Document 4vMky6r4OdR3Vz5VkLMke6nNx

FILE NAME Industrial Hygiene Foundation IHF DATE 1947 DOC IHF009 DOCUMENT DESCRIPTION IHF Conference Proceedings - Health in Industry - Transactions Bulletin BA sso a. REE \ ao, 3,40 INDEXE OCT a 961 HEALTH IN INDUSTRY | | ee meg TRANSACTIONS Bulletin No. 8 a ee spree a Eleventh ARMYARMY Annual Meeting NMEDICAL NMEDICAL e NMEDICAL 5 WAR 7 Faised LIBRAR To enastetecannsne To IndustIndust Indust 1 FaisedBull e moog : Bull year 7 | | a Bull | , ae ore INDUSTRIAL HYGIENE 4400 FIFTH AVENUE FOUNDATION TR PITTSBURGH 13 PA CONTENTS Health in Industry Andrew Fletcher - -- - H in 1946 John F. McMahon - Production Comes from People People Admiral Ben Moreell - - Trends in Industrial Health Administrative Practices C. O. Sappington D. Dr. H. - -- Page Findings from Foundation Plant and Laboratory Research T. F. Hatch W. C. L. Hemeon M. and F. R. Holden Ph D. Dr. Leroy U. Gardner A. J. Lanza M. - : Summary of Medical Conference C. Richard Walmer M. - - - - - Summary of Engineering Conference Prof. Philip Drinker - - Summary of Conference on Chemistry and Toxicology H. F. Smyth Jr. Ph D. and Francis R. Holden Ph D. Management's Opportunity to Advance Occupational Health R. H. Pass - --- Acute Respiratory Infections and Their Control in Special Reference to Influenza Immunization Industry with Anna M. Baetjer Sc D. - - Discussion C. Richard Walmer D. -_ . Treatment of Chemical Burns of the Eye Ralph S. McLaughlin M. - - - . Discussion C. Kutscher M. - - - Legal Developments Respecting Occupational Health Theodore C. Waters - - Codes for the Prevention and Control of Occupational Diseases J. J. Bloomfield - - - Legal and Administrative Handicaps to a Rehabilitation B. E. Kuechle - Program - - - - - Generalized Pulmonary Granulomatosis Occurring Among Workers Believed to be Exposed to Beryllium or Its L. U. Gardner M. - Compounds - -- - . The Human Factor in the Design of Industrial Machines Theodore F. Hatch - - Sick Absenteeism Among a Sample of Member Industrial Hygiene Foundation 1945 and Companies of Earlier W. M. Gafafer Sc - Years -- - - . - 100 C. O. Sappington M. D. Dr. P. H. addressing the Foundation's Annual Meeting TRENDS IN INDUSTRIAL HEALTH ADMINISTRATIVE PRACTICES Progress Report of a year Field Study on Industrial Health Department Functions and Relationships C. O. SAPPINGTON M. Dr. H. As previously mentioned in the preliminary report given at the last annual meeting of the Foundation most surveys of this type are done on a quantitative basis study is qualitative for the most part although some quantitative data have been secured We are interested particularly in finding out what the policies and procedures of industrial health departments are how they are administered and what the results are as to the efficiency of their application The great majority of the contacts were made in person although in some instances on account of restrictions of travel and other difficulties a minority has been reached by correspondence Contacts which have been made in person for the past several years have been used and new ones have been made The active work began on this study during April 1945 and has included 278 groups in 33 states embracing the manufacture of diverse war and peace products and also various types of services The total population covered was 1,180,551 of which 861,396 were men and 319.155 were women It is important to keep in mind that the data herewith presented indicate trends only that it would be an impossibility to get an accurate picture of what is being done in industry with respect to the various subheadings which are here considered The period covered permitted us to get material during the latter part of the war and during the first year of reconversion In this interim report only a few of the many important phases of the study have been selected for presentation and comment including group classifications examinations and dispensary service other functions intramural relationships records and reports and cost of service Group Classification The first table shows the various sized groups and the percentage of the whole number of groups involved in each population grouping Size No. Groups Under 500 000.0... 