MEDICO/LEGAL ASPECTS OF OCCUPATIONAL DERMATOSES*t

S the titIe of this contribution A indicates, the subject has at Ieast three major aspects: the medical (dermatologic), the forensic, and the industria1 or economic. It is obviously impossibIe to do justice to al1 three in this relativeIy brief communication. For the discussion of the IegaI aspect aIone wouId require a voIuminous treatise, as each country, and, in the United States, each State, has its own laws covering occupational disease; thus from the IegaI viewpoint no discussion would be of more than Iocal interest unIess each separate law were given individual consideration. This paper is therefore confined, in the main, to the dermatologic considerations, including only certain generaIities regarding the industrial and the Iegal, and the forensic issues are envisaged soIeIy from the viewpoint of the physician. As regards the law: its formulation, revision, interpretation and enforcement, I necessariIy adhere to the viewpoint of the dermatoIogist; and the suggestions which I shall make are those which, from this viewpoint, seem most likely to insure justice to the worker, to the employer, to the insurance carrier and to the community at Iarge. Certain examples of imperfections of compensation law and its enforcement are cited to clarify specific points. These exampIes are chosen from my own experience with the Iaws of New York State. ObviousIy, these examples cannot be vaIid in States or countries whose Iaws differ from those of my experience in regard to the specific points under discussion. To those who have not been in intimate contact with the subject, the revelation of the actua1 numerica and fiscal (economic) importance of occupationa dermatoses must be staggering. The most accurate figures at present avaiIabIe in the United States show that occupational dermatoses constitute over 63 per cent of all industrial disease.l The estimated Ioss per annum is over 4,000,000 dolIars. And the United States seems to be no exception, for in England, Overton’s statistics state that in the year 1927, of 1349 cases of industria1 compensable disease, 979, or approximateIy 72 per cent, were skin diseases. (Cited from Ref. 4.) Prosser White in England, and Oppenheim in Austria fix the incidence of occupational dermatoses at 13 to 20 per cent of all skin diseases.12-14 These figures seem incredibly large, but in reaIity they are probably below the actual incidence; for I should like to venture the opinion that occupational skin diseases are not being regularly diagnosed and classified as such in the majority of Iarge pubIic hospitals and cIinics of the country. In fact, to my knowledge, no official dermatologic diagnostic and classification list contains the heading “ occupational dermatoses ” or “ industrial dermatoses.“5