- 1 c. o I Or 
 
 The Beginning of Occupa¬ 
 tional Disease Reports 
 
 JOHN B. ANDREWS' 
 
 Secretary American Association for Labor Legislation 
 NEW YORK 
 
 Reprinted from The Journal of the American Medical Association 
 Dec. 16, 1911, Vol. LVII, pp. 1984-1986 
 
 Copyright, 1911 
 
 American Medical Association 
 Five Hundred and Thirty-Five Dearborn Avenue 
 CHICAGO 
 
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 THE BEGINNING OF OCCUPATIONAL 
 DISEASE EEPOETS 
 
 JOHN B. ANDREWS 
 
 Secretary American Association for Labor Legislation 
 NEW YORK 
 
 In 1911, for the first time in America, six states 
 enacted laws requiring physicians to report cases of 
 occupational diseases. These states are California, Con¬ 
 necticut, Illinois, Michigan, New York and Wisconsin. 
 These laws have many points in common, and most com¬ 
 monly the diseases to be reported are: anthrax, com¬ 
 pressed air illness, and poisoning from lead, phosphorus, 
 arsenic and mercury or their compounds. In Wisconsin, 
 for some unexplained reason, anthrax is omitted from 
 this list, and in Illinois the law is obscure, but appar¬ 
 ently includes poisoning from “sugar of lead, white lead, 
 r.Ndead chromate, litharge, red lead, arsenate of lead or 
 paris green,” and “the manufacture of brass or the 
 ^smelting of lead or zinc.” 
 
 In most instances the notification by the physician is 
 to include as a minimum the name and full postal 
 address and place of employment of the patient, and the 
 disease. Michigan specifically requires in addition, “the 
 length of time of such employment,” and New York 
 adds, “with such other and further information as may 
 be required by the commissioner of labor.” 
 
 In four states the reports are to be sent to the State 
 J Board of Health and thereby transmitted to the depart¬ 
 ment most directly interested in industrial inspection 
 within the state. In Connecticut and New York notifi¬ 
 cation is direct to the commissioner of labor. 
 
 In every state except Connecticut there is a penalty 
 for failing to report, but in all states except California 
 and Connecticut, where a fee of fifty cents is allowed, 
 no compensation is paid for reports. 
 
 It is an interesting fact that one of the features of 
 this bill which excited most comment among physicians 
 was the provision for the payment of a fee of fifty cents 
 
2 
 
 for each report. “It is an insult to offer a medical man 
 a fee for sending in a report to the state/’ exclaimed 
 many physicians, while fully as many declared that the 
 offer of fifty cents would result in their sending in too 
 many reports. 
 
 This pioneer legislation is part of a definite organized 
 effort to arouse wider interest among physicians in the 
 subject of industrial hygiene, and to secure for public 
 use a regular supply of information .from those who 
 should be best informed on the subject. For this pur¬ 
 pose a tentative bill, based on twelve years of English 
 experience, 1 was drafted and introduced, in 1911, into 
 the legislatures of eight leading industrial states. This 
 bill had been passed unanimously by one house of the 
 Minnesota legislature when adjournment postponed 
 action for two years. In Pennsylvania some legal 
 experts added a clause to one section of the bill and after 
 it had passed both houses of the legislature the governor 
 vetoed it on the ground that this particular new clause 
 made it “unconstitutional.” In Illinois where the State 
 Occupational Disease Commission was still at work, no 
 action was taken by the friends of the measure after 
 reaching an understanding that the reporting feature 
 would be included in the commission’s bill. With the 
 slight local modifications already noted the standard bill 
 was enacted, and it went into operation in six states 
 during, the summer. 
 
 The educational'campaign resulting in the enactment 
 of this measure included the publication and distribution 
 of a special four-page leaflet on “Deporting of Occupa¬ 
 tional Diseases.” This leaflet included the following 
 statement: 
 
 When the International Congress on Occupational Diseases 
 met at Brussels last September, Dr. Legge, Medical Inspector 
 of Factories in England, read a paper on “Results of Ten 
 Years’ Notification of Lead Poisoning.” In 1900 more than 
 1,000 workers in that country were reported as suffering from 
 this occupational poisoning. Last year the number was only 
 553, although the system of recording each case has steadily 
 improved. In some branches of the dangerous trades in Eng¬ 
 land this occupational poison is now only one-fourth as serious 
 in its effects as ten years ago. 
 