43 500 - 999 oe 49 1000 - 1499 50 1500 - 1999 17 2000 - 3999 42 9999 43 10000 & over 34 % 15.5 17.6 18.0 6.1 15.1 15.5 12.2 Industrial Health Consultant 278 17 100.0 Originally it was decided to have only three population groups including a called small sized plant group under 1,000 employees medium sized plants up to 5,000 employees and large sized plants including 5,000 employees and over It was decided eventually however to use substantially the same classifications as had been previously used in Dr. D. Selby's report on The Medical and Surgical Care of Industrial Workers published as Public Health Bulletin No. 99 by the U. Public Health Service in 1919. Is was found in going over the data in this mentioned report that it was possible to make some comparison between the data therein published and the figures in the present study showing substantial progress with respect to certain types of administrative practices It will be observed that the number of groups and the fairly evenly divided with the exception of the group 1,50p0ertcoen1t,a9g9e9s eamr-e ployees which is smaller than the others apparently was a matter of ctihoannfcoer tihtis is the way it occurred and evidently there is no other explana- Examinations and Dispensary Service The provisions for various types of examinations and vice form a rather important part of industrial health a dispensary ser- tice and therefore data are offered on this subject in thaedmfionlilsotwriantgivteabplreac- No. Groups Size 43 Under 500 000... 49 500 999 1... Prepl 83.7 53 50 1499 0... 62.8 17 1999 82.3 42 3999 2000 - ...., 71.5 43 9999 72.2 34 10000 & over ........ 91.1 Periodic Ret to Wk Exit 53.2 65 11.6 36.7 49 6.1 60 64 14 64.7 70.6 17.7 59.5 61.8 9.5 67.5 67.5 11.6 91.1 94.1 52.8 Disp 46.5 47 60 53 59.5 74.4 94.1 278 Average 72.7 60.7 65.8 16.2 61.8 This table provides data divided into the various reference to the groupings with percentage frequency of preplacement periodic return to work after illness and injury and exit examinations and also shows the percentage occurrence of the use of dispensaries It will be noted that with some exceptions there the percentage of dispensaries used was a gradual rise in size and as might be as the population groups increased in expected the smallest percentage of dispensaries was found in the under 500 group and the largest in the over group It is also seen that the 10,000 and inations showed percentage of different types of exam- considerable variation in the different sized might be expected averaged lowest in the exit examinations bgurtouwpesreanfadiralsy close together in the preplacement periodic and return to work examina- tions It should be stated that there are certain organizations in which pre- employment examinations are not done routinely even among some of the larger ones which would include the shipyards on the Pacific public utilities and certain types of service Coast many organizations 18 Other Functions The percentage of organizations providing dental industrial safety and sanitation services and giving instruction in hygiene is shown in the following table health and safety Groups Size Under 500 43 ........ 49 500 999 .. 50 1000 - 1499 17 1500 - 1999 0... 42 2000 - 3999 0... 43 4000 - 9999 0... 34 10000 & over ........ Dental 7 4.1 12 11 9.5 18.6 53 Ind. Hyg 51.2 36.7 50 24.3 47.7 65 88.2 Safety & San 69.8 49 57 64.7 61.8 65 91.2 Instr 41.8 34.7 34 64.7 40 58.5 53 278 Average 16.9 54 64.1 13.5 It will be seen that provision for dental services showed the lowest percentage in this table in the smaller groups the service care and prophylaxis by outside dentists was emergency on reference and there were no inplant dental services Beginning with the 1,500-1,999 there few examples of time and group were a time dentists rendering inplant services Industrial hygiene services of some type were rendered on the in 54 of the entire group of plants the variations in the differenatvesriazgeed groups being shown in the table This ranged from inspections by safety engineers nurses physicians and others to technical studies and work Technical studies were made in follow health insurance companies and groups by state departments of company laboratories with the occasional use of private agencies and consultants There were a few examples of inplant services by a laboratory owned and organization maintained by the Safety and sanitation activities showed inspections in the smaller groups mainly by state representatives committees commercial companies nurses foremen physicians and beginning with the supply there were organized programs of 1,500-1,999 1,500-1,999 group good coordination between the safety supervision with apparently safety and medical departments It is note- worthy that among all groups there were frequent examples of the of physicians and nurses in sanitation inspections use An average of 43 of all establishments gave some type of instruction in health and safety this seems somewhat low and perhaps was very definitely affected by the activities of the war and reconversion periods It is also seen that in the two highest groups only 53 provided some form of health and safety instructions Intramural Relationships This subject was discussed in the will again be limited to preliminary report one year ago and