Document 3e9akyjd5mqbzj89vrwY7YzY3

P-NSC-7 i 12S8579 33l.S2.Ml5 /? 3S,fM cress anti Ex-, 'ctobcr JO-14.: ! contain; the; of the various1 e Street and': e Transit, the; Council Officers and Directors.......................................... Council Purposes and Policies.......................................... Annual Meeting of Members.............................................. Annual Banquet................................. Special Subject Sessions- Agricultural Safety ..................................................... Dusts, Fumes, Gases and Vapors.............................. 4 9 11 31 33 45 Falls of Workers.......................................................... 59 .iustrial irsm-j Fire Prevention ............................................................. 69 ibers who are: Governmental Officials .............................................. 85 :s it contains.; Health Service in Industry......................................... 101 n Volume II; Industrial Accident Investigations........................... 115 Industrial Explosion Hazards..................................... 125 tribute copies! foremen and.' rmation they t etcrence pur-* e obtained as: i : 11 or more ; cost 75 cents! t Industrial Nursing ....................................................... 139 Industrial Safety Lectures......................................... 163 Maintaining Interest in Safety................................. 185 Midwestern Rehabilitation Meeting.........................201 Occupational Disease................................................... 211 Off-the-Job Accidents ................................................. 229 Safety Fundamentals................................................... 249 Safe Use of Electricity................................................. 257 Safe Use of Petroleum Products...............................269 ! of the pro-' Aeronautical Section ...................................... 281 C papers ar.d: A. S. S. E.--Engineering Section.:................ :.............295 s matter, ah-- Automotive and Machine Shop Section...........................301 >iiasizc what; Cement and Quarry Section............................................... 313 romoting c-t-- Chemical Section.................................................................... 339 t prevention Construction Section ........................................................... 373 : somewhat Food Section ...........................................................................385 ticular vaiue. Marine Section........................................................................ 407 having itt'-re Meat Packing. Tanning and Leather Industries penal ma:r.:- Section ................................................................................... 455 desired, in Metals Section..................... '................................................ 473 Mining Section ...................................................................... 521 -cs. seek? tot pertir..-:'.:' `trary to the y. !:') s- -. h .have Paper ar.d Pulp Section....................................................... 555 Petroleum Section.................................................................. 613 Power Press Section............................................................. 665 Public Utilities Section....................................................... 671 Refrigeration Section................................................. . . . .691 Rubber Section ................................................. Steam Railroad ................................................. Textile Section ................................................. Wood Products Section.................................. Safety Preposition--List Exhibitor; Index Dusts, Fumes, Cases and Vapors ,WEDNESDAY MORNING SESSION October 12 1938 Assembling in the Grand Ballroom of pany, Hartford, Conn., and Vice-President The Stevens Hotel, this meeting was called for Engineering, National Safety Council. to order by Chairman Walter S. Paine, Chairman Paine briefly outlined the session Manager, Engineering and Inspection De objectives, and then introduced the speakpartment, Aetna Casualty & Surety Com- ' ers. Recent Developments in Detecting Hazardous Dusts, Fumes, Gases and Vapors By WARREN A- COOK Superintendent, Engineering Department, Zurich General Accident and Liability Insurance Company, Ltd., Chicago In discussing the determination oi injuri ous dusts, fumes, gases and vapors, I am very sure that you are not interested so much in a meticulous dissertation on such phases of the subject as whether the loga rithm of the reciprocal of the hydrogen ion should be 9.5 or 9.0 for the determination of lead by the dithizone method, but rather in a discussion of this matter along broad lines, pointing out what types of potentially injurious materials should be looked for, whether determination of them is in order, a brief discussion on some of the more im portant and common methods of determina tion, and interpretation of the results ob tained. Foolhardy to "Work in the Dark" Working in the dark without any means of illumination where there may be hazard ous conditions serious enough to cause loss of life or severe injury would be considered most foolhardy; vet every day men conduct their operations in atmospheres containing dusts, gases, and vapors which may cause death or severe injury to health without be ing able to see or otherwise perceive the potentially hazardous condition. Most gases and vapors can no more be seen than the well-known black cat in the coal cellar. Some of them cannot even be detected by odor, though odor is itself.no reliable criterion as is evidenced by the gas, hydrogen sulfide, which has a most ob-. noxious odor but has caused many a case\ of poisoning. . /' How, then, are we to know whether the' atmosphere in which we work is safe or injurious? Are we to wait until we see the effects of unhealtliful or irrespirable at mospheres on our men or is it not more intelligent to determine, \vituir^W-3--l*a4Jti=-- . tions of modern methods and practical ap plications, just what sort of atmosphere we are subjected to? The importance of having facts before us is well illustrated by an atmospheric con dition where a life could be snufted out in a few minutes, even though the more com mon situation is where excessive exposures may require weeks, months or years to cause their injurious effects. 45 Silver Jubilee Safety Congress 46 Thirteen years ago this month a powder crew was walking down the tunnel of a new water supply system of a Connecticut city. Their duty was to inspect the roof case of carbon monoxide poisoning, was the ready availability of a simple means of determining the carbon monoxide concen tration on the job. and the face, to see that all the shots were fired. On approaching the tunnel heading The present tendency in development of methods of determination of injurious ma immediately after the blast, they found that terials in air is toward such simple, quick flying rock had broken the compressed air acting devices. As many of you know, the line, which had been left turned on in order Hoolamite carbon monoxide detector op to blow the smoke and gas away from the erates merely by pressing a rubber bulb ten face of the tunnel. The crew, consequently, times and comparing- a purple color which ran into a heavy blanket of smoke, but they' develops in presence of carbon monoxide were hardened workers, used to smoke and with a standard color scale mounted on the gas, and a little smoke, even though they knew it contained carbon monoxide, did not hold them back. They found the roof intact. But four of the holes had not fired. Caps with 3-foot fuses were inserted in sticks of dynamite, one for each of the holes. The gas condi tion by the time this work had been ac complished was beginning to make these men feel a bit groggy. Following the usual practice, the powder foreman sent the rest of the men back down the tunnel before he lighted the fuses. instrument--an operation which requires about a minute. Instruments oi this type are especially important for gases which may cause acute poisoning such as carbon monoxide, hydrogen cyanide, and hydrogen sulphide. An instrument for determination of hy drogen cyanide, similar to the Hoolamite carbon monoxide detector, bns recently been developed hy' the United States Bu reau of Mine workers, and, together with a number of other of these simple detec tors, is now available commercially. De termination of such materials can accord The men walked back through the smoke to the car, about a quarter of a mile down the tunnel. There they waited for the fore man. Seconds passed. The time stretched to a minute. Down the tunnel came the ingly be made much more widely than formerly when laborious chemical labora tory methods were necessary. Potentially Hazardous Materials boom of the blast--but no foreman. The The first step in an organized endeavor men rushed to the heading and found the ; avoid environmental conditions which foreman stretched on the tunnel floor, tny cause injury to health is a listing of all nearly covered with rock from the blast, taterials, used or produced, which may where he had collapsed from the effects of nder certain conditions be deleterious. It ,i. monoxide. .as found in a study by the United States This is a true story' up to a certain point, but I have omitted a part of the story, and the ending, f am glad to say, is pure fiction. The part of the story which 1 omitted was that carbon monoxide determinations cre being taken when those men got up to the heading, and a concentration of .3 per cent carbon monoxide was shown to be present by means of the Koolamite carbon monox ide detector. With such a high concentra tion, it was realized by the man making the determinations that it would not take long 'ublic Health Service of potential hazards n a typical industrial area (1) that a conklerable percentage, nearly ZO per cent, of lie workers were exposed potentially to arbon monoxide. The report by no means miniated that this percentage of workers vcrc being poisoned by carbon monoxide. Hit rather that if things went wrong and a .ouccntration of jhe gas built, up_ta_.hU. nirious proportions these men might be- :ome poisoned. So I suggest that you go through your for exposed persons to collapse. He in plants and see what operations involve P0- formed the crew of the condition and hur ried them back to the car to wait until the smoke and gas had cleared enuugh to per tcntially injurious materials. Of the dusts, those which may produce s-ilicosis occur not only in the well-known industries \v her* mit them to work safely and fire the blast. mnjor <tttclics of conditions have btcu cofl* The difference between fact and fiction in ducted hut in other industries as this cz;C, between a brief delay and a fatal ware raanufacturir may be exposed dust in making u for use within the tries in which su exist is given in ti Silicosis Conferenc The toxic dusts readily spotted. V against lead expo plants, but often ov as where red lead vehicle by a work top floor of the pla steel part. It is r pound of lead or . but the extent to u air breathed by the Carbon monoxic hydrogen cyanide 1 examples of gases, curs where produci used. The last nam where fumigating r to time. Where dry or fermentation pr carbon dioxide is li deaths usually at 1 areas such as ships' tanks. Vapors are pres solvents are used. D "'here high concenti curred when a drum on a basement stora open, and again whe "as being used for fk wt,le fumiSt>tor !. basement ns his h last. Injury from con(i ,.ent vapor at conn their effect after wc TMre common cor solvents differ wide: 0 vapor necessary ; Qlvldcd into grotoxicity in a > le Northwestern Ur Uccopaticnnl Disease Where Should I Mi ;ne \vh SOi"S VCr > s where potential)- m *tPreSent' " is m>'' makl"S actual detern 3T rit `i.'Olling, wa, ".pie rac.nn oi ~>xfcic cnnccn- -vclopmciu of umirious ma-implc, quickyou know, the detector optuber bulb ten e color which on monoxide ounted on the Inch requires oi this type gases which ten as carbon and hydrogen tation of hye Hoolamitc ha; recently i States liu.cccthcr with -im.ple detccrrciaily. De- can accordwidcly than xicai labora- laterials zed endeavor .ions which kiting of all which may eterious. It cited States '-tiai hazards that a conper cent, of tCT.tialiv to ; r.o means of workers u monoxide. zcr.g and a t up to inm.ight be- .rough your tr.volvc po the dusts. . - r c v. --YzSi where con- as well, in siivcr- Dusts, Fumes, Cases and Vapors 47 ware manufacturing, for example, one man may be exposed day after day to tripoli dust in making up a polishing compound for use within the plant. A list of indus tries in which such dust exposures may exist is given in the report of the National Siiicosis Conference.' The toxic dusts and fumes are more readily spotted. We recognize and guard against lead exposure in storage battery plants, but often overlook such an operation as where red lead is being mixed with a vehicle by a worker in one corner of the top floor of the plant to color lettering on a steel part. It is not so much whether a pound of lead or a ton is used in a day, but the extent to which it contaminates the air breathed by the worker. Carbon monoxide, ' hydrogen sulphide, hydrogen cyanide have been mentioned as examples of gases. The first of these oc curs where producer gas or water gas is used. Tlte last named should be looked for where fumigating may be done from time to time. Wltere dry ice is used in quantity or fermentation processes are conducted, carbon dioxide is liberated and has caused deaths usually at the bottom of confined areas such as ships' holds and fermentation tanks. Vapors are present wherever organic solvents arc used. Death may result quickly where high concentrations exist as has oc curred when a drum of solvent was dropped on a basement storage room fioor and split open, and again where carbon tetrachloride was being used for fumigating a flour mill and the fumigator sprinkled the liquid in the basement as liis last operation. It was his last. Injury from continued exposure to sol vent vapor at concentration; which cause their effect after weeks'of exposure is the more common condition. The various solvents differ widely in the concentration of vapor necessary to cause injury. These are divided into groups in accordance with their toxicity in a paper delivered before the Northwestern University Symposium on Occupational Diseases a year ago.1 Where Should Determinations Be Made? After going over your plants and learn ing where potentially hazardous materials are present, it is my suggestion that, beiore maxing actual determinations of' concentra tions in air or instituting control measures, you make a thorough survey oi the condi tions and divide the various operations where these materials are present into groups r (1) those which are obviously safe; (2) those which are admittedly causr ing injury- to health or are worse than good industrial practice dictates; (3) those conditions where it is not readily discern ible by general observation whether the ex posure is within sate limits. Certain conditions we know definitely and can say definitely will not cause injury to health. I would not say that those arc to be forgotten, but-at least they need not be the subject of initial action. If, for ex ample, a gas containing 30 or 40 per cent carbon monoxide is used for hot plates, and those hot plates are connected with rigid conduit rather than with rubber tub ing, you can fee! reasonably safe that the carbon monoxide exposure is within safe limits, and I would not recommend that determinations be made. Where spraypainting is being done in a well ventilated booth in such a manner that there is no excessive rebound into the face of the sprayer, determinations of vapor or pigment need not be made even though the odor of the solvent is detectable. From time to time it may be well for state authorities to check some of these lesser exposures, but there is a considerable number of such ex posures which can be accepted as safe. The second group of exposures--that where conditions arc admittedly severe--is another where determination; are not es sential. Institute control measures immedi ately. If there are clouds oi dust contain ing free silica in your plant, rz to work on them. If excessive lead absorption is shown by development of symptom; or by high basophilic aggregation percer.zages, reduce the lead exposure. It may be desirable to make determinations even in these cases either to provide a before-and-after picture of exposures to show what improvement is effected or to obtain a clear picture of just what part of an operation is responsible for the excessive exposure to the end that con trol measures can be more specifically ap plied. This latter use of air analysis data is of especial value where' the materials arc invisible as is the cast with gases, vapors and even some of the more toxic dusts such as quartz and lead. The principal use for determination of 48 Silver Jubilee Safety Congress injurious materials in air is where general observation does not give the necessary in formation. Suppose exhaust ventilation and partial enclosure have been installed to reduce exposure to a dust high in free silica. You might learn whether control measures are effective by waiting ten or a dozen years to see whether silicosis devel ops among those exposed. It is much more economical to run a group of dust de terminations. A recent series of such de terminations indicated that exhaust ventila tion was adequate at an operation where pulverized silica was being transferred to the hopper of an elevator, but the manipu lation was at fault. . -- -- ......... ...... Where fumigation with cyanide has been conducted, it has long been the practice to depend upon a time period of ventilation and upon the nose of the fumigator to establish that the premises are safe for occupancy. Xow that a simple hydrogen cyanide detector is available, it is in order that determinations be made in every case before re-occupancy and, further, that every municipality where cyanide _ fumigation is carried on enact an ordinance covering such fumigation with the provision that deter minations be made, especially in any dead air spaces, before the premises are consid ered safe for occupancy. Hydrogen sulphide determinations are today being made routinely in the spinning rooms of viscose rayon manufacturing plants. Carbon disulphide determinations involve a more laborious procedure but are regularly made in a number of departments of the larger plants of this same industry. Operations are regulated so that any ex posures to these materials are within safe limits, but the continual checks permit de tection of any excessive exposures before injury to health develops. A good general rule to adopt is to make determinations of concentrations of injuri ous materials in air wherever there is any question that these may produce deleterious exposures. Methods of Determination Discussion of methods of determination will be limited to certain general considera tions, reference to complete descriptions of available methods, and comments of timely interest on a very tew methods. In the collection of samples, it is of ut most importance that these samples are such as to provide the desired information. It has been pointed out that one set of conditions exists today, and quite a differ ent set of conditions may exist the next day; that if air analyses show conditions to be satisfactory on the first day, our eyes may be closed to the fact that conditions are much worse on the second day. So, rather than encouraging the installation of safeguards, we are setting up obstacles to them. My plea is that methods of determination be used intelligently and honestly. If it is desired to show exposures under the most severe conditions, be sure to set up these conditions when you make the test; if rep resentative conditions are desired, see that they are truly representative. Whether you yourselves make these tests in your own plants, whether you bring consultants in to make them, whether state departments, in surance companies, or some other agency makes these determinations, make a real effort to see that conditions are as repre sented when these determinations are made. For a comprehensive discussion of equipment for conducting determinations of dusts, fumes, gases and vapors, may I refer you to a paper entitled "The Industrial Hygiene Laboratory.'" This paper includes descriptions of both field equipment and laboratory apparatus, together with a dis cussion of their applications. References to the methods themselves may be obtained in the reports of .the Com mittee on Methods of Determination of In jurious Materials in Air.' These reports are available on application to the Amer ican Public Health Association. The Preventive Engineering Committee of the Air Hygiene Foundation of Amer ica has recently developed a bulletin on Methods of Determination,* and in that bulletin are included only those methods which have been satisfactorily used in this country. The trouble with many papers on methods of determination is that they are woefully deficient in their practical qual ities and simply do not work when put to ritje test. . ___ _ You are all interested, I believe, in a brief discussion of the methods available today for dust determination and some of the up-to-date viewpoints on collection and determination of dust. It is my opinion that where it is desirable to know whether a condition investigate try, it is v of the imp the advant: at the pretion to the oped at the able comm the bulkim It is to pinger will the differ methods c a duplicat: by the use other instplers, whir a second . value for impinger ; an hour exists, we erations c concentre: meter, a I some ins: concentre: obtain pri tions whi dust. Further condition sampling as a cont has a du desirably methods they com not is of tant thine at levels If dustin dust pro and com Collect timely ir ability o tator. M lead in impinger This in; collectic: material given o. pinger c less th.a ormation c set of a differthe next iitions to our eyes onditions day. So,' iation of tacles to mination If it is the most up these ; if repsee that tlier you ; sur own us in to oms, in agency a ral s repre-e made, ion of tions of I refer '.dustrial includes ent and . a dis- mselves e Com. of In reports Amer- lmittee Air.er.tin on n that ethods in this ers on ev are quaiput to in a silabie rre^ctl r. and ninion tether Dusts, Fumes, Gases and Vapors 49 a condition is or is not safe in the light of electrostatic precipitation method, which is investigations so far conducted in this coun about the most efficient method of collec try it is "ell to collect samples by means tion, is a preferable instrument for mate of the impinger method. I will not go into rials of sufficiently fine division to be the advantages or drawbacks of that method classed as fumes. This type of instrument at the present time beyond bringing atten has long been available, but only recently tion to the micro-impinger set-up as devel commercially; and I feel that where lead oped at the Bureau of Mines and now avail in the form of fume is encountered, the able commercially which largely overcomes electrostatic precipitator should be used. (|ie bulkiness of the original equipment. The facts which we have'in the literature It is to be emphasized that only the im today concerning the production of lead pinger will give impinger results. Due to fumes in workrooms where high tempera the' different characteristics of other ture melting pots are used are based on the methods of determination, you