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Workmen compensation cases as seen by the allergist
212
THE JOURNAL
OF ALLERGY
to one thing or, usually, as Dr. Vaughan says, to a variety of things. I think we shall get farther if we regard the allergic group as simply a variation of the normal group. DR. VAUGHAN.-I was a little worried about my figures on heredity until I realized I was studying quite a, different group from those that had been studied by Cooke and his associates, and by Miss Atkinson, because among those who are classed as nonallergic I had just as. strong a family history of allergy as among those who were cla,ssed as allergic. When I did realize that we were really studying a different group, becaus,e we were including certain conditions which they had not included, I interpreted it in this way: They have not ha,d allergy, but they have the hereditary predisposition and may develop it a,t any time in the future. I am very much interested in Dr. Rowe’s figures, because I think it is most interesting that thcg correspond with ours as closely as they do. Dr. F’einberg, I am going to read one paragraph, and it is not in the This survey was made by a trained conclusions; it is in the middle. social investigator who had worked with mc in my office for some months, and lived in the town where the survey was made. “It is possible that a survey based upon an exhaustive personal discussion with each patient, together with the indicated sensitization reactions, might show a lower percentage with minor allergy, but I do not anticipate tha,t the difference from. our findings would be sufficient to invalidate our conclusions. I recognize the hazard involved in attempting to’ designate as allergic, recurrent hea.daches and dermatitis, from the patient’s general description, but would once again emphasize the importance in t,his connection of the patient’s ability usually to name definitely the offending agent.” Then there is’ also this additional facto’r: I would not consider, as was brought out in the discussion of Dr. Rowe’s paper, the negative skin rea,ction as final evidence against the allergic state.
Workmen
Compensation
Cases as E&en by the Allergist.
XALVATORE
J. PARLATO, M.D., Buffalo, N. P. (Abstract.) With the tremendous progress which this country has achieved in industry and invention, there has come great improvement in the social and economic welfare of the workma,n. State legislatures have made provision to continue wages during the time a workman is disabled by any injury which he may suffer while at work. Of late years, the tendency has been to favor the workman. The compensation laws are interpreted broadly and liberally, and controversy sometimes arises as to the nature of the injury and the cause and extent of the disability. The physician’s testimony often will determine whether compensation will be given. Compensation laws may vary in the several states. Of interest to the allergist is the fact that awards are made for disablement which is incurred by any process involving contact with acids, alkalies or oils8 capable of causing dermatitis venenata. From time to time, changes and even extension of compensation laws will be sought by insurance companies, employers, social service workers and the labor unions. The medical profession should have a directing
SOCIETY PROCEEDINGS
213
hand in formulating any new statutes. lt can do much to hold a salutary balance between the one side which desires a too easy and liberal inter. pretation of th.e laws and an extension of their provisions which would amount to state medicine, and the other side which would1 ask for minimal award to the injured workman and a too restricted operation of the laws, especially those which cover occupational diseases. In this study cases are reported which offer concrete examples where the allergist is called to give expert testimony. In this way, a good part of the clinical and laboratory data on human hypersensitiveness becomes a permanent part of court records. This means the establishment of precedents or test cases by which other disputed compensation claims are settled. Moreover, these test cases are used as arguments for the extension of the provisions of the compensation law. It is therefore very importa.nt that caution and conservatism, along with fairness to all concerned, shall be the dominant thought in offering medical testimony by the allergist or any ether practicing physician. DISCUSSION DR. KARL D. FIGLEY, Toledo, Ohio.-1 wish to congratulate Dr. Par1 think the industrial comlate on this very timely presentation. missions are becoming better informed regarding contact dermatitis as it appears in industry, but I do not think they know very much about the constitutional hypersensitiveness. One of the cases that was included in my report this morning concerns a man who’ worked in a plate glass factory at Toledo. He claimed tha.t his atopic eczema first appeared in 1925 while he was employed in this factory as an oiler. His job was to lubricate the grinding machinery. This dermatitis then first appeared, according to his statement. He was seen and treated by various dermatologists over a period of several years; as a matter of fact, from 1925 until last month. During all this time he received compensation. To make a long story short, it turned out that this man was hypersensitive to silk, to house dust, to some pollens, and to some foods. The silk was his major hypersensitiveness. He did not have contact dermatitis at all, but he had aliergic or at,opic eczema. He changed his job several times, and he got a.way from the oil. He did bricklaying and had other occupations, and yet the dermatitis persisted. All that time he was paid compensation for his all.eged dermatitis from oil, which proved to, be no such thing. DR. HARRY I;. HUBER, Chicago.-There is another important question that has not b’een discussed. The allergist should .be compensated for his expert testimony. What determines the amount of this compensation ?
