^i n s t a n c e s t h e
“ m e n t a l a g e ” ( o r , b e t t e r , t h e “ c o e ffic ie n t o f i n t e l l i g e n c e ” ) m a y b e
166
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
t h o u g h t o f a s in a r o u g h w a y s u g g e s tiv e o f th e a m o u n t o f th i
a c q u ir e d im p a ir m e n t.
S o m e 3 0 ca ses c o m in g f r o m th e in d u s tr ia l a c c id e n t b o a r d h a v e t o
d a t e b e e n p a tie n ts a t th e P s y c h o p a t h ic H o s p it a l.
S a tis fa c to r y p s y
c h o l o g i c a l e x a m i n a t i o n s h a v e b e e n o b t a i n e d w i t12 o n l yt h e s e .
h
f
T h e m a t e r ia l is o f c o u r s e n o t s u ffic ie n t o r h o m o g e n e o u s e n o u g h f o r
s a t is fa c t o r y s ta tis tic a l tre a tm e n t. B u t it is in te r e s tin g t o n o te th a t
t h e a v e r a g e m e n t a l a g e i s 1 0 .3 , a n d t h a t o n l y t w o g r a d e a b o v e 1 2 .
T h o u g h 10 o f t h e12 g r a d e a t o r c l o s e t o f e e b l e - m i n d e d a g e , i t c a n
h a r d l y b e s u p p o s e d t h a t t h is is t h e p r o p o r t io n o f m e n t a lly d e fe c t iv e ,
a n d t h a t n o t a ll o f th e s eg iv e e x a m in a tio n s s u c h a s a r e s h o w n b y
10
th e fe e b le -m in d e d as in d ic a t e d b y th e ir r e g u la r it y .
T h e a v erage
ir r e g u la r it y o f a g r o u p o f 156 p r im a r y a m e n ts w a s 17 p o in t s , b u t
t h e i r r e g u l a r i t y o f t h i s g r o u 22 is o i n t s ; o n l y o n e c a s e g i v e s a n
p p
i r r e g u l a r i t y o f 17.
T h e e s s e n tia l d iff e r e n c e b e t w e e n t h e s h o w i n g o f t h is g r o u p a n d o f
a s im ila r g r o u p o f th e f e e b le - m in d e d is f u r t h e r b r o u g h t o u t b y a
s t u d y o f th e r e c o r d s o n th e s u p p le m e n t a r y tests.
T h e s e in d u s tr ia l
a c c i d e n t b o a r d c a s e s a v e r a g e le s s t h a n h a l f a s m a n y c o r r e c t m o v e s ,
a n d ta k e t w ic e a s lo n g , in fillin g in th e H e a ly A p p e r c e p t io n P u z z le
a s w o u ld b e e x p e c te d o f a s im ila r g r o u p o f fe e b le -m in d e d ca ses
T h e y ta k e 25 p e r c e n t m o r e m o v e s a n d t w ic e a s lo n g to s o lv e H e a ly
P u z z l e B , a n d m a k et i m e s a s m a n y f a i l u r e s . O n t h e H e a l y P i c t u r e
8
F o r m B o a r d t h e y f a i l 9 m o r e tim e s .
T h e y re m e m b e r 60 p e r ce n t
l e s s o f t h e l o g i c a l m e m o r y p a s s a g e , l e a r n 3 0 p e r c e n t le s s i n a l e a r n
in g te st, t h o u g h t h e y ta k e 4 0 p e r c e n t m o r e tim e in th e le a r n in g ,
a n d in a n o th e r le a r n in g te s t r e ta in a b o u t h a l f a s m u c h .
Ther
s h o u ld th e n in m o s t ea ses b e n o d iffic u lty in d is t in g u is h in g ca ses
g r a d in g a t fe e b le -m in d e d a g e s o le ly b e ca u s e o f m e n ta l d e r a n g e m e n t
f r o m th o s e p r im a r ily s u b n o r m a l, i f ir r e g u la r it y a n d s u p p le m e n t a r y
te sts a re th u s s tu d ie d in e v e r y case.
T h e im p o r t a n c e o f th e se ca ses a n d th e som ew T a t s p e c ia l p r o b le m
h
t h e y p r e s e n t t o th e p s y c h o lo g ic a l e x a m in e r h a v e s u g g e s te d th is b r i e f
s t u d y o f th e d a ta a lr e a d y a t h a n d . A w r o n g e v a lu a t io n o f th e fin d
in g s w it h th e p s y c h o lo g i c a l te s ts is in s u c h in s t a n c e s v e r y e a s y , a n d
th e im p o r ta n c e o f t a k in g in to a c c o u n t th e m a k e -u p o f th e e x a m in a
tio n , th e ir r e g u la r it y , n o t g e n e r a lly u n d e r s to o d . A c o n c e p t o f ir r e g u
la r it y as a m e a su re o f th e r e lia b ilit y o f th e e x a m in a tio n seem s lik e ly
t o p r o v e d e c id e d ly v a lu a b le .
W h e r e a n e x a m i n a t i o n is i r r e g u l a r
c e r ta in tests a re a ffe c te d m u c h m o r e th a n o th e rs. T h o s e te sts w h ic h
a r e m o s t s e n s itiv e h a v e b e e n c o m b in e d in a d iffe r e n t ia l g r o u p , f o r
w h ic h n o r m s a re n o w b e in g w o r k e d o u t a t th e P s y c h o p a t h ic H o s
p it a l.
T h e v a lu e o f a p s y c h o lo g ic a l e x a m in a t io n in s u c h ca ses a
h a v e b e e n ju s t d e s c r ib e d h a s b e e n d is c o u n te d in th e p a s t b e c a u s e o f
PSYCHOLOGICAL EXAMINATIONS— S. L. PRESSEY , PH. D.
167
t h e d iff ic u lt y i n d is t i n g u is h i n g r e s u lts o f o r i g i n a l d e f e c t a n d o f a c
q u ir e d m e n t a l d is t u r b a n c e . T h e u se o f e x a c t m e a s u r e s o f ir r e g u la r it y
a n d o f s p e c ia l d iffe r e n t ia l g r o u p s o f te sts m a k e s p o s s ib le s o m e su ch
a n a ly s is .
S u c h s p e c ia l m e th o d s c a n b e u s e d o n ly b y tr a in e d e x
a m in e r s , t h o r o u g h ly f a m i l ia r w it h th e te s ts a n d e x p e r ie n c e d in w o r k
w i t h p a t ie n t s a b n o r m a l m e n ta lly .
B u t u n d e r th e s e c ir c u m s t a n c e s
th e p s y c h o lo g ic a l e x a m in a tio n is c a p a b le o f m a k in g a d is t in c t iv e
c o n t r ib u t io n t o th e t o t a l s t u d y o f th e ease.
I t w i l l b e e v i d e n t f r o m D r . P r e s s e y ’s r e m a r k s t h a t h e , a s a p s y
c h o lo g is t , is s t ill w o r k in g t o w a r d a g r e a t e r r e lia b ilit y o f m e th o d s in
th e fie ld o f p s y c h o lo g y .
A s a P s y c h o p a t h ic H o s p it a l d ir e c t o r a n d
p s y c h ia t r is t , h o w e v e r , I w a n t t o m a k e th e p o in t th a t w e c o u ld n o t
a t a ll g e t o n w it h o u r w o r k n o w a d a y s w it h o u t th e m e n ta l tests e v e n
i n t h e ir p r e s e n t in c o m p le t e sta te.
T h e P s y c h o p a t h ic H o s p it a
m e th o d s h a v e b een th o se d e v e lo p e d b y P r o f . (n o w M a jo r ) E . M
Y e r k e s , w h o w a s f o r fiv e y e a r s p s y c h o lo g is t t o th e P s y c h o p a t h ic
H o s p i t a l b e f o r e h e w a s c a lle d t o M in n e s o ta a n d th e n fo r t h w it h in t o
th e S a n ita r y C o r p s as h e a d o f th e p s y c h o lo g ic a l w o r k u n d e r S u rg .
G en. G orgas.
P r o f . Y e r k e s ’ m o n o g r a p h o n “ T h e P ” i1n t S c a l e
o
in d ic a te s th e d ir e c t io n in w h ic h th e w o r k r a n , a lth o u g h n u m e ro u s
im p r o v e m e n t s h a v e b e e n m a d e b y P r o f . Y e r k e s a n d h is c o w o r k e r s
s in c e t h a t tim e .
W e h a v e p la c e d u n d e r r e v ie w so m e 31 ca ses sen t t o us b y th e in
d u s t r ia l a c c id e n t b o a r d f o r s p e c ia l e x a m in a t io n o n a c c o u n t o f d iffi
c u lt ie s in th e in t e r p r e t a t io n o f t h e ir m e n t a l c a p a c it ie s o r sta tu s. I
m a y r e m a r k th a t o f th ese 31 ca ses, 1 7 e v e n t u a lly r e c e iv e d c o m p e n s a
t i o n , p a r t i a l o r c o m p l e t e ; t h a1t1 i c a s e s f i n d i n g s w e r e m a d e f o r t h e
n
in s u r e r , l e a v i n g 3 c a s e s f o r t h e m o m e n t u n s e t t le d .
C o n c e r n in g th e s e ca ses, I w ill fir s t m a k e a n u m b e r o f r e m a r k s
s h o w i n g s o m e o f t h e o d d it ie s a n d d iffic u lt ie s o f t h e fie ld . I h a v e b e
f o r e m e a ca se in w h ic h th e fin d in g w a s f o r th e in s u r e r, a lt h o u g h
t h e r e i s s o m e e v i d e n c e , n o t d e n i e d b y a n y o n e , o f o r g a n i c d is e a s e ,
p o s s ib ly i n v o l v i n g th e c e r e b e llu m a n d d u e t o th e a c c id e n t.
H ow
e v e r, th e m a n r e fu s e d to m a k e an e ffo r t to r e tu rn to w o r k a n d r e fu s e d
t o g o t o t h e P s y c h o p a t h i c H o s p i t a l f o r o u r e x a m in a t io n . H i s is a
c a s e o f w h a t th e F r e n c h w o u ld te r m m a u v a is e v o lo n t e s u ch as is n o t
in fr e q u e n t ly fo u n d in th e s h e ll-s h o c k g r o u p . W e n e e d f o r a ca se o f
t h i s s o r t a s o c i a l s e r v i we h i c h s h a l l g o d e l i b e r a t e l y o u t a f t e r t h e
2 c
p a t ie n t a n d a lt e r , i f p o s s ib le , h is a t t it u d e a n d t h a t o f h is f a m i l y as
* Y erk es, B rid g es, an d H a r d w ic k : T h e P o in t S ca le f o r M e a s u rin g M en ta l A b ility .
M on ograp h. N o. 1 o f th e P s y c h o p a t h ic H o s p ita l S eries, 1 915.
W a r w ick & Y o rk , B a lt i
m ore.
2
J a r re tt, M. C . : “ T h e p s y c h o p a th ic e m p lo y e e : A p ro b le m o f in d u s try .”
M ed icin e and
S u rg ery , St. L ou is, Septem ber, 1917.
168
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
r e g a r d s th e s itu a tio n . W h e t h e r s u c h w o r k in a g iv e n ca se s h a ll b e
d o n e u n d e r th e a u s p ic e s o f th e in d u s t r ia l a c c id e n t b o a r d it s e lf, o r
u n d e r s o m e o t h e r a u s p ic e s , see m s t o m e t o b e a q u e s tio n n o t t o b e
s e ttle d b y fo r m u la .
I h a v e b e fo r e m e a n o th e r ca se in w h ic h d e lir iu m tre m en s e n te re d
t o o b s c u r e t h e r e s u lt .
T h e ca se is t h e o r e t ic a lly s u b je c t to r e v ie w
b u t as th e m a n h a s d r o p p e d o u t o f th e fie ld o f a tte n tio n , e ith e r o f
th e in s u r a n c e c o m p a n y o r o f t h e a c c id e n t b o a r d , n o t h in g is b e in g
d o n e a b o u t th e m a n o r h is f a m i l y .
M o s t s o c ia l a g e n c ie s d is lik e t o
e n te r a ca se o f th is s o r t o n a c c o u n t o f th e p r i o r a u t h o r it y o f th e in
d u s tr ia l b o a r d a n d th e p e c u lia r fin a n c ia l a n d le g a l a s p e c ts th a t s u ch
a ca se p re s e n ts .
I h a v e b e f o r e m e a n o th e r ca se , p r o b a b ly o f d e m e n tia p ra e co x , in
w h ic h th e in t e r e s t in g f i n d i n g f o r th e e m p lo y e e is a s f o l l o w s :
Insurer to confer with State insanity authorities to see whether or not
arrangements can be made to continue treatment of the employee without cost
so that the fund may be retained intact when he is discharged from the insane
hospital.
I n a c a s e o f g e n e r a l p a r e s is , s o m e c o m p e n s a t io n w a s g iv e n , b u t
th e fin d in g w a s th a t th e a c c id e n t w a s n o t c a u s a lly c o n n e c te d w it h
t h e illn e s s , a n d m e d ic a l t e s t im o n y i n d i c a t e d t h a t c o m p e n s a t io n
s h o u ld n e v e r h a v e b e e n g iv e n .
H o w e v e r , w it h r e s p e c t t o g e n e r a l p a r e s is a n d o t h e r s y p h i li t ic d is
ea ses o f th e n e r v o u s s y s te m , th e r e a re o th e r ca ses in w h ic h th e fin d
in g h a s b e e n f o r th e e m p lo y e e . A llo w a n c e h a s b e e n m a d e f o r to ta l
i n c a p a c it y in a p a r e t ic .
T h is k in d o f fin d in g h a s r e la tio n
w h a t I s a id a b o v e c o n c e r n in g - th e p o s s ib ilit y th a t e m p lo y e r s in th e
fu t u r e m a y d e m a n d a n o n s y p h ilit ic r e c o r d f r o m e m p lo y e e s . I f , as
I u n d e r s t a n d it , a m a n b l in d o f o n e e y e c a n r e c e iv e c o m p e n s a t io n f o r
t o t a l b lin d n e s s i f h is o t h e r e y e b e b lin d e d , h o w d o e s th e s it u a t io n
d iffe r fr o m th a t o f s y p h ilit ic in fe c t io n ?
T h e c o m p a n y a ccep ts
m a n w it h a b lin d e y e ; th e c o m p a n y a c ce p ts a m a n w it h s y p h ilis . A n
i n ju r y d e s t r o y s th e s o u n d e y e ; a n i n j u r y lib e r a t e s , a g g r a v a t e s , o r
a c c e le r a t e s s y p h i li t ic d is e a s e o f t h e n e r v o u s s y s te m . T h e r e d o e s n o t
see m t o b e a n y l o g i c a l d iffe r e n c e b e tw e e n th e t w o lia b ilit ie s .
I n o n e c a s e th e q u e s tio n o f fe e b le -m in d e d n e s s w a s r a is e d as h a v i n g
a b e a r in g o n th e a m o u n t o f c o m p e n s a tio n .
M e n ta l te sts, h o w e v e r ,
s h o w e d th a t th e p a tie n t w a s m e n ta lly n o r m a l; fe e b le -m in d e d n e s s
c o u ld b e s a fe ly r u le d o u t. T h e in c a p a c it y t o w o r k w a s in t h is ca se
m e n ta l, b u t it w a s n o t d u e t o m e n ta l d e fe c t so m u c h as t o m e n ta l
d is o r d e r .
I n a n o t h e r c a s e fe e b le -m in d e d n e s s w a s p r o v e d t o e x is t.
Th
p a t ie n t m a d e a s c o r in g t o c o r r e s p o n d w it h th e n in t h y e a r o f a g e a n d
t h e s c o r i n g w a s c o n s i s t e n t l y a t t h a t l e v e l ; t h a t is , t h e p a t i e n t d i d n o t
s h o w th e i r r e g u la r it y t o w h ic h D r . P r e s s e y h a s a b o v e c a lle d a tte n
PSYCHOLOGICAL EXAMINATION'S---- E. E. SOUTHARD, M . D.
169
t io n . T h e a t t o r n e y f o r th e c la im a n t, h o w e v e r , c o n te n d e d t h a t a c o n
d i t i o n o f n e u r o s is h a d f o l l o w e d t h e a c c id e n t . T h e r e w e r e n o fe a tu r e s
o f n e u r o s is in t h e c la s s ic a l s e n se o f th e te r m . T h e p a t ie n t , h o w e v e r ,
-h a d a c o n v ic t io n o f i n a b i l it y t o w o r k , a n d i t r e m a in s d o u b t f u
wT e t h e r h e e v e r w i l l w o r k .
h
T h e p a t ie n t ’s c o n v ic t io n th a t w o r k in g
c a p a c it y w a s g o n e (d e s p it e e n tir e n e u r o m u s c u la r c a p a c it y ) w a s
d o u b t le s s a m a t t e r o f p o o r ju d g m e n t a n d in s ig h t , t h e r e s u lt o f fe e b le
m in d e d n e s s .
W e h a v e h a d a n u m b e r o f le s s o n s c o n c e r n in g m e n t a l tests.
In
a n o th e r ca se, m a k in g b u t lit t le o v e r th e g r a d e o f th e ca se ju s t m e n
tio n e d , th e re w a s a m a r k e d ir r e g u la r it y d e m o n s tr a te d b y th e p s y
c h o lo g is t s a ft e r th e m a n n e r o f D r . P r e s s e y ’s sta te m e n ts a b o v e , a n d
t h e p s y c h ia t r is t s , o n t h e b a s is o f t h e p s y c h o l o g i s t ’s r e s u lts , w e r e e n
a b le d to m a k e th e d ia g n o s is o f d e m e n tia p rs e co x . M a k in g t h is d ia g
n o s is h a d a n im p o r t a n t b e a r in g o n th e fin d in g s o f th e in d u s t r ia l
board.
A n o t h e r im p o r t a n t v a lu e o f m e n t a l te s ts lie s in t h e e v id e n c e t h e y
m a y g iv e o f im p r o v e m e n t.
S p a c e d te sts, p e r h a p s s ix m o n th s a p a r t ,
m a y s h o w s ig n s o f g r e a t im p r o v e m e n t.
W e h a v e a n in s t a n c e in
w h i c h 5/7 w a s m a d e a t a c e r t a i n p e r i o d 2/6 d f i v7e m o n t h s
an
la te r .
I n d u s t r ia l b o a r d s , in s u r a n c e c o m p a n ie s , a n d e m p lo y e r s m a y
p e r h a p s u t iliz e th e se m e n ta l tests t o g a u g e th e a m o u n t o f c o m p e n s a
t io n th a t s h o u ld b e p a id . I n s o m e in s ta n c e s w e h a v e m a d e t h e r e c o m
m e n d a t io n th a t th e ca se s s h o u ld b e se n t t o u s f o r fu r t h e r e x a m in a
tio n a t set p e r io d s m e r e ly f o r th e p u r p o s e o f g a u g in g th e a m o u n t o f
im p r o v e m e n t. I n d e e d th e u t ilit y o f m e n ta l tests in g e n e r a l in d u s t r y
is g r e a t . A t o n e t i m e w e m a d e s u c h m e n t a l t e s t s f o r t h e a t t e n d a n t s
in o u r o w n h o s p it a l a n d w e r e a b le t o e x c lu d e a n d in c lu d e a n u m b e r
o f m e n w h o m o f f h a n d j u d g m e n t m i g h t h a v e w r o n g l y d i a g n.1o s t i c a t e d
T o su m u p , th e n , I h a v e m e n tio n e d a s u r p r is in g n u m b e r o f p o in t s
o f c o n ta ct m a d e o f re ce n t y e a r s b y p s y c h ia tr y a n d p s y c h o lo g y w ith
in d u s tr ia l p ro b le m s .
I h a v e p r e s e n te d a s p e c ia l r e p o r t o f D r . S . L . P r e s s e y s h o w in g th e
r e lia b ilit y o f p s y c h o lo g ic a l te sts in in d u s t r ia l a c c id e n t ca ses, a n d D r .
P r e s s e y h a s in c lu d e d in h is r e p o r t a n u m b e r o f s p e c ia l in s ta n c e s in
w h ic h th e w o r k in g o f th e s e te sts m a y b e seen.
A fe w in s ta n c e s f r o m o u r r e v ie w h a v e b e e n g iv e n , s h o w in g th e
d e c id e d b e a r in g w h ic h p s y c h ia t r ic d ia g n o s is m a y h a v e u p o n th e fin d
in g s f o r c la im a n t o r in s u r e r , a s th e ca se m a y b e , a n d o n th e a m o u n t o f
c o m p e n s a t io n w h e n r e n d e r e d .
A n u m b e r o f t h e p i t f a l l s o f t h e w o r k h a v e b e e n e n u m e r a t e d ;. I
h a v e la id th e g r e a te s t stress u p o n p s y c h o m e t r ic ( “ m e n ta l t e s t ” )
1 R o ss y , C. S . : “ T h e Y erk es-B rid g es’ P o in t S c a le : A s a p p lie d to ca n d id a te s f o r em p lo y
m e n t a t the P s y c h o p a th ic H o s p it a l.” B o s to n M ed ica l a n d S u rg ica l J o u rn a l, V o l. C L X X V ,
N o. 23, D ec. 7, 1916, pp. 8 2 2 -8 2 4 .
170
MEDICAL COMPETENCE AND HOSPITAL EFFICIENCY.
w o r k b e ca u se o f its q u a n tita tiv e n a tu r e a n d its r e la tiv e ly r e c e n t d e
v e lo p m e n ts . I n th e in d u s t r ia l a c c id e n t b o a r d g r o u p , f r o m th e p s y
c h ia t r ic p o in t o f v ie w , I fin d ca se s o f s y p h ilis o f th e n e r v o u s s y s te m ,
o f f e e b l e - m i n d e d n e s s , e p i l e p s y , a l c o h o l i s m , f o c a l b r a i n d is e a s e , d e
m e n tia p ra e c o x , a n d m a n ic -d e p r e s s iv e p s y c h o s is , t o s a y n o t h in g o f th e
t r a u m a t i c v a r i e t y o f p s y c h o n e u r o s i s a n d a n u m b e r o f o d d c a s e s d if f i
c u lt to c la s s ify .
I t h in k t h e r e is n o d o u b t t h a t ju s t a s t h is w o r k w i l l b e n e fit t h o s e
p h y s ic ia n s a n d p s y c h ia t r is t s th a t a re g o in g t o d e a l w it h th e s h e ll
s h o c k w r e c k s o f th is w a r , s o th e e n t ir e w o r k o f in d u s t r ia l a c c id e n t
b o a r d s t h r o u g h o u t t h e w o r l d is g o i n g t o p r o v e o f m o s t c o n c r e t e v a lu e
in th e w h o le fie ld o f a ft e r -w a r r e e d u c a tio n .
T H U R S D A Y , A U G U S T 23— A F T E R N O O N S E SSIO N (L U N C H EO N ).
CHAIRMAN, DUDLEY M. HOLMAN, PRESIDENT, L A. L A. B. C.
T h e C h a i r m a n W e h a v e w it h u s th is a ft e r n o o n M r . E d w i n M u l.
r e a d y , th e c o m m is s io n e r o f la b o r o f M a ssa ch u se tts , w h o w ill g iv e u s
a b r i e f t a lk u p o n M a s s a c h u s e tts fa c t o r y in s p e c tio n .
MASSACHUSETTS FACTORY INSPECTION.
BY
E D W IN
M U LREADY,
COM M ISSIONER
OE
LABOR
OF
M ASSxlC H U SETTS.
B e f o r e s p e a k in g u p o n th e t o p ic a s s ig n e d , “ M a s s a c h u s e tts fa c t o r y
in s p e c t io n ,” m a y w e n o t c o n s id e r f o r a m o m e n t th e g r e a t v a lu e o f
fa c t o r y in s p e c tio n in g e n e r a l ?
T h i s is t h e a g e o f s p e c ia lt ie s , a n d in n o fie ld o f e n d e a v o r m o r e s o
th a n in th a t o f m e d icin e .
N o t lo n g a g o th e fa m ily p h y s ic ia n w a s
c a lle d in e v e r y p o s s ib le h e a lth c o n t in g e n c y . G r a d u a lly , b u t n o n e th e
le s s s u r e ly , t h e m e d ic a l f r a t e r n i t y h a s t u r n e d t o th e s p e c ia lis t , a n d
w h ile th e p h y s ic ia n m a y h a v e a g r e a t fu n d o f g e n e ra l m e d ic a
k n o w le d g e , h e w ill, u n d e r th e n e w r e g im e , u se th a t k n o w le d g e s im p ly
a s a n a d ju n c t t o h is s p e c ia lty .
W e a re t o ld th a t s u ch p r o g r e s s h a s b e e n m a d e in t h is d ir e c t io n t h a t
a c e r t a in c la s s o f m e d ic a l m e n h a v e b e e n e d u c a t e d t o s p e c ia liz e i n t h e
d ia g n o s is o f th e c a s e w h ic h o t h e r s p e c ia lis t s m a y a f t e r w a r d tr e a t .
T h i s b r in g s in t o th e fie ld o f m e d ic a l p r a c t ic e m e n w h o a re r e a lly
th e d e t e r m in in g fa c t o r s in th e fie ld o f p a t h o lo g y , f o r u p o n t h e ir
s c ie n t if ic s t a n d a r d s is f o u n d e d t h e t r e a t m e n t w h i c h t h e p a t ie n t s h a ll
r e c e i v e . I t i s t h e i r b u s i n e s s t o d e t e r m i n e t h e d is e a s e b y m e a n s o f i t s
d is t in c t iv e m a r k s o r c h a r a c te r is tic s , a n d th e o th e r f e llo w ’s jo b t o
t r e a t t h e d is e a s e .
M a y w e n o t, t h e r e fo r e , d ir e c t o u r a tte n tio n to th e g r e a t im p o r ta n c e
o f f a c t o r y in s p e c t io n b y c o m p a r in g th e fa c t o r y in s p e c t o r t o th e g r e a t
s p e c i a l i s t s i t t i n g i n h i s o f f ic e o r l a b o r a t o r y , d e t e r m i n i n g t h e d i s e a s e
wri t h w h i c h h i s p a t i e n t s a r e a f f l i c t e d ? M o s t i n t e r e s t i n g s t u d i e s h a v e
f o u n d a p la c e u p o n th e p r o g r a m o f th is c o n v e n t io n , b u t in t h e la s t
a n a l y s i s t h e f a c t s u p o n w h i c h t h e s e s t u d i e s a r e f o u n d e d c o m e t o usi
f r o m th e s t u d io u s a n d e n e r g e tic in s p e c t o r , w h o g o e s o u t in t o th e fie ld
o f in d u s t r y a n d d e te r m in e s th e c a u s e o f t h e t r o u b le w h ic h w e se e k t o
rem edy.
O u r g o o d fr ie n d , D r . B e y e r , w h o h a s b ee n su ch a la r g e c o n tr ib u to r
t o th e c a u s e o f a c c id e n t p r e v e n t io n , c a lle d o u r a tte n tio n t o th e f a c t
t h a t t h e “ m e r e n u m b e r o f a c c id e n t s f r o m a g iv e n c a u se is n o t a s a t is
f a c t o r y b a s is w h e n d e t e r m in in g th e s e r io u s n e s s o f t h a t c a u s e as a n
171
172
LUNCHEON.
a c c id e n t p r o d u c e r , s in c e in c o n s id e r in g o n ly th e n u m b e r o f a c c id e n t s
th e sa m e w e ig h t is g iv e n t o a c u t fin g e r as t o a fr a c t u r e d s k u l l ; t h a t
th e m o n e y co s t a n d th e lo s t tim e a re th e re a l m e a su res o f th e s e r io u s
n e ss o f a c c id e n t s ; th a t w h ile m e c h a n ic a l a c cid e n ts in M a s s a c h u s e tts
w e r e b u t 33 p e r ce n t o f th e t o t a l n u m b e r o f a c cid e n ts , t h e y w e r e
r e s p o n s ib le f o r le s s t h a n 7 p e r c e n t o f t h e f a t a l i t i e s .”
S o m e t im e , I tr u s t, w e s h a ll b e a b le t o g o fu r t h e r w it h t h is s t u d y
a n d d e te r m in e w it h s o m e d e g r e e o f a c c u r a c y th e p r o p o r t io n o f a c c i
d e n ts w h ic h w e c o n s id e r p u r e ly m e c h a n ic a l to th o s e w h ic h a re r e a lly
c a u s e d as th e r e s u lt o f fa t ig u e , o r i m p r o p e r lig h t i n g , o r p o o r v e n t ila
t io n , o r t h e o c c u p a t io n a l d is e a s e , i f y o u p le a s e , o f t h e p e r s o n w h o i s
o p e r a t in g t h e m a c h in e .
T h e S ta te o f M a s s a c h u s e tts h a s p r o v id e d b y la w f o r m e e tin g th e
t h r e e e le m e n ts o f in d u s t r ia l a c c id e n t w o r k w h ic h w e r e m e n t io n e d b y
t h e p r e s id e n t in h is a n n u a l a d d r e s s .
W h ile M r. H o lm a n d id n o t
a t t e m p t t o p la c e t h e th r e e e le m e n ts in t h e ir t r u e r e la t iv e p o s it io n s , I
a m in c lin e d to m e n tio n th e m in th e o r d e r o f th e ir im p o r ta n c e , as t h e y
a p p e a r t o m e — p r e v e n t io n , r e h a b ilit a t io n , a n d c o m p e n s a tio n .
P r e v e n t io n — a p r e c a u t io n a r y m e a s u re w h ic h w o u ld s to p o r h in d e r
th e t h in g fr o m h a p p e n in g . T o p r e p a r e f o r e m e r g e n c y b e f o r e it o c
c u rs, to e d u c a te th e e m p lo y e r a n d th e e m p lo y e d — th ese a n d m a n y
m o re are th e m e th o d s w h ic h p re v e n t.
S u r e ly p r e v e n t io n s h o u ld b e
n u m b e r o n e in o u r m in d s , a s w e p r e p a r e f o r in d u s tr ia l a c c id e n t w o r k .
R e h a b ilit a t io n — a n a tte m p t to re s to r e th e c a p a c it y o f th e in ju r e d
p a r t y , t o r e in s t a t e , i f s u c h a t h in g is p o s s ib le , t h e i n ju r e d o n e in t h e
p o s it io n w h ic h h e o c c u p ie d b e f o r e ; i f n o t p o s s ib le , th e n t o cre a te a n
o p p o r t u n it y f o r s u ch a o n e . T h i s s h o u ld s u r e ly b e n u m b e r t w o in o u r
c a lc u la tio n s .
C o m p e n s a tio n — th a t w h ic h seek s t o m a k e g o o d th e in ju r y w h ic h
h a s b e e n d o n e ; to g iv e s o m e th in g w h ic h m a y b e e q u iv a le n t t o th e
t h in g w h ic h h a s b e e n lo s t. W e k n o w h o w fu t ile o u r e ffo r t s m u s t b e
in th is d ir e c t io n , f o r th e r e a re m a n y t h in g s w h ic h m o n e y c a n n o t b u y ,
a n d lo s s e s w h i c h c a n n e v e r b e m e t b y c o m p e n s a t io n .
T h e m easu re
o f c o m p e n s a t io n m a y b e h a r d t o fix , b u t th e m o r e d iffic u lt it i s t o
e s t a b lis h t h e s t a n d a r d t h e m o r e n e c e s s a r y t h a t i n d u s t r y s h o u ld m e e t
it s o b lig a t io n b y p r o p e r s u b s t a n t ia l c o m p e n s a t io n .
T h e B o a r d o f L a b o r a n d I n d u s tr ie s o f M a ssa ch u se tts h a s r e c e n t ly
b e e n c h a r g e d w it h th e p r e v e n t iv e s id e o f th is w o r k . T h e in d u s t r ia l
a c c id e n t b o a r d h a s th e d u ty o f a d ju d ic a t in g p a y m e n ts f o r c o m p e n s a
t io n , a n d in c id e n t a l t o t h is ta s k , th e v e r y im p o r t a n t d u t y o f r e h a b ili
ta tio n o f th e in ju r e d p e rs o n .
I s i t a n e x a g g e r a t io n t o s a y t h a t su cc e s s in a ll t h is w o r k is b a s e d
u p o n s a t is fa c t o r y in s p e c t io n s e r v ic e , a n d th a t la x it y o n th e p a r t o f
th e in s p e c t o r w ill in e v it a b ly d e la y th e tim e w h e n su cce ss s h a ll c r o w n
o u r e ffo r ts in th e ca u se o f a c c id e n t p r e v e n t io n ?
T h e S ta te b o a r d o f la b o r a n d in d u s tr ie s h a s n o t o n ly th e d u ty o f
f a c t o r y in s p e c t io n , b u t h a s in c lu d e d w it h th a t th e d u t y o f in s p e c t in g
MASSACHUSETTS FACTORY INSPECTION---- EDWIN MULREADY.
173
w o r k s h o p s , m e c h a n ic a l e s t a b lis h m e n t s , la u n d r ie s , f o u n d r i e s , te n e
m e n t-h o u s e w o r k s h o p s , a n d a ll o th e r b u ild in g s o r p a r ts o f b u ild in g s
in w h ic h m a n u fa c t u r in g is c a r r ie d o n , i n c lu d in g m e r c a n tile e s ta b lis h
m e n t s — t h e e s t i m a t e d n u m b e r o f a l l b e i n g a p p r o x i m a t e l y 7 0 ,0 0 0 .
T w e n t y - f o u r i n s p e c t o r s — 1 8 m e n 6 a n do m e n — a r e e m p l o y e d i n
w
t h is w o r k .
D u r i n g t h e y e a r 1 9 1 6 , 4 1 ,3 2 9 i n s p e c t i o n s w e r e m a d e .
O v e r 12,000 o r d e r s w e r e i s s u e d a s t h e r e s u l t o f t h e s e i n s p e c t i o n s , a n d
n e a r l y 11,000 o f t h e s e o r d e r s a f f e c t e d d a n g e r o u s m a c h i n e r y , t h i s n u m
b e r b e in g c o n s id e r a b ly s m a lle r th a n m ig h t b e e x p e c te d , f o r th e r e a s o n
th a t a v e r y c o m p e te n t c o m m itte e , a c t in g u n d e r th e d ir e c t io n o f th e
b o a r d , h a s b e e n e n g a g e d in p r e p a r in g s a f e t y r u le s a n d r e g u la t io n s
a n d m a c h in e r y sta n d a rd s .
T h e r e w e r e 2 ,3 9 8 h o m e s v i s i t e d i n o r d e r t o d e t e r m i n e t h e i r s u i t a
b i l i t y f o r i n d u s t r ia l w o r k t h e r e in .
T h e o b je c t o f f a c t o r y in s p e c t io n m u s t n o t o n ly b e th e d e t e c t io n o f
c e r t a in d e fe c t s in m a c h in e r y , b u t it s h o u ld a ls o in c lu d e t h e e d u c a t io n
o f th o se w h o c o n tr o l fa c t o r y o r g a n iz a tio n to a p o in t w h e re th e y w ill
r e c o g n iz e t h e g r e a t v a lu e , n o t o f o r d e r s g iv e n , b u t o f s u g g e s t io n s
m a d e f o r m o r e i m p r o v e d c o n d i t io n s i n t h e d if f e r e n t e s t a b lis h m e n t s .
I n t h is g r e a t e d u c a t io n a l m o v e m e n t th e f a c t o r y in s p e c t o r b e c o m e s
a n im p o r t a n t fa c t o r . F a c t o r y in s p e c t io n , u n d e r ta k e n w it h th is a t t i
t u d e , is n o t lo o k e d u p o n as a n in t r u s io n o n t h e p e r s o n a l r ig h t s o f t h e
e m p lo y e r s , b u t r e a lly is a c o n t r ib u t io n t o th e su cce ss o f e v e r y e le
m e n t in th e b u s in e s s e n t e r p r is e .
I fir m ly b e lie v e th a t th e tim e w ill c o m e in th e v e r y n e a r fu t u r e in
M a s s a c h u s e tts w h e n m e n w il l a p p r e c ia t e th a t th e g r e a te s t asset in
t h e i r f a c t o r y o r g a n i z a t i o n is t h e n u m b e r o f c o n t e n t e d , h e a l t h y , w e l l p a id , a n d p r o p e r ly p r o te c te d w o rk e rs.
T h e q u e s tio n o f m a c h in e r y s a fe g u a r d s w il l b e s e ttle d w h e n th e
m a n u fa c t u r e r s o f m a c h in e r y s h a ll c o n s id e r t h e ir m a c h in e s i m p e r f e c t
i f t h e y a re n o t p r o p e r ly s a fe g u a r d e d b e f o r e t h e y le a v e th e m a c h in e
sh op .
M a s s a c h u s e tts is a g r e a t in d u s t r ia l S ta te . I t h a s n o t r e a c h e d t h is
p o s it io n b y v e r y r a p i d s t r id e s , b u t w a s k n o w n as a n in d u s t r ia l c e n t e r
m a n y y e a r s a g o . G r e a t in d u s t r ia l c h a n g e s c o n t r ib u t e d t o t h is c o n d i
t i o n l o n g b e f o r e w e b e g a n o u r p u b l i c - s a f e t y c a m p a ig n . I t is e a s ie r t o
e s t a b lis h a n e w p la n t o n c o r r e c t lin e s th a n t o c h a n g e th e lin e s u p o n
w h ic h a n o ld p la n t h a s b e e n r u n n in g f a i r l y s u c c e s s fu lly a g r e a t m a n y
y e a rs . N o t w it h s t a n d in g th is fa c t , w e a re e n c o u r a g e d t o b e lie v e th a t
in t e llig e n t fa c t o r y in s p e c t io n a n d th e s tu d y w h ic h s h a ll f o llo w th e
f a c t o r y in s p e c t io n w ill le a d t o im p r o v e d c o n d it io n s in th e fu t u r e , a n d
w e a re s tr e n g th e n e d in t h is o p in io n b y th e fa c t th a t m a n u fa c tu r e r s
a ll o v e r o u r S ta te a re c o o p e r a t in g to th e fu lle s t e x te n t w it h th e d iffe r
e n t b o a r d s w h o h a v e c h a r g e o f t h is i m p o r t a n t w o r k .
S O U N D T A B L E D IS C U S S IO N .
[T h e c h a ir m a n r e fe r r e d t o a n in f o r m a l d is c u s s io n b e g u n d u r in g
t h e i n s p e c t i o n o f t h e p l a n t o f t h e G e n e r a l E l e c t r i c C o . , L y n n , M a s s .,
in th e m o r n in g , a n d a s k e d D r . F r a n k E . S c h u b m e h l, o f t h e G e n e r a l
E l e c t r i c C o ., a n d D r . R u b in o w t o c o n t in u e t h e d is c u s s io n .
D r . S c h u b m e h l m e n tio n e d a c a r d th a t h a d b e e n p a sse d a r o u n d in
th e m o r n in g .
T h is c a r d c o n ta in e d a c o m p ila t io n o f th e m e d ic a
s u p e r v is io n in 99 p la n t s in th e U n it e d S ta te s , c o m p r is in g e v e r y k in d
o f in d u s t r y , w h ic h w a s, h e s a id , a v e r y c o m p le t e r e c o r d , a n d w o u ld
g i v e a b a s is u p o n w h ic h t o a n s w e r t h e q u e s t io n s o o f t e n a s k e d , “ W h a t
is t h e a v e r a g e a d e q u a t e m e d ic a l c a r e in th e v a r io u s in d u s t r ie s ? ” H e
b e lie v e d th a t fr e e c h o ic e o f p h y s ic ia n s h o u ld n o t b e p la c e d in th e
h a n d s o f e m p lo y e e s , a s so m a n y a re n o t r e a s o n a b le o r c a r e f u l in th e ir
c h o ic e , a n d t h e ir h e a lth a n d w e lfa r e a r e t o o im p o r t a n t t o a llo w o f
s u ch a r is k b e in g ta k e n w h e n t h e ir e a r n in g c a p a c it y is a t sta k e .
D r . R u b in o w s a id th a t th e q u e s tio n o f fr e e c h o ic e o f p h y s ic ia n s
w a s n o t a p o l i t i c a l p r o b l e m . H e h a d b e e n t 20r oour g h 5 S t a t e s
h
2
in th e y e a r p r e v io u s a n d h a d fo u n d e v e r y w h e r e a v e r y s t r o n g s e n ti
m e n t f o r th e fr e e c h o ic e o f p h y s ic ia n a n d h e p r e d ic t e d le g is la tiv e
a c tio n in a n in c r e a s in g n u m b e r o f S ta te s g iv in g s u ch c h o ic e .
The
w o r k e r s w a n t s u ch a p r o v is io n b e c a u s e o f th e g r e a t e r c o n fid e n c e t h e y
p la c e o n p h y s ic ia n s o f th e ir o w n c h o ic e .
T h e p h y s ic ia n s w h o are
p r iv a t e p r a c t it io n e r s a re a ls o a s k in g f o r su ch a p r o v is io n .
Dr
R u b in o w s a id , h o w e v e r , th a t in p a s s in g s u c h le g is la t io n in c o n n e c t io n
w it h m e d ic a l a id th e in te r e s ts o f th o s e p a r t ic u la r ly c o n c e r n e d — th e
e m p lo y e r s , th e e m p lo y e e s , a n d th e m e d ic a l p r o fe s s io n — m u s t b e c o n
s id e re d . T h e e m p lo y e r w a n ts th e m a n t o b e c u r e d as r a p id ly as p o s
s ib le , s o th a t h e m a y g e t b a c k t o w o r k , a n d t o h a v e it d o n e as e c o
n o m ic a lly as p o s s ib le .
E m p lo y e r s , o f co u r s e , d iffe r as t o th e m o s t
e c o n o m ic a l w a y , s o m e s a y in g “ W h a t ’s th e u se o f p a y in g h ig h fe e s ?
G e t a ch e a p d o c t o r . H e w ill b e a ll r ig h t ,” w h ile o th e r s a r g u e th a t it
is t o t h e ir in t e r e s t t o g e t g o o d m e d ic a l a id , as th e q u ic k e r t h e r e
c o v e r y t h e le s s t h e r e is t o p a y . T h e e m p lo y e e , o f c o u r s e , h a s b u t o n e
in te r e s t— t o g e t w e ll as s o o n as p o s s ib le .
N o h u m a n b e in g w a n ts
to b e a c r ip p le .
H e w a n ts t o c h o o s e h is o w n p h y s ic ia n b e c a u s e h e
w il l th e n h a v e g r e a t e r c o n fid e n c e in h im .
T h e o n ly t r o u b le w it h
a l l o w i n g h i m t o d o s o is t h a t h e m a y n o t k n o w t h e g o o d d o c t o r f r o m
th e b a d o n e . A s to th e m e d ic a l p r o fe s s io n , i f y o u p u t in to th e h a n d s
o f th e e m p lo y e r s th e r ig h t t o h a v e th e ir p h y s ic ia n s d o m u c h o f th e
w o r k th a t h a s b e e n d o n e in p r iv a t e p r a c t ic e , th e c o m p e n s a t io n o f th e
p h y s ic ia n s w ill b e d e p e n d e n t o n th e g e n e r o s it y o f th e e m p lo y e r s o r
174
ROUND TABLE DISCUSSION.
175
th e lim it im p o s e d b y th e le g is la tu r e .
D r . R u b in o w t h in k s t h a t , a ll
t h in g s b e in g e q u a l, t h e e m p lo y e e s h o u ld h a v e t h e r ig h t t o s e le c t
h is o w n p h y s ic ia n . T h e e m p lo y e e s h o u ld n o t b e a llo w e d t o s u s p e c t
th a t th e p h y s ic ia n is a c t in g f o r th e e m p lo y e r r a th e r th a n in th e
in te r e s ts o f th e e m p lo y e e , a n d th e in d u s t r ia l p h y s ic ia n , n o m a tte r
h o w in t e r e s t e d h e m a y b e in m o s t ca s e s , s t ill is a c t in g f o r th e e m
p lo y e r . T h e p s y c h o lo g ic a l e ffe c t o f th e c o n fid e n c e o f th e p a t ie n t in
th e p h y s ic ia n o f h is o w n c h o ic e te n d s t o r e d u c e th e p e r io d o f d is
a b ility . A s t o h o w t o a v o id th e s e le c tio n o f a n in c o m p e te n t p h y s i
c ia n , D r . R u b in o w t h in k s f r e e c h o ic e s h o u ld b e lim it e d t o p h y s ic ia n s
w h o a r e q u a lifie d t o d o in d u s t r ia l s u r g e r y , a n d t h a t t h is m e a n s th e
f o r m a t i o n o f a p a n e l o f in d u s t r ia l s u r g e o n s in e v e r y c o m m u n it y , t o
b e o p e n t o a ll w h o m e e t t h e r e q u ir e m e n t s , s u c h r e q u ir e m e n t s t o b e
e s t a b lis h e d b y c o n s u lt a t io n b e t w e e n t h e m e d ic a l p r o f e s s io n a n d th e
in d u s tr ia l a c cid e n t c o m m is s io n a n d p o s s ib ly b y a n a m e n d m e n t to
th e la w .]
C apt . W illiam P . W hite , o f t h e A s s o c i a t e d I n d u s t r i e s o f M a s
s a c h u s e tts . I w o u ld l ik e t o a s k a q u e s t io n . W h y s h o u ld n ’t y o u h a v e
t h e sa m e p a n e l f o r t h e e m p lo y e r t o s e le c t f r o m ?
D r . R ubinow . A f t e r y o u g e t t h a t p a n e l , w h a t r i g h t , s o c i a l l y o r
m o r a lly , h a v e y o u t o ta k e a w a y th e c h o ic e o f m e n ?
A ll th a t i
im p o s e d o n th e in d u s tr ia l a c c id e n t b o a r d s a n d c o m m is s io n s . M a k in g
a v e r y d e fin ite sta te m e n t, it is n o u se t a lk in g a b o u t in d u s t r ia l s u r
g e r y so lo n g as th e se q u a lific a tio n lim it a t io n s a re u p o n th e sta tu te
b o o k s . O n l y f o u r o r fiv e S t a t e s h a v e y e t s e e n fit t o g i v e a s u ffic ie n t
a m o u n t o f m e d ic a l a id .
M o s t o f th e W e s te rn S ta te s h a v e, b eca u se
th e r e a re n o lim it a t io n s o n th e a m o u n t th a t c a n b e g iv e n . T h e r e a re
C a lifo r n ia a n d W is c o n s in a n d a fe w oth ers. I n o th e r w o r d s , y o u h a v e
t o c o n d u c t y o u r c a m p a ig n f o r th e im p r o v e m e n t o f th e s e r v ic e s id e b y
s id e w it h th a t f o r t h e r e m o v a l o f th e lim ita tio n s .
C apt . W h ite . A s a n e m p l o y e r , I w o u l d l i k e t o r a i s e t w o o r t h r e e
q u e s tio n s in r e g a r d t o w h a t D r . R u b in o w h a s s a id . I n th e fir s t p la c e ,
th e in d iv id u a l w h o c o m e s in to th e e m p lo y m e n t h a s n o t th e sa m e
k i n d o f o p p o r t u n i t y f o r s e l e c t i o n a s t h e p e r s o n w h o is e m p l o y i n g
h im . T h e m a n w h o h a s e n lis t e d in th e U n it e d S ta te s A r m y o r N a v y
i n h is e n lis t m e n t g iv e s u p h is f r e e d o m o f c h o ic e . I t is t h e s a m e w a y
in e v e r y c o u n tr y . I f th e la w c o m p e ls th e e m p lo y e r to p r o v id e a d e
q u a te m e d ic a l s e r v ic e s , th e e m p lo y e r s h o u ld c e r t a in ly h a v e s o m e
s a y in r e g a r d t o th e c h a r a c t e r o f th e s e r v ic e s , as b e tw e e n th e w o r k
t h a t th e in d u s t r ia l p h y s ic ia n is d o i n g a n d t h a t o f th e s u r g e o n t h a t
m a y b e s e le c te d b y th e in ju r e d e m p lo y e e . T h e f a c t r e m a in s th a t th e
m e d ic a l p r a c t it i o n e r o r d i n a r i l y is n o t p r o p e r l y e q u ip p e d t o d o t h e
w o r k th a t ca n b e d o n e b y th e in d u s tr ia l p h y s ic ia n , a n d th e a n sw e r
t o th e q u e s tio n w h y th e e m p lo y e r h a s n o t a d e q u a te e q u ip m e n t in h is
176
LUNCHEON.
o w n e s ta b lis h m e n t is , t h a t h e s h o u ld h a v e r e c o u r s e t o a h o s p it a l
w h e re p r o p e r a n d a d e q u a te m e a n s m a y b e ta k e n f o r d is c o v e r in g th e
c h a r a c t e r o f t h e i n j u r y a n d w h e r e a p r o p e r f o r c e is a l r e a d y e q u ip p e d
f o r t r e a t in g s u c h in ju r y t o th e b e s t in te r e s t o f th e e m p lo y e e .
P sy
c h o l o g i c a l l y , t h e r e is g r e a t r e a s o n f o r t h e e m p lo y e e s e le c t in g h is o w n
p h y s ic ia n , b u t as f a r as in ju r ie s a re c o n c e r n e d , h e s h o u ld b e tr e a te d
b y a s u rg e o n a n d n o t th e o r d in a r y d o c t o r , a n d th e o r d in a r y e m p lo y e e
d o e s n o t k n o w w h e t h e r h is p h y s ic ia n is a g o o d s u r g e o n o r n o t .
![T h e c h a irm a n , s p e a k in g o f so m e o f th e p r o b le m s r e la tin g t o m e d i
c a l a id th a t c o n f r o n t in d u s t r ia l a c c id e n t b o a r d s a n d c o m m is s io n s , a n d
r e fe r r in g e s p e c ia lly to th e e x p e r ie n c e u n d e r th e M a s s a ch u s e tts la w ,
s a id th a t i t h a d h e e n f o u n d t h a t p h y s ic ia n s a n d h o s p it a ls c h a r g e d
e x o r b it a n t fe e s a n d th a t m a jo r o p e r a t io n s w e r e p e r f o r m e d b y p h y s i
c ia n s w h o w e r e n o t e x p e r ie n c e d in s u r g e r y b u t w h o s e c h a r g e s w e r e
s t a r t lin g ly h ig h . A s illu s t r a t iv e o f t h is , h e s a id t h a t in M a s s a c h u
setts th e la s t y e a r u n d e r th e e m p lo y e r ’s lia b ilit y a c t th e r e w a s p a id t o
p h y s i c i a n s a n d s u r g e o n s $ 1 5 0 ,0 0 0 , w h i l e f o r t h e y e a r e n d i n g N o v e m
b e r 30, 1916, th e r e w a s p a id to d o c t o r s a n d h o s p ita ls f o r m e d ic a l
t r e a t m e n t u n d e r t h e c o m p e n s a t i o n l a w o v e r $ 8 3 4 ,5 0 0 .
O n th e oth er
h a n d , w h e r e t h e in s u r a n c e c o m p a n ie s p r o v id e d o c t o r s , t h e y a re f r e
q u e n t ly in c o m p e t e n t , b e in g e m p lo y e d b e c a u s e t h e y w il l w o r k f o r a
c e r ta in s a la r y , o r th e y h a v e c o n tr a c te d t o ca re f o r so m a n y e m
p l o y e e s — i n o n e i n s t a n c e 3 0 ,0 0 0 — t h a t i t i s i m p o s s i b l e t o t a k e c a r e o f
th e m a n d g iv e th e m a d e q u a te tre a tm e n t. M a n y th o u s a n d s o f d o lla r s
c o u ld b e s a v e d b y th e p r o v is io n o f c o m p e t e n t m e d ic a l a id . I n M a s s a
ch u se tts, as a m e a n s o f s o lv in g th is p r o b le m o f in c o m p e te n t p h y s i
c ia n s a n d o f e x o r b it a n t fe e s o f p h y s ic ia n s a n d h o s p it a ls , a m e e t in g o f
d e le g a te s o f a ll th e m e d ic a l s o c ie tie s o f th e S t a te w a s c a lle d a n d th e
s itu a tio n p r e s e n te d t o th e m a n d th e ir a s s is ta n c e a s k e d . A c o m m itte e
w a s a p p o in t e d w h ic h in v e s t ig a t e d c o n d it io n s , a n d as a r e s u lt w h a t is
k n o w n as a n in d u s t r ia l r a te w a s d e v is e d . T h i s h a s b e e n s a t is fa c t o r y
t o th e p h y s ic ia n s . F r e e c h o ic e o f p h y s ic ia n M r . H o lm a n t h o u g h t a n
id e a l c o n d it io n b u t h a r d ly p r a c tic a l, b eca u se o f th e te n d e n c y o f e m
p lo y e e s t o g o w h e re t h e y c o u ld g e t c h e a p tre a tm e n t, t o d o c t o r s w h o
s p e a k th e ir o w n la n g u a g e , o r to lo d g e d o c to r s . H e th o u g h t D r . R u b in o w ’s id e a o f a p a n e l o f p h y s ic ia n s a g o o d o n e i f it c o u ld b e esta b
lis h e d , b u t q u e s t io n e d i f a p h y s ic ia n e n t it le d t o p r a c t ic e in M a s s a
ch u setts, f o r in s ta n ce , c o u ld b e d e p r iv e d o f th e r ig h t t o c a re f o r a
m a n i f su ch m a n h a s fr e e c h o ic e a n d c o m e s to th e p h y s ic ia n f o r
t r e a t m e n t .]
D r . R u binow . T h e l e g a l r i g h t t o p r a c t i c e r e m a i n s u n d i s t u r b e d .
A n y m a n h a s a r ig h t to tr e a t a n y p a tie n t w h o is w illin g t o c o m e t o
h im a n d p a y , b u t i f a p a t ie n t c o m e s t o h im a n d sa y s, “ Y o u tr e a t m e ,
s o m e b o d y e ls e is g o i n g t o p a y f o r i t , ” y o u e s t a b lis h a t h i r d i n t e r e s t ;
ROUND TABLE DISCUSSION.
177
th e p r a c t ic e th e n b e c o m e s in th r e e p a rts , n o t t w o p a rts . A m a n h a s
a r ig h t to p r a c tic e a n y s o r t o f m e d ic in e h e w a n t s ; h e ca n p r a c tic e a n y
b r a n c h o f m e d ic in e h e w is h e s t o p r a c t ic e .
T h e C h a ir m an . W e l l , t h e n , I a m t h e f a m i l y p h y s i c i a n , w e w i l l s a y ,
o f J o h n S m it h . N o w , J o h n S m it h is i n ju r e d in t h e G e n e r a l E l e c t r i c
C o . ’s w o r k s , a n d I a m n o t o n y o u r p a n e l , a n d t h e G e n e r a l E l e c t r i c C o .
s a y s, “ W e d o n o t r e c o g n iz e y o u as a m a n q u a lifie d t o tr e a t th e s e
c a s e s .”
H o w a re y o u g o in g t o p r e v e n t m y tr e a t in g h im ?
H o w are
y o u g o in g t o p r e v e n t h im fr o m c o n s u lt in g m e ?
D r . R u binow . I a s s u m e t h e l e g i s l a t u r e w i l l p a s s l a w s t o t h a t e f f e c t .
J o h n S m it h c a n g o t o h is p h y s i c i a n i f h e w a n ts t o p a y f o r it , a n d t h e
t h ir d p a r t y is h is in s u r a n c e c o m p a n y .
T h e C h a ir m an . H e a l w a y s h a s t h a t r i g h t . T h e i n d i v i d u a l , u n d e r
in s t r u c t io n s h e r e in M a s s a c h u s e tts , a lw a y s h a d th e r ig h t t o s e le c t h is
o w n p h y s ic ia n , i f h e so e le c t e d , b u t t h e n h e p a id t h e b ills .
D r . R ubinow . U n d e r t h e l a w a t p r e s e n t h e h a s t h e r i g h t t o s e l e c t
h is o w n p h y s ic ia n a n d h e h a s t h e r ig h t t o p a y t h e b i ll , b u t t h e o n l y
r e m e d y is , i n s t e a d o f t r a n s f e r r i n g t h e r i g h t -to s e l e c t , t r a n s f e r t o t h e
t h ir d p a r t y a n d a g r e e t o a p a n e l.
T h e le g is la tu r e w ill t r a n s fe r t o
y o u r in d u s t r ia l c o m m is s io n th e r i g h t t o e s t a b lis h s t a n d a r d s f o r p e r
s o n s t o p r a c t ic e in d u s t r ia l s u r g e r y a t th e c o s t o f t h is t h ir d p a r t y .
D r . M eeker. I w a n t t o a s k D r . R u b i n o w i f h e t h o r o u g h l y d i g e s t e d
th e s ta te m e n t h e m a d e to th e e ffe ct th a t in d u s t r ia l p h y s ic ia n s w e r e
th e m o s t c o m p e te n t p h y s ic ia n s in th e c o u n t r y ?
D r . R ubinow . I did.
D r . M eeker. I t i s n o t i n a c c o r d w i t h m y e x p e r i e n c e .
I am n ot
s p e a k in g o f th e G e n e r a l E le c t r ic C o . o r th e U n it e d S ta te s S te e l C o r
p o r a t io n , o r a n u m b e r o f o th e r g r e a t b ig c o r p o r a t io n s , b u t s p e a k in g
o f in d u s t r y in g e n e r a l.
Y o u c e r t a in ly h a v e m e t d iffe r e n t p la n
p h y s ic ia n s f r o m th o s e th a t I h a v e m e t i f y o u r e a lly w is h t o s ta n d b y
th a t sta te m e n t. I w o u ld lik e t o h e a r w h a t D r . S c h u b m e h l w o u ld sa y
as to th a t.
D r . S chubmehl . I t h i n k t h a t t h o s e p h y s c i a n s I h a v e h a d a n o p
p o r t u n it y t o c o m e in c o n t a c t w it h a r e d o i n g g o o d in d u s t r ia l w o r k .
I n r e g a r d t o o th e r p h y s ic ia n s , I w o u ld h a v e t o a g re e w ith D r
R u b in o w .
N o w , th a t d oes n o t m ea n p h y s ic ia n s th a t a re b e in g em
p lo y e d a t so m u ch p e r d a y to see h o w m u ch in d u s tr ia l w o r k th e y ca n
g e t a w a y w it h — th o s e a re n o t in d u s tr ia l p h y s ic ia n s .
T h ey do not
c o m e u n d e r t h a t r u le a t a ll. I w a s v e r y m u c h im p r e s s e d w it h D r .
R u b i n o w ’s t a lk , a n d I t h in k i t h a s w e ig h t , b u t m y id e a is n o t t o a llo w
th e e m p lo y e e t o g e t in to th e h a n d s o f a m a n w h o w ill d o h im in ju r y .
O f c o u r s e , t h a t i s w e l l l o o k e d o u t f o r b y o u r v e r y e f f ic ie n t i n d u s t r i a l
a c c i d e n t b o a r d , w h i c h is a l r e a d y m a k i n g i t s e l f f e l t a l o n g t h e s e l in e s .
78532°'—Bull, 248—19------12
178
LUNCHEON.
I b e lie v e w e w il l lia v e th is la w r e v e r s e d o r r e p e a le d h e r e in M a s s a c h u
se tts b eca u se o f th e a ttitu d e th a t th e in d u s tr ia l a c c id e n t b o a r d o f
t h i s S t a t e is t a k i n g t o w a r d s t h e s e c a s e s . I t h i n k t h e t h i n g i s g o i n g t o
e lim in a t e it s e lf. I t lo o k s th a t w a y n o w . W e m a y b e m o r e th a n f o r
tu n a te w it h o u r b o a r d , b u t f r o m t h e e v id e n c e s w e h a v e see n f r o m
o t h e r b o a r d s i n t h e c o u n t r y , I t h i n k t h e y a r e a l l f o l l o w i n g ws.
D r . Ch a n e y . I a m t h o r o u g h l y i n t e r e s t e d i n t h i s m e d i c a l p r o b l e m .