a brief consideration of the relationship of the indus- trial health department to other departments within the or plant At the time of the same organization previous report there was some discussion con- cerning the varying differences of opinion as to the results the chief physician or medical director reports to the indusotcrciuarlrirneglawtihoenns division or officer as compared with the results when the same medical 19 officer reports to top management Reference is made to that discussion and also will be carried more into detail in the final report The following table shows the complete data with reference to intramural relationships No. Groups 43 49 50 17 42 43 34 Size Y Size Direct to Top Mgt Under 500 0.00... 48.8 500 999 ow. 22.4 1499 oo... 40 1500 1999 2000-3999 oo... .......... 4000 - 9999 .. 10000 & over .......... 23.5 42.8 38.5 32.4 Divs 3 On Par 30.2 36.8 48 41.2 42.8 46.5 35.3 Health Dept. Final Word 30.2 30.8 54 47.8 50 51.2 53 278 . Average 36 39.2 43.2 ago These figures differ considerably from those given on the incomplete data one year in that the majority of the establishments included at that time reported to top management had the three divisions of health safety and industrial relations on an administrative par and the health department had the final word on health problems It will be observed here that these relationships are carried out in approximately only 40 of the total number of groups included in this study It will also be observed that in the percentage reporting to top management the highest percentage occurred in the groups under 500 employees and one of the lowest in groups of 10,000 employees and over is easily explained on the basis that in the smallest plants top management is very close to all activities and that in the complex administrative arrangements as seen in the largest plants it appears much easier to delegate supervision to others than top manage- ment Records and Reports It is of interest to know what is going on with respect to the health records of employees and allied activities The following table shows fig- ures with respect to the individual records of employees being under medical control and available to medical staff only with respect to information being given to individual employees regarding examination findings the giving of industrial hygiene information to individual employees and the production of regular reports on health department activities RECORDS AND REPORTS No Groups Size 43 Under 500 ............ 49 500 999 ........ % Medical Control 16.3 18.7 50 1000 - 1499 28 17 1500 - 1999 29.4 42 2000 - 3999 35.7 43 4000 - 9999 .. 39.6 34 10000 & over 88.2 % Exam Inf 16.3 - 34.8 R 12.5 R 34 20 R 35.323.5 35.323.5 35.323.5 R 30.9 R 39.6 R 53 20.6 R 01 ind Hyg Inf 13.9 R 20 R 16.6 R 23.5 R 16.7 R 30.3 R 38.2-23.5 38.2-23.5 38.2-23.5 R oe: eK Reports 53.5 27.9 54 53.8 52.4 53 91.3 278 Average 34.8 31.3 R 21.9 R 55.7 20 On the average approximately 35 of all groups maintained individual health records available only to the medical department staff of course there are exceptions when records must be consulted for other purposes but in the mentioned percentage individual health records were directly under medical staff control In this respect the figures show what might be expected a gradual increase in the percentage of medical control of health records as the size of the groups increased except that there was a disproportional increase between the last two groups Giving Results of Examinations With regard to giving individual employees the results of various examinations there was considerable variation as shown in column 4 of the table Here we have a split column on the left being the percentages in which the examination information was routinely given to individual employees and on the right when it was given upon request only can be seen that on the whole the figures were somewhat larger for routine procedure than with reference to request Addition of these two columns of figures across from left to right gives the total percentage of examination information given to the individual employees in the various groups this reached 73 in the largest working group and 51 in the smallest with an average of 50 for all groups The method of reporting examination information to individual employees was largely verbal although there were a few examples of regularly written reports There were also instances where routine reports were made verbally to individuals with physical defects with recommendations and follow The giving of industrial hygiene information to individual employees shows a considerably less percentage as might be expected in the various groups with an average of 27 for all establishments with approximately 22 being