cannot get results of impinger samples, and so until we a duplication under a variety of conditions get further data from the electrostatic pre by the use of other instruments. However, cipitator, we have a big question mark as other instruments, such as the grab sam to whether there is more lead fume in the plers, which take a sample over a period of air where lead melting pots are present than a second or two, are of very considerable .we had previously anticipated. value for a number of purposes. If an impinger sample collected over a period of an hour shows a high dust concentration exists, we may know what particular op erations during that hour caused this high concentration. If we have a Zeiss konimeter, a Bausch and Lomb dust counter, or some instrument which will give us the concentration at any given instant, we can obtain precise information on those opera tions which arc contributing most of the dust. Furthermore, after we know whether a condition is safe or not, one of these quicksampling instruments is extremely valuable as a controi measure. Wherever a concern has a dust condition, determinations may A year ago, the A.P.H.A. Committee on Air Analysis mentioned above obtained in formation from all the laboratories in the country conducting industrial hygiene de terminations concerning what injurious at mospheric constituents had been analyzed, what methods were used and whether these were satisfactory. Lead was the material which was de termined by the largest number of labora tories. The next material of interest was hydrogen sulfide, and the reason being that most rayon manufacturers make routine tests for this gas. If any of you believe that a man will not voluntarily walk into a dangerous hydrogen desirably be taken by some of these quick sulfide concentration, let me recount the methods regularly as a control. Whether experience of one of the promising young they compare exactly with the impinger or workers in industrial toxicology who walked not is of no great consequence; the impor into his laboratory one morning, about two tant thing is whether conditions are holding years ago, found that a hydrogen sulfide at levels shown by the impinger to be safe. cylinder had tipped over and the valve If dustiness is on the increase, a survey.o_ .broken.off. .In trying to get the cylinder to dust producing operations should be made an exhaust hood, he collapsed and was and controi measures instituted. found dead in his laboratory by the janitor Collection of lead dust and fumes is of timely interest with the commercial avail ability of the portable electrostatic precipi tator, Most of us who have been sampling [tad in this country have been using the "npinger for the collection of these samples. This instrument is highly efficient for the who arrived not long after. Certainly if an intelligent research worker, thoroughly aware of the toxic action of this gas, could so expose himseli, we must not assume that the odor of hydrogen sulfide will cause the plant worker to avoid dangerous amounts of it. collection of samples where lead dust is the Carbon monoxide was next in the list of ^atenal of interest. Where lead fumes are injurious materials placed'Tn the'order'of Siven off, we have evidence that the im- the number of laboratories making deter Pmger collects these fumes at appreciably minations of them. In addition to the small Ks than ICO per cent. We feel that the Hoolamite detector, previously mentioned, 50 Silver Jubilee Safety Congress several types of detectors and continuous indicators are available commercially, both portable and stationary. A home-made de ing air through a cylinder, turning a dial I permit proper interpret;; and reading the concentration. Unfortu ditions are essentially st: nately the interferometer is not specific for sample may be adequate vice has just been suggested' whereby air any one vapor, merely measuring differ. , As previously mention is drawn past the filament of a cigar lighter ences in densities. The cost of the instru such value to have avai for combustion and the COi formed by any ment is high, but it is available through a CO present is determined colorimetrically. number of investigators and some of the collecting devices: one tinuous sample over a U This ingenious device may solve the prob lem where the exposure may not justify the expense of the continuous indicator. insurance companies, and, where many de terminations are to be made, amply ju*.--' tifies itself. _. , the other which gives t any given instant. The able information on the Mercury was the next in line. Unfortu-_ ------------------ Interpretation of the worker, and the nately we do not at the present time have ticular operation causing a quick method for mercury. One method In the interpretation of results, there are of that exposure. Th will give concentrations of vapors within a number of important items to be taken methods, used together injurious limits if the sample is of several into consideration. It is appreciated that the cases much more com hours duration, but we would like to be results must be referred to some threshold interpretation of existir able to obtain the desired information with a ten or twenty minute sample. The list then includes sulphur' dioxide, hydrogen cyanide, ammonia and chlorine in that order. value such as 100 parts per million for carbon monoxide or 2 milligrams per ten cubic meters for mercury. There are sev- - eral collections of such threshold values, that published by Bowditch1 being one of = the most complete. :, Know the limitatior used and interpret the We must remember th: a very convenient tooj, a it should not be empl Of the organic materials, the greatest number of laboratories made determinations of hydrocarbons as such. The inflammable vapor indicator, orig inally designed to show whether an at mosphere was within inflammable limits, is of value for hygienic purposes in some cases, but just because an inflammable vapor indicator shows negative results is no good reason for assuming that the condi tion is necessarily safe from a hygienic In referring results of determinations to.5. these standards, consideration should be-' taken of the duration of exposure of the:. worker and also the duration of the ex- . posures used in developing the threshold / limits. If a worker is exposed to a con--' centration of 20 milligrams of lead per 10 cubic meters of air for a period of an hour a week, we need have little apprehension that he will develop lead poisoning; but if a group of workers is exposed to this con mortise and tenon join tions have their defini: try to read more into worth. Determinations extensively to great r determinations, we car exposure to dust, fum is safe or dangerous > riot see them. Let us : but rather, cast all lit otherwise invisible ha: point of view. One of these indicators has centration as an average condition^thcn we been sensitized so that it will give as low can anticipate lead poisoning cases. as 20 parts of a million of benzene vapor, but the minimum reading on most of these The conditions under which the air instruments is 1,000 parts per million. samples were collected must be carefully ?!i. Carbon disulphide has been of much in considered. In some instances winter con terest. ditions may be the more severe; in other CHAUtsuN Paine: 'i:ir A method has been developed, and is commercially available, for the determina tion of chlorinated hydrocarbons, such as trichloroethylene, with which we are be coming more familiar through its use in vapor degreasers. The chemical method will give chlorinated hydrocarbon concen cases, summer conditions. If open windows adjacent to a chromium plating tank cause high concentrations of chromic acid to be blown into the plating room, the results of determination should be interpreted to in dicate the need, not of increasing the local ventilation, but of keeping adjacent win- dc-.vs' closed. ---- -- portant subject, and I who would like to di: us make our questior A. G. Speer (Westc thome): Are you faconnected with arc w and ozone, and mean Vir trations in the presence of such other ma terials as gasoline, with which they are sometimes mixed. A rapid physical method for the deter mination of all vapors and gases having a density substantially different from air (and this includes most of them--notable excep tions being CO, HCX, methanol, and ethane) is the portable interferometer. The operation, after calibration, involves draw Careful note should be made of all opera tions which may contribute to the exposure. The dust concentrations near a group of molders in an iron foundry may be exces sive, but it is possible that the cause may be due not to the molding operations, but to an unprotected sand conditioning ma chine in the vicinity. Where conditions change rapidly, samples must be taken fre quently or over a long period in order to Mr. Cook: A stu iron oxide concentra: arc welding, with th amount of iron oxidi arc welder might ir. determinations have though the lungs lc they were severely pretty conclusively does not cause injt ."! I Dusts, Fumes, Gases and yapors 51 turning a jj-Jjt ^jtrrnit proper interpretation. Where con- References on. Untort*r --dSons are essentially static, a single brief, :oi specific f0< : '. '.'sample may be adequate. ... curing difitry -*V'As previously mentioned, it is usually of = i the insiru;'" -'s^ich value to have available two types of able through y -"collecting devices: one which takes a con- some of tinuous sample over a long period of time, :ere many the other which gives the concentration at - imply . ' jny given instant. The former gives valu- (1) Bloomfield, J. J., Johnson, W. S., and Sayers, R. R.: The potential problems of industrial hygiene in a typical indus trial area in the United States. U. S. Public Health Bull. No. 216 (1934). (2) Summary reports of the National Sili cosis Conference. U. S. Div. of Labor Standards Bull. No. 13 (1937). ' able information on the average exposure of the worker, and the latter on the par , -HfK. u:ti, there are ; to be talceh" tiated that the ome threshold r million for`; rams per tea' ticular operation causing the major portions r-0 that exposure. The results of both " methods, used together, permit in many - gases much more complete and valuable \ interpretation of existing conditions. Know the limitations of the methods here are sev-'. shold values,' being one of --used and interpret the findings accordingly. We must remember that a screw driver is ' a very convenient tool and it has its use, but .. 4 rminations to should be' osureof the' t o: the ex'-' he threshold :d to a con-". : lead per 10. d ot an hour apprehension'" oning; but iN i to this con-^ ' it should not be employed for making a mortise and tenon joint. These determina- lions have their definite value, but do not ' try to read more into them than they are . worth. Determinations can be used more extensively to great advantage. Through determinations, we can learn whether the exposure to dust, fumes, gases and vapors r is safe or dangerous even though we can 'not see them. Let us not work in the dark, but rather, cast all light possible on these .otherwise invisible hazards. tior., then we" (3) Cook, W. A.: Industrial 'solvent ex posures and their control. Proceedings Occupational Disease Symposium. Northwestern University Medical School (1937). (4) Cook, W. A.: The industrial hygiene laboratory. J. Ind. Hygiene and Tox., 18, 623-636 (Nov. 1936). (5) Report of Committee on Methods of Air Analysis. 1935 Report available as reprint, 1936 Report available in 193637 A.P.H.A. Year Book. American Public Health Assn., N.Y.C. (6) Routine sampling for control of atmos pheric impurities. Committee of Pre ventive Engineering. Bulletin in pub lication by Air Hygiene Foundation of America, Inc., Pittsburgh, Pa. (7) Make your own carbon monoxide test. Safety Engineering (Sept. 193S). (8) Bowditch, M.: Toxic Limits of Injuri ous Materials. Div. of Occ. Hygiene, 23 Joy St., Boston, Mass. iSCS- M ich the air be carefully winter con-' re; in other en windows tank cause acid to be c- results of e:ed to innc the local jacent win- <f all operae exposure, a group of y be excescause may -a::cns, but coning ml- conditions taken fren order to Discussion Chairman- Paine: This is a mighty im conclusion has been reached in two sep portant subject, and I know there are many arate investigations. who would like to discuss phases oi it. Let us make our questions clear and concise. The collection of iron oxide was made by the electrostatic precipitation method. A. G. Speer (Western Electric thorne): Are you familiar with connected with arc welding, .like Co., the iron Haw fumes oxide" Mr. -such a Speer: We had occasion to make determination but we used the im- and ozone, and means"6 detecting them? pinger method, and we did not find toxic Mr. Cook: A study has been made of qualities or properties. We could not find any available data on that particular subject. iron oxide concentrations in connection with arc welding, with the thought that a large Mr. Cook: A paper was published by amount of iron oxide being breathed by the Drinker, together with a number of other arc welder might injure his health. X-ray investigators, in the Journal of Industrial determinations have been made, and al Hygiene, and the conclusion was that in though the lungs looked very much as if jury to health was caused by nitrogen ox they were severely fibrosed, it has been ides, with a possibility of ozone entering pretty conclusively shown that iron oxide into the picture. ____________________ __ does not cause injury to the lungs. This R. C. Meldrim (Glens Falls Indemnity 52 Silver Jubilee Safety Congress Co., Glens Falls, X. Y.): Mr. Cook, do you believe that an arsine determination should be made in a metal pickling operation? Mr. Cook: Generally, no. I have seen no actual arsine poisoning from metal pickling, even though the literature includes such cases. As far as cases in this country are concerned, it has seemed to me to be largely a literature condition. In talking with Dr. Cunningham, of the Ontario Department of Health, Division of Industrial Hygiene re cently, he mentioned a considerable number of arsine poisoning cases and I suggest you write him for further details. I have not seen any thorough investigation of the sub ject, and that has been one of the things that lead me to believe that the condition isn't sufficiently severe to cause us great apprehension. The experience in this coun try has hardly indicated the necessity of making such determinations. I have not made any myself. However I should like to see somebody make a series of them at a half-dozen locations where metal pickling is done. F. L. Warner (U.S.S. Lead Refinery, Inc., East Chicago): Do you feel that fur ther investigation with the precipitator will change the present permissible limit of lead exposure that has been determined by the impinger method? Mr. Cook: The answer to that question is "X'o," but I feel that this further thought can be added: We have had many opera tions where lead dust was the prime ex posure. Where the lead is in dust form, the impinger will get essentially the total amount of the lead; consequently where we have made physical examinations of large numbers of workers in such exposures, correlation of the results of physical ex aminations of workers and of incidence of cases of actual lead poisoning with concen trations of lead in air have fixed fairly definitely, within workable limits, just about how much lead can be considered to be safe. The threshold limit based on such ex posure to lead dust would be the same whether the samples were collected with impinger or electrostatic precipitator. On the other hand in rooms where lead casting is done, where there are lead melt ing pots, the impinger probably gives low results. The chances are that the concen tration of lead in those rooms is greater than found by the impinger. But those im pinger results, those that we have made, may have been around 2 of a milligram whereas 1.5 milligrams per ten cubic meters is definitely sate. Suppose instead of 2 of a milligram per ten cubic meters, there are two or three times as much present in the form of a fume as found by the electro static precipitator. Even if .6 or .8 milli gram were present we would be within safe limits. This is further shown by the fact that physical examinations of workers in rooms where lead melting pots are present have demonstrated that Jhere is no great lead absorption.------- So my conclusion is that the collection of samples by means of the electrostatic pre-, cipitator is not going to confuse the issue at all. It is going to give us more accurate data on some of these exposures where lead is present in the form of fume. G. VV. Daubexspech (Illinois Department of Labor, Chicago): How would you de termine arsine in air around pickling tanks? Mr. Cook: It would be necessary to re sort to a chemical method, and I think that I had better not use the time for a discus sion of chemical methods. J. W. Fehnel (Metropolitan Life Insur ance Co., New York City): You mentioned the use of the electrostatic precipitator in lead sampling. I have been doing that work myself along with the impinger samples, at various times, to correlate results on lead, both dust and fumes, since 1926. Here is an interesting thing. I know that Bloomfield a few years ago made some tests in a large baking plant and found lead. He came up to consult with Dr. Wright about it, and it was concluded that the source of the lead was the paint they used. That sampling was done with the impinger. About two years ago I made an extensive survey in one of the General Motors plants where there were extensive soldering opera tions. I took impinger samples, and I got a series of factors that I presented in the report, and a short time later I was called _9n_J.be carpet and told that my figures did not agree with their plant chemist's. So I consulted with the chemist. When hr sampled with the electrostatic precipitator and I with the impinger, and we took them on identical reading levels, we got the same results. He had consistently gotten lower results--and we proved this later by checked samples--because he had his electrostatic precipitator mounted on a little truck that he pushed throe working on a pi. 18 inches higher meant that ins breathing zone sampling at abo1 Robert Winti Co., Carteret, N one point, Mr. metallurgical cc the kettles. If hand, or if you heat your kettle heit, if you can Fahrenheit, why heit, because th; more liberation duced the hazar Mr. Cook stat Men Who C Vice President The title of t Down to Their taken extreme!) know, there are (of which we g lation in our de truck tanks and both of which : city streets we 1 for utilities, pov age that are alsc as we call them excavations, sha factories, you h: ment rooms, v Even open pits board ships you enclosed spaces. Even when you try, as we hcr< dangerous enclc the bottom of many varieties are pickles, anc Will you pice demonstration ;. tential conditio: there may be e: need a very gn Dusts, Fumes, Gases and Vapors 53 lie pushed through the aisles, and the men working on a platform that was about 12 to lg inches higher than his main aisle, which meant that instead of- sampling at the breathing zone of the workmen, he was sampling at about his waist level. Robert Winters (U. S. Metals Refining Co., Carteret, N. J.): We have overlooked one point, Mr. Chairman, and that is the metallurgical control, the heat control of the kettles. If you have a problem on hand, or if you are pouring lead and you heat your kettle up to 1,000 degrees Fahren heit, if you can pour that same lead at 750 Fahrenheit, why pour it at 1,000 Fahren heit, because the more heat you have, the more liberation of oxide? So we have re duced the hazard to a large extent now. Mr. Cook stated that the impinger system is a little too cumbersome. I would say that where you have a definite hazard in the lead industry, have your impinger sys tem a permanent system of the organization of your department and keep it there as a permanent fixture. The question came up too, as to the merits of the electrostatic precipitator against the impinger, and I cannot agree with that statement at all because the fumes are made up of minute particles of dust--a fraction of a micron in size--and we found that the impinger system gener ally is just as efficient as the electrostatic precipitator, with the exception that we do have at least six impinger bottles in series, because you cannot get efficient sampling with one or two or three bottles. You must take enough bottles to get a reliable result. FVtm 'Njfc'l Men Who Go Down to Their Death in Tanks--A Demonstration By S. E. WHITING Vice President and Chief Engineer, Liberty Mutual Insurance Company, Boston The title of this feature, "Men Who Go Down to Their Death in Tanks," should be taken extremely broadly because, as you know, there are not only stationary tanks (of which we give you a very crude simu lation in our demonstrations) but there are truck tanks and there are railroad car tanks, both of which are enclosed spaces. In our city streets we have thousands of manholes for utilities, power and telephone and sew age that are also enclosed spaces, or "tanks" as we call them here. You have trenches, excavations, shafts, tunnels, mines. In your factories, you have tanks again, small base ment rooms, vauits, cisterns and sumps. Even open pits may prove hazardous. On board ships you have a very complete set of enclosed spaces, compartments and holds. Even when you go out into the open coun try, as we here look at it, you may find dangerous enclosures--grain bins, wells and the bottom of silos. 'So there are just as many varieties of enclosed spaces as there are pickles, and perhaps more. Will you please remember that from this demonstration you are to visualize the po tential conditions in your own plant where there may be enclosed spaces--and you will need a very great power of imagination to do so with our necessarily crude demon stration apparatus. There are two hazards in enclosed spaces that we shall not dwell upon at length. In any enclosed space that has not much venti lation, that collects moisture and is dark, you will have a severe slipping hazard and an accentuated electrocution hazard--but we shall here consider only the typical asphyx iation and explosion hazards. Most of those enclosed spaces are nor mally just as good to work in as outside spaces_and that is part of the danger. Men have worked in tanks year after year with no trouble, only to have something ex traordinary come up to contaminate the tank, something that they have not antici pated, to make that enclosure a hell hole, as we shall demonstrate in merely reproducing not an exaggerated situation but only what has actually taken piace. How do these spaces get into that condi tion? Merely because there is no free cir culation of. norm?!.atmacphe-c- That is of fundamental importance because all animal life, especially higher animal life, must have a constant supply of normal atmosphere to sustain life. The normal atmosphere is re- Occupational Disease THURSDAY MORNING SESSION October 13, 1938 jrhe'session for the discussion of outending problems in the field of occupa-fial disease was called to order by the 'on. P- J- Angsten, Chairman, the Illinois n'distrial Commission, Chicago, who pre sided. The Chairman emphasized the im portance of the selected subjects to be pre sented by eminent speakers, and promptly introduced the first scheduled speaker. The Trend of Occupational Disease Legislation ' By HENRY D. SAYER 'Mariager of the Casualty Department, Association of Casualty and Surety Executives jiet us consider the differences between the accidental injury and the occupational ^disease. For these distinctions are important .'smd must constantly be borne in mind when e consider either legislation on the sub ject of disease, or engineering methods of prevention or control. j Generally speaking, accidents occur at a Specific moment in point of time, and, from gihe standpoint of fixing liability under any impolicy of insurance, it is in the future; that j^s to say, at the moment of the acceptance .iS^*f lability under any insurance contract ^-``the accident for which liability may be as5^>:'.sumed has not yet happened. That frei y-iiguently is not so with the occupational dis- v'tase. Insurance by its very nature can \VVonly assume liabilities that have yet to .