T h e U n it e d S ta te s B u r e a u o f L a b o r S ta tis tic s c o n s id e r s t h e q u e s tio n
o f a d e q u a te m e d ic a l s e r v ic e as o n e o f g r e a t im p o r ta n c e , a n d b e ca u se
o f th is I c o m e in c o n t a c t w it h a v e r y la r g e n u m b e r o f p h y s ic ia n s w h o
a r e e m p lo y e d b y ir o n a n d s te e l in d u s tr ie s i n t a k in g c a r e o f t h e ir p e r
s o n a l in ju r y cases. I h a v e t o c o n fe s s th a t th e a v e r a g e p h y s ic ia n w h o
is s o e m p lo y e d w it h w h o m I c o m e in c o n t a c t is a p o o r k in d o f a p h y s i
c ia n . H e is a s o r t o f a c o n t r a c t p h y s i c i a n w h o h a s n o r e a l in te r e s t.
I n a g r e a t m a n y cases h e h a s b e e n a fa ilu r e . M e n w h o c o u ld n o t g e t
p r a c t ic e e n o u g h o n t h e ir o w n m e r its w e r e ta k e n b y th e e m p lo y e r t o
ta k e c a re o f th e ir p e o p le . N o w , th e a v e r a g e p h y s ic ia n o f th a t k in d
th a t I h a v e c o m e in c o n ta c t w it h is b e lo w p a r. H e is n o t u p to th e
s ta n d a rd s o f th e a v e ra g e d o c to r .
D iffe r e n t, o f c o u r s e , is th e p h y s i
c ia n in la r g e c o m p a n ie s lik e th e G e n e r a l E le c t r ic C o . a n d th e stee l
c o r p o r a tio n s , b u t th e p re s e n t sta tu s o f th e m e d ic a l p r a c t it io n e r w h o
is in in d u s tr ia l w o r k , in th e sen se o f b e in g e m p lo y e d , in m y ju d g m e n t
is v e r y lo w .
[M r . K in g s t o n s a id th a t w h a t h a d b e e n s a id as t o in d u s t r ia l p h y s i
c ia n s n o t b e in g u p t o th e s t a n d a r d w a s n o t t r u e o f s u c h p h y s ic ia n s in
O n t a r io , a n d s p o k e o f th e s p le n d id w o r k o f t h e ir p h y s ic ia n s w h o h a d
g o n e to th e W e s te r n f r o n t a n d w e r e c a r r y in g o n th e w o r k in F r a n c e
a n d B e lg iu m , t e llin g o f th e p r id e O n ta r io t o o k in h e r d o c to r s .
A s to
fr e e c h o ic e o f p h y s ic ia n s , h e s a id t h e ir la w h a d ju s t c o m e in t o e ffe c t as
f a r as m e d ic a l a id is c o n c e r n e d .
T h e la w p r o v id e s th a t th e d o c t o r
m u s t b e a g r e e a b le t o b o t h th e e m p lo y e r a n d t h e e m p lo y e e , th u s g i v in g
n e it h e r th e e x c lu s iv e r ig h t o f fr e e c h o ic e .
I f th e e m p lo y e e a n d th e
e m p lo y e r d o n o t a g r e e , it is l e f t t o t h e b o a r d t o a p p o in t t h e d o c t o r .
T h e r e s u lt so f a r h a s b e e n t h a t t h e r e h a v e b e e n n o a p p lic a t io n s t o th e
b o a r d , a s th e e m p lo y e r a n d e m p lo y e e a lw a y s a g ree .
I f it is a s e r io u s
ca se , a n d th e e m p lo y e e is n o t a b le t o m a k e a c h o ic e , t h e e m p lo y e r
sen d s th e m a n t o th e n e a re st p h y s ic ia n , it m a y b e th e c o n tr a c t p h y s i
c ia n , b u t i t w il l b e th e d o c t o r w h o w il l ta k e th e b e s t c a r e o f th e e m
p lo y e e .
M r . K in g s t o n t h o u g h t, p e r s o n a lly , th a t fr e e c h o ic e o f p h y s i
c ia n w a s a m is ta k e , a n d t h a t th e r e w a s m u c h t o b e s a id in f a v o r o f
g i v in g th e e m p lo y e r s o m e s a y as t o w h o th e d o c t o r s h a ll b e.
M r . W illia m M . S m it h , c h a ir m a n , M ic h ig a n I n d u s tr ia l A c c id e n t
B o a r d , t h o u g h t th a t m e d ic a l a n d h o s p it a l tre a tm e n t s h o u ld b e u n lim
it e d as t o tim e , b u t t h a t th e a m o u n t s h o u ld b e r e a s o n a b le .
W h ile h e
h a d p r e v io u s ly b e e n o f t h e o p i n i o n t h a t t h e e m p lo y e r s h o u ld s e le c t
ROUND TABLE DISCUSSION.
179
th e p h y s ic ia n , h e t h o u g h t D r . R u b in o w ’s a r g u m e n t r a th e r c o n v in c in g ,
b u t th a t h is s o lu t io n w a s im p r a c t ic a l.
H e s a id t h a t in h is S ta t
( M ic h ig a n ) th e r e is t o b e a c o m m is s io n , a p p o in t e d b y th e g o v e r n o r , t o
r e c o m m e n d c h a n g e s in th e w o r k m e n ’s c o m p e n s a t io n a c t, as, w h ile
th e ir la w is p r e t t y s a t is fa c t o r y as a w h o le , a g o o d m a n y ch a n g e s
s h o u ld b e m a d e .
T h e le g is la tu r e h a s p r o v id e d a c e r ta in m e th o d b y
w h i c h t h e m e d i c a l p r a c t i t i o n e r c a n b e p a i d le s s .
A s th e m e d ic a l p r o
f e s s i o n h a s h a d m u c h t o d o w i t h w h a t t h e l a w is , h e w o n d e r e d i f t h e
m e d ic a l p r o fe s s io n in e v e r y v illa g e in th e S ta te w o u ld n o t p r o te s t
i f th e le g is la tu r e s h o u ld a tte m p t t o c la s s ify p h y s ic ia n s a n d s u rg e o n s
th a t h a v e a lr e a d y b e e n lic e n s e d t o p r a c t ic e m e d ic in e in th e S ta te , a n d
s a y th a t o n ly a p r iv ile g e d fe w o r a c e r ta in p o r t io n s h a ll b e p e r m it t e d
t o p r a c t i c e t h i s p a r t ic u la r * k i n d o f i n d u s t r i a l s u r g e r y . H e t h o u g h t
s u ch a s o lu tio n a b s o lu te ly u n w o r k a b le a n d im p o s s ib le as a g o v e r n
m e n ta l o r p o lit ic a l p r o p o s itio n , a n d a sk ed i f th ere w e re n o t som e
o t h e r w a y o f g e t t in g a t it. H e a ls o q u e s t io n e d w h e t h e r t h e in d u s t r ia l
a c c id e n t b o a r d , c o m p o s e d o f la y m e n , n o t p h y s ic ia n s , w e r e b e tte r fitte d
th a n th e m e d ic a l c o lle g e s a n d th e S ta te b o a r d o f m e d ic a l e x a m in e r s
t o d e te r m in e w h o s h a ll a n d w h o s h a ll n o t p r a c t ic e in d u s t r ia l s u r g e r y .]
D r . R u b i n o w. I w a n t t o s a y i n r e g a r d t o t h e r i g h t s o f e m p l o y e r s ,
th a t I d o r e c o g n iz e th a t th e e m p lo y e r w h o p a y s th e b ill h a s a
in t e r e s t in t h e m a tte r .
D o e s it fo llo w t h e r e fr o m th a t h e m u st h a v e
th e r ig h t t o s e le c t th e in d iv id u a l p h y s ic ia n ? I t h in k y o u a llo w th a t
r ig h t.
J u s t w h a t is c o n s is t e n t as c o m p a r e d w it h t h e r ig h t o f t h e i n
ju r e d e m p lo y e e ?
T h e e m p lo y e r h a s th e r ig h t t o see th a t th e w o r k is
d o n e p r o p e r l y , b e c a u s e , u n l e s s i t is d o n e p r o p e r l y , h e h a s t o p a y m o r e
c o m p e n s a t io n ; b u t, o f cou rse, th e c o m p e te n t p h y s ic ia n h a s a r ig h t to
s a y s o m e th in g as t o th e c o s t o f th e m e d ic a l s e r v ic e , t h o u g h th a
d o e s n ’t m e a n t h a t a n y m a n c a n c h a r g e a n y t h i n g h e w a n t s t o c h a r g e .
T h e e m p lo y e e s h o u ld h a v e a r ig h t t o s e le c t a m a n w it h w h o m h e c a n
g e t a lo n g , a n d s in c e th e i n ju r e d e m p lo y e e m a y o f t e n se le c t a p h y s ic ia n
w h o s p e a k s h is o w n la n g u a g e , I s a y h e h a s a d e c id e d r ig h t t o h a v e a
d o c t o r t o w h o m h e c a n t a lk , r a t h e r t h a n h a v e a g o o d d o c t o r t h a t c a n ’t
t a lk h is la n g u a g e .
T h e e m p lo y e e h a s th e r ig h t o f in d iv id u a l c h o ic e .
T h e C h a i r m a n O n b e h a l f o f th e a s s o c ia tio n , I fe e l th a t w e s h o u ld
.
e x te n d o u r s in c e r e th a n k s t o th e G e n e r a l E le c t r ic C o . f o r th e ir c o u r
te o u s tre a tm e n t o f o u r a s s o cia tio n , f o r th e o p p o r t u n it y th a t th e y h a v e
a f f o r d e d u s t o se e t h e w o r k t h a t is b e i n g c a r r ie d o n — a n d s u c c e s s f u lly
c a r r ie d o n — n o t m e r e ly in s a fe g u a r d in g b u t. in t h e ir m e d ic a l d e p a r t
m e n t.
I a m s u re w e h a v e a ll b e n e fit e d g r e a t ly b y th e o p p o r t u n it y
th a t h a s th u s b e e n e x te n d e d to u s, a n d I w ill a sk th e a s s o c ia tio n t o g iv e
a r is in g v o te o f th a n k s to th e G e n e ra l E le c tr ic C o.
[ T h e c h a ir m a n a n n o u n c e d th a t W illia m H . T o lm a n , P h . D ., w h o
w a s t o r e a d a p a p e r o n “ E d u c a t in g th e e m p lo y e r a n d e m p lo y e e ,” w a s
u n a v o id a b ly a b s e n t o n a c c o u n t o f illn e s s .]
T H U R S D A Y , A U G U S T 23, 1917— E V E N IN G SESSION .
CHAIRMAN, ROYAL M
EEKER, U S. COM ISSIONER OF LABOR STATISTICS.
.
M
V . A C C ID E N T P R O B L E M S ,
RESTORING THE DISABLED TO INDUSTRY.
B Y T. N ORM AN DEAN, ST AT ISTIC IAN , W O R K M E N ’ S COMPENSATION BOARD OF ONTARIO.
T o a s s e m b le t h e e x a c t fig u r e s o f s y n c h r o n iz in g E u r o p e a n a n d
A m e r ic a n a c c id e n t d a ta is a ta s k b e s id e w h ic h th e H e r c u le a n la b o r
o f r e n o v a t in g th e A u g e a n s ta b le s w a s a p o s it iv e s in e c u r e , E u r o p e a n
s ta tis tic s , a s f a r a s c o m p a r a b le v a lu e s g o , b e i n g in m u c h th e sa m e
fr a g m e n t a r y a n d c h a o t ic s ta te a s a r e A m e r i c a n fig u r e s .
T h e r e fo re ,
le t th e f o l l o w i n g a s s u m p t io n s b e q u a li f i e d :
1 . T h e a n n u a l in d u s t r ia l d e a th r o ll o f th e n o w b e llig e r e n t c o u n tr ie s
i s 100 ,000.
2 . D e a t h f r e q u e n c y 2i s n e a c h 1 0 0 a c c i d e n t s .
i
T h e a n n u a l t o l l i s 5 ,0 0 0 ,0 0 0 i n d u s t r i a l a c c i d e n t s . H a l v e t h i s e s t i
m a t e , i f y o u w i l l ; q u a r t e r i t , y o u w h o w i l l ; a n d t h e f i g u r e i s 1 ,2 5 0 ,0 0 0 .
T h e g r e a te s t h o r r o r o f th e p re s e n t E u r o p e a n s t r u g g le is in th e
a p p a l l i n g c a s u a lt y lis t s .
I n th a t a lo n e w a r h a s p a s s e d b e y o n d th e
c o n c e p t io n o f m a n . B u t c o n ju r e , i f y o u c a n , o n e su ch w a r in e a ch
g e n e r a tio n o f 30 y e a rs .
T h e t o t a l n u m b e r o f in d u s t r ia l c a s u a lt ie s
f o r a c e n tu r y e x c e e d s th r e e tim e s th e t o t a l n u m b e r o f m e n e n g a g e d in
t h e t h r e e w a r s o f t h a t c e n t u r y , t h e t o t a l b e i n g 1 2 5 ,0 0 0 ,0 0 0 , a n d t h a t
a 75 p e r c e n t d is c o u n t o f a c o n s e r v a t iv e e s tim a te c a r e f u l l y c a lc u la t e d
f r o m e x is te n t d a ta . I f t h is w a r b e A r m a g e d d o n , t h e n o u r in d u s t r ia l
M o lo c h h a s s q u a tte d o n th e h ills s u r r o u n d in g th e V a lle y o f J a e l !
O u r s u p e r la t iv e s e n s itiv e n e s s t o o u r s o ld ie r s ’ w e lfa r e ca u se s u s t o
s t a n d a g h a s t a t th e b l o o d p r i c e o f w a r ; o u r s u b lim e in d iffe r e n c e t o
o u r n e ig h b o r s ’ w ea l h a s ca u se d u s t o sta n d a lo o f fr o m th e b lo o d p r ic e
o f p ea ce.
Y e t , i f m a g n it u d e o f e c o n o m ic lo s s b e th e c r it e r io n , o u r
s e n t im e n t fin d s th e n a r r o w c h a n n e l w h ile th e b r o a d o n e is ig n o r e d .
W h y a r e d is a b le d s o ld ie r s r e s t o r e d t o in d u s t r y o r p e n s io n e d f o r
d is a b ility ?
I s it f r o m a p u r e ly s e n tim e n ta l s t a n d p o in t o f a b s t r a c t
d u ty o r b e ca u se o f th e n e a rn e ss a n d a c u ity o f th e p r o b le m ?
I f th e
t h e o r y o f o b l i g a t i o n o b t a in s a s th e in d i v i d u a l v i e w p o i n t , i t is lo s t
in t h e n a t io n a l s t a n d p o in t o f e c o n o m ic lo s s . T h e fo r m e r t h e o r y o f
p e n s io n s as r e w a r d s f o r s e r v ic e o r f o r w o u n d in g s h a s c h a n g e d ; t o
d a y b e llig e r e n t n a t io n s a r e p a y i n g p e n s io n s o n th e t h e o r y o f c o m
p e n s a t io n f o r d e fin it e lo ss.
180
RESTORING THE DISABLED TO INDUSTRY— T. N. DEAN.
181
F o r t h is id e a w o r k m e n ’s c o m p e n s a t io n h a s b e e n r e s p o n s ib le . T h e r e
is , h o w e v e r , a f u n d a m e n t a l d i f f e r e n c e — t h i s i s e q u a l i t y o f lo s s e s ,
p h y s ic a l m u t ila t io n b e in g th e test.
T h e a r m y is a h o m o g e n e o u s w a g e g r o u p , th e o n l y d iffe r e n c e b e i n g
th a t o f ra n k . E a c h m a n in w a r s e r v ic e h a s o ffe r e d t o th e S ta te h e
serv e s a b o d ily p e r fe c t io n , w h ic h is e x e m p lifie d b y th e m e d ic a l e x
a m in a t io n w h ic h p e r m it s h is e n t r y in t o t h a t s e r v ic e . T h e o b l i g a t i o n
o f th e S ta te h a s to d o w ith th e p e rs o n a o f its m ilit a r y se rv a n ts
a n d t h a t o b l i g a t i o n e n d s w it h t h a t w it h w h ic h i t b e g in s . T h e p e r
so n a is th e c o m m o n a t t r ib u t e o f a ll s o ld ie r s , b e i n g b r o u g h t t o th e
.s e r v i c e e q u a l l y b y t h e f a r m h a n d a n d t h e s k i l l e d a r t is a n , b y t h e l o r d
a n d t h e la b o r e r , b y t h e r ig h t e o u s a n d t h e u n k a n c tifie d .
T h e s a c r i
fi c e o f p r i v a t e r e m u n e r a t i o n o r p r o f e s s i o n a l c a p a c i t y i s t h e s o c i a l
r is k , w a r in i t s e l f b e i n g a s o c ia l h a z a r d , w h ic h lik e th e L o r d ’s r a in
f a l l s a lik e o n t h e ju s t a n d th e u n ju s t .
I f s o m e p a r t o f th e p e r s o n a b e lo s t t h r o u g h s e r v ic e t o th e S ta te , th e
S ta te r ig h t ly h a s c o n c e r n w it h th a t w h ic h h a s b e e n lo s t.
T h e o b li
g a t io n d e v o lv e s u p o n t h e S t a t e t o p la c e a ll its s e r v a n t s o n a p a r i t y
as to th a t w h ic h it d e m a n d e d o f th e m .
T h e u n w o u n d e d s o ld ie r r e
t u r n s w it h h is p e r f e c t b o d y , t h e S t a t e h a s u s e d n o t h in g o f t h a t w h ic h
it d e m a n d e d o f h im , a n d h e n c e th e o b l i g a t i o n in t h a t d ir e c t io n h a s
en ded.
I n r e s p e c t t o th e p a r t ia lly o r w h o ll y d is a b le d s o ld ie r th e
o b l i g a t i o n is e q u a lly d e fin ite , t o r e s t o r e t h a t w h ic h it n o t o n l y d e
m a n d e d b u t u sed.
O b v io u s ly , n o g o v e r n m e n ta l in te r fe r e n c e ca n m a k e g o o d p h y s ic a lly
“ th e lim b th a t t r a ile d , th e h a n d th a t fa ile d , th e b l o o d y fin g e r t ip s ,”
b u t th e S ta te ca n c o m p e n s a te — t r u ly n e v e r a d e q u a te ly , f o r th e s u f
f e r in g e n d u r e d , n o r f o r in c o n v e n ie n c e — b u t c e r t a in ly f o r th e m a te r ia l
lo s s o n t h e e c o n o m ic s id e , th e p o w e r o f s e c u r in g m a in t e n a n c e in d e
c e n t c o m f o r t , o r a t le a s t in lik e s ta n d a r d t o th a t w h ic h p r e v a ile d
p r i o r t o w a r s e r v ic e .
M a n ife s t ly , th e fir s t t h in g is t o r e d u c e d is a
b i l i t y t o a n a b s o lu t e ly ir r e d u c ib le m in im u m .
T h e s u c c e s s iv e ste p s
i n v o l v e d in t h is a r e n e c e s s a r y m e d ic a l a n d s u r g ic a l a t t e n t io n t o r e
lie v e p h y s ic a l d is a b ilit y as f a r a s p o s s ib le , p r o p e r fit t in g a n d in s t r u c
t io n in th e u se o f a r tific ia l a p p lia n c e s t o o v e r c o m e b o d ily d is a d
v a n ta g e , r e e d u c a tio n to h a sten a n d e n c o u r a g e s o c ia l a n d e c o n o m ic
r e h a b ilit a t io n , a n d g o v e r n m e n t a l fa c ilit ie s a n d a id t o in s u r e e m p lo y
m e n t c o n s o n a n t w it h d is a b ility .
F in a lly , a ll t h in g s h u m a n ly p o s s i
b le b e in g d o n e , th e r e r e m a in s th e s u b t r a c t io n o f th e n e w f r o m th e
o l d , in m o s t ca s e s a p o s i t iv e r e s u lt .
F o r th is lo s s th e o n ly c o m p e n s a
t i o n is , o f n e c e s s it y , a m o n e y c o n s id e r a t io n f o r a p h y s ic a l c o n d it io n
w h ic h p e r s is t s t o t h e d e a t h o f h im w h o h a s b e e n d is a b le d .
That
c o m p e n s a t io n , i f i t is t o c o v e r th e p e r s is t e n c e a d e q u a t e ly , m u s t b e
in th e f o r m o f a p e n s io n .
182
ACCIDENT PROBLEMS,
T h is , th e n , is th e t h e o r y b e h in d e ffo r t s t o r e h a b ilit a t e d is a b le d s o l
d ie r s in t o t h e n o r m a l a c t iv it y o f p e a c e tim e s — th e r e d u c t io n o f d is
a b ilit y t o a n ir r e d u c ib le m in im u m .
I t i s a n e n t i r e l y n e w i d e a in
s o c i a l p r o g r e s s , n o t e v e n t o b e f o u n d i n w o r k m e n ’s c o m p e n s a t i o n . I n
d e e d , s o b e la t e d h a v e w e b e e n t h a t , o n t h is c o n t in e n t a t le a s t, t h e
o r d in a r y in te r p r e ta tio n o f “ p e rm a n e n t d is a b ilit y ” h a s b een “ p e r
m a n e n t i n ju r y o f a n a t o m ic a l e x t e n t .” A g a in , th e t h e o r y o f s p e c ific
in d e m n it y s c h e d u le s , s o m a n y w e e k s ’ c o m p e n s a t io n f o r s u c h a n d s u c h
a lo ss, c o n n o t e s r e h a b ilit a t io n .
I f th e re b e c o m p le te r e h a b ilit a t io n
w it h in th e s p e c ifie d tim e , t h e n a t t h e e x p ir a t io n o f th a t t im e th e r e is
n o d is a b ility , a n d s in c e th e d is a b ilit y h a s p a s s e d a w a y its p e r m a n e n c y
h a s d is s o lv e d in t o t h in a ir . I f th e d is a b ilit y is p e r m a n e n t, th e n th e
s p e c ific in d e m n it y d o e s n o t c o v e r t h e d is a b ilit y , f o r th e c o m p e n s a t io n
w il l h a v e p a s s e d a w a y a n d th e d is a b ilit y w il l r e m a in .
I t m a y b e u r g e d th a t th e s p e c ific in d e m n it y g iv e s th e i n ju r e d m a n
h is m o n e y w h e n h e n e e d s i t m o s t. B u t th e m a n s u ffe r s a r e d u c t io n in
w a g e s b y r e c e iv in g o n ly a f r a c t io n a l c o m p e n s a t io n a n d t h a t o n a n
a v e ra g e o f w a g e s h e h a s ea rn ed , p r e d ic a tin g a fu n c tio n a l a n d p r o fe s
s io n a l r e e d u c a tio n w it h a fr a c t io n a l p a r t o f h is w a g e s , w h e n it h a s
a lr e a d y b e e n p o s tu la te d t h a t w it h f u ll w a g e s a n d w it h o u t a n y d is
a b ilit y , m u t ila t io n , o r i n ju r y h e c o u ld n o t h a v e a d v a n c e d h is e c o n o m ic
p o s itio n .
N o r d o l i f e p e n s io n s m e e t th e s itu a tio n . T h e i n ju r e d w o r k e r w h e n
s u r g ic a lly d is c h a r g e d g o e s b a c k t o in d u s t r y , o n h is o w n in it ia t iv e a n d
g e n e r a lly ig n o r a n t o f w h e r e t o g o , w it h a lw a y s th e p e r c e n ta g e r e
d u c t io n o f t h e c o m p e n s a t io n f o r t h e lo s s h e h a s s u s ta in e d , w it h o u t
a s s is ta n c e a n d w it h o u t g u id a n c e , t o d o t h e b e s t h e c a n , ir r e s p e c t iv e
o f h is p r e s e n t o r p o s s ib le s o c ia l v a lu e . I t is w r o n g , o f c o u r s e , t o s a y
“ c o m p e n s a t i o n f o r t h e l o s s h e h a s s u s t a i n e d ” ; i t is r a t h e r t h e a v e r a g e
lo s s o f w o r k e r s o f h is o c c u p a t io n , as in C a l i f o r n i a a n d O n t a r io , o r o f
a ll w o r k e r s , as in e v e r y o t h e r ju r is d ic t io n . I f o c c u p a t io n b e th e te st,
t h e m a n i n t h e h ig h e r c la s s o f w o r k d r o p s d o w n s o t h a t h is s u p e r io r
in t e llig e n c e m a y , t o s o m e e x te n t, o ffs e t h is h a n d ic a p i n c o m p e t it io n ;
b u t t h e m e n i n t h e lo w e s t c la s s e s o f w o r k a r e f o r c e d t o m e e t t h e c o m
p e t it io n n o t o n ly o f m e n o f s u p e r io r in t e llig e n c e w it h e q u a l d is a b le
m e n ts , b u t o f m e n o f e q u a l i n t e llig e n c e w it h o u t a n y d is a b le m e n ts .
A n d f r o m th e b o t t o m o f th e s c a le th is r u n s t o th e t o p in v a r y i n g
in te n s ity .
W h i l e t h e a v e r a g e is p e r h a p s t h e o n l y p r a c t i c a l b a s i s o f a d m i n i s t e r
i n g p e r m a n e n t d is a b il i t y p a y m e n t s , t h e in d i v i d u a l is c o n c e r n e d w it h
h i s o w n a m o u n t . I t i s r a r e l y a n d c o i n c i d e n t a l l y t h a t t h e a v e r a g e is
e n c o u n te r e d a s a r e a l q u a n tity .
S e le c t in g a h a lf d o z e n fig u re s a t
r a n d o m , 7 8, 9, 10 , 1 1 , 1 2 , a d d i n g t h e m , 5 7 , d i v i d i n g t o g e t t h e a v
,
e r a g e , 9^ , a r e s u l t i s o b t a i n e d t h a t d o e s n o t a p p e a r i n t h e f i g u r e s , y e t
RESTORING THE DISABLED TO INDUSTRY---- T. N . DEAN.
183
t h a t is a n a v e r a g e . I f t h e 9 | b e t h e c o m p e n s a t i o n p a y m e n t t h a t i s a b
s o lu te ly n e c e s s a r y t o m a in t a in l if e , t h e n h a l f o f t h e c a s e s w o u ld s ta r v e
t o d e a th . T h a t is a n e x t r e m e e x a m p le , y e t it is t h e t h e o r y b e h in d p a y
m e n ts f o r p e r m a n e n t d is a b ilit y ; a n d in th e ca se o f c o m m u ta tio n s th e
a v e r a g e l if e t im e is t a k e n , n o t t h e e q u a l c h a n c e o f l i v i n g n o r t h e m o s t
p r o b a b le l if e t im e , a n d t h is is p r o m u lg a t e d a s a “ ju s t a n d p r o p e r " ’
p a y m e n t t o t h e i n d iv id u a l f o r h is l o s s !
G o w h e r e y o u w ill t o -d a y a n d d i g b e n e a th th e r a m ific a tio n s o f
v a r ia n t f a c t o r s a n d y o u w i l l fin d t h a t t h e p h y s ic a l m u t ila t io n is t h e
b a s is u p o n w h ic h a ll p e r m a n e n t -in ju r y p a y m e n t s a r e m a d e , ir r e s p e c
t iv e o f d is a b ility a c c r u in g th e r e fr o m .
T h e i n d i v i d u a l is r e c e iv e d
d ir e c t f r o m s u r g ic a l tr e a tm e n t, o ft e n c r ip p le d m o r e fr o m in a d e q u a te
a n d ig n o r a n t a tte n tio n th a n b y in ju r y , g e n e r a lly w ith o u t p r o p e r
p r o s th e s is , a n d a lw a y s w it h o u t s p e c ia l k n o w le d g e b e in g a p p lie d ,
w it h o u t a n y tim e f o r r e a d ju s tm e n t t o th e c h a n g e d c o n d it io n s , w it h
o u t e ith e r fu n c t io n a l o r p r o f e s s io n a l r e e d u c a tio n , g iv e n a p e n s io n ,
a n d , w it h o u t a id o r a s s is ta n c e e x c e p t f r o m b e n e v o le n c e o r s h a m e o f
e m p lo y e r s o r c h a r it y f r o m o u ts id e r s , is t h r o w n u p o n h is o w
r e s o u r c e s a n d a llo w e d ig n o r a n t ly a n d p a s s iv e ly t o r e h a b ilit a t e h im
s e lf as b est h e can .
S ir H . R id e r H a g g a r d s a id o f th e C a n a d ia n sy ste m o f r e s t o r in g
m ilit a r y c r ip p le s to in d u s t r y : “ I m a k e n o c o m p a r is o n s .
W e ar
t a u g h t th a t c o m p a r is o n s a re o d io u s .
B u t I h a v e tr a v e le d th r o u g h
th e E m p ir e , a n d I k n o w o f n o sy stem w h ic h a p p r o a c h e s th a t w h ic h
y o u a r e fo r t u n a t e e n o u g h t o h a v e in C a n a d a .”
I n th e r e s t o r a t io n
o f its d is a b le d m e n t o in d u s t r y , th e C a n a d ia n id e a is t h a t s o ld ie r s
a r e c it iz e n s a n d m u s t b e t r e a t e d in t h e l ig h t o f t h e ir c it iz e n s h ip .
T h e o r g a n i z a t i o n o f t h e C a n a d i a n s y s t e m is t h r1 e eD oo lm :i n
. f d
io n : T h e d e p a r tm e n t o f m ilit ia a n d d e fe n s e , u n d e r w h ic h th e s o ld ie r
is f r o m e n lis t m e n t t o d is c h a r g e ; t h e m i l it a r y h o s p it a ls c o m m is s io n ,
f o r p r o v id in g c o n v a le s c e n t h o m e s , m e d ic a l tre a tm e n t, a n d v o c a t io n a l
r e e d u c a t io n f o r d is a b le d r e t u r n e d s o l d ie r s ; th e b o a r d o f p e n s io n s
c o m m is s io n e r s , w h ic h h a s e x c lu s iv e ju r is d ic t io n
o v e r g r a t u it ie s ,
a llo w a n c e s , a n d a s s is ta n c e s t o m e m b e r s o f t h e C a n a d ia n fo r c e s a n d
t h e i r d e p e n d e n t s .2 . P r o v i n c i a l c o m m i s s i o n s i n e a c h P r o v i n c e t o
p r o v i d e e m p lo y m e n t f o r d is c h a r g e d s o ld ie r s . 3. V o l u n t a r y : W e l c o m
i n g c o m m itte e s , p h ila n t h r o p ic o r g a n iz a tio n s , e m p lo y m e n t b u re a u s ,
v i s i t in g c o m m itte e s , e tc . B e s id e s th e s e , v a r io u s d e p a r t m e n t s o f F e d
e r a l a n d p r o v in c ia l g o v e r n m e n t s a id in la n d s e ttle m e n t s c h e m e s,
e m p lo y m e n t b u re a u s , e tc.
A C a n a d ia n c a s u a lt y is h a n d le d a t th e f r o n t , in E n g l a n d , a n d
a c r o s s t h e A t la n t ic t o th e C a n a d ia n r e c e iv in g d e p o t b y th e d e p a r t
m e n t o f m ilitia a n d d e fe n s e .
T h e m ilit a r y h o s p it a ls c o m m is s io n
ta k e s c h a r g e o f h im t h r o u g h th e h o s p it a l a n d c o n v a le s c e n t h o m e s
184
ACCIDENT PROBLEMS.
u p t o d is c h a r g e , th e n t h r o u g h r e e d u c a tio n .
T h e b o a r d o f p e n s io n s
c o m m is s io n e r s a n d th e p r o v in c ia l c o m m is s io n d e a l w it h th e m a n
a f t e r d is c h a r g e .
U p t o d is c h a r g e , p a y a n d a llo w a n c e , fie ld a n d s e p a r a tio n , c o n
tin u e .
O n d is c h a r g e , a c c r u e d a r re a rs a n d th r e e m o n t h s ’ p a y a r e
g iv e n . I f t h e s o l d ie r g o e s i n t o r e e d u c a t io n , h e is p u t in t o th e m i l i t a r y
h o s p it a ls c o m m a n d , a u n it o f th e s e r v ic e , a n d p a y a n d a llo w a n c e s
a re restored .
A s l o n g a s a m a n is in s e r v ic e h is d e p e n d e n t s , i
n e e d y , a re io o k e d a ft e r b y th e C a n a d ia n p a t r io t ic fu n d , w h ic h
a lth o u g h s u p p o r te d b y v o lu n t a r y c o n tr ib u tio n s , is u n d e r D o m in io n
c h a r t e r . I t is t o b e n o t e d t h a t e n lis t m e n ts in th e m i l it a r y h o s p it a ls
c o m m is s io n c o m m a n d a r e f o r tr e a tm e n t, n o t f o r s e r v ic e .
T h e s e r v i c e p a y a n d a l l o w a n c e s f o r r a n k a n d f i l e a $ 1e : a P a y ,
r
d a y ; f i e l d a l l o w a n c10, c e n t s a d a y ; s e p a r a t i o n a l l o w a n c e a
e
$20 ,
m o n t h . U p t$20 a m o n t h p a y m a y b e a s s i g n e d t o d e p e n d e n t s . A t
o
d is c h a r g e th r e e m o n t h s ’ p a y a n d a llo w a n c e s a r e g iv e n .
D u r in g
r e e d u c a t io n , i f n o t in h o s p it a l, s u b s is te n c e a llo w a n ca d a y is
$1 e o f
g iv e n , b e s id e s s e p a r a t io n a llo w a n c e u p t o $ 3 5 a m o n t h , le s s p e n s io n ,
f o r w i f e , a n d v a r y i n g s u m s o f f r o m $ 3 t o $ 7 .5 0 a m o n t h f o r c h i l d r e n ,
th e m a x im u m a llo w a n c e f o r w if e a n d c h ild r e n b e in g $55 a m o n th .
T h e h o s p it a l a n d c o n v a le s c e n t h o m e o r g a n iz a t io n c o m p r is e s s p e c ia l
h o s p it a l c a r s , s a n ita r iu m s f o r ca s e s o f t u b e r c u lo s is — f o r in c ip ie n t
a n d f o r in c u r a b le ca ses— h o s p it a l f o r p s y c h ia t r ic tre a tm e n t, h o s p ita ls ,
c o n v a le s c e n t h o m e s , h o s p it a ls f o r ca ses o f r h e u m a tis m , s p e c ia l tr e a t
m e n t, a n d rest a n d su m m e r ca m p s.
W h e n th o u g h t a d v is a b le m e n
a r e a llo w e d t o r e c u p e r a t e in t h e ir o w n h o m e s , s u b s is te n c e a llo w a n c e
b e in g m a d e.
T h e m e d ic a l a n d s u r g ic a l t r e a tm e n t is th e b e s t a n d m o s t e ffe c tu a l
t h a t s c ie n c e c a n o f f e r ; it in c lu d e s f u n c t i o n a l r e e d u c a t io n a s w e ll a s
t r e a t m e n t . F r o m th e m e d ic a l s id e , r a d i o g r a p h a p p a r a t u s , a c t iv e a n d
p a s s iv e m e c a n o th e r a p y , g a lv a n ic , s ta tic , fa r a d ic , a n d h ig h -t e n s io n
c u r re n ts , v ib r a t io n , e le c tr ic m a s s a g e , b a k in g , h o t -a ir b la s t, c o n t in u
ou s h o t-w a te r b a th s , a n d th e b a la n ce d m a g n e t a re som e o f th e m e th
o d s a n d d e v ic e s u s e d . F r o m th e f u n c t io n a l r e e d u c a t io n a l s id e , D r .
B o t t s ’s a p p a r a t u s , m o d ific a t io n o n th e A m a r p r i n c i p l e t o r e s t o r e lo s t
f u n c t io n a l m o t io n a n d t o c u r e h y s t e r ia , t o r s io n m a c h in e s , e x e r c is e s ,
a n d g y m n a s iu m s a re illu s t r a t io n s o f th e c a r e ta k e n . I n a m p u ta tio n
ca se s e v e r y e ffo r t is m a d e t o g e t th e p a tie n t t o e v o lv e as m u c h fu n c
t i o n a l m o v e m e n t a s is p o s s i b l e i n t h e s t u m p . I t i s a l i k e t h e F r e n c h ,
th e G e r m a n , a n d th e C a n a d ia n id e a th a t w o r k p r o p e r ly s e le c te d a n d
g r a d u a t e d h a s a h ig h p s y c h ic v a lu e a n d c o n s t it u t e s t h e b e s t p o s s ib le
m e a n s o f r e a c c u s t o m in g m u s c le s t o a c t io n . T h e p o w e r o f b a l a n c i n g
o n t h e g o o d l e g a n d s w i n g i n g t h e s t u m p o f t h e a m p u t a t e d l e g is p r o
m o te d , f o r e x a m p le , b y h u n d r e d -y a r d d a sh e s, c r u tc h e s b e in g d is
RESTORING THE DISABLED TO INDUSTRY— T. N. DEAN.
185
card ed .
E v e r y e ffo r t is ta k e n d u r in g tr e a tm e n t t o c o n v in c e th e
m e n th a t t h e y s h o u ld a n d c a n b e c o m e s e lf-s u p p o r t in g , a n d in d e e d
t h e p r o f e s s io n a l r e e d u c a t io n is c o m m e n c e d a n d s o m e tim e s fin is h e d
d u r in g th e tim e o f a c t iv e tr e a tm e n t.
T h e d is c u s s io n o f p r o s t h e s is is o n e t h a t m u s t b e a p p r o a c h e d w it h
c a re , f o r s o m e e x c e lle n t F r e n c h o p in io n is r a t h e r s k e p t ic a l o f th e
e c o n o m ic su cc e s s o f a r t ific ia l a tta c h m e n ts , e s p e c ia lly i f h ig h l y s t a n d
a r d iz e d . T h e r e is, o f c o u r s e , a lw a y s t h e c o n f lic t o f t h e c o s m e t ic a n d
e c o n o m ic v ie w p o in t s . T h e C a n a d ia n p o l i c y h a s b e e n t o a s s e m b le a ll
th e a m p u t a t io n ca se s in o r t h o p e d ic h o s p it a ls , w h e r e fu n c t io n a l a n d
p r o f e s s i o n a l r e e d u c a t io n is c a r r ie d o n . T h u s t h e i n d i v i d u a l c a s e — h is
p o w e r o f a d a p t a b ilit y a n d h is a ttitu d e t o w a r d e c o n o m ic r e h a b ilit a
t io n — c a n b e s tu d ie d .
A l l lim b s a re m a d e a t th ese h o s p it a ls ; th u s
b e n e fit s a r e o b t a in e d o f t h e la t e s t im p r o v e m e n t s , s o m e o f w h ic h a r e
n o t a v a i l a b l e f r o m i n d i v i d u a l fi r m s . N o e x p e n s e i s b e i n g s p a r e d i n
o b t a i n in g t h e m o s t s u it a b le a tta c h m e n ts , b e a r in g in m in d t h e p r i o r
o r p o s s ib le o c c u p a tio n o f th e in ju r e d m a n h im s e lf, d e v e lo p in g th e
fu n c t io n a l u se o f th e s tu m p , a n d c o n s id e r in g th e a d a p t a b ilit y o f th e
p a t ie n t . I t h a s b e e n r e c o g n iz e d th a t th e m o s t e x p e n s iv e a r m o r l e g
is n o t a lw a y s th e m o s t s e r v ic e a b le a n d th a t o r d in a r y in g e n u it y
q u ic k ly d e v is e s a p p lia n c e s f o r m a k in g e a s y o p e r a t io n s w h ic h a p h y
s ic a l lo s s h a s m a d e d iffic u lt. O n e t h in g c a n n o t b e o v e r e m p h a s iz e d —
t h e s u cc e s s o f th e o n e -a r m e d o r o n e -le g g e d m a n is v a s t ly in c r e a s e d
w h e n h e le a r n s a n d a c ts o n th e k n o w le d g e th a t p o w e r a n d s k ill c a n
b e d e v e lo p e d in th e r e m a in in g s tu m p . F u n c t io n a l r e e d u c a t io n is m o s t
v a lu a b le .
T h e p u r p o s e b e h i n d p r o f e s s i o n a l r e e d u c a t i o n is t h a t t h e d i s a b l e d
m a n b e r e s to r e d t o in d u s t r y , g iv e n b a c k h is p o w e r t o w o r k , w h ic h
c o n s t it u t e s h is m a n h o o d , t o th e e n d t h a t h e b e n o t t h r o w n i n t o th e
g a r b a g e ca n o f c iv iliz a t io n — p o v e r t y r e lie v e d b y c h a r it y .
P r iv a te
P a t is q u o t e d as s a y in g —
It’s a long trench that has no turning,
A piffling wage that takes no earning,
And a lazy loon that wants no learning.
T h e m a n c h o o s e s h is o w n o c c u p a t io n , b e in g a d r o it ly “ s t e e r e d ”
b y t h e v i s i t o r s o f t h e l o c a l c o m m i t t e e a n d t h e v o c a t i o n a l o ff ic e r s , w h o
a c t u p o n th e r e p o r t s r e c e iv e d d u r in g fu n c t io n a l r e e d u c a tio n .
The
w o r k is c o m m e n c e d d u r in g c o n v a le s c e n c e a n d c o n t in u e d , i f n e c e s s a r y ,
beyond.
T h e g e n e ra l t r a in in g c o m e s fir s t : In s tr u c tio n in E n g lis h
f o r n o n -E n g lis h s p e a k in g p e rs o n s , la n g u a g e , p e n m a n s h ip , a n d a r it h
m e tic .
T h e v o c a t io n a l r e t r a in in g c o v e r s m a n y fie ld s , i n c lu d in g
b o o k k e e p in g , s h o r th a n d , t y p e w r it in g , te le g r a p h y , w o o d w o r k in g ,
lig h t -m e t a l w o r k , le a th e r w o r k in g , a u t o m o b ile a n d in t e r n a l-c o m b u s tio n e n g in e e r in g , s h o e r e p a ir in g , g a r d e n in g , p o u lt r y k e e p in g ,
b e e k e e p in g , v e g e ta b le a n d flo w e r r a is in g , r o a d b u ild in g , a n d g e n e r a l
186
ACCIDENT PROBLEMS.
fa r m in g . E v e r y e ffo r t h a s b e e n m a d e to s e cu re e x p e r t s in th e v a rio u s
lin e s a s in s tr u c to r s .
I n s o m e ca ses— th e p r a c t ic e , i t is u n d e r s t o o d ,
is t o b e c o m e m o r e g e n e r a l— a p p r e n t ic e s h ip c o n t r a c t s a r e s e c u r e d in
in d u s t r ia l e s t a b lis h m e n t s . T h e t r a in i n g g i v e n is n o t g i v e n m e r e ly a s
tr a in in g , b u t a s a p o w e r to s e c u re liv e lih o o d , a n d as su ch th e d e m a n d
is c a r e f u lly w a tc h e d a n d th e s u p p ly r e g u la te d . I t w o u ld b e p o s s ib le ,
g iv e n tim e e n o u g h , t o m a k e o v e r d is a b le d m e n in t o p r o f e s s o r s o f
H in d u p h ilo s o p h y — b u t t o w h a t a v a il?
‘
A g a in , e x p e r ie n c e h a s
s h o w n th a t in c o n s e q u e n tia l t r a in in g , as t a ttin g , k n it t in g , o r b a s k e t
w e a v i n g , e t c ., i s o f l i t t l e v a l u e e x c e p t a s t r e a t m e n t .
S p e c ia l m e th o d s a re e m p lo y e d f o r th e r e e d u c a tio n o f th e t o t a lly
b lin d a n d t o t a lly d e a f, c o n v e r t in g th e se fr o m th e c a t e g o r y o f t o t a lly
d is a b le d t o s e lf-s u p p o r t in g .
T h e w o r k o f r e e m p lo y m e n t is c a r r ie d o n u n d e r p r o v in c ia l o r g a n i
z a t io n s , c o m m is s io n s a p p o in t e d b y th e l o c a l g o v e r n m e n t s .
T h e ir
w o r k is s u p p le m e n t e d b y t h e e ffo r t s o f m u n ic ip a l, lo c a l, v o lu n t a r y ,
a n d p h i l a n t h r o p i c /o r g a n iz a t io n s .
T h e e n d in v ie w is t o g e t th e
s o ld ie r in t o in d u s t r y , fin d in g h im a p o s it io n w h ic h h e is c a p a b le o f
fillin g , s o th a t h e ca n m e e t th e c o m p e t itio n o f m e n w h o h a v e n o t
b e e n d is a b le d .
B y k e e p in g c a r e fu l r e c o r d o f th e m a n , b y v is it in g
h i m , a n d b y e n c o u r a g i n g h i m m u c h i s b e i n g d o n e . T h e i d e a is t h a t
a s o ld ie r n a t u r a lly s u ffe r s f r o m w a r s h o c k a n d c o m e s b a c k m e n t a lly
a n d p h y s ic a lly c h a n g e d , a c cu s to m e d to w a itin g f o r a n d a c tin g o n
s p e c ific o r d e r s , a n d h e n c e is l a c k i n g in in i t i a t iv e , a n d b e c a u s e o f t h is
m u s t b e e n c o u r a g e d a n d a id e d . J o b a f t e r jo b m u s t b e f o u n d s u it a b le
t o h is d is a b le d p h y s ic a l s t r u c t u r e a n d c h a n g e d p s y c h i c c o n d it io n s ,
t i l l a t la s t t im e o b lit e r a t e s h is r e s tle s s n e s s a n d r e h a b ilit a t io n r e s t o r e s
h is in d u s t r ia l p o w e r t o c o m p e t e in th e o p e n m a r k e t.
T o d a te , in C a n a d a th e r e a re m o r e jo b s th a n jo b le s s , th e p o s it io n s
f i l l e d p a y i n g f r o $ 10 a w e e k t o $ 1 5 0 a m o n t h .
m
T h e C a n a d ia n
M a n u f a c t u r e r s ’ A s s o c i a t i o n is in t e r e s t in g it s m e m b e r s , p u b l i c i t y
a g e n c i e s a r e c o o p e r a t i n g , a n d i n v e s t i g a t i v e t a l e n t is p r e p a r i n g a l i s t
o f o c c u p a t io n s in w h ic h d is a b le d m e n m a y c o m p e te , s o t h a t a c o m
p le te in d u s t r ia l s u r v e y m a y b e m a d e . S te p s a r e a ls o b e in g ta k e n t o
r e g u la t e th e p r o b le m o f c o m p e n s a tio n , a n d a c c id e n t a n d l i f e in
s u r a n c e p r e m iu m s in r e s p e c t t o d is a b le d m e n .
T o t h e m a x im u m p e n s io n s f o r t o t a l d is a b ilit y is a d d e d a n a l lo w
a n c e f o r a t t e n d a n c e , i f t h e d is a b ilit y is s u ch t h a t i t n e c e s s ita te s a t
te n tio n . T h e m a x im u m p e n s io n in C a n a d a , $ 4 0 a m o n t h (r a n k a n d
f i l e a l l o w a n c e ) f o r a m a n w i t h o u t c h i l d r e n , i s i n$6 e a s m do n t h
cr
e
f o r e a ch c h ild .
T h e $ 4 0 a m o n t h is th e fig u r e w h ic h , in th e b e s t
ju d g m e n t , is t h e a m o u n t r e q u is it e t o m a in t a in t h e a v e r a g e w o r k e r
in a s ta n d a rd o f d e ce n t c o m fo r t.
T h e r a t in g s c h e d u le a n d th
m o n t h ly m a x im u m a re , it is u n d e r s to o d , t o u n d e r g o a c h a n g e , a n d
p r o v is io n f o r c o n s t a n t r e v is io n is t o b e m a d e , r e v is io n b e in g b a s e d ,
RESTORING THE DISABLED TO INDUSTRY— T. N . DEAN.
187
a s a r e in it ia l a llo w a n c e s , o n p h y s ic a l i n ju r y a lo n e , n o d e d u c t io n t o
b e m a d e f o r a n y e a r n in g s w h ic h a r e t h e r e s u lt o f r e e d u c a t io n
T h e la n d s e ttle m e n t s c h e m e s o f t h e v a r io u s g o v e r n m e n t s c o m
p r is e fr e e la n d , f r e e f a r m i n g in s t r u c t io n , fr e e s u p e r v is io n , a n d
s u b s t a n t ia l a s s is ta n c e i n t h e f o r m o f s t o c k , lu m b e r , im p le m e n t s , a n d
ca sh .
O n th e e v e o f A m e r i c a ’s a c tiv e p a r t ic ip a t io n in t h e E u r o p e a n w a r
a n d b y r e a s o n o f C a n a d a ’s e ffo r t s , th is c o n t in e n t h a s b e e n s h o c k e d
in t o e n d e a v o r t o r e s to r e d is a b le d s o ld ie r s t o in d u s t r y .
T o - n i g h t i t is
u r g e d th a t th e w o r k o f r e h a b ilita tin g in d u s t r y ’s c r ip p le s b e h a ste n e d .
F r o m th e e c o n o m ic a n d n a tio n a l s t a n d p o in t a c r ip p le is a s o c ia l
lo s s , w h e th e r m ilit a r y o r in d u s tr ia l.
T h e p r o b le m s g o h a n d in h a n d ,
e v e n i f t h r o u g h th e m ilit a r y —
There runs
The red resentment of the guns,
And you, yourself, would mutter when
You took the things that once were men
And sped them through that zone of hate
To where the dripping surgeons wait,
And wonder too, if in God’s sight,
War ever, ever can be right.
— a n d th e in d u s t r ia l is b u r ie d in h o p e le s s n e s s , s u ffe r in g , a n d d e s p a ir
in t h e c o tta g e s o f th e to ile r s .
$
$
^
$
S t a t is t ic s is t h e s c ie n c e o f c o u n t i n g .
T h e im p o r ta n c e o f c o u n tin g
c a n n o t b e o v e r e s tim a te d .
T h e fir s t m e n t io n o f c o u n t in g is in t h e
fir s t c h a p t e r o f G e n e s is .
E v e r y t h in g w a s d iv id e d in to p e r io d s —
r e g u la r in te r v a ls .
S o in c o u n tin g , n o m a tte r w h e r e y o u b e g in o r
w h a t y o u a re d o in g , y o u h a v e g o t to k n o w h o w m u ch y o u h a v e
d o n e a n d h o w m u ch r e m a in s t o b e d o n e .
T h a t s ta tis tic s ca n b e
a p p lie d t o a lm o s t a n y t h in g is illu s tr a te d b y a c u r io u s fa c t .
For
t h e fir s t t im e in t h e h is t o r y o f G r e a t B r it a i n t h e S c o t t is h s o ld ie r s
h a v e d is c a r d e d th e t r a d it io n a l k ilts a n d a re fig h t in g in k h a k i.
T h ere
is a re a s o n f o r th a t, I a m g iv e n t o u n d e r s ta n d b y th o s e in p o s it io n
to k n ow .
I t w a s f o u n d th a t ca se s o f a r t h r it is o f th e k n e e w e r e m o s t
p r e v a le n t a m o n g t h e S c o t t is h s o ld ie r s a n d t h is le d t o a n in v e s t ig a
t io n .
I t w a s fo u n d th a t th e s la p p in g o f th e m u d -c a k e d k ilt s o n th e
k n e e s set u p a c o n d i t io n o f th e jo in t s t h a t n e c e s s it a t e d , s o m e tim e s ,
t h e d is c h a r g e o f th e H i g h l a n d s o ld ie r f r o m th e s e r v ic e .
That i
o n e e x a m p le o f th e u se o f s ta tis tic s .
I n d ia g n o s e s , as a lm o s t a n y
p r a c t it io n e r w ill te ll y o u , s ta tis tic s a r e a b s o lu te ly th e w h o le t h in g .
O f c o u r s e it is u n n e c e s s a r y t o s p e a k o f t h e im p o r t a n c e o f s t a t is t ic s
in a c c id e n t p r e v e n t io n w o r k , a n d in e v e r y p r o b le m w h ic h a n in d u s
t r ia l a c c id e n t b o a r d m e ets. T t h a s b e e n f o u n d in t h e C a n a d ia n m ili
t a r y s e r v ic e th a t s ta tis tic s , th e c o n s ta n t r e p o r t i n g o f s ta tis tic a l d a t a ,
188
ACCIDENT PROBLEMS.
is th e b a s is u p o n w h ic h so m a n y o f th e se w o n d e r fu l t h in g s th a t th e y
a r e d o i n g in r e s t o r in g t h e in ju r e d t o in d u s t r y h a v e b e e n a r r iv e d a t.
I f y o u a re g o i n g t o h a v e r e a l s ta tis tic s in th is w o r k , I th in k t h a t a
u n ifo r m , c o n c r e te p o lic y is th e o n ly th in g .
W e in O n t a r io c a n g
o n f o r y e a r s a n d c e n t u r ie s a n d w e c a n n o t g e t t o g e t h e r a s m u c h d a t a
as w e c a n in a s in g le y e a r in th e U n it e d S ta te s a n d C a n a d a .
One
t y p e o f in d u s t r y in N e w Y o r k n e c e s s ita te s a h ig h e r r a t e th a n t h e
s a m e t y p e o f in d u s t r y in O h io o r M a s s a c h u s e tts , o r a n y o th e r S ta te .
T h e r e is o n l y o n e w a y in w h ic h w e c a n fin d o u t t h e r e a s o n f o r it
I t is n o t b y t h e e x p e r ie n c e o f a n y s in g le m a n o r fiv e o r te n m e n , b u t
b y t h e e x p e r ie n c e o f t h e c o u n t r y a s a w h o le .
I a m a s k in g , n a
p le a d in g w it h th e c o m m is s io n e r s h e r e t o -n ig h t t h a t t h e y ta k e u p th is
q u e s tio n o f s ta tis tic a l w o r k ; th a t th e e ffo r t s o f th e c o m m it t e e a lr e a d y
a p p o in t e d b e c o n t in u e d ; th a t th e c o m m itte e it s e lf b e c o n tin u e d —
i f n e c e s s a r y , b e p u t u pko np e r m a n e n t b a s i s .
S o m e o f t h e a b le s t
m e n in s ta tis tic a l w o r k o n th e A m e r ic a n C o n tin e n t t o -d a y , s o m e o f
th e a b le s t m e n in s t a t is t ic a l w o r k in r e la t io n t o w o r k m e n ’ s c o m p e n s a
t io n , a re m e m b e r s o f th is c o m m itte e .
Y o u h a v e an o p p o r t u n it y
t h r o u g h t h e c o m m it t e e , t o g a in th e i n f o r m a t io n y o u m a y w is h y o u h a d
n ow or h ad h ad years ago.
A ls o , d o n o t s o lim it y o u r s ta tis ticia n in
m o n e y o r h e lp o r a p p lia n c e s th a t h e ca n b a r e ly g e t to g e th e r a fe w
m is e r a b le , p a lt r y fig u r e s t o r e p r e s e n t a ll th e e x p e r ie n c e o f t h e S ta te .
W h y h a m p e r y o u r s ta tis ticia n s b y g i v in g th e m a fe w p a g e s in th e
b a c k o f th e b o o k .
I w o u ld lik e t o s a y t h a t it h a s b e e n t h is h a m p e r in g
t h a t h a s b r o u g h t th e s ta tis tica l p r o fe s s io n in t o th e a w fu l c o n d it io n
i n w h i c h i t n o w is .
I u r g e t w o t h in g s : F ir s t , th a t th is c o m m itte
o n s ta tis tic s b e c o n t in u e d , p e r h a p s p e r m a n e n t ly , i f y o u so f e e l ; a n d ,
secon d , th a t w h e n y o u g o h o m e a n d co m e to th e a ctu a l w o r k th a t
t h is c o m m it t e e h a s a c c o m p lis h e d d o n ’t t h r o w th e r e p o r t s o n th e s id e
o f y o u r d e s k a n d sa y , “ T h is m e a n s n o th in g .
T h a t ’s a ll r ig h t f o r a
f e w ju r is d ic t io n s th a t w a n t t o s p e n d a l o t o f m o n e y .”
W e a re s t r iv
in g to g e t to g e th e r d a ta th a t is g o in g t o h e lp in th e a d m in is tr a tio n
o f c o m p e n s a t io n la w s .
I ask y o u to d o w h a t y o u ca n to w a r d h e lp in g
th e s ta tis tic ia n s in th is c o u n t r y t o g e t d a ta th a t a re n o t m e a n in g le s s ,
b u t h a v e s o m e r e a l b e a r in g o n th e s o lu t io n o f th e p r o b le m s b e f o r e u s.
IN D U S T R IA L
SAFETY THROUGH
S T A T IS T IC S *
BY CHARLES H . VERRILL, STATISTICIAN , UNITED STATES EMPLOYEES’ COMPENSATION
COMMISSION.
F o r th e o r g a n iz in g a n d c a r r y in g o n o f e ffe c tiv e a c c id e n t-p r e v e n tio n
w o r k t h e fir s t e s s e n t ia l is a n a c c u r a t e k n o w le d g e o f w h e r e , h o w , a n d
w h y a c c id e n ts o c c u r . N o c o m p e n s a tio n c o m m is s io n a n d c e r t a in ly n o
e x p e r ie n c e d s a fe t y m a n n e e d s t o w a it f o r a c c id e n t s ta tis tic s in o r d e r
t o r e c o g n iz e th e c o m m o n d a n g e r p o in t s in in d u s tr y , s u ch as u n
g u a r d e d sa w s, g e a r s , o r s h a ft in g . B u t e m p lo y e r s , e s p e c ia lly in s m a ll
e s t a b lis h m e n t s , a re s o m e tim e s b lin d t o e v e n s u c h d a n g e r s as th e s e , o r
a r e s lo w t o r e c o g n iz e th e m a s a c tu a l d a n g e r s in t h e ir o w n p la n t s .
B u t th e o b v io u s d a n g e r s a r e o n ly a s m a ll p a r t o f th e w h o le , a n d f o r
p r o g r e s s i v e r e s u lt s t h e r e m u s t b e e d u c a t io n a l w o r k , w it h a c o n t in u o u s
s tu d y o f th e ca u ses o f a c c id e n t o ccu rre n ce .
T h e s a fe t y m a n m u s t k n o w in w h a t d e p a r tm e n t a n d in w h a t o c c u
p a t io n o r p r o c e s s a c c id e n ts a re o c c u r r in g , a n d in c o n n e c tio n w it h
w h a t s t r u c t u r e s , m a c h i n e s , o r a p p l i a n c e s , wT e t h e r f r o m d e f e c t o f d e
h
s ig n o r m a t e r ia l, o f s t r u c t u r e , m a c h in e , o r a p p lia n c e .
T h e la c k o f
p r a c t ic a b le s a fe g u a r d s , th e im p r o p e r u se o f m a te r ia l o r a p p lia n c e s ,
o r t h e i g n o r a n c e o r la c k o f c a r e o n t h e p a r t o f t h e e m p lo y e e is a f r e
q u e n t d ir e c t o r u n d e r ly in g ca u se o f a c c id e n ts .
H e m u st, in s h o r t,
k n o w w h a t e v e r it is p o s s ib le t o a s c e r t a in in r e g a r d t o t h e m a n n e r in
w h ic h th e a c c id e n ts a re o c c u r r in g .
C a u se s o f a c c id e n t, i f im p e r fe c t ly d e s c r ib e d , a re o f lim it e d u se f o r
a c c id e n t p r e v e n t io n .
F o r e x a m p le , i f t h e c a u s e is g iv e n m e r e ly a s
“ f l y i n g p a r t i c l,’5s u n r e l a t e d t o a n y p a r t i c u l a r m a c h i n e o r k i n d o f
e
w o r k , it fu r n is h e s a v e r y im p e r fe c t g u id e t o a c c id e n t p r e v e n t io n . W e
k n o w t h a t s o m e m a c h in e o r w o r k s h o u ld h a v e b e e n so g u a r d e d th a t
p a r t ic le s c o u ld n o t b e t h r o w n o ff, o r , i f th a t w a s n o t p o s s ib le , t h a t an
e m p lo y e e a t s o m e w o r k s h o u ld h a v e w o r n g o g g le s , b u t n e ith e r th e
m a c h in e n o r th e w o r k c a n b e d e fin ite ly lo c a te d so th a t th e n e c e s s a r y
s te p s m a y b e ta k e n t o p r e v e n t o th e r s im ila r a c c id e n ts .
A g a in , an
a c c id e n t s a id t o b e c a u s e d b y a f a l l f r o m a la d d e r m a y b e d u e t o th e
f a l l o f th e m a n , o w i n g t o lo s s o f b a la n c e , t o b r e a k in g o f a r o u n d o f a
la d d e r , t o th e s l ip p in g o f t h e la d d e r , o r t o its t w is t in g o r t u r n in g a n d
t h r o w in g th e m a n . I f th e r e c o r d s a re t o b e u s e fu l f o r a c cid e n t p r e
v e n t io n , th e ca u s e s s h o u ld b e s p e c ific a lly sta te d .