on request only and most of the data showing that the information was given only in this way The making of regular reports shows figures which may seem surprising since approximately only 55 of all groups made regular reports on their health activities to some agency or person In most instances reports were made to management with a few examples of outside agencies such as state departments or unofficial agencies It was apparent in many instances that special reports only were issued at irregular intervals and also in a large number of cases verbal conferences were held rather than depending upon written material In those instances where regular written reports were made they were usually monthly and annual in frequency Cost of Service Reference was made in the preliminary report given a year ago to a general discussion with reference to the cost of industrial health services citing the factors influencing cost the types of unit rating of cost and some material with reference to a number of different types of plants This material need not be repeated here but additional material will be given It was possible to assemble cost figures from a group of nine plants three in the under 1,000 three in the medium sized three in the large class from a large corporation having fairly well centralized control The following table shows the number of persons in each plant the original investment the maintenance cost on a monthly basis the salaries on a monthly basis and the personnel and the salary percentage of the total monthly cost 21 oN ' COST FIGURES Persons Orig Maint Salaries Sal Invest mo mo Personnel e 557 $ 3000 $ 65 $ 525 2N - 1pMD 89 853 1200 300 250 IN 45 958 1000 55 170 1pN 76 2329 16000 300 850 1MD - 2N 74 3153 3436 7621 10671 12500 11500 12500 13500 550 950 650 1100 1000 1MD - 2N1 1Clk - 1Dr { 6611 1300 1MD - 3N1 1Clk J 558 8 1100 1MD4N 1MD4N 1MD4N 1Clk - 1Dr{ 6633 2200 1MD 9N ray 67 3Clk - Dr | | 14347 15000 1000 2800 1MD PT 30lk 71 2Dr | It is immediately apparent that neither the original investment nor the maintenance cost were direct functions of the number of persons served although there is some relationship for example in the fifth group with 3,153 persons as compared with the seventh group with 7,621 persons the latter more than twice as large the original investment was the same 12,500 The monthly maintenance cost was very similar as was also the monthly item of salaries and the percentage of salaries of the monthly total cost The only difference seemed to be that there were two more time nurses in the larger group With respect to the abbreviations here in the personnel column all personnel are considered time unless otherwise shown the small letter p standing for time and the abbre- viation clk for clerk and Dr for driver PT for physical therapist It will be noted that the fourth and last groups in this table showed an original investment of 16,000 and 15,000 each is accounted for by the large number of rooms and equipment therefor in each instance the fourth one using 18 rooms and the last one using 14 rooms with separate women's and men's wards and separate examination rooms for men and women as well as diagnostic laboratory facilities and physical therapy The salary percentage of the total monthly cost varies from 45 in the second establishment of 853 persons to 89 in the first establishment of 557 persons with an average percentage of approximately 68 for all nine groups As might be expected the cost of monthly maintenance is considerably influenced by the number and kind of personnel In the main also the monthly salaries increased as the size of the plant and the personnel increased with the exception of the establishments 2 and 3 which had no regularly attending physicians The subject of cost in the smaller plants has always been a favorite 22 one with many statisticians and industrialists We were fortunate ^fin securing similar data on costs for small plants this being a group of 12 establishments under 500 employees located in 12 different widely scattered states SMALL PLANT COSTS Persons Orig Inv 430 17000 357 656 175 500 426 7600 349 51800 196 500 143 1500 483 3000 345 345 1000 480 1000 Maint mo $ 240 100 10 108 1067 50 20 100 . 25 Salaries Other mo mo Personnel Sal S 390 $ 45 1pMD - IN 5858 Att 4 339 IpMD IN 75 - 2cMD - 2 Att m 319 5084 125 140 =: IpMD IN 75 5000 1MD AN Isup - Asst == Dir - 2 Engrs Dieten - Insp 20 2CMD - 2 Att &M 2CMD - IN 4 S| 450 IpMD IN s2 700 .