-..- arise--not .those that have already accrued. Again, speaking generally, the industrial ^accident is something Jhat.car_be--seen-- fnj' 5ven though unforeseen. It may be visualand described in words, setting forth -y---specifically the time, place and manner of ; happening. It can then be determined, after - the happening of the event, whether it was :. Preventable or inevitable; blame, if any, can ' e assessed; the worker involved, or his foreman or superintendent, can be shown the fault, and effective measures can be taken to guard against a like future hap- ".Pening. _____ _ But some will say, truly, not all accidents happen in the manner described; that not always are they held to occur only at a specific moment or under circumstances where they can be visualized and described. By administrative and court decisions, it is true in some jurisdictions that the definition of "accident" has been greatly broadened. We find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, and even the specific time and place not definitely known, except that it is shown to have probably occurred in the employment, being held to be an accident. (Hiers vs. Hull, J78 App. Civ. 350, 164 N.Y 767, an anthrax case: Vennen vs. New Del! Lum ber Co., 161 Wis. 370, a typhoid case: and others.) Poisoning of the body through the effects of a deleterious or toxic substance used in the employmentrthe dangers of which were unknown to the worker, the employer hav ing been negligent in safeguarding properly the use of such substance, has been held to be the result of an industrial accident. (Victory Sparkler & Specialty Co. vs. Francks, 147 Maryland, 363; and the very recent case of Bfack vs. Creston Auto Co., Iowa Supreme Court, August 5, 1938, 281, N.W. 189.) And where negligence of the employer has been shown, an injury to health, even though not occurring through a happening r--gi-veu-itne and place, but by repeated 211 .* :.r '!,': v . !` v " '. 1:i *''. v'V,,\, '*;'v ...` ^,;V j <** 'ii,.- I !I Jl rli i:ii k &*< 212 Silver Jubilee Safety Congress exposures over months of time, has been islatively or administratively. These include? ." To effect cc held to be an accident. the well-known metallic and chemical poj.^ ' pon law. 'her (McNeely vs. Carolina Asbestos Co., 206, North Carolina :6S, an asbestosis case.) These and other cases I might cite are the exceptions and not the general rule as to what constitutes an accidental injury. I think we may fairly assume that the efforts of administrators of the law and the courts have been directly inspired by sons that are so definite and characteristjJll a part of some industrial processes. WeSjf the diseases arising from the use of th^f substances the only occupational diseased* with which we need concern ourselves, thjbf legislative difficulty would be largely rer5 moved, and we could safely entrust problem to the doctor and the engineer, d j,,d vague Ian jj| occupation; definition phrase "and s: eases," is to c one that may ^appointing 1 of the law is 'certainly be a their belief in the necessity of finding a But we have seen that the legislative- ' employers. remedy for an industrial ill for which no problem is not so simple. Nor is it simple*! An exceller clear remedy had been provided by specific administratively.--We- find ourselves floun-S statutory drat': language of the statute. May we considet-- dering in a veritable morass, either because'* cite, certain c them as straws 'in the wind, showing a trend toward industrial disease liability? of the inherent difficulties of the situation,* or because we have not or cannot agree-? psed in their than to reso: It may observed that the tendency of the on our objective. If all parties would ree-g meaningless v. courts is to construe the term "accident" ognize the difficulties and the limitations onje of which may in a more limited manner in those states what industry can do, or can fairly be exM the objective where there is specific provision in the law- pected to do, we could much more cou^g is bred by u covering occupational diseases. Thus, we fidently face the future. If we could agreejg controversy h have clear instances of what has , been that provision for "occupational diseases'' is* Litigation is - termed "judicial legislation," that is, the not synonymous with general health and life*, causes delay; : courts broadening the meaning of the law insurance tor industrial workers at indus-f^ disappointment to cover situations not clearly included try's expense, then I am sure we could getj V even breed di. within the terms of the law by the duly con somewhere very definitely. -orderly proces stituted legislative authorities. But has there not been too much loose Why then s: Let us now consider what we mean or in thinking on the subject? We are met with, .-'demand for ti tend by the term "occupational disease." a curious situation. We find the advocates it. with the v Here we find a more difficult field--difficult of so-called "all-inclusive" statutory cover? / may result in from the standpoint of administration and age deliberately seeking indefiniteness. This1 - workers who i judicial interpretation; and difficult from is unlike them, for when they know what? - besets us all the standpoint of the doctor and the en their objective is, and are willing to dis^ in our play, ir. gineer. close it, they have not refrained from press^ ; our sleep, as What is disease? We think we know, and at least to laymen the term conjures up in our minds something of a rather defi ing their advantage with definite and spe-s i Perhaps not-- cific purpose, and with, exact language to^p ` a more simp accomplish that purpose. That, at any ra'V-X . could not othc nite nature. When we pause to consider it, is correct legislative procedure. - Are we to 1 of course, infinite qualifications of the term occur to us, and we are confronted with many conditions that fall into the zone of doubt--such as, for example, whether her nia is a disease. At any rate, we say it is an abnormal condition, and let it go at that. But when we come to add to the doubt ful term "disease" the even more indefinite term "occupational" or "industrial," we find ourselve; - in an arc., -of' highlight sur rounded by a vast and increasing zone of twilight shading off into Ercbian night. Just ho-.v then shall we define the term "occupational disease"? Some diseases stand out in our minds as clearly and definitely occupational. As to them we have no great difficulty, cither leg-_ But in this field, even where the liability: of the employer is made inescapable, th<^ ' the most cor. ..fife may beco: its source or > constant suggestion is put forth that it futile for the legislature to attempt a defir^S nition or delimitation of occupational dis--j| M incident dition there p \ that a pre-ex eases, ar.d, therefore, words of the most-^ gfaeneral charavcter Jshould be emprlo. y* ed, t ? S^vated by *'v** 5ge* order. ing to the courts the interpretation 01 " -g law as they see fit. I submit that it is n ^ the function of the courts to make up thj| legislative mind; that is the function an aj i :. *0,^ keco me of life, p a show "Udition or the right and the duty of the legislatu "ch diseases Nor should the legislature seek _ to ,av0J0gf numerate. and evade responsibility by transferring courts and commissions the determinal ^ of questions of liability which the k8lS. ^ turc find; too difficult for it to determ jg for itself. Ki* ..But we kno l0r luberculo numero-feQr' deaths ST Occupational Disease 213 'effect coverage under the compcnsa- Add to these pneumonia, asthma, arthritis, a'aCt'ris(jc'; is-^STcs5?rf--jggio3oad" -'v|ia--dawg**u,-e t--hIlanennrgerufoargcece, by any such general as the term "any and sj occupational diseases, or by adding to rheumatism, and a host of others; and we discern in this the beginning of a system of health insurance of the most costly type-- SR3SX - definition of "accidental injury" the -aii ais^.. * ` i^phrase "and shall include occupational dis- fjjsis,'' is to create an uncertain liability-- a system moreover that would discrim inate bitterly against the many millions who contract such diseases in perhaps ac 'ise that may require endless and perhaps tually the same way, but who have no em disappointing litigation-before the meanin; ployment at all against which to assess lia ]aw is established; and will most bility. Should not the man who falls vic ^ . - Mbertainly be a disservice to workers and tim to a disease of ordinary life while legislative i employers. searching for a job be just as much the con 5 >t simple ' !v floia. ^An excellent rule--a cardinal rule--in cern of the state as the man who becomes tatutory drafting, is to use words of defi- disabled from the same disease and who er because 7 jle,' certain and understandable meaning, is so fortunate as to have a job? - situation':; nnot agrg-5 would ;tc7f stations is 7 [,, their common acceptance, rather Ibail. to resort to vague, uncertain and meaningless words, or words the meaning jf which may have the effect of distorting Let us be realistic about this thing called health 1 111 health is a deviation from the normal. irly be ex.~^ more coo* 'ould igrtt diseases" is ; be objective that is sought. Controversy j'bred by uncertainty of language, and 'controversy leads to litigation in courts. Litigation is expensive for all parties; it But what is "normal?" How great a devia tion is abnormal? Disease is of many and varying degrees. To what extent does the mind affect the working status? Or what th and lift fcjsduses delay; and it frequently causes bitter at ir.dus- disappointment. It breeds rancor. It may part in the situation is played by "will power"? These are not fanciful questions, : could get ' feven breed disrespect for the law and for they are encountered and will obtrude [^orderly process of government. themselves continually in determination of ^nuch loose * PSSSisWhy then should there be this continuing e met with lemand for the all-inclusive coverage? Is : advocates"' tNwith the vague hope that satisfaction compensation for disease where we depart from the known and characteristic occupa tional diseases. :ory cover-7 nay result in some cases of misfortune to From these remarks perhaps some will mess. This. ^workers who fall victims of the disease that say we are opposed to coverage of occupa <r.ow what Txbesets us all and lurks in waiting for us tional diseases under compensation laws. ng to dis- N'in our play, in our homes, yes, and even in Not so! The stock casualty companies rom press- T-Our sleep, as well -is in our employment? represented in the Association have not op t and spe- ^Perhaps not--yet if that were the design, posed and do not oppose the principle of nguage to V* more simple way of succeeding in it compensation for occupational diseases, if : any rate 7could not otherwise be contrived, thereby is meant compensation for those is' Are we to understand that any disease of diseases that arise from a "trade risk," or -.e liability pabie, the that it is spt a defi;ional disthe most oyed, leav- .on of the t it is not ,ke up the .ction and egislature. to avoid ferring to :rmination -r the most common and ordinary risk of from conditions that are normally and usu ' life may become an occupational disease if ally present in the particular employment, 7 its source or supposed source had its origin as distinguished from those ordinary hu 211 incident of the employment or a con man ills that beset all of us. Our view of dition there present, or if claim was made it is that the policy of coverage under the Vthat a pre-existing disease had been ag- . law is a matter of local concern, to be de ijpavated by such condition? That is a termined by local legislatures in the light ylirge order. It would mean that industry of local demand and with due regard to would become liable for any ordinary dis- local opinion of both labor and industry. cise of life, provided that disease could be, No employer in this age can reasonably *'th a show of plausibility, related to a object to fair compensation for disease Wndition or incident of the employment, arising from such occupational risks, any ouch diseases are almost too numerous to more than he can object to reasonable com enumerate.' pensation for disabilities due to accidental . r %ve know that claims have been made injuries. :e legisla* or tuberculosis and heart disease, the two This conception of industry's obligation determine mst numerous diseases and ffie cause of is, however, quite different from the con more deaths than any two other diseases. ception of a public obligation to care for hi m 214 Silver Jubilee Safety Congress and compensate tor all sickness and death acteristically the obligation of industry under a form of health and life insurance. why continually insist upon the use of lan-X' The latter obligation, if it be a valid one, guage which is susceptible-of misinterpret is the obligation of the state and the nation tation? Be well assured, if legislatures <J0"7 --not the obligation of industry alone. not perform their duty and lay down clears* The reasonable, the intelligent, the sane definitions of liability, industrial boards andv- way for industry to discharge its obligation commissions cannot in the presence of theg to its workers for conditions of health is widows, orphans, and industrial cripples,'* to provide for the greatest reasonable re be expected to exercise greater courage* quirements for industrial hygiene, and to than the legislatures. The law in the handi* provide compensation only for those con of such an administrative body will beg ditions that arise from specific named dis eases that are truly occupational, charac--- . scanned, and I fear scanned limiting--words-or~language in to vain, stay for* the5 teristic of, and peculiar to the processes in hand of industry's self-constituted almoner.'? ^ work is performed a ijlstase, and which car. followed as a natural in ,j a result of the expo (be nature of the empi on be fairly traced to lie proximate cause, ar come from a hazard t vould have been equal! ol the employment. TSjicidental to the charac and not independent oi pioyer and employee. Ti to have been foreseen 0.its contraction it must ; which the worker is engaged. The legislative trend, I am happy to re-.2 its origin in a risk conn Industry will, I am sure, meet the chal port, in recent years has been toward thew ployment and to have lenge of the occupational disease problem, if it is presented under a law that pre scribes the liability of industry in under standable terms. In the early days, the general rule was to include occupational diseases in the compensation law by specify ing the particular diseases or the particu lar conditions leading to diseases that are deemed to be occupational and compensable. This we call a "schedule" law. It is the form in which compensation for occupa tional diseases is covered in all of the countries of Europe and of South Amer ica. It is so simple; it is so sensible; it is so easily administered, that the wonder is that the acceptance of the principle is not definite, rather than the indefinite. Despite' source as a rational cons tremendous pressure, no legislature has, in G the past three years, adopted a blind, "all-in-?j elusive" occupational disease law, except*. Under this definition jger can, with any assu New York, of which I shall speak more inH detail presently. Michigan, Rhode Island,^ what his obligation is tc `assuredly no workman Pennsylvania, Delaware, North Carolina,and Washington, among the states most recently enacting occupational diseases lawsShave adopted the "schedule" or sperificag method of coverage. Two years ago, OhiVj amended its scheduled occupational disease^ law by adding dust diseases to its existing: schedule. In two other states, namely, Iffi-I nois and Indiana, occupational disease lawjjg ease can surely know titled to compensation 1 .coarse, as is to be expe the interpretation of tl ready in progress in b< And situations will ariJ future where the facts .. only litigation in the cc the liability of industr have been enacted in general terms. How-3, the worker to be compc: universal. ever, in identical language, these two states^ .-. The claims actually have undertaken to limit and define occupa-- - dustrial Commission t If we will keep ever before us the prin ciple that a disease, to be deemed occupa tional, must be "characteristic of and pe culiar to" the occupation, there should be no great difficulty in arriving at a proper statutory' setup for the coverage of all true occupational diseases. Metallic poisonings are characteristic of occupations in which such metals are used. The diseases charac teristic of chemicals, of acids, of alkalies, gases and fumes, are characteristic of and peculiar to those occupations in which the tional diseases and have attempted therein I "elude undulant fever to safeguard industry against liability for .. K commonly communi the diseases of ordinary life. "cut products), tularcir Although doubtless familiar to many, theig 'arthritis, rheumatic hi definition in the laws of those two states* . amebic dysentery varic will bear repetition, as indicating the ex-* , athlete's foot, cerebral treme of difficulty in attempting to exactly^ * M due to overwork define an occupational disease. aetre disorder. I have "Sec. 6. In this Act the term `Occupay* I claims for characterist such as silicosi- tional Disease' means a disease arising out 5 . Wisoning, and the vari< of and in the course of the employment.^* tutions which clearly cc employees are so exposed. The diseases of Ordinary' diseases of life to which the gen the respiratory system, due to the inhala eral public is exposed outside of the {m" ,, ;'-v*.have referred to tion of--dust-x,---are ilie-naTural accorrrpani-' ployment shall not be compensable, exceP S* a'one> has in rer ment and the characteristic effect of workin such dusts. When such clear and specific language i; available, why should we be asked to use vague, broad terms, the use of which may constitute the giving of a blank check by industry? If the purpose is not to charge industry with diseases which are not ch.ar- where the said diseases follow as an "wg ` * covering occupatic cident of an occupational disease as define - terms. New York in this section. 3 w , believe, to enact an 0 "A disease shall be deemed to arise to*\`or occupational d. ^he law was a sc of the employment, only if there is nppa^.yt to the rational mind upon consideration 0 all the circumstances, a direct causal cc ^ nection between the conditions under "In -happens that I had t i in'* 0? (hose svho coital f.vJSof that raw'.) We Occupational Disease 21; rndusj^ - of m ;nttrPo :urjf " ciej?* ar<lsai s of cripple.'^! cohura*a! v" w-Ul ^ork >s performed ami the occupational tr'tJZc. and which can be seen to have ^YHnwed as a natural incident of the work JO}1? u|t 0f the exposure occasioned by ^ nature of the employment and which be fairly traced to the employment as 1 proximate cause, and which does not une from a hazard to which workmen Sold have been equally exposed outside oTthe employment. The disease must be Rental to the character of the business jd hot independent of the relation of em- new subject. We examined the existing laws in other countries and adopted the form that seemed best adapted to our con ditions, namely, the English law on occupa tional diseases. The schedule was, from time to time, enlarged as new industrial processes developed new diseases. By 1929, the schedule had been enlarged to include every disease that was a potential hazard to the workers in New York State, with the single exception of the dust diseases of the lungs. In order surely and certainly stay altrti Joyer and employee. The disease need not to bring such conditions within the pur Jo'have been foreseen or expected but after view of the law, there was enacted an ad Iti contraction it must appear to have had ditional item in the schedule, reading "any 1y vard 5**5 dpi^; - hai,`ag] i, "all-SH "K&gi more d ? z_ Island,^ its' origin in a risk connected with the emdoyment and to have flowed from that 'loorce as a rational consequence." IJnder this definition no industrial man ager can, with any assurance, be informed hat his obligation is to his workman, and Assuredly no workman suffering from dis Carols :es ml ies laj sped__ JO, OlSov .1 disease^ existu^-g -.eiy, mi-.-; .ase laws*-? 5. Hok" ease can surely know whether he is en siled to compensation under that law. Of lurse, as is to be expected, litigation over ie'interpretation of this definition is alady in progress in both of these states. And situations will arise constantly in the ^future where the facts will be such that ;jpoly litigation in the courts will determine dhe liability of industry, or the right of *the worker to be compensated. o states' 3jj3Y.The claims actually filed with the In- OCCJpl:. therein ility for .fir.dustrial Commission of Illinois already include undulant fever (a disease said to vfj be commonly communicated by milk and $r..meat products), tularemia, rheumatic fever, :anv, the .^rthrjtis, rheumatic heart, heart disease, o states ?amebic dysentery, varicose veins, flat feet, the ex- y:' athlete's foot, cerebral hemorrhage alleged - exactly ih.';;*0 be due to overwork, syringomyelia, and h^i:net7e disorder. I have not mentioned the' Occu pa cing ont ioyme-iL the gen- exclaims for characteristic occupational diseases, such as silicosis, carbon monoxide ir: Poisoning, and the various other toxic con.S.*.<utions which clearly come under the Act. and all occupational diseases." The sched ule was not repealed, and the administrative provisions in the law with respect to the schedule were continued. One of the first questions that arose under this new law was whether the new classification super seded the schedule and the limitations set forth therein, or whether it was an addi tion to the schedule and applied only to those conditions not previously included therein. The legislature, having evaded the duty of defining the term "occupational disease," the Industrial Board, which administers the law, adopted a definition. That definition is well worth repeating: that the Board deems a disease to be occupational only when it is "characteristic of and peculiar to the trade, employment, or occupation" in which a worker was engaged. This defi nition was adopted almost verbatim in the Rhode Island and Michigan Laws. The Appellate Division of the Supreme Court, however, declined to follow it, and by a vote of three to two, held that any disease that arises out of a condition incidental to the employment must be deemed to be an occupational disease. (Bisbop vs. Comer & Pollock, 251 Appellate Division, 492; Goldberg vs. 954 Marcy Corpora tion, 2S1 Appellate Division, 904.) The Goldberg case was appealed to the the ets- ylyi have referred to the fact that New Court of Appeals--the court of last resort . except f *orN alone, has in recent years enacted a in New York. So completely do the facts ; an in; denned .... law covering occupational diseases in gen- in the Goldberg case bear out what I have . i*?!,.