E v e r y o n e w h o h a s h a d o c c a s io n to s tu d y a c c id e n t ca u se s, o r , in fa c t ,
a n y p h a s e o f in d u s t r ia l c o n d it io n s , is f a m i l i a r w it h ca s e s w h e r e e m
p lo y e r s h a v e b e e n w h o l l y u n a w a r e o f s e r io u s a n d e a s ily r e m e d ia b le
189
190
ACCIDENT PROBLEMS.
d a n g e r s in t h e ir p la n t s .
O n ly in v e s tig a tio n a n d th e s u m m a r iz in g
o r t h e s t a t is t ic a l p r e s e n t a t io n o f t h e r e s u lt s h a v e b e e n a b le t o m a s s
th e e v id e n c e s o as t o b r in g h o m e th e n e e d o f t h e p r o p e r c o r r e c t iv e
m easures.
I r e f e r b r ie fly t o s e v e r a l e x a m p le s . T h e d a n g e r o f th e n e w e m
p lo y e e h a s n o t a lw a y s b e e n r e c o g n iz e d a s it is n o w . I n a r e p o r t w h i c h
th e U n it e d S ta te s B u r e a u o f L a b o r S ta tis tic s p u b lis h e d e a r ly in 1911
th e h a z a r d o f th e n ew m a n w a s b r o u g h t o u t m o re s tr ik in g ly th a n ev e r
b e f o r e o r s in c e , I b e lie v e .
T h e in v e s tig a tio n s h o w e d th a t a m o n g
s t a m p in g a n d p u n c h p r e s s h a n d s , 32 9 w e r e i n ju r e d d u r in g t h e ir fir s t
d a y o n t h e m a c h in e , as a g a in s t 4 6 d u r in g t h e r e m a in d e r o f t h e ir fir s t
w e e k a n d 7 d u r in g th e r e m a in in g w e e k s o f t h e ir fir s t m o n th .
Y ou
a r e a ll fa m i l ia r w it h th e e x c e s s iv e n u m b e r o f a c c id e n t s a m o n g n o n E n g lis h -s p e a k in g e m p lo y e e s , a s p e c ia l h a z a r d n o t g e n e r a lly r e c o g
n iz e d b e f o r e its s ta tis tic a l d e m o n s tr a tio n .
E v e n m o r e s t r ik in g in s ta n c e s o f th e s u cc e ss o f in v e s t ig a t io n s a r e t o
b e fo u n d in s o m e o f th e o c c u p a t io n a l-d is e a s e s tu d ie s o f th e B u r e a u o f
L a b o r S ta tis tics .
B e f o r e th e b u r e a u ’s in v e s t ig a t io n o f p h o s p h o r u s
p o is o n in g in 1909, it w a s th e c la im o f A m e r ic a n m a tc h m a n u fa c
tu r e r s — a n d th e r e w a s a p o p u la r im p r e s s io n — t h a t th e t r o u b le h a d
n o t e x i s t e d i n t h i s c o u n t r y i n a s e r i o u s f o 20 y e a r s .
rm fo
The
r e c o r d s o f m o r e t h a n a h u n d r e d c a s e s o f t h e d is e a s e w e r e d is c o v e r e d
in a v e r y s h o r t t im e , w it h t h e r e s u lt t h a t m o s t m a t c h m a n u fa c t u r e r s
jo in e d in th e m o v e m e n t f o r th e le g is la tiv e p r o h ib it io n o f th e u se o f
th e p o is o n in th e in d u s tr y .
E v e n m o r e s tr ik in g w a s th e ig n o r a n c e s h o w n b y o w n e r s o r m a n
a g e r s in th e w h it e -le a d in d u s t r y as t o a c tu a l s ic k n e s s a m o n g th e ir
m e n . 6 S e v e r a l tim e s m e n , a p p a r e n t ly q u ite s in c e r e , m a in t a in e d t h a t
6
th e r e w a s n o le a d p o is o n in g a t a ll in t h e ir fa c t o r ie s .
I n o n e in s t a n c e
t h e m a n a g e r s a i d t h a t t h e y h a d h a d b a ste s i n 7 y e a r s ; 1 7 c a s e s
2 cu
w e r e f o u n d in th e h o s p it a l r e c o r d s o f s o m e 15 m o n th s .
A n oth er
m a n a g e r c h a l l e n g e d t h e w r i t e r t o 1 f icnad e f o r w h i c h t h e f a c t o r y
s
w a s r e s p o n s ib le , a n d w e r e f o u n d , s c a t t e r e d t h r o u g h t w o y e a r s ’ tim e .
21
T h e m a n a g e r p r o m p t ly in s ta lle d a p h y s ic ia n as m e d ic a l e x a m in e r , a
m e a s u r e h e h a d , u p t o t h a t t im e , c o n s id e r e d q u it e s u p e r flu o u s .”
(B u l
l e t i n N o . 9 5 o f t h e U . S . B u r e a u o f L a b o r S t a t i s t i c s , p . 1 9 0 .)
To
m a n y o t h e r o f t h e e m p lo y e r s t h e r e s u lt s o f t h e in v e s t i g a t i o n w e r e a
r e v e la t io n , a n d im m e d ia t e s te p s w e r e ta k e n t o r e m o v e o r t o m in im iz e
th e d a n g e r s w h ic h h a d b e c o m e s o c le a r ly a p p a r e n t.
I n a r e ce n t in v e s tig a tio n b y th e B u re a u o f L a b o r S ta tis tic s o f a n
t h r a x , a d is e a s e r e p u t e d t o b e p r e v a le n t o n l y in f o r e i g n c o u n t r ie s ,
“ o n e D e la w a r e p h y s ic ia n w a s a b le t o fu r n is h f r o m h is o w n p r a c t ic e
d a t a o n 4 8 c a s e s t r e a t e d w i t h i n s i x y e a 6 sD ”u r i n g t h e s a m e p e r i o d
r4 .
a s i n g l e P h i l a d e l p h i a h o s p i t a l t r e a t e d 3 2 6 aos fe sw h i c h w e r e f a t a l . ”
c
,
INDUSTRIAL SAFETY THROUGH STATISTICS---- C. H . YERRILL.
191
T h e r e c o m m e n d a t io n s o f th e c o m m itte e o n s ta tis tic s o f th e a sso
c ia t io n p r o v id e f o r th e a n a ly s is o f c a u s e s in g r o u p s a n d in d e t a il,
a c c o r d in g t o th e lis t o f c a u se s s u b m itte d a t th e C o lu m b u s m e e t in g
o f t h e a s s o c i a t i o n a n d p r i n t e d i n B u l l e t i 201 o .f t h e U n i t e d S t a t e s
n N
B u r e a u o f L a b o r S ta tis tics .
I n t h is a n a ly s is th e a c c id e n ts a re d is
t in g u is h e d as r e s u lt in g in d e a th , p e r m a n e n t t o t a l d is a b ility , p e r m a
n e n t p a r t i a l d i s a b i l i t y , a n d t e m p o r a r y d i s a b i l i t y , t h e l a s t c la s s b e i n g
s u b d iv id e d in to th o s e o f o n e w e e k a n d u n d e r , o v e r o n e to t w o w e e k s,
a n d o v e r tw o w eek s.
F o r e a c h ca u se a n d e a ch k in d o f d is a b ility d a y s
lo s t a s w e ll a s n u m b e r o f a c c id e n ts a re t o b e s h o w n .
S u c h a n a n a ly s is
w ill s h o w th e n u m e ric a l im p o r ta n c e a n d th e im p o r ta n c e f r o m th e
s t a n d p o in t o f s e v e r ity o f e a c h a c c id e n t ca u se , t h u s i d e n t i f y i n g th e
ca u se s m o s t u r g e n t ly c a llin g f o r c o r r e c t iv e m e a su res.
. T h e c o m m it t e e h a s r e c o m m e n d e d t h a t t h is f o r m o f a n a ly s is s h o u ld
b e m a d e f o r ea ch im p o r ta n t in d u s tr y a n d f o r e a ch im p o r t a n t in d u s tr y
grou p.
T h e c o m m itte e s u g g e s ts fu r t h e r th e a n a ly s is o f th e ca u s e s o f
fa t a litie s a n d p e r m a n e n t in ju r ie s b y lo c a tio n o f in ju r y .
A f u r t h e r a n a ly s is o f c a u se s r e c o m m e n d e d b y th e c o m m it t e e is
a c c o r d in g t o n a tu r e o f in ju r y , a n d a s p e c ia l a n a ly s is o f in fe c t e d in
ju r ie s b y n a tu r e o f i n ju r y a n d e x t e n t o f r e s u lt in g d is a b ility .
T h is
a n a ly s is o f in fe c t e d in ju r ie s d is t in g u is h e s b e tw e e n in ju r ie s r e s u lt in g
in d e a th a n d th o s e r e s u lt in g in t o t a l lo s s o r in p e r m a n e n t im p a ir m e n t
o f s p e c ifie d i m p o r t a n t m e m b e r s a n d t h o s e r e s u lt in g in t e m p o r a r y d is
a b ilit y , g i v i n g t o t h e la s t c la s s d a y s lo s t a s w e ll a s n u m b e r o f d is
a b ilit ie s .
I t is h a r d ly p o s s ib le t o o v e r s ta te th e im p o r ta n c e o f p r o m p t a n d
e f f ic ie n t f i r s t a i d t o s h o r t e n a n d m i n i m i z e t h e e f f e c t s o f a c c i d e n t s .
In
s o m e e s t a b l i s h m e n t s t h e r e c o r d s s h o w i n f e c t i o n i n m o10e pt e ra n
r
h
c e n t o f th e in ju r ie s , p e r m a n e n t d is a b ilit y a n d e v e n d e a th r e s u lt in g
f r o m in ju r ie s w h ic h , w it h o u t in fe c t io n , s h o u ld h a v e b e e n o n ly t r iv ia l.
C o n t r a s t w it h t h is “ t h e r e c o r d s o f t h e p la n t o f t h e N o r t o n C o ., a t
W o r c e s t e r , M a s s ., w h e r e f i r s t - a i d w o r k h a s b e e n i n c h a r g e o f D r . W .
I r v i n g C la r k , w h ic h s h o w th a t th e re w a s n o t a s in g le ca se o f in fe c t io n
f o l l o w i n g i n ju r y d u r in g fiv e y e a r s .”
A C C ID E N T R A T E S SIN C E 1914.
B Y D U D L E Y R. K E N N E D Y , A S S I S T A N T TO T H E P R E S ID E N T OF T H E Y O U N G S T O W N
SH EET
& TUBE CO.
I t is a lm o s t a n a x io m t h a t a p e r s o n in p r e p a r i n g a n a d d r e s s , o r a
p a p e r , a c q u ir e s m o r e l ig h t u p o n th e s u b je c t t h a n h e is a b le t o p u t
u p o n p a p e r o r c o n v e y t o a n a u d ie n c e .
I f th e fo r e g o in g sta tem en t w ere e v e r tru e, I h a v e fo u n d it so in
th is in s ta n c e .
T o m a rsh a l en ou g h h on est an d tru stw o rth y in fo r m a r
t io n so a s n o t t o im p o s e u p o n th e tim e o f e x p e r ts w it h a r a m b lin g
g e n e r a liz a t io n , w h e r e t h e l it t l e m e a t o f f a c t s is a b o u t i n p r o p o r t i o n
to th e m e a t in th e p re s e n t h ig h -p r ic e d h o te l s a n d w ic h , h a s b ee n
q u it e a ta s k .
S o m e o f y o u p e rh a p s k n o w — a n d m y g o o d fr ie n d , D r . M ee k e r,
k n o w s t o o w e ll— th a t I p e r s o n a lly h a v e b e e n a lm o s t a n u is a n c e f o r
th e la s t th r e e o r f o u r y e a r s ,.in t r y i n g t o b r in g a b o u t so m e s o r t o f
s t a n d a r d iz a t io n o f s ta tis tic s .
I h a v e h a d th e m a tte r u p a t d iffe r e n t
tim e s f o r t h e la s t f o u r y e a r s w it h t h e N a t io n a l S a f e t y C o u n c il, t h e
O h io I n d u s t r ia l C o m m is s io n , a n d m o r e f u l l y w it h th e U n it e d S ta te s
D e p a rtm e n t o f L a b o r, th ro u g h D r. R o y a l M eek er.
I n ju s t ic e t o th e B u r e a u o f L a b o r S t a t is t ic s o f th e U n it e d S ta te s
D e p a r t m e n t o f L a b o r , it m u s t b e s a id , h o w e v e r , t h a t t h e y h a v e
la b o r e d l o n g a n d e a r n e s tly in th is b e h a lf.
I n its M o n t h ly R e v ie w ,
J u ly , 191 6 , V o lu m e I I I , N o . 1, y o u w ill fin d a v e r y lu c id e x p la n a
t io n o f th e b u r e a u ’s id e a s , s h o w in g th e m a tu r e t h o u g h t e x p e n d e d
b y D r . M e e k e r a n d h is b u r e a u u p o n th e p r o b le m .
E v e n su ch r e co m
m e n d a t io n s a r e o f s m a ll v a lu e u n le s s a p p lie d , a n d i t a p p e a r s a s
t h o u g h t h e o n l y m e t h o d o f a p p l i c a t i o n w a s t h r o u g h t h is o r g a n i z a
tio n .
I f y o u w o u ld a p p o in t a c o m m itte e t o c o n f e r w it h th e U n it e d
S ta te s B u r e a u o f L a b o r S ta tis tic s a n d a g re e u p o n s o m e s ta n d a r d
o f c o m p ila t io n , a n d th e n r e v is e y o u r v a r io u s S ta te s ta tis tic a l d e p a r t
m e n ts a c c o r d in g ly , so as t o b e in h a r m o n y , it w o u ld b e in m y ju d g
m e n t t h e g r e a te s t s in g le a d v a n c e in a t r e m e n d o u s ly la r g e p r o b le m .
T h o s e o f u s w h o h a v e b e e n s e a r c h in g f o r th e fa c t s , r e g a r d le s s o f
w h e th e r o r n o t th e fa c t s w e r e p le a s in g a n d fla t t e r in g , h a v e c o n s t a n t ly
b e e n b a lk e d b y t h e a b s o lu t e la c k o f s t a t is t ic s , a n d b y s t a t is t ic s w h ic h
w e r e c a r e le s s ly p r e p a r e d , t o s a y t h e le a s t, i f n o t d e lib e r a t e ly c o m
p ile d f o r th e p u r p o s e o f fla t t e r in g th e in d iv id u a l in c h a r g e o f th e
w o r k o r th e c o n c e r n w h ic h e m p lo y e d h im .
192
ACCIDENT HATES SINCE 1014— D. R. K E N N E D Y .
193
I n a d d it io n t o a ll t h is , a g r e a t m a n y c o n c e r n s , e s p e c ia lly th e la r g e r
o f th e m , a r e t r y i n g t o k e e p r e a l s ta tis tic s , a n d a r e as a n x io u s a s i t is
p o s s ib le t o b e t o a g re e , t h r o u g h so m e m e d iu m , u p o n a s ta n d a r d w a y
o f k e e p i n g s t a t i s t i c s , i n o r d e r t h a t t h e y m a y m a k e c o m p a r i s o n w ith ,
o t h e r f a c t o r ie s in t h e s a m e o r s im ila r lin e s o f b u s in e s s , n o t a t a ll
f o r v a in g lo r io u s rea son s, b u t b eca u se th e y a re g iv in g t o a c c id e n t
p r e v e n tio n m o r e a n d m o r e im p o r t a n c e e v e r y d a y , a n d h e n ce m o r e
a n d m o r e r e a l a n a ly tic a l s tu d y .
B u t th ese co n c e r n s , in m a n y S ta te s,
a re c o m p e lle d t o k e e p th e ir r e c o r d s in a c c o r d a n c e w ith p r e s c r ib e d
r u le s o f th e S ta te a c c id e n t b o a r d o r in d u s t r ia l c o m m is s io n , a n d i f
t h e r e a r e a n y t w o S ta te s w h o s e r e q u ir e m e n t s a r e th e s a m e , n o b o d y
w it h in m y a c q u a in ta n c e h a s b e e n a d v is e d o f th e fa c t .
I t is m y m is fo r t u n e p e r h a p s t o b e b lu n t a n d s ta te th e c a s e a s I see it,
r a t h e r t h a n t o t r y t o p le a s e y o u b y t a lk o f a c o m p li m e n t a r y n a t u r e .
I h a v e r e g r e tte d a th o u s a n d tim e s th a t I c o u ld n o t b r in g t o b e a r b e
fo r e y o u t o -d a y som e c o n v in c in g lo g ic , som e fo r c e fu l a rg u m e n t
s o m e s ilv e r -t o n g u e d o r a t o r y th a t w o u ld s p u r y o u , t h r o u g h y o u r
o r g a n iz a t io n , t o so m e s u c h t a n g ib le f o r m o f p r o c e d u r e o r a c t io n a s
t o g iv e p r o m is e w it h in th e n e a r fu tu r e o f s o m e u n ifo r m it y o f a c c i
d e n t s ta tis tic s as b e tw e e n th e S ta te s.
Y o u m u s t u n d e r s t a n d t h a t t h is
c r i t ic is m is n o t d ir e c t e d a g a in s t th e p e r s o n n e l o f t h e v a r io u s b o a r d s ,
o r th e p e rs o n s w h o m th e y re p re se n t, b u t y o u c e r ta in ly m u st b e a w a re
th a t th e v a r io u s S ta te b o a r d s , a n d th e U n it e d S ta te s B u re a u o f L a b o r
S t a t is t ic s it s e lf, a r e c o n s t a n t ly s u b je c t e d t o a n a v a la n c h e o f c r it ic is m
at th e h a n d s o f th e la r g e e m p lo y e r s o f la b o r in t h is c o u n tr y , b e c a u se
o f t h e ir tr e m e n d o u s a n d c o n s ta n t d e m a n d f o r s ta tis tic s , so c a lle d ,
w h ic h m a n y , m a n y tim e s , o r in fa c t a la r g e p e r c e n t a g e o f th e tim e ,
h a v e lit t le o r n o m e a n in g o r co n s e q u e n ce ev e n a fte r th e y a re p r e
p a r e d w it h g r e a t tim e a n d e ffo r t. Y o u m u s t a ls o b e a r in m in d th a t
th e m a n o n th e jo b , w h o p r e p a r e s th e s e s ta tis tic s , is u s u a lly m u c h
m o r e in t e r e s te d t h a n t h e c le r ic a l f o r c e w h o r e c e iv e s a n d c o m p ile s
t h e m a s a p a r t o f t h e d a y ’s w o r k i n m o r e o r l e s s p e r f u n c t o r y m a n n e r .
I n o r d e r t o g e t so m e c o n c r e te a n d r e lia b le in fo r m a t io n as t o w h a t
h a s h a p p e n e d t o o u r a c c id e n t fr e q u e n c y in th is c o u n t r y , b y r e a s o n
o f th e tr e m e n d o u s in c r e a s e in p r o d u c t io n in c id e n t t o th e w a r a n d t h e
u n p r e c e d e n t e d e x p a n s io n in b u s in e s s in t h e la s t t h r e e o r f o u r y e a r s ,
I w r o te t o a lm o s t 100 o f th e la r g e r e p r e s e n ta tiv e c o n c e r n s in th e
U n it e d S ta te s , a s k in g th e m , in a c o n fid e n t ia l w a y , f o r t h e ir e x p e r i
e n ce o v e r th is p e r io d .
I p r o m is e d th e m th a t th e in fo r m a t io n th u s
o b ta in e d w o u ld b e c o m p ile d in c o m p o s it e ta b le s in s u ch a m a n n e r a s
t o p r e c lu d e th e ir id e n tity b e c o m in g k n o w n .
O n ly in t h is m a n n e r
w a s it p o s s ib le t o o b t a in t h is in f o r m a t io n , a n d a lm o s t a ll o f t h e c o n
c e r n s w h o h a v e g iv e n m e th is in fo r m a t io n h a v e th a n k e d m e f o r a p
p r o a c h in g th e m a tte r as I h a v e in d ic a t e d , b e c a u s e t h e y f e lt t h a t it
78532°— Bull. 248— 19------- 13
1M
ACCIDENT PROBLEMS.
w a s u n fa ir t o g iv e in fo r m a tio n th a t m ig h t b e c o m p a r e d a n d e o n t r a s t e d w it h s ta tis tic s th a t w e r e b a s e d u p o n e n tir e ly d iffe r e n t c o n c e p
t i o n s p e r h a p s o r d e lib e r a t e ly p a in t e d t o c o n v e y c e r t a in im p r e s s io n s .
I w is h a t th is tim e s in c e r e ly t o t h a n k a ll o f th e s e c o n c e r n s a n d th e
in d iv id u a ls w h o p r e p a r e d th e in fo r m a t io n f o r y o u r c o n s id e r a tio n ,
a n d I d e s ire t o th a n k y o u f o r h o n o r in g m e in a s k in g th a t I p r e p a r e
a p a p e r o n a s u b je c t s o in t e r e s tin g a n d v it a lly im p o r t a n t in o u r e c o
n o m ic t r a n s fo r m a t io n n o w in p ro ce s s .
W e h a v e r e d u c e d th e d a ta o b t a in e d f r o m in te r e s te d m a n u fa c t u r e r s
t o c o m p o s it e t a b le s a n d c h a r ts , w h ic h a re , a f t e r a ll, th e m o s t te rse
a n d s t r ik in g m o d e o f e x p r e s s io n , as w e ll as th e m o s t b r ie f.
T h e con
c lu s io n s r e a c h e d , a n d t h e t e n d e n c ie s a s c le a r ly s h o w n , m a y o r m a y n o t
b e p le a s in g , b u t t h e y a r e a s n e a r ly h o n e s t a n d r e lia b le as i t w a s p o s s ib le t o o b ta in .
T h e s e a r c h e r f o r f a c t s o f t e n fin d s f a c t s n o t p le a s in g .
T h e fo llo w in g co n c e r n s w e r e k in d e n o u g h t o fu r n is h th e in fo r m a
t io n re q u e s te d b y th e w r it e r , a n d I s h a ll c r a v e y o u r in d u lg e n c e in
e n u m e r a t in g t h e m f o r t h e r e a s o n o n l y t h a t t h e ir s iz e a n d im p o r t a n c e
a n d th e w e ll- k n o w n in te r e s t d is p la y e d b y th e m g iv e c o n s id e r a b le
w e ig h t t o th e c o n c lu s io n s r e a c h e d :
United States Steel Corporation.
The Bethlehem Steel Co.
The Am erican R olling M ill Co.
Republic Iron & Steel Co.
Commonwealth Steel Co.
Inland Steel Co.
T he Youngstown Sheet & Tube Co.
Am erican Steel Foundries.
W inchester Firearm Co.
Scoville M anufacturing Co.
Goodyear Tire & Rubber Co.
T h e Republic Rubber Co.
The N orfolk & W estern Railroad.
W estinghouse Co.
General Electric Co.
The New Jersey Zinc Co.
Raritan Copper W orks.
Fairbanks-M orse M anufacturing Co.
International H arvester Co.
The F ord M otor Co.
Eastman K odak Co.
Corn Products Refining Co.
Omaha Gas Co.
A ls o —
National Safety Council.
United States Bureau o f Mines.
Departm ent o f Labor and Industry o f Pennsylvania.
Industrial Commission o f W isconsin.
Industrial Commission o f Ohio.
Industrial Commission o f New York.
ACCIDENT RATES SINCE 1914— p . R. K E N N E D Y .
195
T h e s e 23 c o n c e r n s e m p l o y , a s o f J u l y 1 , 1 9 1 7 , o n e - h a l f m i l l i o n
e m p lo y e e s , a n d y o u w il l n o t ic e t h a t a lm o s t e v e r y la r g e g r o u p is
i n c lu d e d ; t h a t w e h a v e e n d e a v o re d to o b t a in th e w o r s t p o s s ib le p h a s e
o f th e s it u a t io n b y u s in g s ta tis tic s f r o m th e in d u s tr ie s a n d c o n c e r n s
w h ic h h a v e h a d th e m o st r a p id a n d p h e n o m e n a l g r o w th th r o u g h th e
d e m a n d f o r m u n it io n s p r o p e r o r f o r p r o d u c t s b r in g in g th e m m o r e o r
le s s w it h in th e n e w ly c o in e d g r o u p 4 w a r b r id e s .”
4
T h e r e h a s b e e n m u c h s p e c u la tio n , a n d a fe w s ta tis tics , m o s t ly o f
in d iv id u a l co n c e r n s , te n d in g t o s h o w a p r o p o r t io n a t e in c re a s e o f
a c c id e n ts d u e t o in c r e a s e d p r o d u c t io n . I t is in d e e d p le a s in g t o fin d
th a t t h is t e n d e n c y h a s b e e n g r e a t ly o v e r e x a g g e r a te d , a lth o u g h th e in
c r e a s e is r e g r e t t a b ly tr u e . T h e c h a r t s p r e s e n t s o m e in t e r e s t in g c o n
tra s ts a n d n o t a fe w a p p a r e n t p a r a d o x e s , w h ic h a re u s u a lly p r e s e n t
w h e n a la r g e n u m b e r o f fa c t o r s , w it h o u t a c o m m o n d e n o m in a to r , a r e
sou g h t to be com p a red .
I t is im p o s s ib le a n d s o m e w h a t m y s t if y in g t o a tte m p t t o a n a ly z e
s e v e r a l o f t h e t h i n g s w h i c h a p p e a r ; f o r i n s t a n c e , i t is t h e a l m o s t
u n iv e r s a l e x p e r ie n c e th a t a c c id e n ts s ta r te d t o in c re a s e e a r ly in 1914,
r e a c h in g th e ir p e a k in 1916 a n d r e c e d in g r a th e r s h a r p ly in t h e fir s t
h a l f o f th is y e a r, in s p it e o f th e fa c t th a t th e e m p lo y m e n t r o ll o f
t h e in d u s t r ie s i n v o l v e d is s t i ll m o u n t in g in t h e s a m e o r m o r e p r o
n o u n c e d p r o p o r t io n .
H u n d r e d s o f rea son s c o u ld b e p r o p e r ly a d
v a n c e d f o r t h is a p p a r e n t p h e n o m e n a , a n d a ll m i g h t b e a p p lic a b le
i n s p e c ific in s ta n c e s , b u t t h e m o s t p la u s ib le a n s w e r , in m y m in d , is
th e f a c t th a t n o t u n t il s o m e tim e in 1916 h a d t h is tr e m e n d o u s in
c r e a s e o f p r o d u c t i o n b e e n e ffic ie n t ly o r g a n i z e d .
W h e n a d d it io n s
b e g a n t o s p r in g u p lik e m u s h r o o m s o v e r n ig h t , w h e n n e w m e n b e g a n
a r r i v i n g l it e r a l l y b y t r a in lo a d s , w h o w e r e m o r e o r le s s u n f a m il i a r
w it h th e n e w t y p e o f e m p lo y m e n t, lu r e d o n b y w a g e s in m a n y ca ses
b e y o n d t h e ir w ild e s t d r e a m s , w h e n s a fe t y d e p a r tm e n ts w e r e a b s o
lu t e ly lo s t in th e m a z e o f n e w c o n s t r u c t io n a n d d o u b le d o r t r e b le d
p r o d u c t io n , i t w a s n o t s u r p r is in g t h a t th e a c c id e n t r a te s h o u ld m o u n t
r a p i d l y a n d s t e a d ily .
T h a t th e 4n ew m a n ” p r o b le m h a d m u ch t o d o
4
w it h th e s it u a t io n is v e r y g r a p h ic a lly s h o w n in v o lu m e 4, N o . 2
o f th e B u lle t in o f th e P e n n s y lv a n ia D e p a r t m e n t o f L a b o r , b y a c h a r t
o f th e C a m b r ia S te e l C o ., s h o w in g th a t th e lia b ilit y t o in ju r y o f th e
m a n o f le s s t h a n 8 0 d a y s ’ e m p lo y m e n t w a s 6 t o 1 as a g a in s t a m a n
o f BO o r m o r e d a y s ’ e x p e r i e n c e . M a n y p e r s o n s h a v e t a k e n t h e m a n u
fa c t u r e r s s e v e r e ly t o ta s k f o r s o -c a lle d 4 s p e e d in g -u p ” m e a su res s u p
4
p o s e d t o h a v e b e e n e m p lo y e d , b u t in m y h u m b le o p in io n m o s t o f th e
4 s p e e d in g u p ” h a s b e e n e n tir e ly v o lu n t a r y , b e ca u se th e b a it o f w a r
4
t im e w a g e s h u n g c o n t in u o u s ly in fr o n t o f th e w o r k e r ’s e y e s a s th e
t e m p t in g fe e d h a n g s b e f o r e th e h o r s e in th e t r e a d m ill.
196
ACCIDENT PROBLEMS.
I t is in d e e d r e g r e t t a b le t h a t s o m e s t a n d a r d o f c o m p u t a t io n f o r
th e s e s ta tis tic s s h o u ld h a v e b e e n la c k in g f o r th e la s t th r e e y e a r s , b e
c a u s e m o r e in fo r m a t io n c o u ld h a v e b e e n m a d e a v a ila b le th a n w a s
e v e r p o s s ib le b e f o r e o r m a y b e a g a in in th e fu t u r e . I t w a s n e c e s s a r y
to le a v e o u t o f d iffe r e n t c h a r ts m a n y c o m p a n ie s w h o fu r n is h e d v a lu
a b le in fo r m a t io n , s im p ly b e c a u s e t h e ir s ta tis tic s a b s o lu t e ly c o u ld n o t
b e c o n tr a s te d th r o u g h th e ir la c k o f a c o m m o n d e n o m in a to r . I t w a s
im p o s s ib le , o f c o u r s e , t o c o n tr a s t t w o c o n c e r n s w h e r e th e d a ta o f o n e
is in t e r m s o f a c c id e n t s , a n d o f t h e o t h e r in t e r m s o f d a y s lo s t f r o m
a c cid e n ts . E v e n w h e r e th e d a ta o f th e t w o c o n c e r n s w e r e f o r a c c i
d e n ts , th e d e fin itio n o f a c c id e n t it s e lf w a s a p p a r e n t ly n o t th e sa m e, as
o n e m ig h t k e e p a ll a c c id e n ts , e x c lu d in g m in o r a c c id e n ts n o t r e p o r t a b le t o sa m e c o m m is s io n , w h ile th e o th e r f o r its o w n in fo r m a t io n r e
c o r d e d e v e r y a c c id e n t, e v e n t h o u g h it b e a m e r e s c r a tc h .
I t is r e a lly d e p lo r a b le t h a t s u c h a m a s s o f in f o r m a t io n a s w a s
o ffe r e d f o r th is p u r p o s e s h o u ld b e s u s c e p tib le o f s u c h lit t le c o m p a r a
t i v e v a lu e .
A f t e r t r y in g t o a d a p t e v e r y r e c o g n iz e d s ta n d a r d o f c o m p a r is o n , w e
fo u n d th a t th e o n ly m e th o d a d a p ta b le f o r e n o u g h c o n c e r n s to m a k e a
r e p r e s e n ta tiv e s h o w in g w a s t o r e d u c e it t o te r m s o f a c c id e n ts p e r
1 0 0 e m p lo y e e s , u s in g th e y e a r s 1 9 1 4 ,1 9 1 5 , 191 6 , a n d 191 7 . O f c o u r s e
w e h a d o n l y o n e -h a lf o f 1 9 1 7 a v a ila b le , b u t w e m u lt ip lie d th e fig u r e s
f o r th e fir s t h a l f o f 1917 b y t w o , a ft e r ju s t if y i n g th e s a m e in a m a n
n e r w h ic h I s h a ll la te r s h o w y o u u p o n a c h a r t.
Y o u u n d e r s ta n d , o f co u rs e , th a t I h o ld n o b r ie f f o r th is t y p e o f
s ta tis tic s , b u t u n t il th e g o o d L o r d in H i s w is d o m (a n d in c id e n t a lly
y o u g e n tle m e n in y o u r s ) p e r m it s u s t o h a v e s o m e t h in g m o r e d e fin ite
a n d m o r e t a n g ib le , w e m u s t a ll b e s a tis fie d w it h th e b e s t t h a t is
a v a ila b le .
I s h a ll n o w p r o c e e d t o th e s h o w in g o f th e c h a r ts w h ic h I h a v e
h ere.
C h a r t N o . 1 s h o w s th e a c c id e n t fr e q u e n c y ra te s p e r 100 e m p lo y e e s
f o r s e v e n la r g e ir o n a n d s te e l p la n t s , a n d f o r n in e o t h e r p la n t s m a n u
fa c t u r in g v a r io u s p r o d u c ts .
T h e ra tes c o v e r th e y e a rs 1914, 1915,
1916, a n d 1917.
T h e t o p lin e is th e c u r v e f o r th e ir o n a n d ste e
p l a n t s ; t h e b o t t o m lin e is t h e c u r v e f o r t h e o t h e r p la n t s .
T h e ir o n a n d ste e l p la n t s w h ic h fu r n is h e d th e c o m p a r a b le s ta tis tic s
w h ic h m a k e u p th e c o m p o s it e fig u r e s f o r t h is c h a r t a r e as f o l l o w s :
Th e Commonwealth Steel Co.
Am erican R olling M ill Co.
Am erican Steel Foundries.
Republic Iron and Steel Co.
Inland Steel Co.
A subsidiary plant o f the United States Steel Corporation.
The Youngstown Sheet and Tube Co.
ACCIDENT BATES SINCE 1014— D. E. K EN N ED Y .
A
c c i d e n tR a t e s P e r
1 0 0 Em p l o y e e .s
1 9 1 4 -1 9 1 7
- - - - - - - - - - 7 I r o n& S t e e lP l a n t s
- - - - - - - - - -9 Ot h e r P l a n t s
NO. 1
19?
ACCIDENT PROBLEMS*
198
F r o m th e r e p o r ts o f th e f o r e g o in g c o m p a n ie s , th e f o l l o w i n g fig u re s
w ere c o m p ile d :
Year.
1914.............................
1915.............................
1916..............................
19171...........................
Number Number Rate per
em
100ployed. injured.
24,802
26,740
37,049
45,945
7,445
8,157
12,951
13,104
30-0
34.2
34.9
28.5
1Data for the first half of 1917 were multiplied by 2 in computing rate for this year.
T h e f o l l o w i n g c o m p a n ie s fu r n is h e d c o m p a r a b le d a t a w h ic h is p r e
se n te d in th e c h a r t :
Th e Ford M otor Co., automobiles.
lEastman K odak Co., cameras.
^Raritan Copper W orks, copper products.
W inchester Firearm Co., arms, ammunition.
G oodyear T ire and Rubber Co., rubber products.
The Republic Rubber Co., rubber products.
-Omaha Gas Co., public utility.
Scoville M anufacturing Co., maclaine tools, etc.
International Harvester Co., farm implements.
Fairbanks-M orse M anufacturing Co., scales.
Year.
1914.............................
1915.............................
1916..............................
19171...........................
Number Number Rate per
em
100.
ployed. injured.
58,240
71,005
95.902
136,999
13,124
20,789
31,635
29,315
22.5
29.2
32.9
21.3
1 Data for the first half of 1917 were multiplied by 2 in computing rate for this year.
T h e c h a r t s h o w s in b o t h g r o u p s th a t th e r e w a s a n in c r e a s e in
th e a c c id e n t -fr e q u e n c y r a te in 1915, a n d th a t it r e a ch e d it s p e a k in
1916. I n 1917 th e ra te h a s g o n e d o w n . T h e r e p o r t s r e c e iv e d s h o w
t h a t th is t e n d e n c y h a s b e e n th e c o m m o n e x p e r ie n c e in n e a r ly e v e r y
p la n t .
O n e o r t w o p la n ts r e p o r t a d r o p in 1916.
N o n e o f th e 2
c o m p a n ie s s h o w s a n in c r e a s e in 1917.
C h a r t N o . 2, t h o u g h a p p a r e n tly c o m p lic a te d , m e r e ly s h o w s th e
i n d i v i d u a l a c c i d e n t r^ite c u r v e o f e a c h o f t h e s e v e n i r o n a n d s t e e l
p la n t s w h ic h fu r n is h e d th e d a ta f o r th e c o m p o s ite c u r v e in C h a r t
N o . 1. T h e r a t e s a r e g i v e n i n t e r m s o f s o m a n y a c c i d e n t s p e r 1 0 0
e m p lo y e e s .
T h e c o m p a n y fu r n is h in g th e s ta tis tic s f o r th e t o p lin e
in th is c h a r t in c lu d e d e v e r y a c c id e n t, w h ile th e o th e r s s h o w e d o n l y
o ff-t im e a c c id e n ts .
T h e d o t t e d c u r v e is t h e a v e r a g e r a t e f o r a ll s e v e n c o m p a n ie s .
T h is c h a r t fu r t h e r d e m o n s tr a te s th e u p w a r d te n d e n c y o f a c c id e n t
r a te s in 1915 a n d 191 6 , a n d t h e ir d o w n w a r d tr e n d in 1917.
ACCIDENT KATES SINCE 1914— D. R. K E N N E D Y .
A
c c id e n t
R
r t c s
P
e r
1 0 0 E
7 Ir o n i S t e e l P l a n t s .
/ $ / 4 -I3 l7
NO. 2
199
m plo ye e s
.
200
ACCIDENT PROBLEMS.
I n o r d e r t o a r r iv e at th e to ta l a c c id e n t fig u r e s f o r th e y e a r 1917,
w h ic h w a s n e ce s s a r y to fu r n is h c o m p a r a b le s ta tis tics w it h th e fig
u re s f o r th e p r e c e d in g y e a rs , s o m e m e th o d h a d t o b e d e v is e d t h a t
c o u ld b e ta k e n as a f a i r b a s is f o r a p p r o x im a t in g th e fig u r e s f o r th e
la s t s ix m o n t h s o f th is y e a r , b a s e d u p o n d a t a o f th e fir s t h a l f o f th e
yea r.
T h e s ta tis tic s o f th e c o m p a n ie s , w h o h a d g iv e n th e m t o u s
in a m o n t h ly s u m m a r y , w e r e c a r e f u l l y s t u d ie d . A s a r e s u lt o f t h is
c o n c lu s io n , w e b e c a m e c o n v in c e d th a t it w o u ld b e r e a s o n a b le t o m u l
t i p l y t h e fig u r e s f o r th e fir s t h a l f o f t h e y e a r b y t w o t o a r r iv e a t
t h e y e a r ’s fig u r e s .
T h e r e c o r d s s h o w e d th a t th e r a te f o r th e fir s t
s ix m o n th s o f e v e r y y e a r w a s h ig h e r th a n f o r th e la s t s ix m o n th s.
A n d as t o th e a c tu a l n u m b e r o f a c cid e n ts , r e g a r d le s s o f th e n u m b e r
e m p l o y e d , w e fin d t h a t th e r e w e r e m o r e a c c id e n t s d u r i n g t h e fir s t
s ix m o n th s th a n d u r in g th e la s t s ix m o n th s , sa v e in 1915.
A sta te m e n t fr o m S . H . S la y m a k e r , w h o fu r n is h e d th e a c c id e n t
s t a t is t ic s f o r t h e F a ir b a n k s - M o r s e C o ., a ls o b e a r s m e o u t in t h is c o n
c lu s io n : “ W e h a v e fo u n d in o u r p a s t e x p e r ie n c e t h a t t h e la te w in t e r
a n d e a r ly s p r in g m o n th s a re a lw a y s c o n d u c iv e to h ig h -a c c id e n t
a v e ra g e s, w h e re a s th e m o n th s o f J u n e , J u ly , A u g u s t, S e p te m b e r, a n d
O c t o b e r i n v a r i a b l y s h o w a m a r k e d d e c r e a s e .”
T h e f o l l o w i n g s u m m a r y s h o w s th e fig u r e s fr o m w h ic h C h a r t N o .
3 w as m ade up.
T h e s e a re th e h a lf-y e a r ly a c c id e n t r e c o r d s o f th e
fo llo w in g co n c e r n s :
.
Am erican R olling Mill Co.
G oodyear T ire and Rubber Co.
T h e New Jersey Zinc Co.
The International Harvester Co.
The Youngstown Sheet & Tube Co.
Period.
January to June...................
July to December................
1914
1915
1916
1917
9,282
6,791
8,859
13,285
13,199
12,093
13,437
I n v ie w o f th e c o m m o n e x p e r ie n c e o f e v e r y o n e th a t I h a v e a p
p r o a c h e d u p o n t h is p o in t , I b e lie v e t h a t t h is m e t h o d w i l l a id u s i n
a r r i v i n g a t v e r y n e a r ly t h e c o r r e c t r e s u lt . A t le a s t w e c a n b e r e a
s o n a b ly c e r ta in th a t th e a c c id e n t fr e q u e n c y r a te f o r th e la s t s ix
m o n th s o f 1 9 1 7 w ill n o t b e a n y g r e a t e r th a n f o r th e fir s t s ix m o n th s .
T h e a c cid e n t e x p e r ie n c e o f th e Y o u n g s t o w n S h ee t & T u b e C o . f o r
th e la s t f o u r y e a r s h a s b e e n s im ila r t o th a t o f th e o th e r ir o
a n d ste e l p la n t s s tu d ie d . C h a r t N o . 4 s h o w s th e r a te o f o ff-t im e a c c i
d e n ts p e r 100 e m p lo y e e s s in c e 1 9 1 3 , a n d a ls o th e a v e r a g e n u m b e r o f
d a y s o f f f o r e a ch o ff-t im e a c cid e n t.
ACCIDENT RATES SINCE 1914-----D. E. K E N N E D Y .
A
c c id e n t
R
r t e s
201
.
B Y % Y a * s m -® i7 .
9 Z8Z
679 /
1914
6859
1915
13285
NQ
5
15199
1916
/2093
/ 34 S7
1917
202
T
ACCIDENT PROBLEMS.
h e
Yo
u n g s t o w n
S
h e e t
& T
u b e
Mc c w c n t R a t e s .
/9 /3 -/9 /Z
C Z1 B
■
2&
s>
I2.t
1915
ate
P e r ID D E m p l o y e e s .
i f\\iQ .D R Y S L o
33./ /3.4
30.2
s t
1.3
2
1914
P e r R e e id e h t
■
$.e J4.»
7
1915
N o.
4
C
o
.
ACCIDENT RATES SINCE 1&L4— D. R. K E N N E D Y .
gQ3
Tshese rates and averages are as follows:
1913
_
Rate of accidents per 100 employees_
Average amaaber of <&ys Jgst.................
1914
28.9
12.8
33.1 ’ 30.2
12.3
.13-4
1915 5 1916 5 1917
37.6
14.9
28.8
13.3
The original statistics which furnished the basis for these rates ar3
as follows:
1913
Number employed.......................
Number of off-time accidents.......
Number of days lost.....................
1914
5,648
7,963
2,302
1,690
29,432 < 22,715
1915
1916
6,500
1,804
22,300
8,000
2,669
39,256
•97
11
■10,500 '
2,732
36,472 !
These statistics also show the importance of the “ new m an ”
problems. The increase in the number employed has been—
1914 to 1915___________________________________________________
852
1915 to 1916___________________________________________________ 1, 500
1916 to 1917___________________________________________________ 2, 500
Rates of accidents per 100 men employed for the first six months
in 1915, 1916, and 1917 give additional emphasis to my point, that
accidents have decreased in 1917- These rates include all accidents
and not merely off-time injuries.
Year.
Jan.
Feb. ’ Mar.
1915...........
1916...........
1917...........
17.9
28.0
17.0
21.0
23.6
15.5
Apr.
May.
June.
22.8
25.3
27.7
25.7
18.3 : 17.3
23.7
24.0
19.5
24.1
21.3
18.2
These figures, compiled from the accident statistics of the Youngs
town Sheet & Tube Co., I believe are a true representation of condi
tions in the iron and steel industry, and the tendency of the curves, as
shown in Chart No. 5, also represent qnite accurately the experience
of the other manufacturing establishments furnishing data for this
study.
Chart No. 6 shows the actual number of off-time accidents by years,
also the number of working-days lost on account of accidents, and the
average yearly number of employees. These figures were furnished
by the following seven plants, which furnished us the information in
the form needed:
The Commonwealth Steel Co.
Am erican Steel Foundries.
The Youngstown Sheet & Tube Co.
A subsidiary o f the United States Steel Corporation.
Fairbanks-M orse M anufacturing Co.
Corn Products Refining Co.
The Republic Rubber Co.
204
T
h e
ACCIDENT PBOBLEMS.
Yo
u n g s t o w n
S
h e e t
& T
u b e
C
o
.
R C C ID C N T R k t e s .
PER
100
EM PLOYEES
I S I S ...............
/ s / e-----%
/ 9 I 7 ------------
J A N .
F E B .
M
A R
N O . 5
( A P R .
M U N E
J A Y .
205
ACCIDENT RATES SINCE 1914— D. E. KENNEDY.
D
f f
Ti m
e
—
A
c c id e n t s
191+
s L
R c c id e n t s
fZ ~ ~ D
l
■
& D m
■
m
s
L d s t
E m ployees
1515
1016
1917
o s t
.
206
ACCIDENT PROBLEMS.
The statistics are as follows :
1914
Total off-time accidents.......
Total days lost.....................
Total employed...................
1915
1916
1917
9,309
59,881
20,497
10,325
55,956
?1,095
16,734
122,401
28,605
17,622
116,060
87,368
The foregoing figures further support the facts already presented,
showing the tendency in industrial accident rates since 1914. All evi
dence thus far has shown that the peak was reached in 1916. Whether
or not accident rates will continue to fall off as they have done in
1917 is hard to state, and as these charts have been prepared to show
existing facts nothing by way o f prophecy has been attempted.
The purpose o f Chart No. 7 is to present some facts concerning
the severity o f work accidents during the period under study. The
data for this study have been taken from the accident experience of
the following concerns:
A subsidiary o f the United States Steel Corporation.
Am erican Steel Foundries.
Fairbanks-M orse M anufacturing Co.
Corn Products Refining Co.
The Youngstown Sheet & Tube C q.
The Republic Rubber Co.
Commonwealth Steel Co.
The total number of working-days lost was divided by the total
number of off-time accidents. This gave the average length of time
lost for one off-time accident, which furnishes a basis for comparison.
These averages were as follows: 1914, 6.4 days; 1915, 5.4 days; 1916,
7.3 days; and 1917, 6.5 days.
These figures show that the severity of accidents in 1917 has de
creased, when compared to those of 1916.
ACCIDENT BATES SINCE 1914— D. B. KENNEDY.
A
v e r s e
O
H
f f
a y s
L o s s Fo
Wm
R
c c id e n t
.
7
m
e
r
.
O
n e
207
D IS C U S S IO N .
Mr. K i n g s t o n . Are you calling everything an accident? Some
people refer to a mere scratch as an accident.
Mr. K e n n e d y . These are all lost-time accidents, not scratches.
Dr. R t j b i n o w . May I ask what method you used in obtaining the
average number of employees ?
Mr. K e n n e d y . I had to take what they gave me. I wrote to these
concerns personally and asked them to give me their average for the
year. How they obtained it, I don’t know.
D r . R t j b i n o w . M y e x p e r i e n c ies t h a t t h e a v e r a g e n u m b e r o f e m
p lo y e e s fr e q u e n t ly v a r ie s , a n d th a t m e a n s th a t th ese ra te s w o u ld h a v e
t o b e ta k e n w it h a g r e a t d e a l o f c a u tio n .
Mr. K i n g s t o n . Would there be a possibility, by reason of your
getting the information so soon after the 1st of July, that there are a
number o f unreported accidents ?
M r . K en n ed y. M o s t o f th e se c o n c e r n s k e e p th e m u p t o w ith in a
m o n th — k e e p th e m u p to w it h in th e 1 5 th o f th e m o n t h fo llo w in g .
T h e y a re k e p t p r e tty w e ll u p to d a te.
I h a v e n ’t t a k e n a n y c o n c e r n
t h a t I w a s n ’t p r e t t y f a m i l i a r w it h . I s i m p ly w is h t o s a y t h a
I h a v e g o n e i n t o t h is n o t f o r m y o w n b e n e fit b u t f o r a ll w h o a r e i n
te r e s te d , a n d y o u m e n w h o a r e in it a ll th e tim e m u s t r e a liz e th a t w e
a re w o e f u l l y o ff as t o s ta n d a r d iz a t io n .
O f 1 0 0 c o n c e r n s t h a t I A vrote
t o w h o w e r e d o i n g th e m o s t a lo n g t h is lin e , a lt h o u g h t h e y s e n t c o n fi
d e n tia l in fo r m a t io n , th e re w e r e o n ly 23 w h o r e p lie d w h o s e in fo r m a
t io n w a s a t a ll u s e fu l, a n d o n ly a b o u t 17 o r 18 sen t in f o r m a t io n w h ic h
w a s r e d u c ib le in e v e n t h is b r o a d w a y in t o a n y s ta tis tic s w o r t h
s h o w in g .
The C h a i r m a n . The reason why the statistics issued by the differ
ent State bureaus and commissions and the United States Bureau of
Labor Statistics are rather slow in coming out has been explained
by Mr. Kennedy. It takes time to evolve statistics. O f course, the
United States Bureau of Labor Statistics couldn’t get out this kind
of a statistical statement. It wouldn’t be worth while. It is worth
while for Mr. Kennedy to get it out for our benefit as a rough first
trial at getting at what is happening in our industries. I was
strongly suspicious that the experience of the United States Steel
Corporation was not the general experience. I was convinced that
their accident rate was tending downward. Their trend began, if I
remember it correctly, in 1916. About the middle o f the year it be
gan to go down, and went down and down and down, ajid from all
208
ACCIDENT PROBLEMS-----DISCUSSION.
209
th e in fo r m a t io n I c o u ld g e t fr o m t a lk in g w it h p e o p le w h o k n o w a n d
f r o m o b s e r v a t io n in in d u s t r y , I f e l t th a t th a t w a s n o t th e t y p ic a l e x
p e r ie n c e .
I f e lt t h a t th e a c c id e n t r a te w a s a v e r y s e r io u s p r o b le m ,
in d e e d , a n d w a s n o t g r o w i n g b e t t e r .
I th in k M r . K e n n e d y h a s s h o w n
th a t * i n t h e p l a n t s f r o m w h i c h h e g o t r e t u r n s c o n d i t i o n s a r e v e r y
c o m m e n d a b le .
B u t th e p la n t s th a t a r e h a v in g b a d e x p e r ie n c e a n d
t h a t a r e n o t b e t t e r i n g t h e i r a c c i d e n t r a t e s d o n ’t r e p o r t .
I th in k y o u
w o u ld a g re e w it h th a t, M r. K e n n e d y .
M r . K e n n e d y . T h a t s ta te m e n t y o u m a d e is tr u e , a n d t h e r e f o r e I
c o u l d n ’t g e t a n y s t a t i s t i c s f r o m s u c h p l a n t s b e c a u s e t h e y d o n ’ t e v e n
r e p o r t t o y o u r b u r e a u , le t a lo n e a n in d iv id u a l.
Mr. E. H. D o w n e y , special deputy, Insurance Department of Penn
sylvania. I was extremely glad to hear what Mr. Kennedy said in
regard to the abominable condition of statistics in this country.
Everything that he said was not only merited, but a good deal more
severe criticism was merited. Even though we recognize that he
doesn’t have an accurate comparison and a complete basis of com
parison, it is really indicative of what the actual complete figures
would show if we could get them from the plants. I want to say
incidentally that the bituminous coal mine industry in 1916 showed
a decrease in the fatality rate and a very considerable increase in the
production o f coal; there was a much larger production, with the
lowest fatality rate in the history o f the State. So that the increase
o f accidents in 1916 from the general experience o f the country was
not the universal experience. Supplementing what Mr. Kennedy
said in regard to lack o f any standard basis of comparison, I know
from experience that it is a good deal easier to lay plans for the
statisticians than it is to induce the States to make any practical use
o f anything that has been suggested. There are few of the States
which have workmen’s compensation acts that have made any at
tempt to compile any kind of statistics, good, bad, or indifferent.
There are very few o f the States that are willing to spend enough
money to hire even one man who knows the difference between sta
tistics and bunk.
I was in the State o f Wisconsin and made an attempt to obtain
figures from a small number o f employers. I succeeded in obtaining
from 25 employers a report of the number of man-hours for which
they paid. There are a number of operators who can give the num
ber o f men who draw pay each pay day, as, o f course, they all have
pay-roll records. They do not know the number of days each man
worked, unless such men were company men, and they do not know
the number of hours that they actually worked each day. There are
few establishments o f any kind which have those records unless the
men are paid by the hour, and then it is quite a job to get up the
78532°— Bull. 248— 19------- 14
ACCIDENT PROBLEMS.
n u m b e r o f a ctu a l h o u rs th a t a re p a id fo r . A n d th e re a re v e r y fe w
e m p lo y e r s w h o f o r th e sa k e o f s ta tis tic s w ill g o t o th e t r o u b le o f
g e t t in g u p th e n u m b e r o f m a n -h o u r s , b u t in e v e r y ju r is d ic t io n w h e re
t h e r e is a w o r k m e n ’s c o m p e n s a t i o n l a w t h e p a y - r o l l p a r t c a n b e
o b ta in e d .
I t is a ls o p o s s ib le t o o b t a in a p r e t t y g o o d i n d i c a t i o n o f
th e a v e r a g e w a g e s o f e a c h in d u s t r y f r o m th e a c c id e n t s ta tis tic s in
e v e r y c o m p e n s a t io n ju r is d ic t io n , b e c a u s e th e a v e r a g e w e e k ly w a g e
m u s t b e d e t e r m in e d i n t h e f ix a t io n o f c o m p e n s a t io n . I t is p o s s ib le ,
f r o m t h a t b a s is , t o o b t a in th e a v e r a g e n u m b e r o f m e n e m p lo y e d , a n d
t h a t is th e o n l y b a s is u p o n w h ic h w e c o u ld a r r iv e a t a n y a p p r o x im a t e
e s tim a te o f th e n u m b e r o f fu ll - t i m e w o r k e r s in a n y ju r i s d ic t io n in
t h is c o u n t r y , s o f a r as I k n o w .
D r . C h an ey. I w a n t t o sa y o n e w o r d a b o u t th e u se o f a v e ra g e d a y s
l o s t f r o m t i m e - o f f a c c id e n t s . M y o w n e x p e r ie n c e is t h a t t h is is a b s o
l u t e l y m i s l e a d i n g u n l e s s t a k e n w i t h s o m e t h i n g e ls e , a n d t h a t i t w i l l n o t
d o t o d r a w a n y c o n c lu s io n s f r o m it. T h r o u g h o u t t h e e x p e r ie n c e o f a
la r g e c o m p a n y th e a v e r a g e lo s s p e r a c c id e n t s t e a d ily in c r e a s e d d u r
i n g th e w h o le tim e w h e n t h e ir a v e r a g e fr e q u e n c y r a te w a s d e c lin in g .
I f y o u w e n t o n th e b a s is o f th e a v e r a g e lo s s p e r a c c id e n t , y o u w o u ld
t h in k t h e y w e r e g e t t in g w o r s e a n a w o r s e ; i f y o u w e n t o n th e b a s is
o f th e ir fr e q u e n c y fr o m y e a r to y e a r, it w o u ld a p p e a r th a t th e y w e re
g e t t in g b e tte r — th e p o in t b e in g t h a t th e fir s t a c c id e n ts t o d is a p p e a r
a re th o s e o f s h o r t d is a b ility , a n d w h e n y o u c u t th o s e o u t a n d le a v e
t h e l o n g d i s a b i l i t y t h e a v e r a g e d i s a b i l i t y r is e s . T h a t i s t h e t e n d e n c y
a lw a y s . I n m a n y c a s e s , a n d I t h in k in a ll c a s e s , it is a n u n s a fe in d e x
a s t o w h a t is o c c u r r in g .
O n t h e p o i n t r a is e d b y M r . D o w n e y , so f a r a s t h e i r o n a n d ste e l
i n d u s t r y is c o n c e r n e d , t h e fig u r e s g a t h e r e d b y t h e B u r e a u o f L a b o r
S t a t is t ic s r e p r e s e n te d a t le a s t 80 p e r c e n t o f th e w o r k e r s in ir o n a n d
s te e l e s t a b lis h m e n t s , a n d w h o s e t im e w a s r e c o r d e d b y h o u r s . I w a s
c e r t a in ly s u r p r is e d t o fin d h o w la r g e a n u m b e r o f m a n u fa c t u r e r s in
o t h e r lin e s d id t h e sa m e t h in g . O f s o m e 2 0 0 m a n u fa c t u r e r s o f m a
c h in e r y 175 h a d r e c o r d s o f tim e w o r k e d b y h o u rs . T h e p la c e w h e r e
I c o u l d n ’t f i n d t h e r e c o r d b y h o u r s w a s i n W i s c o n s i n .
M r . K in g s t o n . I w a n t t o s a y t h a t I d o n o t t h i n k w e s h o u l d r u n
th e r is k o f d e c e iv in g o u r s e lv e s . I t is a f a i r i n f e r e n c e t o b e d r a w n
f r o m M r . K e n n e d y ’s c h a r t a n d fig u r e s th a t a c c id e n ts o n th e w h o le
a re o n th e d o w n w a r d g r a d e in fr e q u e n c y f o r th e fir s t h a l f o f th e
y e a r 1 9 17. T h is , h o w e v e r , is n o t in a c c o r d w it h o u r e x p e r ie n c e in
O n ta r io .
I t h in k M r . D e a n w ill a g r e e w it h m e in t h a t sta te m e n t,
th a t th e c o m p e n s a b le in ju r ie s in th e a g g r e g a te a re n o t o n th e d e
crea se.
I s u p p o s e in t h is lis t M r . K e n n e d y h a s p r o b a b ly in c lu d e d
t h e 1 7 o r 18 fir m s w h o a r e d o i n g m o s t f o r a c c i d e n t p r e v e n t io n a n d
m o s t fir s t -a id w o r k t o m in im iz e th e s e v e r ity o f a c c id e n ts .
Y ou add
ACCIDENT PROBLEMS— DISCUSSION.
211
th o se 17 to th e su m to ta l o f a ll th e o th e rs a n d ta k e th e a v e ra g e , a n d
i t i s m y g u e s s t h a t t h e l i n e f o r 1 9 1 7 is n o t g o i n g t o b e a r d o w n w a r d .
I r a th e r t h in k th e te n d e n c y w o u ld b e u p w a r d .
M r . D ean . T h e e x p e r i e n c e i n O n t a r i o f o r t h e f i r s t s e v e n m o n t h s
o f th e y e a r 191 7 is k e e p in g a b o u t e v e n , w it h th e sa m e fir m s r e p o r t in g ,
as th e t o t a l e x p e r ie n c e f o r th e y e a r 1915 a n d o v e r th r e e -q u a r te r s o f
th e y e a r 1916. I m e r e ly s u g g e s t th e fa c t th a t p e rh a p s a g o o d b it o f
t h e in c r e a s e in t h e r a te is d u e t o th e c h a n g e o f c h a r a c t e r o f th e w o r k
i n g p o p u la t io n , a n d I v e n tu r e t o s a y th a t in th e n e x t h a lf o f 1 9 1 7
y o u w il l see a t r e m e n d o u s in c r e a s e in th e a c c id e n t s r e p o r t e d in t h e
U n it e d S ta te s, s im p ly b e ca u se o f th e c h a n g e d c h a r a c te r o f th e w o r k
in g p o p u la t io n .
D r . R u b in o w . T h e n u m b e r o f e m p l o y e e s g i v e n i n 1 9 1 7 , i n J u l y ,
i s n ’t c h a r a c t e r i s t i c o f t h e n u m b e r o f a v e r a g e e m p l o y e e s .
T h e fig
u r e s o f J u ly 1, 1 9 1 7 , r e p r e s e n t t h e m a x im u m n u m b e r o f e m p lo y e e s ,
a n d th e p la n ts h a v e n o t b e e n g iv e n th e o p p o r t u n it y o f fig u r in g o u t
th e a v e r a g e n u m b e r o f e m p lo y e e s ; a n d e v e n i f th e y d id , I w o u ld b e
a l it t le s u s p ic io u s o f th e fig u r e s . T h e fig u r e s g iv e n as o f J u ly 1 ,1 9 1 7 ,
a r e n o t g iv e n as c o n s t it u t in g a n y b a s is o f c o m p a r is o n .