DR. PARLATO.-I started my paper by saying that the workman is .being favored. The compensation law of New York Stat,e (I am versed in that one only, and I am sure that the same thing would hold in the other states) provides for what they call expert testimony. It is hoped that it is still the common practice that the one who gives this type of testimony is paid for it. The fee is determined by the presiding officer whether he be a referee in compensation court, or a judge in county
214
THE
JOURNAL
OF
ALLERGY
court. However, this same officer of any court can issue a subpoena. compelling the physician to appear in court and give test,imony. While the attending allergist may refuse to give expert testimony unless there has been an arrangement for payment of a considerable fee, the fact remains that he is, thereby, placed in a. very embarrassing situation. Should he refuse to testify, he will be placed in a very bad light with the workman and his family. The only thing he can do is to give the desired testimony under protest and trust that he may be later remunerated. AS to Dr. Figley’s case, it is true that there are many claims which are made by workmen that are settled in their favor, perhaps unfairly. When I say unfairly, we must remember that there are two people who are mainly concerned in these disputes: one is the employer and the other is the employee. If we are too liberal with awards to the alleged disabled workman, we are liable to endanger t,he possibility of that man ever getting any other employment. Furthermore, it would mean the raising of the cost of production of that particular product in which he was engaged. Finally, the insurance companies would gradually get their own doctors who might give testimony which would not be so favorable to the workman. Already there are a great number of disputed compensation cases where the s’ervices of an allergist would prove valuable to both sides. I think that gradually the insurance companies as well as the employers are beginning to realize the necessity of consulting with an allergist, not two or three years after a wo’rkman has drawn compensation for an alleged disability but as soon as it is practically pos,sible to do so.
The Allergic Nature of the Infantile Diatheses and the Associated Frequency of a Widened lVIediamstinal Shadow (Thymus?). I. HARRISOX
TUMIPE~ER,
M.D., Chicago,
Ill.
(Abstract.)
The introduction to this paper is. an interesting r&urn& of the r61e of pediatrics in the early development of the technic employed in allergy. The general contributions of the laboratory worktr, internist and other clinicians, are mentioned next. Finally, the suggestion is made that the pediatrician has further valuable contributions to make because he ha.s the unique opportunity of observing, recording and studying trends and tendencies which begin in earliest infancy and which he may follow through until adolescence. In the orientation of the subject it will occur to the pediatrician that the essential symptoms of the allergic constitution have been described by the older observers under t,he name of the various infantile diatheses. The records of agroup of babies from private practice were reviewed with a, view of determining the’ incidence of certain findings. which occurred so frequently that they seemed to belong to a, common larger group. It was found that every baby falling in the) classification of the infantile dia.thes,es, exhibited several of the following manifestations: widened mediastinal sbadow, pylorospasm, eraniotabes, eczema, “cradle respiration, stuffiness of cap, ” urticaria, breath holding, “fluttering” the nose, sneezing: wheezing, st,ridor, choking spells, and noisy nursing, anal spasm, and exaggerated response to disease, The actual statistics
THE JOURNAL
OF ALLERGY
to one thing or, usually, as Dr. Vaughan says, to a variety of things. I think we shall get farther if we regard the allergic group as simply a variation of the normal group. DR. VAUGHAN.-I was a little worried about my figures on heredity until I realized I was studying quite a, different group from those that had been studied by Cooke and his associates, and by Miss Atkinson, because among those who are classed as nonallergic I had just as. strong a family history of allergy as among those who were cla,ssed as allergic. When I did realize that we were really studying a different group, becaus,e we were including certain conditions which they had not included, I interpreted it in this way: They have not ha,d allergy, but they have the hereditary predisposition and may develop it a,t any time in the future. I am very much interested in Dr. Rowe’s figures, because I think it is most interesting that thcg correspond with ours as closely as they do. Dr. F’einberg, I am going to read one paragraph, and it is not in the This survey was made by a trained conclusions; it is in the middle. social investigator who had worked with mc in my office for some months, and lived in the town where the survey was made. “It is possible that a survey based upon an exhaustive personal discussion with each patient, together with the indicated sensitization reactions, might show a lower percentage with minor allergy, but I do not anticipate tha,t the difference from. our findings would be sufficient to invalidate our conclusions. I recognize the hazard involved in attempting to’ designate as allergic, recurrent hea.daches and dermatitis, from the patient’s general description, but would once again emphasize the importance in t,his connection of the patient’s ability usually to name definitely the offending agent.” Then there is’ also this additional facto’r: I would not consider, as was brought out in the discussion of Dr. Rowe’s paper, the negative skin rea,ction as final evidence against the allergic state.
Workmen
Compensation
Cases as E&en by the Allergist.