*6TM5' blew York was the first state, said about indefinite liabilities under an all- k '. "*''eve, to enact an outright compensation inclusive law, that they wiil bear repetition. rise ont for occupatiwu.Ldi.K5ij. It-d:d-;o in.. -Shirley Goldberg was employed to sell apparent Y The law was a schedule type law. (It tickets in a moving picture theater. Her aticn ot sal conr which 50 happens that I had the privilege of being Y.. ?ne f those who collaborated in the draftj_ ^ that law.) We were dealing with a booth was on the sidewalk. It was kept heated, in cold weather, by a small electric heater, operated from a switch in the it i 216 Silver Jubilee Safety Congress booth. She contracted what she described as blotches or a rash on her legs. The blotches or rash she claimed were due to the alternate heating and chilling ,of her legs when she switched or. or off the heater. They did not constitute a disability. How ever, on complaint to her employer, she was told to see her doctor. While on her way to see her doctor, on her own time, she slipped on the sidewalk and fell,-fracturing an ankle. Although the day was cold and she testified there was ice and snow on the sidewalk, the claimant alleged that she fell solely due to weakness resulting from these blotches, and the Industrial Board so found; and found that the cause of the fall was an occupational disease, character istic of and peculiar to her employment. The Court of Appeals, in an opinion that bristles with logic and sound sense, struck this free-for-all system from the language of the Xew York Act. They unanimouslyrefused to concede that this was an occu pational disease. To make every- disease that arose out of and in the course of em ployment compensable as an occupational disease, they said, would be to make the compensation law "the equivalent of life and health insurance." The court further said that to be "occupational," the disease must be one which "results from the na ture of the employment"; and that by na ture of the employment is meant--conditions to which all employees of a class are subject, and which attach to the occupation--"a hazard which distinguishes it from the usual run of occupations, and is in excess of the hazard attending employment in general." (Goldberg vs. 954 Marcy Corporation, decided 'January 11, 193 J, and reported in 276, -N\ Y. 313 12 X.E. 2nd. 311.) Thus, after more than two years of great uncertainty as to the meaning of the law, the Court of Appeals has eliminated from the Xew York Statute the diseases of ordinary life which are only incidental or speculatively related to the occupation. Just a word about hernia as an occupa tional disease. Xevcr heretofore regarded as an occupational disease, but quite gen erally recognized under certain circum stances as an accidental injury--the Occu pational Disease Law of Michigan, enacted last year, specifically included hernia in the schedule oi diseases. Not all herniae, however, are so included, hut only those clearly of recent origin, as to which dis-- ability follows immediately, and in which prompt report to the employer is made. This is not far different from the rule in , regard to hernia as an accident. But in '.. X'ew York, during the past year, it has become somewhat the fashion to regard 7 almost every hernia as either an accident or an occupational disease. Cf This followed on.a.decision of the Court -- of "Appeals, sustaining an award for hernia T as an occupational disease wherein the In-' dustrial Board specifically found that no -. accident had occurred. In the case pre-'J sented, the worker was required, in the.-! course of his employment, at frequents intervals, to rotate his body on the hips. This man was employed in a glass factory. He gathered molten glass on the end of ~ a punny, which he, in turn, swung about J and placed in a mold. The weight was notcT undies of their e: ,rt still going forw ent fact stands u that these diseas to point of dtsaa: rtjrs of exposure t pat, varying from pore years, is dept: open the concern:-position of the dust posed during wor^: dividual susceptibm: worker. Another : that the fibrosis c qutred, is permane nt uncomplicated ca medical treatment. Many thousands c no lawh but the c: excessive, being only a matter oi a fei5 employed in employ pounds. In affirming this award, the Court-S. more or less heavy of Appeals said: for many years. Ir. "The finding, supported by evidence, is?? ment of an occur- that the continuous gathering and lifting of-1? eluding those disc: glass from a furnace involved a constant';^ itself, at the strcV twisting and straining of the body. This;r conditions already process, from gradual stretching, resulted:-; years of employ"-. in a hernia which is a disease (Matter of come disabling at a Alpert vs. Powers 223 X. Y. 97, 101.) Therc.^ uation, the best g is medical testimony that claimant's occu-rr ment is continuous pation would produce this disease and there:? Many a man, acv. are judicial decisions in other jurisdictions^ tarn good wages, holding that hernia is an occupational dis-^ be able to demon; ease (Marathon Paper Mills Co. vs. Ind.j ical examination t: Comm. 203 W'is. 17; Travelers Ins. Co'yt degree of silicon vs. Locke 56 Fed. (2nd) 443, 444)." because of depress! (Foster vs. Cillender Brothers Inc., 278 N. ^-^1\ Hence arises the 328 16 N. E. 2nd 360.) . rfST/'"accrued liabilities Perhaps the most controversial question-ry tome into comme involved in occupational disease legislation exact term, in t is the treatment of liabilities for dust dis--^ ?ocur until disao cases of the lungs. In no class of cases..^ 'S only "accrued" is the marked difference between accidents^ .have in mind v. arising at a given time and place and occU',| liabilities is the pational diseases more pronounced. In l1 cj_ die lungs which"; category of cases, we find silicosis, anthr3C J acquired over a silicosis, and asbestosis. all of them frn' -^. condition, being of in psnoemuenioonfocothneioirsisf.ormWshilearethesaemotnlgiiOthe.fgk be worker, whale bis employment. most ancient, their ravages having been ret ^Pression' would ognized generations ago, little has b.e0Lj| . in(1 yet they are known until recent years of their causaho- Edition giving of their pathology,`and of their comp&c*'^* - .^(stent. tions with other diseases. A vast fund - industry tells i knowledge oi these diseases has been S3f"* . "ft now pay lV;! ered in the past, ten -cars, and intense? . .'21 income to a' ! -- Occupational Disease 217 :n '*hi<j|'J ot tlieir etiology- and pathology industry who may have in the past in 15 H^stiil going forward. curred some degree of fibrosis of the lungs. ;u,= a- ^it'bne fact st3ndi out clearl>> an<* that ' 't jSvi that *hcsc diseases do not progress to 3 r'gsrd ' cidot--- '.rsy 5g#\ point of disability until after many ^rs oi exposure to dust. The length of JjfVl starving from five to twenty-five or ignore years, is dependent in large measure le Conn"'*' 3r hernia ' the [0. fe-'opo--tictnheofcothnecendtursatt,iontheoftimdeusat,cttuhaellycoemx-- that oo y ,,-d during working hours, and the in- ;;is prt. ~ ^Vdiriduai susceptibility or resistance of the , tn the' ' trequeoi ^worker. Another fact that stands out is prjhat the fibrosis of the lungs, once ac- the hips, *"tanifs4 is permanent and incurable, and, factory, fjp ^complicated cases is not susceptible to end of ^medical treatment. about Sir-Many thousands of workers today, under "as not jSCho law but the common law, have been a fe* .^"employed in employments exposing them to e Court i^more or less heavy concentrations of dust ^"for many years. In the event of the enact- ence, is p'^ijot of ar. occupational disease law in- iting of- icclnding those diseases, industry will find But if industry cannot assume these liabil ities. how much less justification is there to call upon insurance, out of the premiums of next year, to pay for disablements ac quired over the past fifteen years, and for which it received no premium? In this difficult situation, it has been found necessary in many states, if em ployment is to be continuous and uninter rupted, and if men are eventually to be compensated for the fibrosis acquired due to future exposures, to absolve, to a great extent, industry from the obligation of com pensation for past exposures, and to base compensation upon the extent of exposure after the enactment of an occupational disease law. Thus, there has come into acceptance in several states the principle of graduated compensation benefits for dust diseases, limited to future exposures, and eliminating in large measure the ex posures of the past. constant feitself, at the stroke of a pen, liable for Under this system compensation for dis This ^conditions already- acquired through long ability or death occurring during the first resulted `IgaTyears of employment, and which may be- month under the new law would be only alter ot j^come disabling at any moment. In this sit- a nominal amount (it has been set as low ) There ^v.tohon, the best guaranty against disable- as $500 to start with). A person disabled '*>me is continuous and steady employment. during the second or third month after and there ^-.Allacy a man, actually able to work and the enactment of an occupational disease sdictions 7^;..tarn good wages, while he has a job, will law will have been exposed, to a small onal dis- ^?.be able to demonstrate by x-ray and clin extent at least, under that law. The ex vs. Ini' gy ical examination the presence of a marked posure is perhaps in itself insufficient to Ins. Co. degree of silicosis, when his job stops actually result in any harm. But the max 78 S. Y. N because of depression or otherwise. imum benefits will be increased, month by Hence arises the question of the so-called month by small increments, until in the -r : "accrued liabilities." This term which has course of two or three years the full limit come into common use is perhaps not an chargeable to industry in the particular exact term, in that "liability" does not state will have been reached. This system pecur until disablement, and the liability is not so complicated as it might seem. ts c.-.iy "accrued" at that time. What we The effect of it is rather to postpone the bare jn mind when we discuss accrued _ going into effect of a dust disease law for liabilities is the condition of. fibrosis of' a matter of two or three years, and experi the lungs which has accrued and has been ence under this law has demonstrated that . acquired over a period of years. This few claims arise where the compensation -. cc<f;tion, being permanent, remains with benefits are so limited, the workers pre the worker, whatever and wherever may be ferring to stay at work as long as they ts employment. Perhaps a more exact can. It may be said that it works harshly expression would be "potential liabilities," in the case of the person who becomes and yet they are more than potential; the really totally disabled in the early months efr-dition giving rise to them is actuallv existent, of law. When measured by the liability with which the employer may fairly be n 1"dustry qui'-e. truly .that ir_caiu. - charged, it does not, in fact, work a hard 0!ino'v pay full compensation out ot cur- ship, and when compared with the exist mcme to all of tile men employed in ing system in states not now under occu- m m ' r:' lit :1 il. i];;!!' ;i: i.' ;r i i; 21S Silver Jubilee Safety Congress pational disease laws, it not only is not terest must be given to industrial health..* jjio, wanting e. a hardship but is, in fact, a great boon. The principle of limited and graduated liability of the employer for dust diseases has been recognized by enactments in New York, Michigan, Pennsylvania and Ohio. An unusual provision has been adopted in the state of Washington, providing under their schedule form of law that the cost of compensation for occupational diseases shall be divided equally between the em ployer and his workers, and deductions The care for the health of the \vorlj must not be confined to the guardnJ against those conditions that are mentio specifically in the law. The engineer's sponsibility is a broader responsibility __ is the legal liability for compensationTM There can be no doubt that the enumeratioS in the law of specific conditions for why* liability is absolute will be of great 3 vantage to the industrial engineer in set ing to enforce proper health standard! Bin it, are not ; Bioly are not d : Much is hear ^ar-line for <. facts may be aif not probable non and again: jyentually to ,-hoffl the heai tafn--the physi the strong? V shall be made from the employees' wages is ar easier, for him to obtain approval if as contributions toward the Insurance His recommendations, if he can point premiums involved. But what, you may say, has all this to do with the safety engineer ? It has much. The safety engineer can no longer regard himself as doing his job if he seeks only ways and means to eliminate the industrial accident. The in dustrial hygienist must become the colleague of the industrial engineer. Medical science must give intensive thought and study to determining the effects upon the human system of various industrial processes, and exposure to various materials therein. All exposures cannot be eliminated and still have industry perform its functions. Most important, therefore, is the medical deter mination of what are safe limits in ex posures--the so-called "threshold limits." The engineer cries aloud today for expert medical guidance on this subject. Armed with such medical opinion and advice, the task of the engineer then is to devise prac-' tical ways and means for attaining condi tions where such threshold limits apply. Every industry presents a problem or series of problems in itself. No two in dustries are exactly alike. What is toler able in one may be intolerable in another. What is good practice in one industry may be totally inapplicable for practical reasons in another. The task of the en gineer then is to find how right principles may be made applicable. Industry today, more than at any time in its history, must bear the burden of responsibility for the health as weil as for the safety of the industrial worker, and if his health and his safety are adequately safeguarded his happiness and the happiness to management that the use of benzol some benzol derivative is specifically no tioned, and point to the specific paragnpL in the law that cites the liability of tb$f employer for that condition. No argument* is needed to convince management of Hj obligation in such a case. The same is true with regard to all i the metallic poisonings and all of the othq wide range of chemical exposures. Psyc logically there is great power in the printt word, and even the most backward manag ment may be made to respond when clear mandate is set forth in the law. Noj so easy will it be, under a general, and all-inclusive occupational disease statnft to convince management that it has spe duties with regard to the elimination health hazards. Thus, we see there is a other and potent argument for the schedojji law, rather than the all-inclusive law. There is perhaps yet another and evq more compelling reason for applying rule of sanity and common justice to 1 islative mandate in the complex field ofi occupational disease. Shall employment limited to those who are physically feet? All humans are not examples oj physical perfection, nor can we by legist* tive fiat reverse the laws of nature whjo immutably decree that we shall grow oldel with the passing years. We have seen and discussed the dangers^ inherent in- the all-inclusive theory ST stretching the law to cover every and condition of disease, and to try^jJ make them employment-related. When stretching is complete, when administr* o of the law find it easy and possible Han. r,... It is a popul; f. tkinal diseases u ognize and pri irany other type f' u this idea ri [" physicians thr. jj^'tional diseases tl' passable beca Woostic difficult! tS Lately, Kelt iytdTus there ? incurable. Do disease is? It r... know anythin: t; -.objection to bt i'.'.ff ' ' ' A-This may iVThere are nr diseases. The r.-,nosable are t 1L.B0I learned h ^tional disease -tance of its t ^*1.disease is per i,, / '-`At least seases are or. ai. r~ iarly when ar present ..'. attend the di. diseases:-- i! diseases are ;\i',, *fie physician "r: .Propriety, it h~: Jetrrology be p ferity 0f cc of those about him will be increased. There burden industry with the responsibility ftwoirvep,, i<t. is of prime import1aUIn11c.eI. <i*n t>h1We "fiVeilud Ih`VeUa1Vlt*h1 insuraunmc.1e, under tmhwe gu--ise of of safety that intensive and increasing in- occupational disease statute, what of tn v:","y not be d ATiile it r. h"}. Occupational Disease 219 ~entiV3-* neer'j 3ii'ty ifcif UR'erj't^|5 :or s^eat. jj ~ 'in ^.si1 -bards,, 'Provafjj .?oint.4tj Ptaaol or illy a: 'arsgr,'^ ''anting employment or seeking lo re- " sidcr the devastation such a situation would are not physically perfect yet cer- produce. Sw are not. dji-s.a-bi.lie-dj?3 jn tjlc jnt{.rest 0{ ai\ workers, the young ftioch is l'eard loday of the drcad forty` ar-line for employment. Whatever the ,,,ris" may bo as t0 tliat> *s '* not possible-- & probable--that industry, in despera- and the old, the perfect and the imperfect, let us not embark upon legislative policies that can lead only to enlarging the field of unemployment, and to closing the door ^"and against its desire, will be forced of industrial opportunity to those skilled -tuai|y to accept only those among and faithful workers who, having passed the health hazards are least uneer- the meridian of life, are subject to those -Jj^_the physically perfect, the young and natural infirmities and ills of the flesh to he strong? We may well pause to con- which all men, in time, must bow. gbs'-' Handicaps in the Diagnosis of Occupational Diseases By CAREY P. McCORD, M.D. argujsjQjj J ' Detroit, Mich. r-t of fcj.r *It is a popular medical belief that occupa undiagnosable occupational diseases, it must - all a; tional diseases are far more difficult to recgnize and precisely to class as such than the otiff,. "other type of disease state. So firmly Psycho--'-;' ilthis idea rooted in the minds of some s printd"I managt^ pfiysicians that they argue that occupa tional diseases never should be made com- hen tig. Nt*i i. vague; > jhsable because of extraordinary diag nostic difficulties. e statute"', ^Lately, Kettering has said, "The doctors : specific h iell .us there are certain diseases that are stion of ^Incurable. Do you know what an incurable ; is an-jj ^disease is? It is one that the doctors don't schedule ^totow anything about. The disease has no r^gtjbjection to being cured at all." be recognized that many remain undiag nosed, or more often misdiagnosed. The prime reason for this is that the usual physician secs only small numbers of any one type of occupational disease. Taking Ohio as a typical industrial state, the total number of occupational diseases, compens able and otherwise, reported to the State Department of Health during the year 193" was 1,666. On the other hand, there are in this state 9,200 physicians. Thus, only one occupational disease arose for every 5.5 doctors in the state. Here then is the foremost handicap to '^jijsSiThis may be paraphrased by saying: the recognition and diagnosis of occupa "fi^There are no undiagnosable occupational tional diseases and at the same time a yjgtdiseases. The only ones that appear undiag- back-handed compliment to industry. In .`i-gtaosable are the ones the physicians have dustry, because of its prevention achieve hjyj'not learned how to diagnose. No occupa- ments, has so limited the number oi oc "'sS-fitlonal disease has ever offered any resis- cupational diseases that day bv day the . .'ytance f its own to being diagnosed. The .ph.ysician is ordinarily. not s.pu.rre.d .to.t.he -disease is perfectly willing to be diagnosed___possibility that any worker v. ho seeks his least one-half of all occupational dis-h;*425'5 are almost sell-diagnosing, particu.'. hj,jfr'y wben arising in groups; the remaining . I present no greater difficulties than attend the diagnosis of some other classes -..- of diseases. To maintain that occupational diseases are heyond the diagnostic skill of professional guidance may have a disease of occupational origin. Here, too, is the funda mental reason why more medical schools do not develop training departments in this field or organize special hospital services for the care of occupational disease pa tients. the physician is pure defeatism. With equal .propriety, it might be suggested that all .neurology be abandoned because the ma. --)qcisjr of --carttlfTRyff-- arising in this field . . may not be diagnosed with ease. ... ... .While it may be said that there are no While there are reasons for rejoicing that there are comparatively so few occupational diseases, we should recognize that there are specific situations which introduce diag nostic difficulties. A number ot these arc now presented, as separate entities. m !