Document 3eO6DzjaGnBeBN4y5n541znNy

mmmmm c o h c ebu ibg t h e woimm m t h e vum ' ' OF THE JQHH30B BKQBZB OOWPAIWf OF gfctf CASTIS. P:fiKS10;MIA The plant In question was visited on March 30* 19kjp in th company of Mr. II. H. Bryant of Robert F Coleman, Xao. and his associate Mr. McGill#. and -Hr.. < w j , an attorney representing Mart F. Coleman in the case vs. Johnson Bronx Company. The afternoon of this day waa.spentT&rgely in-'the discussion of th available facta in th .case. Mention is sad- of th cas in this memorandum solely for th purpose, of illustrating a point that will be referred to later - that there'were no medical records in th possession of t-h Johnson Brans Company, fro which th facts could fee obtained or on which any medical defense against the claim could be baaed* Such facts as were available, were fragmentary* wholly in adequate* and so fur as they went were,such a to show that the de ceased been retained- in employment Tong.after ho should have been removed from hazardous load exposur But for th avails; biXity of record obtained by physicians who had no responsibility toward th Johnson Bronx Company# the nature of Ms illness could not have been surmised and th assumption that ho died of lead poison ing would have- been justified for purposes of compensation. Under pre sent circumstances similar cases can be. expected to occur* and it is imperative that the management of this industry have th information that will enable It to know th medical status of its employees* not only for th purpose of safeguarding their -health but for th protec tion of th Industry against 111 founded and mistaken claims of occu pational illness. Specific recommendations will be mad for the pur pose of fulfilling this urgent need* in a subsequent part of this 9m i&smorasdtsa A second visit ms mad to th plant on the- following day, primarily for th purpose of inspecting the foundry and ascertaining its status from an hygienic viewpoint. Conversation with th superin tendent of th foundry, with th engineer concerned with safety, and with th foreman and assistant foreman In the foundry revealed many significant facts, while detailed examination of th premises from th top of the roof to the ground floor supplied necessary details concerning th sources of fumes and dusts and the methods undertaken to control their dissemination. Th essential facts may bo summarised without reference to th means by which they were ascertained. The hazards arising from exposure to lead compounds are doubtless th most important to be considered, and. these will receive th most detailed attention, nevertheless there are other potential ha gar-da which should b looked into, such as the exposure to cadmium and to silica* Fortunately th measures which will be reocsmendod to reduce lead exposure will also help la th case of cadmium. Hi exposure to silica, on the other hand will require same additional consideration. lm.& eropamre In sea arounH tha foundry head-*containing materials in th atmosphere of the foundry exist in two forms, ~ (1) fumes given off from mixtures of metals melted at hi$b temperatures, and (2) dusts arising from materials contaminated with lead, from the condensation and settling of fumes, and fro the fragmentation or virtual pulverisation of metals handled under a variety of conditions* Both fumes and dusts contaminate th air breathed by workmen. At certain points, such as around th fur- KfT 0013968 mces and pots, (the fumes go wherever the pots are taken, and therefor the bay are heavily contaminated at times), fumes are given off into the air la hi$i concentration* 3hese fuses are distributed irregularly throng the foundry, and m doubt their concentration varies greatly from time to time. She ventilation of the furnaces is fairly effective, but the fumes that are removed are discharged to the outside of the plant In such a maimer and at such levels as to provide ample opportunity for their return into the foundry through windows and other openings, The fumes in the bays are not removed effectively, the ventilation her being Quite unsatisfactory in volume and design* Bust from the saad^reelalning equipment is very badly han dled , and is generously distributed. In general the dusts are removed inadequately but to m considerable extent, and these as veil as con densed fumes and debris from the furnace stack (cupalo) drop down on tli flat or gently eloping roof,from which a portion of them are swept book into the shop and all other workroom of the plant, as well as into the foundry, by very air current or braeae that moves in the proper direction* A very considerable proportion of the dangerous material that is removed by ventilators and stacks is being reintro duced into tli plant and recirculated, this being facilitated greatly by the fact that the foundry la under a continuous suction so that contaminated air la being' dram in at every opening. In addition to th ^introduction of contaminated air from the outside, the dust that arises from inadequate housekeeping la pre valent everywhere. Pafters, ledges, sills, and even the top of lockers in the wash-rocsa are burdened with dust. This dust Is also picked up by the strong air currents and is added to that which ori- KE 0013969 4* gtn&toa from th necessary operations of th plant* a foundry with all of Its accessory areas# including the vaoh-rocsa* locker-room# toilets* and lunch*room Is' deplorably and unnecessarily filthy. Under those circumstance it is not possible for the mm to b clean# and it is inevitable that they should have failed to develop any Mbits conducive to aelf-protaction against lead exposure They oat dusts with their food# and they, inhale dusts even in the periods when they are eating or relaxing in the roann