- IpMD 2 IN 600 1pMD - INT 96 96 2 Att 323 450 100 300 415 2250 50 625 : 1pMD 2N Ip S. Insp 75 1pD Asst IpMD 2 IN | 983 1pVN - 1pClk4 It is immediately apparent that the original investment for the first group of 430 17,000 and the fifth group of 349 persons 851.800 is considerably in excess of the original investments of other groups In the first instance this is because the original investment included a separate building for the health department and in the second instance it included the building of a small hospital and clinie with adequate facilities for surgery and regular bed patients in an isolated major community It will be noted also that the fifth establishment in the table maintained a relatively large personnel and a service cost of considerable amount this was because of the peculiar nature of the industry and the necessity for setting very extensive preventive program It up a was only in this group that there was a time physician rest of the groups shown in this table either had physicians on time or on call The amount of the original invest- ments in all the other instances depended upon the space and equipment of the health department but it still shows a considerable variation The monthly maintenance expense was also subject to considerable variation as were the salaries- for a group of plants with proportionately less variation in the number of persons served 23 The salary percentage of the monthly expense varied from a low of 46 to a high of 96 with an average of approximately 75 for the whole study It is therefore evident that at least this small group of small plants have apparently done a very good job of financing their health departments and getting adequate personnel Comments on General Observations Before giving a summary of the material presented in this it is probably well to give some commentscomments paper on general observations made dur- ing the course of this study 1 Greater confidence and mutual respect is apparently needed between medicine and management to accomplish the utmost in industrial health programs We have encountered instances in which management seemed fearful of delegating responsibility to the medical staff and also the reverse has been true It would seem advantageous that physicians should learn more about health administration in industry perhaps the less inter- functions health ference department betterwith the technical of the the it could be administered still management could continue to be well informed about health activities industrial health 2 The pattern of activities as observed in this study was exceedingly variable because of differences in the final health program needs of various groups There are however certain fundamentals common to all groups which will be dis- cussed in the report It is obvious that optimum programs can only be tailored to fit each establishment after adequate study of the group materials processes equipment and products 3 There were frequently encountered instances indicating that there is still prevalent some misunderstanding and confusion regarding the specific meanings of the terms industrial hygiene industrial safety and industrial sanitation and one might well include personal hygiene and industrial health Although it would be expected that such confusion would occur mostly in smaller plants especially where the safety engineer may be responsible for industrial hygiene industrial safety and industrial sanitation considerable inci- clarification dence was also found in medium sized and large groups A of these terms would be advisable It would seem necessity physicians apropiate the sugest devoting devoting and be nurses relieved sanitation inspections 4 There was considerable evidence that the conception of the importance of prevention still lags somewhat it also seemed that many physicians still call employees patients regardless of the type of service rendered 5. time The The amount ofof time devoted to the acquiring acquiring of first hand knowledge of processes and materials by physicians and nurses remains comparatively low even in good sized concerns 24 6 Much has been said about the defects of the service in small plants it is true that many of them did not have ade- quate facilities there were some which did have outstanding programs and what seems more interesting it was apparent that considerable improvement could be made in some of the medium sized and large groups Summary The data from 278 groups of various sizes involving many types of manufacturing and service in 33 different states and including a population of 1,180,551 employees showed the following results 1 Approximately 70 of all organizations did preplacement and periodic examinations and also examinations on return to work after injury or illness the smallest of the plants had a very good record in this respect as did the largest although there were considerable variations in the other sized organizations Exit examinations at termination of employment were done in relatively few instances except in the largest