|J |i.;jj l :'Tv M 220 Silver Jubilee Safety Congress Definition and Terminology Much contusion is caused by lack of uniformity and clarity in definition. Scarcely any two states in their statutes accept the same definition of an occupational disease. In a few states, hernia is by law specified as an occupational disease However, in the majority of states it is, when related to in dustry as a cause, classed as a traumatic injury. In a few states, the definition of an occupational disease provided by statute is such that certain items later appearing on schedules themselves do not conform tothe definition furnished. Well meaning legislators might enact a law declaring that two and two make seven, but the mathematical facts still might re main otherwise. So with legislation in volving occupational disease diagnosis, there may be demands for legal acceptance of certain conditions as occupational diseases, when elementary medical facts point other wise. One group of physicians may reserve the term "injur)'" for exclusive use in con nection with trauma, while another with propriety may assert that occupational dis eases of many natures represent "injury" to the same extent implied by the term "traumatism." Let us consider, for example, the occur rence of an accidental injury on the one hand and a clear-cut occurrence of an oc cupational disease on the other, both caused from one and the same substance, but under different circumstances. It might come about in a given factory that a workman entered a tank car, lately emptied of ben zol, and in the absence of suitable protec tive and precautionary measures might, within ten minutes, become asphyxiated as a result of breathing benzol vapors. Man ifestly, such an occurrence as this would be accepted as an accidental injury and no compensation board would ever raise a question that such was not the case. On the other hand, this same benzol, taken from this tank car, might be utilized in this same factory in some productive operation, giving rise to benzol vapors. Day by day, another workman might inhale some of these vapors. In due course, this work exposure might produce the usual and characteristic features of that occupational disease known as benzol poisoning. Here again it is most unlikely that any physician or compensation board would entertain any fra- This does dishonesty or. Between these extremes, there is sotae-y point at which difficulties would arise L patient and on:; frailties sharet distinguishing occupational diseases fro- -flo less, the his accidental injuries. This same situation aoJv plies to many other substances and many* Lw influence the Ss. may lead to ; other occupational diseases. There is perSs way for unwarr haps no warrant for any attempt at a hard!? fjthout any evil ir and fast demarcation in terms of time, nfij? iysidan.. It is tn dicating where an accidental injury expo^ iysician is all too jurcJeaves off arid an occupational disease^, worth of work exposure begins. nded by a patient, However, there may be some justification*? for the practice of many physicians, who hold that if the exposure leading to damage? is less than one work period, the ensuing injury should be recognized as an accident r Conversely, if the exposure period extends1? gsume that a spe visited by a patient jo connection with dan may record t: forge operator, ahead and make m jor more than one work period, then the'-:resulting damage may with propriety be ac- ft cepted as an occupational disease. In gen-j* eral, it may be claimed that one of the?g disturbing handicaps to uniformity,' clarity;?? and precision in connection with occupa-^. tional disease diagnoses stands in relation^ to awkward legal situations, inadequate defi-;'J nitions, unsuited classifications and such. i3 looking for the ca' infection, from sy If, however, he : work history, and ate this work histc to blow that this perhaps exposed t enssion as ever c trial work and t ' dearly is an occu Fallacious Medical Histories from sustained nc As a result of careful training, every physician Is disposed to attach significance to the history statements given by a pa tient or members of his family with re gard to any disease. The less a physician may know about the possible etiologic facts in any situation, the more consideration he is likely to give to history statements. It is human nature to associate all of our ills with some particular happening or senes of happenings. A cold may be associated with a particular period of sitting in 1 draft. A gastro-intcstinal upset is prone to be associated with some particular alco holic bout or food engorgement. In the case of industrial workers, there is an especial proneness to associate any bodily ailment with some aspect of work. Inasmuch as almost every workman hopes, openly or secretly, that any and all dts eases from which he may suffer may It may be ass physicians, vithov their misundersta: tions .of work op - sponsible for a large number o: ? have flooded the In short, one of t diagnosis of occi r" found in the atta. to the patient's s ditions, when thable to appraise Some physicians more remote to t 1 workman is Jrade. ,iqts:ilabjy sarily be the : There still may believe that lead work in making laid at the door of his employer, he >s Time as a 1 most likely to stress and emphasize the h'S probability that this condition tinfailifS ^ was produced by the chemicals, gases, '* pors, dusts, etc. that attend bis work ope1" , Too often the field of occ' . Se* the patient < Occupational Disease 221 ' repres entj, tase. __ _ This docs not necessarily repre- is to be appraised until long after that *^Vdishonestv or cupidity on the part of time within which the disease might have `ere is oatient and only may involve those hu1 frailties shared by all of us. Ko less, the history statement may un- situation j . if and. DWoy i h*re ts Tlpt_at a hj'rj l ' 'influence the physician in his diagmay lead to misdiagnosing, may pave if* way for unwarranted claims or law suits ^fthout anv evil intent on the part of the . .t tlme, iivinjury Upo." iSihrsiaan. It is most unfortunate that the igjjyjician is all too often unable to appraise :`nal disease &be worth of work history statements pro- Sfcj-ded ^ a patient. Let us, for the moment, .. e justification . ysiaans, whil; 1 & to damage the ensuing^ ^assume that a specialist in ear diseases is crisited by a patient on account of deafness, .connection with the history, the physiinay record that this patient is a drop an accidatt. " ^forge operator. The physician may go "iod extends., Sfihead and make many careful examinations, od, then the' ^.looking for the cause of the deafness, from spriety be ah- - ^infection, from syphilis, from heredity, etc. iase. In ga." however, he had obtained a complete one of the i. |]%work history, and was in position to evalu- mity, clarity S^Sate this work history', he might come at once with occupa-"' -know that this drop forge operator is s in relation'' ^perhaps exposed to as much noise and con- adequate defi-'if ^"cussion as ever arises in ordinary indus- and such, ffe"trial work and that the deafness present ^-clearly is an occupational disease, resulting stories -hfifrom sustained noise exposure. been diagnosed with precision. Without any purpose of condemning or finding fault, the fact must be faced that in many in stances the. decision of a patient to blame his ailment on work causes was not made within that period when some or all of the characteristic manifestations were pres ent Then, at some later time, a physician qualified in occupational disease work may be called upon to examine the claimant or to reach a decision based upon the exam ination of inadequate records of another physician who himself did not carry out any examinations with particular reference to that occupational disease for which a claim later has been filed. This is asking too much of the diagnostic ability of any good physician. On the witness stand, the charlatan al ways makes the better impression on a jury, because he is unhampered by the caution and reserve that guide the up right witness. Being positive is often merely a matter of being wrong in a loud voice. The point is that the time to make a diag nosis of an occupational disease is that period during which the disease exists. sining, every - . .^- It may be asserted that well meaning Otherwise, the most accomplished physi ' significance . ^physicians, without any evil intent, through cian may be placed in an unfortunate po en by a' pa- " V their misunderstanding of patients' descrip sition in the reaching of his decisions. _i!y with re- tions of work operations have become re- a physician sponsible for a high percentage of the Insufficient Training and Experience tiologic facts : large number of unwarranted suits that An outstanding drawback to the proper ^deration he have flooded the country in recent years. diagnosis of occupational diseases may be ntements. It In short, one of the handicaps to the proper found in inadequate training in medical all of our diagnosis of occupational diseases is to be schools for this aspect of medical work. :ing or series found in the attaching of undue significance This is not a thrust at the doctor, nor may c associated to the patient's statements as to work con any complaint be made against medical ed sitting in a ditions, when the physician himself is un- ucation today. It may not be expected that : is prone to able to appraise their reliability and merit__ medical schools will markedly enlarge an ' icular alco- Some physicians need to make themselves already over-crowded curriculum to pro . "ore remote to the fallacy that just because vide extensive instructions with reference irkers. there ssociate any ct of work. :;raan hopes, and all disTer may be a workman is employed in a dangerous tsade, inevitably any ailment must neces sarily be the result of work exposure. There still may be a few persons who may believe that lead poisoning may arise from *ork in making lead pencils. to occupational diseases when the number of cases yearly is so small as to provide oniv one for ever}' five or six physicians. Realizing his own shortcomings in this fieid, a good general practitioner may hon estly shun this type of work, but this step lover, he is size the high Time as a Handicap in Diagnosis on his part may eventuate in even more undesirable situations. unfailingly -Oo wherTtlle physician well qualified in The patient, instead of being referred gases, va- , me field of occupational diseases, does not to a better qualified physician in this field, svorlc oper- sec the patient or claimant whose condition is given no advices, whereupon he gravi- :i:ihte 5rrJW J:i! iif! :li ill i! ! I i>: I! 222 Silver Jubilee Safety Congress rAk?,' tates toward an inferior physician, less con of the chest of this workman may stroa| bttd work place: cerned with the lack of qualifications. The 'suggest the possibility of silicosis, nowhi out all ma: extent to which lack of qualifications in oc on the work record may it be shown jiese physicians cupational disease work may go is reflected for a period of seven years at some mi stored miners; d in the fact that recently a duly licensed earlier time this workman was employed sioers' wives; tre physician in the State of Michigan reported a laborer in a pottery. measles and . "intestinal peristalsis" as a diagnosis of an In this same connection it should be __ occupational disease. phasized that one of the many handicai While the unwillingness of a physician to to the physician in making an aceui accept responsibility for pathologic states diagnosis is to be found in the widespri__ with which he is not conversant is com practice.of hospitals,"of clinics, insuring mendable, there still.remains a duty to di-~ "records, etc., in merely naming the trade of) rect his patient into channels wherein ade a workman rather than describing his quate services may be procured. occupation. It is quite insufficient for mi Industrial Terminology One of the most annoying handicaps in ical purposes for a record merely to shoup for example, that the patient was employ* as an "automobile worker." Under tempted to meet t detached commur J poies contributec physicians and tingle man was ta month in order jalary. Thus ar Physician." This represent the bes ill instances were of the highest ty; establishing the exact etiology of a possible heading, there are perhaps not less Later some of occupational disease resides in the wide 200 different and dissimilar types of ea4 larger towns, or spread practice of industry in using code ployment leading to different exposuresg c i-tant sought to symbols in the designation of its substances. such for example as to silica in the foundry^ . fad that the cor, On inquiry, the patient may state to his cyanide in the heat treating room, chromiums K. saddle. This ga physician that his work consists of filling in the plating department, lead in body fb*| Foot of this "Pan containers with "B-72." But, inquires the ishing, and on and on. '-`IS k numerable evils physician, "What is B-72?" The patient tad the highest continues, "B-72 is a mixture of M-20 with Lack of Library Facilities "j pi supervision undt H-W and L-97." Completely the physician With some temerity the statement SI I? commendable ci is left in the dark, but if the truth were made that regardless of many book pubfif Income a tradition known it might be shown that this patient cations in the field of industrial hygiene the medical prof- was engaged in the filling of cans with a and occupational diseases, special magajg t' manner of their varnish remover, which consists of a mix zines, and articles appearing in generals ^ industrial physic ture of wood alcohol, benzol and a syn medical magazine publications, there iv? i_ affection that thetic wax. this time, no condensed, informative m groups have sou Such situations may become so confus ing that it may be almost impossible for the physician to obtain proper information as to work exposures. Medical, saiety, so cial service or insurance departments all may have difficulty in obtaining full in terial on occupational diseases well suite to the needs of the family'practitioner, It is of course impossible and undesii that any attempt should be made to redut all of the lore of occupational diseases some thin book to which the pracuur" ' most any form dee and in som j.hership in medi Physicans. As : [R cans in some r K'wth a scarlet let formation as to actual chemicals and mix tures of chemicals designated in production operations only by code numbers. The Absence of Records The majority of industrial plants fail to maintain sufficient medical ar.d work records to serve the physician properly in connection with occupational disease work. In a given instance an afflicted workman may give as his occupation some innocu ous job as "elevator operator." He may re member that the job before that was as a "truck driver." There his memory may fail. His work record may show'no items as to transfer within the factory of his last employment and no record of any pre vious employments. Although the x-ray may refer and with certainty obtain all A ;This queer ; guidance needed in the treatment and n rgSv^uay serve as a agement of occupational diseases. Grantinfi Ty f occupational all this, there still is occasion to assert that U\ best physicians, a real need now exists for a book public" M .timid ones, fear tion on occupational diseases designed * ^ smirched by cc services to the neighborhood physician w ^ !<S mec^ca' endeavc in the aggregate sees far more occupab9r' disease cases than the small number specialists in this field. ' p" "y dose affiliat "' eyebrow's by th-. g of the professic Attitude Toward Industrial Medici6. SCyrKow that thi '^.cation is some- In times long ago, when mine wor. sawmills, and railroad construction < bas organi: ".Health, includi: were established in remote sections ot ..dastrial medico country, far removed from the usual souTMjj| rPPPod that aft. of medical services, it became news J that the management bring into these tnay becom Occupational Disease 223 workman may strJ y of silicosis, nowb2': may it be shown n years at some -cman was employ^ work places a physician who might --""out all manner of medical services. Sf?, rhvsicians set the broken arms of * dJ e_ Iliveroe/-d? lhthae IvbiaKbt ies of the fliers' wives; treated the miners' children ^measles and mumps and otherwise at- New Chemicals A further deterrent to accurate diag nosis of occupational diseases is linked up with an almost endless flow of new chem icals into industry's processes. Year by year, a far greater number of new chem :tion it should be - the many handi making an accurj and in the widesproj , of clinics, insurai^t >' naming the trade'sp in describing his e insufficient for ecord merely to sS patient was empfojij' worker." Under thif erhaps not less ^similar types of tat' different exposures; " o silica in the foundry,*:; rating room, chromica r.ent, lead in body fia-j'; *nted to meet the medical needs of these ^ched communities. Usually the com es contributed to the income of these sicians and every family and every 'le man was taxed a stipulated sum each lth in order to cover the physician's Thus arose the term "Contract tysician."' This perhaps did not always ' resent the best of medicine and not in instances were these contract physicians jthe highest type. ter some of these communities became er towns, or cities, and other physi__ s sought to gain a livelihood, only to Jd that the contract physician was in the Me. This gave rise to complaint and of this "Pandora's box" have come inerable evils that even to this day at- icals are introduced than the number of investigations referable to their toxicity. It is often true that nowhere in the entire literature concerned with industrial tox icology may any word be found aiding the physician in determining if a given chemical might be responsible for a series of objec tive and subjective symptoms in any patient. One of the most desirable changes needed in connection with worker health protec tion is the requirement that no new sub stance be introduced into industry on a production basis until it shall have been established to the extent possible, through animal experimentation, that such a sub stance is without dangerous potentialities. Significance of Handicaps in Diagnosis ary Facilities ,'the highest type of industrial medical A recital of the type just presented "sion under the most ethical and might be continued almost indefinitely, but :ty the statemehr lendable circumstances. It has be- perhaps without profit. The entire situa of many book pubS-^1 e a tradition on the part of many of tion may be summarized by stating that of industrial hygiene" IFmedical profession to blame almost any whereas occupational diseases themselves eases, special magJr : appearing in genmTalications, there is/'al. sed, informative' nu-*" diseases well suited nily practitioner. jjfanner of their economic dfficulties upon ustrial physicians. So real is this dis- 'affection that some organized medical ups have sought to legislate against al- yndst any form of industrial medical prac tice and in some instances to deny mem are probably as diagnosable as any other difficult class of diseases, just about every stumbling block that may be produced is laid-at the door of the physician sincerely seeking to acquire sufficient evidence upon which to make exact diagnostic decision. ssible and undesirable bership in medical societies to industrial The greater number of these stumbling id be made to reduce yphysicans. As a result, industrial physi- blocks represent no willful desire to hamper rupational diseases to Cg.Oans in some respects have been branded the physician, but instead arise from the hich the practitioner JTWith a scarlet letter. results of peculiar circumstances that in -Ttainty obtain all tie pfiThis queer situation, strange to say, some measure separate industrial diseases r treatment and man- . serve as a handicap in the diagnosis from the general run of afflictions. al diseases. Grandn* Ifgpf Occupational diseases, since some of the ccasion to assert that. ripest physicians, and particularly-the more 3 for a book public*- _ ones> ^ear lest they may become be- iiseases designed fw: S-P'tye<* by cooperating in this type of irhood physician wbo <3?$?>e<Iieal endeavor and to some extent shun ar more occupation^ close affiliation that might lead to lifted e small number of, fifehrows by those regarded as the leaders --/V. ?e proless'on- ---- As "a" consequence, large numbers of un warranted diagnoses of occupational dis eases have been made and are being made. Scores of suits have been instituted and some have been won by claimants whose claims possess no whit of merit, chiefly be cause well meaning physicians unhappily implanted the seed of possibility that his '.dustrial Medicine that the American Medical Asso- disease might have been caused by work hen mine working^ i^TjOabon `s somewhat alert to this situation - construction. camf* 'Cyp ,^as organized a Council on Industrial mote sections of including some members with in- rom the usual soured medical experience, it is to be : became necctsswT. 5V lhat after all the industrial phvsi- aring into these i50" Kg?" may become respectable. and that the responsibility might be, laid at the door of the employer. While the re sults may have appeared to work an in justice and monetary loss upon the em ployer, in the long run the interests of the worker himself are not served by these Mj 224 Silver Jubilee Safety Congress spurious claims predicated upon improper medical advices. The usual trial of an oc cupational disease case is a travesty. The bombastic statements of some physicians, unattended by any iota of fact, bring into disrepute the entire medical profession and take away its time honored traditions of integrity and skill. A further significance in the misdiagnosis of occupational diseases on the part of physicians is to be found in unwarranted hardships imposed upon, employers.' Re cently a physician made a diagnosis of silicosis in two workmen in a given depart ment. As a result, widespread apprenhensions arose among the remaining workers, strikes were threatened, talk developed as to demands for high wages because of un usual exposures and the expectancy ot a short work life. The employer was com pelled to spend some 583,000 in the installa tion of an elaborate dust control system. As a matter of fact, these two workmen did not suffer from silicosis, were not in any wise disabled, had never been exposed to silica; no silica or any other harmful dusts were created. There was no need for the expensive installation made and contrariwise other departments did present practical exposures for which this $83,000 might have been spent to better advantage in procurement of needed protection. The Road to Betterment This entire discussion would be without any value if present day practices and sit uations only were condemned. More ac curate diagnoses as to occupational diseases are badly needed. These better diagnoses will come in proportion to the extent that the changes now listed are brought to ac tuality. (a) The general level of knowledge of occupational diseases on the part of the medical profession should be increased through the introduction into medical col lege training of a practical amount of in struction on industrial hygiene and occu pational diseases furnished by men who have had first hand experience in this field and are not wholly dependent upon textbook lore. However, it is emphasized that in undergraduate medical training this form of instruction necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is "fession, through its or liter its attitude toward at least in every industrial state, "ti Jj1 gne, shall recognize this should be available for cooperation with |*r the antithesis of th general medical profession a number ofT of state medicine, much experienced and highly skilled ot # realize that industry, ur. pational disease consultants, who, thro jk* of able medical directors, limiting their professional activities to ag-t source of numerous cas one aspect of medicine, may become hi; proficient in the solution of occupatii dis_ease_etiigmas. (c) In every state and in some of ti ' Necess larger industrial cities, there should I j Ir. maintained public institutions devoted ; industrial hygiene and occupational di I eases whose technical services may be avai j able to the physician in charge of patia Chief, Division of I who may be suffering from occupation diseases, and these public bureaus shoo ? . You are all aware of serve as fact finding bodies, equally inte i dent statistics. You kne ested in the worker and his employer. ;; quency and severity ra (d) Much will .be gained ii all responsible for the health ooxf * m solution of the sail iunmduustsriuaHl i^i would be groping in t! .v-w- are available, we awepvdirfroefeoorsqkneruetmnarttsetoenaiontnu,dbntadaiptneisanyrssttpc,amraneaapadcnatiiedscneirtgiyam-wlasamso,yratksomyehaemtihkcsaehtotkionrewieeogrgsyar,rkinebeaoanpt'de-^rjj^fI'4R;il-.'.Jvl^aiaavnl'efuoaetmhneeoroa.f-spuporonerestuaanmrrieeteythnnoeteodee-. possible exposures. Today, the grip of is'dosing down upon (e) Controversies should be eliminated w public health and sai in the largest possible measure from occu^gj .. however imperfect, ar pational disease work. Many abler phya-S: .