available for such purposes. Respirator* are available for certain of the operations These are not of the type that protects against fuse# and their us is desultory# there being no supervision or regulation 'of their use and no systematic care of the respirators* The facilities with re* apect to wash-rccsas, luiudwroaas and locker*row are wholly inade quate and as indicated above they are not clean* Under present airmastenoes they cannot be kept clean. The men do not change clothing before and after going to work and therefore they are not free of lead exposure when out of the plant* They eat and handle food and beverage in the foundry and while at work and therefore they contaminate their food and drink* They are not supervised in such matters and therefore they do not do as well as could be don under the circumstances. nevertheless the inadequacy of the facilities for promoting cleanliness is an important factor in this situation. Some point w& made at the plant of the' fact that the mm do not bath regularly and that for this reason they my be exposing themselves to unnecessary risks. This Is undoubtedly true# but the nature of the lead exposure arising' from this situation should be mad clear. The Inhalation of lead fumes is undoubtedly the greatest source of danger to the workmen. Rext In order of importance cesses the inhalation of duet# the particles of which are larger then those of the fumes-and are therefor less readily inhaled and absorbed. Hext K* 0013970 0* eon&tt the swallowing of lead compounds, both thorn caught in the upper respiratory tract and then svmlloved, and those taken In with food, tobacco and other articles contaminated with dust before being intro* dueed Into the mouth. Least Important, end In fact of no practical importune at all, is that which ts absorbed by the contaminated skin* It lias been shown that none of the inorganic lead compounds are ab* sorbed In appreciable quantities through the skin* the dirtiness of the skin and clothing is important therefore* only because it gives rise to (frost that may be inhaled, anil contaminates articles that may go Into the mouth. This umieceesasy source of 1m& exposure can be avoided except during the actual work periods * Because it Is avoidable by means that can readily be made available even at the present difficult time, stress will be laid on reocesaendatleans to this end A few additional consents ur justified in explanation of the fact that there have been sore complaints of illness among the workmen In recent months than in any previous time* A number of factors have coined to bring this about* There Is no doubt that th load exposure is greater during the winter months because of th poorer ventilation of th foundry In cold w@ath.or. have noted this sasi condition In other similar foundries. Moreover, th hours of work ar longer than they were formerly, thereby providing a proper** tlonaiiy greater exposure, (the extent of th lead absorption is dotextBlaed by two factors, (1) the intensity of the exposure, and (S) the length of time over which it occurs.) Other factors probably contribute something to th actual increase in th lead exposure * An attempt ms made to look into- Bam of these factors but records and Kr 0013971 information were not readll7 available* Mention is mad of certain of thes points in order that information may be obtained on them in the future. for sample* the actual quantities of th various atala used up in_a given period of time provide a good index of the overall exposure to these materials* More specifically the fro* queney tilth which alloys of high lead content are employed in a given period of tine, and the total output of hearing* of euoh high lead content as compared to those of lew lead content, will give invaluable toforsation concemlmi the exposure. In other words, other things remaining unchanged lead exposure and the incidence of lead poisoning because of It, will correlate with the quantity and proportional mho-up of the product handled to the foundry* The exposure will also bo influenced by the weather and the composition of the population of the foundry* !* whether constant, or incematant by reason of rapid labor turnover or rapid increase or decrease in number* In a well regulated industry it should bo possible to weigh these factors carefully by means of records that are kept to convenient form for examination. The factors that influence industrial health from month to month or from season to eeaeon should be surveyed and appraised systematically just as the factors- that are directly concerned with production.* cost accounting and similar plant activities * In addition to the foregoing factors that influence the severity of lead exposure there is ocutloty among the sm at present that Induces a greater frequency of ocnplslAts* Every minor illmm is regarded with apprehension, lest it result to serious Illness or even to death. The correction of the latter situation can be achieved only by medical moans, and tb-vreforo somewhat detailed suggestions and K 0013972 T rocossBeadatioa will be given along this line* A considerable amount of attention lias been given by the laamgffi^nt to the installation of ventilating equipment to correct some of the worst features of the present condition ia the foundry. Use program contemplated wrn? looked into. It appears to be in accord with the principles that must guide all successful attempt of this kind, in that) (1) it provides for the collection of dusts and fusses, rather than merely drawing then out and dumping them into the sur rounding atmosphere to be deposited leewber or ^Introduced Into the plant! (2!! it provides for the introduction of clean tempered air to replace that withdrawn by suction, and. (J) it tends