 1. On the advice of expert medical authority in England only a 
 few of the most clearly defined and most easily recognizable of occu¬ 
 pational diseases are included in the beginning. When physicians 
 have become familiar with the purpose and the operation of the law 
 its scope may be extended. 
 
o 
 
 In partial explanation of this striking improvement 
 in the conditions affecting those who work with indus¬ 
 trial poisons, the leaflet continues: 
 
 In Great Britain when a practicing physician observes in 
 a patient symptoms which lead him to suspect that there is 
 suffering from industrial lead, phosphorus, mercurial or arsen¬ 
 ical poisoning or anthrax, he is compelled under penalty by 
 the government to report the case to the factory inspector. 
 Scientific men in the public service are then in a position to 
 study intelligently the conditions which undermine health, to 
 suggest simple, inexpensive precautions to the manufacturers 
 and to instruct the work-people in the use of measures for 
 the prevention of unnecessary suffering and death. 
 
 Every class in the community is directly interested in 
 scientific efforts to conserve the health, vitality, energy and 
 industrial efficiency of wage-earners. This interest is par¬ 
 ticularly apparent in cases of suffering and inefficiency due to 
 unliealthful conditions of employment in occupations in which 
 deadly poisons are in use. 
 
 After briefly summarizing the causes and effects of 
 anthrax, compressed air illness, and poisoning from lead, 
 phosphorus, mercury and arsenic, the descriptive portion 
 of the leaflet concludes as follows: 
 
 In order that the necessary mechanical and other precau¬ 
 tions may be taken, the state should be enabled to determine 
 where and how men are exposed to these perils. The state 
 should be advised of incipient cases, so that dangerous condi¬ 
 tions may be improved. English experience during twelve 
 years indicates that the most practical and economical method 
 of securing this information is through the enactment of a 
 law requiring every physician treating a case of one of these 
 occupational diseases to report it to the proper authority 
 precisely as he now reports cases of contagious diseases. From 
 the data thus contributed preventive and remedial measures 
 can be intelligently formulated and applied. The American 
 Association for Labor Legislation, in its campaign for the 
 conservation of human resources, invites the cooperation of 
 other organizations in securing uniform legislation on this 
 subject. 
 
 This printed leaflet, the final page of which was a 
 tentative hill, was accompanied by additional literature 
 and circular letters and addressed to legislators, editors 
 and members of the Association for Labor Legislation, 
 who added their personal influence to the campaign, and 
 in several instances appeared at legislative hearings to 
 explain the object of the measure. 
 
4 
 
 From the standpoint of the association the real educa¬ 
 tional work is merely begun with the enactment of these 
 laws. With the arrival of the date when each law went 
 into effect a news notice w T as prepared for editorial use 
 in that state; additional information, including copies 
 of the notification schedule now used by physicians in 
 England, were furnished on request to officials charged 
 with the law’s enforcement. 
 
 In New York the law was translated by an Italian 
 editor, and with accompanying explanations it was 
 widely republished among Italian readers. Cases of 
 occupational poisoning incidentally met with in our 
 related investigations are now carefully noted and filed 
 for future reference, or mailed forthwith to the proper 
 state authority. 
 
 The desirability of the uniform reporting of industrial 
 injuries in the different states is so apparent to those 
 who wish to make intelligent use of such statistics rather 
 than to merely compile columns of figures, that an effort 
 has already been made to encourage the adoption of a 
 standard schedule. 2 To the rather meager information 
 specifically required as a minimum under the various 
 laws, the state officials are encouraged to add as many 
 facts as possible through the use of more elaborate 
 blanks or by special investigations. One year’s experi¬ 
 ence in securing this information in half a dozen states 
 should indicate whether the standard schedule now in 
 preparation is practicable for general use among physi¬ 
 cians. Already, in several states, information of great 
 significance has been secured by state authorities under 
 this law, and individual physicians as well as boards of 
 health are preparing for the study and prevention of 
 occupational diseases. 
 
 1 Madison Avenue. 
 
 2. A national committee on standard schedule was appointed 
 last September and it is now at work on a plan for uniform 
 reporting. 
 
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