-..means now available f cians eschew all connections with this typeis longevity and the [ of medical practice because of the sad ex*v - services in the battle r perience that nearly every case may be so'^' - So well recognized^ involved in controversy, litigation, disafjy; principle that the eff fection, until the good physician may .0 qr"state health depart that he may be degraded. ...large measure, by th. (f) A need exists for greater disclosure,! '.. plcteness of its mor to physicians of the chemical nature reports and records. work materials to the harmful nature ---^ The same principle which employees may be subjected. rf'Se hue for the groups dustry may have excellent reasons for bi<*vj|t in a factory, mine, qv ing the nature of some of its chemical rrw^j- department store. terials under code _terms, but more oft^ ' These records are these code terms are designed only to indicate what ha; convenience and not for secret formula i -[ this is important enc purposes. A greater degree of cooperaU IT .to management the on the part of the manufacturer will ev?iK ^d, therefore, the tuate in the better hcaith protection of j g'.;:-rW8.it, as they are t workers through the more intelligent lig Insufficient data h; istrations of the patient's physician. "t z. -.the recognition of (g) Lastly, it may be pointed out tl^ .b^uliar to wage-ear. better diagnoses of occupational dtse -jg evidence to indicat will come when the general medical P .mortality rates arc 1 Occupational Disease 225 aduate auspice'' community '1^' rial state, ft* -fsfffession, through its organizations, shall * filter its attitude toward industrial mediISf^rr. shall recognize this type of work as peration wift^-- iiStust the antithesis of the undesirable as- n a number jj *oect5 of state medicine, and may come to hly skilled occ^. i?5rSlize that industry, under the guidance :s, who, througj, of medical directors, is the meritorious activities to thj, ay become highly -JSi's! 'ource of numerous cases to be referred of occupation^ to almost every specialty in medicine. The organized medical profession whole-heart edly should render its approval and support to the efforts of the physicians earnestly seeking to protect workers from the many dangers connected with industry's thousands of substances and work conditions. in some of ft* i}\ ` Necessity for Uniform Absenteeism Record there should h ions devoted fo In the Industrial Health Program occupational dij. By MILTON H. KRONENBERG, M.D. ces may be avail., narge of patieau tom occupational Chief, Division of Industrial Hygiene, Department of Public Health, State of NTS^/i. Illinois, Chicago bureaus should you are au aware of the value of acci- These excessive rates are especially not es, equally inter- -."dent statistics. You know that without fre- able for unskilled workers as shown in is employer. - " qutney and severity rates there would be the accompanying table. . if all physicians th of industrial : av make greater rk histories, both seek to gain ah to the work eamachinery .and '"'r"no solution of the safety problem and we - "4would be groping in" the dark. But, since "they are available, we know where correc tive measures are needed and this affords --.-'fas an opportunity to correctly judge the -Rvalue of one method of prevention over .-^another. These death rates could only have been prepared by statistical methods of analy sis and, therefore, clearly point out where one phase of our problem lies. If told nothing more than this we would have plenty to do trying to uncover the menaces to health among the unskilled group of .f-U;Today, the grip of statistical methods workers. id be eliminated asure from ocasfany abler physns with this type se of the sad ex case may be so litigation, disafvsician may fee! reater disclosure mical nature oi rmful nature of subjected. In reasons for hidits chemical mibut more otto .-signed only for secret formulae :e of cooperation .cturer will evenprotection of Hi* a intelligent miniiysician. pointed out that rational disease* raj medical pro - ^.is closing down upon industry, medicine, public health and safety. Vital statistics, . rhowever imperfect, are one of the chief means now available for measuring health, -'longevity and the progress of medical services in the battle against diseases. So well recognized is this fundamental principle that the effectiveness of a city or state health department is judged, in a large measure, by the accuracy and com pleteness of its morbidity and mortalityreports and records. The same principle obviously should hold true for the groups of workers employed *n a factory', mine, quarry, public utility or department store. _ ______ _______ These records are oi value not so much to indicate what has been done, although this is important enough in demonstrating to management the value of certain work . *^>d, therefore, the advisability of continu,n? it, as they are to chart future action. Insufficient data have thus far prevented the recognition of some health problems Poouliar to wage-earners and there is ample evidence to indicate that morbidity and ortality rates are higher for some groups. The morbidity and mortality data laid down by uniform and adequate reporting of cases can also serve as a basis for pre vention and health education among work ers, the same as is and has been done for accidents. It may interest you to know that the Eastman Kodak Company, Edison Electric Illuminating Company, Hood Rubber Com pany, Westinghouse, Metropolitan Life, Gen eral Motors, and several others have for years made sickness studies with the aid of statistical methods. In this way they were able to evaluate the different sickness problems confronting them and those need ing attention, and at the same time with these sickness records properly appraised and evaluated, they were able to educate their employees regarding digestive dis eases. colds, pneumonia, tuberculosis, can cer, skin disorders, as well as other ail ments. Furthermore, studies conducted in spe cific industrial undertakings have shown the value or statistical methods in revealing the incidence of such diseases as pr.eu- monia, tuberculosis, and degenerative dis- 226 Silver Jubilee Safety Congress Occupation Professional men Skilled worker Death Rites by Occupation .-1// Causes 670.5 828.9 Tuberculosis of the Lunts 26.2 72.1 Pneumonta 38.8 59.7 Cancer and Tumors 70.3 85.4 health problems. Peri [he industrial establishr jjult to undertake a co: 0[ absenteeism. I do t make a start somevhc [jo elaborate. Semi-skilled worker 1009.3 102.1 71.6 90.8 I have heard it said Unskilled worker 1447.7 184.9 135.9 106.6 to detect illnesses wht absenteeism from work Rates per 100,000 occupied males, based on U. S. Census data in ten selected States. jeal examinations. I an vitit this type of pre seases to be higher than the average" for dents, the' quality of his work is of helpful where the iilnt the entire industrial population. This was lower grade, team work is disrupted, fac-? a week or ten days, t clearly demonstrated in a pneumonia study tory processes are dislocated, undue burdens be done about the fr !: among steel workers which was conducted are placed on other workers and the worker three day absences, anc by the U. S. Public Health Service. himself becomes dissatisfied. If he is oc-.3 physical examinations Drury, some years ago, was able to show cupied with weighty matters of policy and4> oendously. This, of cc a high rate of tuberculosis among workers production then someone in that organizakp* that industrial medical in the a.\-grinding industry, and the Earrc, tion must assume the leadership and ac-'j? don or minimize that j Vermont, study revealed a high tubercu quaint him with the problem by understand-^ ice. losis rate among granite workers. No doubt, able and intelligent facts and figures. The industrial hygie: I'-; other occupational undertakings would re There are progressive industrial organ' Health Departments ar veal data for prevention, control and edu izations who may and have spent largtjjjl State Public Health S. cation were it possible to have adequate sums of money for the improvement o! employment and use o: statistical records as revealed in the slide working conditions and for the care of| E; recording and reportin just shown you. workers who become ill, but without cup *orker due to sicknes Dr. Selby of General Motors, in calling rent plant information about the human' Tods have been develoj attention to his statistics shows that about factor much of this money and effort hap some twenty years b; 0.6 of a day per annum is lost due to oc been spent on "general principles" or per^ Service and also as a cupational injuries and that includes occu haps concentrated upon the elimination of, National Health I nver pational diseases as well, whereas, eight, only one or two publicized health hazards;; else affecting workers, nine or ten days per year is the total and only from the standpoint of existing; health agencies will t lost time from all illnesses. In Dr. New- compensation laws, as for example, sfli*> operate with Industrie quist's report for the American College of cosis. But the extent of the health problenv Surgeons, the figures are about the same. in a plant necessarily may not end here. This shows us that our industrial illness problem is approximately fifteen times the size of our accident problem. It is evident that industry could well afford to concentrate on illnesses among wage-earners, other than the occupational diseases, because they are the ones that cause the greatest amount of absenteeism and are the biggest drain on industry. With the progress of industry especially^ on the chemical side, new health problems will arise resulting in physiological a pathological upsets. The effect on health will, therefore, have to be measured and evaluated. We must have data in or"?S for one to judge the efficacy of methods employed to combat disease, so we first know where health is being menace _ VSnw s CP Clock i*' Dipl. Occupati '- In the recent National Conference on the relationship of occupation to these dis-j Health Conservation, it was estimated that cases and the causative factors responsee._ the nation's bill for illness and premature The records you keep will be a guide to a1" deaths amounts to approximately, ten bil tion as well as a record of action. lion dollars annually, and that on every average day about four million persons in the United States are incapacitated by ill ness. No doubt many industrial workers are in that last figure. The industrialist of today should recog nize that a sick worker is prone to acci Therefore, I say, prove your value industry since many a skilled induct medical department has been limited 'n - budget and activities because it overl the necessity and value of abscnteeiftn ports and records which could have h used to enlighten management regarding.^. *K j iTr2 T5S H S Occupational Disease 227 cion oF cards, isting siliobiem lr-: SJSlth problems. Perhaps in some cases ^'"dus'trial establishment may find it difi*.'"jo undertake a complete record system ^absenteeism. I do urge you, though, to fggfce a start somewhere. It need not be ^"elaborate. have heard it said that the best way pig detect illnesses which are causative of ibsenteeism from work is by periodic phystL] examinations. I am not fully in accord i^Hth this type of prevention. It may be Stfcelpfu! where the illness lasts longer than ">'week or ten days, but something should :fce' done about the frequent one, two or ItJifee day absences, and I fear that periodic rjjjysical examinations will not help trejnendously. This, of course, does not mean ^that industrial medical services should aban don or minimise that phase of health serv- Sice. jhe industrial hygiene divisions of State (Health Departments and that of the United State Public Health Service arc urging the employment and use of a uniform code for rding and reporting absenteeism of the worker due to sickness. Forms and methjods have been developed after a study of f/iome twenty years by the Public Health igs5ervice and also as a result of the recent .;5National Health Inventory of chronic dis Jmease affecting workers. The aforementioned jthealth agencies will gladly assist and co-^operate with industries desirous of setting up and maintaining records of sickness in their particular plants. An analysis and evaluation of these reports and records is another service offered by them to manage ment. Before showing you a form on which to collect your absenteeism data, and which can be termed the "master sheet," I should like to acquaint you with several important items that must be had for your records be tore they can lend themselves to analysis and evaluation. The form is self explana tory' except for a few general remarks. A card should be made out for each and every employee on the payroll, regardless of whether he or she gets sick or not. This is necessary in order to ascertain the ratio of those sick to the number on the payroll. The workers' age, sex, color and occupation are important to record since they will have to be related to the specific exposed popu lation. Under "occupation" state the work in which the employee was engaged when his sickness began. The "date disability began" should only be recorded for one full day or longer. In the column "work days lost" we refer to calendar days and this is neces sary to put lost time on a comparable basis for all employees. For "diagnosis" one should list the sickness or injury when defi nitely known; if there is any doubt about the correctness of the diagnosis, a statement Sickness Record Form or Clock So. i 1 Dept. Occu potion -Iff Sex Color i Date Dis ability Began Date Dis ability Ended IVork Days Lost (Cal endar days) Dia gnosis By Whom Diag nosed Termination 0/ Case --- l | -- j j 1j it { 1 li I U'n: I ij pr it SB IP :; I m .`haUflwfg r-a> i ! ii> -: i ( ii oi the symptoms experienced by the patient should be recorded. The point is that facts should be recorded and not guesses. It is more important, tor example, to know that ten men in a given occupation were dis abled by "pain in the stomach" than to get ten different guesses of the disease or ail ment causing the pain. Another item of importance on the record is "by whom diagnosed," and should show whether the diagnosis was made by the family, phys-ician, plant physician, nurse or the patient himself. Under "termination" of case, one should record whether the illness terminated in recovery, death, relapse or ended in a chronic condition. The following statistical information and data are, therefore, possible if the items listed in the slide just shown you are care fully prepared. 1. The frequency or severity rate of any given disease for the entire plant, individi departments or occupations. 2. The time lost due to any given da? ease or to all diseases combined in the _* tire plant or by departments or occupation." 3. The mortality rate, 4. The case fatality rate, expressed the percentage of cases of a given disea which, terminates fatally." The intelligent application of prevent! measures, of control, of health preservation!* must have statistics and they will alwjyrp be an integral part in the solution of aiijf problem. That it holds true in industrial? hygiene is represented in my next slides* which shows that the strength of any wheeds is dependent on each ar.d every' spoke an^ each is dependent upon the other, otherwise^ your structure is unbalanced or collapses. The panel discussion odents" convened wi Harvey, Managing Dir Conservation Bureau o Casualty and Surety Er City, presiding. The following partidiscussion were presen '. jj D. Berman, D: . r. Health, Western ..iT. Chicago. j. T. Brown, Safety " ^miPont de Nemour . ^.Hickory, Tenn. ADJOURNMENT Bushnell, V Personnel Depart; feTy! land- Cement Co., Kv.-Chairman Ha Kt .something of a r ]3. ?(.accident preve have been mu {"fcnee, and th V. feeling that in th ,y off-the-job act & ,1 will receiv V; ^rmot help but f . f.n conducting I lor various men E Ipond >n a mort ?r 5ir,tl?ilar subjec r "PPOrtun r'Z? for questions i members of h'h ^'ousiy the *- #1:; ?vi,r-^f im [M j** jr*` m itigM S8&" Cement and Quarry Section :cir rcpresentatj ' Ji^.g-stfnt aciaiyrjefunlataunradl hazards for even the skillful driver, and if ire discussed r '* tjents are to be reduced, wc must stress l. uchk on diffZ? ` TT1 pc the results 0fT= of proper attention to highway en- ! bth t0 'He R&neenng, improving, widening, elimination :V,S,- Plays * r`"'*fhaiards and make the highways conform ;s S!v at each *' ied 'V'tJl a tra^ the speed and traffic to which they --^nool mainuinin. vcr 30 days' j? f,`5|g'Suliiecd. pt't'fdlTie Iowa State Safety Council is defion record against diversion of motor :n, the.tfophy wdj ^ ->ol winch had it .u ~cs during the )UT iride license fees for any purpose other pa^in highway construction, maintenance and safety, and we believe there is no tendency on the part of the great majority of our legislators to even consider such a plan at this time; a: least up to the present time there has never been any diversion in Iowa and wc have been very vigorously opposed to any program of this nature. "Save 100 lives during 193S and 1939 in Iowa'' was announced early this year as the goal of the Iowa State Safety Coun cil's program; and if there is no upturn in killings late this year, the 1938 part of the goal is assured. '- ^"'ety Council *,j nc Court. This %- 2 students. They vj Prosecuting and r`d their own is found guilty 0{ a THURSDAY AFTERNOON SESSION October 13, 1938 } be given the rig* c or other means cf ; City jail for any It. What About the Health of Quarry Workers? By W. C. JAMES lias been operatingce': ;.i00 per year fuiaocri' Safety Engineer, Portland Cement Association, Chicago strics of Mason Ctj;- t-leHa spite of the widely recognized need for :;ling our prograin It t protective measures in certain types of - "-tv, we have had af- r^aines, relatively little attention has been part time ofricc helf Kegfveh to the related occupation, quarrying. 'dividual memberihir.i yt.lt is apparent, though, that qtiarrv work- `iid now have about yimen were pretty much alert to what might iiips. - lie expected from their employment. attribute his condition to his employment. On the other hand, if a quarry worker is discovered to have tuberculosis, which is also contagious, there is a general disposi tion to assume that his occupation is re sponsible. Sometimes this assumption is carried to ridiculous lengths. For example, erro Gordo Couch j.-'-Tn 1913, the English factory inspector, i 03 County or Co.et- Dr. E. L. Collis, reported that masons and '-, cut of 99 ccuntlc ; qtiarrymen "are said to regard sandstones with the Iowa Sam . ..as dangerous while limestones they regard a state ntemberih: . as harmless.'" This interesting tradition of 0 individual cititettv t the stoneworkers' profession is a quite tncils feel that they ; ^curate summary of the modern scientific rial support for U-! ; proposition that quartz is the causaihe 1 highway protect* -agent in practically all forms of cccupa- tional lung disease. v teen worked ca ke railroad coiRTVeiiicle Deparrntrf- 'Council for :on for Sue i:- Since this is true, it will readiiy be ap parent that discussion of quarry health hazards cannot very well be general. It J'Ust be specific for the type of material -'-iag quarried. This paper, thcreforr. p;o- 10 new grade ' ling of fa::' c-j^cr; out c: r;-'" ryes to suggest V ltat is known about the . ;:-t of einployw.rn: in tour representative lies of quarries : sandstone, " "aicsionc. Ki-st. tkomjj... "4. ncaith to broadly mu.u y employ:!-.'.::: a cement contractor's employee discovered that he had tuberculosis. He promptly demanded compensation--on the ground that a small amount of the mix from the mechanical mixer had splashed on him. Yet tins ciaim was given serious enough con'-idcration to warrant two trials. George G. Ornstein, a New York physi cian on the staff of Sea View Hospital, suggests that a possible connection between employment ar.J tuberculosis can be estab lished only in those occupations where workers are regularly exposed to tubereuYrs (nurses, for example) or in trades .`.ere there is continuous and extensive eposure to silica dusty Sandstone Obviously, sar.dstcr.e contains quartz, ft has bug recognized as potentially .zaril ius. C:1 . renoris that dour ludlers meriv red from a .v'verc lung d: y viii'.-.iv di-aryeared vviun rru.f.' Hr; illl'i.nh till i\- ;y.i iiiiii;!,' itffcb :: :i Ii 'i-'.u!I i `fliS* ife IP iiiiis? ii;i a in Kll:, *1! IiPi )hiI V1; .'jldniMUitr-ir i prSlvlIS* ; !;.h i|!l !rl^5 ,' ',b ' hi :: -,n- ' . . Ar-jv-kt ''him... i rjtjffv.aBT* mm 324 Silver Jubilee Safety Cuuarcss **4 Cemcu grinding wheels.- lie attributed this disease to quartz in the stone dust liberated during the dressing of the wheel.' Dr. James Wheatley, county medical offi cer for lu-aith of Shropshire, England, in vestigated the health of sandstone quarriers in the Grirtskill quarries in 1911.* The rock iti these workings consisted of 95.4 per cent silica. It was quarried by hand, picks being used to gutter or channel the stone. The quarried slabs were dressed dry by hand in open shecs. Wheatley found that.the death rate from "phthisis" among the quarry workers was 7.94 per 1.C00 and among the masons was 16.71 per 1.COO, while the general death rate from lung disease in this community was 1.47 for mates over 20. Very few living men over the age of 60 in the district had worked long in the quarries. Wheatley concluded that their occupation was responsible for their high mortality, because: 1. The stone workers were economically a little above the average of the district and were temperate in habit. .2. The death rate from phthisis varied with the amount of exposure to stone dust. The masons and dressers experienced over twice the deaths per 1,000 that the quar riers did, but that the rate for quarriers was far in excess of the rate for the gen eral population. 3. Wives and children of stone quarriers who died o: phthisis showed no extraordi nary mortality. Therefore, the condition was not infectious and might be designated more specifically, lithosis; that is, stone disease. He recommended that protection of the men from dust by wet methods and the use of respirators, and periodic physical examination; would be necessary to reduce the high death rate. Of course ir. modern standstor.c quarries improved mt-tr.ods of operation and crnciciu protective measures have undoubtedly done much to obviate the hazard that Wheatley describes. In 1927, three investigators of the Ohio Department :: Health. Haynurst, Kindcl anu Xeisv. under in collaboration with Health Commissioner Barrett of Lorain Cour.iy, mr. t; careful physical examina tions with x-rays of 912 men engaged in sandstone quarrying in the vicinity cr ' 5. hersi.' Xo cllort was made to sc|jjr. ''* dv quarry workers from the dressers o* ^ ishers, it being assumed that all wcrr^ject to the same hazard. They found 2S.3 per cent of t|!e group with silicosis but only 1.4 p^hn A. - i-'vwith a complication of tuberculosis and A* cosis. Comparative vital statistics sho*A ' that in the villages of Amherst and Amherst, where most of the employe^ v-b 1 the death rate from tuberculosis (a]| f0 both sexes and presumably all ages) almost twice that of the county andpj Lenr-4 of Serv..- times the rate for the nearest indiistr^ city, Lorain. .V^v-lgV .AW!'Granite There is a wealth of informatioiin on the effect of exposure to granite dw/JJ/'SIt: practically all of it deals exclusively' granite cutters rather than quarrier$."llieti is one inconclusive study of a gToup bp" 87 quarry workers in Boya, Western Aus. fls-. tralia made in 1927.* Twenty-five of these Emflo)'"/"1 rcrxxt s-to 10-15 15-20 JO-25 3205--3350 35-10 40-15 45-50 50-55 Total Xo of Quarry Workers 64 11239 34 23 18 men had had previous mining experience, u 7-qbr None of the 62 without previous experience- showed lung pathology. Three of- those-- who had worked in mines showed definite.; " dust reaction in the lungs but they had all worked from 16 to 40 years in mints 'ar.d ' lac.lienee of X-ray Evidence^: less than 10 years in the quarry. Further-:1 more, wet drilling was the rule so thert'g was practically no dust exposure. In'viei,`..;.pg of the known harmful quality of granite^ dust when not controlled, this repoii ..aib ^ least demonstrates the value of; control measures. . .h-wSj Period Under 30 i 30-40 r-io-so -150-60 ' 60-70 . 