Attachment 4


                        ARMY SERVICE FORCES
                   UNITED STATES ENGINEER OFFICE
                        MANHATTAN DISTRICT
                       OAK RIDGE, TENNESSEE


Subject:  Determination of Policy on Cases of Exposure to
          Occupational Disease.

MEMORANDUM to Major C. A. Taney, Jr., P.O. Box 42, Station
ILLEGIBLE, New York, New York.

     1.   In conference with officers of the Insurance Section
and the Medical Section at the Clinton Engineer Works, they have
pointed out a problem of importance to the District.  They are
not confronted with a case of nephritis for the first time in
which it appears with some degree of probability that the disease
was occasioned by exposure.  The plant involved is Tennessee-
Eastman Corporation.  The woman plant worker involved was
assigned to chemical recovery.  She cleaned D units as they came
from the tracks.  Those units are still warm and fumes from "T"
materials as well as NCL and CL are present during this
operation.  The worker began her employment in 1943 without pre-
employment examination and has had almost two years of exposure. 
She is unaware of her condition which now shows up on routine
physical check and urinalysis.

     2.   The medical officers anticipate that we will have
continued cases of this character.  In some cases there will be a
permanent impairment of kidney functions.  In simple terms, the
filtering efficiency of the kidneys is impaired to the extent
that there is a beginning trace of albumin in the urine and
progressive uremic poisoning in the system which ultimately
produces a high degree of toxicity.  The patient in this
condition is more vulnerable to increase in kidney damage from
such conditions as strep threat or similar infections.

     3.   In addition to nephritis, the incidence of discovered
tuberculosis among employees is becoming manifest through more
careful and frequent check.  Though, in the opinion of the
medical officers plant conditions and materials are not the
producing cause of the disease, we will face difficulty in
disproving aggravation.  The rate of discovery is now about one a
week.

     4.   The employees must necessarily be rotated out, and not
permitted to resume further exposure.  In frequent instances no
other type of employment is available.  Claims and litigation
will be necessarily flow from the circumstances outlined.

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Subject:  Determination of Policy on Cases of Exposure to
          Occupational Disease.


     5.   The following critical problems are submitted to higher
authority for determination of policy and guidance in the
handling thereof:

     a.   Labor Relations:

     Rotation of affected workers from present duties will invoke
observation and comment on the part of other workers.  Rotation
is vital to the physical welfare of the workers but will
undoubtedly invite suspicion and doubt in the minds of others
about continuing their work.  What policy or plan of rotation may
be adopted so that it may be accomplished as diplomatically and
expeditiously as possible without disturbing relations between
employer and employee.

     b.   Morale:

     Ancillary to the labor relations problem is that of moral of
the workers.  A knowledge on their part that their health is
being or may be permanently impaired will have a drastic effect
upon the spirit and willingness of the workers.  What program or
policy may be adopted so that moral may be maintained to the
maximum efficiency possible.

     c.   Litigation and Claims:

     Necessarily claims and litigation will result from
occupational disease cases.  The litigation itself is not of
paramount consideration since it is a chronic problem of
industry.  There are certain related problems arising from it
however.  How and by what means is security to be maintained? 
How and in what manner may it be accomplished in the courts?  Can
we successfully fend off the postpone trial of numbers of cases? 
What policy is to be adopted generally with reference to
procedural handling of occupational disease litigation?  How, by
whom and in what manner are the benefits of the health and
hazards clause of the contract to be extended to such affected
employees?

     d.   Security:

     Security may be jeopardized in several ways.  Rotation of
employees may result in cessation of employment.  In such event
the employee will doubtless seek independent medical attention
which will result in inquiries about the manner and tape of
exposure.  Ailment or illness of the employee who has terminated
his duties will invite comment and questioning by friends,
neighbors and relatives.  prospect of litigation means that we
must be prepared in all courts to meet and successfully combat
the challenge to security.  We will be dealing with perhaps five
Circuit Courts of Tennessee and the United States District Court
for the Eastern District of Tennessee.  It is conceivable that we
may be called upon to meet this challenge in various other
courts.  What overall policy and program should be adopted to
solve these problems?

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Subject:  Determination of Policy on Cases of Exposure to
          Occupational Disease.


     e.   Ethical Considerations:

     The feelings of the medical officers are keenly appreciated.
Are they in accordance with their  canons of ethics to be
permitted to advise the patient of his true condition, its cause,
effect and probable prognosis?  If not on ethical grounds, are
they to be permitted to fulfill their moral obligation to the
individual employee in so advising him:  If not or moral grounds,
are those civilian medical doctors employed here bound to make
full disclosure to the patients under penalty of liability for
malpractice or proceeding for revocation of license for their
failure so to do?

     6.   Your consideration is invited to the submission and
solution of these and related problems looking toward
determination of policy for guidance of all concerned.



                                        PHILIP J. CLOSE,
                                        2nd Lt., J.A.G.D.


cc:  Colonel S. L. Warren

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