M r . K en n ed y. I t h in k a ll th e c r it ic is m is w e ll t a k e n .
I sta rted
o u t b y e x p la in in g th a t th e ch a rts w e re ju s t w h a t th e y w e r e a n d th e
b e s t I c o u ld ge t.
T h e y a re w o r t h y o f a ll th e c r it ic is m a n d m o r e
th a n h a s b e e n g iv e n .
T h e C h a ir m a n . M r . K e n n e d y p r e p a r e d t h is a t m y s p e c i a l r e q u e s t .
I f e l t t h a t w e d i d n ’t k n o w m u c h a b o u t w h a t w a s a c t u a l l y h a p p e n i n g ,
a n d I k n e w it w o u ld b e a lo n g w h ile b e fo r e th e B u re a u o f L a b o r
S ta tis tics c o u ld g e t a c cu ra te d a ta .
I w a n te d t o g e t a t th e tr e n d
f r o m su ch d a ta as c o u ld b e o b ta in e d , a n d I a m p e r s o n a lly v e r y g r a t e
fu l to M r. K en n e d y .
H e to o k u p a n e x tr e m e ly h a z a r d o u s o c c u p a
t io n , a n d h e h a s e s c a p e d r e m a r k a b ly w e ll.
I d o n ’t t h i n k h e h a s s u s
ta in e d a c o m p e n s a b le in ju r y .
I w a n t t o s u g g e s t th a t w e lis t e n t o M r .
P r i c e ’ s e x c e lle n t p a p e r n o w , a n d b e g in a t 9 o ’c lo c k t o -m o r r o w m o r n
in g , a s p e r s c h e d u le , a n d g e t t h r o u g h w it h o u r b u s in e s s m e e t in g .
W e
h a v e r e a l b u s in e s s t o tr a n s a c t. I w o u ld s u g g e s t t h a t y o u r e a d th e b i ll
th a t h a s b e e n p r e p a r e d f o r p r e s e n ta tio n in C o n g r e s s , p r o v id in g c o m
p e n s a t io n a n d in s u r a n c e f o r th e s o ld ie r s a n d s a ilo r s o f th e U n it e d
S ta te s.
C o p ie s m a y b e o b t a in e d h e r e a t th e d e s k ; a ls o c o m m u n ic a
tio n s a n d so m e o f th e h e a r in g s th a t h a v e b e e n h e ld o n th a t b ill.
T hey
a re c o n ta in e d in a p a m p h le t.
I t h i n k i t is h i g h l y i m p o r t a n t t h a t t h i s
b o d y t a k e s o m e s t a n d o n t h a t q u e s tio n .
D o n ’t f o r g e t t h a t w a r is
m e r e ly s p e c ia liz e d in d u s tr y .
A n e w o c c u p a t io n h a s s p r u n g u p — th e
o c c u p a t io n o f k i ll i n g a n d d is a b lin g as m a n y G e r m a n s as p o s s ib le
w i t h a s s m a l l a c a s u a l t y l is t o n o u r p a r t $ s w e c a n m a n a g e t o e s c a p e
w ith .
I t is a n e x t r a h a z a r d o u s o c c u p a t io n , y o u w il l a d m it , a n d is a
212
ACCIDENT PROBLEMS.
n e ce s s a r y o c c u p a t io n .
Y o u w il l a d m it t lia t w e o u g h t t o p r o v i d e
c o m p e n s a t io n f o r t h is n e w h a z a r d o u s o c c u p a t io n .
W e ou gh t to
p r o v id e it o n a c o m p e n s a t io n b a s is , a s I see it.
I w is h y o u w o u ld
t h in k th a t o v e r .
Y o u h a v e a m p le le is u r e b e tw e e n n o w a n d 9 o ’c lo c k
t o -m o r r o w m o r n in g t o a b s o r b th e g e n e r a l te n u re o f th e b ill, a n d b e
p r e p a r e d t o a ct fin a lly as t o w h e th e r y o u w a n t t o a p p o in t a c o m m itte e
t o ta k e t h is u n d e r c o n s id e r a t io n t o fu r t h e r th e m e a s u r e a t W a s h in g
to n , o r w h e t h e r y o u w a n t t o r e s o lv e in f a v o r o f o r a g a in s t it.
For
m y s e lf, I w a n t t o sta te a g a in th a t it is th e o n ly s e n s ib le a n d r ig h t
t h in g to d o .
I f w e c a n w ip e th e o l d p e n s io n s y s te m o ff th e m a p , le t’s
d o i t ; i t ’s t h e b e s t w o r k w e c o u ld e n g a g e in .
A n d le t u s n o t fo r g e t
t h a t th e m e n w h o g o t o th e tr e n c h e s , w h o e n c o u n t e r th e s e s p e c ia l
h a z a r d s , s h o u ld b e t a k e n c a r e o f a s t h e i n d u s t r ia l a r m y is t a k e n c a r e
o f in som e o f o u r S ta te s , o n ly a g o o d d e a l b e tte r th a n a n y o f th e
S ta te s are d o in g .
SH O P LIG H T IN G A S A M E A N S O F A C C ID E N T P R E V E N T IO N .
B Y C. W . P R IC E , U N IT E D
S T A T E S E M P L O Y E E S ’ C O M P E N S A T IO N
C O M M IS S IO N .
T h e T r a v e l e r s ’ I n s u r a n c e C o m p a n y r e c e n t l y a n a l y z e d 9 1 ,0 0 0 a c c i
d e n ts w h ic h o c c u r r e d in fa c t o r ie s a n d d is c o v e r e d th a t 10 p e r c e n
w e r e c a u s e d d i r e c t l y b y p o o r l i g h t i n g , a n d i n 1 3 .8 p e r c e n t o f t h
a c c id e n ts p o o r lig h t in g w a s a c o n t r ib u t o r y ca u se.
A s tu d y o f in
d u s tr ia l a c c id e n ts b y th e B r it is h G o v e r n m e n t r e v e a le d th e f a c t t h a t
3 9 .5 p e r c e n t m o r e m e n s t u m b l e a n d f a l l d u r i n g t h e w i n t e r m o n t h s
th a n d u r in g th e su m m e r.
T h i s c la s s o f a c c i d e n t s , m o r e t h a n a n
o th e r , i t w a s c o n te n d e d , is d u e t o im p r o p e r lig h t in g .
A l l o f th e c o m p a n ie s w h ic h , d u r in g th e p a s t fiv e y e a rs , h a v e m a d e
t h e la r g e s t r e d u c t io n s in a c c id e n t s , t e s t i f y t h a t g o o d l ig h t is in d is
p e n s a b le t o s a fe t y — a d a r k s h o p is a d a n g e r o u s s h o p .
LIGHT AND EFFICIENCY.
“ A d e q u a t e lig h t w ill in c r e a s e th e t o t a l o u t p u t o f s u ch p la n t s a s
s te e l m ills 2 p e r c e n t, a n d in p la n t s s u c h as s h o e fa c t o r ie s a n d t e x t ile
m ills it w il l in c r e a s e t h e o u t p u t 10 p e r c e n t ,” is t h e s ta te m e n t o
M r . C . L . E s h le m a n , a p r o m in e n t e le c tr ic a l e n g in e e r , p u b lis h e d in th e
p r o c e e d in g s o f th e A m e r ic a n I n s titu te o f E le c t r ic a l E n g in e e r s .
T h e e x p e r ie n c e o f a la r g e n u m b e r o f p la n t s r e v e a ls th e f a c t t h a t
th e t o t a l c o s t o f fu r n is h in g a d e q u a te a r tific ia l lig h t in a n a v e r a g e
p la n t d o e s n o t e x c e e d o n e -h a lf o f 1 p e r c e n t o f w a g e s . F o r in s ta n c e ,
it w ill c o s t ju s t 1 c e n t a d a y to fu r n is h a m p le lig h t f o r e a ch m a
e a r n in g $ 2 . T h is is p r o o f p o s it iv e th a t g o o d l ig h t is a p a y i n g in
vestm en t.
STANDARDS FOR EQUIPMENT.
Am ount o f light .— T h e f o l l o w i n g s t a n d a r d s a r e b a s e d o n t h e e x
p e r ie n c e o f s u c h c o m p a n ie s a s th e I n t e r n a t io n a l H a r v e s t e r C o ., th e
P fis t e r & V o g e l L e a t h e r C o ., a n d th e K im b e r ly - C l a r k C o .
These
s ta n d a r d s a r e e m b o d ie d in th e o r d e r s o f th e I n d u s t r ia l C o m m is s io n
o f W is co n s in :
I n s h o p s w h e r e th e r e is n o s m o k e o r g a s th e r e s h a ll b e p r o v id e d f o r
e a ch fo u r s q u a re fe e t o f flo o r s p a ce lig h t e q u iv a le n t t o th e lig h t p r o
d u c e d b y a 1 -c a n d le p o w e r la m p h u n g 10 fe e t fr o m th e flo o r , o r t
p u t it m o r e s im p ly , o n e -q u a r te r c a n d le p o w e r p e r sq u a re flo o r fo o t .
A 1 0 0 -c a n d le p o w e r la m p w ill illu m in e 4 0 0 sq u a r e fe e t o f flo o r sp a ce .
213
214
ACCIDENT PROBLEMS.
O n e - e i g l i t h c a n d l e p o w e r p e r s q u a r e f l o o r f o o t is r e q u i r e d f o r w a r e
h ou ses.
O n m a c h in e s a n d b e n c h e s , w h e r e c lo s e w o r k is d o n e , s u fficie n t l i g h t
m u s t b e p r o v i d e d t o p r e v e n t e y e s t r a in .
E x p e r ie n c e h a s d e m o n stra te d th a t th e a b o v e s ta n d a rd s fo r g e n
e r a l illu m in a t io n , in c lu d e d in s e c tio n s 1 a n d 2, a r e n o t o n ly a d e q u a te
f o r s a fe ty , b u t in a ll d e p a r tm e n ts w h e r e o r d in a r y w o r k is d o n e , su ch
a s p a p e r m ills a n d w o o d w o r k in g a n d c o a r s e m e ta l w o r k in g s h o p s ,
th e s e s t a n d a r d s p r o v i d e s u ffic ie n t l i g h t f o r a f a i r d e g r e e o f e ffic ie n c y
a n d m a k e u n n e c e s s a r y th e u se o f in d i v i d u a l m a c h in e lig h t s . W h e n
fin e r w o r k in d o n e o n e -h a lf t o 1 c a n d le p o w e r p e r sq u a re flo o r f o o t
is n e ce ssa ry .
LAMPS AND REFLECTORS.
Lam ps -— T h e t u n g s t e n l a m p i s r e c o m m e n d e d a s t h e m o s t e ff ic ie n t
t y p e o f l a m p f o r a l l c o n d i t i o n s i n s h o p s . T h6e t unna g s e e n ?? i s
6
m t
n o t a t r a d e n a m e , b u t a p p lie s t o a ll la m p s m a d e w it h fila m e n t s o f
t u n g s t e n m e ta l.
T h e r e a re a n u m b e r o f c o m p e t in g c o m p a n ie s w h ic h
m a n u fa c t u r e th e s e la m p s .
T h e m o d e r n t u n g s t e n la m p is a g r e a t e c o n o m iz e r o f c u r r e n t . T h e
o ld t y p e o f c a r b o n -fila m e n t la m p c o n s u m e d 5 4 w a tts f o r 16 c a n d le p o w e r , o r a b o u t 3J w a tts p e r c a n d le p o w e r .
T h e g a s -fille d tu n g s te n
la m p co n s u m e s f r o m s e v e n -te n th s t o o n e w a t t p e r c a n d le p o w e r . O n e
o f th e le a d in g sh o e fa c t o r ie s o f W is c o n s in r e c e n tly t o o k o u t a d r a y
lo a d o f th e o ld t y p e o f d r o p c o r d s w ith c a r b o n la m p s a n d in s ta lle d
t u n g s t e n l a m p s w i t h e f f ic ie n t r e f l e c t o r s .
T h e a m o u n t o f lig h t w a s
in c r e a s e d 4 0 0 p e r c e n t a n d th e c o s t o f c u r r e n t w a s d e c r e a s e d 25 p e r
cen t.
T h e g u a r a n t e e d l i f e o f t h e t u n g s t e n l a m p i s 1 ,0 0 0 h o u r s .
M any
p l a n t s a r e g e t t i n g a n a v e r a g e o f 1 ,5 0 0 h o u r s o f l i f e w i t h t h e 1 0 0 - w a t t
u n its a n d la r g e r .
Reflectors .— A p r o p e r l y d e s i g n e d r e f l e c t o r w i l l i n c r e a s e t h e e ffi
c ie n c y o f a la m p 35 t o 50 p e r c e n t. S ix t y -fiv e p e r c e n t o f th e l ig h t
f r o m a g a s -fille d tu n g s te n la m p p r o c e e d s h o r iz o n t a lly f r o m th e fila
m e n t. U n le s s t h is l i g h t is r e d ir e c t e d b y a r e fle c t o r t o t h e w o r k in g
p la n e it is w a s te d o n th e u p p e r p a r ts o f th e r o o m .
T h e d e e p b o w l r e fle c t o r is r e c o m m e n d e d f o r g e n e r a l illu m in a t io n .
I t p r o p e r l y c o n c e n t r a t e s a n d d is t r ib u t e s t h e l ig h t u p o n th e w o r k in g
p la n e .
( S e e c u t , N o . 8 .)
T h e s e r e fle c to r s s h o u ld b e m a d e o f w h it e
p o r c e l a i n - e n a m e l e d s t e e l. T h i s m a t e r i a l i s d u r a b l e , i n e x p e n s i v e , a n d
e a s ily c le a n e d .
W h e n r e fle c t o r s a r e k e p t c le a n t h e e ffic ie n c y is i n
cre a s e d 2 5 p e r cen t.
T h e la m p s h o u ld b e so a tta c h e d in th e r e fle c to r th a t th e c e n te r
o f t h e fila m e n t is lo c a t e d o n a p la n e d r a w n t h r o u g h t h e c e n t e r o f t h e
r e fle c tin g s u r fa c e .
SHOP LIG H TIN G AS ACCIDENT PREVENTION— C. W . PRICE.
GENERAL ILL U M IN A T IO N OF DEPARTM ENTS IN W H IC H
IS DONE— CEILINGS 12 TO 16 FEET.
215
COARSE W O R K
L am p .— O n e h u n d r e d w a t t g a s - f i l l e d t u n g s t e n .
Reflectors.— D e e p b o w l , 1 0 i n c h e s i n d i a m e t e r ( c u t , N o . 8 ) .
H eight. — T e n f e e t t o b o t t o m o f r e f l e c t o r .
Spacing.— T w e n t y - f o o t c e n t e r s .
D o n o t a r ra n g e r e g u la r ly
over
r o o m , b u t lo c a t e la m p s o v e r m a c h in e s a n d b e n c h e s s o f a r as p o s s ib le .
T h is a r ra n g e m e n t w ill m a k e u n n e c e s s a ry in d iv id u a l lig h t s in d e p a r t
m e n t s w h e r e t h e r e is n o c lo s e w o r k .
A m ount o f light.— N o t l e s s t h a n o n e - f o u r t h c a n d l e p o w e r f o r e a c h
sq u a re fo o t o f flo o r sp a ce .
O n e 1 0 0 -w a tt la m p w ill illu m in a te 4 0 0
sq u a re fe e t o f flo o r sp a ce.
O n e -h a lf c a n d le p o w e r f o r ea ch sq u a re
f o o t o f flo o r sp a ce is n e ce s s a ry in m a n y d e p a rtm e n ts w h e n th e w o r k
i s a t a l l c l o s e t o s e c u r e e f f ic ie n c y .
W AR EH O U SE S W IT H LO W CEILINGS AND BASEM ENTS OF M ILLS.
Lamp.— T u n g s t e n , 6 0 - w a t t .
R eflector .— S h a l l o w b o w l , 1 2 i n c h e s i n d i a m e t e r ( c u t , N o . 2 ) .
H eight. — A s h i g h a s p o s s i b l e .
Spacing.— N i n e t e e n - f o o t c e n t e r s .
A m ount o f light.— O n e - e i g h t h c a n d l e p o w e r p e r s q u a r e f l o o r f o o t .
ST A IR W A Y S.
Lamp.— T u n g s t e n , 4 0 - w a t t .
R eflector .— C o n e s h a p e d ( c u t , N o . 4 ) .
H eight. — A s h i g h a s c e i l i n g w i l l p e r m i t .
Location. — A t h e a d o f s t a i r s .
PLATFORMS.
Lamp.— T u n g s t e n , 6 0 - w a t t .
Reflector. — ( C u t , N o s . 2 a n d 7 . )
H eight. — T w e l v e f e e t f r o m f l o o r .
Spacing.— O v e r c e n t e r i f p l a t f o r m
is c o v e r e d . I f o p e n , a tta ch t o
b r a c k e t s a b o u t 4 f e e t lo n g , e x t e n d i n g f r o m s id e w a lls .
Am ount o f light.— O n e - e i g h t h c a n d l e p o w e r p e r s q u a r e f l o o r f o o t .
Y ARD S.
Lamp.— T u n g s t e n , 3 0 0 - w a t t .
Reflector. — ( C u t , N o . 7 . )
D ia m e te r , 16 in c h e s.
H eigh t.— T w e n t y f e e t .
Spacing.— T w o T h u n d r e d - f o o t c e n t e r .
216
ACCIDENT PROBLEMS.
IN D IV ID U A L M ACHINES.
W h e r e th e w o r k is c lo s e a n d t h e r e is d a n g e r o f e y e s t r a in , i n d i v i d
u a l lig h t s m u s t b e p r o v id e d .
Lamp.— T u n g s t e n , 2 5 - w a t t .
R eflector .— ( C u t , N o . 8 , w i t h d i a m e t e r o f 7 i n c h e s . )
(C u t , N os. 10
a n d 1 1 .)
L ocation .— A t t a c h e d o r h u n g s o t h a t t h e m a x i m u m l i g h t r e a c h e s
t o o l. T h e m o s t e s s e n t ia l t h i n g is t h a t t h e la m p s h a ll b e c o m p le t e ly
c o n c e a le d fr o m th e e y e s o f th e o p e r a t o r .
O n m a n y m a c h in e s it is
im p o r t a n t t o u se a d ju s ta b le fix tu r e s t o h o ld lig h t in p o s it io n .
(C u t,
N o s . 12, 1 3 .)
A m ount o f light .— S u f f i c i e n t t o a v o i d e y e s t r a i n .
BENCHES.
Lam p .— T u n g s t e n , 2 5 - w a t t .
R eflector .— ( C u t , N o . 8 , w i t h d i a m e t e r o f 7 i n c h e s . )
H eigh t .— E i g h t e e n i n c h e s a b o v e t a b l e .
L ocation .— E i g h t e e n i n c h e s f r o m f r o n t o f t a b l e .
A m ount o f light .— S u f f i c i e n t t o a v o i d e y e s t r a i n .
D R A F T IN G
TAB LE.
Lam p .— T u n g s t e n , 4 0 - w a t t .
R eflector .— ( C u t , N o . 8 , w i t h d i a m e t e r o f 7 i n c h e s . )
H eigh t .— F o r t y - t w o i n c h e s a b o v e t a b l e .
L ocation .— O v e r c e n t e r o f t a b l e o r o v e r l e f t - h a n d c o r n e r .
C O M P A R IS O N O F IN D U S T R IA L W IT H M IL IT A R Y C A S U A L T IE S .
B Y I.
M . R U B IN O W , DIRECTOR, B U R E A U
OF
S O C IA L
S T A T IS T I C S ,
NEW
YORK
C IT Y .
T h e e n tr a n c e o f th e U n it e d S ta te s in t o th e b l o o d y c o n flic t h a
t a k e n p la c e u n d e r c ir c u m s t a n c e s v e r y d iffe r e n t f r o m th o s e a t th
b e g in n in g o f th e w a r th re e y e a r s a g o .
In s te a d o f th e b lin d c o s m i
c a ta c ly s m a lto g e th e r u n e x p e c te d b y th e g r e a t m a sses, o u rs is a d e
lib e r a te a c t io n u n d e r ta k e n f o r m a n y d e fin ite r e a s o n s a n d a im in
t o w a r d c e r t a in d e fin ite e n d s.
C o u p le d w it h th e a b se n ce o f a n y im
m e d ia te d a n g e r fr o m th e o u ts id e , t h is h a s its m a n y a d v a n t a g e s ; b u t
i t a ls o im p o s e s c e r ta in im p o r t a n t o b lig a t io n s .
T h e n e ce ssa ry step s
m a y b e c a r e f u lly p la n n e d , m a n y e r r o r s m a y b e p r e v e n t e d , a n d p e r
h a p s th e c o s t m a y , a t le a s t a p p r o x im a t e ly , b e e s t im a t e d in a d v a n c e ;
b u t s id e b y s id e w it h th e s e a c tu a r ia l o r s ta tis tic a l p r o b le m s th e o b li
g a t io n rests u p o n th e N a t io n t o d o a ll th a t c a n b e d o n e , n o t o n ly t o
r e d u c e t h e m a t e r ia l c o s t , b u t a ls o t o c o m p e n s a t e th e lo s s , t o r e lie v e th e
s u ffe r in g — p h y s ic a l, e c o n o m ic , a n d
s p ir it u a l— t o th e ir r e d u c ib l
m in im u m .
I t is u n n e c e s s a r y t o a r g u e b e f o r e a b o d y o f s p e c ia lis t s s u c h a s t h is ,
e v e r y m e m b e r o f w h ic h fin d s h im s e lf in d a ily d e p e n d e n c e u p o n s ta
t is t ic a l d a ta , h o w im p o r t a n t a t th is t im e a r e s o m e r e lia b le s ta tis tic s o f
m i l it a r y lo s s e s .
I t is e a s y f o r th e s k e p t ic t o q u e s tio n h o w f a r th
m o s t a c c u r a t e s t a t is t ic s o f m i l it a r y c a s u a lt ie s w i l l e n a b le u s t o r e d u c e
th e d e a d ly e ffe c t o f G e r m a n s h r a p n e l.
I t m a y a ls o b e d iffic u lt t
p r o v e th a t th e r e h a s b e e n a n y s e n s a tio n a l r e d u c t io n in th e n u m b e r
o f in d u s t r ia l a c c id e n t s w it h in th e la s t fiv e y e a r s , t h r o u g h c a r e f u
a c c id e n t s ta tis tic s o r in a n y o t h e r w a y .
B u t s o m e s ta tis tic a l d a ta a s
t o t h e p r o b a b le v o lu m e o f c a s u a lt ie s a r e a t le a s t a s i m p o r t a n t a s s o m e
e s tim a te s o f th e p r o b a b le c o s t o f a m m u n itio n , i f th e N a t io n in te n d s
t o m a k e r e a d y f o r th e r e lie f o f s u ffe r in g a n d n e e d w h ic h m u st f o l
lo w in th e fo o ts te p s o f m o d e r n w a r fa r e .
A fe w m o n th s a g o , a t th e re q u e s t o f P r o f . E . T . D e v in e a n d o
b e h a lf o f th e R e d C ro s s In s titu te f o r C r ip p le d S o ld ie r s a n d S a ilo r s , I
u n d e r t o o k t o o b ta in o r p r e p a r e a r e a s o n a b le e s tim a te o f th e p r o b a b le
n u m b e r o f c a s u a lt ie s w it h w h ic h s u c h a n i n s t it u t io n f o r t h e r e d u c t io n
o f c r ip p le s m a y b e e x p e c t e d t o d e a l.
I n th e m o n th o f M a y it w a s n o t
a t a ll c e r ta in th a t th e A m e r ic a n p e o p le w o u ld b e c a lle d u p o n t o ta k e
a n a c t iv e p a r t in th e E u r o p e a n c o n flic t n o r c o u ld a n y o n e h a z a r d th e
gu ess as t o h o w fa r su ch p a r t ic ip a t io n m ig h t g o .
T h e r e fo re ,
fo r m u la t e d th e q u e s tio n in th e c o n c r e te , t h o u g h s o m e w h a t h y p o t h e t
ic a l w a y , as f o llo w s :
217
218
ACCIDENT PROBLEMS.
A s s u m in g th a t a m illio n A m e r ic a n t r o o p s w e r e t o ta k e a c tiv e p a r t
i n th e E u r o p e a n W a r d u r in g th e p e r io d o f o n e y e a r , h o w m a n y c r i p
p le s m ig h t b e e x p e c t e d t o r e tu r n t o o u r s h o re s ?
T h e fir s t o b v io u s d iff ic u lt y a r is e s f r o m th e f a c t t h a t t h e r e is n o
g e n e r a lly a c ce p te d d e fin itio n o f th e w o r d “ c r ip p le .”
F o r p r a c t ic a l
p u r p o s e s , h o w e v e r , th e w o r d m a y b e a ssu m e d as e q u iv a le n t t o th e
te r m “ p e rm a n e n t d is a b ilit y ” in th e la n g u a g e o f w o r k m e n ’s c o m
p e n s a tio n .
L o s s o f m e m b e r o r p a r t o f m e m b e r is e v id e n t l y n o t a
n e c e s s a r y fa c t o r , n o r d o e s n e c e s s a r ily e v e r y lo s s o f b o d i l y s u b s ta n c e
r e s u l t i n t h e m a k i n g o f a c r i p p l e . T h e c o n c e p t a f t e r a l l is a n e c o
n o m ic r a t h e r th a n a s u r g ic a l on e . T h e d e fin it io n fo r m u la t e d b y a
c o m m itte e in th e c it y o f B ir m in g h a m f o r ce n s u s p u r p o s e s m a y h e re
b e a c c e p t e d , n a m e l y : u A c r ip p le is a p e r s o n w h o s e m o v e m e n ts a re so
f a r r e s t r i c t e d b y a c c i d e n t o r d is e a s e a s t o a f f e c t h i s c a p a c i t y f o r s e l f s u p p o r t .”
I t a p p e a rs , th e r e fo r e , th a t th e p r o b le m p la c e d b e f o r e m e h a s b ee n
n a r r o w e d d o w n c o n s id e r a b ly .
T h e q u e s tio n o f m o r t a lit y o f m ilit a r y
f o r c e s , w h e t h e r d u e t o d ir e c t m i l i t a r y o p e r a t io n s o r d is e a s e — a q u e s
t io n o f g r e a t e c o n o m ic im p o r t a n c e , e s p e c ia lly in fa c e o f th e p la n s a d
v a n c e d f o r in s u r a n c e o f o u r A r m y — w a s n o t e n te re d in to , b e ca u se
it h a d n o d ir e c t b e a r in g u p o n th e fu n c t io n s o f th e p r o p o s e d in s titu
tio n .
N e it h e r w a s i t c o n s id e r e d w o r t h w h ile t o e s tim a te th e v e r y
m u c h la r g e r n u m b e r o f c a s u a lt ie s w h ic h , in m ilit a r y o p e r a t io n s as in
in d u s t r ia l o p e r a t io n s , w o u ld in a r e a s o n a b le t im e r e s u lt in r e c o v e r y .
P e r h a p s th e m o s t c o n v in c in g c o n c lu s io n r e a ch e d , a ft e r a fe w w eek s
o f in q u ir y , w a s th e u t t e r ly d e p lo r a b le c o n d it io n , i f n o t c o m p le t e
a b s e n c e , o f s t a t is t ic s o f m i l it a r y c a s u a lt ie s .
C o n s id e r in g th a t w a r
fa r e h a s b e e n th e m o st c h a r a c te r is tic fa c t o r o f c iv iliz e d s o c ie ty , o n e
is s u r p r is e d t o fin d h o w lit t le c a s u a ltie s o f w a r h a v e b e e n s t u d ie d .
P e r h a p s t h e o n l y e x p l a n a t i o n o n e c a n t h i n k o f is t h e f a c t t h a t a t
le a s t d u r in g th e la s t c e n t u r y o r s o , w h e n s ta tis tic a l s t u d y m ig h t h a v e
b e e n p o s s ib le , h u m a n it y a lw a y s c h e r is h e d th e t h o u g h t t h a t th e la te s t
wra r w a s a l s o t h e l a s t o n e .
D u r i n g th e la s t t h r e e y e a r s t h e n e w s p a p e r s h a v e b e e n f u l l o f
v a r io u s c o n f li c t i n g s t a te m e n ts c o n c e r n i n g th e n u m b e r o f c a s u a lt ie s
s u ffe r e d b y v a r io u s c o m b a t a n t s , b u t n o o ffic ia l i n f o r m a t i o n is a v a il
a b le as y e t.
T h is m a y b e d u e t o a d e fin ite d e c is io n n o t t o a n n o u n c e
t h e l o s s e s f o r t h e t i m e b e i n g ; b u t f o r t h e e a r l i e r w^ars n o s u c h e x c u s e
c a n b e g i v e n , a n d y e t l i t t l e b e y o n d s t a t i s t i c s o f f a t a l i t i e s is k n o w n .
I t b e c a m e n e ce s s a r y , th e r e fo r e , t o m a k e u se o f v a r io u s p u b lis h e d
e s tim a te s a n d fr a g m e n t a r y b it s o f in fo r m a t io n f o r th e p u r p o s e o f
t h is in q u ir y .
T h e r e s u lt, t h e r e fo r e , m u s t b e a c c e p t e d w it h a g r e a t
d e a l o f c a u tio n .
E v e n i f c a r e f u l s ta tis tic s o f e a r lie r w a r s h a d b e e n a v a ila b le , a n y
d e d u c t io n fr o m s u ch s ta tis tic s w o u ld h a v e b e e n v e r y d a n g e r o u s
COMPARISON OF CASUALTIES---- I. M . RU BINO W .
21&
in d e e d , b eca u se c o n d it io n s o f m o d e r n w a r fa r e d iffe r so w id e ly fr o m
th o s e o f ev en th e re ce n t p a st.
M o r t a li t y f r o m s ic k n e s s , w h ic h w a s
t h e g r e a t c a u s e o f lo s s e s in w a r f a r e e v e n a s r e c e n t ly a s t h e S p a n is h A m e r ic a n W a r ? h a s a lm o s t b e e n e lim in a t e d b y m o d e r n m e th o d s o f
s a n it a t io n a n d s u r g e r y ; b u t , as a g a in s t t h a t , t h e r e h a s b e e n
t e r r ib le in c r e a s e in th e d e a d ly e ffe c t o f th e m o d e r n im p le m e n ts o f
w a r.
I n t h e C i v i l W a r 9 0 p e r c e n t o f t h e b a t t le lo s s e s w e r e c a u s e d
b y r ifle w o u n d s a n d le s s t h a n 10 p e r c e n t b y a r t ille r y .
P r e s e n t lo s s e s
f r o m a r t ille r y fir e r a n g e f r o m 35 t o 4 0 p e r c e n t, a n d in th e ca se o f
o n e F r e n c h a r m y c o r p s 70 p e r c e n t o f th e w o u n d s w e r e d u e to s h e ll
a n d s h r a p n e l, 5 p e r c e n t t o th e b l o w in g u p o f th e tr e n c h e s b y m in e s ,
3^ p e r c e n t t o h a n d g r e n a d e s , a n d o n ly 14 p e r c e n t t o s m a ll a rm s.
T h e s h e ll a n d s h r a p n e l w o u n d s a re , o f c o u r s e , m u c h m o r e d e s t r u c
t iv e , a n d e v e n th e tr iu m p h s o f m o d e r n s u r g e r y , th e im p r o v e d te c h n ic
o f a m p u t a t i o n , e t c ., m a y b y t h e r e d u c t i o n o f m o r t a l i t y i n c r e a s e t h e
n u m b e r o f c rip p le s .
I n t h e C i v i l W a r 2 2 5 ,0 0 0 m e n a r e s a i d t o h a v e
d i e d b y d is e a s e , a s a g a i n s t 1 1 0 ,0 0 0 k i l l e d o r d y i n g b y w o u n d s , w h i l e
d u r i n g t h e p r e s e n t w a r f o r t h e f i r s t t w o y e a r s G e r m a n y is s a i d t o
h a v e l o s t l e s s t h a n 5 0 ,0 0 0 m e n f r o m d is e a s e , a g a i n s t 7 3 5 ,0 0 0 k i l l e d
o r d y in g o f w o u n d s , o r o n ly 6 p e r cen t.
O f th e to t a l n u m b e r o
w o u n d e d in th e U n io n fo r c e s in th e C iv il W a r , 14^ p e r ce n t d ie d ;
o f th e G e r m a n fo r c e s in t h e F r a n c o - P r u s s ia n w a r 11 p e r c e n t.
O f
t h e J a p a n e s e f o r c e s i n 1 9 0 5 , 6 .6 p e r c e n t , w h i l e f o r t h e p r e s e n t w a r
G e r m a n y h a s th e fo llo w in g r e c o r d : T h e p r o p o r t io n o f d ea th a m o n g
w o u n d e d in A u g u s t, 1914, w a s o n ly 3 p e r cen t, g r a d u a lly re d u ce d t o
le s s t h a n 1 p e r c e n t t o w a r d t h e e n d o f 1 915.
E a c h o f th e c o m b a ta n t c o u n tr ie s r e a d ily p u b lis h e s s ta tis tic s o f
lo s s e s o f t h e o t h e r s id e . I n s e v e r a l n e u t r a l c o u n t r ie s , h o w e v e r , p r e
s u m a b ly n e u t r a l e ff o r t s h a v e b e e n m a d e t o a s c e r t a in th e e x t e n t o f
lo s s e s o n b o t h s id e s . A c c o r d i n g t o t h e e s t im a t e o f a C o p e n h a g e n s o
c ie t y f o r s t u d y in g th e lo s s e s o f w a r , th e fa t a l i t i e s f o r t h e fir s t y e a r
e q u a l e d 4 ,6 3 1 ,0 0 0 a n d t h e t o t a l n u m b e r o f w o u n d e d 1 1 ,2 4 5 ,0 0 0 , m a k
i n g a t o t a l l o s s o f 1 5 ,8 7 6 ,0 0 0 . I t i s w e l l k n o w n , h o w e v e r , t h a t t h e
v a s t m a jo r i t y o f th e w o u n d e d r e t u r n t o th e f r o n t . A n o t h e r e s tim a te ,
m o s t c a r e f u lly p r e p a r e d b y C o l. H a r ts , o f th e A r m y W a r C o lle g e ,
p l a c e s t h e n u m b e r o f k i l l e d a t 4 ,3 4 1 ,0 0 0 , n u m b e r o f p e r m a n e n t l y
d i s a b l e d 2 ,3 1 4 ,0 0 0 , m a k i n g a t o t a l l o s s o f 6 ,6 5 5 ,0 0 0 . I n g e t t i n g t h e
n u m b e r o f th o s e d is a b le d b y w o u n d s , it w a s e s tim a te d th a t in G e r
m a n y s o m e 9 0 p e r c e n t o f th e w o u n d e d a n d in o t h e r c o u n t r ie s 80 p e r
ce n t e v e n tu a lly r e c o v e r e d a n d r e tu rn e d t o th e fr o n t.
T h e s e lo s s e s o f 2 4 m o n t h s r e la te t o th e e s t im a t e d f o r c e s , w h ic h
p r o b a b l y a v e r a g e d s o m e 2 0 ,0 0 0 ,0 0 0 . H o w f a r t h i s l a t t e r e s t i m a t e i s
a p p l i c a b l e t o t h e e n t ir e c o u r s e o f t h e w a r i t is v e r y d iffic u lt t o s a y ,
b u t it is a t le a s t p r o b a b le t h a t th e lo s s e s o f d e a d , w o u n d e d , a n d
220
ACCIDENT PROBLEMS.
p r is o n e r s h a v e b e e n r a p i d l y c o m p e n s a te d f o r in ca se o f m o s t b e l l ig
eren ts b y th e c a llin g o u t o f reserves.
A s l ig h t c o r r e c t io n m u s t b e m a d e in t h e e s t im a t e o f lo s s e s b e c a u s e
a ll o f th e b e llig e r e n t c o u n t r ie s d id n o t b e g in h o s t ilit ie s a t th e s a m e
t im e , s o t h a t a ll o f t h e m w e r e n o t s u b je c t t o lo s s e s d u r i n g t h e 2 4
m o n th s o f th e fir s t t w o y e a r s . M a k i n g th e c o r r e c t io n f o r th is fa c t o r ,
in t o th e d e t a ils o f w h ic h i t is u n n e c e s s a r y t o e n te r , I a r r iv e a t t h e
g e n e r a l e s t i m a t e o f t h e n u m b e r k i l l e d p e r m o n t h a s 1 8 5 ,0 0 0 , t h e t o t a l
n u m b e r w o u n d e d s o m e 4 5 0 ,0 0 0 , a n d t h e n u m b e r p e r m a n e n t l y d i s
a b l e d a s a b o u t 1 0 5 ,0 0 0 p e r m o n t h .
A s s u m i n g a n A m e r i c a n A r m y o f 1 ,0 0 0 ,0 0 0 m e n i n E u r o p e , t h i s
w i l l g i v e u s p e r m o n t h 9 ,2 5 0 k i l l e d a n d 2 2 ,5 0 0 w o u n d e d , o f w h i c h
5 ,2 5 0 T yill b e p e r m a n e n t l y d i s a b l e d . A n e s t i m a t e f o r o n e y e a r s h o u l d
b e 1 1 1 ,0 0 0 k i l l e d a n d 2 7 0 ,0 0 0 w o u n d e d , a n d o f t h i s n u m b e r 6 3 ,0 0 0
p e r m a n e n t ly d is a b le d .
V e r y l it t l e r e lia b le s t a t is t ic a l i n f o r m a t i o n is o b t a in a b le a t t h is
tim e a s t o th e n a tu r e o f th e s e p e r m a n e n t d is a b ilitie s .
S om e fr a g
m e n t a r y in fo r m a t io n r e f e r r i n g t o C a n a d ia n fo r c e s m a y ju s t i f y th e
f o l l o w i n g v e r y r o u g h e s tim a te o f th e p r o b a b le d is t r ib u t io n o f th e
6 3 ,0 0 0 i n v a l i d s o f w a r .
Am putation o f l e g __________________________________about__7,000
Am putation o f arm or hand__________________________________6, 500
Injuries to leg, requiring no am putation---------------------------------9, 500
Injuries to arm, requiring no am putation___________________9, 000
Injuries to hand, requiring partial or no amputation_______ _8, 000
Total cripples ------------------------------------------------------------ 40,000
Eyesight cases --------------------------------------------------------------------- 7,500
D e a fn e s s ____________________________________________________ 4,500
Other injuries and w ounds__________________________________11, 000
Total permanently injured by wounds_______________
63, 000
T o this must be added about 33,000 permanently injured by disease, nam ely:
Diseases o f chest, o f heart, and rheumatism_______________ 23, 000
Insanity, epilepsy, and nervous diseases------------------------------- 4,500
Other s ic k n e s s ______________________________________________
5, 500
Total fo r diseases____________________________________ 33,000
Total number o f perm anently disabled______ about__ 96,000
N o o n e a p p r e c ia te s b e tte r th a n m y s e lf th e s lig h t s ta tis tic a l f o u n d a
t io n u p o n w h ic h th e s e c o m p ila t io n s a re b u ilt , b u t w h e th e r th e n u m b e r
b e 5 0 ,0 0 0 o r 1 5 0 ,0 0 0 i t i s o b v i o u s t h a t a y e a r o f m i l i t a r y o p e r a t i o n s
w it h a m i l li o n m e n in t h e fie ld w i l l r e s u lt in s u b s t a n t ia l lo s s e s o f l i f e
a s w e ll as lim b a n d w o r k in g a b ilit y .
T h e c h a r g e w o u ld b e u n ju s t th a t th e c o u n t r y a n d th e G o v e r n m e n t
a r e n o t s u ffic ie n t ly a w a r e o f t h is c e r t a in c o s t . T h e r e c e n t c o n f e r e n c e s
in W a s h in g t o n c o n c e r n in g th e p r o p o s a ls o f in s u r a n c e f o r a r m y fo r c e s
COMPARISON OF CASUALTIES---- 1. M . RU BINO W .
221
a n d th e b ill to b e in t r o d u c e d in C o n g r e s s a re s p le n d id d e m o n s tr a
tio n s o f fo r e s ig h t , su ch as p e r h a p s h a s n e v e r b e e n s h o w n in s im ila r
c o n d it io n s b e fo r e . I n c id e n t a lly , i t m a y b e r e c o r d e d th a t th e s e p la n s
r e p r e s e n t a v e r y v a lu a b le d e m o n s t r a t io n o f th e t r iu m p h o f th e s o c ia l
in s u r a n c e p r i n c i p l e in t h is c o u n t r y , p a r t i c u l a r l y v a lu a b le a t t h is
tim e , a ft e r s ix m o n th s o f v ic io u s o p p o s it io n t o th e r is in g s o c ia l in s u r
a n c e m o v e m e n t a s u n -A m e r ic a n a n d u n d e m o c r a tic .
I t is s c a r c e ly n e ce s s a ry to a r g u e b e f o r e th is g a th e r in g th a t m e re
m o n e y i n d e m n i t y d o e s n o t s o l v e a l l t h e p r o b l e m s c r e a t e d b y 1 0 0 ,0 0 0
c r ip p le s a n d in v a lid s .
D r a w i n g a p a r a lle l f r o m th e r e la te d fie ld ,
o n e b y - p r o d u c t o f c o m p e n s a t io n le g is la t io n w a s th e im p o r t a n t m o v e
m e n t f o r a c c id e n t p r e v e n t io n .
T h e w e ll-k n o w n
a u th o r o f th
a n a ly t ic s c h e d u le , M r . H a n s e n , c r e a te d th e m o tt o , “ C o m p e n s a t io n
is p a llia t iv e , a c c id e n t p r e v e n t io n is p r o p h y l a c t i c .”
M r . W . C o w le s ,
o f th e T r a v e le r s ’ I n s u r a n c e C o ., h a s c o in e d th e p h r a s e t h a t is e q u a lly
w e l l s o u n d i n g , “ A n a c c i d e n t c o m p e n s a t e d is a n a p o l o g y , a n a c c i d e n t
p r e v e n t e d is a b e n e f a c t i o n . ”
P e r h a p s th e fig u r e s a b o v e q u o t e d g iv e u s n o k e y t o th e p r e v e n t io n
o f m i l i t a r y c a s u a l t i e s , b u t a f t e r a l l is s a i d f o r a n d d o n e i n t h e w a y o f
b o t h c o m p e n s a tio n a n d p r e v e n t io n , is th e p r o b le m o f in d u s t r ia l a c c i
d e n ts a lto g e th e r s o lv e d ?
E v e n i f t h e 1 0 0 ,0 0 0 c r i p p l e s a n d i n v a l i d s
h a v e b e e n a m p ly c o m p e n s a te d , a g o o d d e a l m o r e r e m a in s t o b e a c
c o m p lis h e d . T h e E u r o p e a n c o m b a t a n t s , w h o m u s t c o u n t t h e i r lo s s e s
b y m illio n s in s te a d o f th o u s a n d s , v e r y e a r ly in th e h is t o r y o f th e w a r
w e re fo r c e d to u n d e r ta k e th e d u ty o f r e e d u c a tio n o f p e r m a n e n tly in
ju r e d in o r d e r to c o n s e r v e th e la b o r fo r c e s o f th e c o u n tr y . O n e m a y
h o p e th a t th e p a r t ic ip a t io n o f th e U n it e d S ta te s in th e w a r w ill
n e v e r r e a c h t h e e x t e n t t h a t th e lo s s e s s u s t a in e d m i g h t s u b s t a n t ia lly r e
d u c e th e a v a ila b le s u p p ly o f la b o r fo r c e s , b u t f o r r e a s o n s s o c ia l a n d
p s y c h o lo g ic e v e n m o r e th a n fin a n c ia l, th e q u e s tio n o f r e b u ild in g in
v a lid s o f w a r t h r o u g h s u c h in s titu tio n s as th e R e d C r o s s I n s t it u t e f o r
C r ip p l e d S o ld ie r s a n d S a ilo r s is v e r y n e c e s s a r y , in d e e d .
S everal
G o v e r n m e n t a g e n c ie s , as w e ll as p r iv a t e p h ila n t h r o p is t s , h a v e a lr e a d y
b e c o m e in t e r e s te d in th e s u b je c t , d r a w i n g u p o n th e e x t e n s iv e e x p e r i
e n c e a n d v a lu a b le r e s u lt s o b t a in e d in s e v e r a l E u r o p e a n c o u n t r ie s .
I n v ie w o f th is f a c t th a t m a n y s p e c ia liz e d in s t it u t io n s f o r r e e d u
c a t io n o f c r i p p l e s a r e b e i n g c r e a t e d , o n e m a y n a t u r a l ly r a is e t h e
q u e s tio n w h e th e r th e n e e d f o r th o s e in s t it u t io n s w ill b e g o n e a ft e r
t h e 1 0 0 ,0 0 0 c r i p p l e s h a v e b e e n t a k e n t h r o u g h t h i s e d u c a t i o n a l t r e a t
m e n t ; a n d s in c e th e h o p e o f a n e a r ly w o r ld p e a c e h a s n o t b e e n
a l t o g e t h e r a b a n d o n e d b y a l l o f u s , e v e n th e* m o r e i m p o r t a n t q u e s t i o n
a r i s e s : S u p p o s i n g t h e s e 1 0 0 ,0 0 0 c r i p p l e s f a i l t o m a t e r i a l i z e , w i l l t h e
m o n e y a n d f o r c e s p e n t in c r e a t in g th e se in s titu tio n s h a v e b e e n a lt o
g e th e r w a sted ?
222
ACCIDENT PROBLEMS.
E v e n t h e s u p e r fic ia l e x a m in a t io n o f t h e r e s u lt s o f c o m p e n s a t io n
e x p e r ie n c e in t h is c o u n t r y , b r i e f a s i t is , g i v e a & e m p h a t ic n e g a t iv e
a n s w e r t o t h is q u e s tio n .
T h e s tu d y o f th e n e e d s o f th e c r ip p le , e s p e c ia lly th e a d u lt c r ip p le
in t h is c o u n t r y , is s t ill in it s i n f a n c y . W h i l e a g o o d d e a l is b e i n g
d o n e f o r t h e c r i p p l e d c h ild , h a r d l y a n y s u b s t a n t ia l in s t it u t io n f o r
h e l p i n g th e a d u lt c r i p p l e t o e c o n o m ic in d e p e n d e n c e e x is ts a s y e t.
T h e r e a r e n o a v a ila b le s t a t is t ic s as t o th e n u m b e r o f c r i p p l e s in t h is
c o u n t r y , t h o u g h s u g g e s tio n s h a d b e e n m a d e a t th e la s t c e n s u s th a t
q u e s tio n s as t o c r ip p le s b e in c lu d e d in th e p o p u la t io n s c h e d u le .
T h e E n g l i s h in v e s t ig a t io n see m s t o in d ic a t e t h a t c r ip p le s c o n s t it u t e
n e a r ly o n e -t h ir d o f 1 p e r ce n t o f th e p o p u la t io n .
T h e c r ip p le
c h i l d r e n c o n s t i t u t e 1 .4 p e r t h o u s a n d a n d a d u l t s 1 .9 p e r t h o u s a n d .
T h e s e r e s u lt s fin d r e m a r k a b le c o r r o b o r a t i o n in th e c e n s u s o f c r i p p l e d
c h i l d r e n f o r t h e e n t i r e G e r m a n E m p i r e , w h i c h f o u n d 7 5 ,0 0 0 o f t h e m ,
o r 1 .5 p e r t h o u s a n d o f p o p u l a t i o n .
O n th e b a s is o f e it h e r o f th e se
t w o e s t i m a t e s , t h e r e m u s t b e i n t h i s c o u n t r y n e a r l y 3 5 0 ,0 0 0 c r i p p l e d
person s.
A c c o r d i n g t o t h e G e r m a n d a t a , o f t h e 7 5 ,0 0 0 c r i p p l e d
c h i l d r e n , l e s s t h a n 2 5 ,0 0 0 , o r o n e - t h i r d ? w e r e c o n g e n i t a l c a s e s , a n d
5 0 .0 0 0 h a d b e c o m e c r i p p l e d s i n c e b i r t h .
T h is p r o p o r tio n m u st b e
s m a lle r a m o n g a d u lt c r ip p le s .
R o u g h l y , p e r h a p s l e s s t h a n 7 5 ,0 0 0
o u t o f 3 5 0 ,0 0 0 c r i p p l e s i n t h i s c o u n t r y a r e c o n g e n i t a l c a s e s . I n s o m e
w a y o r o t h e r m o d e r n l i f e h a s c r e a t e d a s u b s t a n tia l a r m y o f , p e r h a p s ,
3 0 0 .0 0 0 p e r s o n s w h o a r e n o t a b l e t o e a r n t h e i r l i v i n g .
A s b oth o f
th e s e in v e s tig a tio n s , th e E n g lis h a n d th e G e r m a n , w e r e m a d e b y
p r i v a t e s o u r c e s it is v e r y l ik e ly t h a t t h e fig u r e s g iv e n a re u n d e r
e s t im a t e d , a n d , s in c e a c c id e n t a l in ju r ie s c o n s t it u t e t h e m o s t p o t e n t
f a c t o r in t h is m a n u fa c t u r e o f c r ip p le s , it is a t le a s t p e r m is s ib le t o
s u s p e c t t h a t t h e n u m b e r o f c r i p p l e s i n t h i s c o u n t r y is e v e n l a r g e r .
N o t u n t il c o m p e n s a t io n le g is la t io n s p r e a d t h r o u g h o u t th e U n it e d
S t a t e s d i d t h is p r o b l e m r e c e iv e s u fficie n t a p p r e c ia t i o n in t h is c o u n
try .
E v e n n o w o n e m a y q u e s tio n h o w t h o r o u g h ly it is u n d e r s t o o d ,
w h e n o ffic ia l r e p o r t s o f p e r m a n e n t d is a b ilit ie s m a d e b y s e v e r a l
in d u s t r ia l b o a r d s a n d c o m m is s io n s in c lu d e v e r y fe w , i f a n y , ca ses o f
p e r m a n e n t d is a b il i t y o u t s id e o f a c t u a l d is m e m b e r m e n t . T h e v i c io u s
d is m e m b e r m e n t s c h e d u le o f o u r c o m p e n s a t io n la w s , t h e s o - c a lle d
4 N e w J e r s e y in v e n t io n ,” a d o p te d f r o m th e c o n d it io n s o f p e r s o n a l4
a c c id e n t in s u r a n c e , h a s fo c u s e d o u r a tte n tio n u p o n o n ly o n e -h a lf o f
th e p r o b le m .
N o t w it h s t a n d in g th e n u m e ro u s e ffo r ts o f v a r io u s o r
g a n iz a t io n s , su ch as th e N a t io n a l S a f e t y C o u n c il, th e U n it e d S ta te s
B u r e a u o f L a b o r S ta tis tic s , th e W o r k m e n ’s C o m p e n s a tio n S e r v ic e
B u r e a u , th e C a s u a lty , A c t u a r ia l, a n d S ta tis tic a l S o c ie t y o f A m e r ic a ,
a n d e v e n t h is a u g u s t b o d y , t o c r e a t e a u n i f o r m s y s te m o f c o m p e n s a
t io n s ta tis tic s , o r p e r h a p s b e c a u s e o f th e s e e ffo r ts , s ta tis tic s o f in d u s
t r i a l a c c id e n t s in t h is c o u n t r y a r e s t ill a m a s s o f in c o h e r e n t fig u r e s .
COMPARISON OF CASUALTIES---- 1. M . RU BINO W .
22a
A c a r e fu l sea rch w a s m a d e th ro u g h th e r e p o rts o f o u r co m p e n sa
t io n S t a t e s t o a r r iv e a t s o m e d e p e n d a b le to ta ls . O n ly 16 S ta te s w e r e
fo u n d t o h a v e d a ta w h ic h c o u ld b e u sed f o r th e p u rp o se , N ew Y o r k ,
C a lifo r n ia , M a ssa ch u se tts , a n d W is c o n s in b e in g a m o n g th e m o s t im
p o r ta n t o f th e se S ta te s.
B e f o r e t h is b o d y o f G o v e r n m e n t o ffic ia ls
it m a y , p e r h a p s , b e s a fe r n o t t o in d u lg e in c r it ic is m o f th e s ta tis tic a l
r e p o r t s o f a n y o n e S ta te b e y o n d a s k in g th e q u e s tio n w h y it s h o u ld h a p
p e n th a t th e lit t le S ta te o f N e v a d a w it h its s m a ll S t a t e in s u r a n c e fu n d
s h o u ld b e e n title d t o th e c r e d it o f h a v in g th e m o s t a ccu ra te in d u s tr ia l
s t a t is t ic s a v a ila b le .
T a k in g , h o w e v e r , th e 16 S ta te s to g e th e r , w it h
n e a r l y 1 0 ,0 0 0 ,0 0 0 e m p l o y e e s c o v e r e d b y t h e a c t , a c c o r d i n g t o t h e
c o m p u t a t i o n m a d e b y t h e U n i t e d S t a t e s B u r e a u o f L a b o r S t a t is t ic s ^ I
f o u n d t h e n u m b e r o f f a t a l a c c i d e n t s t o e q u a l 7 ,1 9 7 , a n d o f n o n f a t a l
t a b u l a t a b l e a c c i d e n t s o f o v e r o n e d a y ’ s d u r a t i o n , 6 2 4 ,0 0 0 , j u s t i f y i n g
t h e e s t i m a t e f o r t h e 2 6 ,0 0 0 ,0 0 0 e m p l o y e e s i n t h e U n i t e d S t a t e s o f
1 9 ,7 0 0 f a t a l a n d 1 ,7 0 0 ,0 0 0 n o n f a t a l i n d u s t r i a l a c c i d e n t s , t o w h i c h
m u s t b e a d d e d th e a c c id e n ts t o U n it e d S ta te s e m p lo y e e s a n d r a ilr o a d
e m p l o y e e s , g i v i n g a t o t a l o f 2 2 , 5 0 0 f a t a l a n d 1 ,8 8 0 ,0 0 0 n o n f a t a l
i n d u s t r i a l a c c i d e n t s , a n d a g r a n d t o t a l o f 1 ,9 0 2 ,5 0 0 .
T h e c h a r a c te r o f in d u s tr ia l in ju r ie s is e v id e n t ly v e r y d iffe r e n t
f r o m th a t o f th e m ilit a r y on es. W h e r e a s th e E u r o p e a n w a r s h o w s
a b o u t 2^ n o n fa t a l a c cid e n ts f o r e v e r y fa t a l o n e , in in d u s t r ia l l i f e
fa t a l i t i e s s e e m t o c o n s t i t u t e l i t t l e m o r e t h a n 1 p e r c e n t o f t h e t o t a l ,
th u s f a i r l y s u p p o r t in g t h e s t a n d a r d a c c id e n t ta b le .
W h e n a n e f f o r t is m a d e t o d e t e r m in e t h e n u m b e r o f p e r m a n e n t d is
a b ilit ie s in th e U n it e d S ta te s , e v e n g r e a t e r d iffic u lt ie s a r e m e t w it h .
O n ly f o r 10 S ta te s (C a lifo r n ia , M a r y la n d , M ic h ig a n , M a ssa ch u se tts ,
M in n e s o ta , M o n t a n a , N e v a d a , N e w Y o r k , W a s h in g t o n , a n d W i s c o n
s i n ) w e r e d a ta i n r e g a r d t o t h e n a t u r e o f in ju r ie s a v a il a b l e ; b u t i t is
s ig n ific a n t t h a t o u t o f th o s e 10 S ta te s 4 f a ile d t o r e p o r t a n y p e r
m a n e n t i n ju r ie s e x c e p t d is m e m b e r m e n t s , a n d i n 2 t h e n u m b e r r e
p o r t e d is s o s m a ll as t o b e u t t e r ly u n t r u s t w o r t h y . N e w Y o r k r e p o r t s
9 5 3 d is m e m b e r m e n t s a n d o n l y 1 7 o t h e r p e r m a n e n t d is a b ilit ie s , w h i l e
l it t l e N e v a d a r e p o r t s 83 d is m e m b e r m e n t s a n d 1 2 8 o t h e r p e r m a n e n t
d is a b ilitie s , t h u s r e m a r k a b ly s u b s t a n t ia t in g th e s t a n d a r d a c c id e n t
ta b le . A t t h is t im e , t h e r e fo r e , o n l y d is m e m b e r m e n t d a t a a r e a t a ll
d e p e n d a b le in A m e r ic a n a c c id e n t s ta tis tic s .
E lim in a t in g cases o f
lo s s o f o n l y o n e p h a la n x , f e w o f w h ic h r e s u lt i n a n y p e r m a n e n t d i s
a b i l i t y , t h e r e p o r t s o f t h o s e 1 0 S t a t e s s h o w s o m e 1 0 ,0 0 0 d i s m e m b e r
m e n t s a s a g a i n s t 6 ,7 4 5 f a t a l c a s e s , o r a b o u t o n e a n d a h a l f d i s m e m b e r
m e n ts f o r e a ch fa t a l ca se. I t is s a fe t o a ssu m e t h a t p e rm a n e n t p a r
t ia l d is a b ilitie s w it h o u t lo s s o f m e m b e r o r p a r t o f m e m b e r a re a t
le a s t a s n u m e r o u s , s o t h a t a c o n s e r v a t iv e e s t im a t e w i l l b e a t le a s t
th r e e p e r m a n e n t p a r t ia l d is a b ilitie s f o r e a c h fa t a l ca se , as a g a in s t
224
ACCIDENT PROBLEMS.
f o u r a n d a h a l f s h o w n in th e s ta n d a r d a c c id e n t ta b le .
A s s u m in g
e v e n a s m a l l c o n s e r v a t i v e e s t i m a t e o f a b o u t 6 5 ,0 0 0 c a s e s o f m o r e o r
le s s p e r m a n e n t d i s a b i l i t y r e s u l t i n g f r o m i n d u s t r i a l a c c i d e n t s e v e r y
y e a r, i f th e s ta n d a r d a c c id e n t ta b le p r o p o r t io n b e a c ce p te d , th e
n u m b e r r i s e s t o s o m e 9 3 ,0 0 0 .
P e r h a p s a n a p o l o g y is n e c e s s a r y f o r t h i s s t r u c t u r e b u i l t o f e s t i
m a te s a n d g u e sse s, a n d y e t a c a r e fu l a n d c r it ic a l s c r u t in y fa ils t o
d i s c l o s e a n y e s s e n t i a l e r r o r i n t h e r e s u lt s .
T h e n a tu re o f p erm a n en t
i n ju r ie s m a y n o t b e a s g r u e s o m e a s t h a t o f c a s u a lt ie s o f w a r .
The
b a r e fa c t , h o w e v e r , r e m a in s t h a t i n p e a c e fu l t im e s in d u s t r ia l l i f e
c r e a t e s a s m a n y h a n d i c a p p e d p e r s o n s a s w o u l d a n a r m y o f 1 ,0 0 0 ,0 0 0
s o ld ie r s fig h t in g o n th e b a ttle fie ld s o f E u r o p e .
A n d y e t n o t h in g h a s
b e e n s a id , b e c a u s e o f to t a l la c k o f i n fo r m a t io n , c o n c e r n in g th e e ffe c t
o f n o n in d u s tr ia l a c c id e n ts , o f w h ic h th e re m u s t b e a v e r y la r g e n u m
b e r in t h is c o u n t r y .
I t is u n n e c e s s a r y t o a r g u e th a t c o m p e n s a t io n le g is la t io n h a s b ee n
a tr e m e n d o u s ste p in a d v a n c e in f a c in g th is p r o b le m .
B u t h as th e
w h o le p r o b le m b e e n a n y w h e r e m e t a s y e t ?
P r a is e w o r t h y in d e e d a re
th e e ffo r ts t o r e d u c e th e n u m b e r o f in d u s tr ia l a c cid e n ts , b u t p u r e ly
U t o p ia n a r e h o p e s t h a t w e m i g h t e lim in a t e th e m a lto g e t h e r .