XALVATORE
J. PARLATO, M.D., Buffalo, N. P. (Abstract.) With the tremendous progress which this country has achieved in industry and invention, there has come great improvement in the social and economic welfare of the workma,n. State legislatures have made provision to continue wages during the time a workman is disabled by any injury which he may suffer while at work. Of late years, the tendency has been to favor the workman. The compensation laws are interpreted broadly and liberally, and controversy sometimes arises as to the nature of the injury and the cause and extent of the disability. The physician’s testimony often will determine whether compensation will be given. Compensation laws may vary in the several states. Of interest to the allergist is the fact that awards are made for disablement which is incurred by any process involving contact with acids, alkalies or oils8 capable of causing dermatitis venenata. From time to time, changes and even extension of compensation laws will be sought by insurance companies, employers, social service workers and the labor unions. The medical profession should have a directing
SOCIETY PROCEEDINGS
213
hand in formulating any new statutes. lt can do much to hold a salutary balance between the one side which desires a too easy and liberal inter. pretation of th.e laws and an extension of their provisions which would amount to state medicine, and the other side which would1 ask for minimal award to the injured workman and a too restricted operation of the laws, especially those which cover occupational diseases. In this study cases are reported which offer concrete examples where the allergist is called to give expert testimony. In this way, a good part of the clinical and laboratory data on human hypersensitiveness becomes a permanent part of court records. This means the establishment of precedents or test cases by which other disputed compensation claims are settled. Moreover, these test cases are used as arguments for the extension of the provisions of the compensation law. It is therefore very importa.nt that caution and conservatism, along with fairness to all concerned, shall be the dominant thought in offering medical testimony by the allergist or any ether practicing physician. DISCUSSION DR. KARL D. FIGLEY, Toledo, Ohio.-1 wish to congratulate Dr. Par1 think the industrial comlate on this very timely presentation. missions are becoming better informed regarding contact dermatitis as it appears in industry, but I do not think they know very much about the constitutional hypersensitiveness. One of the cases that was included in my report this morning concerns a man who’ worked in a plate glass factory at Toledo. He claimed tha.t his atopic eczema first appeared in 1925 while he was employed in this factory as an oiler. His job was to lubricate the grinding machinery. This dermatitis then first appeared, according to his statement. He was seen and treated by various dermatologists over a period of several years; as a matter of fact, from 1925 until last month. During all this time he received compensation. To make a long story short, it turned out that this man was hypersensitive to silk, to house dust, to some pollens, and to some foods. The silk was his major hypersensitiveness. He did not have contact dermatitis at all, but he had aliergic or at,opic eczema. He changed his job several times, and he got a.way from the oil. He did bricklaying and had other occupations, and yet the dermatitis persisted. All that time he was paid compensation for his all.eged dermatitis from oil, which proved to, be no such thing. DR. HARRY I;. HUBER, Chicago.-There is another important question that has not b’een discussed. The allergist should .be compensated for his expert testimony. What determines the amount of this compensation ?
DR. PARLATO.-I started my paper by saying that the workman is .being favored. The compensation law of New York Stat,e (I am versed in that one only, and I am sure that the same thing would hold in the other states) provides for what they call expert testimony. It is hoped that it is still the common practice that the one who gives this type of testimony is paid for it. The fee is determined by the presiding officer whether he be a referee in compensation court, or a judge in county
214
THE
JOURNAL
OF
ALLERGY
court. However, this same officer of any court can issue a subpoena. compelling the physician to appear in court and give test,imony. While the attending allergist may refuse to give expert testimony unless there has been an arrangement for payment of a considerable fee, the fact remains that he is, thereby, placed in a. very embarrassing situation. Should he refuse to testify, he will be placed in a very bad light with the workman and his family. The only thing he can do is to give the desired testimony under protest and trust that he may be later remunerated. AS to Dr. Figley’s case, it is true that there are many claims which are made by workmen that are settled in their favor, perhaps unfairly. When I say unfairly, we must remember that there are two people who are mainly concerned in these disputes: one is the employer and the other is the employee. If we are too liberal with awards to the alleged disabled workman, we are liable to endanger t,he possibility of that man ever getting any other employment. Furthermore, it would mean the raising of the cost of production of that particular product in which he was engaged. Finally, the insurance companies would gradually get their own doctors who might give testimony which would not be so favorable to the workman. Already there are a great number of disputed compensation cases where the s’ervices of an allergist would prove valuable to both sides. I think that gradually the insurance companies as well as the employers are beginning to realize the necessity of consulting with an allergist, not two or three years after a wo’rkman has drawn compensation for an alleged disability but as soon as it is practically pos,sible to do so.
The Allergic Nature of the Infantile Diatheses and the Associated Frequency of a Widened lVIediamstinal Shadow (Thymus?). I. HARRISOX
TUMIPE~ER,
M.D., Chicago,
Ill.
(Abstract.)
The introduction to this paper is. an interesting r&urn& of the r61e of pediatrics in the early development of the technic employed in allergy. The general contributions of the laboratory worktr, internist and other clinicians, are mentioned next. Finally, the suggestion is made that the pediatrician has further valuable contributions to make because he ha.s the unique opportunity of observing, recording and studying trends and tendencies which begin in earliest infancy and which he may follow through until adolescence. In the orientation of the subject it will occur to the pediatrician that the essential symptoms of the allergic constitution have been described by the older observers under t,he name of the various infantile diatheses. The records of agroup of babies from private practice were reviewed with a, view of determining the’ incidence of certain findings. which occurred so frequently that they seemed to belong to a, common larger group. It was found that every baby falling in the) classification of the infantile dia.thes,es, exhibited several of the following manifestations: widened mediastinal sbadow, pylorospasm, eraniotabes, eczema, “cradle respiration, stuffiness of cap, ” urticaria, breath holding, “fluttering” the nose, sneezing: wheezing, st,ridor, choking spells, and noisy nursing, anal spasm, and exaggerated response to disease, The actual statistics