state. If these states require reports of accidents at all, there is no uniformity in the data reported, the results are not comparable, and the burden of injuries in any specific industry as a whole remains unknown.

An examination of some of the better state reports-for example, those of New York, Wisconsin, and Minnesota-shows further that there is no uniform definition of terms explaining the nature and duration of disability from accident, or the effect upon earning power. Neither is there a uniform method of presenting results so as to render them comparable. The need is for a more definite meaning of terms in the schedule of inquiry, for a clearer understanding of the purposes of tabulation, and for a uniform method of presentation in the reports.

FACTS NEEDED IN OCCUPATIONAL DISEASE REPORTS

Unlike accidents, most occupational diseases do not have a definite, easily identified point of origin. The first fact to be ascertained is, therefore, the occupational origin of the particular disease. That this is of vital importance has been shown by the many instances in which a physician has failed properly to diagnose a case because of lack of knowledge of his patient's occupation. The report, then, must contain a careful statement of the patient's occupation and the industry in which it is pursued; and the physician who makes the report must weigh carefully the causative influence of occupation as compared with other possible causes. As in the case of accident reports, moreover, and for the same reasons, it is necessary to have uniformity between states on all important points, especially on questions of nomenclature.

THE NEED OF A STANDARD SCHEDULE

The preceding discussion suggests the desirability of having the records of industrial accidents and occupational diseases made out on forms drawn up with as much uniformity as the nature of the occupation will permit, and tabulated from year to year according to a general scheme. If such reports were rendered under a federal law, this would be an easy matter. But under our system at present the enactment and administration of practically all reporting laws are in the hands of the states. In some states the pressure for such information is stronger than in others, because public sentiment has

been aroused, because accidents are more frequent, or because the social costs of the neglect of human life and health are more apparent. Such states have been working for years upon the problem of securing more accurate information upon the basis of which a policy of conservation may be worked out. Other states have felt the need for information only in certain dominant industries, such as mining. Still others have not yet been awakened to the problem. It is no wonder, therefore, that there have been many different kinds of reporting schedules.

Situated as our states are, however, in a larger community where state lines do not mark industrial boundaries, this accident problem is no longer simply local. It is wider than that. The purpose of information is prevention of accidents and diffusion of their burdens through some adequate scheme of insurance. But a preventive or insurance policy enacted into law and enforced in one state may, it is frequently claimed, penalize the employers of that state who must compete with employers in the same business in other less advanced. states. Moreover, lowered standards of life and loss of earnings, with consequent ill-health and inefficiency, spread their effects in other communities. The growing army of low-paid, standardless men moves on from place to place, from state to state, to menace the standards of other communities. No community can hope to be safe from the consequences of the waste of human life and health. It is necessary, therefore, sooner or later, for the states to cooperate in the campaign for prevention and insurance. But this cannot be done as long as individual self interest rules in place of the interests of the community.

The position of the American Association for Labor Legislation in this matter of reporting accidents and trade diseases is, therefore, clear. Accurate and complete information for all states which have to deal with the accident problem is desired.. It is hoped that this information will lead to a growing uniformity of legislation so far as the varying conditions among the states will permit. A schedule of inquiry has been drawn up with the advice of many of those who administer the present state accident laws. This schedule has already been adopted by Massachusetts, New York and Washington, while other states are considering the matter or have closely approached this form of inquiry. The essentials discussed in the first part of this paper have been embodied in this schedule of inquiry. Other questions may be added in any state, but it has been the opinion of those consulted that at least this minimum of information is

needed to understand industrial accidents and to enable the various states to pass such laws as will place employers in different states on an equality of competition. It will enable the authorities to comprehend the accident problem in an industry which operates in more than one state and to deal with it on similar lines, learning constantly from the experience of sister states as to the effects of a given. policy. To-day the states cannot thus profit by experience, because the records of the facts do not have the same meaning in two states. The adoption of this standard schedule involves certain additional legislation in many states before it can be put into effect. The state bureaus must in numerous cases be given authority to collect facts not at present authorized by law. The legislature must support the state bureau in many cases by putting the essential principles of the standard schedule into the law, and in all cases by putting into the hands of the state official power to gather such facts as he may deem necessary to carry the standard schedule into effect. A standard accident reporting bill has now been drafted for this purpose by the Association for Labor Legislation.

A standard schedule for the reporting of occupational diseases, and a standard bill to authorize its use, are equally needed, and fortunately they have already been adopted in several states. So far as it can be ascertained, we are anxious to know the entire burden of occupational diseases as well as of industrial accidents, classified by industries and causes. Such information will lead the way to wise legislation.

Williams, Hon. John, New York State Commissioner of Labor, Address at Health Officers' Conference (Utica, N. Y., December 2, 1912).