of the plants 2. A dispensary service was provided in approximately 60 of all groups varying from 47 in the smallest to 94 in the largest ones 3 Slightly over half of the establishments rendered some type of industrial hygiene service running as high as 88 in the largest organizations Safety and sanitation services were provided for in approximately 65 of the concerns here the smallest and the largest plants showing the highest percen- tages of services provided Dental services were provided in very few instances and were limited almost entirely to emer- gency and prophylaxis service outside of the plants while almost examples Instruction all than less of there were of time dentists in and classifications Instruction in health and safety was the given in half the groups on average with slight variations in the different classifications 4 With respect to intramural relationships the health department reported directly to top management in approximately 36 of all groups the three divisions of health safety and personnel relations were on a par administratively in approximately 40 of all groups and the health department had the final word with respect to health problems in approximately 43 of all groups 5 With regard to records and reports individual health records were kept in the medical department and available only to the medical staff in approximately third of all organizations with variations from 16 in the small plants to 88 in the largest examination information was given to individual em- ployees routinely for all groups in about 31 of instances and in about 20 of instances on request only Industrial hygiene information was given to individual employees mainly on request only on an average of 22 and in very few instances routinely on the average Regular reports were made by the 25 ) ) 3 industrial health departments in slightly over half of all polragnatnsizations as an average running up to 91 n the largest plraonsottmastes was Cost figures varied greatly even in the plants of a poration with fairly good centralized large cor- control These variations were due mostly to differences in the of the used and to arrangement and number sonnel Itwas possible original equipment as well as perto show an array of figures concerning small scattered costs in a group of 12 small plants in 12 widely There was also which considerable variation here mainly to the type of housing and equipment originally and also with respect to variations in personnel with Finally reference to costs of service there fundamentals and basic are certain principles which can be set forth as followsfundametls . A. The original investment for a small plant industrial department usually will run from 500 to health from 300 to 700 a 3,000 the upkeep month for medium sized plants from 5,000 to 10,000 original investment and to 3,000 a month for upkeep of 1,000 a large plant from 10,000 to 81,2050,000a0 mooringtihnal investment and upkeep from 2,000 to B. The small plants can do and have done very fine programs in industrial health work without the cost being what is termed excessive C. Per capita cost of industrial health work will run somewhere between 10.00 and 14.00 annually in most plants FINDINGS FROM FOUNDATION PLANT AND LABORATORY RESEARCH T. F. HATCH W. C. L. HEMEON M. and F. R. HOLDEN Ph D. devoted provide provide Foundation to A primary objective of Industrial Hygiene member companies with the services of a central agency devoted technical technical continuing study of industrial health problems investi- Accordingly technical the staff members spend a considerable portion of their time in active companies gation of specific problems in industrial hygiene in the plants of investi- companies affiliated with the Foundation problems Facilities for such direct participation in the of value togetherthe derived together the real companies were established in belief that derived from bringing the varied experiences of many industries together and --often each would supplement the other Thus the knowledge that know problem gained in one investigation aids in the solution of another -often --often field in quite a different manufacturing The selected cross section of American industry and the great variety of manufacturing operations which characterize the membership in the Foundation offer many many attractive the possibilities in the fulfillment of this objective An annual review of success activities of the technical staff provides useful measure of the success attained in this phase of the Foundation program Growth of Plant Work studies The Foundation has grown steadily from the beginning in Figure membership 1 size of staff and extent of plant investigation Plant have been distributed among the different industries which make up the membership as shown in Table I. TABLE I DISTRIBUTION OF FOUNDATION INVESTIGATIONS BY INDUSTRY 1937-1945 Industrial Group Percent of Total Studies 1. Ceramic asbestos stone products ...cc.ccccccccceceseseeeee 33 2. Mining smelting and refining metal processing 25 3 Manufacturing metal and miscellaneous 2.0.00... 