In
m a n y o f th e S ta te s th e a m o u n t o f c o m p e n s a t io n p r o v id e d f o r p e r
m a n e n t i n j u r i e s i s s u c h t h a t M r . C o w l e s ’s d e s c r i p t i o n o f c o m p e n
s a t io n a s a n a p o l o g y se e m s p e r f e c t l y ju s t ifie d .
T im e d o e s n o t p e r
m it m e t o e n te r in t o d is c u s s io n o f t h e w h o le su b j e c t o f A m e r ic a n c o m
p e n s a t io n s c a le s f o r p e r m a n e n t d is a b il i t y ca se s.
M oreover, I have
a lr e a d y d o n e s o o n a n o t h e r o c c a s io n , a n d th e s t u d y is a v a ila b le t o
a n y o n e in te r e s te d .
T h is m u c h , h o w e v e r , m a y b e s a id : T h e w h o le
t h e o r y o f s p e c ific b e n e fit s a p p l i c a b l e i n m o s t o f th e S ta te s a n d t h e
t e n d e n c y t o t r e a t p e r m a n e n t d is a b ilit y ( n o t d is m e m b e r m e n t ) ca s e s
in th e s a m e w a y , w h e t h e r a u t h o r it y f o r it is f o u n d in t h e la n g u a g e
o f t h e la w o r n o t , is b a s e d u p o n th e t h e o r y o f r e h a b ilit a t io n , o r , o n e
m ig h t s a y , u p o n th e A m e r ic a n t h e o r y th a t th e p e r m a n e n t d is a b ilitie s
a re r e a lly n o t p e r m a n e n t a t a ll e x c e p t in v e r y ra re ca ses.
U n d o u b t
e d ly , in a g o o d m a n y ca se s r e h a b ilit a t io n is p o s s ib le , ju s t p o s s ib le ,
b u t n o o n e c a n im a g in e f o r a m o m e n t th a t it ta k e s p la c e a u to m a ti
c a ll y n o r u n le s s s y s t e m a t ic e ff o r t is m a d e t o h e lp th e i n ju r e d w a g e
w o r k e r t o w a r d t h is g o a l.
T h is seem s t o b e th e p r a c t ic a l c o n c lu s io n o n e m a y d r a w fr o m th e
c o m p a r i s o n o f in d u s t r i a l a n d m i l it a r y c a s u a lt ie s . T h e p r o b l e m o f i n
d u s t r ia l r e e d u c a t io n o f c r i p p l e d s a ilo r s a n d s o ld ie r s is a s e r io u s p r o b
le m in d e e d . B e c a u s e o f th e p a t r io t ic a n d s e n tim e n ta l a p p e a l it w ill
s c a r c e ly f a i l t o fin d a s a t is fa c t o r y s o lu tio n .
B u t a t w o r s t it is
te m p o r a r y p r o b le m .
T h e p r o b le m o f th e in d u s t r ia l c r ip p le , a lm o s t
e q u a lly g r a v e , is a p e r m a n e n t fe a t u r e o f o u r in d u s t r ia l l if e .
The
t im e is r ip e f o r a c o n c e r t e d m o v e m e n t t o w a r d m a k in g th e r e e d u
COMPARISON OP CASUALTIES— I. M . RU B IN O W .
225
c a t io n o f th e w o r k m a n s e r io u s ly in ju r e d a t w o r k a d e fin ite fe a tu r e
o f o u r c o m p e n s a t io n le g is la t io n .
T h e r e a re on e o r t w o o th e r c o n c lu s io n s th a t m ig h t b e m a d e fr o m
th is b r o a d g e n e r a liz a tio n .
T o b e g in w it h , t h is n e c e s s ity o f r e
h a b ilit a t io n a n d r e c o n s t r u c t io n a d d s a n a d d it io n a l a r g u m e n t a g a in s t
a n y lim it a t io n o f m e d ic a l a id .
Y o u c a n n o t s e r io u s ly a d v o c a te r e
h a b ilit a t io n a n d r e e d u c a tio n a n d lim it m e d ic a l a id t o t w o w eek s.
H o w a re y o u g o in g to p r o v id e a n y fo r m o f a id w h e n su ch lim i
t a t io n is s t a r in g y o u in th e f a c e ?
P e r h a p s t h e r e is ju s t o n e m o r e
c o n c lu s io n w h ic h y o u m ig h t a r r iv e a t, a n d t h a t is th a t th e w h o le
t h e o r y o f r e h a b ilita tio n , r e e d u c a tio n , a n d r e c o n s tr u c tio n o f th e m a n
is a b s o lu te ly o p p o s e d t o a n y t h e o r y o f le a v in g th e w a g e w o r k e r s t o
p r iv a t e in s u r a n c e .
Y o u c a n n o t h a v e p r iv a t e in s u r a n c e a n d a t th e
sa m e tim e h a v e r e h a b ilit a t io n a n d r e e d u c a tio n , w h e r e a ll p r e s s u r e is
l e f t o u t o f c o n s id e r a tio n .
78532°— Bull. 248— 19------- 15
F R ID A Y , A U G U S T 24,1917— M O R N IN G SESSION.
CHAIRMAN, DUDLEY M. HOLMAN, PRESIDENT, I. A . I. A . B. C.
BU SINESS M EETING.
[ I t w a s v o t e d t o h o ld t h e n e x t c o n v e n t io n a t M a d is o n , W is ., a n d
t h e f o l l o w i n g o f f ic e r s w e r e e l e c t e d f o r t h e e n s u i n g y e a r : P r e s i d e n t ,
F . M . W i l c o x , W is c o n s in I n d u s t r ia l C o m m is s io n ; v ic e p r e s id e n t ,
G e o r g e A . K in g s t o n , c o m m is s io n e r , O n t a r i o W o r k m e n ’s C o m p e n
s a tio n B o a r d ; s e c r e ta r y -tr e a s u r e r , R o y a l M e e k e r, U n it e d S ta te s
C o m m is s io n e r o f L a b o r S t a t is t ic s .]
226
F R ID A Y , A U G U S T 24 ,191 7—A F T E R N O O N SESSION .
CHAIRMAN, GEORGE A . KINGSTON, COMMISSIONER, W ORKMEN’S COMPENSATION
BOARD OF ONTARIO.
VL NEEDED CHANGES IN LEGISLATION.
M r . H o lm an . T h e fir s t it e m o n th e a f t e r n o o n p r o g r a m is a p a p e r
p r e p a r e d b y M r . P ills b u r y , c h a ir m a n o f th e C a lifo r n ia S ta te C o m
m is s io n .
M r . P ills b u r y , as y o u k n o w , is n o t h e r e , a n d I w il l a sk
M r . F r e n c h , o n e o f th e m e m b e rs o f th e C a lifo r n ia b o a r d , t o r e a d
M r . P ills b u r y ’s p a p e r .
M r . F ren ch . T h e i m p o r t a n c e o f th e p a p e r t o b e d is c u s s e d a t t h is
tim e c a n n o t b e o v e r e s tim a te d .
A s y o u k n o w , th e S u p re m e C o u rt
o f th e U n it e d S ta te s b y a 5 t o 4 d e c is io n h a s d e c id e d th a t th e S ta te s
d o n o t h a v e ju r is d ic t io n a s r e g a r d s in ju r e d m a r it im e w o r k e r s o r in
m a n y ca se s th a t c o m e u n d e r in te r s ta te la w .
I n C a lifo r n ia w e h a v e
p la n n e d a m u tu a l a g r e e m e n t b e tw e e n e m p lo y e r s a n d , e m p lo y e e s
w h e r e b y th e in d u s tr ia l a c c id e n t c o m m is s io n w ill s e rv e as a b o a r d
o f a r b i t r a t i o n i n c a s e o f d i s p u t e , a n d i t is i n t e r e s t i n g t o n o t e t h a t
b o t h th e e m p lo y e r s a n d e m p lo y e e s w e re p a r t ic u la r ly a n x io u s t o h a v e
th e c o m p e n s a tio n sy s te m c o n t in u e d d e s p ite th e fa c t th a t m a n y o f
th e a tto r n e y s r e p r e s e n tin g th e in s u r a n c e c a r r ie r s a n d s o m e e m p lo y e r s
q u e s tio n e d o u r ju r is d ic t io n u p t o th e tim e th e U n it e d S ta te s S u p r e m e
C o u r t r e n d e r e d its d ic t u m , b u t n o w , r a t h e r t h a n fa c e c o u r t p r o c e e d
i n g s , c o m p e n s a t i o n is p r e f e r r e d .
N e e d le s s t o s a y , th e in ju r e d m a n
a n d e m p lo y e e s g e n e r a lly a ls o h a v e a p r e fe r e n c e f o r w o r k m e n ’s c o m
p e n s a tio n .
T h a t is i n t e r e s t i n g a s s h o w i n g t h e t r e n d d e c i d e d l y a w a y
f r o m e m p lo y e r s ’ l ia b ilit y e v e n t h o u g h th e o p p o r t u n it y b e a v a ila b le
f o r th e e m p lo y e r .
227
C O N F L IC T B E T W E E N F E D E R A L A N D S T A T E JU R IS D IC T IO N S IN
A C C ID E N T C A S E S .
BY A.
J . P IL L S B U R Y ,
C H A IR M A N
OF IN D U S T R IA L
A C C ID E N T
C O M M I S S IO N
OF
C A L IF O R N IA .
[Read by Will J. French, of the Industrial Accident Commission of California.]
SYNOPSIS.
1. W ith a single dissenting vote, this association last year, at Columbus,
adopted a resolution favoring the relinquishment by the Federal Government to
the States o f ju risdiction over injuries sustained in Interstate commerce.
2. The w ork done by the w riter, in pursuance o f such resolution, convinced
him that it w ould be necessary to w ait fo r the United States Supreme Court to
clear the w ay for action.
3. By decision o f the Supreme Court o f the United States in the Jensen case,
a similar conflict in jurisdictions now extends to injuries happening in commerce
by water as wT as by railroad, and w e are confronted by tw o problems instead
ell
o f one.
4. Of the 37 States and Territories now having compensation laws, not all are
beneficent or reasonably adequate to afford needful relief to injured workmen.
5. The interest o f the Federal Government in and responsibility for employees
injured while in the service o f commerce are incidental, indirect, and relatively
immaterial, whereas that o f the States in which they and their fam ilies reside
are proximate, immediate, and vital to the social w elfare o f each Common
wealth.
6. Our 48 free and independent State sovereignties differ one from another in
spirit, habits, customs, standards o f living, and w ays o f viewing questions o f
dom estic policy, and a compensation law that may fit com fortably in one State
might chafe or gall in another. No one law could serve acceptably fo r all.
7. The Federal Government is huge. Upon the National Capital focus the
hundred thousand interests o f a hundred million people, and it is impossible that
such a Government can legislate to fit the individual needs o f the several States.
• 8. All compensation laws are still in a state o f flux and evolution, and needed
amendments that, in any State, may be effected at any session o f a legislature
might conceivably involve 10 years o f effort if dependent upon Congress.
9. The crux o f the issue has been missed by both sides to the controversy.
That crux is that compensation fo r industrial injuries, however and wherever
suffered, has and should have no essential, constitutional connection w ith com
merce, either interstate or intrastate, but is one department o f and belongs to a
general scheme o f local, domestic, social insurance against the hazards o f pov
erty, with which the Federal Government should have only an incidental concern.
10. Therefore, it is neither feasible nor desirable that there be uniform ity o f
compensation legislation throughout the United States in relation to injuries
sustained w hile in the service o f transportation by railroad or by water.
11. Federal ju risdiction over injuries sustained in the service o f transportation
by railroad can, w ithout amendment o f the Federal Constitution, and by right
ought to be, relinquished to the States, and the same principle holds equally true
o f service in transportation by water if it can be legally effected.
12. There are no practical difficulties in the w ay o f such relinquishment. The
hindrances are all technical, artificial, legalistic, and would not have existed
i f the fifth man on the bench o f the Supreme Court o f the United States had
held w ith the dissenting four, who had the weight o f argument and reasonable
ness on their side, but, unfortunately for hundreds o f thousands o f toilers in
hazardous industries, lacked one vote.
228
JURISDICTION IN ACCIDENT CASES-----A. J . PILLSBURY.
229
13. What, if anything, is this association going to do about these unfortunate
conflicts between Federal and State jurisdictions over industrial injuries hap
pening in the transportation service, whether by rail or by w ater? Several pos
sible courses have been suggested, but this association can not, in view o f its
lim it as to time and crowded program, venture to choose the w isest course and
fram e the requisite legislation.
14. Therefore, it is respectfully submitted that a standing committee o f five
earnest and discreet persons, to be selected by the president and secretarytreasurer o f this association jointly, be constituted, w ith full power to act, and
that such committee be directed to assemble in W ashington, D. C., in October o f
this year, fo r the purpose o f form ulating and prom oting such a plan and cam
paign fo r elim inating conflicts in jurisdiction between Federal and State ju ris
diction in cases involving industrial injuries happening in transportation by
railroad and by wT
ater, w ithout regard to whether such commerce be interstate
of* in trastate; and that the good faith and cooperation o f this association be
pledged to the support o f such plan when perfected by such committee.
I h a d th e h o n o r la s t y e a r a t C o lu m b u s , O h io , t o a d d r e s s t h is a s s o
c ia t io n in p e r s o n u p o n t h is sa m e s u b je c t, a n d , w it h a s in g le d is s e n t in g
v o te , th e a s s o c ia tio n a d o p te d th e r e s o lu t io n f o l l o w i n g :
R esolved by the International A ssociation o f Industrial Accident Boards and
Commissions in its third annual m eeting, held at Columbus, Ohio, A pril 25-28,
1916, That Congress be, and it is hereby, memoralized to so amend the employ
ers’ liability act o f 1908-1910, and any Federal compensation law that may be
enacted, as to exempt from the operation o f such law or act all States and T erri
tories o f the United States having in operation com pulsory compensation laws
competent to afford adequate protection to employees engaged in transportation
by railroad, whether in interstate or intrastate commerce, and to perm it rail
roads and their employees to elect to operate under compensation laws in States
in which such laws are elective, thereby divesting injuries sustained in trans
portation by railroad o f their interstate character in all such States, w hile
retaining under Federal jurisdiction all States and T erritories which do not
enact and enforce laws providing fo r adequate compensation to injured w ork
men w ithout regard to negligence.
E q u ip p e d w it h th is in d o r s e m e n t I w e n t t o N e w Y o r k a n d P h i l a
d e lp h ia a n d h e ld c o n fe r e n c e s w it h th e h e a d s o f th e c la im s d e p a r t
m e n ts o f s e v e r a l o f th e g r e a t r a ilr o a d sy stem s.
A t C le v e la n d I w a s
a b le t o m e e t a n d p r e s e n t th e m a tte r t o t w o o r th r e e in flu e n tia l p e r s o n s
c o n n e c te d w it h th e r a ilr o a d b r o th e r h o o d s , a n d a t W a s h in g t o n I h e ld
s e v e r a l c o n fe r e n c e s w it h th e W a s h in g t o n r e p r e s e n ta tiv e s o f a ll o f th e
r a ilr o a d b r o th e r h o o d s .
M a k in g a llo w a n c e s f o r th e u r b a n it y o f th e
g e n t le m e n w h o m I m e t, I t h in k t h a t I m a y s a y t h a t th e id e a set f o r t h
in th e r e s o lu t io n se e m e d to m e e t a fa v o r a b le r e c e p t io n , a n d in th e ca se
o f th e P e n n s y lv a n ia R a ilr o a d I fo u n d in o p e r a tio n , b y a s o r t o f g e n
tle m e n ’s a g re e m e n t b e tw e e n th e c o m p a n y a n d th e m e n , a s y s te m
w h e r e b y it w a s u n d e r s to o d th a t i f in ju r e d m e n w o u ld n o t su e f o r d a m
a g e s w h e r e n e g lig e n c e m ig h t b e e s t a b lis h e d , t h e y w o u ld b e p a id c o m
p e n s a tio n as i f t h e y w e r e u n d e r th e c o m p e n s a t io n la w s o f th e S ta te
in w h ic h e a c h e m p lo y e e r e s id e d a t th e tim e o f s u s ta in in g th e in ju r y .
230
NEEDED CHANGES IN LEGISLATION.
W h e n I c a m e t o ta k e u p th e s u b je c t w it h M e m b e r s o f C o n g r e s s I
f o u n d , a s I h a d a n t i c i p a t e d , t h a t i t w a s t h e n t o o l a t e i n t h e s e s s io n t o
s ta r t a n y n e w t h in g , a n d , w h a t I a ls o fo r e k n e w t o b e tr u e , t h a t i t
w o u ld b e n e ce s s a r y t o w a it u n til th e S u p re m e C o u r t o f th e U n it e d
S t a t e s h a d , s o t o s p e a k , c le a r e d t h e d e c k s f o r a c t io n .
I t w a s at th a t
tim e g e n e r a lly b e lie v e d th a t a d e c is io n in th e r a ilr o a d ca ses fr o m
N e w Y o r k a n d N e w J e r s e y w o u ld b e r e n d e r e d p o s s ib ly in M a y , b u t
a lm o s t c e r t a in ly in J u n e , a n d I r e tu r n e d h o m e w ith th a t e x p e c t a t io n
i n m in d . T h e s e ca ses w e r e d e c id e d in M a y , b u t M a y , 1 9 1 7 , in s te a d
o f 1916.
M e a n tim e a n y p la n s t h a t I m a y h a v e h a d f o r f o r w a r d i n g
t h e m o v e m e n t s ta r te d a t C o lu m b u s w e r e e ffe c t u a lly s ta y e d b y th e
n o n a c t io n o f th e S u p r e m e C o u r t o f th e U n ite d S ta te s. T h e r e w a s
n o t h i n g t o d o b u t t o m a r k t im e , a n d I m a r k e d it.
A SOURCE OF OPPOSITION.
T h e m o s t im p o r t a n t s o u r ce o f o p p o s it io n t o c o m p e n s a tio n le g is la
t i o n in a n y f o r m is t h a t o f t h e r a il r o a d e m p lo y e e s t h e m s e lv e s , v o ic e d
b y t h e ir lo c a l o r g a n i z a t i o n s a t h o m e , a n d t h e r e a s o n f o r t h is o p p o
s it io n w a s n e it h e r d iffic u lt t o a s c e r t a in n o r t o u n d e r s t a n d .
I have
n e v e r k n o w n a r a ilr o a d tr a in m a n w h o w a s in ju r e d w h o d id n o t w a n t
c o m p e n s a t io n f o r h is in ju r y u n d e r o u r c o m p e n s a t io n la w , a n d I h a v e
n o t c o n v e r s e d w it h o n e o n th e s u b je c t w h o w a s n o t fa v o r a b le t o th e
id e a . W h e r e v e r r a ilr o a d c la im a g e n ts fe e l th a t a b a s is o f n e g lig e n c e
m i g h t b e e s ta b lis h e d a g a in s t th e m t h e y a r e q u ic k t o s e ttle o n a c o m
p e n s a t io n b a s is i f t h e y c a n , a n d in o u r S ta te th e r e h a v e b e e n in s ta n c e s
in w h ic h th e p a r tie s s tip u la te d th a t o u r c o m m is s io n h a d ju r is d ic t io n
w h e n w e w e re p re tty su re th a t w e h a d n o t, a n d a w a rd s h a v e b een
m a d e o n s u ch s t ip u la t io n s a n d d u ly p a id .
N e v e r th e le s s , o p p o s it io n
t o a F e d e r a l o r a n y k in d o f a c o m p e n s a t io n la w d o e s e x is t in th e
lo c a l o r g a n iz a tio n s o f r a ilr o a d m e n , a n d th a t o p p o s it io n h a s u n til
n o w b e e n e ffe c tiv e t o b lo c k a ll su ch le g is la tio n .
T h e r e a s o n f o r s u c h o p p o s i t io n is t h is : A l l o v e r t h e c o u n t r y c e r
t a i n y o u n g m e n w h o h a v e g o n e in t o t h e t r a in s e r v ic e o f r a ilr o a d s
h a v e b e e n in ju r e d . B y r e a s o n o f th e s e v e r it y o f t h e ir in ju r ie s t h e y
h a d t o g iv e u p r a ilr o a d w o r k . S o m e o f th e m s tu d ie d la w , w e r e a d
m it t e d t o th e b a r , a n d n a t u r a lly g r a v it a t e d in t o d a m a g e -s u it lit i g a
t io n , c h ie fly o n b e h a l f o f t h e ir fo r m e r f e l l o w e m p lo y e e s a n d a g a in s t
th e r a ilr o a d s .
T h e y h a v e r e ta in e d t h e ir m e m b e r s h ip in th e lo c a l
o r g a n iz a t io n s o f r a ilr o a d e m p lo y e e s a n d th e ir in flu e n c e in th e m is
g r e a t. T h e y sa w in th e e n a c tm e n t o f c o m p e n s a tio n la w s a s e r io u s
im p a ir m e n t , i f n o t d e s t r u c t io n , o f th e la w b u s in e s s t h e y h a d b u ilt
u p a n d n o t u n n a tu r a lly c o n c lu d e d th a t w h a t w a s b a d f o r th e m m ig h t
a ls o b e b a d f o r t h e r a il r o a d t r a in m e n t h e m s e lv e s . T h e y w e r e a b le t o
p e r s u a d e th e m e m b e r s o f th e lo c a ls t o w h ic h th e y b e lo n g th a t in
JURISDICTION IN ACCIDENT CASES---- A. J . PILLSBURY.
231-
r e lin q u is h in g th e r ig h t t o su e f o r d a m a g e s w h e re n e g lig e n c e ca n b e
e s t a b lis h e d t h e y w e r e g i v i n g u p a r ig h t o f c it iz e n s h ip w h ic h s h o u ld
b e in a lie n a b le a n d a t th e s a m e tim e t o h o ld o u t th e g a m b le r ’s c h a n c e
f o r a w h o p p i n g b i g v e r d ic t w h e n a s u it c a n s u c c e s s f u lly b e m a i n
t a in e d u n d e r th e F e d e r a l e m p lo y e r s ’ l ia b i l it y a c t o f 1 9 0 8 -1 9 1 0 .
I w o u ld n o t m in im iz e th e im p o r t a n c e o f th is o p p o s it io n t o th e
p la n o u t lin e d in th e r e s o lu t io n a d o p te d b y t h is a s s o c ia tio n la s t y e a r ,
b u t I d o n o t r e g a r d it as in s u r m o u n ta b le . I t h a s m a d e th e le a d e r s in
th e b r o t h e r h o o d s o f tr a in m e n e it h e r t im id o r d is c o u r a g e d , b u t th e
o b je c t le s s o n s d e r iv e d f r o m th e o p e r a t io n o f b e n e fic e n t c o m p e n s a t io n
la w s in a ll o th e r b r a n c h e s o f in d u s t r y w ill, in th e c o u r s e o f tim e ,
o p e n th e e y e s a n d c h a n g e th e v ie w s o f t r a in m e n in a ll S ta te s h a v i n g
a d e q u a te c o m p e n s a t io n la w s .
NOT ALL COMPENSATION LAW S BENEFICENT.
J u s t h e r e is a v u ln e r a b le p o i n t in o u r a r m o r .
O f th e 37 S ta te s
h a v i n g c o m p e n s a t i o n l a w s , le s s t h a n h a l f o f t h e m c o n f e r b e n e f i t s
th a t a re a d e q u a te t o p r e v e n t th a t p o v e r t y a r is in g o u t o f in d u s tr ia l in
ju r ie s w h ic h ju s t ifie s t h e e x is te n c e o f s u c h la w s . I n n o t a f e w o f t h e
S t a t e s t h e e n t ir e c o m p e n s a t io n b e n e fits r e c e iv a b le w i l l n o t c o v e r t h e
s u r g ic a l a n d h o s p it a l c o s ts in ca se s o f s e r io u s in ju r y . S u c h c o m p e n
s a tio n la w s a re fa ls e p re te n se s, a n d n o b e tte r s e r v ic e ca n b e r e n d e r e d
t o th e ca u se o f d is s o lv in g th e c o n flic t b e tw e e n F e d e r a l a n d S ta te
ju r is d ic t io n s o v e r in ju r ie s s u s ta in e d in t r a n s p o r t a t io n b y w a t e r a n d
r a il r o a d t h a n t o b r i n g t h e b e n e fit s p r o v id e d b y t h e c o m p e n s a t io n la w s
in illib e r a l S ta te s u p t o a ju s t s ta n d a r d ; a n d , p a r i p a ssu , n o b e tte r
s e r v ic e c a n b e r e n d e r e d t o th e ca u se o f b r in g i n g c o m p e n s a t io n la w s in
illib e r a l S ta te s u p t o a lib e r a l s ta n d a r d th a n t o h a v e th e F e d e r a l
G o v e r n m e n t fix a ju s t s t a n d a r d in p u r s u a n c e o f th e r e s o lu t io n
a d o p t e d b y t h is a s s o c ia t io n a t C o lu m b u s la s t y e a r . W h a t e v e r is d o n e
f o r e ith e r ca u s e h e lp s b o th .
TWO FIELDS OF CONFLICT INSTEAD OF ONE.
I n a p a p e r p r e s e n te d a y e a r a g o u p o n th e s u b je c t o f c o n flic t s b e
tw e e n F e d e r a l a n d S ta te ju r is d ic t io n s in c o m m e r c e ca se s, I c o n fin e d
m y s e lf w h o lly t o s u ch c o n flic ts a s a r o s e o u t o f t r a n s p o r t a t io n b y
r a ilr o a d .1 A t th a t tim e it se e m e d t o m e t o b e a lto g e th e r u n lik e ly
th a t th e ju r is d ic t io n s o f th e s e v e r a l S ta te s o v e r in ju r ie s h a p p e n in g
u p o n t h e ir o w n n a v ig a b le w a te r s w o u ld b e s e r io u s ly in t e r fe r e d w ith .
T h e fa c t th a t th e d o c tr in e th a t th e ju r is d ic t io n o f a S ta te o v e r its
o w n s h ip s f o l l o w s th e m w h e r e v e r t h e y g o o n th e h ig h sea s w a s a ls o
w e ll e s t a b lis h e d , le d m e t o th e c o n c lu s io n t h a t th e w h o le fie ld w a s
1 At the meeting of the International Association o f Industrial Accident Boards and
Commissions, held at Columbus, Ohio, April 25-28, 1916. Paper reprinted in Bulletin
210 of the Bureau of Labor Statistics, pp. 33-55.
232
NEEDED CHANGES IN LEGISLATION.
f a i r l y c o v e r e d b y S ta te ju r is d ic t io n . W h e n , o n F e b r u a r y 3, 1917, th e
S u p r e m e C o u r t o f C a lif o r n ia , in a v e r y a b le o p in io n , s u s ta in e d t h e
ju r is d ic t io n o f o u r c o m m is s io n in u n e q u iv o c a l te rm s , I f e lt th a t o u r
a s s u m p t io n o f ju r i s d ic t io n w a s d o u b ly a ssu re d .
I h a d le f t th e S u p r e m e C o u r t o f th e U n it e d S ta te s o u t o f m y
r e c k o n in g .
I t s d e c i s i o n i n S o u t h e r n P a c i v. c J C n s e n p r e c i p i
fi e o .
ta te d c h a o s w h e r e o r d e r w a s e v o lv in g . T h is w a s a n in s ta n c e w h e re
a p r e p o n d e r a n c e o f s o u n d a r g u m e n t w a s o n o n e s id e a n d th e p r e
p o n d e r a n c e o f v o t in g p o w e r o n th e o th e r , a s itu a tio n th a t o c c u r s n o t
in fr e q u e n tly .
I t h a s b e e n a h o b b y o f m in e f o r m a n y y e a r s th a t w h e r e , as in t h is
c a s e , c o u r t s o f l a s t r e s o r t d i v i d e n e a r l y e q u a l l y u p o n is s u e s i n v o l v i n g
N a t io n a l o r S t a t e p o l i c y , t h e d e c is io n s h o u ld n o t b e fin a l, b u t t h e is s u e
s h o u ld a u t o m a t ic a lly a n d a t o n c e b e r e fe r r e d t o C o n g r e s s o r th e
le g is la t u r e in o r d e r th a t th e p e o p le , b y t h e ir r e p r e s e n ta tiv e s , m a y
d e te r m in e w h ic h o f th e t w o p o lic ie s s h a ll b e th e la w o f th e l a n d ;
b u t I d o n o t r e m e m b e r e v e r to h a v e fo u n d a ju d g e o r ju s t ic e w h o
a g r e e d w ith th a t v ie w .
A fu n d a m e n t a l n e c e s s ity , b e f o r e a n y r e m e d ia l a c t io n c a n b e ta k e n ,
is t o a s c e r t a in p r e c is e ly t h e e x is t i n g s t a t e o f t h e la w g o v e r n i n g t r a n s
p o r t a t io n b y r a il a n d b y w a te r , r e s p e c t iv e ly .
THE L A W REGARD IN G TRANSPORTATIO N B Y RAILRO AD .
T h e d e c is io n s o f th e S u p r e m e C o u r t o f th e U n ite d S ta te s in th e
t w o W in fie ld c a s e s 1 d id n o t m a t e r ia lly a lte r th e sta tu s r e la tin g t o
t r a n s p o r t a t io n b y r a ilr o a d , b u t o n ly c le a r e d u p a f e w n o t v e r y d o u b t
f u l p o in t s . T h e F e d e r a l s ta tu te is e x c lu s iv e w h e r e , a t th e in s t a n t o f
th e h a p p e n in g o f a n in ju r y , th e e m p lo y e e is e n g a g e d in an a ct o f in
te r s ta te c o m m e r c e o r o n e so c lo s e ly c o n n e c te d w it h it as n o t t o b e
s e p a r a b le f r o m it. W h e r e n e g lig e n c e c a n n o t b e im p u t e d n o l ia b ilit y
e x is ts . T h e r is k s o f t h e e m p lo y m e n t a ll r e s t u p o n t h e e m p lo y e e s . I n
th e se ca ses, as in th e J e n s e n ca se, th e m o r e c o n v in c in g a r g u m e n ts
w e r e m a d e b y th e d is s e n tin g m e m b e r s o f th e c o u r t , b u t th e o t h e r s id e
h a d th e v otes.
O n th e o th e r h a n d , w h e re , a t th e in s ta n t o f th e h a p p e n in g o f th e
in ju r y , th e e m p lo y e e is e n g a g e d in a n a c t o f in tr a s ta te c o m m e r c e , o r
a n a c t c le a r ly s e p a r a b le f r o m in te r s ta te c o m m e r c e , th e ju r is d ic t io n o f
th e S ta te s is e x c lu s iv e a n d p le n a r y a n d F e d e r a l a u t h o r it y c a n n o t
t a k e c o g n iz a n c e o f s u c h i n ju r ie s u n le s s th e C o n s t it u t io n o f t h e U n it e d
S t a t e s is s o a m e n d e d a s t o p e r m i t i t , w h i c h i s s o u n l i k e l y a s t o b e w e l l n ig h u n th in k a b le , o r th e U n it e d S ta te s S u p r e m e C o u r t r e v e r s e s a
1 New York Central Railroad Co. v. Winfield, and Erie Railroad Co. v. Winfield, May,
1917. In these cases the Supreme Court, with two justices dissenting, held that when an
employee engaged in interstate commerce was injured his only right to recover arose from
the provision of the Federal employers’ liability act. The power of the States to supple
ment such legislation was denied.
JURISDICTION IN ACCIDENT CASES---- A. J . PILLSBURY.
233
l o n g l i n e o f i t s o w n d e c i s i o n s , w h i c h is a l s o e x t r e m e l y u n l i k e l y t o
happen.
T h e r e fo r e , w h ile , in t h e o r y , a ll c o n flic t b e tw e e n F e d e r a l a n d S ta te
j u r i s d i c t i o n s is c l e a r e d u p a n d a p l a i n l i n e o f d e m a r c a t i o n e s t a b l i s h e d ,
in p r a c t ic e it is f r e q u e n t ly , i f n o t u s u a lly , n e c e s s a r y t o t r y e a c h c a s e
i n o r d e r t o a s c e r t a in w h e t h e r o r n o t th e t r ib u n a l u n d e r t a k in g t o
h e a r a n d d e te r m in e th e c o n t r o v e r s y h a s ju r is d ic t io n o v e r th e p a r tie s
t o th e p r o c e e d in g .
T h e s it u a t io n is a b s u r d .
R o u g h l y s p e a k in g it
m a y b e s a id , h o w e v e r , th a t in ju r ie s t o tr a in m e n a n d m e n e m p lo y e d
u p o n m a in te n a n c e o f w a y w ill f a l l u n d e r F e d e r a l a u th o r ity , w h ile
s h o p m e n a n d o f f ic e e m p l o y e e s m a y b e u n d e r t h e p r o t e c t i o n o f S t a t e
la w s — w it h a b u n d a n t e x c e p t io n s t o a ll s u ch g e n e r a l r u le s f o r p r e
d e te r m in in g ju r is d ic tio n .
T h e r a ilr o a d e m p lo y e e s o f th e U n it e d
S ta te s a re , in t h is r e s p e c t, u n d e r h a r d b o n d a g e .
THE L A W REG ARD IN G TRANSPORTATION B Y W A T E R .
I n o n ly o n e p a r t ic u la r d id th e J e n s e n d e c i s i o n 1 m a k e c le a r a n d
c o n c l u s i v e t h e e x c l u s i v e c h a r a c t e r o f F e d e r a l j u r i s d i c t i o n , a n d t h a t is
w it h r e fe r e n c e to in ju r ie s h a p p e n in g u p o n th e h ig h sea s a n d n a v i
g a b le w a ters.
E v e n th e n it c o n c e d e s th a t th e g e n e r a l b o d y o f m a r i
t im e la w m a y , t o s o m e e x te n t, b e c h a n g e d , m o d ifie d , o r a ffe c te d b y
S ta te le g is la tio n , b u t d o e s n o t a tte m p t t o te ll h o w fa r .
U p t o t h e t i m e o f t h e - d e c is i o n o f t h e J e n s e n c a s e t h e p r i n c i p l e h a d
b e e n r e g a r d e d a s w e ll e s t a b lis h e d in a d m ir a lt y la w t h a t j u r i s d ic t io n
o v e r c o n t r a c ts d e p e n d e d u p o n th e s u b je c t m a t t e r o f th e c o n t r a c t, r e
g a r d le s s o f th e lo c a lit y o f th e tr a n s a c tio n .
I t h a d b e e n e q u a lly w e ll
e s t a b lis h e d t h a t ju r i s d ic t io n o v e r t o r t s d e p e n d e d w h o ll y u p o n t h e
lo c a lit y w h e r e th e t o r t w a s c o m m itte d , t o w it, u p o n th e h ig h seas o r
n a v ig a b le w a ters.
A r e p r o c e e d in g s u n d e r a w o r k m e n ’s c o m p e n s a t io n a c t fo u n d e d in
c o n t r a c t o r in t o r t ? I f in c o n t r a c t, th e n , u n d e r a n e le c t iv e la w , a t a ll
e v en ts, th e e m p lo y m e n t o f a s te v e d o re w o u ld , in th e la n g u a g e o f M r.
J u s t ic e M c R e y n o l d s , b e “ m a r it im e in it s n a t u r e ,” a n d ju r i s d ic t io n
1 Southern Pacific Co. v. Jensen, May, 1017, four justices dissenting. The plaintiff in
this case was the widow of a stevedore engaged in unloading a steamship in New York
Harbor. The vessel was owned by a railroad company, which also operates a steamship
line plying between the ports of New York and Galveston. An award in the claimant’s
favor had been made by the State workmen’s compensation commission in October, 1914,
and was approved by the various courts of the State. (Jensen v. Southern Pacific Co.,
215 N. Y. 514, 109 N. E. 600; see Bui. No. 189, U. S. Bureau of Labor Statistics, pp.
221-224.) The New York courts had held that the case was not covered by the Federal
statute governing interstate carriers by railroad, and as no statute had been enacted by
Congress governing carriers by water, there was no Federal legislation applicable to the
case. The decision of the Supreme Court was identical so far as the application of the
Federal liability law was concerned, but an objection raised by the company to the
decision of the court below that the compensation law was “ unconstitutional in that it
violates Article III, section 2, of the Constitution, conferring admiralty jurisdiction upon
the courts of the United States,” was upheld by the Supreme Court as regards the par
ticular portion applying the law to maritime injuries. See Monthly Review of the
Bureau o f Labor Statistics for July, 1917 (p. 101), for further account of this case.
234
NEEDED CHANGES IN LEGISLATION.
w o u ld v e s t in a d m ir a lt y c o u r t s w h e th e r th e i n ju r y h a p p e n e d o n s h ip
o r o n d o c k ; b u t i f fo u n d e d in t o r t , a d m ir a lt y ju r is d ic t io n w o u ld e x is t
o n ly w h e n th e in ju r y h a p p e n e d o n s h ip a n d n o t o n d o c k .
P e r s o n a lly ,
I a m o f t h e o p i n i o n t h a t , a t le a s t i n S t a t e s w h e r e c o m p e n s a t io n is c o m
p u ls o r y , c la im s t h e r e f o r a r is e o u t o f n e it h e r c o n t r a c t n o r t o r t , b u t o u t
o f sta tu s, o u t o f a c o n d it io n w h ic h th e la w c re a te s a t th e b e h e s t o f
th e p o lic e p o w e r o f g o v e r n m e n t.
I f , as see m s p o s s ib le u n d e r th is d e c is io n , a lt h o u g h n o t fin a lly d e te r
m in e d , a s a ilo r o r s t e v e d o r e , i n ju r e d u p o n a w h a r f , c a n n o t b r i n g s u it
in a d m ir a lt y f o r t o r t , b e ca u s e th e in ju r y d id n o t h a p p e n o n n a v ig a
b l e w a te r s , a n d a ls o c a n n o t c la im c o m p e n s a t io n b e c a u s e th e “ w o r k o f
a s te v e d o r e is m a r it im e in its n a t u r e ,” w h a t c a n th e m a n d o ?
H e
is in a “ n o - m a n ’s l a n d ,” w it h n o r i g h t o f r e d r e s s in a n y c o u r t o r
c o m m is s io n .
I n th e J e n s e n ca se th e a c c id e n t h a p p e n e d u p o n a s h ip a n d , th e r e
f o r e , it w a s n o t in d is p e n s a b ly n e c e s s a r y t o a d e c is io n o f th e ca se a t
b a r t h a t t h e c o u r t i n d ic a t e w h a t w o u ld h a v e b e e n its d e c is io n i f t h e
a c c id e n t h a d h a p p e n e d o n th e d o c k , a n d th e p o in t w a s p a s s e d w it h
o u t a t a ll c o n s id e r in g th a t im p o r t a n t d iffe r e n c e .
I t ca n n o t h a v e b ee n th e in te n tio n o f th e S u p r e m e C o u r t o f th e
U n it e d S ta te s to c re a te a t w ilig h t z o n e in w h ic h n o r ig h t o r r e m e d y
e x is ts .
S u c h a c o n d it io n is a s r e p u g n a n t t o la w as a v a c u u m t o
n a tu re . I t w o u ld seem , th e r e fo r e , th a t, in fu t u r e d e c is io n s , th e c o u r t
m u st d o on e o f tw o t h in g s :
1. D e c i d e t h a t a d m i r a l t y j u r i s d i c t i o n d o e s e x t e n d t o c o v e r a l l i n
ju r ie s t o s a ilo r s o r s te v e d o r e s w it h o u t r e g a r d t o w h e th e r th e r ig h t
b e fo u n d e d in c o n tr a c t, t o r t , o r sta tu s, a n d w it h o u t r e g a r d t o w h e th e r
t h e i n ju r y h a p p e n s o n s h ip , d o c k , d r y d o c k , o r e ls e w h e r e , s o th a t it b e
w h ile in th e p e r fo r m a n c e o f a s e r v ic e in t r a n s p o r ta tio n b y w a t e r ; o r
2. I t c a n d e fin e a d m ir a lt y ju r i s d ic t io n as e x t e n d in g t o i n ju r ie s
h a p p e n in g o n s h ip b o a r d o r g a n g p la n k , le a v in g t o th e c o m p e n s a tio n
o r n e g lig e n c e la w s o f th e s e v e r a l S ta te s th e ju r is d ic t io n o v e r a ll s u c h
in ju r ie s n o t so h a p p e n in g .
I t is n o t in c u m b e n t u p o n m e a t t h is t im e t o v e n t u r e a n y c o n je c t u r e
a s t o w h a t a t t i t u d e t h e S u p r e m e C o u r t w i l l t a k e w h e n t h e p o i n t a r is e s .
I t is s u ffic ie n t f o r th e p r e s e n t t o p o i n t o u t t h a t a c o n f lic t o f j u r i s d i c
t i o n b e t w e e n F e d e r a l a n d S t a t e G o v e r n m e n t s a s c e r t a in ly e x is ts r e la
t iv e t o in ju r ie s s u s ta in e d b y e m p lo y e e s e n g a g e d in t r a n s p o r t a t io n
b y w a t e r a s b y r a il a n d e n t a ils g r e a t h a r d s h ip u p o n l a b o r e n g a g e d
i n t h is d a n g e r o u s o c c u p a t io n .
T h e q u e s tio n f o r u s t o d e a l w it h a t
th is tim e i s : W h a t a re w e g o in g t o d o a b o u t it ?
A STOP-GAP ARRAN GEM EN T.
I n C a lif o r n ia e m p lo y e r s a n d th e ir e m p lo y e e s e n g a g e d in tr a n s
p o r t a t i o n b y w a t e r h a v e t r i e d o u r c o m p e n s a t io n la w a n d lik e it. W e
JURISDICTION IK ACCIDENT CASES— A. J . PILLSBURY.
235
c la im e d ju r is d ic t io n , e x t r a t e r r it o r ia l a n d a ll, a n d u n t il th e J e n s e n
ea se u p s e t u s, w e h a d m a d e it s tick .
B o t h s id e s w is h t o c o n t in u e
u n d e r th e a ct.
O u r c o m m i s s i o n t e n d e r e d i t s g o o d o ff ic e s t o b o t h
s id e s in a n e ff o r t t o b r in g a b o u t a n a g r e e m e n t w h e r e b y th e p a r t ie s
m a y c o n t r a c t th a t, in th e e v e n t o f in ju r y , th e in ju r e d e m p lo y e e w ill
a c c e p t, a n d th e e m p lo y e r w ill p a y , c o m p e n s a tio n in a c c o r d a n c e w it h
th e te r m s o f o u r a c t, ju s t as t h o u g h th e y w e r e u n d e r it, th e y a ls o
m u t u a lly a g r e e in g t h a t , i n t h e e v e n t o f c o n t r o v e r s y , th e is s u e s h a ll b e
p u t u p to th e in d u s tr ia l a c c id e n t c o m m is s io n f o r d e te r m in a tio n , as
h e r e t o f o r e , a n d t h a t b o t h s id e s w i l l a b id e b y t h e r e s u lt .
I t is n o t d o u b t e d t h a t s o f a r as t h e m e n t h e m s e lv e s , a n d t h e i r e m
p lo y e r s a re c o n c e r n e d , su ch a c o n tr a c t ca n b e e n fo r c e d a n d th a t a n y
c o u r t o f a d m ir a lt y w o u ld r e c o g n iz e i t , f o r t h e r e is in a d m ir a lt y la w
n o p r o h i b i t i o n a g a i n s t “ c o n t r a c t i n g o u t ” a s t h e r e is i n t h e F e d e r a l
e m p l o y e r s ’ l ia b i l it y a c t. T h e o n l y t r o u b le is t h a t th e e m p lo y e e c a n
n o t b a r th e r ig h t , in th e e v e n t o f h is d e a t h b y i n ju r y , o f a d e p e n d e n t
t o su e in a d m ir a lty .
T h i s is n o t c a u s in g e m p lo y e r s m u c h u n e a s i
n e s s , in a s m u c h a s, w h e n e v e r a s a ilo r o r s t e v e d o r e lo s e s h is l i f e as a
r e s u lt o f i n ju r y , t h e p l i g h t o f h is d e p e n d e n t s is g e n e r a lly s o s e r io u s
t h a t c o m p e n s a t io n i n h a n d is f a r m o r e a t t r a c t iv e t o t h e m t h a n a n
a c t io n f o r d a m a g e s u p o n w h ic h n o t h in g c a n b e r e a liz e d f o r y e a r s t o
com e.
O u r S ta te c o m p e n s a tio n in s u r a n c e fu n d is s e llin g p o lic ie s
t o m a r it im e e m p lo y e r s ju s t a s t h o u g h th e J e n s e n c a s e h a d n e v e r b e e n
d e c i d e d , a n d w i l l p a y t h e b e n e f it s , a n d i s p a y i n g t h e m o n p o l i c i e s
h e r e t o fo r e s o ld , w it h o u t r e g a r d t o th a t d e c is io n .
I
a m h o p e fu l th a t th e a rra n g e m e n t h e re o u tlin e d m a y v e r y g e
e r a lly b e e ffe c te d th r o u g h o u t th e S ta te o f C a lifo r n ia , a lth o u g h w e
a re ju s t n o w in th e p ro c e s s o f g e t t in g to g e th e r. I f it su cce e d s, o th e r
S t a t e s m a y p r o f i t b y o u r e x a m p l e . H o w e v e r , t h i s d e v i c e is i n t e n d e d
t o la s t o n l y u n t il o r d e r s h a ll h a v e b e e n b r o u g h t o u t o f t h is c h a o s ,
e it h e r t h r o u g h F e d e r a l le g is la t io n o r j u d i c i a l r e in t e r p r e t a t io n .
WHO IS THE PR O X IM A T E P A R T Y IN IN TE REST?
T h e v e r y t h e o r y u p o n w h ic h fr e e S ta te s fe d e r a t e a s a n a tio n is
t h a t th e F e d e r a l a u t h o r it y s h a ll b e s u p r e m e in a ll th o s e fu n c t io n s o f
g o v e r n m e n t w h ic h p r o x im a t e ly c o n c e r n th e w e lfa r e o f a n a t io n as a
w h o le , a n d th a t a ll o t h e r fu n c t io n s o f g o v e r n m e n t a r e r e s e r v e d t o
a n d r e s id e in th e S t a t e s s e v e r a lly a n d t h e ir s u b d iv is io n s .
W h e r e , th e n , v e s ts t h e p r o x im a t e , im m e d ia t e , a n d v it a l in te r e s ts in
th e w e lfa r e o f e m p lo y e e s e n g a g e d in tr a n s p o r t a t io n , w h e th e r b y
r a il o r w a te r ? A fr e ig h t tr a in lo a d e d w it h o r ie n ta l c o m m e r c e p u lls
o u t o f th e O a k la n d y a r d b o u n d f o r m a r k e ts in th e M id d le W e s t o r
E a s t . T h e r e is a w a s h o u t , t h e l o c o m o t i v e g o e s in t o t h e d it c h , a n d
iw it h i t t h e l o c o m o t i v e e n g i n e e r .
I s th e re a n y w a y b y w h ic h th e
236
NEEDED CHANGES IN LEGISLATION.
F e d e r a l G o v e r n m e n t c a n b e m a d e r e s p o n s ib le f o r o r r e n d e r a id t o
th a t e n g in e e r i f c r ip p le d , o r t o h is fa m ily i f h e is k ille d ? W h o m u s t
see t o th e e d u c a t io n o f h is c h ild r e n a n d , i f p o v e r t y p lu n g e s t h e m fir s t
in t o d e lin q u e n c y a n d a ft e r w a r d in t o c r im in a lit y , is i t t h e S ta te o r th e
N a t io n th a t p r o x im a t e ly s u ffe r s ?
A s h ip s te a m s o u t t h r o u g h th e G o ld e n G a t e b o u n d f o r th e A la s k a
fis h e r ie s . A s t e a m p i p e b u r s t s a n d a m a r in e e n g in e e r is s c a ld e d . I s
h is d e p e n d e n t f a m i l y w it h in th e k e e p in g o f th e N a t io n o r th e S ta te ?
W h o p a y s t h e w i f e h e r w id o w ’s p e n s io n t h a t s h e m a y k e e p h e r
fa m ily to g e th e r?
W h o su p p o rts th e o rp h a n a g e s th a t ca re fo r h er
c h ild r e n i f sh e ca n n o t?
T h e q u e s tio n s a ll a n s w e r th e m s e lv e s a n d , M r . J u s t ic e M c R e y n o ld s t o th e c o n t r a r y n o t w it h s t a n d in g , th e in te re s t o f th e F e d e r a l
G o v e r n m e n t in th e w e lfa r e o f th o s e e n g a g e d in tr a n s p o r t a t io n
w h e t h e r b y r a il o r s h ip , is b u t in c id e n t a l a n d r e m o t e in c o m p a r is o n
w it h th e in t e r e s t o f t h e S t a t e a n d it s s u b d iv is io n s , w h ic h is im m e d ia t e
a n d p r o x im a t e a n d v it a l. I s t h e r e n e e d f o r a r g u m e n t t o s u s ta in t h e
c o n t e n t io n t h a t w h e r e t h e im m e d ia t e , v i t a l in te r e s t is , t h e r e th e ju r i s
d ic t io n s h o u ld v e s t? T h e fu n d a m e n ta l p r in c ip le u n d e r ly in g F e d e r a l
G o v e r n m e n t a f f ir m s t h e v a l i d i t y o f t h i s c o n t e n t i o n . I f i t b e u n s o u n d ,
th e n fe d e r a t io n it s e lf is u n s o u n d .
U N IF O R M ITY NOT DESIRABLE.
U p o n r e fle c tio n , I h a v e c o n c lu d e d t h a t u n if o r m it y in c o m p e n s a t io n
le g is la t io n t h r o u g h o u t th e U n it e d S ta te s t o u c h in g t r a n s p o r t a t io n
e ith e r b y r a il o r w a te r is n e it h e r n e c e s s a r y n o r d e s ir a b le . T h e F e d
e r a l G o v e r n m e n t is h u g e . T h e c o n c e r n s o f a h u n d r e d m i l li o n p e o p le
w it h a m illio n c o n flic t in g in te re s ts fo c u s u p o n W a s h in g t o n . F e d e r a l
l e g i s l a t i o n is d iffic u lt a n d c o s t ly . C o m p e n s a t io n la w s a r e i n a s ta te o f
e v o lu tio n . N o a d e q u a te la w c o u ld b e e n a c te d a t th is tim e , e v e n i f
C o n g r e s s w e r e m in d e d t o t a k e t h e is s u e i n h a n d . C o u r t s , in s t r i v i n g
t o m a k e a ll n e w m e a su re s fit in t o o ld m o ld s , m a k e h o le s in o u r a c ts
w h ic h n e e d t o b e p lu g g e d .
W e , in C a lifo r n ia , h a v e h a d th e m a jo r
p o r t i o n o f o u r c o m p e n s a t io n la w r e v is e d a n d r e e n a c te d , p a r t ly b e
c a u se o f w h a t th e c o u r ts h a d d o n e t o it, a n d p a r t ly b e c a u s e o f w h a t
w e w e r e a fr a id th e y m ig h t d o . T h is r e v is io n c o m p r is e d th e p lu g g in g
o f 11 h o le s w h ic h ju d i c i a l in t e r p r e t a t io n h a d p u n c h e d a n d th e p a t c h
i n g o f 35 fla w s d is c o v e r e d b y e x p e r ie n c e in th e a d m in is t r a t io n o f th e
la w , a n d a ls o th e t a k in g o f 2 3 f o r w a r d s te p s in S t a t e p o l i c y r e g a r d
i n g c o m p e n s a tio n . S u c h a r e v is io n o f a F e d e r a l a c t m ig h t e a s ily i n
v o lv e 10 y e a r s o f a g ita tio n a n d c o n tin u o u s e ffo r t. W e a c c o m p lis h e d
it in th ree m o n th s.
T h e 4 8 S ta te s o f th e U n io n c o n s titu te 4 8 d iff e r in g c iv iliz a t io n s , a n i
m a te d b y d iffe r e n t s p ir it s , h a b it s , c u s to m s , s t a n d a r d s o f liv in g , w a g e s ,
a n d w a y s o f l o o k i n g a t t h i n g s . A c o m p e n s a t i o n l a w t h a t f it s c o m
JURISDICTION IN ACCIDENT CASES---- A. J. PILLSBURY.
237
f o r t a b l y a n d w o r k s w e l l i n o n e S t a t e m i g h t n o t f it a s c o m f o r t a b l y o r
w o r k as w e ll in a n y o th e r . U n ifo r m it y in la w s r e la tin g to m a r r ia g e ,
d iv o r c e , in s u r a n c e , t a x a tio n , e d u c a t io n , a n d c o m p e n s a tio n , w o u ld b e
a t th e c o s t o f fr e e d o m o f a c tio n o n th e p a r t o f th e in d e p e n d e n t s o v
e r e ig n t ie s t h a t m a k e u p th e U n io n a n d m ig h t c h a fe a n d g a ll a n d
m a k e a g a in s t n a t io n a l s o lid a r it y . F o r o n c e I f a v o r S ta te r ig h t s .
F o r th re e a n d a h a lf y e a rs I h a v e h e lp e d t o a d m in is te r a c o m p e n
s a tio n la w th a t a ssu m e d ju r is d ic t io n o v e r m a r it im e in ju r ie s a n d
u n t il th e J e n s e n ca se in t r o d u c e d c o n flic t in t o th a t ju r is d ic t io n , a l
w e n t w e ll. I f i t w a s a C a lif o r n ia s h ip , o u r ju r is d ic t io n o v e r it f o l
lo w e d i t w h e r e v e r i t w e n t. I f it w a s n o t a C a lif o r n ia s h ip a n d w a s
n o t m a n n e d in o u r p o r t s a n d a n y o th e r S ta te c la im e d ju r is d ic t io n
w e d id n o t . B y t h e a p p lic a t io n o f s im ila r s im p le r u le s a ll c o n f lic
b e tw e e n th e 48 s is te r S ta te s m a y e a s ily b e a v o id e d .
I t is o n ly ’ th e
a s s e r tio n o f F e d e r a l ju r is d ic t io n o v e r in d u s t r ia l in ju r ie s th a t p r o
d u c e s p e r p le x it y , c o n te n tio u s n e s s , a n d w r o n g .
THE W RONG EOOT FIRST.
T h e t r u t h is t h a t t h e c a u s e o f c o m p e n s a t io n f o r in d u s t r ia l i n ju r ie s
s t a r t e d o f f th e w r o n g f o o t firs t. T h e r e is n o t h in g s t r a n g e a b o u t t h is ,
in a s m u c h as h u m a n p r o g r e s s is a lw a y s d ir e c t e d t o w a r d , a n d s e ld o m
sta rts fr o m , c o r r e c t p r in c ip le s .
“ C o m p e n s a t i o n ” is in s u r a n c e , a n d
c o m p e n s a t io n in s u r a n c e is o n e f a c t o r o f a s c h e m e o f s o c ia l in s u r a n c e
th a t w ill o n e d a y p r o te c t e a ch t o ile r fr o m c r a d le to g r a v e .
T her
i s n o o t h e r s a fe g u a r d a g a in s t t h e m e n a c e o f a n a ll- p e r v a s iv e p o v e r t y ,
a n d a n a ll-p e r v a s iv e p o v e r t y s p e lls a n a r c h y .
O f e v e r y 100 p e r s o n s w h o d ie in th e U n it e d S ta te s 65 d ie p e n n ile s s ,
2 5 o t h e r s l e a v e e s t a t e s o f a n a v e r a g e v a l u e o f $ 1 ,3 0 0 o r l e s s ; f e w e r
t h a n 9 l e a v e e s t a t e s o f t h e v a l u e o f $ 5 ,0 0 0 o r o v e r ; a n d f e w e r t h a n
2 c a n b e c la s s e d a s h a v i n g b e e n w e ll t o d o .
I s t h is b e c a u s e t h e w o r k
ers h a v e n o t p r a c t ic e d t h r ift ?
A s I p o in t e d o u t la s t y e a r , b e tw e e n t w o -t h ir d s a n d t h r e e -fo u r t h s o f
t h e a d u lt m a le w o r k e r s in th e U n it e d S ta te s , a n d n in e te e n -tw e n tie th s
o f t h e a d u lt f e m a le s e a r n le s s t h a n $ 6 0 0 a y e a r .
L e ss th a n o n e -te n th
o f th e m e a rn $8 0 0 o r m o re , a n d y e t th e a n n u a l c o s t o f m a in ta in in g
a f a m i l y o f fiv e p e r s o n s u p o n w h a t w e lik e t o t h in k o f a s a n A m e r i
c a n s t a n d a r d o f l i v i n g r e q u i r e s $ 9 0 0 t o $ 1 ,0 0 0 o u t g o .
H o w , th e n , is w id e s p r e a d p o v e r t y t o b e s t r ip p e d o f its m e n a c in g
a ttitu d e , e x c e p t t h r o u g h in s u r a n c e a g a in s t th e p o v e r t y -m a k in
d a n g e r s o f s ic k n e s s , u n e m p lo y m e n t , i n d u s t r ia l i n j u r y , p r e m a t u r e
d e a t h , o l d a g e , m a t e r n it y b e n e fits f o r w o r k i n g w o m e n , a n d b u r i a
b e n e fit s w h e n t h e e n d c o m e s ?
N o c o u n tr y th a t lo o k e d w e ll to th
w e lfa r e o f its w o r k in g p o p u la t io n e v e r s u ffe r e d r e v o lu t io n .
N
c o u n t r y t h a t a llo w e d p o v e r t y t o b e c o m e w id e ly p e r v a s iv e lo n
e s c a p e d it.
T h e p e o p le o f G e r m a n y r e fu s e t o in a u g u r a te a r e v o lu
NEEDED CHANGES I N LEGISLATION.
238
t io n b e ca u s e , d o m e s t ic a lly , th e y h a v e b e e n w e ll c a r e d f o r b y t h e ir
G ov ern m e n t.
R u s s ia h a s r e s o lv e d it s e lf in t o s o c ia l c h a o s b e c a u s e
t h e p e o p le h a v e n o t b e e n c a r e d f o r a t a ll.
W e in A m e r ic a h a v
g o n e a h e a d o n t h e p r in c ip le o f “ E v e r y b o d y f o r h im s e lf, d e v il ta k e
th e h in d e r m o s t ,” w it h t h e r e s u lt t h a t t h e d e v i l h a s p r e t t y g e n e r a lly
g o t t e n h im .
I t is n o t in c o n c e iv a b le t h a t w e m a y h a v e t o c h o o s e
b e tw e e n s o c ia l in s u r a n c e , s o c ia lis m , a n d s o c ia l a n a r c h y .
C o m p e n s a t io n f o r in d u s t r ia l in ju r ie s is b u t o n e f a c t o r in
s c h e m e o f s o c ia l in s u r a n c e , a n d s o c ia l in s u r a n c e is a S t a t e p r o b le m
r a th e r th a n a F e d e r a l, a lth o u g h F e d e r a l a u th o r ity m ig h t c o n c e iv a b ly
fo s t e r a n d e n c o u r a g e it a m o n g th e S ta te s.
O f e v e ry 100 p erson s
w h o a tta in th e a g e o f 65 y e a r s , 9 7 liv e , a t le a s t in g r e a t e r p a r t , u p o n
p u b lic o r p r iv a t e c h a r it y .
T h e q u e s tio n is n o t w h e th e r o r n o t th e
a g e d s h a ll b e p e n s io n e d ; t h e y a r e p e n s io n e r s a lr e a d y , a n d th e o n l y
is s u e i s a s t o h o w t h o s e p e n s io n s s h a ll b e p a id a n d w h e r e s h a ll r e s t
th e b u r d e n o f p a y in g th e m .
S o c ia l in s u r a n c e b e a r s o n l y a n i n c i
d e n ta l a n d u n im p o r t a n t r e la tio n t o c o m m e rc e , e ith e r b y r a il o r b y
w a te r , in te r s ta te o r in tr a s ta te , a n d it s r e la tio n t o m a s te r a n d s e r v a n t
is a lm o s t e q u a lly in c id e n t a l.
T h e o b lig a t io n o f th e e m p lo y e r ru n s t o
t h e S t a t e t o c a r r y t h is in s u r a n c e , n o t m e r e ly f o r t h e b e n e fit o f t h e
e m p lo y e e , b u t p r im a r ily f o r th e p r o t e c t io n o f th e S ta te a g a in s t t h e
m en ace o f p ov e rty .