70-80 Total So. of Men 61 119 SO 52 24 4 O .Vo. . % 57 93.4- no 92.4-: 6S 85.C' 41 73.S. 19 70 j ` 1 2S.O- In 1934, Drecssen and Bloomfield made an examination of 63 quarry workers in Ver 340 296 87. C- mont, of whom the drillers were exposed to dust concentrations in the neighborhood ; of 100 million particles per cubic loot.' No j y lung pathology was noted in men with less deuce of X-ray Evidcr.-e in Qur.:~ tb.au five years' service. In the group o: jv men with from 5 to 19 years' service, one- , Em pi. third or the men showed definite lung Period pathology zr.d four-fifths of the men with w. . 20 years or service were found to h>vc ; silicosis. ' The small number of men examined not absolutely conclusive, but the distir.ciron between the findings in these quany men as compared to those ir. Austral1* o. f :. 0- 5 5-10 10-15 15-20 20-25 25-30 30-35 35-40 40-45 45-50 Total ,V.j. of Mat 64 113 79 34 23 18 7 ___ l 1 0 So. 55 5 100 1 32 18 * 14 4 - 1U 1 where wet drilling methods were used l! j i certainty siyr.incartr. ; 3-10 2)6 ;t 'Cllllly of ;;`dc t0 scparat' V drcssrs or r tl,at a11 "cre ' cent of the Only 1.4 niiV; 'jberculosis and 2 *>'* sh0 Amherst and So^ ' tne employees hV irculosis nobly all (all f0OrrVm, aS) - 1,le county and l; 5 nearest industry * 4/r Group Oder 30 3<H0 <0-50 50-60 : 60-70 . 70-80 mpioymeni Period Tolol .Vo of Quarry Workers 61 139 SO 52 24 4 J40 17.94 3S.00 2J.53 35.29 7.06 3. IS 7 31 22 14 4 1 79 Length of Service of Quarry Workers and Drillers Total No.'of Quarry Workers % of Quarry Workers Total .Vo. o/ Drillers S.S6 39.24 27.85 17.72 5.06 1.27 %0f Drillers . information on the' granite dust, but . els exclusively with-' ..an quarriers. There -'dy of a group by ooya, Western Aus* i'wenty-five of these mining experience t previous experience" ry. Three of'those .:ncs showed definite sags but they had a!1 years in mines arhe quarry. Furtheris the rule so there : exposure. In vie* quality of granite led, this report at value of control riioomneld made an ry workers in Ver niers were exposed the neighborhood per cubic foot.' No ."d in men with less In the group o'. years' service, oneved definite iunj s of the men with ere found to have examined u out distinc- i:t these crarr-- ho<e in Austra'-y od; were '= 0- S 5-10 10-15 15-20 20-25 25-30 30-3S 35-40 40-45 45-50 30-55 64 113 79 34 23 IS 7 -- 1 340 IS.62 33.24 23.24 10.00 6.76 5.29 2.06 -- .29 .29 13 16.46 26 32.91 20 25.32 9 11.39 3 J.SO 6 7.59 2 2.53 ---- ---- -- 79 Incidence of X-ray Evidence of Luna Changes Possibly Attributable to Dust in Quarry Workers by Ago ; 'V Age Period Under 30 *. 30-40 40-50 50-60 > 60-70 70-S0 Total .Vo. of Men 61 119 SO 52 24 4 340 Vo. 0 (7 57 93.44 no 92.44 <>H 65.00 41 78.85 19 79 i; 1 25.00 296 ST. 06 *% Vo. 3 4 92 7 5.88 6 10.00 10 19.23 5 20.83 2 50 00 35 10.29 Fi No. % ' __ 2 1.68 1.25 _-- -- 25.00 4 1.18 St Vo. r*. 1 i.<n --- 2 2.50 --- _-- -- 3 C 55 Sj Vo. % _ --- 1 1.25 l 1.92 -- -- 2 0.59 Incidence of X-ray Evidence of tun; Conditions Possibly Attributable to Dust in Quarry Workers by Length of Service Em pi. J'ertod 0- 5 5-10 10-- 5 15-20 20-25 Ji-JO 50-JS 40--5 45-50 To.'ot .Vo. of Men 0 Vo. r*. Fi Vo. `."o No. Vo ;Yt>. ' : o .Vo Sz rr0 64 55 85.94 : 10.94 1.56 _` 56 _ 113 1UU S8.49 $ 7. OS 2.65 : *: --- 79 7! .co s: r> 7 59 - -- - -- 1 2.53 34 V* 94.11 2 5.8* - -- _ _ _-- 2J - 75.26 1 % ; ::.7s : 71 *' _ -- -- -- _-- -- _-- 5 7.(4 ' 4;. co - -- -- --- _, ion no _ __ _ __ _ _ _ 1 too.no - -- -- -- "_ s; .o> 5 5 10.29 1.1s > j 0 59 326 Silver Jubilee Sziety Connress t Slate Slate is apparently a material of widely varying composition, as far ns quanta con tent is concerned. Dreessen analyzed some green slate and red slate in this country in 1933.' He found only a trace of quartz in the green slate and 3 per cent in the red slate. In neither case would any serious effect be expected. This was tentatively confirmed by examina tion of 79 workers, none of whom showed any specific lung pathology. It is, however, dillicult to draw definite conclusions with assurance from this data, since few of the workers had been exposed more than ten years. Considerable information is available about the Gwyrfai, Wales slate quarying district. The slate here is estimated to contain 25-45 per cent quartz, 25-35 per cent mica, and, the balance, hydrated alum inum silicate and fcrromaqncsium silicate. In 1927, Dr. T. W, Wade of the Welsh Board of Health published an extensive survey lie had made cr. the incidence of pulmonary tuberculosis in this district.* He found a high tuberculosis mortality rate in the entire population which he attributes mostly to unfavorable ciimate, but par tially to peculiar dietary habits of the na tives. Superimposed on this, lie found an even higher rate among slate quarriers, par ticularly in the higher age groups. The wives of these men also die of tuberculosis in advanced age more frequently, which suggests that the tuberculosis in these workers may he of the true infectious type as contrasted with the "litliosis" of Wheatley's sandstone workers. The high tuberculosis death rate was associated with a high pneumonia and bronchitis mortality also. Dr. Wade quotes Ccliii in support of his contention that the exposure to quartz dust in the slate quarries accounted for tins rise: "If in any given class." Collis said, "a high death rate from pulmonary tuberculosis is found occurring at a '..ter period of life titan usual and if thus high death rate is associated with a high death rate from other respiratory diseases then that class is exposed to injurious dust.' 1 In 1930, Sutherland and B rysott supple mented the work of Dr. Wade by making x-ray examinations of the chests of 120 slate quarriers, in the same district.'1 Fifty- six or 46.0 per cent of these men shox^ definite lung fibrosis, ot a type wi,^ : ..on-clinical and not specifically <juj * quartz dust. Fourteen men. all of wh^j had more than 20 years' experience in . industry were found to have definite ug. cosis. In this study careful analysts ^ both the rock and the atmospheric were made. While the rock contained fro*"' 25 per cent to 42 per cent quartz, the quanta content of the dust was between 40 perctsw and 50 per cent. The authors concluded' that slate dust, when it contains quartz, a- ' harmful, but takes longer to exert its eSec, , than pure quartz would. Limestone 4 0' . - Little scientific data on the health n*' EmployTM*"1 Period Tat. So. of . limestone quarriers lias been available uciy'i now. Yon have probably read ocasiotalA references to chnlicosis, defined as "a Itmjx disease peculiar to stone cutters." The ttna.A "disease" ns applied to the effect of liw-'w stone dust on lungs is definiteiy a rai2? nomcr. The harmless fibrosis which occaStJ. sionally is seen in the fiims of perscaS?' os--to5 10-15 15-20 ' 20-25 25-30 30-35 : *0-45 ^45-50 -i 50-55 04 113 "9 34 23 IX breathing noil-siliceous dusts is, as''iPi^4.' Gardner frequently says, of no morvEs-tO'J portancc than the callouses on the palms oL-dtff.w'k j- thc hands." There is no increase in tuiaavtVV-'' culosis or other chronic Htr.g disability, eo-.-' evidence of limited chest expansion, cl!n*%] *tr; 47.9 per cent core than ten years' of tl quarr ical shortness of breath cr any other oftk* W7 per cent had worked typical symptoms of the silicotic. Limestone-:' jars in quarry operations. quarriers arc, in general, a quite healthy -. ' Lung conditions which group of persons, as the following inform*' Lied to dust e.vjQ'Urc a' lion, here presented for ike first time, w,Jg,,i The nou-Specif.c pr.eumo show. . t disease, silicosis, Early in 1936, Dr. Leroy U. Gardner staff of the Saranac Laboratory for Study of Tuberculosis embarked on anex -t 4 :,|- iitions may be seen on t: ration of the normal 1uraggerations teiwg class tensive study of the health of cement > employees." The study included eleven - > txo degrees oi intensity. Vu degree is almost in plants located in Xttw York, Fennsylvt>nfl j Indiana, Iowa, Missouri, Alabama, KaB-^x. we of the leading roent -ttntry. Dr. K. L. Saiv Texas, and California. 'AnatOTmm, *avs that * -fe not specifically lo Three hundred anti forty of the - , edition, he would iqno: ployccs examined during this study i r^aminence. He caiis it workers whose predominant exper- - 4 owion.14 was in the quarrv. Two hundred and fr'_ .-ix (72.25 per cent) had been emuppload" efusively in the quarry. Seventy-!11'* . : = second itaqc i* "f [fenced but still is a U important facts a' these men were pneumatic hammer drt be understood. I:i: which is generally conceded to be lh 3^ -eading authorities, i lest quarry job. Almost half of these (47.06 per cent) were 40' years of J? 1 7 ^ iust as well the slight circulatory d over and 23.5 per cent were 3n0 "''irS Aft; Cement and Quarry Section 327 cent of these men shc^, rosis, of o type ' not specifically * urtcen men, a!! a '.0 years' experience'm * -hi. M* ptrtod .und to have definite ^ tudy careful analysts . and the atmospheric ,1--------y . JO-40 ie the rock contained per cent quartz, the i 70-80 n,;t was between 40 perc^' The authors condu^ id .hen it contains quarto, t ' s longer would. to exert its* tSeq .imestont . -p- f 'jj'f data on the health ' -s has been available ej probably read ocasioa iicosis, defined as "a lua; 1 stone cutters." The tin -,cd to the effect o! lies- mgs is definitely a mis.' nlcss fibrosis which oca- in the (aims of p.ersoa iliccous dusts is, as'lSt tly says, of no more fa- Employment Period ' * 5-10 , JO-15 h'.h 15-20 V : 20-25 - 25-30 ' 30-35 >V' 40-45 : V: '45-50 . JT: 50-55 Infections of Quarry Workers by Age Total .Yo. of Men 61 119 SO 52 24 4 340 PC *Vo. To 9 14.75 IS IS. 13 19 23.75 10 19.22 8 33.33 1 25.00 65 19.12 Old TB .Vo. % _-- 3 2.52 4 5.00 3 5.77 2 8.33 I 25.00 13 3.82 Non TB .No % _-- --- 1 1.25 --- - -- --- 1 0.29 PUurisv No. % --- 2. 1.65 7 8.75 1 1.92 2 8.33 l 25.00 13 3.82 Infections of Quarry Workers by Length of Service Total No. of Men 64 113 79 34 23 18 7 -- 1 340 PC -Vo. 13 20.31 23 20.36 12 15.19 8 23. SJ 5 21.74 3 16.67 --- --- ---- 1 100.00 65 19.12 Old TB No % 1 1.56 5 4.63 2 2.53 3 S.S2 2 8.70 --- --- --- ---- --- 13 3.82 Non TB No. % 1 1.56 --- --- --- --- --- --- --- ---- *-- 1 0.29 Pleurisy No. % 2 3.13 3 2.65 2 2.53 l 2.94 2 8.70 2 11.11 1 14.29 --- ---- --- 13 3.82 rc is no increase in tut*T u-o/p'r-r.': dironic lung disability, 3; ted clicst expansion, cli> 'rcath or any other of the if the silicotic. Limesta general, a quite healthy as the following inform.1 for the first time, "'.1 i r. Lcroy Gardner ar.i -u.no Laboratory for lit osis embarked on an tr ue health of cement rtu study included clevt' sew \ ork, Pcrmsylvanu. -souri, Alabama, Kansat. nia. 'over; 47.9 per cem.t of the met) had had more than ten years' quarry experience and 14.7 per cent had worked for more than 20 years in quarry operations. Lung conditions which nrc directly re lated to dust exposure arc of two types: The non-specific pneumoconiosis and the 'pecinc disease, silicosis. Non-specific con ditions may be seen on the x-ray as exagCtration of the r.:rmal lung shadows, these exaggerations being classified according to hvo degrees of intensity. Pi and F-,, The first degree is almost imaginary. In fact, one of the leading roentgenologists of the country, Dr. H. L. Sampson of Trudeau Sanatorium, says that it the interpreter and forty of the en during t.'iis study f': uredomiu.nm experift* Two hundred anti f':rr hat: I..-cm employed tv tarry, Scvcmy-iiir.e L' ttuuruc .---.'.uimcr dm--' uiiecd---'- io l,e the be most half o: these t e -0 yenrs 0: ngc - *cre not specin.-a'.iy looking for a dust condition, he we-ld ignore first stage linear {'eminence. K; calls it the stage of imag ination." 'he second s:ac.- -ome\\ nut rare pre- 3'nced bt r- 5' a healthy corvJitic u. * K'o irnpertan* * * IliiOUi tili i:or:d:: :* ,u't be unders*- First oi r.'ii. ucto: r" fading au;h i;co::c rburc-: :-1 f/.o --M'.;: .*f r/ivancim sclerosis or other non-occupational troubles as of dust inhalation. Furthermore, it is non-clinical; that is, it gives rise to `no symptoms, signs or complaints nor does it have any effect on the individual. Any per son, especially it he has Jived in a large city where he inhales considerable quantities of coal smoke, might show this condition, yet be entirely unaware of it. This fact is worti: remembering, since many physicians un skilled in x-ray interpretive technique are apt to classify these harmless conditions as "`oariy silicosis," thus unnecessarily fright ening both the worker and his employer. Tf tiic "linear exaggeration" as it is often termed is the result of such a variety of causes, one might wonder how it can be shown that it is ever due to dust. Gardnerexplanation is: If a majority of individual* exposed to a given dust show this condition and the treouency of the condition increase^ with length of service the assumption that the tlust is the cause is iu:incd.,J Tiic incidence of this condition i.y act -hov.n. Yen will no-o the: only 11.5 per cent o; i;c 3-0 limestone cuarricr^ show* f . evidence c-f the condition and in cno ::s per cent did the condition go beyond the stage of imagination. This compares most favorably with the Weish slate iiidristr.y where almost 50 per cent of the men were found to have linear fibrosis." mmc. this .. an ov.::t:.nci:r.? eMni . the absolute i'ccurationai necessity history fceto know, -in. -0 relating I,rc. ,1]^ to present employment. The history 0( V: fifth silicotic will be discussed later. '"'n Attention is aiso called to the steadily increasing percentage of men with this condition with advancing age. The other two columns of this table. headed St and S:, show a few cases of sili cosis among these men. The history of hese cases is interesting. Four of them arc m-- i:n--er-s-, -a1l1l .w..i:t,hL 'less *thua-n_ i1n0 y---e--a---rst' --exper:t ence in limestone, and all of that experience gained in a mine where wet drilling meth ods were used and where the Saranac Lab oratory engineer chemists were unable to collect enough dust for analysis. deferring once more to Ft and F,, jt seen that there was a steady Progress;-**! in the incidence of Ft with advancing ,'^j Vet the same progression is not stn,'^ increasing lengths of service, up to 20 yeanjJ fn the very long service groups (20"y^" and over) the number oi workers is hard-' pennnotumghlt ttno 1bme esiigcmniifficiraanntf. `F These tables clearly demonstrate i^.cl workers employed in limestone quarries art's not liable to acquire disabling lung disease," and that the soluble nature of the limestone' dust even modifies the usual tendency 0; < Specifically, the one man with S; had workers in non-siliceous dusts to develop worked seven years in the limestone mine a non-specific, non-clinical, mild fibrosis. and the three men with Si had worked 9, Dusts arc often suspected of increasing-^ and 2 years respectively. Even in ex the exposed individual's susceptibility 10 I posure to highly siliceous dusts, it is gen infectious lung diseases, particularly tu erally agreed that at least seven to ten berculosis. The situation in the Welsh slate case oi active tubcrcu years is required to develop Si. The an industry, for example, demonstrates that the x-rays of 340 cmjik swer. of course, is simple. All of these men had worked in meta! mines lying in hard rock before employment in the limestone some dusts do predispose to infection. L J of the men had at one t this The the case with limestone quarry dusts? tables here give the answer. Not one 4J-dfetscisen'btg--uewtnheietrnahlltayhdeashxse-uaTMmmleeedud 0 - jiitrially employed males .. Age Period Under 30 30-40 40-50 50-60 60-70 70-80 Incidence of X-ray Evidence of Luos Condition* Possibly Due to Dust in Drillers by Age T Total .Vo. of Men 7 3! 22 14 4 l .Vo. 0 ' ct<r3 7 100.00 28 90.32 17 77.27 12 85.71 2 50.00 ~-- F> % So. __ 3 9 6S 4 IS IS J 14.29 2 50 00 \ \oo.oo Fz So. _ _ _ % __ -- -- -- -- Si So. _ _ _ _ _ - % _ __ -- -- -- -- * ,\0. % -- --- l 4 SS --- -- -" fill be found to have act Jamdt anywhere f'.ro-m- 4.5 would show the per sea: Jiuicscent infection. Such a record would I; :ible in the presence of a Wording to authorities. T >r healed tuberculosis, F especially,' would in all pr 79 66 S3.53 11 15.19 -- - -- 1 1.27 tone active in the prescr 1 silica h.aiard. In this interesting to note Card j Empl. 1 Pcnovf 0- 5 5-10 10-15 15-20 20-25 25-30 30-35 35-40 Incidence of X-ray Evidence of Luna Conditions Possibly Due to Dust in Drillers by Lecjlb cf Service Total So. of Men 13 26 20 9 -J 6 2 -- 79 0 .Vo. % 10 76.92 26 100 00 14 70.00 S SS 89 3 100.00 4 66.67 1 50.00 -- 66 S3.53 F, So. ''o 3 21 0.i --- 5 25 CO l 11.11 --- j 33.53 I 50 00 --- 12 15.19 Pi So. _ _ _ _ -- -- -- __-- -- -- 5; .Yu. % -- --- --- _-- --- __ -- - --- -- *% So. -- --- 1 --- --- ---- --- -_ 1 t 27 the American mining an i ?neers last February. F dam compounds, there deposition in the areas Scneration and an ace the infecccttiioonn. . . . On : in the body at 1 v1.Uscpae, cific stimulating c: t the tubercle bacilli." Primary complex or -ercuiosis and pleurisy ot oid infections pr vears l.ealcd many Cement and Quarry Section 329 r .exs"'plt ^ p**, lt,nS silicon.. Chronic Lung Infections in Pneumatic Drillers By Age "'r.iu;, '. prSressio, 'ancing , not *0 in X to20vari ps (20 yon. ''ers IS hardly Total No. of Men 7 31 14 4 1 PC 71.43 19.35 22.73 14.29 18 22.78 Old TB No. % 3.22 7.14 25.00 3.80 Pleurisy No. 3.80 By Length cf Service instrate ihai' quarries arc 'ung disease, limestone tendency c! ' to deveh . - fibrosis. Total No. of Men .Yo. % 14 42.86 26 19.23 19 15.79 9 22.22 3 33.33 6 16.67 2 .Vo. 5.26 22.22 No. 3.85 11.11 16.67 t increasing 'eptibility to ticularly 'tut : Welsh slats ' istraies that'* "case of active tuberculosis was seen infection. Is" l^sji-'the. x-rays of 340 employees. 3.S per uarry dusts?- rtjsent of the men had at one time had tuber- or. Not one ' JfcJailosis, but it had healed or was at least ^S-quiescent when the x-ray was taken. " -." It is generally assumed that among tn"dustrially employed males about 2 per cent ' will be found to have active tuberculosis .'and anywhere from 4.5 per cent to 11 per cent would show the scars of healed or quiescent infection. 1 1.27 Such a record would have bee:! impos sible in the presence of a real dust hazard, according to authorities. These cases oi old or healed tuberculosis, in the cider men especially, would in all probability have be come active in the presence of a dust with a silica hazard. In this connection it is interesting to note Gardner's statement to the American mining and metallurgical cn- Eyteers last Fcbruar-.. He said: "With cal cium compounds, there is a ter.dcr.cy to deposition in the areas of tuberculous de generation and an accelerated healing of he intection. ... On the other hand, free 5 I Ml'ca, in -t icasti .eerr- to have 4.specific stimulating effect upon the growtii 01 the tubercle baettii."" v (3r`,nary complex or healed el. bb.eod m- ;-creu!osi.t a.td rienrio arc -mi:. ..-.-tences 3.80 only as a matter of general interest and have no bearing on the question oi occu pational health. Since a large number of quarry workers arc not exposed to more dust than tiic aver age outdoor worker, it seemed desirable to make a special analysis of the pneumatic hammer drillers. If the dust of limestone quarries is at all harmful, one would ex pect to find these men affected. The follow ing charts tell the story even more cleariy than words. Xo case of pronounced linear exaggeration was found among the drillers but there is a higher percentage oi F, in all age groups. The or.e case of Ss was found in a driller in a sandstone quarry being operated in conjunction with a cement plant. He was the only sandstone driller found durir.u tite survey and had been working at this job fur a little ever ten years, in a dust concentra tion in tite neighborhood of 12 million par ticles e.-r cubic foot. It should he noted that this man was n.ot disabled, even par tially. In th: e ins si neat ion by length of ter-, ice the satr.i increase in p'-rccni.-.gc cf F. anti ike same lack of umiorin meres.-': in the eottititti-.t tit u.c: va-ci nr.oh of r\ re ...Section- p-fiua.o.v a .-.tr'ii mat .V:0 .S'i7:v.' Jui'Hcc Sufr:': U. | iliKt, cvct: ii:oug!i the concentrations L>c moderate, will increa>e the incidence of this distinctly harmless departure from normal-- but, 11:e increase is not progressive with increased length of service and as tar as is now known, never goes beyond the harm less stage. The incidence of healed lung infection among drillers paralleled closely the inci dence among quarry workers generally. Both were under the average of 4-r% tor adult males.1* Acute Illness Little satisfactory data on the amount of acute illness among quarry workers exclu sively is available. In Gardner's survey of the cement industry, which we have just been discussing, the men were asked to report any disabling attacks of acute res piratory illness they might have had in their working lives. Approximately 17 per cent of the quarry workers reported that they had suffered at least one attack of influ enza. Only a little over I per cent had suf fered from pneumonia and V/i per cent had suffered a disabling attack of bronchitis. Among the drillers 9 per cent reported influenza, 1 Yx per cent, pneumonia, and 2'A per cent gave a history of bronchitis. Gardner's observation is that these figures do not seem excessive. He could hardly say more without a definite basis of com parison with the general population. During the last two years, the Portland cement industry has made a complete analysis ot" absenteeism among its employ ees.11'" This has given us valuable informa tion on the exact condition of health of cement industry's workers. No effort was made to secure information on quarry work ers separately but in general it can be stated that cement workers showed no pro nounced difference from other men of their age and economic condition. The upper res piratory illnesses, influenza, rheumatism and heart trouble were the leading illness causes, as would he expected in any group of pre dominantly outdoor workers. Unfortunately, so few other industries have kept accurate absenteeism records (at least they have not published them) that no general compari sons can be made. An excellent statement of the value of absenteeism studies has been made by Dr. U. R. Sayers, Senior Surgeon. United States Public Hcr.iih Service" "A knowl,; of absen'.vcimi ii;li rc.-pect to freque^T duration arid cau-e in each numcricallv a pnrtam occupational group in an indLj or in a factory, serves to reveal to tby j responsible for the industrial health ^ gram the type of action which should1. taken to obiain a maximum reduction ii amount of time lost from work on accot-U of disability, [n the absence of such ^ ' formation it is impossible to estimate tV relative importance of sickness probity in need of attention. For example, the* cidence of pneumonia may be abnormjj, MiP. D,<! ,9J0. U;s Oi"1" miiicv.Ik' 1 l.tcwrt be:o.s'>' rises or t cl Cvh Loo^ cmei u' lJ. Cardi: Uie health c H. Sami nos'1 f S'V jiu>y*' Wausau, high in some occupational group, but tli situation may he undiscovered for yeut when the number of eases occurring in tb group is not related to the population o- Protec posed. When such sickness rates arc aval.' able tor specific diseases by occupation, si* effect on health of certain environmentf' conditions may he measured anti evaluated.' Bibliography I 1. Collin, E. L. Quoted by Colibct, L.: Tk causes of ttiberctdosi.s, Cambridge University Prati Cambridge 191", p. 9S. In quarr ical equiP; ards to tl year theri plants. T! 2. Orstcin. George (/.: Tuberculosis in Industkr Inndduus.itirial Methane, 7:419'429, July, 193S. . and the k chine tem 3. Collis. E. L. Quoted by Cobbet, L.: Tljk causes of tuberculosis, Cambridge University Prea* ... Cambridge 1917. p. 9JJ. ^3 4. Wheatley, J.: Report on the prevalence; hunt dica<c arr.or.ir workers at UriiifkiH QuarriesCounty Medical Officer for Shropshire, Shreftfr bury, 1912. AJ*o abac, in n.