That modern industrial processes are responsible for various forms of disease has been recognized for many years. The increasing number of persons engaged in identical occupations who were under medical treatment and manifesting the same symptoms, led to inquiry as to the causes, and it was found that such persons had contracted diseases by contact with or absorption of certain poisonous substances used in the processes of manufacture in which they were engaged.

In 1911 the legislature of the State of New York, upon the initiative of the American Association for Labor Legislation, enacted a law requiring every practising physician in the state to report to the commissioner of labor every person upon whom he is called to visit or attend, whom he believes to be suffering from poisoning from lead, phosphorus, arsenic or mercury their compounds, from anthrax, or from compressed-air illness (commonly called "bends"), contracted as the result of the nature of the patient's employment.

or

It is unnecessary to point out the reason for such a law. The state at last awoke to a realization of its obligation to its citizens. Men engaged in its industrial establishments were falling victims to insidious attacks, culminating in total physical disability and often in death. So, in order to lay a foundation for such preventive and remedial measures as might prove necessary, it was decided to find out definitely the extent, nature and location of the seat of the trouble. This could be accomplished only by securing exact information from those qualified to furnish it.

This law has been in effect for a little more than a year, and we are beginning to find out what employments are surrounded by dangers that are almost invisible, but none the less terribly real and a menace to the persons engaged in such employments. The information that comes into our possession enables us to call direct attention to conditions in factories which threaten the health of the workers.

Wilbur, Dr. Cressy L., United States Bureau of the Census. American Labor Legislation Review, Vol. II, No. 2, June, 1912, p. 339. The notification of all cases of occupational or industrial diseases ought to be a most valuable aid for the complete and satisfactory registration of all deaths from such diseases; and likewise the registration of deaths should be a most important check on the completeness and promptness of the notification. Thompson, Dr. W. Gilman, Cornell University Medical College. American Labor Legislation Review, Vol. II, No. 2, June, 1912, P. 189.

It is clearly undesirable that hasty or unfair legislation, based on insufficient data, should be enacted, and it is therefore of the greatest importance that physicians everywhere enter into hearty cooperation with the state authorities in the collection of accurate statistics which shall be of true scientific value.

References: Among the most important articles on the subject of the reporting of industrial accidents and occupational diseases are: American Labor Legislation Review, Vol. I, No. 2, June, 1911, "Comparative Analysis of Existing Laws: Accidents to be Reported"; Vol. II, No. 1, February, 1912, "Uniform Reporting of Industrial Injuries" by Leonard W. Hatch; Vol. I, No. 4, November, 1911, "The Beginning of Occupational Disease Reports", by John B. Andrews; Vol. II, No. 2, June, 1912, "Compulsory Reporting by Physicians", by Leonard W. Hatch; and Quarterly Publications of the American Statistical Association, New Series, No. 98, June, 1912, “Reporting of Industrial Accidents", by Robert E. Chaddock. The laws of this country requiring these reports will be found summarized in the annual Reviews of Labor Legislation of the American Association for Labor Legislation, and are printed in full in the Twenty-second Annual Report of the United States Commissioner of Labor and in the Bulletins of the (U. S.) Bureau of Labor, Nos. 85, 91, 95 and 97. The New York State Department of Labor has published a pamphlet for physicians on Reporting of Occupational Diseases, which contains the law, a statement of its purpose, and information in regard to the diseases to be reported and their symptoms.

COMPENSATION OF FEDERAL EMPLOYEES FOR ACCIDENTS AND DISEASES

Immediate Legislative Program: Secure a revision of the federal employees' compensation act, including extension of the compensation principle to embrace occupational diseases as well as industrial accidents.

The federal "act granting to certain employees of the United States the right to compensation for injuries received in the course of their employment",1 approved May 30, 1908, went into effect on August 1 of the same year. The "certain employees" covered are artisans and laborers employed in the manufacturing establishments, arsenals, or navy yards of the United States, or in the construction of river and harbor or fortification work, or in hazardous employment in reclamation work or under the Isthmian Canal Commission. The compensation allowed is regular wages until able to resume work, but in no case extending over one year. Should death ensue within the year, the remainder of the compensation is payable to the widow, to children under sixteen, or to the dependent parents. With the terms of the act as so adopted there was almost immediate dissatisfaction. The first change to be made was in relation to the limitation of compensation to injuries received in "hazardous employment" in the Canal Zone. In 1909 it was explicitely provided that nothing in the compensation act was to prevent the Canal Commission from extending leave of absence with pay up to thirty days to injured employees, "whether engaged in a hazardous employment or otherwise". This broadening of the act was carried still further in 19113 when "all employees" in the Canal Zone were allowed one full year's pay as compensation. The amendment of 1911 took another very important step toward liberalizing the provisions of the law. Previously a workman could

1 25 Stat., 556.

Acts 1908-9, C. 179. Approved February 24, 1909.

'Acts 1910-11, C. 285, sec. 5. Approved March 4, 1911.