FED ERAL JURISDICTION SHOULD BE RELINQUISHED.
F e d e r a l ju r is d ic t io n o v e r in d u s t r ia l in ju r ie s o u t o f th e w a y , o u r
p r o b le m b e c o m e s e a s y o f s o lu tio n a n d th e b u r d e n lig h t .
T h e S ta tes
w ill ta k e c a re o f it in d u e se a son .
T h e r e a re b a c k w a r d S ta te s in
th is U n io n .
T h e r e a re S ta te s in w h ic h la b o r h a s fe w r ig h t s a n d
a m b u la n c e -c h a s in g a tto r n e y s th r iv e .
S h a ll a ll o f th e S ta te s b e h e ld
b a c k f r o m d o in g ju s t ic e a n d s h o w in g m e r c y b e ca u se o f th e s e ?
T h e w a y is n o w c le a r w h e r e b y C o n g r e s s m a y , a t le a s t , e x e m p t
i n ju r y s u s ta in e d in in te r s ta te c o m m e r c e b y r a ilr o a d f r o m its in te r
sta te ch a r a cte r w h e n it h a p p e n s in a n y S ta te d e s ir in g t o e n jo y su ch
e x e m p t io n f o r t h e b e n e fit o f it s c itiz e n s .
T h e W e b b -K e n y o n A c t,
t o w h ic h I c a lle d th e a t t e n t io n o f th is a s s o c ia tio n la s t y e a r , a n d w h ic h
d iv e s ts liq u o r s o f t h e ir in te r s ta te c h a r a c t e r as c o m m e r c e w h e n t h e y
r e a c h t h e b o u n d a r ie s o f a p r o h i b it i o n S ta te , h a s s in c e h a d its c o n
s t it u t i o n a lit y a ffir m e d b y t h e S u p r e m e C o u r t o f t h e U n it e d S ta te s .
I f i t b e s o w it h liq u o r s , w h y n o t w it h in d u s t r ia l in ju r ie s ?
Th
p o w e r o f C o n g r e s s s o t o d o is , i t s e e m s t o m e , n o l o n g e r q u e s t i o n a b l e .
W H A T A R E W E GOING TO DO ABOUT IT ?
T h e e x is tin g c h a o t ic c o n d it io n in r e la tio n t o c o n flic ts b e tw e e n S ta te
a n d F e d e r a l ju r is d ic t io n o v e r in ju r ie s s u s ta in e d in t r a n s p o r t a t io n
w h e t h e r b y w a t e r o r b y r a il is in t o le r a b le . W h a t is th e r e m e d y ?
JURISDICTION IN ACCIDENT CASES---- A. J . PILLSBURY.
239
A n a r t ic le in th e J u ly M o n t h ly R e v ie w o f th e U n it e d S ta te
B u r e a u o f L a b o r S ta t is t ic s s u g g e s ts th e f o l l o w i n g p o s s ib le s o lu t io n s
o f th e p r o b le m :
1.
A n a m e n d m e n t t o th e C o n s titu tio n o f th e U n it e d S ta te s g iv i
C o n g r e s s ju r i s d ic t io n o v e r in t r a s t a t e as w e ll a s in t e r s t a t e c o m m e r c e ,
p r e p a r a t o r y , it m a y b e in fe r r e d , to e n a c t in g a c o m p r e h e n s iv e F e d e r a l
c o m p e n s a t io n la w c o v e r in g a ll r a ilr o a d e m p lo y e e s .
% T h e r e p e a l o f th e e m p lo y e r s ’ l ia b i l it y la w o f 1 9 0 8 -1 9 1 0 , r e le g a t
in g th e p r o b le m , s o f a r as th e r a ilr o a d s a re c o n c e r n e d , to th e S ta te s.
3.
T h e e n a c tm e n t o f a F e d e r a l c o m p e n s a t io n la w t o b e e ffe c t
o n ly in S ta te s n o t h a v in g su ch a la w o f s ta n d a r d ty p e .
T h e fir s t r e m e d y s u g g e s t e d m ig h t r e q u ir e a g e n e r a t io n f o r it s
a c c o m p lis h m e n t ; th e s e c o n d w o u ld le a v e th e r a ilr o a d m e n in th e
b a c k w a r d S ta te s in w o r s e p lig h t t h a n th e y a re a t p r e s e n t ; th e t h ir d
h a s m o r e t o r e c o m m e n d it, b u t, f o r r e a s o n s a lr e a d y e x p la in e d
C o n g r e s s h a s n o t b e e n m in d e d t o p a s s a n y c o m p e n s a t io n la w a t a ll
in r e la tio n t o in te r s ta te c o m m e r c e .
M r . J u s t ic e B r a n d e is , i n h is d is s e n tin g o p in io n in o n e o f th e W i n
fie ld ca ses, s u g g e s te d t h a t “ I t w o u ld o b v io u s ly h a v e b e e n p o s s ib le
f o r C o n g r e s s t o p r o v id e in te r m s th a t w h e r e v e r su ch in ju r ie s o
d e a t h r e s u l t f r o m t h e r a i l r o a d ’s n e g l i g e n c e t h e r e m e d y s h o u l d b e
s o u g h t b y a c t io n f o r d a m a g e s ; a n d w h e n e v e r i n ju r y o r d e a t h r e s u lt s
f r o m ca u se s o t h e r th a n th e r a ilr o a d ’s n e g lig e n c e , c o m p e n s a t io n m a y
b e s o u g h t 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 la w s o f t h e S t a t e s .”
W h il e t h is s o lu t io n w o u ld d o u b tle s s b e a c c e p ta b le t o th e r a il
r o a d e m p lo y e e s , th e r a ilr o a d c o m p a n ie s w o u ld o p p o s e s u ch
m e a su re , n o t w it h s t a n d in g th e f a c t th a t in G r e a t B r it a in e v e r
in ju r e d w o r k m a n m a y ta k e h is c o m p e n s a tio n o r su e f o r d a m a g e s as
h e m a y e le c t, a n d n o t w it h s t a n d in g th e fu r t h e r f a c t th a t w h ic h e v e r
r e m e d y t h e i n ju r e d e m p lo y e e e le c ts , h e a lm o s t u n i f o r m l y s e c u r e s
a b o u t w h a t th e c o m p e n s a t io n s ta tu te w o u ld h a v e g iv e n h im .
J u rie s ,
k n o w i n g n o o t h e r s c a le b y w h i c h t o m e a s u r e d a m a g e s , c h o o s e t h e
o n e fu r n is h e d b y th e c o m p e n s a tio n la w w it h w h ic h t h e y a re fa m ilia r .
A n o th e r m e th o d h a s b ee n su g g e ste d to m e : L e t C o n g re ss, i f it
w ill , e n a c t a c o m p e n s a t io n la w c o v e r in g in te r s ta te in ju r ie s a n d th e n
c o n fe r u p o n in d u s tr ia l a c c id e n t b o a r d s a n d c o m m is s io n s o f th e s e v
e r a l S ta te s th e a d m in is t r a t io n o f th e a ct.
I f t h is c a n n o t b e d o n
d ir e c t ly , th e U n it e d S ta te s D is t r ic t C o u r ts c o u ld b e a u th o r iz e d to r e
f e r a ll s u ch ca ses t o su ch b o a r d s o r c o m m is s io n s f o r d e te r m in a tio n o f
t h e fa c t s , u n le s s a j u r y w e r e d e m a n d e d , as s u c h c o u r t s n o w r e f e r
s u c h is s u e s t o s p e c i a l c o m m i s s i o n s o r r e f e r e e s .
T h e n , w h en a case
com es b e fo r e su ch c o m m is s io n , i f th e fa c t s p r o v e th e in ju r y t
h a v e b e e n s u ffe r e d in in t e r s t a t e c o m m e r c e a p p l y th e F e d e r a l la w , i f
in in tr a s ta te , th e n a p p ly th e S ta te c o m p e n s a t io n la w .
T h e su gges
t io n is n o t w it h o u t p e r s u a s iv e fo r c e .
240
NEEDED CHANGES IN LEGISLATION.
W H A T ABOUT THE CONFLICT IN A D M IR A L T Y JURISDICTION?
T h e r e m e d y t h a t d o e s n o t r e s o lv e t h is c o n flic t u p o n w a t e r a s w e ll
as u p o n r a ilr o a d w ill p r o v e b u t h a lf a r e m e d y . W h a t a b o u t th a t?
T h e w r i t e r i n t h e M o n t h l y R e v i e w , a b o v e r e f e r r e d t o , a f f ir m s
th a t, “ O n ly C o n g r e s s ca n le g is la te as t o in ju r ie s o n h ig h sea s a n d
n a v ig a b le w a te r s o f th e c o u n t r y .”
I t h a s b e e n a s s t o u t ly a ffir m e d
th a t C o n g r e s s it s e lf c a n n e ith e r a d d to n o r ta k e a w a y f r o m th e ju r is
d ic t io n o f th e U n it e d S ta te s D is t r ic t C o u r ts o v e r a d m ir a lt y cases.
I f b o t h o f th e s e p r o p o s it io n s b e tr u e , a n d it is a ls o tr u e t h a t a d
m ir a lt y ju r is d ic t io n d o e s n o t e x te n d t o in ju r ie s h a p p e n in g u p o n th e
d o ck s , th e n th e c o n flic t o f ju r is d ic t io n b e tw e e n S ta te a n d F e d e r a l
a u t h o r it y o v e r in ju r ie s h a p p e n in g in c o m m e r c e is e v e n m o r e h o p e
le s s o f r e m e d y w h e n s u c h c o m m e r c e is b y w a t e r t h a n w h e n b y r a il
r o a d , f o r n o W e b b -K e n y o n sta tu te h a s b ee n e n a cte d a n d ju d ic ia lly
u p h e ld w h ic h c a n d iv e s t a m a r it im e i n ju r y o f it s a d m ir a lt y ju r i s d ic
tio n , e v e n w h e n it h a p p e n s in a S ta te h a v in g a n a d e q u a te c o m p e n s a
t i o n la w .
T h e r e a re t w o k in d s o f m a r itim e la w — th e s ta tu te s o f C o n g r e s s
a n d th e g e n e r a l, ju d g e -m a d e , la w m a r it im e .
C o n g re s s h a s en a cted
n o e m p lo y e r s ’ l ia b i l it y la w c o v e r i n g i n ju r ie s s u ffe r e d in t h e b u s in e s s
o f t r a n s p o r t a t io n b y w a te r , a n d th e g e n e r a l la w m a r itim e , a lt h o u g h
fa r m o r e lib e r a l t o w a r d in ju r e d m e n th a n th e o ld c o m m o n -la w lia
b ili t y d o c t r in e , a llo w s in d e m n it y f o r in ju r ie s o n ly w h e r e n e g lig e n c e
c a n b e e s t a b lis h e d a n d n o n e a t a ll in c a s e s w h e r e th e i n ju r ie s r e s u lt
in d e a th . C o n g r e s s c a n e n a c t a c o m p e n s a t io n la w c o v e r in g a ll m a r i
tim e in ju r ie s , a n d th e c o u r t s m a y h o ld th a t d o c k a n d d r y - d o c k in
ju r ie s a r e m a r itim e , b u t i f s u c h a la w w e r e a d m in is te r e d b y th e
U n it e d S ta te s D is t r ic t C o u r ts th e c o s t o f it w o u ld c o n s u m e th e b e n e
fi t s a n d h o p e d - f o r r e l i e f w o u l d n o t r e s u lt .
S u p p o s e t h a t o n e o f th e fiv e ju s t ic e s w h o v o t e d f o r t h e J e n s e n d e
c is io n h a d v o t e d th e o th e r w a y , w h a t w o u ld h a v e b e e n th e sta tu s o f
th o s e e n g a g e d in c o m m e rc e b y w a te r ?
T h a t d e c is io n c o m m itte d th e c o u r t to t w o d o c t r in e s :
1. T h a t t h e p r o c e d u r e f o l l o w e d b y t h e I n d u s t r i a l C o m m i s s i o n o f
N e w Y o r k d id n o t c o n s t it u t e a c o m m o n -la w r e m e d y w it h in th e
m e a n in g o f s e c tio n 9 o f th e a c t o f 1 7 8 9 ; a n d
2 . T h a t t h e c o m p e n s a t i o n l a w o f N e w Y o r k is , i n s u b s t a n c e , i n
c o n t r a v e n t io n o f th e g e n e r a l b o d y o f a d m ir a lt y la w .
I f o n e o t h e r ju s t ic e h a d v o t e d w it h t h e d is s e n tin g f o u r , th e p r o
c e d u r e s o f in d u s tr ia l a c c id e n t b o a r d s a n d c o m m is s io n s w o u ld h a v e
c o n s t it u t e d c o m m o n -la w r e m e d ie s a n d , in p u r s u a n c e o f th e a c t o f
178 9 , w o u ld h a v e b e e n “ s a v e d t o s u it o r s ,” a n d it w o u ld a ls o h a v e
b e e n h e l d t h a t s t ic h c o m p e n s a t i o n l a w s w e r e n o t i n c o n t r a v e n t i o n o f
th e g e n e r a l m a r it im e la w , w h ic h it s e l f w o u ld h a v e b e e n m a d e su b
o r d in a t e to th e c o m m o n -la w r e m e d y .
JURISDICTION m
ACCIDENT CASES— A. J . PILLSBURY.
241
U n d e r s u c h a d e c is io n t h e s h ip p in g in te r e s ts w o u ld s p e e d ily p la c e
t h e m s e lv e s u n d e r t h e p r o t e c t i o n o f t h e c o m p e n s a t io n la w s o f t h e
S ta te s h a v in g s u ch la w s , a n d a ll w o u ld s o o n b e w e ll w ith th e la r g e r
sh a re o f m e n w h o t o il in c o m m e rc e b y w a te r.
W h e n w e r e fle c
u p o n th e f a c t t h a t th e in te r e s ts o f h u n d r e d s o f th o u s a n d s , it m a y b e
m illio n s , o f t o ile r s w e r e so u n fa v o r a b ly a ffe c te d b y th e fift h m a n o n
th a t b e n c h , o n e c a n n o t r e s is t th e fe e li n g t h a t th a t f i f t h m a
c a n n o t f u l l y h a v e r e a liz e d th e c o n s e q u e n c e s c e r t a in t o flo w f r o m
h is a c t. I s h o u ld lik e t o see t h e is s u e g o b a c k t o t h e c o u r t o n t h e
d o c k s id e o f it, a n d s h a ll d o m y b e s t t o see t h a t s u ch a ca s e g e ts th e re .
O u r c o m m i s s i o n p r o p o s e s t o a s s u m e j u r i s d i c t i o n o v e r a c c id e n t s * h a p
p e n in g o n th e d o ck s.
A PR A C T IC A L SOLUTION SOUGHT.
A F e d e r a l c o m p e n s a t io n la w g o v e r n in g t r a n s p o r t a t io n b y r a il
r o a d is n o t , in m y o p in io n , p r a c t ic a b le , b e c a u s e in e la s tic , n o t r e a d
i ly s u s ce p tib le t o a m e n d m e n t, w o u ld c o v e r in te rs ta te in ju r ie s o n ly ,
w o u ld a t t e m p t t o d e a l w it h w h a t is e s s e n t ia lly a S ta te p r o b le m , a n d ,
a n y h o w , c o u l d n o t b e e n a c t e d w it h o u t g r e a t d iffic u lt y .
C o n c e r t e d p r e s s u r e s h o u ld , in m y ju d g m e n t , b e b r o u g h t u p o n C o n
g r e s s b y a ll c o m p e n s a t io n S ta te s , to r e lin q u is h th e w h o le s u b je c t o f
in ju r ie s s u s ta in e d in in t e r s t a t e c o m m e r c e b y r a ilr o a d in S ta te s h a v
i n g a d e q u a te c o m p e n s a tio n la w s a n d f ix in g a s ta n d a r d o f a d e q u a c y
t h e r e fo r , r e t a in in g th e e m p lo y e r s ’ lia b ilit y la w in f u ll fo r c e a n d
e f f e c t i n S t a t e s f a l l i n g b e l o w s u c h a s t a n d a r d o r h a v i n g n o n e a t a l l.
S u c h a m e a s u r e c o u ld p r o b a b ly b e p u t t h r o u g h C o n g r e s s a t t h is tim e .
W it h r e fe r e n c e to c o m m e rc e b y w a te r it m a y b e fo u n d a d v is a b le
n o t t o a t t e m p t F e d e r a l le g is la t io n a t t h is t im e , b u t in s t e a d t o b r in g
n e w a n d m o re fu lly a r g u e d cases b e fo r e th e S u p re m e C o u r t o f th e
U n it e d S ta te s.
M e a n t im e , p u s h a lo n g th e C a l if o r n i a id e a o f g e t t in g
s e a fa r in g e m p lo y e r s a n d t h e ir e m p lo y e e s t o a c c e p t th e c o m p e n s a tio n
a c ts o f th e s e v e r a l m a r it im e S ta te s , s u p p le m e n t in g th e a c c e p ta n c e
w it h a w a iv e r o f th e r ig h t t o su e in a d m ir a lt y w h e r e a b a s is o f n e g li
g e n c e m ig h t b e la id .
T h e r e is n o sta tu te p r o h i b it i n g c o n t r a c t in g
o u t f r o m u n d e r a d m ir a lt y ju r i s d ic t io n , a n d t h e r e is e v e r y r e a s o n in
th e w o r ld w h y m e n w h o t o i l in s h ip p in g s h o u ld w is h t o c o n t r a c t o u t
fr o m a la w th a t d o e s n o t a ffo r d th e m p r o t e c t io n a n d u n d e r a la w
th a t d oes. S u ch a c o n tr a c t w o u ld b in d a ll e x c e p t th e d e p e n d e n ts o f
d e ce a se d e m p lo y e e s , a n d t h e y w o u ld h a v e n o t h in g t o su e f o r a n y w a y
e x c e p t in S ta te s th a t h a v e g iv e n a r ig h t o f a c t io n in d e a th ca ses.
T h e g e n e r a l m a r itim e la w g iv e s n o s u ch r ig h t , n o r d o e s a n y F e d e r a l
sta tu te .
A TE N TA TIV E STANDARD.
I h a v e s p o k e n o f a s ta n d a rd o f a d e q u a cy t o b e im p o s e d b y th e
F e d e r a l G o v e r n m e n t as a c o n d it io n p r e c e d e n t t o r e lin q u is h in g its
78582°— Bull. 248— 19-------16
NEEDED CHANGES IN LEGISLATION.
a u t h o r it y o v e r in ju r ie s h a p p e n in g in in te r s ta te c o m m e r c e in S ta te s
h a lv in g c o m p e n s a t i o n l a w s c o n f e r r i n g e q u a l i z e d b e n e f i t s a p p r o x i
m a t in g t o th e s ta n d a r d im p o s e d .
A t a v e n tu r e I t o o k th e sta tu te a ffo r d in g w C o m p e n s a tio n f o r in
ju r i e s t o c i v i l e m p lo y e e s o f t h e U n it e d S t a t e s ,” a p p r o v e d S e p t e m b e r
7 , 1 9 1 6 , a n d f i n d t h a t it a f f o r d s t h e h ig h e s t b e n e fit s o f a n y c o m p e n s a
t io n sta tu te in t h e U n it e d S ta te s . I f t h is w e r e ta k e n a s th e s ta n d a r d ,
th e la w o f n o S ta te w o u ld b e a d e q u a te . T h e c o m p e n s a t io n la w s o f
N e w Y o r k a n d O h i o w o u ld f a l l a b o u t 10 p e r c e n t lo w e r . T h e c o m
p e n s a tio n la w s o f C a lif o r n ia , W e s t V i r g in i a , a n d W is c o n s in w o u ld
f a l l a b o u t 2 0 p e r c e n t lo w e r ; I llin o is w o u ld b e 3 0 p e r c e n t lo w e r ,
a n d M a r y la n d , N e b ra sk a , a n d O k la h o m a f r o m 3 0 t o 4 0 p e r ce n t
lo w e r . T h e c o m p e n s a t io n a ffo r d e d b y th e la w s o f C o n n e c tic u t , I n
d ia n a , I o w a , L o u is ia n a , M ic h ig a n , M in n e s o ta , M o n t a n a , N e w J e r s e y ,
a n d R h o d e I s la n d w o u ld b e b e tw e e n 40 a n d 5 0 p e r ce n t lo w e r , a n d
th o s e o f V e r m o n t a n d C o lo r a d o w o u ld b e m o r e th a n 50 p e r c e n t lo w e r .
I d id n o t c o n tin u e th e in v e s tig a tio n fu r th e r .
I n m y ju d g m e n t th o s e S ta te s a ffo r d in g c o m p e n s a t io n m o r e th a n
30 p e r c e n t l o w e r th a n th e F e d e r a l c o m p e n s a t io n a c t a b o v e d e s ig
n a te d c o u ld r e a s o n a b ly b e h e ld t o fa ll b e lo w th e s ta n d a rd o f a d e
qu a cy.
T h e s e fig u r e s w e r e a ll c o m p u t e d a c c o r d in g t o th e d iffe r e n t ia ls e m
p l o y e d b y in s u r a n c e a c t u a r ie s in d e t e r m i n i n g t h e r e la t iv e b e n e fit s
c o n f e r r e d b y th e s e v e r a l S ta te s as c o m p a r e d w it h th e M a s s a c h u s e tts
a c t o f 19*11. T h e r u l e i s a p p l i e d b y a l l o f t h e i n s u r a n c e c a r r i e r s o f
th e U n it e d S ta te s in d e t e r m in in g ra tes in th e s e v e r a l S ta te s, a n d I
t h in k is a c c u r a t e .
APPOINT A COMMITTEE.
T h e s e is s u e s a r e t o o im p o r t a n t t o b e d is p o s e d o f in a s u m m a r y
f a s h i o n a t a s e s s io n o f a n a s s o c i a t i o n s u c h a s t h i s , w i t h a c r o w d e d
p r o g r a m , tim e b e in g n e e d e d t o m a ste r th a t p r o b le m in p r in c ip le a n d
d e ta il.
S o m e t h in g s h o u ld a n d , I b e lie v e , c a n b e d o n e t o r e lie v e th e
s it u a t io n o f its e m b a r r a s s m e n ts a n d th e h a r d s h ip s in flic t e d u p o n
s e v e r a l m illio n s o f t o ile r s in h a z a r d o u s in d u s tr ie s .
I w o u ld , t h e r e fo r e , u r g e th a t a s t a n d in g c o m m itte e o f fiv e e a rn e st
a n d d is c r e e t p e r s o n s b e a p p o in t e d , t o b e s e le c te d b y th e p r e s id e n t a n d
s e c r e ta r y -tr e a s u r e r jo in t ly , w ith p o w e r to a c t ; th a t su ch c o m m itte e
b e in s tr u c te d t o m e e t in W a s h in g t o n e a r ly in O c t o b e r , t o s it f o r o n e
w e e k o r t w o w eek s, as th e case m a y b e, f o r th e p u r p o s e o f fo r m u la t
in g a n d in a u g u r a t in g su ch a p la n a n d c a m p a ig n f o r r e s o lv in g a n d
e lim in a t in g a ll c o n flic ts in ju r is d ic t io n b e tw e e n F e d e r a l a n d S ta te
G o v e r n m e n t s in ca ses o f in d u s t r ia l in ju r ie s h a p p e n in g in c o m m e r c e ,
w h e th e r b y r a ilr o a d o r b y w a t e r , as m a y b e d e e m e d a d v is a b le ; a n d
t h a t th e g o o d f a i t h o f t h is a s s o c ia t io n b e c o n s id e r e d a s p le d g e d t o
th e s u p p o r t o f s u ch p la n as m a y b e p e r f e c t e d b y s a id c o m m itte e .
D IS C U S S IO N .
M r . F rench. I w o u ld lik e t o s ta te t h a t w e h a v e h a d p r e p a r e d a
n u m b e r o f c o p ie s o f a s y n o p s is o f t h is a r t ic le th a t I t h in k w il l b e
fo u n d in t e r e s tin g a n d I s h a ll b e g l a d t o h a n d th e m a r o u n d . I f y o u
w a n t m o r e t h a n o n e , w e h a v e lo t s : o f t h e m .
M r . S m i t h . I t s e e m s t o e t h a t t h i s p a p e r o f M r . P i l l s b u r y ’ s,
m
f r o m a le g a l p o i n t o f v ie w , is a m a s t e r p ie c e .
W h ile n o t p o s s ib ly
a g r e e in g w it h e v e r y w o r d in it, I c e r t a in ly d o a g r e e w it h th e le g a l
a r g u m e n t a n d w it h th e fa c t s sta te d , th a t in e v e r y S ta te w o r k m e n ’s
c o m p e n s a t io n b o a r d s a r e “ u p a g a in s t it ” o n a c c o u n t o f th e J e n s e n
a n d W a l k e r a n d th e t w o W in fie ld d e c is io n s .
W e h a v e h a d it in
M ic h ig a n , a n d I d o n ’t m i n d s a y in g t h a t i n f o u r ca s e s w h ic h w e h a d
p e n d in g w h e n th e J en se n , W a lk e r , a n d t w o W in fie ld cases ca m e
d o w n , w e p r o m p t ly d e c id e d c o n t r a r y to th e d e c is io n o f th e U n it e d
S ta te s S u p re m e C o u rt. W e m a d e u p o u r m in d s th a t i f th a t w a s th e
la w , o u r S t a te s u p r e m e c o u r t w o u ld h a v e t o s a y s o fir s t b e f o r e t h e
in d u s tr ia l a c c id e n t b o a r d d id a n d th e n th e U n it e d S ta te s S u p re m e
C o u r t s a y s o a f t e r w a r d s . I m i g h t s a y t h a t t h e N e w Y o r k la w is , o f
c o u r s e , e n tir e ly c o m p u ls o r y a n d th e N e w J e r s e y la w s e m ic o m p u ls o r y
a n d s e m ie le e t iv e ; th e M ic h ig a n la w is e n t ir e ly e le c t iv e , w h ie h w o u ld
m a k e q u ite a d iffe r e n c e a n d o u r d e c is io n s m ig h t b e d iffe r e n t.
It
se e m s t o m e t h a t t h is is t h e b i g g e s t q u e s t io n t h a t h a s c o m e b e f o r e
t h is a s s o c ia t io n a n d I u n d e r s t a n d t h a t t h e N e w Y o r k S ta te I n d u s
t r ia l C o m m is s io n t h r o u g h it s c h a ir m a n , M r . M it c h e ll, h a s s u b m itte d
a r e s o lu tio n o n th e s u b je c t o f th e m a r itim e c o m m e r c e ' d iv is io n o f
t h is q u e s t io n t o t h e c o m m it t e e o n r e s o lu t io n s .
I t seem s t o m e th a t
t h is a s s o c ia tio n s h o u ld a p p o in t a c o m m itte e s u c h a s s u g g e s te d in th e
p a p e r o f M r . P ills b u r y , r e a d b y M r . F r e n c h , a n d a ls o ta k e s o m e
a c t io n a l o n g t h e lin e s s u g g e s t e d in th e r e s o lu t io n w h ic h h a s b e e n
s u b m itte d t o th e c o m m itte e o n r e s o lu t io n s b y M r . M it c h e ll, a n d I
m o v e t h a t th e e n t ir e q u e s tio n b e s u b m itte d n o w , o r b e r e fe r r e d t o
th e c o m m it t e e o n r e s o lu tio n s w it h in s t r u c t io n s t o r e p o r t a t o u r n e x t
m e e t in g a s u it a b le r e s o lu t io n o n t h is p r o p o s it io n .
T h e C h a ir m a n . B e f o r e p u t t i n g t h e m o t i o n b y M r . S m i t h , I m a y
g a y t h a t th e p r o g r a m h a s d o w n f o r d is c u s s in g t h is s u b je c t M r . A r
cher, o f N ew Y o rk .
M r . A r e h e r w a s u n a b le t o c o m e , b u t w e a re v e r y
g l a d t o h a v e w it h u s th e c h a ir m a n o f th e N e w Y o r k b o a r d , M r
M it c h e ll, a n d I w il l b e g l a d i f h e w il l n o w d is c u s s th e s u b je e t a n d s a y
w h a t i s i n h is m in d r e g a r d in g th e r e s o lu tio n M r . S m it h sp e a k s o f .
243
244
NEEDED CHANGES IN LEGISLATION.
M r . J o h n M it c h e l l , c h a i r m a n , N e w Y o r k ; S t a t e I n d u s t r i a l C o m
m is s io n . I h a v e b e e n p r o m p t e d to c o m e h e r e t o -d a y b e c a u s e o f th e s it
u a t io n c r e a te d in th e S ta te o f N e w Y o r k t h r o u g h th e d e c is io n o f th e
U n it e d S ta te s S u p r e m e C o u r t in th e J e n s e n a n d W a lk e r cases. A s
y o u k n o w , it w a s fr o m th a t S ta te th e se p e o p le w e n t.
I t w as fr o m
th e S ta te o f N e w Y o r k th e W in fie ld ca se w e n t to th e U n it e d S ta te s
S u p re m e C o u r t a n d w h ile I a m n o t g o in g t o ta k e y o u r tim e in
d is c u s s in g th e W in fie ld ca se , I w ill ta k e tim e t o s a y th a t th e o ld N e w
Y o r k C o m p e n s a tio n C o m m is s io n , w h ic h w a s th e p r e d e c e s s o r o f th e
p r e s e n t S ta te I n d u s t r ia l C o m m is s io n , d e c id e d t h a t a r a ilr o a d e m
p lo y e e in ju r e d t h r o u g h n o fa u lt o f th e r a ilr o a d c o m p a n y s h o u ld
b e e n title d t o c o m p e n s a t io n u n d e r th e N e w Y o r k a ct. W e f e l t th a t
th e F e d e r a l e m p lo y e r s ’ l ia b ilit y a c t a s a ffe c t in g in te r s ta te c o m
m e r c e a p p lie d o n ly t o th o s e ca se s in w h ic h th e in ju r e d m a n o r th e
d e p e n d e n ts o f th e w o r k m a n k ille d h a d r e a l r e m e d y u n d e r th e F e d
e r a l a c t ; th a t w h e re th e F e d e r a l G o v e r n m e n t h a d m a d e n o p r o v is io n
a t a ll f o r th e m a n in ju r e d t h r o u g h n o fa u lt o f th e r a ilr o a d c o m
p a n y , th a t su ch m a n c a m e u n d e r th e p r o v is io n o f th e S ta te a cts,
a n d w e a w a r d e d a c c o r d in g ly .
O u r d e c is io n w a s u p h e ld b y u n a n i
m o u s v o t e o f th e N e w Y o r k c o u r ts , a n d I th in k th a t e v e r y o n e w ill
a g re e th a t th e N e w Y o r k C o u r t o f A p p e a ls , th e h ig h e s t c o u r t in
N e w Y o r k S t a t e , is a v e r y c o n s e r v a t iv e c o u r t a n d th a t its d e c is io n s
a re fo llo w e d b y th e h ig h e r c o u r ts o f o th e r S ta te s a n d r a r e ly r e
v e rs e d b y th e S u p re m e C o u r t o f th e U n it e d S ta te s.
T h e r e fo r e , w h e n
th a t g r e a t c o u r t d e c id e d th a t th e N e w Y o r k w o r k m e n ’s co m p e n s a
t io n a ct, a p p lie d t o r a ilr o a d e m p lo y e e s w h o w e r e in ju r e d th r o u g h
n o fa u lt o f th e c o m p a n y a n d th e r e fo r e h a d n o rea l re m e d y u n d e r th e
F e d e r a l a ct, w e h a d r e a s o n to h o p e th a t th e U n it e d S ta te s S u p r e m e
C o u r t m i g h t a ff ir m t h a t d e c i s i o n .
H o w e v e r , th a t g r e a t b o d y h as
se e n fit t o r e v e r s e t h a t d e c is io n b y a v o t e , n o t o f fiv e t o f o u r , b u t ,
I b e lie v e , o f se v e n t o tw o , a n d w h ile w e r e g r e t th a t d e c is io n , w e h o p e
t h a t t h e t i m e is n o t f a r d i s t a n t w h e n C o n g r e s s w i l l e n a c t a F e d e r a l
c o m p e n s a t io n a c t a p p l y i n g t o th e e m p lo y e e s o f in te r s ta te r a ilw a y s .
P e r s o n a lly , I d is a g r e e w it h M r . P i l ls b u r y ’ s s u g g e s t io n th a t th e
e m p lo y e e s o f in te r s ta te r a ilr o a d s s h o u ld b e b r o u g h t u n d e r S ta te
a cts. I b e lie v e in th e ca se o f r a ilw a y e m p lo y e e s it w o u ld b e m u c h
b e tte r i f th e F e d e r a l G o v e rn m e n t w ere to a ct a n d to a ct so as to
c o v e r p r a c t ic a l ly a ll, i f n o t a ll, o f t h e e m p lo y e e s o f in t e r s t a t e r a ilr o a d s ,
a n d as y o u k n o w , th e r e h a s b e e n p e n d in g in th e S e n a te o f th e U n it e d
S ta te s a b ill in tr o d u c e d b y S e n a to r S u th e r la n d p r o v id in g co m p e n s a
t io n f o r r a ilw a y e m p lo y e e s . T h e b ill as o r ig in a lly d r a ft e d p r o v id
i n g th e r a te s o f c o m p e n s a t io n w a s s o w h o lly in a d e q u a t e as n o t t o
c o m m e n d i t s e l f t o th e ju d g m e n t o f a n y o n e w h o w a s in t e r e s te d in
th e w e lfa r e o f e m p lo y e e s .
T h e b ill w a s a m e n d e d a n d r e v is e d a n d
JURISDICTION IN ACCIDENT CASES---- DISCUSSION.
245
fin a lly p u t in su ch sh a p e as to b e m u ch b e tte r th a n o r ig in a lly in t r o
d u c e d b u t a t n o t im e d id t h e b i l l c o m m e n d i t s e l f t o a t le a s t t w o o f
th e g r e a t r a ilr o a d b r o th e r h o o d s .
T h e b r o t h e r h o o d s w e r e d iv id e d ,
t w o o f th e m s ta n d in g f o r th e b ill a n d tw o o p p o s e d . U n t il th e r a il
r o a d b r o t h e r h o o d s c a n b e p e r s u a d e d t h a t c o m p e n s a t io n is b e tte r
t h a n t h e s u it s f o r d a m a g e s w it h a ll t h e ir u n c e r t a in t ie s , t h e r e is n ’t
m u c h c h a n c e o f th e b ill b e in g e n a c te d in t o la w .
R e c e n t ly I w r o t e
M r . G o m p e r s , a s k in g h im i f h e w o u ld n o t c a ll a c o n fe r e n c e o f th e
h e a d s o f th o s e u n io n s e m p lo y e d in r a ilr o a d s e r v ic e f o r th e p u r p o s e
o f c o n s id e r in g a g a in c o n s c ie n t io u s F e d e r a l le g is la t io n c o n c e r n in g
r a ilr o a d e m p lo y e e s .
N o w , t h e s u b je c t t o - d a y r e la te s o n l y t o t h o s e e n g a g e d in t h e l o a d
i n g a n d u n l o a d i n g o f s h ip s . O f c o u r s e i f t h e F e d e r a l C o n g r e s s w e r e
t o a c t f o r b o t h th e m a r it im e w o r k e r s a n d r a ilw a y e m p lo y e e s , it w o u ld
h a v e t o b e in s e p a r a te b ills b e ca u s e o n e b ill c o u ld n o t c o v e r b o t h k in d s
o f e m p lo y e e s .
T h e r e fo r e , t h is r e s o lu tio n , w h ic h w il l p r o b a b ly b e
r e f e r r e d t o th e c o m m it t e e o n r e s o lu t io n s , r e la te s o n l y t o m e n e n g a g e d
i n l o a d i n g a n d u n l o a d i n g v e s s e ls .
T h e d e c is io n o f th e U n it e
S ta te s S u p r e m e C o u r t w a s h a n d e d d o w n in t w o ca ses, in b o t h o f
w h ic h th e b o a ts o n w h ic h th e se a c cid e n ts o c c u r r e d w e r e fo r e ig n v e s
s e ls ; t h a t is t o s a y , t h e y w e r e n o t v e s s e ls o f t h e S t a t e o f N e w -Y o r k .
O n e w a s o w n e d b y th e S o u th e r n P a c ific R a ilr o a d C o . a n d th e o th e r
b y t h e C l y d e S t e a m s h ip C o . T h e r e f o r e t h e U n it e d S t a te s S u p r e m e
C o u r t d id n o t h a v e th e o p p o r t u n it y o f d e c id in g in th a t ca se w h e th e r
b o a ts o w n e d in th e S ta te w h e re th e a c c id e n t o c c u r r e d w e re e x c lu d e d
f r o m th e p r o v is io n s o f th e w o r k m e n ’s c o m p e n s a tio n a c t, a lt h o u g h I
im a g in e f r o m th e g e n e r a l lin e s o f th e d e c is io n i t w a s in t e n d e d t o e x
c lu d e b o a ts w h e th e r t h e y b e o w n e d in th e S ta te w h e re th e a c cid e n t
o c c u r r e d o r e n g a g e d in fo r e ig n a n d in te rs ta te c o m m e rc e a n d o w n e d
in o t h e r S ta te s o r o t h e r c o u n t r ie s . T h e S u p r e m e C o u r t h a s n o t d e
c id e d d e fin ite ly th a t lo n g s h o r e m e n in ju r e d o n th e d o c k a re e x c lu d e d
f r o m t h e b e n e fit s o f 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, a lt h o u g h i t
seem s th e con sen su s o f o p in io n a m o n g a d m ir a lty la w y e r s o f th e S ta te
o f N e w Y o r k th a t th e d e c is io n d o e s e x c lu d e m e n in ju r e d o n th e d o c k .
N o w , p e r s o n a lly , m u c h as I s h o u ld lik e t o h a v e th a t d e c is io
d e fin e d s o as t o le a v e t o th e S ta te as m a n y o f th e w o r k in g m e n as
p o s s i b l e , I b e l i e v e i t w o u l d l e a d t o e n d le s s c o n f u s i o n . T h e l o n g s h o r e
m a n m o v e s p e r h a p s a h u n d r e d tim e s e a c h d a y f r o m t h e d o c k t o th e
b o a t a n d b a c k a g a in , a n d t h e r e f o r e w e w o u ld h a v e t h e d iffic u lt y o f
d e te r m in in g a n d t r y in g t o a d ju d ic a te ca ses o f m e n w h o a re o n e m in
u te o n th e b o a t a n d th e n e x t m in u te o n th e d o c k a n d p a r t o f th e tim e
o n th e g a n g p la n k b e tw e e n th e d o c k a n d th e b o a t. I ca n n o t see w h e re
th e r e w o u ld b e a n y s u c c e s s fu l a d m in is t r a t io n o f th e la w u n d e r th o s e
c ir c u m s t a n c e s .
246
NEEDED CHANGES IN LEGISLATION.
T h e r e f o r e ’ i t s e e m s t o m e a n d t o m y a s s o c i a t e s i n the* N e w Y o r k
c o m m is s io n a n d t o o th e r m e n in te r e s te d in s o c ia l le g is la t io n w it h
w h o m I h a v e c o n f e r r e d , t h a t C o n g r e s s s h o u l d be? a p p e a l e d t o n o w t o
w i t h d r a w i t s j u r i s d i c t i o n — w i t h d r a w F e d e r a l j u r i s d i c t i o n — K^ver t h e
m e n e m p lo y e d o n b o a ts — e m p lo y e d in lo a d in g a n d u n lo a d in g b o a ts ,
l e g i s l a t i o n o f th a t k in d w o u ld b e e x tr e m e ly s im p le i f C o n g r e s s w e r e
d i s p o s e d to* a c t . I t r e q u i r e s n o e l a b o r a t e m a c h i n e r y ; a l l t h a t w o u l d
b e n e c e s s a r y t o d o w o u ld b e t o p a s s i n a fe w lin e s a n a c t w it h d r a w
in g ju r is d ic t io n o f th e F e d e r a l G o v e rn m e n t fr o m ca se s su ch as w e re
d e te r m in e d b y th e U n it e d S ta te s S u p r e m e C o u r t in th e J e n s e n a n d
W a lk e r ca ses. I t w o u ld b e m u ch m o r e ea sy t o secu re le g is la tio n o f
th a t s o r t, I t h in k , th a n t o h a v e th e F e d e r a l G o v e r n m e n t c r e a te a
c o m p e n s a t io n : a c t a p p l y i n g t o m e n l o a d i n g a n d u n l o a d i n g v e s s e ls o r
m e n e m p lo y e d o n b o a ts o n n a v ig a b le w a ters.
N o w , I h a v e in d ic a te d th a t I fa v o r S ta te le g is la tio n f o r th e m e n o n
d o ck s , lo n g s h o r e m e n , a n d s te v e d o re s , a n d F e d e r a l le g is la tio n f o r m e n
e m p lo y e d o n r a ilr o a d s .
T h e s it u a t io n c r e a t e d is s o la m e n t a b l e ; t o see t h e g r e a t n u m b e r s o f
w id o w s - a n d c h i ld r e n o f t h e m e n k i ll e d , t h e r e a r e s i m p ly h u n d r e d s
o f t h e m ; I s a y it is d e p lo r a b le . T h e N e w Y o r k I n d u s t r ia l C o m m is
s io n h a s m a d e a w a r d s a n d th o s e a w a r d s h a v e b e e n a c c e p te d b y th e
in s u r a n c e c o m p a n ie s , o r , w h e r e a n e m p lo y e r w a s n o t in s u r e d , th e
s t e a m s h ip c o m p a n y h a s p a id t h e a w a r d s w it h o u t p r o t e s t .
A p p e a ls
h a v e n o t b e e n t a k e n ; th e y h a v e c o n s e n te d to th e a w a rd s , a n d th ese
w o m e n h a v e b ee n d r a w in g th e ir m o n e y e v e r y t w o w eek s, a n d th a t
h a s b e e n g o in g o n f o r th r e e y e a rs . I n so m e S ta te s sta tu tes o f lim it a
t io n h a v e r u n a g a in s t th e m , a n d n o w th e in s u r a n c e c o m p a n ie s r e fu s e
to pay.
T h e e m p lo y e r s r e fu s e t o c a r r y o u t th e a w a r d s , a n d th is
g r e a t a r m y o f w o m e n a n d c h ild r e n a r e l e f t h e lp le s s a n d d o n ’t k n o w
w hat to do.
N o w , th e in s u r a n c e c o m p a n ie s a re n o t c o m in g t o th e
c o m m is s io n a n d a s k in g th e m t o set th e a w a rd s a s id e ; th e y a re s im p ly
r e fu s in g t o p a y , a n d th e se w o m e n — a v e r y la r g e n u m b e r o f th e m
d o n o t s p e a k o u r la n g u a g e — fe e l t h a t a g r e a t in ju s tic e h a s b ee n d o n e
th e m a n d fe e l t h a t th e in d u s t r ia l c o m m is s io n h a s p o w e r to r e m e d y
t h a t in ju s t ic e .
N o w , w h a t i s t o b e c lo n e I d o n ’ t k n o w .
O f cou rse
t h e N e w Y o r k c o m m is s io n , u n le s s it is a d v is e d b y a h ig h e r a u t h o r it y
th a n it s e lf, w ill n o t r e v o k e th e a w a r d s it h a s m a d e in a n y o f th e s e
eases.
W e w i l l a t t e m p t t o c o m p e l th e in s u r a n c e c o m p a n ie s t o p a y
th e a w a rd s w h ic h w e r e m a d e a n d fr o m w h ic h n o a p p e a l w a s ta k en .
I f in th a t w a y t h e m a tte r g e ts b a c k t o th e U n it e d S ta te s S u p r e m e
C o u r t, w e ll a n d g o o d .
O r d in a r ily , I a m n o t d is p o s e d t o c r it ic is e
h ig h e r c o u r t s ; I ca n u n d e r s ta n d th a t th e y h a v e th e ir g r e a t p r o b le m s
t o o , b u t I w is h it h a d b e e n p o s s ib le f o r th e m e m b e r s o f th e U n it e d
S ta te s S u p r e m e C o u r t t o h a v e sa t in th e c o u r t o v e r w h ic h I p r e s id e
a n d b e e n c a lle d u p o n t o r e v e rs e th e a w a r d s m a d e t o th e se w o m e n
JURISDICTION IN ACCIDENT CASES— DISCUSSION.
247
a n d in ju r e d m e n .
I t w o u ld h a v e b e e n a l it t l e m o r e d iffic u lt f o r
th e m t o h a v e r e a ch e d th e ir c o n c lu s io n s i f th e y c o u ld h a v e seen th e
g r e a t a r m y o f w id o w s a n d o r p h a n c h ild r e n w h o s e c o m p e n s a tio n w a s
b e in g ta k e n f r o m th e m , th a n it w a s t o s it in W a s h in g t o n , w h e re ,
p e r h a p s , th e y n e v e r h a d th e o p p o r t u n it y o f s e e in g a w o r k in g m a n
©r w o m a n .
I k n o w th e c o m m itte e o n r e s o lu tio n s w il l m a k e a r r a n g e m e n ts w it h
r e g a r d t o th e m a tte rs p re s e n te d t o th e m a n d I tr u s t th e y w il
a d v is e p r o m p t a c t io n .
I r e g a r d t h is as th e m o s t p r o p it io u s tim e in
th e h is t o r y o f th e U n it e d S ta te s t o s e c u r e im m e d ia t e le g is la t io n
f r o m th e F e d e r a l C o n g re s s .
A g r e a t w a r is o n , a n d p r a c t ic a l ly
e v e r y m e a su re th a t h a s b e e n p re s e n te d t o C o n g r e s s f o r th e fu r t h e r
a n c e o f th a t w a r h a s v e r y p r o p e r ly r e c e iv e d t h e ir r e a s o n a b ly p r o m p t
a n d c o n s id e r a te a tte n tio n , a n d it see m s t o m e th a t w h e n s o la r g e a
n u m b e r o f o u r c it iz e n s a r e e m p lo y e d d a y a ft e r d a y lo a d in g s h ip s
w it h m u n it io n s , e m p l o y e d e v e r y d a y d o i n g s o m e t h in g t h a t is g o i n g
t o fu r t h e r o r r e ta rd th e p r o g r e s s o f th e s u cc e s s fu l p r o s e c u tio n o f th o
w a r , t h a t c it iz e n s w h o a r e a liv e t o th e n e e d s o f t h e s it u a t io n m a y
e ffe c t iv e ly a p p e a l to C o n g r e s s t o p a s s as a n e m e r g e n c y m e a su re a
la w t h a t w il l in p a r t a t le a s t c o r r e c t th e h a r d s h ip s c a u s e d b y th e
d e c is io n r e n d e r e d r e c e n tly in th e J e n s e n c a se b y th e U n it e d S ta te s
S u p re m e C ou rt.
C a p t . W h it e . W h a t d o y o u d o i n N e w Y o r k i n a c a s e w h e r e
m e m b e rs o f th e c re w a re in ju r e d o n s h ip ?
D o th e y co m e u n d e r th e
N e w Y o r k la w ?
M r . M i t c h e l l ,. W e h a v e b e e n m a k i n g a w a r d s t o t h e m i n N e w
Y ork .
C a p t . W h it e . A s l o n g a s t h e y a r e w i t h i n p o l i c e j u r i s d i c t i o n o f
N e w Y o r k S ta te y o u c o n s id e r th e m as c o m in g u n d e r y o u r a c t?
M r . M it c h e l l . I f a f o r e i g n v e s s e l , w e d o n o t .
I n case o f f o r
e i g n v e s s e ls w e d o n o t a s s u m e j u r i s d ic t io n , b u t w e h a v e a lw a y s
h e ld th a t a v e sse l r e g is te r e d in th e S ta te o f N e w Y o r k , t h o u g h o w n e d
in th e S ta te o f K e n t u c k y , as w a s th e ca se in th e S o u th e r n P a c ific
R a ilr o a d C o .— w e h e ld t h a t a b o a t r e g is te r e d in th e p o r t o f N e w
Y o r k w a s a N e w Y o r k v e s s e l, a n d I u n d e r s t a n d t h a t h a s b e e n d e
te r m in e d in a d m ir a lt y ; s o w e m a d e a w a r d s in th o s e ea ses, b u t n o t
w h e r e a v e s s e l w a s o w n e d b y s o m e o t h e r n a t io n .
C a p t . W h it e . T h e n t h e p r o p o s e d c h a n g e i n t h e l a w i s s i m p l y a p
p lic a b le t o m e n w o r k in g t e m p o r a r ily in c o n n e c t io n w it h th a t w o r k ?
M r . M it c h e l l . W e l l , w h e r e v e r t h e y m a y b e o n a N e w Y o r k v e s
s e l.
I t is t h e t h e o r y o f th e la w t h a t th e S t a t e f o l l o w s t h e v e s s e l ; f o r
in s ta n c e , i f a N e w Y o r k v e sse l w e r e in L iv e r p o o l, it w o u ld s t ill b e in
th e S t a t e o f N e w Y o r k b e c a u s e t h e v e s s e l is p a r t o f t h e S t a t e o f
N e w Y o r k a n d t h a t is t h e f a c t a l l o v e r t h e c o u n t r y ; f o r i n s t a n c e ,
in B r it is h C o lu m b ia a n d o n th e C o n tin e n t.
248
NEEDED CHANGES IN LEGISLATION.
Capt. W h i t e . I am speaking particularly of the steamship dock;
whether on the ship or on the dock, simply because they were citi
zens of the State of New York or residents of the State of New
York, they would properly come under the law of New York in
occupation.
The C h a i r m a n . D o you consider, Mr. Mitchell, that an act of
Congress divesting itself of jurisdiction would by that very act auto
matically, so to speak, give the State jurisdiction without positive
enactment from some quarter ?
Mr. M i t c h e l l . I think there is no doubt about that. I think if
the'Federal Government withdrew its jurisdiction, it would then
come under the State. Of course our Government is founded on the
principle that the State reserves to itself all rights not delegated to
the Federal Government. I don’t think they would necessarily go
to Congress to have jurisdiction, but if they did it could very easily
be done. Might very well withdraw admiralty jurisdiction in States
where they had compensation act, but not otherwise. The law ap
plies to the members of the crew of a vessel coming under the juris
diction of the State of New York.
Capt. W h i t e . Should not the Federal law follow a vessel? The
employees are those men who are engaged on the vessel. The Fed
eral law would properly follow them, and the jurisdiction of the
State of New York simply follow its residents who are temporarily
employed as stevedores on the vessel.
Mr. M i t c h e l l . Of course that would not take care of the crews.
Capt. W h i t e . The Federal law would take care of the crews
wherever it might be owned in the United States.
M r . M i t c h e l l . Of course the Federal law does not take care of
them.
Capt. W h i t e . Y o u mean if we had a Federal compensation act to
follow the crews of vessels wherever they go?
Mr. M i t c h e l l . That might be one way of correcting the decision,
although I can not see any reason why the acts of the State should
not follow the vessel, because as a matter of fact it is the citizens of
the State who are injured on these vessels and killed, and the State
must provide for their dependents. The burden falls on the State;
it does not fall on the Federal Government. In other words, the
Federal Government does nothing to provide for the vicissitudes of
the citizens stricken; the State itself must provide for all vicissi
tudes of its citizens.
Capt. W h i t e . Then a resident of the State of Maine employed
on a ship in New York would have to seek compensation under the
laws of Maine ?
JURISDICTION IN ACCIDENT CASES— DISCUSSION.
249
Mr. M itc h e ll. Yes.
Capt.
W
h it e
.
I f he were on a New York vessel?
Mr. M itchell, Because that would be the home port of the vessel.
Capt. W h i t e . From what I judge, the employee would have to go
back to his own residence to get compensation for any accident that
might happen on a vessel wherever he was employed.
. Mr. M i t c h e l l . That is just the operation now. In the case of a
mechanic employed in the State of New York by a New York em
ployer to do work in Maine we would pay.
The C h a i r m a n . We had a very able paper on that subject pre
sented by the late Mr. Yaple at the Seattle conference two years,
ago—on this question of concurrent jurisdiction between States.
Practically the same point arises with relation to the border waters
between Ontario and the States. We occasionally have the point up
where a seaman on an American vessel in one of our ports becomes
injured while, possibly, on the wharf or the gangplank, but at all
events within our territorial jurisdiction for the moment. The ques
tion might properly arise, Has Ontario jurisdiction to deal with
such an accident? We have rather taken the view where it has
arisen that we wish to divest ourselves of that jurisdiction, although
it may be admitted that we have it. I think the best opinion, and
this was concurred in by Mr. Yaple, of Ohio, is that both have
jurisdiction but that jurisdiction should be exercised only by the
home State, so to speak; that is to say, Ontario would say to such a
man, “ I f Ohio, or Michigan, or Wisconsin, your home State, as the
case may be, will give you compensation, or will deal with your case,
we will have nothing to say about it ” ; just so we would assume juris
diction if an Ontario man were injured on an Ontario vessel which
happened to be at the moment in a New York State port. That
point of jurisdiction between States, however, is quite a different
problem from the one presented by Mr. Pillsbury.
Capt. W h ite . The difficulty seems to lie in providing for the com
pensation. Where do the States get funds to provide this compen
sation, or what insurance companies or what carriers pay the award ?
Mr. F r e n c h . The insurance carrier representing the employer.
There are thousands of insured employers.
The C h a i r m a n . Y o u instanced a case of a man from Maine being
employed in New York. I would say residence does not make any
difference; he may be a resident of Ontario or any other foreign
jurisdiction. I f a man goes to New York from Maine for employ
ment, as far as the law governing his compensation is concerned he
places himself under the jurisdiction of New York State, is sub
ject to its laws and at the same time is entitled to the protection of
its laws.
2& 0
NEEDED CHANGES IN LEGISLATION.
Mr. S m i t h . I might suggest that this question of Mr. White’s is
absolutely foreign to our present question.
Mr. H o l m a n . Y o u have handed a resolution to the committee on
resolutions and there is no action, I suppose, to take at the moment
with reference to it.
Mr. S m i t h . I placed a motion that the paper of Mr. Pillsbury
and his recommendation, together with that of Mr. Mitchell, be sub
mitted to the committee on resolutions.
The C h a i r m a n . Mr. Wilcox is down to discuss the question but
as he has gone home we will go to the next item, a paper by Mr.
Little, chairman of the United States Employees’ Compensation
Commission, on the subject, “ Compensation for occupational
diseases.”
COMPENSATION FOR OCCUPATIONAL DISEASES.
BY BILEY M. LITTLE, CHAIRMAN, UNITED STATES EMPLOYEES’ COMPENSATION
COMMISSION.
T h e u n d e r l y i n g p r i n c i p l e o f c o m p e n s a tio n : la w s is t h a t t h e h a z a r d ®
o f in d u s t r y s h o u ld b e b o r n e b y s o c ie ty a s a w h o le , a n d n o t b y in d i
v id u a l w o r k in g m e n a lo n e .
T h e p r i n c i p l e r e s ts u p o n m a n ’s s o c i a l
n a tu re.
W e a re m e m b e r s o f o n e b o d y , a n d i f o n e m e m b e r s u ffe r s
a l l m e m b e r s s u f f e r w i t h h i m . T h e i n j u r y o f erne i s t h e i n j u r y o f a l l ;
t h e w e l f a r eo i o n e i s t h e w e l f a r e o f a l l . A f r a c t i o n o f t h e p e o p l e
m a y b e in ju r e d a n d s u ffe r , a n d a ll o f s o c ie t y n o t b e c o n s c io u s o f th e
s u ffe r in g b e c a u s e o f th e h e a lth a n d v i t a l it y o f th e w h o le , ju s t a s
o n e ’s b o d y m a y h a v e a d is e a s e d m e m b e r , b u t b e c a u s e o f o n e ’s g e n
e r a l h e a lth a n d s tr e n g th , h e m a y n o t t h in k m u ch a b o u t th e d e c a y e d
to o th , th e d e fe c t iv e e y e s ig h t, o r th e w e a k h ea rt.
B u t a n i n j u r e d b o d y is n o t a p e r f e c t l y s o u n d b o d y , a n d t h
h e a lt h y m e m b e r s o f th e b o d y m u s t m a k e u p f o r th e w e a k e n e d m e m
b e r s b y c a r r y in g a n in c re a s e d b u rd e n .
A m an b ecom es a stro n g e r
a n d m o r e e f f e c t iv e m a n w h e n e v e r y o r g a n o f h is b o d y is s o u n d a n d
w e ll a n d p e r f o r m in g its p r o p e r fu n c tio n .
A s t r o n g v ir ile S ta te m a y c o n tin u e t o g r o w , a n d d e v e lo p a fin e
c iv il i z a t i o n w h ile so m e o f its c it iz e n s a re h a n d ic a p p e d a n d a r e u n
e q u a lly b e a r in g th e b u r d e n s o f lif e , b u t it w il l b e a s t r o n g e r S ta te
a n d h a v e a fin e r c iv il i z a t i o n i f a ll o f its c it iz e n s a r e l i v i n g n o r m a l,
h a p p y , u s e f u l liv e s .
T h i s t r u i s m is r e c e i v i n g t r e m e n d o u s e m p h a s i s
b y th e p re se n t w o r ld s tr u g g le fo r d e m o c ra cy .
I a m m e r e ly r e c it in g th e A , B , C o f w h a t w e a ll k n o w , in o r d e r
th a t w e m a y b e a r in m in d th e fu n d a m e n ta l c o n s id e r a tio n — w h y o c
c u p a t i o n a l d is e a s e s s h o u l d b e c o m p e n s a t e d . T h e y e x e r t a d i r e c t a n d
b l i g h t i n g in flu e n c e u p o n th e S ta te , as w e ll a s u p o n th e a fflic te d w o r k
in g m a n . T h e y a ffe c t h is h e a lth , w o r k in g p o w e r , a n d e c o n o m ic a n d
s o c ia l sta tu s . T h e y a ls o a ffe c t in d u s t r y as t o o u t p u t , lo s s o f t im e , a n d
e ffic ie n c y . T h e y a ffe c t s o c ie t y a n d t h e w o r l d w h i c h i n d u s t r y s e r v e s .
T h e r e i s a l o s s a l l a l o n g t h e l i n e t h r o u g h o c c u p a t i o n a l d is e a s e s , a s
w e ll a s o n a c c o u n t o f in d u s t r ia l a c c id e n ts .
I t is a ll b u t u n iv e r s a lly c o n c e d e d th a t c o m p e n s a t io n s h o u ld b e
g r a n te d t o th o s e w h o a r e in ju r e d b y a c c id e n ts w h ile in th e c o u r s e o f
fch eir e m p l o y m e n t o r i n t h e p e r f o r m a n c e o f t h e i r d u t i e s . A c c i d e n t s
a re c a u s e d b y fo r c e s w h ic h o p e r a te f r o m th e o u ts id e . T h e y a r e c o n
s id e r e d u n t o w a r d e v e n ts w h ic h s u d d e n ly a n d u n e x p e c t e d ly o c c u r .
251
252
NEEDED CHANGES IN LEGISLATION.
T h e y e m a n a te f r o m a w o r k in g m a n ’s e n v ir o n m e n t. T h e y a r e c a u s e d
b y t a n g ib le in s tr u m e n ts o r c o n d it io n s . T h e y a r e e a s ily s u s c e p tib le
o f p r o o f , a n d c a n b e ta b u la te d o r a n a ly z e d , a n d th e r e s p o n s ib ilit y
f o r th e m ca n b e fix e d a n d th e c o sts assessed .
M o s t p e o p le b e lie v e w h a t t h e y ca n see, a n d a re s lo w t o b e lie v e w h a t
t h e y c a n n o t see. B e c a u s e a c c id e n t s a r e e x t e r n a l— w it h in t h e l i g h t
o f co m m o n d a y — a n d b eca u se th e y o c c u r w h ile m e n a re at w o r k , th e
a w a k e n in g s o c ia l c o n s c ie n c e h a s m a d e p r o v is io n as to th e m in 37
S ta te s a n d in th e F e d e r a l G o v e r n m e n t ; b u t w e a re s lo w t o m a k e
- s im ila r p r o v is io n a g a in s t th e h a z a r d s o f in d u s t r y o n a c c o u n t o f o c c u
p a t i o n a l d is e a s e s .