to Hsake the ventilation independent of the natural opening of the foundry, in recognition of the fact that the latter serve not to help but to unbalance a properly designed ventilating system. As far as it goes, the plan appears to be good, and it is believed that nom of the items of equipment that have been ordered will be wasted. However, the equipment will probably not be available for some ilia and meanwhile every effort should bo made to bring tins loud exposure under better control. Moreover, the program contemplated has not been designed to complete the job of ventilation in the foundry* It seems advisable that careful and detailed attention be given to the possibility of rearranging the foundry before an attempt is made to complete the ven tilating equipment If the furnaces and the pouring operations could b located in one part of the foundry, a carrier system could be ar ranged to convey the molds to the pouring site*. By this mean the hazardous operations could be concentrated in on well ventilated area, and the men engaged in intrinsically nen-hazardous occupations would KE 0013973 8 not b exposed t lead fumes and dusts. The unfortunate aspect of the present lay-out of the foundry Is that most of the workmen need not have any lead exposure if the plant war properly designed. A further practical point la that fey distributing the hasard throughout the foundry it becomes necessary to ventilate It all# The ventila tion must be unnecessarily expensive, therefore. If It Is to be ef fective, and In addition the difficulty and expense of mintaining reasonable temperatures in the foundry in cold weather are greatly multiplied* Th objection has been raised that the us of a conveyor system In a foundry of this typ doe not provide for the many types of alloys that must be used.. This objection does not appear to be valid, since a multiple conveyor system could bo used withsuitiple units of melting and pouring eq^ipeent# Regardlees of th equipment eventually installed for the removal of fuses and dusts, this Is but on aspect of the problem. It Will be necessary in any case to set up something approaching adequate acdle&l and general hygienic facilities. Without these it will not be possible to determine what the hygienic statu of the plant really I now or at any future time, hacking such information the m&migmmnt of the plant will always tm in the dark with respect to the likelihood of difficulties among the employ based cm actual or alleged complaint of occupational lllnosc# 001397 4 Boecmenaa t lom X* The first requirement ie to sot up a satisfactory typo of nodical suparvislon of the worioaea* Co&vere&tloa with Dr* Davia .ferry hm served to denonetret* that thin cm be done to the extent of tli time that can bo saad available by Dr* Perry. As time go m it is to be expected that more time will need to bo given to direct medical work in the plant* At present what Is done should be correct in principle after Which it can b expended as conditions re quire and circumstances permit. *fho medical activities that should be und@rts.lcon Imediately are as follow! (l) All the xtten sow employed in the foundry and all appli cants for future ^ploysent should tm given careful physical examinations B the records of which should be complete, These records should b in the custody of the plant physician to be held by him In that degree of professional confidence that accords with ethical medical practice. {} T&o medical records should contain the history of employment* a satisfactory general medical history the detail of a physical ossa!nation# and notations concerning advice given or treat ment recommended. (3) laboratory examinations should be mad in the ease of each mans consisting at a minimum, of examination of the urine for albumin and sugar, and xamimtion of the blood to determine the- num ber of erythrocytes, the number and. type distribution of leucocyte* the hemoglobin content, and the number of stippled erythrocytes per million erythrocytes* Other laboratory tests may bo carried out in ac cordance with the retirement of the case at the request of the physi cian* Stereoscopic chest roentgenograms stay b necessary in some instance Ktr 0013975 Ic) specially if there Is reason to suspect significant exposure to allies# as in the ease of some of the solders Bet-.^logical tests also ms b required in some cases. In b a d ? Industrie# these are required routinely Hi advice of the pleat physician oa this point should be followed* (k\ All mn whose clinical picture suggests the existence of lead intoxication should have Iced detormina11om made on the blood and urine# as a means of substantiating or eliminating that diagnosis* If local arrangements can b made to have such tests carried out, this worlc can be don locally. If not# this laboratory is pre pared to carry out such teats at cost for such a period as may bo necessary for the maintenance of the progress recommended * Detailed information on this point will be supplied to Dr. Perry# la the ex pectation that he as the responsible physician will express his wishes to the mnagoment for their consideration* (5) Periodic re-examination of the workmen and periodic rechscfelng of th laboratory findings should b carried out at such intervals m may be necessary and feasible. The frequency with which this should be done will depend upon the actual severity of th expo sure encountered by workmen in the foundry. It is anticipated that observations will be made to determine the extent of the exposure (see later i^mwsiexvMtions in this regard)# and that reoGam&endations as to the freqmms of th periodic examinations can b based thereon. In any case# in view of tit facts of recent months* It is believed that th# blood examinations (microscopic) must be repeated at quarterly intervals la th case of persons whose condition justifies the sus picion of undue load absorption they will have to be don at.store frequent intervals at th discretion of th plant physician. (6 ) fhe plant pi. rsiclaa should visit the plant daily if posai^e. tie should see and examine all persons whose ecaolaintn in K- 0013978 .11 hla opinion justify such examination. H should supervise ih nurses la all their work and should provide standard written orders for the handling of all types of Injuries and illnesses. In other worda he should direct all medical activities in the plant in detail and should keep himself informed of all that transpires that, my be related to health and medicine. .