THE PREVALENCE OF OCCUPATIONAL FACTORS IN DISEASE 249

trial pursuits who are below the physiologic normal, and who seek medical aid for preventable afflictions. Such records have little value to the student of economics.

7. A most important first remedy is a proper nomenclature for industrial relations to take the place of the word "occupation." Such a nomenclature is here propounded. The chief feature of this is the introduction of the term "industry-department-process" for the word occupation. Adoption of this proposed term, furthermore, renders a logical classification of occupations possible. No such classification now exists.

8. The powers and functions of the community health-governing body should be extended to the prompt investigation of all industrial complaints, and to the prompt remedying of them without the necessity of preliminary legislation against certain alleged responsible industries.

9. In spite of the fact that the State in which this study was made has an occupational disease law, workers are still coming into its charitable institutions from the same types of trades, and in some instances, from the same manufacturing establishments, in even greater numbers than at a period three years previous, when the Illinois Commission on Occupational Diseases made its investigation. This, we charge, is most directly due to the non-existence of a correlating body between the hospital and the factory.

10. Too much importance is usually given to alcoholism, with a failure to appreciate that subjection to industrial health-hazards in itself induces and promotes stimulantism.

As a noted health officer has stated, many occupational afflictions might well be made the subject of a grand jury investigation, and others, of a coroner's inquest. The vastness of the public and private sums now spent on preventable sickness and death. should induce those who pay the tax to bend every effort to run down these contributory factors and abolish them.

THE CAUSES OF INDUSTRIAL ACCIDENTS

It is being spread abroad that intoxication is responsible for a large part of industrial accidents. For instance, at the recent meeting of the National Council for Industrial Safety at Chicago. the chief inspector of the Pennsylvania Department of Labor and Safety said that 60 per cent. of the industrial accidents in the United States should be charged to liquor. At the same time A. T. Morey, of the Commonwealth Steel Company, declared that "it is recognized that most industrial accidents are brought about through the use of alcoholic stimulants." It is also observable that in the orders promulgated by various railroad companies and other corporations attention has been focused upon liquor, and it is implied that alcohol is very largely responsible for the numerous industrial casualties.

How far are these allegations true? Or how far do they seem. intended to find a convenient scape-goat and perhaps hide the many other conditions productive of accidents, some of which perhaps the corporations are reluctant to improve? Now neither of the startling assertions cited above is supported by any evidence whatsoever. But it is possible to give some light on the situation in regard to accidents and that from official sources, and the latter tell quite a different story.

CHIEF CAUSES OF ACCIDENTS LONG KNOWN

For years there has been persistent agitation to provide for the safety of workers and for bettering dangerous and insanitary conditions on railroads, in shops, factories and mines. And during all this agitation one heard very little about drink as a cause of accidents and disease. That's a new development. In regard to the frightful rate of accidents on railroads, the years of effort to secure the Safety-Appliance law will be recalled. Time and again. the railway employees were refused the simple protection that lies in automatic couplers, grab irons, air brakes, etc. It was cheaper to sacrifice lives than to provide these things. The railroads fought the law and have often been found guilty of violating it.

Speaking of the recognized causes of industrial accidents the Factory Inspector of Pennsylvania said in 1894: "Many accidents

attributed to the carelessness of the employee might justly be transferred to the shoulders of the employers. Where guards and appliances of protection might be applied to much advantage, employees are often permitted, or rather expected, to depend solely upon their dexterity of hand and their continued vigilance to avoid personal injury." Factory Inspector Watchorn said: "Dangerous machinery has slain its thousands, but a defective sanitary system, together with an insufficient supply of ventilation, has slain its tens of thousands."

All these factors in accidents are clearly recognized in the numerous legislative acts of recent years for the protection of the health and limbs of workers. One might instance the laws in regard to ventilation, heating and lighting, to exhaust fans for carrying off dust and poisonous fumes, to overcrowding, to keeping machinery clean and guarding that which is dangerous, etc. In all this mass of legislation drink was not marked out as being a conspicuous cause of accident.

Then one might recall the fact of the multitude of women and children employed in industry who are all liable to injury; but it requires great disrespect for facts to assert that when they are hit by accidents it must largely be due to their intemperate habits.