E v e r y c o m p e n s a t io n la w r e c o g n iz e s in d iv id u a l r e s p o n s ib ilit y b y
d e n y i n g a w o r k m a n c o m p e n s a t io n f o r a n i n j u r y w h i c h h e s u s ta in s
t h r o u g h h is o w n w i l l f u l m i s c o n d u c t o r i n t o x i c a t i o n ; a ls o w h e n h e
is d o i n g s o m e t h in g o n h is o w n a c c o u n t , o r in t h a t p e r i o d o f t h e d a y
w h ic h b e lo n g s t o h im s e lf a lo n e . B u t w h e n a m a n is e n g a g e d in a n
in d u s t r y d o in g s o m e th in g u s e fu l f o r h is e m p lo y e r a n d f o r s o c ie ty ,
h is e m p lo y e r a n d s o c ie t y a re h is p a r tn e r s , a n d w it h h im jo i n t ly
r e s p o n s ib le f o r th e p e r s o n a l in ju r ie s w h ic h h e m a y r e c e iv e . C o m p e n
s a t io n la w s d o n o t a b s o lv e m e n f r o m t h e ir p e r s o n a l r e s p o n s ib ilit y ,
n o r s h o u ld t h e y ; b u t t h e y d o d e fin e th e in t e r r e la t io n s o f l i f e m o r e
c lo s e ly th a n h e r e t o fo r e , a n d t h e y d o a tte m p t— ju s t ly — t o d is t r ib u t e
th e r e s p o n s ib ilit y a n d h a z a r d o f th e w o r k in g a n d p r o d u c in g w o r ld
a m o n g a ll t h o s e w h o r e c e iv e b e n e fit s f r o m t h e w o r k i n g a n d p r o d u c i n g
w o r ld .
A l r e a d y , th e e x p e r ie n c e g a in e d f r o m c o m p e n s a t io n la w s o n a c c o u n t
o f a c c id e n t s s h o w s t h a t t h e y a r e s o u n d a n d ju s t , a n d f o r t h e w e l f a r e
o f s o c ie ty .
T h e s u ffe r in g s o f th o u s a n d s o f w o r k in g m e n h a v e b e e n
m it ig a t e d b y th e b e n e fit s ; fa m ilie s h a v e b e e n k e p t i n t a c t ; th e sen se
o f in ju s t ic e h a s b e e n a p p e a s e d . T h o s e w h o d o th e h a r d w o r k o f th e
w o r ld a m id s t its d a n g e r s a r e c o m in g to r e c o g n iz e t h a t s o c ie ty , a s a
w h o le , c a re s f o r t h e ir w e lfa r e . P r e v e n t io n h a s b e e n s t im u la t e d ; c o n
d it io n s o f t o il a re b e in g m a d e s a fe r ; a c c id e n t fr e q u e n c y h a s b e e n
r e d u c e d , a n d lo s t tim e g r e a t ly s h o r t e n e d ; in d u s t r y is b e c o m in g m o r e
e f f ic ie n t ; a n d l i f e is s w e e t e r a n d m e a n s m o r e t o a m u lt it u d e o f t o ile r s .
O u r c o m p e n s a t io n la w s e m b o d y th e c o n v ic t io n th a t w e r e a lly b e
l i e v e t h a t a m a n is o f m o r e v a l u e t h a n a s h e e p . W e a r e d i s c o v e r i n g
t h a t s o u n d , h e a lt h y w o r k in g m e n a re m o r e v a lu a b le th a n m a im e d a n d
m a n g le d e m p lo y e e s , a n d e v e n th e d iv id e n d s a r e m o r e r e lia b le .
T h i s h a p p y e x p e r ie n c e is b r i n g i n g u s t o a n a t t it u d e o f m i n d t h a t
r e c o g n iz e s th e ju s t ic e in p r o v id i n g c o m p e n s a t io n f o r o c c u p a t io n a l
d is e a s e s . T h e y a s d i s t i n c t l y a r i s e o u t o f t h e n a t u r e o f e m p l o y m e n t
a n d b e lo n g t o th e h a z a r d s o f in d u s t r y as d o a c c id e n ts .
I f th e o n e
s h o u ld b e c o m p e n s a te d , so s h o u ld th e o th e r . I f s o c ie t y s h o u ld s h a re
w it h th e w o r k in g m a n th e lo s s h e e x p e r ie n c e s b e c a u s e o f a n a c c id e n t,
C O M P E N SA TIO N FOR O C CU PATIO N AL DISEASES---- R. M . L IT T L E .
253
why should not society likewise share with him in the loss and suf
fering which he experiences on account of a disease which he con
tracts* because of his employment? For the reason previously stated,
it was quite natural that compensation laws should first take cog
nizance o f accidents, but it is apparently difficult for many minds to
broaden sufficiently in their thinking to include occupational diseases.
However, the logic of the underlying principle and the practical ex
perience o f the industrial world must carry us forward to include
the latter in our schemes of compensation.
Think o f the injustice of discriminating against occupational dis
eases. A workingman left his position with a railroad to accept one
at a tannery at an increase of $2 per week in his wages. Within a
few weeks he contracted anthrax, and after a short illness he died.
The diagnosis was clear and conclusive that he contracted the dis
ease while working with hides. He left a wife and two children, and
an unborn child— foreigners in a strange city—with $100 in money,
$78 o f which was used to pay funeral expenses. In course o f time,
the case came before the compensation board of Pennsylvania, which
disallowed the claim. The widow and children in their helplessness
were cared for by the charity society o f the city. It was necessary to
move the family twice within three months. The widow made a
brave, energetic struggle against her adverse circumstances, but her
health failed. When the charity society asked the employer to make
a reasonable contribution to a pension fund for the family, the presi
dent offered to contribute “ $10 once in a while,” whereas the needs of
the family were $400 a year to eke out a meager existence. I f the man
had been injured by an external force and died therefrom, his family
would have secured more than $2,500.
A strong, able-bodied, productive workingman of 37 years o f age
was placed in a position where he was subject to a virulent infection
which destroyed his life within a few weeks, which left his widow
and little children helpless—the objects of charity and the benevolent
spirit o f the community. Justice was what they were entitled to,
not charity, but the law or its interpretation denied them justice.
In contrast to the attitude of this Pennsylvania company was that
of an Illinois manufacturing establishment, where 20 employees died
on account o f diphtheria and typhoid fever. They contracted the
disease by drinking polluted water furnished by the company. There
was a voluntary settlement o f the claims without contest. Unfortu
nately, employers can not all be depended upon to deal justly with
their employees without the compulsion o f law.
The basic difficulty, o f course, is in the wording o f the laws. Most
compensation laws are intended, primarily, to assure compensation
for industrial accidents, and, naturally, compensation boards and the
courts must follow the laws. However, ten States do not employ
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D EED ED C H A N G E S IN LEG ISLA TIO N .
the term “ accident ” in describing compensable injuries, but they
use the terms “ injuries” or “ personal injuries.” These States are
California, Connecticut, Iowa, Massachusetts, Michigan, New Hamp
shire, Ohio, Texas, West Virginia, and Wyoming. The meaning o f
the term “ injuries ” or “ personal injuries ” as interpreted by the
commissions and courts in these States is confusing and conflicting.
Apparently it was the intent of the legislatures in some o f the States
to include occupational diseases when the word “ injury ” was sub
stituted for the British term “ injury by accident,” but with the sin
gle exception o f Massachusetts, the courts, where cases have come
before them, have ruled against the inclusion of such diseases. In
Iowa and Wyoming, occupational diseases have been specifically
excluded by the laws, although they do not use the term “ accident.”
There is an express provision in those States against occupational
diseases being compensable. In Connecticut, Michigan, Ohio, and
Texas, occupational diseases have been excluded by the courts. In
Connecticut, Michigan, and Texas, the courts have overruled the ad
ministrative commissions which had allowed compensation for occu
pational diseases. In excluding such diseases in Michigan, the court
relied upon the use of the word “ accident ” found in the title, but
not in the body of the act. In New Hampshire, the law declares the
employer liable “ for any injury arising out of and in the course
o f employment ” ; but as the law announces its purpose to be “ t o
establish a new system of compensation for accidents to workmen,”
and repeatedly uses the term “ accident ” in prescribing the methods
of administration, it is probable that occupational diseases are ex
cluded in New Hampshire. In California and West Virginia, the
phraseology o f the law favors more strongly the inclusion of occu
pational diseases. The original West Virginia law included two
references to accidents, but the most significant of these was changed
in 1915 from “ accident” to “ injury.” In California the law was
amended in 1915, substituting the word “ injury ” for “ accident,”
wherever the latter word appeared, with the apparent intention of
including occupational diseases. Such diseases are now being com
pensated in California. Massachusetts and California, however, are
the only States in which both the compensation board and the courts
have ruled that occupational diseases are included within the scope
o f the act. The United States Employees’ Compensation Commis
sion has held that the Federal act covers occupational diseases. The
language o f the act is as follow s:
That the United States shall pay compensation* as hereinafter specified for
the disability or death of an employee resulting from a personal injury sus
tained while in the performance of his duty.
The word “ accident ” is not used in the Federal act, but the
broader term “ personal in ju ry” is employed. What is a personal
C O M P E N SA TIO N FOR O C CU PATIO N AL DISEASES— R . M . L IT T L E .
255
injury ? The primary idea of “ injury ” is something not right, or
unjust. The secondary meaning is a wrong or damage done to
another in his person, rights, property, or reputation; the unlawful
infringement or privation of rights. The term “ personal injury”
in law means injury to one’s body.
The Supreme Judicial Court of Massachusetts^ in considering a
compensation case for occupational diseases* has declared that
“ Under the act ‘personal injury’ is not limited to injuries caused
by external violence, physical foree, or as the result of ‘accident ’ in
the sense in which that word is commonly used and understood, but
under the statute is to be given a much broader and more liberal
meaning, and includes any bodily injury.” The pending War Risk
Insurance bill in Congress declares that “ The term ‘ injury ’ includes
disease.”
The United States Employees’ Compensation Commission, in in
terpreting the words “ personal injury,” has taken them in their
comprehensive meaning as given in the dictionaries and by the
Supreme Court of Massachusetts. We are unable to distinguish
between “ personal injuries ” which civil employees may receive while
in the performance of their duty, by infection, or virulent poison,
and those which are caused by a sudden external physical force.
Four decisions of the commission may serve to illustrate its atti
tude toward occupational diseases:
(1)
A case of lead poisoning. A painter in one of the Govern^
ment establishments experienced some symptoms of lead poisoning
for several weeks,, but, being a strong, robust man, did not pay much
attention to the illness. Suddenly, one afternoon he fell over un
conscious, and was quickly taken to the dispensary, where the attend
ing physician pronounced it a case of epilepsy, and kt once the
patient was sent to an emergency hospital. In addition to the
physicians of the hospital, the family physician was present, but
within a short time the patient died. The superintendent of the
hospital and the family physician were inclined to believe that it
was a case of lead poisoning.
When the claim for compensation came before the commission,
there was the conflict of opinion between the medical officer of the
Government establishment and the physicians who last attended the
deceased. Every particle of evidence bearing upon the case was
carefully sifted, and the judgment of a number of impartial
physicians secured. In their opinion, the preponderance of evidence
indicated lead poisoning. The complete record was placed before
the Surgeon General of the department, whose opinion coincided
with that of the other physicians and against the hasty diagnosis of
his subordinate officer. With all these facts before the commission,
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NEEDED C H AN G ES IN L E G ISLA TIO N .
they decided that the man died from a personal injury sustained
while in the performance of his duties. The claim was allowed.
(2) A claim on account of disability caused by inflammatory
rheumatism has been allowed by the commission. The circumstances
were as follow s: A young man was employed as a stock clerk in a
room which had a dirt floor, and in order to keep the floor in good
condition it was necessary to sprinkle it with oil and then with
water. The oil prevented the water from being absorbed and caused
it to form puddles on the floor. A ll the employees in the stock room
suffered from the extreme moisture and cold. The claimant suffered
severely with la grippe and then with a serious illness which the
attending physician diagnosed as rheumatism, articular, acute, in
both ankles, hips, and knees, and left elbow, and in his opinion the
disease was incurred while in the performance of duty. Three
physicians agreed that most likely the claimant was afflicted with
rheumatism because of the unhygienic conditions under which he
was employed. The claim, therefore, was allowed.
(3) A riveter in one of the navy yards, while riveting the boiler
beds on a vessel, was compelled to lie on the tank tops, using a com
pressed air machine. Continuous working in that difficult position,
and the constant jarring o f the machine and rubbing the cold iron,
caused water on his elbow. His claim for compensation was allowed.
(4) A mining engineer, who attempted to do rescue work after an
explosion, entered a mine with protective apparatus, but inhaled the
gases. He was carried unconscious into the fresh air, but all efforts
to revive him failed, and he died. The claim was allowed on the
ground that the injury was received while in the performance o f
his duties.
These cases illustrate not only the attitude o f the commission
toward occupational diseases, but also its procedure in considering
border-line cases.
Euling that occupational diseases are compensable brings us into
the midst of a multitude of difficulties, because the knowledge of
such diseases is not complete or always clear and definite in partic
ular cases. However, they do exist, and they cause personal injuries
resulting in disability and death. They occur in the course o f em
ployment, and arise out of employment, while employees are per
forming their duties for the Government. The fact that allowing
claims for occupational diseases leads us into a disputed field is not
sufficient reason to disallow them. There is a twilight zone sur
rounding accidents; there is a larger twilight zone, perhaps, sur
rounding occupational diseases; there is also a twilight zone lying
between accidents and occupational diseases. By including occupa
tional diseases as compensable, the Federal commission is not con
C O M P E N SA TIO N FOR O C CU PATIO N AL DISEASES---- R. M . L IT T L E .
257
fronted by any more twilight zones than are those who administer
the laws which grant compensation only because of accidents, for
by granting compensation for occupational diseases we have elimi
nated the twilight zone between accidents and occupational diseases.
Even if our knowledge of occupational diseases is incomplete and at
times vague, we do have certain definite knowledge about a number
o f diseases, and with further investigations we shall have more defi
nite and dependable knowledge, but in the meantime we are acting
upon the knowledge which we already have. Compensation com
missions and courts, when the law permits, should follow medical
science and award compensation only for those cases which com
petent medical authority believes are due to conditions of employ
ment.
The principal contention of this paper is that the hazards of indus
try ought to be borne by society as a whole and not by individual
workingmen. It is perfectly obvious that many working people
suffer because o f harmful conditions of physical environment, in
juries to nerves, muscles and bones, injuries to special organs o f the
body as the skin, eyes, ears, nose, and throat; injuries to the blood,
circulatory system, respiratory system, nervous system, digestive sys
tem, muscular system, cutaneous system, urinary system, and special
sense organs. There is a large field of occupational diseases clearly
charted and defined. As the safety movement is the corollary of
the employers’ liability laws and compensation acts, so sanitary and
health measures will become the corollaries o f compensation on ac
count o f occupational diseases. It is highly desirable, therefore,
that compensation laws in the various States should be amended
when necessary so as to include occupational diseases. Their inclu
sion will not impose an appreciable burden upon society, but will
lift an unjust burden from a considerable number of wage earners,
and will help to fill out the meaning and just scope o f our compen
sation laws.
78532°—Bull. 248—19------17
DISCUSSION.
Mr. J ohn B. A ndrews, secretary, American Association for Labor
Legislation. May I ask, Mr. Little, what is your procedure ?
Mr. E . M. L i t t l e , chairman, United States Employees’ Compensa
tion Commission. Well, I presume that the procedure o f the Federal
Compensation Board by force o f circumstances is a good deal differ
ent from a good many compensation boards. The law directs that a
record o f the injury must be made out and signed by the immediate
superior officer o f the employee, then signed by the medical officer of
the navy yard or arsenal; the claim for compensation must be signed
by the same two officers o f the staff and any witnesses who were pres
ent. Now, we do not hold hearings all over the country; it would be
impossible to go all over the United States because o f the scattered
nature o f the work, and therefore we simply take the judgment o f the
officers that were there, very largely, and now when it comes to a case
where there is a dispute, like this lead-poisoning case, in Washington,
we got the judgment o f the attending physician, which was epilepsy,
but there were certain circumstances round about it which indicated to
us that the diagnosis was not satisfactory; he made it in fifteen minutes— and so we gathered all the circumstances surrounding it we could
and then took the testimony of the superintendent o f the hospital where
he died and the testimony of the family physician. Now, there was
not a full and complete analysis o f that case that demonstrated to the
last word that it was lead poisoning, but the whole preponderance o f
evidence was in favor o f lead poisoning and as we are not pitting
the advantages of the Government against the employee, we resolved
in his favor whatever shadow of doubt there might have been in our
minds—there wasn’t any shadow of doubt, really. That may not
have answered your question. I am going back on my own tracks.
Mr. A n d r e w s . Did these doctors come before you and testify?
Mr. L i t t l e . Our health doctor happened to know personally the
physician of the yard who made the first statement; he esteemed him
a very high-grade man. He took four or five physicians from the
Public Health Service, then when we got all the circumstances and the
judgment o f the medical men, we placed it before the Surgeon General
o f the Department and he looked it all over and said there was no
question in his mind but what the man died o f lead poisoning. That
was the proceeding in that particular case.
258
C O M P E N SA TIO N FOR O CC U P A TIO N A L DISEASES— DISCUSSION*
259
Mr. A n d r e w s . Suppose the case had arisen a long way from Wash
ington; would you instruct one o f your officers there to make some
investigation ?
Mr. L i t t l e . O f course we are using—the law prescribes that we
must use the health service the Government already has in the Navy
—the naval officers, medical officers in the dispensaries and hospitals;
the same in the A rm y; and then in addition to that, the widespread
Public Health Service. In all the large populous centers of the coun
try there are designated hospitals, if there are none under the control
o f the Public Health Service. W e would refer such a case, if in a city
and anywhere near a public health officer of the Government, to him
and he would go and make further investigation; that would be our
proceeding. I f he was not available and there was no Government
doctor or surgeon near by, we would try to select by correspondence
or knowledge o f the best grade medical men, experts in the particular
line. We get impartial men of the highest possible standing to do
it for us. It is the only way we could do it.
Mr. A n d r e w s . Does this act apply to men in the Army?
Mr. L i t t l e . It does not cover enlisted men; only civil employees
o f the Government.
Mr. S m i t h . May I ask whether you take that as testimony or
simply send out an investigator and take his report?
Mr. L i t t l e . Not sworn testimony, for the reason that every officer
in the United States Government is under oath. We sometimes
would i f it were in the case of an employee, but the certification of
an officer of the Government is under oath anyway.
Mr. S m i t h . Then ordinarily you have very little testimony taken.
Mr. L i t t l e . Not very much. We are not holding hearings, just
a few occasionally in Washington. We have a few field men who go
out and investigate complicated claims, but as we are getting more
and more in touch with the Government’s machinery and the officers
in those places understand the working of the law, why we feel it
is to that extent working well and believe it will work out quite
satisfactorily.
Mr. A r m s t r o n g . Does the workman himself make any statement
o f his injuries?
Mr. L i t t l e . Oh yes, he signs it; it is the same form.
Mr. W right. In that case of lead poisoning I didn’t get what the
evidence was. We in Ontario would compensate a case of lead
poisoning but we must have satisfactory evidence that it did arise
out o f employment. One case I have in mind now; Mr. Kingston
investigated i t ; the doctor had no doubt in his report that it was lead
poisoning, but assumed that it was lead poisoning because the man
was a painter. Mr. Kingston’s investigation showed that while the
260
NEEDED CH AN G ES IN LE G ISLA TIO N .
man was engaged in such occupation he was not using lead paints
at all, and the evidence seemed to show it was not a case of lead
poisoning arising from occupation. Under our act these cases would
be compensated, but we must have evidence that they arose out o f
employment and happened in the course of it.
Mr. L i t t l e . I did not try to give the evidence in this particular
case of lead poisoning further than these general facts; he was a
man o f splendid reputation, a workman in the navy yard for 5
years—most o f the time inside— using gloves but not always. His
fingers and under the nails showed lead. He was willing to do work
in difficult positions. He was a strong robust m an; had a nice family.
He did not complain particularly to his wife about being ill; she
did not know of his illness at all. He said something about it to his
fellow workmen from time to time. His wrist dropped a few times;
those were common occurrences about it. There had never been any
epilepsy in the family and he never had any epilepsy and when he
fell over unconscious that day, there was more or less confusion.
He was taken to the dispensary and the head physician who was
very busy looked at him just a few minutes and in 15 minutes
sent him to the emergency hospital. Over at the emergency hos
pital they did not make a thorough diagnosis of the urine for lead—
it would show up in that—but the superintendent of the hospital said
“ Why, that must be a case o f lead,” and so he called the family
physician. He thought perhaps he would know the whole history
o f the case. Then it got out among the workmen that it was a case
o f injustice; the man’s family was going to be denied compensation
because it had been reported that the man died o f epilepsy. We sent
out an investigator and that did not seem to be quite conclusive. W e
put in a great deal o f time. We did not have the chemical analysis
and dropped the case for that reason, but we had the judgment of the
two physicians who were with him when he died. We had the judg
ment of three other impartial physicians in the Public Health
Service besides the health officer of the commission and at last, with
the accumulative evidence, we had the judgment of the Surgeon
General o f the Navy. He died of lead poisoning in his judgment.
I give it to you as an illustration that even when the commission
does not have a chemical analysis that would demonstrate finally,
when the preponderance o f available evidence shows that a man died
of a disease contracted in the course of employment or while in the
performance o f his duties, we compensate his family for his death.
Mr. W r i g h t . I can see that with such evidence as you have in that
case we would most certainly consider it a case of lead poisoning and
compensate, but in a case where a man is ill with lead poisoning and
dies o f lead poisoning and there is absolutely no evidence that he
C O M PEN SATIO N FO R O C CU PATIO N AL D ISE A SE S-^D ISC U SSIO N .
261
could have contracted it while in the course of occupation— in that
case we would not compensate; but with reference to the whole ques
tion o f occupational disease, while we have a few diseases specified, we
also feel that is a source of difficulty to our board. We felt that because
o f the number o f diseases specified— occupational diseases—that we
were debarred, unless an “ accident ” could be shown, from compensat
ing another case that did not come under this list, and our board has
decided that, while we would not like exactly to take the Massachu
setts plan and say “ all persons injured” —we did contemplate sug
gesting an amendment like that at one time— we have made up our
minds now when a case comes up, if we are satisfied that that illness
or death arose actually out of employment and was caused by it, even
though accident is not definitely proven, we are going to treat it is
an accident and compensate accordingly.
Mr. L i t t l e . O f course the point of view of my paper is getting rid
o f the word “ accident ” and calling it “ personal injury,” and if per
sonal injury occurs in the performance of duty or arises out of em
ployment, why it is due to employment, and those injuries a man re
ceives are just as compensable as if he had been hit with a hammer.
Mr. A r m s t r o n g . May I ask another question ? Are your decisions
final ?
Mr. L i t t l e . Yes, sir.
Mr. A r m s t r o n g . I am glad they are.
The C h a i r m a n . I want to congratulate Mr. Little on being the
chairman o f the board that is administering a law on a basis so simi
lar to the law in Ontario. It almost seemed as if he were reading a
paper having the Ontario experience in his mind except for the point
o f difference Mr. Wright refers to. Those o f you who are on ad
ministering boards in jurisdictions where there is the right of appeal
to a higher court will appreciate the position occupied by Mr. Little
and the board in Washington as well as the board in Ontario who are
a court of last resort unto themselves.
Capt. W h i t e . Mr. Chairman, may I say one thing about Mr- Lit
tle’s paper ? I notice he said that the accident should be borne by so
ciety as a whole. W e believe— the manufacturers believe—that the
industry should bear the burden of the cost of accidents. Now, in the
question o f workmen’s compensation, the law of workmen’s compensa
tion simply took the place of an antecedent condition where the work
man was empowered by law, if he received an injury, to take his case
into court and get compensation through the forms of law. The
workmen’s compensation act was passed so as to make it easier for
the accident to be compensable; that the workman might not haTe to
take his case into court, and, I think, it is very generally accepted by
the manufacturers that the manufacturers at large have gained by
262
NEEDED C H AN G ES IN L E G IS L A T IO N .
that method; that we are benefited by having a method that will
enable the funds which otherwise might be used in fighting a ease
in court properly given to the man who was injured.
Now, in case of disease it has not always been so sure or certain. It
is only in modern times that modern methods o f investigation prove
that disease may grow out o f occupation and that injury resulting
from disease gained in occupation might be properly charged to in
dustry. Occupational disease in itself is very difficult o f determina
tion. The very question o f lead poisoning brought up in this case
shows, we might $ay, that it is not necessarily an occupational dis
ease. The man who is a painter does not necessarily get lead poison
ing. Because he happens to be a painter and gets lead poisoning it
does not necessarily follow that his lead poisoning is due to the fact
that he is using paint, but it may be that he is careless in his habits,
in not cleaning himself before he takes his meals, or he may be using
tobacco and get the lead into his system through his mouth through
carelessness. So that lead poisoning in particular, I feel, is not prop*
erly an occupational disease., although the law does say it is and may
properly be charged to the industry.
Mr. W r i g h t . With reference to one thing the gentleman just said,
that the cost of compensation should be borne by the industry, I
think there is a threefold burden; the employee bears his share, the
employer should bear his, but society at large also has a share. It
is to the interest of everyone that industry should be carried on. A
man may be injured in a factory or workshop through no fault o f
his own, through no fault o f his employer, but by an accident that
simply could not be avoided and not an accident of employment at
all. While I would not urge that the law should be amended in any
way I would like the public conscience always to be awake to the
fact that every workman who meets with an injury should be con
sidered by society at large as one in whose compensation they should
bear a share. Now, you are going to do some compensating here in
the United States as we are doing in Canada for the war. I hope
your share will not be as large a portion as ours, but you will have
to bear your burden. It is going to be borne by the whole people,
and I trust the whole people while bearing that share will not for
get that the soldiers are entitled to the very best that can be given.
We are not quite doing that in Canada but we are coming pretty
near it.
The C h a i r m a n . In that conneetion may I quote an expression by
one of our most eminent jurists in Ontario, to whom, on the original
investigation leading up to the passage of our act, it was urged that
the employee should be made to bear the burden or a portion of the
burden of compensation instead of, as suggested, putting all on the
COM PENSATION' FOR OCCUPATIONAL, DISEASE$“
D ISCU SSIO N .
263
employer. He retorted with this answer: “ Do you mean to tell me
that the employee is not bearing a portion of the burden o f compen
sation? ” We are paying 55 per cent in Ontario; “ doesn’t the em
ployee bear the other 45 per cent? Doesn’t the employee bear all
the suffering consequent upon the accident ? I f there is a deformity
doesn’t he carry that through life ? ” Who, let me ask you, is bear
ing the biggest share of the burden, even as it stands to-day in our
law and in every one of your laws? It can not be said of any State
in the Union or any Province of Canada that the employee is not
bearing a very, very substantial share of the burden or loss, which
ever you may call it, resulting from an industrial accident.
W e have Mr. Lissner, o f California, down to discuss this question,
but as he is not here, I am going to ask Mr. French to say what is
in his m ind; he may have some notes from Mr. Lissner with refer
ence to it.
Mr. F rench . I haven’t anything from Mr. Lissner in this connec
tion. I do want to digress just for a moment to add to the rea
sons you gave why the employee bears his percentage of the burden
also, that in the final analysis the working man and woman of any
State or country are the largest factor in the purchasing power, and
every employer who possibly can adds to the cost of production the
cost o f his compensation insurance, and so if we had some German
professors here they would be able to tell us exactly how through the
different processes the employee pays it all or very nearly all.
The problem o f occupational diseases has been so well presented
by Mr. Little that I feel I have hardly anything to add, excepting to
say that his two main contentions are, I think, absolutely sound:
first, that the occupation or the industry should pay for the loss sus
tained by occupational disease just as it does for injury; and second,
that because of charging industry as it should be charged for occupa
tional disease, there will be taken that care to surround the workers
with healthful conditions that now gives vitality to “ safety first”
tinder our workmen’s compensation laws.
The decisions quoted by Mr. Little were interesting. There is one
from Wisconsin that he did not refer to, the case of Vennen v. New
Dells Lumber Co. When Wisconsin first had the word “ accident,”
the commission of that State ordered compensation to a widow who
lost her husband through typhoid fever and the source o f con
tamination was found related so directly to industry that the award
was forthcoming. Now, to the surprise of those of us that follow
this kind of legislation the higher courts in Wisconsin upheld the
Wisconsin Industrial Commission’s decisions, and in Massachusetts
we have had a similar decision, as alluded to.
I copied briefly the words used in the laws on this subject. I shall
just summarize them. I copied them from the Workmen’s Com
264
NEEDED C H AN G ES IN L E G ISLA TIO N .
pensation Publicity Bureau Digest, issued in December, 1915. There
may have since been some changes.
In Alaska the law calls for “ personal injuries by accident.”
In Arizona, the same.
In California, “ all personal injuries proximately arising out o f
and in the course of the employment.” There is rather interesting
history in that connection. Our act first stated that compensation
should be paid for industrial accidents. We had a case of a man
working with wood alcohol and all of a sudden he became totally
blind. The doctors informed us that the wood alcohol was a danger
ous and treacherous liquid with which to work, and that it was re
sponsible for the man’s incapacity. We awarded him compensa
tion, but our supreme court determined that we did not have that
right because of the word “ accident.” Therefore, we promptly
changed it the next time the legislature met and made the word
“ injury,” and we believe that the supreme court will undoubtedly
uphold our decisions, awarding compensation for occupational dis
eases. W e were asked by the employers to name a certain number of
special diseases. In England and Great Britain they have about 24.
Now, we did not do that and thought it best not to for this reason:
That all the time there are changes in industry, new occupations com
ing along, and it might be that a man would be as much entitled to
compensation for an occupational disease outside of those specified.
So we preferred, and the plan is working well so far, to simply make
the generalization of “ personal injury” and thereby include occu
pational diseases.
In Colorado I find that all personal injuries accidentally sustained
are covered.
In Connecticut, “ personal injuries arising out of and in the course
o f employment.”
Hawaii— “ Personal injuries by accident, not to include diseases
except if they result from injury,” which, of course, excludes what
might be termed the pure occupational diseases, i f there be such a
thing.
Illinois— “ A ll accidental injuries.” There may have been changes;
I ’m not sure about that, Mr. Andrus.
Indiana—“ Personal injuries by accident, not to include disease
except as it results from injury.”
Iowa— “ A ll personal injuries, not to include disease except as it
results from injury.”
Kansas— “ Personal injuries by accident.”
Maine— “ Personal injuries by accident.”
Michigan— “ Personal injuries arising out of and in the course
o f employment.” Is that right, Mr. Smith ?
CO M P E N SA TIO N FOR O C CU PATIO N AL DISEASES---- D ISCUSSIO N.
265
Mr. S m i t h . Yes, except that the word “ accident ” is in the title.
Mr. F r e n c h . You ought to have it changed to “ injury.”
Minnesota— “ Personal injuries by accident.”
Montana— “ Injuries arising out of and in the course of employ
ment, but not disease— special restrictions applicable in case of
hernia.”
Nebraska— “ Personal injuries by accident; occupational diseases
not included.”
Nevada—“ Personal injuries by accident.”
New Hampshire— “ Any injury arising out of and in course of
employment.”
New Jersey—“ Personal injuries by accident.”
Ohio—■ Personal injuries in the course of employment.”
“
Oklahoma— “ Accidental personal injuries and such disease or in
fection as may result therefrom.”
Oregon—“ Personal injuries by accident.”
Pennsylvania—“ Injuries sustained by accident and such disease
or infection as naturally results therefrom.”
Rhode Island—“ Personal injuries by accident.”
Texas— “ Personal injuries sustained in the course of employ
ment.”
Vermont— “ Personal injuries by accident not to include disease
except as it results from injury.” Is that correct, Mr. Simonds?
That has been changed, has it? I am reading the summary given
by the Workmen’s Compensation Publicity Bureau Digest.
Washington—“ Personal injuries; contraction of disease not
deemed an injury.” Is that correct, Mr. Wilson?
West Virginia— “ Personal injuries with special restrictions as to
hernia.”
Wisconsin— “ Personal injuries sustained in performing service.”
The law has been changed in Wisconsin from “ accident ” to “ injury.”
Wyoming—“ Injuries sustained in course of employment not to
include disease unless it results directly from injury.” Is that right,
Miss Anderson ?
I find in the last Digest which was dated November 1, 1916, that in
Kentucky— “ Personal injuries by accident not to include disease
except where it is the natural and direct result of a traumatic injury
by accident, not the result of a preexisting disease.”
Louisiana— “ Personal injuries by accident.”
Maryland— “ Accidental personal injuries and disease of infection
naturally arising out of the employment.” They inserted the word
“ naturally ” in Maryland to make it a little different.
New York—“ Personal injuries by accident and disease or infec
tion arising out of the employment.” Is that correct, Mr. Mitchell?
266
NEEDED CH A N G E S IN LE G ISLA TIO N .
Mr. M i t c h e l l . That is substantially correct—4 such disease and
4
infection as.”
Mr. F r e n c h . New Jersey— “ Personal injuries by accident,” and
then in Massachusetts we have “ personal injuries.”
Porto Bico— 4 Personal injuries by accident ” and then in the
4
United States, as described, “ personal injuries.”
Now, Mr. Kingston, this digest does not cover the Canadian Prov
inces, and it might be well just to have the gentlemen interested add
a few words to have the record complete.
Ontario— 4 Personal injury by accident arising out of and in
4
course o f employment,” with a supplementary Schedule 3 naming
seven specific diseases providing they are due to the nature o f any
employment in which the workman was engaged at any time within
12 months previous to the date of his disablement.
To Pennsylvania should be added 4 injuries arising from violence
4
to the physical structure o f the body.”
Mr. A r m s t r o n g . Nova Scotia has practically the same as the On
tario section, but the commission has power to add additional in
dustrial diseases by regulation.
Mr. F r e n c h . The only suggestion I have to make from the six
years’ experience I have had on the California commission is that
these States that have any qualifying term not as clear as it should
be would do well to adopt amendments to cover occupational dis
eases, and, I trust, not to specify the diseases, but to include all that
rightly belong to the industry. For instance, in California there are
efforts being made to discover means o f procuring potash. We have
lately had manufactories fo r the purpose of getting potash from
kelp which is found on the seashore there, and we find in those fac
tories that there is coming, and we see it in the distance, as it were,
an occupational disease, because of the effect on the workmen. Now,
i f that were not specified in our act we, o f course, would be unable to
include it should the occasion arise, and therefore by making the act
elastic and having the word “ injury ” you cover all that is to be
desired.
Capt. W h i t e . What is the trouble that comes from the handling
of kelp ?
Mr. F r e n c h . I could not say as to that; I am not familiar with the
details. It is a new industry there.
Here we have British Columbia: 4 Personal injury by accident
4
arising out of and in the course of employment, together with such
industrial diseases as may be added by the regulation of the work
men’s compensation board.” That is good.
C O M P E N SA TIO N FOR OCCUPATIONAL,. DISEASES^— DISCU SSION .
267
Mr. W i l l i a m N e i l l , assistant commissioner, Workmen’s Compen
sation Board o f Manitoba. Regarding Manitoba, the law in this re-<
spect is practically the same as that in Ontario.
The C h a i r m a n . That concludes the special program for the after*
noon.
Mr. H olman . To-morrow morning a steamer will leave Eastern
Avenue Pier at 9.30 to give the delegates a view o f Boston Harbor,
the navy yard, and the entire waterfront o f the city o f Boston. This
steamer is furnished by his honor, the Mayor, who will accompany
the delegates on the trip down the harbor. Nine thirty o’clock,
Eastern Avenue Pier, which is at the foot o f Fleet Street.
The C h a i r m a n . The only fault I find with this convention is that
we are tied up here so much that we have not had an opportunity of
seeing as much of this beautiful city as we would all like to.
Now about the session to-night. Another fault I find w ith this
T
convention is that they have left to the last night of the last day, not
the paper that I have to read, but the question of administrative
problems. My idea is that what we are mostly here for is to discuss
administrative problems. W e have not had administrative problems
dealt with very much so far and I don’t believe we are going to get
anywhere near over the ground that we would like to get over in
the two hours and a half that we may have at our disposal to-night.
However, I promise you I will not take very long on the subject that
has been assigned to me, and I did rather hope that there would be a
very full meeting to-night and we would leave the meeting open to
discuss the problems that are lying next to the minds and hearts o f
all o f us in the difficulties we meet with every day at home. Have
you anything to suggest, Dr. Meeker?
Dr. M e e k e r . I suppose I am responsible more than anybody else
for the overspeeding and suffering from fatigue that has marked
this conference. I will promise that if ever I have anything to do
with making another program, I am going to follow out resolutely
the plan that I have always started out to try to follow and then
always got 4 cold feet ” and did not follow it. I am going to make
4
a programless program ; I think it would work well.
As to administrative problems, it was our intention to, and we had
thought we had, spread them all over the program, beginning with
the first real session, 4 Accident prevention ”—that certainly is an
4
administrative problem. The next session in the evening, 6 How
4
claims are handled with special reference to lump-sum settlements ” —•
to be sure, I did not get what I was 4 fishing for,” but it was in
4
tended that the administrative difficulties that confront the commis
sions would there be dealt with frankly. 4 How do you handle your
4
claims?”— if that is not an administrative problem, I can not state
268
NEEDED C H AN G ES IN LE G ISLA TIO N .
it any more clearly. And so with our medical sessions; it was in
tended that the administrative problems having to do with the ad
ministration o f medicine should be brought out, and so on. I don’t
want to take up any more time with that, but it was our plan and
hope that more would stay over and go on the trip and there we
would have a more thorough discussion, a more heart-to-heart talk—
“ How do you do this?” “ We do it this way; now how do you fel
lows do it, anyway?” That was just the idea of putting the trip at
the last instead of “ busting ” the week wide open with a trip, after
which three-thirds of the conference would disappear.
Now, I want to urge that this evening everyone here attend, every
commissioner at least attend, and if it is possible to find any of the
lost commissioners to bring them also, for we are going to consider
some very important resolutions. The committee on resolutions—
unfortunately, I was made chairman o f that committee unbeknown
to me, and it has been very difficult for me to do anything because
o f the many other things devolving upon me, but we have under
consideration even more important resolutions than we have thus
far formulated, and by all means let us get as large a representative
gathering together as nearly as possible at the hour set, so that we
can transact this important business and still attend to the regularly
stated program.
F R I D A Y , A U G U S T 24— E V E N IN G S E S SIO N .
CHAIRMAN, DUDLEY M HOLM
.
AN, PRESIDENT, I. A. I. A. B. C
.
VII, ADMINISTRATIVE PROBLEMS.
The C h a i r m a n . Owing to the fact that the first speaker of the
evening has not as yet arrived, Mr. Kingston has consented to go
ahead with his paper.
EYE INJURIES.
BY
GEORGE
A.
K IN G S T O N ,
C O M M IS S IO N E R ,
W ORKMEN’S
C O M P E N S A T IO N
BOARD
OF
ON TARIO .
The subject matter that I am to speak about, as noted in the pro
gram, is “ Eye injuries” or rather “ Compensation for injuries to
the eye.” Perhaps the question o f injuries to the eye is one o f the
most difficult problems with which those o f us who are administer
ing compensation laws have to deal. I am not now referring in that
expression o f difficulty to the case o f a man who has lost the sight of
the eye entirely—that is, complete blindness in the eye or enucleation
o f the eye; that is a simple proposition for us all. Many o f the
States, as you know, have specified amounts, usually expressed in
terms o f so many weeks’ compensation, for the loss of an eye. With
us in Ontario we have no express provision or limitation in the
statute to cover compensation for injuries to the eye any more than
any other case, but very shortly after we started the administration
o f our law we determined on a basis for this type of injury and we
now express it in terms o f percentage— 16 per cent for the loss of
sight o f an eye: that is, 16 per cent total disability, and in the event
o f enucleation it is a little higher— 18 per cent. Some of you who
were at the Columbus convention may remember a paper I read
there, which gave a comparison o f compensation allowance for vari
ous injuries, including, amongst others, the loss o f an eye; that gave
the result in real money that would be allowed for the loss o f an eye
in some 35 different jurisdictions in the United States and Canada.
That paper can be found in Bulletin No. 210 of the United States
Bureau o f Labor Statistics.
There are a number of controlling features in the different juris
dictions which enter into that comparison. Average earnings are
adopted practically everywhere as the controlling basis. It may be
269
270
A D M IN IST R A TIV E PRO B LEM S.
50 per cent of the wages in one State, 55 per cent in another, 60 per
cent in another, 65 per cent in another, and 66f per cent in another.
But there are several other considerations and they vary as often
as there are different jurisdictions. There are varying maximum
and minimum limits, varying compensation within those limits,
varying periods during which compensation is payable, expressed
as I said a moment ago in terms of so many weeks. Then the age
of the injured man has to do with the question of compensation in
a few of the States. There are varying periods of medical attend
ance, varying waiting periods and varying methods of compensa
tion during the healing period. It is surprising what lack of uni
formity there is in the various jurisdictions in the United States and
Canada on these several points I have noted. I don’t propose to go
into these at length, but I desire to mention two of the items for a
moment: viz, medical aid and compensation during the healing
period.
Some States appear to give similar compensation for injuries to
the eye, but let us not deceive ourselves but look at the question of
medical aid. Two States may give 100 or 150 or 125 weeks’ compen
sation for the loss of an eye, but if they do not both give medical aid
in addition, they are far from giving equal compensation.
Then on the question of the healing period, it is unfortunate that
there is not unanimity or uniformity in this respect. I was amazed
when I prepared that paper for Columbus to find that in some States
where this specific number of weeks is mentioned the “ weeks ” will
start from the date of the accident, whereas in others the “ weeks ”
will start from the termination of the healing period; in other words,
when the man is able to go back to work he will have so many weeks.
The result is, as you will see, that in the jurisdictions which start
the time running from the date of the accident it gives the man very
little compensation for the loss of the eye because in some cases—
not many, but in some cases—the man is totally disabled probably
for a great portion of the number of weeks specified. My idea is,
and I think it meets with the approval of a great many to whom I
have spoken on the subject, that these periods should run con
secutively not concurrently; that is to say, the time should begin
at the end of the healing period. The disability during the healing
period is not for the loss of the eye: it is for the shock to the man;
he does not miss the eye, or in other words the mere loss of the eye
causes no disability or special wage loss during the healing period
because he is not able to go to work for other reasons. The loss of
the eye becomes a real loss to him only when he has recovered from
the shock of the accident and is able to return to his duties again.
The point I have just mentioned applies not only to the loss of
the eye but applies to every type of permanent partial disability
that you can suggest involving loss of a limb or member.
E Y E IN J U R IE S — G. A. K IN G S T O N .
271
To come back, however, to our subject, I want first to mention the
agencies which cause traumatic action on the eye. They may be
divided into three: First— objects which cut, strike, or prick, the
result of which is so much the more considerable according as the
force of the projection is increased; second— foreign bodies, which
are more irritating by the continuance of their presence rather than
by the violence of the blow; third—thermic agencies, resulting either
in physical, chemical, or electrical burns. As a usual thing eye in
juries involving less than complete loss of vision are the result of
slight wounds of the first class; that is, wounds that do not penetrate
very deeply into the inner structure of the eye. Wounds caused by
severe burns or heavy blows or deeply penetrating wounds usually
bring about much more serious results. I do not propose to deal
with these injuries to the deeper structures of the eye involving com
plete loss of sight but rather with a few cases which involve merely
partial loss of vision, such as injuries to the cornea or the lens.
I fancy Dr. Donoghue will agree with me when I quote statistics
which suggest that about 75 per cent of the cases of less than
permanent loss of sight have reference only to corneal injuries re
sulting in corneal astigmatism. In these slight injuries, what has
happened is simply this: No sooner is the wound in the cornea made
than nature proceeds to heal it. If there has been no infection, it
is a comparatively simple matter: the wound will probably not be
serious. If the injury is only to the outer surface of the eye—I ven
ture to use a technical word, the “ epithelium”—it will almost al
ways clear up readily and will leave practically no disabling result.
The cornea, which is this window so to speak in front of the eye,
covering both the iris and pupil, has five very fine layers; the first
layer as stated above is the epithelium, the second layer is known as
Bowman’s membrane, and the third is called “ the real substance of
the cornea.” If a penetrating wound reaches this far we are almost
sure to have a corneal astigmatism. I don’t know that I need attempt
to explain at any length what a corneal astigmatism is. It simply
amounts to this: when a wound is made, particularly if there is in
fection, there is left a scar, just the same as would be the case on your
hand or arm or any other part of the body. You know the effect
when a scar is thus formed—fibrous tissue is created and the finer
particles of tissue adjoining this scar are drawn together in very fine
little irregular ripples. When that happens in the eye, the rippling
draws the surrounding* tissue of the cornea together and it produces
an effect somewhat like prismatic glass. The fibrous tissue that is
created right where the scar is becomes translucent instead of trans
parent, and the result is there is no sight— or rather, no clear sight—
immediately over where that scar has formed. Surrounding the
fibrous tissue caused by the scar, this rippling takes place and in
272
A D M IN IST R A TIV E PRO BLEM S.
stead of letting the light through the cornea in a clear definite way,
it deflects the light through the lens in different directions, confus^
ing the sight, depriving the lens of its ability to focus the rays of
light on the retina, and the result is an astigmatism, which deprives
the man of the ability to see with that clearness which a man with a
good eye ought to see.
Just a reference now for a moment to an injury involving the
lens. The lens, as I said a moment ago, is that portion of the struc
ture of the eye which focuses the rays of light coming into the eye
on the retina, which is at the back part of the eyeball. If that lens
is punctured or suffers a blow, it results usually in what is commonly
known as cataract. Some doctors advise an operation to remove the
lens under such circumstances, but the weight of medical opinion
seems to favor no such operation if the eye is quiet, unless the other
eye should be destroyed. With loss of lens the man’s vision in that
eye is practically gone. Fairly good vision can, however, sometimes
be restored after a successful operation by the use of a glass lens
which the eye specialist will prescribe, but there will always be the
lack of accommodation. A man can see with an artificial lens say
at this distance (indicating about 15 inches), but if you ask him to
see definitely a few feet farther away or bring the object up closer
he cannot see clearly at all. An eye with such a lens in front of it
will not mate up with the other eye, so the only good to the injured
man, you might say, of an eye which has lost the lens and has been
provided with an artificial lens is as a reserve eye. In the event
that the other should be destroyed he is not hopelessly blind by any
means; he can s£e to get about and to do rough work, but to do fine
work with such an eye is out of the question.
I have brought with me to-night, in order to demonstrate some
of the points I have just mentioned, a number of references to cases
which we have decided in Ontario. I don’t know whether we give
too much or too little compensation in these cases, but I think it will
help to illustrate what we are doing if I refer shortly to a few of
them, and I will be glad if it elicits a response from you gentlemen
here who are meeting the same problems, in the way of suggestions
as to what you would do under somewhat similar conditions.
The first case on my list is No. 03684. In this case the workman
was employed by a large implement manufacturer and while grind
ing castings he got a piece of emery in his eye. The report which
comes to us from the eye specialist describes the two eyes thus—
O.D. ^ , O.S. f . Those of you meeting this sort of problem every
day will recognize at once that the eye specialist means the right eye
reads
and the left eye f , the latter being practically perfect.
This reading of the eyes is by Snellen’s Test Card that card you see
in nearly every doctor’s office with the big letter “ E ” on top and
EYE IN J U R IE S ---- G. A. K IN G S T O N .
273
eight or nine rows of letters below, each row containing letters a cer
tain degree smaller than the row above. The fractional expression
simply means that this man can see with the right eye at only 6
meters what he should be able to see at 36 meters; that is to say, he
can see clearly only about as far as from where I am standing to
that first chair (indicating about 20 feet) whereas with a good eye
he ought to see clearly down to the front of the building. These
figures are an indication too, by the way, that this physician has
been a student abroad. If he had studied in one of the medic'al
colleges in America, instead of using the expression ^ he would
probably have used
referring to feet instead of meters. O. D.
and O. S. are the abbreviated expressions for the right and left eyes,
respectively. In this case a scar was left covering nearly the whole
pupil area, following a severe corneal ulcer. He was totally dis
abled 59 days and the board awarded him in addition to his total
disability allowance of 55 per cent of weekly wages, a lump sum of
$325.
Dr. Donoghue. What was the basis of the $325? Was that based
on his earning capacity ?
Mr. K ingston. We treated that as a 6 per cent case or approxi
mately that. Having regard to the fact that 16 per cent would be
the basis for total loss of sight, we regarded his remaining vision in
that eye as equivalent to about one-third the value of a good eye.
This therefore being an under *1 per cent case, we awarded a lump
0
sum in accordance with the provisions of section 38.
Mr. Armstrong. I s that done in all cases under 10 per cent?
Mr. K ingston. Practically all under 10 per cent cases are paid by
lump sums unless the man happens to be an alien enemy or we have
reason to believe he would be very improvident with a lump sum if
he got it, in which event we usually dole it out to him in small sums.
I may say that we do not deprive workmen who happen to be citi
zens of enemy countries of their compensation should they be in
jured in industry, if they behave themselves, but we do not consider
it wise to give them lump sums.
The next case No. 07403 is that of a planer hand working in a
carriage factory. He was struck by a piece of wood in the eye, caus
ing a leucoma— i. e. a dense white spot on the cornea. This was only
a slight injury and the doctor reported the eye to read x2 ; that would
6
be regarded as indicating very little disability. I don’t know whether
any of the jurisdictions would allow anything for that. The doctor
say's he had an infected ulcer reaching into the pupillary region.
We gave him $100 in addition to two weeks’ total disability. The
fact that the scar was over the pupillary area is probably the reason
78532°—Bull. 248—19------18
274
A D M IN IST R A T IV E P R O B L E M S.
we made even this small allowance. When a scar is immediately over
the pupil, of course, it is much more serious than if the scar was
merely over the iris or sclera, as anything involving the pupillary
area disturbs the sight.
The next case, No. 0678, is a very interesting one, one of the very
fe¥/ cases of this kind that are met with, and I will be interested to
know if any of you have ever had a case of this sort. An electrical
worker got a 13,000 volt shock from a high-voltage wire while stand
ing on top of a transformer in one of our large electrical power
houses. He fell to the cement pavement a few feet below and in
addition to the shock he got quite a severe scalp wound. I was told
by a doctor with whom I discussed the case that the scalp wound
was probably his salvation. Strange to say he recovered from the
apparent effects of the shock within a few weeks. His sight began
to be impaired, however, about eight months after. The man en
listed about the time his sight began to fail or a little before. At all
events, he had sight good enough to pass the medical examination for
enlistment in the military service. Shortly after he enlisted his
sight became very bad and he soon to all appearances went com
pletely blind. He was then examined by the military doctor of his
regiment and it was found that he had developed double cataract as
a result, it was thought, of the shock several months before; claim
was then made to the board. Our eye specialist said that he had
had only one case in his experience where a shock of this sort caused
cataract, and I ran across a French book dealing with this subject
which refers to two such cases in the author’s experience. I presume,
however, this type of case is likely to become more frequent as the
years go on and more use is made of electricity. My friend from
Wisconsin mentioned to me yesterday that he met a case in his State
recently almost similar. This man has been successfully operated
on for cataract in one eye but he can not see to do any close work
at all. He can tell 30 or 40 feet away whether two men or one
man is passing by; large objects he can distinguish fairly well,
-but as his former employer told me, he would be a very unsafe man
around machinery. Put a paper in front of his eyes like that (12
inches away), and he will read quite well with his very strong arti
ficial lens. Certainly he would be an unsafe man around a power
house or around machinery, but in coarse work around the farm
where he is actually working now he will probably be able to make
himself useful. However, for the present he is being carried as a
totally disabled workman and I am not sure how long we may have
to continue this.
Dr. D onoghue. What was the age of that man?
EYE INJURIES— G. A. KINGSTON.
275
Mr, K ingston. He was 28. It will be of interest to read what our
eye specialist in that case (Dr. F. C, Trebilcock) said in a report
dated November, 1916:
About tlie end of March, 1916, the vision of the right eye failed and in June
the left one followed suit, [The accident, bear in mind, happened in July of
1915.] During the winter following the accident he was at the exhibition
camp and had no difficulty in his target shooting. That was six months after
the accident, so it may be considered that his sight was normal at that time.
The lesion is formation of cataract in both eyes. The right lens has been re
moved with very satisfactory result. It is too early to be sure of the resulting
vision but it promises that with a proper glass he will see practically as well
as ever and be able to read his paper with the drawbacks incident upon the
loss of his accommodation and need for wearing very strong lens. The left
eye sees about A • The lens shows marked changes, and I am not able to say
whether it will get worse or not. It appears to have been stationary for three
months.
It would appear that the point of debate is whether these lesions are the
direct result of the electrical charge which he received. This is a difficult mat
ter to decide. The majority who receive such injuries do not survive the initial
shock. It so happens that there is one of my own eases who received the same
sort of charge in September, 1915, with more disastrous results generally and
developed a double cataract the following spring.
In both these cases, men about 28 years of age, having received an electrical
charge of 18,000 volts entered through the skull, double cataract developed in
the course of the next few months and my own mind is clearly made up that
the electrical charge entering through the head was the causative agent in both
eases. Of course, I realize that the point is one which can not be absolutely
proven and one would not take such strong ground if this man was in the age
limits of the ordinary senile cataract changes.
I have looked up the textbooks dealing with cases due to electric charges
and I find that nearly all the cataracts recorded in this connection are following
lightning strokes or experimental. The definite causes suggested by different
men are: 1. Concussion; 2. Heat; 3. Chemical change in the body fluids elec
trolytic in character. In this connection, Hess has proven to his satisfaction
that following a high charge of electricity there follows death of the cells of
the anterior capsule of the lens, so the aqueous can get at the lens fibers and
that always causes cataract.
All authorities agree that cataract may follow the administration of ergot
and naphthol compound, the latter even when used in ointment form for skin
disease. This result would be toxic of course and the electrolytic result might
be in a sense auto toxic.
It would appear, however, that the whole question is too vague for anyone
to be positive about and I am unable to say how the effect is brought about,
but there appears to be no questioning the fact that cataract does follow elec
tric charges of high voltage passing into the body in some, perhaps a few, cases.
In this case it appears that the vision of the right eye was down to
in
June last. With that vision he could not use a rifle from his right shoulder at
all. Then he says his duty required him to read small ammeter scales so I
feel sure that we may take it for granted that the condition of lens change
has come on subsequently to the accident. It is impossible, however, to abso
lutely prove a cause and effect relationship, although I think it exists.
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I would be glad, Dr. Donoghue, if you would say whether or not
you have come across a case of that character in your experience in
Massachusetts.
Dr. Donoghue. We have not had a case as far as I know in con
nection with our board, but that fact has been recognized, although
we have not had such a case— the charge from heavy voltage either
entering the head or arcing across the head; in other words, heavy
voltage entering the body directly is pretty sure to kill; 15,000 or
20,000 volts can not cross the head and not kill and still give elec
trical charges in the head tissues. We have not had such a case, but
the possibility is recognized. The possibility is recognized under the
cataract agents; over that there is grave doubt whether it is due
to accident, i. e., to the electrical charge instead of to the man’s
age. If that man was above 45, there would be considerable doubt;
at 28 I think not.
Mr. K ingston. That seemed to be the idea in Dr. Trebilcock’s
mind. Senile cataract change would not be looked for in a man
only 28 years of age.
The next case, No. 02579, was that of a worker in a silver mine.
A piece of rock flew into his left eye, causing a long oblique cut
through the cornea and sclerotic with prolapse of the iris. Surgeon
successfully operated for removal of prolapse and incarcerated iris,
but the vision was left permanently defective due to a small opacity
of the lens and a corneal scar, together with an irregularly shaped
pupil sometimes called a keyhole pupil. Surgeon describes the in
jured eye as reading -gfo but can be corrected with glasses to
He was totally disabled 78 days, and in addition to this time al
lowance we gave him a lump sum award of $500.
That was on a basis of an impairment of about 6 per cent. Awards
in like amounts, however, do not always mean the same percentage
in these cases; we give a man more or less in money, depending on
his “ average earnings,” and a 6 per cent award to a $20 per week
man would give him considerably more than the same percentage to
a $12 or $15 man.
Now, I will run hurriedly over a few other cases. I can not hope
to deal with all I have here.
No. 05405— the case of a man working in a box factory being
struck by a piece of ice. The injury was merely to the cornea.
Surgeon’s report reads
but the eye can be corrected to -fg-.
Changing these figures to the metric basis the eye would read about
corrected to about
The epithelium and corneal tissue were
cut and some ulceration resulted, leaving permanent opacity over
the right pupil. We gave the workman $300 in addition to six
weeks’ total disability. Surgeon says he would probably soon need
EYE IN J U R IE S — G. A. K IN G ST O N .
277
to wear glasses apart from his injury, but we now force him to wear
a special glass to make practical use of the damaged eye. As you all
know it is very difficult for workmen, particularly of the more ordi
nary laboring class, to accustom themselves to the wearing of glasses
in their daily labor.
No. 04441— an electrician in one of our big steel plants was struck
in the left eye by a piece of steel from an emery wheel. This work
man had previously lost the sight of the other eye, but even this
misfortune does not seem to have been sufficient to make him feel
the necessity of always wearing goggles, particularly while engaged
on this type of work.
The present injury, fortunately, was not as serious as it easily
might have been. Surgeon reports that the foreign body was re
moved from the eye the following day, but an infected ulcer re
sulted, leaving a scar on the cornea directly over the pupil. Vision
• - but with glasses this can be brought up tof£. This, to a man with
f-g
the other eye perfect, would not indicate an injury of any conse
quence, but as this is the only eye he has we considered the injury
on this account somewhat more serious and allowed him $500 in
addition to eight weeks’ total disability.
No. 09036—the case of a riveter, aged 29, in a shipbuilding plant.
While engaged cutting out rivets with an air hammer a small steel
chip pierced his right eye, causing a lacerated wound of the cornea
and prolapse of the iris. An iridectomy was immediately done by
surgeon, but the ultimate result was a pupil shaped like an ordinary
keyhole.
There was also some opacity in the lens capsule and vision read
T
This could not be improved with glasses. The uninjured eye,
however, read f-g-, so on the assumption that he formerly saw alike in
both eyes it was considered that the workman did not have perfect
vision in the injured eye before accident.
The award in this case was $275 in addition to the usual allow
ance of 55 per cent of wages during the period of total disability.
This award was on a basis of an impairment of about 5 per cent in
earning capacity.
The element of disfigurement enters to some extent into the con
sideration of this case. It is considered that in the labor market a
workman with a disfigured eye such as this man has does not stand
quite so good a chance of employment as the man who, though with
no better vision, has no visible disfigurement.
Mr. Kingston. I would like now, Dr. Donoghue, if you will give
us the benefit of your experience in Massachusetts in the matter of
these lesser injuries to the eye.
Dr. Donoghue. Mr. Gleason of our board is here.
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.A D M im S T H A T IV E P H 0 3 L S M S ,
Mr. C h ester E. G leason, member, Massachusetts Industrial Acci
dent Board. I have only been on the board a year and I think Dr.
©onoghue is more familiar with those cases than I am.
Dr. Donoghue= Our compensation is different from that of yours
apparently. Our compensation is based first upon the inability to
work and then it is based on a specific payment when the vision is
reduced below one-tenth normal vision; then they get 50 weeks’
extra compensation based upon the wages at the time of the injury
in addition to disability payment.
Mr. K ingston. Well, how do you ascertain or determine when a
man has lost one-tenth of his normal vision ?
Dr. D onoghue . That is a matter for determination by the eye
expert who reports on the amount o f vision that he has, based upon
a so-called normal standard; if below one-tenth, which really means
that he has no practical vision with a glass for near work, he is al
lowed as for a lost eye.
Mr. Kingston. That is, he has lost nine-tenths ©r one-tenth?
Dr. Donoghue. Nine-tenths: he has to lose nine-tenths and a
glass can not improve it. If below one-tenth of normal vision with
a glass, then he gets specific compensation of 50 extra weeks’ pay
ment in addition to the time he is disabled and that “ normal vision ”
the board has interpreted to mean normal working vision; in other
words, if he has an injury to the eye so that he has a keyhole pupil in
the eye and that eye will not operate with the normal eye, then that
eye is looked upon as being reduced below one-tenth normal practical
vision, rather eliminating the one-tenth theoretical vision, and is
treated as lost vision or vision below one-tenth.