(7) The plant physician should inspect the plant carefully at once# and, at intervals, should keep himself familiar vith all the operations# vith the various types of work in which the men are engaged, and vith all changes that take place from time to time# to the end that he will understand the opportunities for hazard that occur nons&lly or under unusual circumstances. (o) The reconaaendatlon of the physician* vith respect to the disposition of men who are ill, end for the transfer of men to leas hazardous jobs for medical or hygienic reasons,should be regarded m mandatory. It is only under such conditions' 'that he can be expected to accept responsibility for the safety of the znoa* and that he can hop to ip in the confidence of the men in Ms professional efforts on their behalf. II* Th second main necessity is to determine the present status of the men in the foundry* with respect to their lead exposure and absorption * Air analyses have been made previously* but It is not certain that the results of these are representative of the facts at present. Certainly they cannot give the information that 1 needed vith respect to the exposure of the men* for they fail to take into account lead that may be swallowed as the result of the conditions previously discussed. It is believed that the best approach to this problem is Kir 0013977 .12 to obtain sample of urine* iM fecea from selected men representative of the various occupations in the foundry sad la the roots accessory to the foundry* This will involve the careful selection of mm on the basis of their reliability, their general stability with respect to the likelihood* of apprehension on their part, their willingness and ability to follow the simple instructions that are necessary for the collection of satisfactory samples, and the length of their service in a particular capacity. Men who have been in the employ of the Company for s o t time are especially desirable for this purpose. Ml classes of employees should be represented if possible. If this is not possible, a limited number of carefully chosen tsen will provide the best samples. The men chosen should spend all their working day in tile foundry* The foreman and assistant foreman, one or two each of the .furnace men, pourers, solders, shakers, sand conditioners, and checkers may best be studied. A janitor should be included, as wall as a minteswmee man if available, and a laborer who has been spending some time in the metal washing room# without entering the foundry A few men from shop areas contiguous to the foundry would also be useful subjects* Containers for the collection of these samples will he supplied in sealed bag . Those should he given to the mn when they are ready to- go home, after cleaning up and changing clothe Written instructions will be provided for each man, and in addition oral in structions will be provided for Issuance by the person who accepts the responsibility for this work* She focal samples will reveal the general magnitude of the exposure to dusts by both Inhalation and swallowing, during the period of a day or two preceding the collection of the sample. Therefore, KE 0-013978 13- the samples mat he collected after a voicing day, and net after a week-end or holiday* 'The urine samples will show the 'extent of the load absorption of the individual and thereby will illustrate the severity of the exposure associated with hie occupation. deplete occupational histories on the selected mm will have to be supplied to facilitate the interpretation of the results. The examination records on these men should also bo supplied. The analytical work will have to be done in this laboratory and the offer to do it is based on the belief that it Is necessary for the proper carrying out of the program recoesaended herein. The work will be dm at coat, atno this is a non-profit organisation, and an estimate of the probable coat can he arrived at by taking account of the fact that the actual cost of such work approximates $5.00 per sample analysed. Tm express chargee on the shipment of containers and sample will be defrayed by the Johnson Brens Company* X connection with this analytical survey, it is suggested that blood eaters on the mm be made in duplicate by the laboratory teeimici&n, he to examine one set and we another, ao m to determine the extent to which agreement occurs* This can be arranged by m&rniu of direct eorraapondessee between the laboratory ana! ourselvee* A report on this work with any additional xwrcaesMgutetlona that my be justified will be submitted* Rote 1 If it should not bo feasible- to carry out the procedure recommended above, it la possible that much the same information can be obtained by the collection of staples of blood and small samples of urino by Dr. Perry in the course of his physical xmainattons* The analyses of feces would be very useful but it can be dispensed with if necessary. The small samples of blood and urine are espe cially adapted to diagnostic work, while those roeemended above are more useful