STATISTICS OF ACCIDENTS AND THEIR CAUSES

Railroad Casualties.—It is unnecessary to dwell upon the numbers who annually are killed or injured, both employees and passengers, in the course of a year or any other period. We know the toll is terribly heavy. In accounting for it, the Interstate Commerce Commission instances quite other causes than drink. First of all, reference is made to violations of the Safety-Appliance Act by railroad companies, for which they are constantly being prosecuted by the United States authorities. In 1912-13 no less than 195 employees were killed and 3,361 were injured while coupling or uncoupling cars, while casualties caused by collisions with overhead and side. obstructions, etc., resulted in 721 deaths and 18,257 injuries. With proper regard for the law in respect to safety appliances and obstructions, perhaps most of these accidents could have been avoided, and the use of safety appliances certainly has no relation to. the personal habits of the employees.

Then there is a fertile source of accidents in road defects.

"With the track and roadway existing upon many railroads in this country the danger of serious derailments is ever present," says the Interstate Commerce Commission. In 1913 derailments cost seventy lives and the injury of 2,230 persons.

Among other fruitful sources of railroad accidents, the Interstate Commerce Commission habitually mentions rotten ties, defective and dangerous locomotives, antiquated equipment. But more significant is the fact that the roads so largely overwork their men, violating the law in regard to hours of service and thus unfit them for their hazardous duties. Some accidents are due to the employment of young and inexperienced men.

But what about the errors of the men themselves-disobedience of rules, mistakes at a critical time, etc.? The Interstate Commerce Commission has shown how many and serious accidents are due to the errors of employees; but says: "It must not be assumed that employees deliberately ignore disciplinary measures which they know from experience are necessary for their own safety as well as for the safety of many others who for the time being are placed in their charge; nor is it conceivable that rules which have been enacted to secure safety in the movement of trains are disregarded by employees, knowing that the result may mean their own death, except under pressure of some compelling motive that for the moment overcomes the force of the regulations."

To sum up some other reasons why many railway accidents are bound to happen, one gathers from the Commission in question that obsolete rules, the increase in speed and weight of trains, the crowding of tracks and terminals, are large factors. Employees must take risks or lose their jobs. The traffic must "keep moving at all hazards."

There are therefore abundant causes of railway accidents which are not attributable to the personal habits of the employees. Obviously, the Interstate Commerce Commission regards intemperance as a neglible factor in railroad accidents. The Bureau of Railway Economics, a private organization, "established by railways of the United States for the scientific study of transportation problems," has investigated 1,431 train accidents in which 3,477 persons were killed and 18,908 injured, with the result that only five of these accidents were definitely ascribable to intoxication. For the rest, the causes referred to above had been at play.

ACCIDENTS IN INDUSTRIES

One of the first private inquiries to analyze the factors in such accidents was made by the Sage Foundation in the steel mills of Pittsburgh and published under the title, "Work Accidents and the Law." The author carefully investigated 410 cases of fatal work accidents and found that only eight cases were to be traced to intoxication, or but two per cent. of the whole number.

The United States Compensation Act covers injuries of workmen employed on government work of different kinds. The number of fatalities has been numerous and, of course, the injuries. far more so. In the second year of the act 2,624 claims for compensation were made and 2,499 allowed. Now such claims are always contested if misconduct can be alleged. But in 406 cases in which the Solicitors of the Department of Commerce and Labor were called upon to give an opinion between 1908 and 1912, there were only eighty cases in which negligence or misconduct were alleged and in but one of these was intoxication charged.

New York State Returns:- The New York State Workers' Compensation Commission has only been in operation a short time; but in the entire 6,813 claims disposed of by it, the question of intoxication was raised by the employer or insurance carrier in only five or ten cases and not a claim was denied.

Massachusetts:-In the course of 1912 and 1913 there occurred a total of more than 84,000 non-fatal accidents, of which 72,000 were insured. At the same time there were 290 fatal accidents, of which 274 were insured. There is thus a fairly large material to draw from. Only a small proportion of industrial accident claims for loss have been contested by appeal. During the periods considered there were only 156 such and in only four of them was there any charge of intoxication.

Washington: The Report of the Industrial Insurance Commission says: "Framers of compensation acts in other States and of the Federal bills for railway employees engaged in interstate commerce have devoted considerable attention to intoxication. The records of this Commission do not show many cases of intoxication." During the year there were in the State of Washington over 11,000 claims submitted by injured workmen which resulted only in twenty-three appeals to the court. It will thus be seen that wilful