Mr. K in gston. You treat a lost lens case or an eye on which a
cataract has been removed as a lost eye?
Dr. D onoghue. A s a lost eye if it will not work with the normal
eye.
Mr. Kingston.. What would you allow for a man who merely had
a bad corneal scar with fibrous tissue over the pupillary area cover
ing in bright light practically the whole pupil ?
Dr. Donoghue. If the vision is not reduced to one^tenth normal—
if he doesn’t lose nine-tenths by that—he gets nothing extra but gets
disability while he is getting well and getting readjusted to his new
job.
Mr. K ingston. If the surgeon reports to you the fractional im
pairment, you don’t have to read the surgeon’s report as to whether
the eye reads % or
%
You get away from that altogether and
simply look at the certified fractional impairment of one-tenth,
three-tenths, four-tenths, or whatever it may be?
E Y E IN J U B IE S — G. A . K IN G S T O N .
279
Dr. D o n o g h u e . He figures the percentage of normal vision.
Mr. K ingston. You get away from a lot of trouble.
One more ease before I conclude—No. 00648, and this is one of
peculiar interest. A workman employed by a mining company, while
engaged in feeding a rock crusher, was struck in the head by a rock
falling from the skip. The immediate result was a simple fracture
of the vault of the cranium. This was the 29th of December, 1915,
He made a fair recovery, however, and was able to return to work on
a lighter job March 1, 1916.
Surgeon reports, however, in August following that he has a
pulsating depression 2 inches by 2J inches by 1 inch deep, just to
the right of the median line ; complained of a pounding sensation in
the head on rising or when stooping and on exertion, also deficiency
in vision; can not concentrate his eyes on one point any length of
time, and the field of vision greatly narrowed.
We had the workman examined by Dr. Trebilcock as referee Janu
ary, 1917. He reports;
Both eyes appear perfectly normal except that there is a certain degree ©f
.horror of light and a hypersensitiveness about them when he thinks that one
is about to touch them. Vision in right eye reads -ft- but greatly restricted in
field so that he says he can see the last letters in the line but can not -see
the first ones at same time without burning to look directly at them. Vision
in left eye reads f, also very much restricted in field.
The slight falling off in central vision is probably not more than he had
before the accident or it might be due to photophobia or nervousness.
The main disability is in the very marked contraction of field and I am in
clined to the opinion that this must be included in those contractions of field
which follow traumatic neuroses.
This condition will likely remain permanent or the improvement will be
comparatively slight, though, of course, if it be all a neurosis and complete
cure should take place then the fields would likely enlarge to their normal size.
In discussing the case with the referee, he demonstrated the con
dition by placing two ordinary mailing tubes before my eyes. One
realizes at once from this simple illustration what a disability such
a restricted field means to a workman.
Dr. Donoghue. That case looks to me like hysterical blindness
with a contracted field of vision, almost a typical hysterical eye.
He has hysteria from the bang on his head without anything that
can be demonstrated in the brain or transmitting fibers. That is
typical of hysteria.
Mr. K ingston. Would you treat such a case as a lost eye ?
Dr. Donoghue. No, that man would not be dealt with on a lost-eye
basis. Total disability would be continued up to the point where it
might be considered necessary, in order to cure the man, to lump-sum
him. He would probably get well within a short time after such
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treatment. While he believes the trouble is there, however, to him it
is a real disability. Perhaps I should not take up the time now, but
I might touch upon this subject a little further for a moment. A
man from hysteria becomes blind in one eye, and while hysterical
remains blind. Those cases have caused us a lot of trouble. We had
one very famous case in which the man undoubtedly had a deficient
eye to start with. He received a blow on the head and lost more
vision; he was hysterically blind; he was a high-grade hysteric; he
was queer and troublesome and threatening; he threatened to “ clean
up ” the board. His case was settled, reopened, and lump-summed,
and after we really got rid of him on the basis of hysterical blindness
he moved to another town. He was a stationary engineer, and could
not go back to work. He had more hysteria, committed murder, and
is now over in the State prison. He was undoubtedly hysterical all
the way, and his eye trouble was hysterical blindness. Hysterical
blindness is a very difficult and trying thing to know what to do with,
whether to treat it as a permanent loss or as a partial loss, and if the
latter to what extent.
Mr. K ingston. We disposed of this case finally on a 30 per cent
basis, i. e., 30 per cent impairment of earning capacity, and allowed
him a pension of $10 a month for life, which at his age represents a
charge on our accident fund of about $2,000.
I have taken up more time than I am entitled to in presenting this
subject, and I will not pursue it at any greater length. Perhaps in
the few cases I have presented, however, there has been sufficient
variety to indicate in a general way how our eye cases are treated in
Ontario. I wish I might hope that the time would come when
all compensation jurisdictions could unite on some common standard
or basis of valuation of eye injuries. I do not claim that the Ontario
method of valuation is ideal or that it is better than others, but if any
of you gentlemen have a plan which you think is an improvement we
would like to study it.
We are all, I am sure, anxious to improve our respective systems
of compensation in every way we can, and if we could get to a better
understanding of each other’s methods of dealing with the problem
of compensating for injuries to the eye we would, I think, be appre
ciably nearer the point from which we might hope to reach common
ground in this respect.
Mr. B. E. K u e c h le , adjuster, Employers’ Mutual Liability Insur
ance Co. of Wausau, Wis. In Wisconsin we had a case that is very simi
lar to the electric-shock case Mr. Kingston mentions. A young boy 18
years of age got a terrific electrical burn from a high-voltage wire;
it entered his forehead, traveled through his body and burned the
two large toes of both feet completely off; he had a severe burn about
EYE IN J U R IE S ---- B. E. K U E C H L E .
281
3 or 4 inches in diameter on his forehead. He got along very well
considering the nature of his burns and actually went back
to work in about four months after his injuries, but about four
months after that he developed a very rapidly growing cataract on
one eye and a slow growing cataract on the other. We brought him up
to Wausau, our home office, and had our eye specialist take care of
him; he performed a cataract extraction on one eye, and after about
four weeks the boy went back to work again and worked for several
months, when he again came to Wausau to have the other eye oper
ated on. He went back to work a second time, and something hap
pened to the iris of his first eye, and he went blind again. We
brought him up to Wausau once more, had another operation, and
he is now back to work, earning $3.50 a day on cement work, laying
cement sidewalks, where he formerly earned $2 a day. He really
made a remarkable recovery.
The C h a irm a n . We have heard a good deal about the different
compensation acts; sometimes I think we are too apt to see only the
good points about compensation and we are apt to overlook the fact
that many of the acts, even the best of them, have defects that should
be remedied. One of the closest students that we have in Massa
chusetts upon workmen’s compensation acts was a former associate
of mine on the industrial accident board, and he has given many,
many years of study to compensation and kindred subjects and is well
qualified to point out defects in compensation laws. It gives me
great pleasure to introduce Mr. Edward F. McSweeney, a former
member of the Massachusetts Industrial Accident Board.
DEFECTS IN THE ADMINISTRATION OF COMPENSATION LAWS.
BY
EDWARD
F.
M ’ SW E E N EY,
FORMER
MEMBER
OF
MASSACHUSETTS
IN
DUSTRIAL. AGCIBENT BOARD.
The first step in considering the defects in the administration of
compensation laws is to find out the extent of our knowledge as
to the character and aspirations of the administrators of the law
and the imperfections of the machinery involved.
Generally speaking, the results of the law have been most satis
factory, but as workmen’s compensation is the foundation stone
of social insurance, the time to correct mistakes and strengthen
weak spots is now.
The great need is for uniformity, both of law and administration.
A t present a great corporation doing an interstate business may have
to write 35 policies to cover the workmen’s compensation risk on
its employees, which proves that some such organization as this is
vitally needed to standardize conditions. Also, there is need of uni
formity as well as exact information regarding accident prevention
work. Claims o f results, in any particular jurisdiction, of diminu
tion of accidents, betterment of conditions in hazardous trades, etc.,
may be true as far as they go, and show that the good work is spread
ing, but they lose most o f their value unless comparison with the
records of other States and other periods of time is possible.
Like most other branches of our code of industrial laws on this
continent, workmen’s compensation has grown up without any sys
tematic information or even any precise idea o f the extent of its
ultimate application. Each year brings additional surprises. The
law in most States, as interpreted by supreme courts who are in sym
pathy with its spirit, has gone much farther in protecting and re
imbursing wage earners than was originally intended. Its his
tory is one o f constant increase in the number of grounds upon
which compensation can be claimed, and of a gradual extension of
benefits to an increasingly larger proportion of workers.
General acceptance of the workmen’s compensation law has
changed bitter and sometimes unreasonable opposition to everything
in the shape of industrial insurance to*a feeling of receptivity to
ward the extension of the social insurance idea, even to the extent
that omissions, defects, or actual invitations to injustice, fraud, or
oppression in existing compensation laws and administration are
glossed over and forgotten in the anxiety to take the next step. Yet
it is supreme folly to try to extend the social insurance field to old282
A D M IN IST R A T IO N OF CO M P E N SA TIO N L A W S — E . F . M cSW E E N E Y *
283
age pensions, health insurance, etc., until workmen’s compensation
laws and administration are standardized.
The principal arguments used in the various States for the passage
of the workmen’s compensation law were that industrial accidents
6 should be treated as part of the cost of production ” ; that there was
6
need for a law that would 4 operate to prevent injuries” ; that in the
4
interests of justice it would be better to have control under “ an ad
ministrative board ” ; and that it was unwise “ to allow the law to be
administered by the judges of the courts,” as under such a process
details of administration would differ as widely as the situation of
the various courts.
Workmen’s compensation boards, under whatever name, were
therefore designed primarily to provide for the uniform settlement
of controversy, to reduce the waste of money connected with litiga
tion, and to provide a system of procedure whereby the determina
tion of any given ease of industrial injury should be not on the
ground of legal liability, but on the ground of the physical incapacity
of the injured wage earner and of the extent and duration of his
injury.
The principal defect in the administration of the workmen’s com
pensation law is the general tendency toward reversion to the con
troversial methods of the old employers’ liability law. The prevail
ing method of determining the right or wrong of any claim by pre
sentation of witnesses and arguments on terminology is neither con
clusive nor in accord with the spirit of the law. This system brings
about a lack of uniformity to the extent that favoritism in the se
lection of experts to give testimony, or in the appearance of friendly
counsel, becomes possible, and gives occasion for the determination
of cases upon personality and prejudice rather than upon any
standardized line of accepted, settled theories of medical cause and
effect.
It was also recognized by the committees which studied the sub
ject before the enactment of these laws in the various States, that
the larger part of their administration would be medical and not
legal. Yet in actual practice the legal and technical aspects over
shadow the medical, to the detriment of all concerned. The nature
of the work urgently demands the services of one or more reputable
and skilled medical officers on every board. After appointment,
medical officers should have stability of tenure of office.
In Massachusetts and some other States occupational diseases are
regarded as injuries under the law. The investigations of the Massa
chusetts Industrial Accident Board and the Massachusetts State
Board of Labor1 have demonstrated that industrial diseases may be
1Gunn-McSweeney report, 1914 ; Dr. M V. Safford report, 1915.
.
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A D M IN IST R A TIV E PRO BLEM S.
contracted so gradually that it is a matter of considerable difficulty—
indeed practically impossible—to adjust equitably the liability of
each employer to any given disabled worker. The line between pub
lic health and industrial hygiene is by no means clear, and it is there
fore almost impossible to assess the relative responsibilities of in
dustry on the one hand and society on the other, even if it were de
sirable to do this. There is constant difficulty in deciding, by the
method of presentation of evidence at arbitration or other hearings,
whether the incapacity in any given case is due to the alleged in
jury, or to the ordinary progress and result of disease, or to degenera
tive changes incident to age which would have arrived independently
of the industrial happening. While it is true that the burden of
compensation is shifted by the employer onto the consumer and con
sequently the community at large really pays the cost, this payment
is extravagant, and frequently, in fact, fails to provide adequately
for those whom it is supposed to benefit. All this goes to emphasize
the claim that under workmen’s compensation acts, medical service
and care are the most important factors.
Closely connected with this matter of medical service is the ques
tion of hospitals. The hospital should not only serve the patient, but
society, and should be properly organized and equipped. The best
medical service must be placed within the reach of all. The National
Government is now feverishly attempting to remedy the hospital un
preparedness to care for anticipated injuries to our soldiers. Yet
there is no real difference in the preparation for the treatment of in
juries of battle and injuries of industry. This fact was seen years
ago by certain of our industi’ial accident board members, but they
were not able to arouse effective attention to the need. If this had
been done, the Nation would now be prepared for the rehabilitation,
reeducation, treatment, and readjustment of injured men, whether
victims of peace or of war. If the vision of the Nation is to-day in
any way equal to its opportunity, every reconstruction hospital built
will be available in the future either for peace or for war. Every
condition made acute by the War existed previously in industry in
a minor degree.
Administrators of workmen’s compensation laws, in the various
States, including their medical advisers, are technically well pre
pared to advise on this work of reconstruction, and if it is not placed
under their direct charge, they should be consulted so that the ex
perience gained in industrial accidents may be utilized for war work
and appropriations of money for such war purposes be continued
later for our national peace needs.
Lack of uniform medical methods by the insuring companies and
lack of the control of medical treatment by the commissions, with
A D M IN IST R A T IO N OF CO M P E N SA TIO N L A W S---- E. F . M cS W E E N E Y .
285
commercial exploitation of charitable funds and charitable institu
tions by insuring companies, leading to inability to exact from hos
pitals accountability as to the kind of diagnosis, treatment, char
acter, result, or accuracy of records, which is not only desirable and
important, but necessary, are defects demanding consideration.
The granting by insurance companies of reduction of premiums
because of the establishment of first-aid rooms has in some cases led
to the establishment of such rooms under the control of male at
tendants, who do not approach in experience even the trained nurse.
These attendants are called upon to pass upon what cases require doc
tors and what cases do not. This gives opportunity for unlicensed
and untrained people to practice medicine at the expense of the em
ployee, simply to save the employer an insurance premium.
I have some personal acquaintance with the administrators of the
industrial accident boards in the various States, and since 1912 have
carefully followed their work. Speaking generally they are an effi
cient body of public servants, devoted to their work and attempting
honestly and sympathetically to work out their problems. In prac
tically all the commonwealths in the United States appointments to
these boards have been by political favor. When new governors are
elected, diligence, industry, and intelligence have not operated to retain
experienced men. It may be true that the new men appointed were
as good to start with as were the ones superseded, but under political
methods, the six months or a year before a member’s term expires are
not useful, because he is naturally giving his time to securing a reap
pointment. If, as is now accepted, there is a loss to ordinary indus
try in hiring and firing employees, measurable in terms of dollars
and cents, this applies in incomparably larger measure to the replace
ment of a capable administrator of workmen’s compensation by an
inexperienced one. In Canada, officials are appointed during good
behavior, and because of this continuity of tenure the Dominion is
taking the lead in working out some of the most important problems
in workmen’s compensation.
The creation of administrative boards with both administrative
and judicial functions to have charge of workmen’s compensation
was a radical step when viewed from the standpoint of precedent,
or surveyed from the morass of legal technicalities. The provision
in practically all the State constitutions regarding the separation of
the legislative, executive, and judicial functions is substantially the
same. The supreme courts of the various States have not yet given
any intimation that the executive and judicial functions were being
illegally combined under the workmen’s compensation act. In
California the supreme court did, in 1916, make this intima
tion, although the opinion was not final. As a result, steps were
taken at the last legislature to reenact the whole workmen’s com
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A D M IN IST R A TIV E PRO B LEM S.
pensation act iix order to bring it under a recently adopted section of
the State constitution, which is believed to be broad enough to remove
all doubts as to the act’s constitutionality. In addition, a special
constitutional amendment covering this particular point was passed
by the legislature of 1917 and will be submitted to popular vote for
ratification.
Inasmuch as this same contingency may occur elsewhere, it may
be well for the other States to take initiative in having all constitu
tional doubts removed. The fact that there is a constitutional con
vention now in session in Massachusetts gives special opportunity in
this State.
In Massachusetts, and there is a similar situation in other States,
there is an unwise distribution of responsibility between the acci
dent board, handling compensation, and the State board of labor and
industries, dealing with safety. An additional distribution of re
sponsibility so as to put the rehabilitation of injured employees on
the Massachusetts State board of education is now being sought.
Lack of uniformity of practice among the three kinds of insurance
systems operating under the law is causing trouble in many States.
Lack of exactness and stability in workmen’s compensation rates is
reflected in constant attempts to shift responsibility and swap risks
in the effort of the smaller companies to escape bankruptcy. An
tagonism between State compensation insurance funds and the pri
vate casualty companies which write this form of insurance con
tinues to be shown. There is also conflict of jurisdiction between the
Federal liability law and the laws of the States on the question of
liability for injuries to employees of interstate commerce carriers.
The people of the United States will never again be deluded into
refusing to do anything that is right of itself because of the plea
that we can not “ afford it.” The first Liberty loan of $2,000,000,000
will pay the combined war bill for but 20 days. Yet a quarter of
this sum would more than pay for all the measures proposed during
the last 10 years to protect the lives and limbs of wage earners. The
common business proverb that “ Things won’t stay still; if they
don’t go forward they will go backward,” is very true regarding
workmen’s compensation, which for two years has been forced to a
subordinate place in the social insurance program, due largely to the
fact the work has lacked “ team play.” In the interest of national
defense, as well as of the worker in industry, workmen’s compensa
tion practice should be perfected.
CLAIM ADJUSTMENTS UNDER WORKMEN’S COMPENSATION.
B Y B. E. K U E C H L E , ADJUSTER, EMPLOYERS’ M U T U A L LIABILITY INSURANCE
CO., OF W A U S A U , W IS.
The legislative committee which drafted the Wisconsin workmen’s
compensation law gave four principal reasons for its enactment:
1. To furnish certain, prompt, and reasonable compensation to the
injured employee.
2. To utilize for injured employees a large portion of the great
amount of money wasted under the old common-law system.
3. To provide a tribunal where disputes between employees and
employers in regard to compensation might be settled promptly,
cheaply, and summarily.
4. To provide means for minimizing the number of industrial
accidents.
To absolutely assure to injured employees the benefits of the com
pensation law, the Wisconsin act provides that an employer must
either insure his liability with some insurance company licensed by
the State or satisfy the industrial commission of his ability financially
to assume his own liability.
Everyone knows that a license granted to an insurance company
is not a guaranty by the State that the company so licensed will be
solvent and able to discharge all obligations promptly during the
life of the license.
We hear frequently of bank failures, and banks are licensed by the
State. So do we hear of insurance company failures—only more
frequently.
The failure of an insurance company writing compensation insur
ance affects, more than anyone else, the injured employee— the very
one whom the law primarily intended to protect. And usually it is
the man who is very seriously injured or some widow, both drawing
long-period payments, who suffers most by such failures. Liability
for pending claims following the failure of an insurance company
always reverts back to the employer. He may be able to discharge
a small loss, but a large one may put him out of business.
Our company has adopted a plan in its policy by which employees
are absolutely guaranteed their compensation when it extends over a
long period of time.
The policy guarantees that in all cases where compensation pay
ments run for a period of six months or more the personal obligation
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o f the employer for such a claim shall be discharged in one o f the
following ways provided in the Wisconsin law :
1. Lump-sum settlement.
2. Purchase of an annuity in some life insurance company.
3. Depositing the present value of the claim with some bank or
trust company which in turn makes periodic payments.
Since our company was organized in 1911 we have had a total o f
over 36,000 accidents reported. O f this number 145 were death cases.
Ninety-two o f these were cases o f total or partial dependency. In
40 of these cases we purchased annuities for the dependents, the
deposits for such annuities totaling $78,000; in 8 cases we placed the
money with some bank or trust company to be held in trust for the
beneficiary ; and the rest were settled by lump sums.
With the exception of a few cases pending awards before the
industrial commission, only one death case has not been disposed
o f in one of the three ways mentioned. In that case three minor
children survived and the commission deemed it advisable to have
us make weekly payments, as that would assure greater flexibility
o f increasing the weekly allowances as the children grow older and
their expenses o f living higher.
At present we are using the last method almost exclusively to
discharge long-period claims. Its advantage is that the money can
usually be placed in the home bank o f both the assured and the
beneficiary, where both parties may have personal accounts and in
which they usually have great confidence.
To discharge such long-period claims by the methods mentioned
is quite costly to an insurance company, because of the interest loss.
The law provides that such accounts can be commuted only on a
3 per cent basis. As our investment earnings average between 5 and
6 per cent, the loss in interest on a single maximum death claim
amounts to slightly over $200. As far as we know there is no other
company operating in the State of Wisconsin which has such a guar
anty in its policy.
One o f the stock company arguments against mutual companies
writing compensation insurance is that the mutual companies, hav
ing no capital, do not offer as great a protection against long-period
claims as stock companies. The argument falls absolutely flat where
a mutual company adjusts its long-period claims as our company
does. In fact, a mutual company, with the assessment liability of
its members, positively guarantees compensation to every injured
employee. Mutual, as compared with stock insurance, is the only
safe way to make compensation certain, as the law intended it to be.
This fact was brought home to Wisconsin in the failure of the
Casualty Co. o f America. This company had a bad case with non
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289
union o f the bones of the leg. The industrial commission, after a
hearing, ordered payment o f compensation due to the date of the
hearing and weekly compensation payments thereafter till further
notice. The company paid the compensation due to the time of its
failure— about $200—but did not pay the doctor and hospital bills,
nor has it made any weekly payments. It was necessary for the
injured to recover from his employer, who thought he was insured.
To cap the climax, the employer about this time took sick and died,
and the Lord only knows when the poor employee will get his money.
Such a condition could never have come up had the casualty com
pany guaranteed in its policy to discharge long-period cases promptly.
Even more than the certainty o f compensation payments is prompt
ness dependent on the insurance carrier. About one o f every hun
dred cases reported to our company is adjusted before the industrial
commission, after formal hearing, and this average, I believe, holds
true for other companies operating in the State. In other words,
the adjusters personally settle 99 per cent of all cases. The carry
ing out o f the main objects o f the law, especially the first—to furnish
certain and prompt compensation to injured employees—you can
see, therefore, rests largely with the insurance companies and ad
justers.
One o f the important problems in furnishing prompt compensa
tion is the medical. Even before an accident is reported, the ad
juster should have made arrangement with the assured that the best
medical attention available is furnished and furnished promptly.
Our company has found, after six years of experience under com
pensation law, that the choice of physicians should be strictly exer
cised by the insurance company. Very few men who are injured
or their families are in a position to choose the doctor who is best
suited to treat their particular injuries. Family physicians are
generally not surgeons, nor are they usually experienced with industrial-accident treatment. The insurer, on the other hand, is in con
stant touch with physicians and is certainly in the best possible posi
tion to select the most capable men.
We in Wisconsin— and by we I mean employees and employers
alike— are particularly fortunate in the generous medical allowances
in our law. The law, as it has been in effect since 1911, provides
for 90-day medical attendance at the expense of the employer. There
are but very few cases in which disability has not terminated at the
end of 90 days. While the medical expense is considerably higher
than in most other States, there can be no doubt that on the whole
the results, through shorter disability periods and fewer perma
nent injuries, more than pay for this added expense. In fact,
insurance companies have generally found it to their advantage to
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continue treating employes at their expense after the 90-day period,
especially when by so doing they could prevent or remedy some
permanent injury. On September 1 of this year an amendment to
our law becomes effective which grants medical attention for 90
days and thereafter as long as it tends to reduce the period o f com
pensation disability. This amendment merely puts into words what
has been the actual practice o f most companies up to date.
In uncontested eases our law provides that compensation shall be
paid beginning with the end o f the second week, and weekly there
after. The average workmen has no savings that he can fall back on,
and to get his compensation weekly usually removes a great burden
from his mind—namely, “ What will become of my family ? ”—and
will hasten recovery. Especially in death cases is a prompt ad
justment o f great. importance. Most widows are under the impres
sion that they must engage an attorney to recover compensation, and
unless prompt adjustments are made, this is done and a useless ex
pense incurred, I have made a practice o f sending widows a few
hundred dollars on account immediately on proof of death—even
before the funeral— and then of stipulating the facts before the in
dustrial commission at the earliest possible date.
An adjuster’s object should be to get men back to work just as
soon as possible. There is a certain hesitance on the part of work
men, especially after serious injuries, to attempt work, This seems
to be especially true following major fractures and major amputa
tions. After a bone has properly knit, it takes exercise to overcome
the pain. The convalescent period is invariably longer than esti
mated by the attending physician. I have found that by allowing a
few weeks more compensation than estimated by the physician, and
paying the compensation in advance, the actual disability period is
reduced. O f course, you really pay a man more compensation than
he has legally coming, but without a settlement he might have laid
off longer than you estimated and would certainly not be as well
satisfied. It is remarkable how the idea of having obtained a “ good
settlement ” appeals to an employee.
DISCUSSION.
The C h a ir m a n . Mr. A. A. McDonald, chairman, State Industrial
Commission o f Oklahoma, will lead the discussion.
Mr. M cD onald. Though I have been a member of the Industrial
Commission during the last three conferences, this Is the first one I
have had the opportunity of attending. I have sat here during the
four days the meeting has been in session and must say that I have
received many very valuable ideas.
On the point of unlimited medical attention raised by the claim
agent for the liability company, we very nearly have it in our State;
though we have a 15-day limit, medical attention has now become
almost unlimited where any practical results can be obtained. I
worked rather hard during the last session o f the legislature to in
crease our period o f medical attention to 60 days, and w hile I thought
T
it a very liberal consideration I must confess that this meeting has
practically converted me to the California period o f unlimited atten
tion. I feel there should be some instructions given, or some discre
tion allowed the administration board as to how far and to what
cases it should apply, but as a general proposition I believe it ought
to apply to all.
I hope there is no industrial commission or accident board in the
United States that has any more distressing experience than our
board in Oklahoma. I guess we had the worst record last year of
any State in the Union. Our law does not cover death cases, which
consequently reduces the amount of compensation paid out. For
every $100 paid out last year as compensation to the workman, $84
was paid to doctors and hospitals. I have often remarked that while
our compensation law got us away from the shyster lawyer, we
1 jumped from the frying pan into the fire” when we fell into the
6
hands of the green medical profession. I am going to come to the
defense o f the profession now. That is not a general condition over
the entire State. In the agricultural communities and the older
cities where the profession has been established there has been no
trouble. It is in the new oil towns that have sprung up over night,
that maybe last night were prairie and to-day are cities of 5,000 or
6,000 people, doctors are rushing in. Everybody is getting rich and
the doctor in common with everybody else wants to get his share
while he can. In such cases the doctors are giving little in return.
In accord with the theory o f rehabilitation there is now being urged
upon the insurance companies the advisability o f bringing men
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injured in these oil fields away from the local hospitals. One I
have in mind is in a town in Woods County where a doctor had a
very ambitious hospital over a moving picture show, while his room
was over one of these mechanical pianos—very quiet surroundings.
W e tried to encourage him to bring the men into the larger cities
where they could receive skilled medical treatment.
I was very much interested in the paper o f Mr. Kingston, o f On
tario, in regard to handling eye cases. We have an entirely dif
ferent statute from Ontario. Our statute provides that for the loss
o f an eye they shall be paid a specific award of 100 weeks. Another
provision, following all specific awards, says the loss o f the hand,
foot, leg, eye, etc., shall be equivalent to the loss o f the use of such
member, including the eye. We have had, I think, more than our
share o f eye cases during the time of our workmen’s compensation
law. A quarter of a million steel tanks for holding oil are being
erected in the State, and it seems impossible to get the men working
on them to wear goggles. They are continually getting slivers o f
steel in the eye and the result is that we have many cases where a
scar will form over the eye such as the doctor from Massachusetts
has described. We have had cases where the vision of one eye was
impaired and only an operation would relieve it, and then it would
not focus with the other eye. In those cases we have allowed for
the loss o f the use o f the other eye. W ith one eye a man can not
do that work. I f he afterwards loses the other eye, o f course an op
eration would be advisable on the injured eye.
Now, we have not the advantage of the Massachusetts law in decid
ing those questions on the basis o f one-tenth. I remember writing
one case where we held that loss of nine-tenths, one-tenth remaining,
was equivalent to the loss o f the eye and gave compensation. In an
other case a man lost h a lf; we decided it was not equivalent to the
loss o f the use o f the eye and allowed him temporary disability.
W e have another case now involving two-tenths, which the commis
sion has under advisement. It is a very difficult proposition to solve
under our act. It may be fair enough to allow 10 weeks for each
one-tenth he might lose, but the great trouble is that every man has
not a normal eye and there is no way o f telling how many tenths he
has lost as the result o f an injury. O f course we always have the
relief o f allowing him one-half his wage-earning capacity before the
injury. That is theoretically sound, but it causes many perplexities.
W e have so many cases of sudden industrial activity that have lured
men from the farm and after the accident they have naturally gravi
tated to the only occupation they knew. I heard a case a few days
ago where a man in the employ o f a large steel company received an
injury that is .undoubtedly going to be permanent. He rented two
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hundred-odd acres of land and he and his wife and six children are
very energetically cultivating cotton. Now, how is anybody going
to determine whether that man is making as much as he made before?
Are you going to consider the fact that when he was working at his
former occupation he was the only one contributing any work? Now,
as is customary in growing a crop o f cotton, it takes the whole fam
ily. How are you going to calculate what portion of wages should
be allowed his wife, his six children, and how much to him?
W e have had another perplexing question that there has been difficulty
in determining. A man has a serious injury to his hand; his thumb
may be badly lacerated and he may lose his first phalanx. It is the
uniform contention of the liability company in Oklahoma that under
the provision o f the act for specific awards there should be full com
pensation allowed. Now, the commission has taken the view that
if a man has another injury distinct from the injury entitling him
to specific award that extends beyond the time that the other injury
healed, he should be entitled to temporary disability during the
period he is recovering from the temporary injury, and then after
that the specific award for the loss o f the member. I notice the
chairman o f the Massachusetts commission is shaking his head. I
would ask him what he would do in the case o f a man having an
accident that happened a year ago. The man fe ll; he was working
on a scaffolding built around a smokestack for taking away the
fumes; the scaffolding gave way and four men were precipitated a
distance o f 271 feet. One was killed; three survived. Now, suppos
ing for instance, that one man had lost the first phalanx of the little*
finger; he would be entitled under our act to 7J weeks or $75. He
might have received an injury to his head or any other part o f his
body that would have laid him up for a year; yet he would be
entitled to only $75 for the loss of the little finger.
There is just one thing—I think this body and commissioners gen
erally want to be impartial in handling these matters. We should
not let ourselves become biased by constantly viewing these matters
from one angle. As a general proposition we just see the side of
the employee who has been injured. We start in open-minded on
these questions but we get to thinking we can not do enough for the
man injured; we can not pay for what he suffers, and naturally we
go from one thing to another and take up other burdens of social
welfare. There is going to be just a little danger that these things
may be carried a little too far. It does not make much difference
how a man was hurt, how the injury arose; whether it arose out of
course o f employment or whether he was run over by an automobile
or was hurt falling down the cellar stairs. The fact is that he re
ceived an injury that will cause him permanent disability which is
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just as severe in one case as in another. I don’t think we ought to
let our sympathies for the injured employee give him everything
where the accident arose out o f the course o f employment and ex
clude the man hurt outside in the course o f employment. The in
jury to the man who falls down the cellar steps is just as severe and
grieves him just as deeply as the injury to the man who got it in the
course o f his employment.
I am not saying this with the idea of throwing any damper on
anybody’s enthusiasm for this work; but I do feel there is danger
if we don’t try to consider everybody interested, society as a whole
rather than one class, and that we may somewhat overreach ourselves
in this propaganda. I don’t want you to gather from this that I am
not in sympathy.
Dr. D onoghue. What do you mean by that?
Mr. M cD onald. I think there is a tendency to unduly exalt the
duties o f society to the injured workman to the exclusion o f people
who are just as deserving. In other words, I don’t think where a
man has been hurt without anybody in particular l>eing at fault—
and really it is more or less difficult to put your finger on it and say
anybody is responsible; the accident just happened— I don’t think
the fact that a man has been hurt in the course of employment makes
him any greater object o f charity or consideration than a man who
has had another unavoidable accident.
Dr. D onoghue. Can he have compensation?
Mr. M cD onald. Don’t misunderstand me on that point. I am ad
vocating in my own State and I advocate everywhere an enlargement
o f the compensation law, but I don’t think we want to go loping into
social insurance and all these other excellent provisions, if society
can stand the cost of them, without at least going slowly. That is
merely a word of caution.
Dr. D onoghue. Y ou don’t think a man is an object o f charity
when he gets compensation?
Mr. M cD onald. Oh, n o ; I think he is entitled to it, but it is a d if
ferent theory than what the world has been proceeding on through
all the ages. There is a danger of continually looking at it from
one viewpoint.
Dr. D onoghue. I s there more than one viewpoint ? Are there two
viewpoints of a man receiving compensation that the law provides ?
Mr. M cD onald. Whatever you do for anybody, somebody is going
to have to bear the cost. I don’t think that one class is entitled to
all the consideration. A ll these benefits given under the workmen’s
compensation law are costing somebody something and don’t deceive
yourselves that the cost is falling on the insurance companies. It is
all being passed on to the ultimate consumer.
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295
Mr. W r i g h t . The producer pays; the consumer doesn’t pay any
thing.
Mr. M cD onald. Well, somebody pays, and I always feel it is the
consumer who pays.
Dr. M e e k e r . I would like to ask Mr. McDonald if he thinks the
burden from accident was invented by compensation laws.
Mr. McDonald. W hy, not at all, only that we are now trying to
scientifically distribute the burden. My remark was not really di
rected at compensation laws; it was just simply these other things.
I am inclined to think we are going pretty fast. In our own State
we are paying widows pensions, whose soldiers fought forty years
before the State was organized. Now the last legislature has created
a soldiers’ home for the soldiers who fought in blue. I think there
should be some limit, to say nothing of the terrific pensions we have
always paid the soldiers. There should be some limit for the people
who are going to be taxed for these things.
Dr. Meeker, I would like to hear Chairman Mitchell of New York
express his views. We so-rarely get him at our conferences—I think
I am correct in saying that this is the first conference that we have
had the honor of having him with us— and I know he has a lot of
things, if he will only tell them to us, that will be most instructive.
Mr. M itchell. The function which brought me here I spoke on to
day and I see my resolution has been reported to the committee on res
olutions. O f course in the administration o f compensation laws there
are many problems that present themselves that are difficult of solu
tion. I have been intensely interested to-night in the discussion o f
questions arising in the various States. It goes without saying that in
a State like New York, where we had 325,000 industrial accidents and
60,000 compensable accidents last year, there are exceptional cases
that are difficult to determine—that is, to determine the merits of them.
We have eye cases and we have no rule for determining them. Our
law provides if a man loses his eye or all his useful vision, he shall
be paid 128 weeks’ compensation at a maximum of $20 a week; that
is to say, if his wages are $30 a week he would then receive $20. Our
law makes that one exception; in all cases of amputation the maxi
mum shall be $20, whereas in other injuries, it is $15 per week; that
is, two-thirds of the wages as a basis. I don’t know just what is the
proper solution of these eye injuries. We amended our law during
the last session of the legislature so as to empower our commission
to pay for a portion of loss of vision. Theretofore the law had pro
vided that a man receive 128 weeks for loss of vision but i f he did
not* lose all his vision and still retained useful vision, then he was
paid on the basis of partial incapacity to earn wages. He drew in
definitely and without limit two-thirds the difference between his
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former wages and his wage-earning capacity. Our commission
thought, as many other commissions have, that when a man lost 80
per cent o f his vision he had lost all useful vision and we made
awards for the loss of his eye, and our courts held that was not in
tended by the act and that we were bound and compelled to make
our awards upon the partial disability basis. The last session of the
legislature amended the act so as to give the commission discretion
to determine the amount o f vision gone, leaving entirely in the hands
o f the commission the amount to be paid. That also applies to in
juries of the arms, hands, feet, or legs, so that now accidents arising
after the 1st of July will be determined on that basis, and I think
that will assist us in disposing of many difficult questions arising as
to the amount to be paid for the partial loss of use of a limb or eye.
I think that what we need in most of the States is more physicians
to assist in the administration of our compensation acts. In New
York, o f course, we have a very large force; our commission employs
700 people—not all in compensation work. About 300 are employed
in the administration o f the compensation bureau alone, the other
400 being employed in other departments under the supervision o f
the commission, so that we are able to give careful supervision
to the administration o f our act. Practically every injured work
man has the opportunity o f appearing before our commission or
before one o f its deputies. We have offices all over the State which
are very well manned, so that advantage may not be taken of the
injured workman. He is not required in New York, as he evidently
is in Wisconsin, to go to the insurance company’s office to settle his
claim; he is not sent for and is not required to go. The injured
workman, if he wants to, comes to the commission and not to the
insurance company. It may be a very good plan and no doubt if
it was properly administered the workman would receive the full
amount o f compensation allowed under the law, but I should greatly
dislike it to be the general practice in the administration of com
pensation acts for the workman to be required to call upon the in
surance company in order to make his adjustment. It seems to me
that these cases cannot be too carefully supervised. Sometimes it
is difficult to get the workmen to go back to work as early as they
should go. It is equally true that a very large number o f workmen
return to work altogether too soon; that is, they return before they
have sufficiently recovered. We have had many cases where men
have attempted to work and have had to stop, being disabled for
a much greater period than they would have been had they remained
under medical care or at home until they had sufficiently recovered.
Now, o f course, I agree, and every friend of the law must agree,
that malingering should be prevented; that the worst enemy of the
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297
compensation law is the workman who takes undue advantage of
it. A t the same time, it is equally important that the commission
shall see that the workman does not go back to work at an earlier
date than it is safe for him to go.
I don’t know whether you know of several amendments made to
the New York act this last time, one o f them being the power of the
commission to pay for a portion o f a man’s eye, leg, or foot, as the
case may be. The last session o f the legislature made compensation
payable from the first day of the accident provided the man is dis
abled for a period of more than seven weeks. We have a 14-day
waiting period under ordinary circumstances, but if disability con
tinues for a period of seven weeks then it relates back to the first
day; that is, it takes in the first two weeks’ waiting period. There
has been a very strong movement in New York, among the workmen
particularly, supported by others, to reduce the waiting period from
two weeks to one week, and some advocate no waiting period. O f
course, in most States it would be extremely difficult to administer
the law if there was 110 waiting period at all. For instance, as I said
a moment ago, 325,000 industrial accidents occurred in New York last
year, of which about 60,000 were compensable. We have a force of
about 300 in our offices taking care of compensation work alone. Now,
if we had to compensate 325,000 instead o f 60,000, it would necessi
tate the employment of perhaps 1,500 or 1,600 people, because it re
quires as much time to make up a case where a man is disabled two
days as it does a case where he is disabled two months; in other words,
the same number of papers have to be filed and examined. Therefore,
I think it would be a physical impossibility to administer the law in
a State as large as New York if there was no waiting period at all.
Now, this scheme of having the compensation relate back to the
first day if the workman is disabled for a period of more than seven
weeks does not increase the work very much because the case is made
up anyway, all the papers are filed, and'the man’s awards have been
made, so that all that it is necessary to do if his disability continues
for more than seven weeks is, on the same papers, simply to add two
weeks to what he has already had. I regard that as a proper change
in the law. I am quite certain that the movement in the United
States to reduce waiting periods is going to gain impetus. In
Massachusetts the waiting period has been reduced to 10 days ; in
Wisconsin to 7 days; in Ohio to 7 days. The movement everywhere is
for a reduction in the waiting period. O f course, in the unimportant
and nonserious accidents it doesn’t make so much difference, but if a
man is disabled so that he has no income from his earnings for six
or eight weeks it is rather an important matter to him that he be paid
for the first two weeks, for, after all, he has suffered a very great re
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duction in his income when he accepts, as in the State of New York,
66f per cent of his usual income. O f course, in New York I think
men on the whole do receive more than 66| per cent of their wages
during disability*; our law says 66| per cent, but our law tells us how
that wa/ge is to be computed and we take the daily wage,, multiply it
by 300 and divide by 52; that is the means of determining the aver
age weekly wage. O f course, in skilled work among the building
trades and longshore work, which is not unskilled work, many of the
workers do not work 300 days a year and with those men we would
assume for the purpose of making up their compensation that they
did work 300 days a year. On the other hand, there are some sevenday employments, where the men work all the time. In the case o f a
man working 332 days in the year we multiply his wage by 332 and
divide by 52 in order to arrive at his average weekly wage. That
is a ruling made by the commission that will possibly not stand the
test o f the courts. I think perhaps the court will hold that we may
not use more than 300 as a multiplier.
I don’t think the commissioner from Oklahoma meant to say ex
actly what he did. I should regard it as quite the function of the
commissioners who are administering these laws to be in sympathy
with them; the injured workmen are not receiving too much
money and the State is not taking too much care of them. Social
insurance is going to grow ; there isn’t any doubt about it. It may
not be at an early date that we will cover the whole field of social in
surance but just as sure as compensation grew, so will other forms
of social insurance grow. As our country has developed, as we have
changed from an agricultural to a great industrial nation, as men
no longer are able to control themselves or protect themselves, just as
surely as that growth has taken place so must the desire of the State
and Nation grow to take care o f the men in the industries. That
will be a good thing for America, too. It will not be a burden upon
industry; that is, it will not be a burden on an industry that will
not be well able to take care of it. As a matter of fact, we know now
that the apprehensions employers felt some years ago as to the effects
o f compensation insurance upon industry were not justified, and
now the strongest supporters o f workmen’s compensation are
largely employers of labor. They found it was a good thing for
them, a good thing for their employees. It removed from the field
o f controversy a question that caused more friction between the work
men and employers than any other one thing I know of.
As a matter of fact, I presume we have all had the experience o f
sitting in court hearing some attorney employed by the injured man
denouncing a perfectly fair and generous employer as though he
took personal delight in the suffering o f his employee. The attorney
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299
o f course had no feeling about it, but he had to convince the jury,
and the best way to convince the jury that the injured man was en
titled to a large verdict was to paint the employer as a heartless man
who had no interest in the welfare of his employees. On the other
hand, we do know that practically every suit for damages that has
been instituted has been attended by perjury o f the worst sort on tlio
part o f both the injured workman and the employer; in other words,
there has been no regard for truth. The employer, fearing a large
judgment, would swear, perhaps not personally but through his super
intendent or bosses, that the man was responsible for his own injury.
On the other hand, the man and his friends would swear the injury
was due to carelessness or negligence of the employer. Now, after
all, you couldn’t blame the injured man very much. I f he got his
arm cut off or his leg cut off, under the old system the only hope in
the world for him and his dependents was to secure enough money
in a lawsuit to take care of him for the rest of his life, and while
no one will condone perjury, a person can readily understand
why men were willing to perjure themselves in order that they might
be protected for the rest o f their lives.
Now, gentlemen, I have been keenly interested all the way through
here to-day at the discussions. It seems to me that the gentlemen who
have come from former commissions have given us very much useful
information. I know the discussions I have heard will be helpful to
me in the administration o f the laws of New York, Unfortunately,
we are all so busy all the while with our own little duties that
possibly we can not get the broad vision of these questions that we
get right here. I hope in the future to be able to get away to attend
some o f the sessions at each of the annual conferences. We have
always sent our representatives, and we have been very ably repre
sented by our own Dr. Lewy, and I understand from what reports
have come to me that Dr. Lewy has given you information
of value to the medical departments of your commissions. Dr.
Lewy has been a savior to others; he is a wonderful man, and I doubt
if there are many medical men in the compensation commissions that
have rendered better service than Dr. Lewy has for this whole move
ment.
I am going to close by expressing the hope that we may evolve
some plan, in those States in which the rates of compensation are
wholly inadequate, as they are in many States, of bringing the rates
there up to the rates paid in the States and Provinces having the
best laws. Fifty per cent of wages is not enough compensation and
$10 a week as a maximum is not enough compensation. The injured
man can not live decently on either 50 per cent o f his wages or on a
maximum o f $10 per week. As a matter of fact, even where the
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rates are highest— I think New York probably has the highest rate on
the whole, some States having 66| per cent as New York has, but
their maximum is $12 per week, whereas ours for ordinary accidents
is $15 with $20 in case of amputation—the men are not overprotected.
It seems to me now that we should try and bring the States having
inadequate laws up to the standard of the best States in order that
these men who have given their lives and limbs in our industrial en
terprises may have a fair measure of protection.
The C h a ir m a n . We still have quite a little business and the first
thing in the order of business would be the election of two members
of the executive committee, because we are now working under the
new charter which provides for such an election.
[W ill J. French, o f California, and Wm. C. Archer, of New York,
were elected as members of the executive committee.]
REPORT OF THE COMMITTEE ON RESOLUTIONS.
[The following resolutions were adopted:]
(1) Resolved, That the thanks of the International Association of Industrial
Accident Boards and Commissions be extended to the Hon. Samuel W. McCall,
governor of Massachusetts, the Hon. James M. Curley, mayor of Boston, the
Massachusetts Industrial Accident Board, our retiring president, Dudley M.
Holman, and the citizens of Boston for the courtesies shown to the members
attending this fourth annual meeting, and also to the press of Boston for pub
licity given to our proceedings.
(2) Whereas the members of this fourth annual meeting of the International
Association of Industrial Accident Boards and Commissions were generously
entertained by the General Electric Co., at its Lynn plant: Therefore be it
Resolved, That the thanks of this association be extended to the management
of the General Electric Co., for the opportunity of viewing its factories and its
efficient medical department, and for the hospitality shown in providing lunch
eon at the conclusion of our visit; and be it further
Resolved, That a copy of these resolutions be forwarded to the General Elec
tric Co.
(3) Whereas in the death of Hon. Wallace D. Yaple, chairman of the Ohio
Industrial Commission, this association has lost one of its most active and
valuable members: Therefore be it
Resolved, That the International Association of Industrial Accident Boards
and Commissions place on record its deep sense of the loss sustained and our
sincere appreciation of the work and worth of our late president; and be it
Resolved, That we extend our heartfelt sympathy to the bereaved family;
and be it further
Resolved, That a copy of these resolutions be sent to Mrs. Yaple and to the
governor of the State of Ohio.
(4) Resolved, That the International Association of Industrial Accident
Boards and Commissions extend the sympathy of its members to our esteemed
president-elect Hon. F. M. Wilcox, because of the loss he has sustained in the
death of his father, and that a copy of this expression of sympathy be sent to
Mr. Wilcox.
AD M IN IST R A TIV E PRO BLEM S---- D ISCUSSIO N.
301
(5) Resolved, That in accordance with the recommendations of Chairman
A. J. Pillsbury, of the Industrial Accident Commission of the State of California,
and Chairman John Mitchell, of the Industrial Commission of the State of
New York, a committee of three, to consist of Royal Meeker, A. J. Pillsbury,
and John Mitchell, be appointed to meet in Washington, D. C., at the earliest
possible date for the purpose of formulating and promoting legislation for
eliminating conflicts in jurisdiction between Federal and State authorities
in cases involving industrial injuries occurring in transportation by railroad or
water, or in the loading and unloading of cargoes, or kindred occupations.
(6) Whereas the question of restoring injured men to industry is only sec
ondary to preventing injuries, and
Whereas our retiring president has brought to the attention of this body the
importance of pending Federal legislation relating to those who may be injured
in the military service of the United States, both as regards compensation or
insurance, and the rehabilitation of such injured men, and
Whereas the support of the International Association of Industrial Accident
Boards and Commissions has been solicited to further the aims of the pending
legislation: Therefore be it
Resolved, That this association emphatically indorses every w ise effort to re
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habilitate those injured in industry and also those injured in military service;
and be it further
Resolved , That the furthering of the Federal legislation mentioned above be
referred to the committee chosen to work on the problem of conflict of jurisdic
tion between Federal and State authorities in cases involving industrial
injuries.
(7) Resolved, That the attention of the incoming executive committee be
directed to the wide variance in some of the provisions of the different com
pensation laws of the United States and Canada, and that this annual meeting
requests the executive committee to report to the Madison meeting next year
the most feasible plan of recommending such uniformity in the laws as is
possible, for submission to the various States and Provinces.
[In the debate on Resolution 7 Mr. Wright made the following
statement:]
Mr. W right. I am not a citizen of the United States and of
course I am not entitled to say anything about your legislation, but
I would like to say that in regard to the action o f this body with
reference to the restoration o f injured men, the rehabilitation of in
jured men, that it is a most important thing and I think something
very definite should be done. I would suggest the appointment of a
committee o f this association to act on this matter. I don’t mean to
refer to this resolution particularly; I might say that resolution
might well be passed without any amendments, but I would suggest
the appointment of a committee whose duty it would be to collect in
formation both in the United States and Canada with reference to
the rehabilitation of injured men. I think we might well act with
those engaged in the rehabilitation of the returning soldiers. As I
said before this evening, I hope you won’t have as many to attend to
as we have. I have great hopes, a great wish at any rate, that this
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A D M IN IST R A T IV E PRO BLEM S.
war may terminate without any very much greater bloodshed, but
you are in it and I have the belief that you will go through to the
end. I don’t believe that it will be a case of u the last in the field and
the first to leave i t ” with the United States. I think that though
last in the field you will be in it until your work is accomplished, but
i f you will remember some things in Mr. Dean’s paper yesterday,
there was one point I did not quite agree with. He said that when
a soldier was returned uninjured, unwounded, the debt was paid;
he was returned as good as before. That never can happen; no man
can go through the terrible strain o f trench work in Flanders and
come through unscathed. H e won’t be the same m an; he can not go
back to industry in the same w ay; he can not fill a job as he did be
fore, and something must be done for that man, and I don’t think
that something should be done in this way.
You are going to give your soldiers pensions; we are going to give
our soldiers pensions. That is all right and proper ; they should get
pensions, but that does not restore them to industry. It doesn’t put
them back where they ought to be. Suppose a man comes back from
the front unable to hold a job through no fault of his—he isn’t the
same kind of a man as he was before he went out to the trenches. As
Lord Kitchener said, he has tasted the very salt of life and he can
not settle down to industry for quite a while to come— not steadily;
he will be at one job to-day and another a week from to-day. Would
it not be well to say to all the returned men, whether wounded or
unwounded, “ Get a job and we, the nation, will pay to your em
ployer $5 every week to be paid to you to put you in a position
a little better than your neighbor beside y o u ” ? Otherwise, you
won’t get employment for these men. They won’t be looked upon
as desirable employees. Steady men will get the preference over
them. That would be an inducement for them to w ork and so long as
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they work they ought to get that $5 a week for say a year or perhaps
more until they get steadily settled into industry again. I throw
that out as a suggestion for a committee of this association acting
together and trying to bring pressure to bear on public men and
public business to help the returned soldier and the injured man in
industry to get back in their proper places. We compensate a man for
the loss o f his leg. We never do compensate him until we make him
as fit for work as he was before. It is all very well to say a man is
as good as he was before, but a blind man is not as good a man as he
was before he became blind. I know o f one man who was blinded
in South Africa who was a better man than he ever was before and
he can earn more money, but that won’t happen with every man and
you can not use any two men alike.
We saw yesterday in Lynn that very interesting place in the ap
prentice shop there. They don’t try the old fool system of appren
A D M IN IST R A T IV E PRO BLEM S---- DISCUSSION.
303
ticeship; they don’t say to this boy, “ You will learn the trade, you
will do this kind of work.” They evidently say, “ We are going to
put each one in the job best suited to him.” Our educational system
is unfortunately not built on that plan. Take two boys in the same
fam ily; just because they happen to be sons of the same father and
mother it doesn’t follow that you can make good doctors out of both.
I have often seen a man preaching in the pulpit and I have thought
“ Now, that is a p ity ; that man would have made a good butcher but
he is a failure as a preacher. Society has lost a good butcher.” And
so with a blacksmith who is dreaming all the time; he might have
been a splendid architect; he is in the wrong place, a square peg in a
round hole. And so with the men returning to industry, we want to
get the round pegs in the round holes as far as possible. I think if
you would appoint a committee, or the incoming president would
appoint a committee from this body to act on this, perhaps by cor
respondence, perhaps by meeting occasionally, great good might be
accomplished.
[The following motion was carried:]
It is moved that a committee of this association be appointed by the incom
ing president to study the question of the rehabilitation and reeducation of crip
ples from the economic and social side, with particular attention to those crip
pled through industrial accidents and under the jurisdiction of the several
boards and commissions of this association, and that such committee be request
ed to correlate existing data on this subject and to present at the next annual
meeting of this association a comprehensive scheme on a national basis dealing
with the subject.
APPENDIX— LIST OF DELEGATES.
Following is a list of those in attendance at the conference:
Miss Eunice G. Anderson, chief clerk, Workmen’s Compensation Department
of Wyoming, Cheyenne, Wyo.
Dr. John B. Andrews, secretary, American Association for Labor Legislation,
New York, N. Y.
Charles S. Andrus, chairman, Industrial Board of Illinois, Chicago, 111.
F. W. Armstrong, vice chairman, Workmen’s Compensation Board of Nova
Scotia, Halifax, Nova Scotia.
George E. Beers, compensation commissioner, third congressional district of
Connecticut, New Haven, Conn.
P. D. Betterley, Graton & Knight Manufacturing Co., Worcester, Mass.
David S. Beyer, Liberty Mutual Insurance Co., Boston, Mass.
Ralph H. Blanchard, Columbia University, New York, N. Y.
Dr. William J. Brickley, Boston, Mass.
Mott A. Brooks, secretary and managing editor, Weekly Underwriter, New
York N. Y.
Percy A. Broderick, assistant secretary, Massachusetts Industrial Accident
Board, Boston, Mass.
Dr. Joseph M. Burke, chief surgeon, Seaboard Air Line Railroad, Petersburg,
Ya.
Mrs. Joseph M. Burke, Petersburg, Ya.
H. R. Bygrave, Frankfort General Insurance Co., New York, N. Y.
George B. Chandler, compensation commissioner, first congressional dis
trict of Connecticut, Hartford, Conn.
Lucian W. Chaney, special agent, United States Bureau of Labor Statistics,
Washington, D. C.
Dr. W. Irving Clark, jr., chief surgeon, Norton Co., Worcester, Mass.
John T. Clarkson, general counsel, legal department, district 13, United Mine
Workers of America, Albia, Iowa.
E. S. Cogswell, third deputy commissioner, Massachusetts Insurance Depart
ment, Boston, Mass.
Dr. Andrew P. Cornwall, impartial physician, Massachusetts Industrial
Accident Board, Boston, Mass.
Dr. F. J. Cotton, Boston, Mass.
H. M. Cousins, Richmond, Va.
T. Norman Dean, statistician, Workmen’s Compensation Board of Ontario,
Toronto, Canada.
James B. Doherty, commissioner of labor of Virginia, Richmond, Va.
Mrs. James B. Doherty, Richmond, Va.
Frank J. Donahue, member of the Massachusetts Industrial Accident Board,
Boston, Mass.
Dr. Francis D. Donoghue, medical adviser, Massachusetts Industrial Accident
Board, Boston, Mass.
Dr. James J. Donohue, compensation commissioner, seconl congressional dis
trict of Connecticut, Norwich, Conn.
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AP P E N D IX ---- LIS T OF DELEGATES.
305
E. H. Downey, special deputy, Insurance Department of Pennsylvania, Har
risburg, Pa.
Frank S. Drown, industrial expert, Children’s P»ureau, Department of Labor,
Washington, D. C.
Dr. Lucile Eaves, director, Research Department of Women’s Educational and
Industrial Union, Boston, Mass.
Robert Fechner, International Association of Machinists, Washington, D. C.
Ora T. Fell, solicitor, Republic Iron & Steel Co., Youngstown, Ohio.
Will J. French, member of the Industrial Accident Commission of California,
San Francisco, Cal.
Mrs. Will J. French, San Francisco, Cal.
Dr. A. W. George, X-ray referee for Massachusetts Industrial Accident Board,
Boston, Mass.
James L. Gernon, first deputy commissioner, New York State Industrial Com
mission, New York, N. Y.
Chester E. Gleason, member of the Massachusetts Industrial Accident Board,
Boston, Mass.
Dr. Cora B. Gross, Boston, Mass.
C. B. Hensley, statistician, Industrial Accident Commission of the State of
California. San Francisco, Gal.
Dudley M. Holman, president of the International Industrial Institute, Bos
ton, Mass.
Carl Hookstadt, expert, United Stares Bureau of Labor Statistics, Washing
ton, D. C.
Chas. F. Horan, director of hygiene and safety, Hood Rubber Co., Watertown,
Mass.
William W. Kennard, chairman, Massachusetts Industrial Accident Board,
Boston, Mass.
Dudley R. Kennedy, assistant to the president, Youngstown Sheet & Tube
Co., Youngstown, Ohio.
George A. Kingston, member of the Workmen’s Compensation Board of On
tario, Toronto, Canada.
B.
E. Kuechle, adjuster, Employers’ Mutual Liability Insurance Co. of Wau
sau, Wausau, Wis.
Mrs. B. E. Kuechle, Wausau, Wis.
Dr. Timothy Leary, Boston, Mass.
Dr. Raphael Lewy, chief medical examiner, New York State Industrial Com
mission, Bureau of Workmen's Compensation, New York, N. Y.
R. M. Little, chairman, United States Employees’ Compensation Commission,.
Washington, D. C.
Dr. John E. McCastin, Boston, Mass.
A. A. McDonald, chairman, State Industrial Commission of Oklahoma, Okla
homa City, Okla.
E.
F. McSweeney, former member of the Massachusetts Industrial Accident
Board, Boston, Mass.
W. N. Magoun, general manager, Massachusetts Rating and Inspection
Bureau, Boston, Mass.
Dr. H. W. Marshall, Boston, Mass.
Dr. Royal Meeker, United States Commissioner of Labor Statistics, Wash
ington, D. C.
John Mitchell, chairman, New York State Industrial Commission, New York,
N. Y.
78532°—Bull. 248— 19------ 20
306
A P P E N D IX ---- LIS T OF DELEGATES.
W. L. Mitchell, Chief of the Department of Workshop and Factory Inspection
of Tennessee, Nashville, Tenn.
Dr. John W. Howell, medical adviser, Industrial Insurance Co. of Washing
ton, Olympia, Wash.
Mrs. John W. Mowell, Olympia, Wash.
Edwin Mulready, commissioner of labor of Massachusetts, Boston, Mass.
William Neill, assistant commissioner, Workmen’s Compensation Board of
Manitoba, Winnipeg, Manitoba, Canada.
Dr. Francis D. Patterson, chief of Division of Industrial Hygiene, Pennsyl
vania Department of Labor, Harrisburg, Pa.
C. W. Price, United States Employees’ Compensation Commission, Washing
ton, D. C.
Dr. I. M. Rubinow, director, Bureau of Social Statistics of New York,
New York, N. Y.
E. B. Saunders, Associated Industries of Massachusetts, National Association
of Manufacturers, Fitchburg, Mass.
Dr. Frank E. Schubmehl, General Electric Co., Lynn, Mass.
Dr. James W. Sever, Boston, Mass.
Robert W. Simonds, commissioner of industries of Vermont, Montpelier, Yt.
William M. Smith, chairman, Michigan Industrial Accident Board, Lansing,
Mich.
Dr. E. E. Southard, Psychopathic Hospital, Boston, Mass.
Charles H. Yerrill, chief statistician, United States Employees’ Compensation
Commission, Washington, D. C.
Charles H. Weeks, chief inspector, Structural Bureau, Department of Labor
of New Jersey, Trenton, N. J.
Capt. W illiam P. White, Associated Industries of Massachusetts, Lowell,
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Mass.
F. M. Wilcox, member of the Industrial Commission of Wisconsin, Madison,
Wis.
Albert W. Whitney, general manager, National Workmen’s Compensation
Service Bureau, New York, N. Y.
John M. W ilson, chairman, Industrial Insurance Department of Washington,
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Olympia, Wash.
E.
S. Winn, chairman, British Columbia Workmen’s Compensation Board,
Vancouver, Canada.
A. W. Wright, vice chairman, Ontario Workmen’s Compensation Board, To
ronto, Canada.
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