for determining the exposure. The cost of th analytical work would be th mm (per sample) regardless of the else and nature Kr 0013979 of the ample, ftlnc* the analytical smnlpulatlona and procedures ar practically the same* *2h primary purpose of determining the coverity of the load, hasard la to find out how far it is necessary to go with respect to control measure* and the frequency of the modleal examinations. An additional advantage lies in the fact that much data will provide a base line toy which to measure the effectiveness of the steps that are taken to reduce the lead exposure. A series of samples of deposited dust haw been requested in order to determine the significance end the distribution of the dust hazard* It is hoped that these can and will be obtained and forwarded before any si^otfleant changes can be affected. Shes campies consist of the following items; Cl) Dust frost top part of foundry near sand collecting sad reclaiming equipment , {} Eafter dust near men* wash-room, (3) other samples (s or 3) of rafter dust from identified locations9 (ft) Dust fro the top of lockers in the taenia wash-roe, (5) Finely divided material fro, that which is taken to the metal washing room* 111. The third major recomendation has to do with the reduction of the .present lead exposure in the foundry by eliminating the unnecessary ingestion (swllowing) of lead associated, with the present lack of cleanliness on the part of the premises and the men. (l) It is entirely necessary that chimgoroom and loekrrocsa facilities of satisfactory character be provided in a suitable, location. Shore should be a double locker system, with lookers for the personal clothing of the men in a clean and unoomtemlnated part or room, with additional lockers for the work-clothes in a section or room that la certain to be somewhat contaminated by the men when coming from their Kf? 0013330 15* work* Shoves* baths should b so installed that men oast go into then froQ the unolean side and emerge froat then into the clean side* If this is possible- The so*ealled'mioleen side should be kept as clean as possible* Busts should not be allowed to accumulate. (2) other sanitary facilities (toilets* and v&eh-basins for us# before eating), should he so arranged that the ''clean7* lockerroom will not be contaminated by mm going and cessing from their work. (3) A lunch-roots p&rafce from the msh-rooms should he provided in such a location that it can readily be'kept clean and fro# of dust and debris. Mm must not he permitted to eater it without removing dust from tha.tr shoes and clothing and vaahiig their bands and faces. (*} Frovision met be made for clothing for man who vork in the foundry- All clothing is to b@ furnished on some mutually agreeable basis and provision is to be mad# for having work clothing laundered (3) Hulea mm% be dram up, posted, ami enforced by su pervision to the end that! (a | All foundrynen change clothing before going to vork and bathe and change before returning, home* fc) That all mm m&h their faces and hands and remove dust from their clothing and shoes before entering the lunch-rooms Co) That no food or beverage (other than that in drinking fountains) be kept or consumed in any of the work-rooms of the foundry# or in any other place then the luncb^rocni (d) That the chewing of tobacco during work hours be dis continued . (This rule is advisable but it may not b feasible to pro- HB 0013981 1 mlgat and enforce it without undue resentment. In lieu of ouch a rule sen can. he instructed how to handle their tobacco with such cure as largely to prevent its ecmtaolaatlon*) (6) Good housekeeping can be carried out even in a foundry by attention to a few simple principles. (a) All dusts that collect cm roofs, rafters, window ledges and. other fiat surfaces should fe cleaned up frequently, pre ferably W vacuum cleaners. (b ) All materials containing lead compounds can he kept in limited locations end disposed of before they dry out entirely, fhis applies chiefly to molding sand and debris, which can bo spread about carelessly or kept oleaned up so as not to be picked up by air currents. Other material should be kept in receptacles so far as possible, and when possible should be handled end transported In a moist state. Careful attention to details of this kind on the part of an intelligent and ingenious* supervisor or safety engineer will eliminate much needless dissemination of tot. Co) Host rooms, loeker-rooms and lunchrooms must be kept entirely fro of dusts, waste and debris. IV* The fourth racommondatien Is a corollary to the third, in that continual supervision of mm and critical examination of current practice is required to procure and maintain safety in hazardous occupations. A tmn responsible for safety, and for the promulgation of safe practices should bo delegated to work with the physician and the management in promoting safe practices and in on* forcing adherence to the. This Job requites intelligence, tact, human understanding, patience* and persistence. It is best if he has authority but usee it sperl-gly* Accordingly the best results are Ke 0013982 1? usually obtained by a technical man, mth experience In and responsi bility for production, who vill be respected by the mn for his knawledg and training. If bo-is agreeable and persuasive at the same time* Ms task mil be easier. He should see that any regulations agreed upon as desirable and necessary are circulated* understood, and com* plied tilth* II should study the plant operations and their hazards and suggest means for improving the former and reducing the latter. April 0, 1943 W?Sm- o <* wnaiUBT* ^4. i..-., *T2r@cTor Kettering laboratory of Applied Physiology# College of Meddiicciinnee, Cincinnati# Ohio KEf 0013983