-iti.di Medicine JouraaC' Yot. 1, 1912, C:-~69S, March 23, 1912. ~ 5. Haylmrht. E. R. Kiniicl, D. P.: Meiswafldff. U. E. and Harrett, C. 1). Silicosis with low ia* dence of tuberculosis in sandstone quarries.. J- were elec and the o enemy, fa age for c per cent c fications, i Quarry which stii ning and : ind. Hyg. 11 1929. " 6. Tyrer, T. L.: Report of an examination^ employees at the State Quarry, Bova. West tralia. Medical Journal of Australia1:361-* 1929. & To brir practices tion of o: the best n 7. Bloomfield. J. J., and Dreessen, W. C.: Sjj* cosis among prsrute quarries, U. S. Public Hsal reports, 49, 679-': 4, 215pp. - S. Dreessen, \.\ C.: Effects of certain dusts on llte Iv.r.vs. J. Ind. Ily"., 15:66-"S. 9. Wade, W. 7.: A report ot an invest'K**^ into the alleged Midi mortality rate from t'1* ` losis of the respiratory system among slate 0U* ^ :ncn ar.d slate orkers in the Gwvrfai rJf3. ?/ met. Report Med. Sub; , Welsh Boat Health, Min. of ffeaku, II. M. ?'.at. On-. ^I,ni 1927. #' 10. Colds, ?,, Milroy Lectures ootf >' j * r , }' I | Holston : it quite ; was no c it at abo; feet of C through -, and form considers chinked i the area shale bu: Quoted in Wad' report, (ee 9>. 11. Setiierian J 1 on an inquiry the lungs from inhalation in the SI-1^ ^ ; dustry in the C-.vyrfat district, 15 I'P- ` : the rock We cir. stripping hauling p`"-V.t-i' - yy I;. iI mu ':-;i vr-v' r : \ ,-t mr;-^ Isi,;`i {<? iUti; ifttfiaW |S-p.1;awr'-3.pi| p|f;p tSjHiiIi f!1* fi t; tit;*, !>,., i afeiiifc B1 % |si|l 1 tip-M flr=lr>i m 6S6 Silver Jubilee Safely Congress I tell him, (j) talk it over, and (4) let him 12. Preventive vs. Corrective Supervision : education in the try the operation by himself. --Supervision should anticipate possible d|.\ *e;e materials, but a! 9. School vs. On-thc-Job.--The decision ficultics or hazards rather than wajt |0r ' employee who is as to method is a question of economy (not these situations to develop and use them is . Usances to be ex|n cheapness). For a given situation--consid "horrible examples" and subjects for dis ; solution for eiim. ering geographical distribution oi students, cipline. An emphasis on safe practices is I . i man who is imiiv: availability ot instructors and equipment, better than a study of accident reports. ' him from expo- effect on service, etc.--one method will be 13. The Foreman's Job.--A technicallv One of the mo.-t tr found to be most effective at least cost. competent workman is not thereby qualified ! . the hazard incident 10. The Foreman's Kit.-- In the old days as a ioreman, since supervision is a "crait" j Outstanding in this gr there was a tendency to create foremen simply by picking a good workman, giving him the title, the ''book of rules," and the authority to boss the gang. 11. Trained Foremen .-Ire Good Super visors.--Just as trained men are good work men, so does it follow with foremen; with the proviso that administration of the or ganization is good. in itself. 14. Developmental vs. Infonnational Train, ing.--Since the nature of the supervisor's job is different, it seems evident that the training approach should be different. De velopmental training cultivates Judgment and an understanding of principles, and so is better suited to supervisory people than in/ormationaf training, which imparts facts. 'ijoride, which is extjQjly toxic. When ini; :'orm in space that is !vill produce unconscit I ally no premonitory sy: ijinost immediate death ' rt made a study of jtrachloride and tour ssed in various mainter. i nonflammable grease arorite in maintaining Occupational Disease Hazard in Public Utility Industry a j generating station, sed in cleaning meter By DR. J. J. WITTMER section and repair of thim had been filed, am Medical Director, Consolidated Edison Co. of New York, Inc., New York City eg, we discourage its An occupational disease has been denned as: "A disease peculiar to tbe occupation in which the employee is or was engaged and due to "causes" in excess of ordinary hazards of employment as such." In 1935 the Xcw York State Industrial Board, before the "all inclusive" amend ment became effective, offered the follow ing definition for the guidance of its refer ees : "The disease must be characteristic and peculiar to the occupation to make it come within the provision of the law." A recent court decision in the Connecti cut Supreme Court of Errors ruled that: "To come within the definition, an oc cupational disease must be a disease which is a natural incident to a particular occupation, and must attach to the occu pation a hazard which distinguishes it from the usual run of occupations, and is in excess of that, attending employment in general." It is with this interpretation that we will consider the occupational disease hazard in the Public Utility Industry. au the operation per; dermatitis can vary from a mild irritation lasting a tew hours or days to a chronic iloride is not necessnr !<B<s in most of the weeping lesion which may continue for weeks or months. Dermatitis may be pro- : duced by the preservatives and insulating substances incorporated in various kinds of :: used. Stations where odispensible have since ained a clean house a: Sf using only clean rag equipment. To avoid dermatitis, particular ... care is necessary not only in the selection ; of insulating materials, preservatives, and even transformer oils but also in the w-ay it C is handled by the men. sot free from dirt, gr Where carbon tetrac * the operation of the i closed system, adcqti; lition or a fresh air : Each summer we have had several com- r*a, whichever is the pensation cases arising in our distribution dose check is kept thn work where contact with poison ivy was v Apartment of the amoi a natural incident in the employees' pat- ^iloride used and throu ticular occupation. Certainly education in - afety group, as to u: the recognition of the poison ivy plant and : E*d. Another importar immunization of the more susceptible helps adiloride is in the fire to eliminate this Itazard. 1- tjfy. fires do not occur Care must be used in the selection oi all V dent exposure is rarch materials for cleaning purposes. Even or-,- ' The use of a su dinary hand soaps for the personal use " , *>rethlene has been rii of employees must be selected. In consider- ' Jfcve it presents a gr ing industrial dermatitis we are all aware- carbon tctraclilorii' of the frequency of individual sensitivity . j"*same precaution me; where the material itself may not be| followed. The extre fault. A substance may be entirely harmles* J"* to the use oi hi to the vast majority of men but peculiarly j'tohol discourages the Consistent with uniform experience, der harmful so a certain few. Therefore, ou .. they present pr matitis is one of our major problems. A problem is not in the selection of materia s vcntivc VS. Corrective Supni'-'M sion should aannttiicciippaattee posVih^ )r hazards rather than Mi'ons to develop and use th ' for examples" and subjects fo"0 *1 \n emphasis on safe practi^'*'*' a study of accident rep01^ education in the proper handling of ; materials, but also in not permitting ^pployee who is allergic to certain '-rices |0 be exposed to them. The solution for elimination of dermatitis , m,n who is individually sensitive is to A.chim from exposure. Foreman's Job.__A Sce of the most troublesome problems : workman is not then, I - hazard incident to volatile solvents. man, since supervision is' ponding in this group is carbon tetracraft vCsfc' which is extremely and danger- dopmcntal vs. Informational Tra' :c the nature of the supervised tterent, it seems evident that th approach should be different ) :al training cultivates juds,,,en] ndcrstandmg ot principles, and suited to supervisory people than anal training, which imparts facts toxic. W hen inhaled in concentrated jn space that is poorly ventilated, it ^produce unconsciousness with practiy no premonitory symptoms, followed by immediate death. Several years ago Stmade a study of the use of carbon - bichloride and found a large amount j^in various maintenance operations. As j ponflammable grease solvent, it was a lontt in maintaining good housekeeping blic Utility Industry ji generating station. It was extensively r id in cleaning meter parts and in the in- ER jjtion and repair of meters. While no fr'm had been filed, and no cases of poison- tw York, Inc., New York City j -e discourage its use entirely where- the operation permits. Carbon tetra- s can vary from a mild irritation ] jjfcride is not necessary for cleaning, pur- few hours or days to a chronic j ijSes in most of the places where it is lesion which may continue for ied." Stations where it was considered r months. Dermatitis may be pro- ifcpensible have since its exclusion main- y the preservatives and insulating - jeed a clean house and efficient operation es incorporated in various kinds of (r osing only clean rags to keep the equip- nt. To avoid dermatitis, particular necessary not only in the selection hating materials, preservatives, and .nsformcr oils but also in the way it d by the men. sot free from dirt, grease, and grime. -Where carbon tetrachloride is essential the operation- of the plant, we insist on idosed system, adequate down draft ven -ummer wc have had several coni: cases arising in our distribution :erc contact with poison ivy was .1 incident in the employees' parocupatinn. Certainly education in .-ration of the poison ivy plant ar.J ation of the more susceptible help ate this hazard. dition or a fresh air mask for the workon, whichever is the more practical. A dae check is kept through our purchasing kpjrtment of the amount of carbon tetra~>ride used and through inspectors of the a:cty group, as to where and how it is **4 Another important use of carbon tetschloride is in the fire extinguisher. Hap- fires do not occur often and the in- r.ust be used in the selection of ail exposure is rarely in a small confined - for cleaning purposes. Even or- Jcc. The use of a substitute such as tri- aand soaps for the personal use ^rethlene has been discouraged, since wc yees must be selected. In consider *ve it presents a greater health hazard :-trial dermatitis we are all aware SB carbon tetrachloride. When it is u-ed frequency of individual sensitivity . :.SJme precaution mentioned above -hould he material itself may not be at ? '"hewed. Tlte extreme fire hazard iuci- substance may be entirely harmlev t to the use of benzene, gasoline, or a-t majority of men but peculiar! -hoi discourages their u-e and. accurd- to a certain few. Therefore, ou- >'- they present practically no health is not in the selection of materia-; -ttstd. Wherever lead is used in any combina tion. the possibility of lead poisoning is present. However, in the utility industry the hazard is easily controlled and can be quickly eliminated. The lead covering the transmission cable and the soldering of splices offers no problem of lead poisoning, if the workman follows ordinary rules of personal hygiene so that he does not ingest the lead. The soldering operations inci dental to meter repair work offer no dif ficulty if hooded ventilation and strict per sonal hygiene are followed. Lead melting operations in the reclaiming of scrap con duit or for surfacing parts is not hazard ous, if the temperature of the lead pot is held to that point where there is no emana tion of extensive fumes, but adequate ex haust ventilation is advisable since one can not always visualize chemical vapors. Acety lene cutting of lead pipes does present a problem of lead poisoning, if the workman is not given adequate protection from lead fumes. The maintenance of equipment and prop erties requires the services of painters who still must use paints containing lead. The degree of hazard and the possibility of con trolling the hazard are th.c same as with painters in any other industry, viz., to cat food uncontamiuated with paint particles from the hands and to keep the hands out of the mouth. Probably the greatest pos sibility of the workman ingesting or inhal ing lead dust in the utility industry exists in the operation of chipping or bloyving off lead paint from old structures preparatory to repainting. Here, respirators and good hygiene are absolutely necessary. The utmost care must be taken in con cluding that an occupational disease really exists. It must not only be clearly demon strated that the individual's complaint or incapacity is due to a toxic material, but very definitely that the particular occupa tion exposes the employee to that toxic ma terial. Three recent cases illustrate this problem. First, a middle aged employee who had been a painter for fifteen years yvas con fined to his home suffering with headache, nausea, vomiting, and elevated temperature. The attending physician, informed on hifirst visit that the man \ya* a painter, filed a report yvith the State Labor Department that the employee yvas suffering from lead i: b'ljijlt: VM ii; 1'! - I;."-!:.! I|u; I'g? ji" ! y I* tg&iM J --i * ?v; Jiffiii --V.WfsIi ipi MM fcH.. 8 Mi mIlIifff!Pe#i$: IlmiIfeIi1 lii tfei a!i4i,`P pi r iWMI ilI:'i'EmlfjP&as.f-murPm&v.tIui'Ml!ji lmm vial I 6SS Silrcr Jubilee Safety Congress poisoning. Extensive studies of blood and urine during the next month tailed to show any evidence of pathological lead absorp tion. The employee actually presented a classical picture of acute intestinal infec tion. He received treatment for this condi tion and was sent back to work in two weeks. Subsequent investigation has shown the man to be in good health since. Conversely, another employee in his thir ties who had worked as a painter less than two years was treated, over a period of three months by several doctors, for gastro enteritis and cystitis. On a close checkup, cystoscopic examination revealed his urin ary tract complaints were due to the heavy metal poisoning. This diagnosis was con firmed by tests of the blood and urine. Again, a case of lead encephalopathy oc curred in a fifty year old Italian laborer, who had always done pick and shovel work. While the mental symptoms might have been thought of as indicative of lead poison ing, extensive investigation revealed that he at no time had ever worked with lead. Our nearest due to the source of the lead poisoning was the fact that the employee had always made his own wine. The reconditioning of equipment, furni ture, and vehicles presents the problem of spray painting with all the attending risk of poisoning from the volatile solvents con tained in the paint removers, paints, enam els, and lacquers. I cannot emphasize too strongly that the employee must be pro tected by forced draft ventilation of a spray paint booth or bv wearing a suitable iresh air mask. While it is generally conceded that the health hazard associated with welding oper ations is not great, yet precautions must be taken. We all are aware of the necessity of protecting the eyes from the rays of electric arc welding. The different metals to be welded, the impurities in these metals and the material contained in the coating used on the welding rods make it necessary to protect the men from the metal fumes emanating therefrom. On the small job in a well ventilated area there is no metal fume hazard. On the big job requiring several days or more of exposure, fresh air masks must be worn, if forced exhaust ventila tion cannot be maintained. In the welding shop where small welding operations arc going on continuously, adequate exhaust ventilation must always be mainta' ; ji one of o- Under all circumstances, the eyes of e ; a a case of welder and "surrounding" be protected. workmen mas*; :.jr employe-. : tsposure am Silicosis is not a problem in the routit operation in the industry. Where there""' any tunneling 'job which requires drilpr through silica-bearing rocks there is 0j { c.j;;y ill nor [t illustrates j in making suj ji any new pr course, a silicosis hazard present. In' Recent atte 1average street excavation work, the Iavii fuse the rese of mains, or the repair of underground poisoning witi transmission lines, I believe that drilling ^ chronic carbc operations incidental to this work preson ( rant some c no silicosis hazard. The workman's bead j ipiestion but is usually well above the street level and I after-effects r being in the open, he is not exposed to J oonoxide pois such a dust concentration as to cause sil ceded that ti icosis. It is conceivable that even in some is greater w: street excavation jobs, the character of the exposed to a excavation can be such that unless dust a long period protection equipment is applied, the man exposure for may be exposed to a dangerous concentra or two. We tion of silica-bearing dust. All jobs must of exposure be studied and answered according to the greater. But conditions presented. `r'fj carbon mono: We are often confronted with the prob lem of the rock driller being incapacitated from silicosis contracted in the course ot. previous employment. In my opinion, this: troublesome problem has been at least par-^ dally solved by the provision in New YorkState whereby the workman is not dt-' prived of employment even though by x-ray and history he shows evidence of silicosur but on the other hand the employer is pro tected by a fixed period of liability, shouH. the workman become incapacitated. Oarinformation and knowledge as to relation ship between pulmonary tuberculosis apd favorable scqi: to the expose carbon monox teen, nor do 1 rhere symptoalt of repeau tation of the There at the dividual had u feeognizc the of the seq onoxidc puiize any prob! Ion monoxide dust exposure is in such a state of confu Contrary to sion that I merely mention pulmonary acute carbc bercuiosis as an associated problem whk , **y industrh still has to be satisfactorily solved ^uirement ot ever there is a possibility of excessive d*/ distribution dc exposurc. The solution of this confu- *nimum amc state rests more with the medical ^ "can safely b the engineering fraternity. ami The inventive mind of the engineer chemist in developing new processes, err P* manufactun3> station is < s,tde than the materials and r.ew uses of oLd materJQ places mechanical progress in advanc*^ our knowledge of the health hazards w may be present in the new procedurt^ an example, I cite the process of rn_e cft ir.g wood and other surfaces. Tht!s_t|C* metallizing process under expertn,en . .... -J "i - Public Utilities Section 689 ; be maintain ,,the eves o{ ne ' "'orkmen num em.`" the routine Where there U requires drilling ^cks there is, 0f v present. In the - work, the laying of underground 'eve that drilling this work present workman's head -= street level and = not exposed to ' as to cause sil"at even in some j.;n one of our construction shops resulted Jjn a case of cadmium poisoning in one of Kour employees. Fortunately, it was a mild ?exPosurc ar>d the employee was not seri ously nor did any after-effects result. ;'jt illustrates the care which must be taken -Yin making sure that no health hazard exists fjin any new procedure. f*- Recent attempts in the literature to con tuse the results of acute carbon monoxide ; poisoning with claimed effects from so-called '..chronic carbon monoxide poisoning war^;rant some comment. There can be ho iSquestion but that in some cases harmful 1-after-effects may result from acute carbon C monoxide poisoning. It is also generally conretded that the possibility of after-effects jvis greater where the individual has been busy metropolitan intersection. It must not be inferred that just because the material is toxic or capable of produc ing an occupational disease, that the mate rial or process must be discarded. Only re cently two methods of processing the ends of poles to prevent decay and termite de struction were presented to our medical de partment for an opinion as to the health hazard. In each process the chemicals used were poisons. However, in conferring with the engineers, a procedure in the uses of these two processes was devised, i.e.. using heavy gloves or long handled brushes; or where the chemical was injected into the pole, unbreakable containers are used, so that there is no health hazard present to the workmen who follow instructions. ; character of the vexposed to a low concentration of gas over The public utility industry must constantly that unless dust i'a long period of time, that is continuous keep before them the possibility that an applied, the man : exposure for several hours or even a day occupational disease hazard may exist in qerous conceatra- i or two. We also know that in this type any of their various operations. It is only t. All jobs must .1 of exposure the probability of fatality is by a continuing preventive program that the according to the .^greater. But these are still cases of acute employee will be adequately protected. Need carbon monoxide poisoning and any un- I say that the employer will also thereby ad with the prob eing incapacitated in the course of my opinion, this been at least par- ion in New York :man is not dcthough by x-ray tence of silicosis; employer is pror liability, should tapacitatcd. Our e as to relationtuberculosis ar.d a state of cornu .n pulmonary tui problem whict: :iv solved whetof excessive duo -,i this confined :e medical than Cfavorable scqucllae which may be attributed to the exposure are the result of "acute" ' carbon monoxide poisoning. I have never -seen, nor do I know of any authentic case - where symptoms or pathology were the re. suit of repeated exposure to a low concen tration of the gas for short periods; or where at the time of the exposure the in. dividual had no symptoms. So, while we do recognize the occupational disease consistt ing oi the scqucll.ic following acute carbon y monoxide poisoning, yet we do not recog r.ize any prohlem of so-called "chronic car` bon monoxide poisoning." . Contrary to popular belief, the incidence 5 of acute carbon monoxide poisoning in the utility industries is comparatively rare. The r requirement of efficiency in production and j distribution demand a closed system and a - minimum amount of waste due to leaks, t can safely be said that the workman in a be aided in getting a better job doner There is no need for any hysteria over the occupational disease laws which arc being enacted. A calm, intelligent, ar.d ra tional approach to the problems which they present will eventually result in an improve ment in the health of our workmen and a benefit to the industry. One of the greatest hazards in thi; in dustry or iu any industry is the human re action to existing hazards. Contempt be cause of familiarity or lonu contact with a procedure or substance is hard to over come. However, constant reiteration of rules and regulations and in special in stances severe disciplinary action do aid in holding down the number of cases. Absentmindedness or periodic lack of concentra tion does increase the exposure hazard. Close observation and an understanding of the character and behavior of each employee ?as manufacturing plant or around a hold- by the immediate supervisor i< of material '.ne engineer a. - -. mg station is exposed to less carbon mon aid. - processes, ne" i oxide than the average traffic officer at a ; old materia-- ; = in advance o- ; h l-.azards wine- j v procedure. --: -<--ss of ir.etah;a-_ , ADJOURNMENT ices. Tibs ;