17 4 Chemicals production o.......0ccccccccecccccccesesscesccerecasesscsssese 25 * Industrial Hygiene Foundation Growth Growth of the Foundation Its Members Technical Services and Staff Number of Plant Survey Reports per Year s oom x ,Y . Number of fr ~~-0 e-ee0. Members ,. _any | Number of / Technical / { Staff H t J| | |Ii|t" 1935 '36 '37 '38 '39 '40 '41 '42 43 44 45'46 45'46 Figure ) 28 With respect to nature of the hazard or process the investigations were distributed as follows Table II TABLE II DISTRIBUTION OF FOUNDATION INVESTIGATIONS BY NATURE OF PROBLEM 1937-1945 Operation or Exposure Percent of Total Studies 1 Dust exposures asbestos nuisance dusts .......0ccccccccceeeeeee 41 2 Various chemical exposures oo ccc cn cece ceeeeeecetseeccsaeessaueseeeresees 21 3 Metal fumes welding soldering cutting foundry 0.000.000... 9 4. Metal cleaning plating degreasing acid mists chromic acid 6 5 betes Dermatitis hygienesurveys hygiene 5 6 General industrial surveys .......cccececccccceeeceececsecceceeceeeee 7 7. Studies of atmospheric pollution 8 8. Heat ventilation 0... ccc cc cess cee cetecesssesstevaveveteesttresteeseaeed 3 Summary of Activities 1946 In continuation of this work a total of 51 separate plant investigations caDSR have been conducted thus far in 1946 involving the collection and analysis of approximately 2,500 samples including over 1.200 dust determinations and studies of dust composition Greatest emphasis has been placed on the producing industries during the year but a variety of chemical operations have also been studied as in the past Table III summarizes the work in 1946 TABLE HII eC SUMMARY OF FOUNDATION INVESTIGATIONS 1946 Number of separate projects ..............0ccccccecees 24 Number of separate plant studies ....0...0...0000.0000. 51 Distribution of projects by nature of problem Dust exposure and control .......0..00 ee 10 Chemical toxicological miscellaneous ................ 6 Lead exposures cece cee ccee ccc eeeees ..00......ccccc 2 Community atmospheric pollution ..........00..... 2 35 plants 4 operations Metal fumesfumes i Heat exposure Dust cee ee see ce ees occ tbeecievereneeees Lead oo. cccccsccccssceseseccessseevsenssnncecens Miscellaneous metals ......... Miscellaneous chemicals 29 The foregoing tabulations summarizing the experience of the Foundation in plant investigations and research demonstrate the variety of undertakings and the considerable coverage in the field of industrial hygiene which has been obtained and certainly lend support to and validate the initial policy which established the technical work as a major activity in the over program A simple tabulation however cannot tell the whole story nor is it completely evident from this summary that the Foundation's activities provide more than could have been obtained by the individual companies within their own organizations or from other agencies We must turn to a more detailed consideration of the work in order to bring out its full value Value of Industry Studies Attention is called to the fact that during 1946 the 10 projects in dustproducing industries included studies in 35 separate plan.cs. Five of these projects were isolated studies involving single plants the other five including 28 plants were multiple studies set up on an industry basis or as over investigations for companies with several different plants These studies were deliberately designed to bring together for critical study the experiences of as many plants as possible having common problems Outstanding among the advantages of these industry studies has been the demonstration that sound solutions of most problems are generally found in the industry all in one plant necessarily but within the total experience The dangerous trades of our fathers have all but disappeared Modern industry demonstrates every day that potentially toxic substances can and are being used without hazard In general one may say that there are more workers by far handling such materials safely than not The problem today is largely one of discovering the effective control measures in actual use and making them available to the whole industry The concept of study on an industry basis is entirely in accord with the primary purpose of the Foundation and moreover is of particular value in that it makes the day work of the organization more valuable to the members than would be possible through independent studies alone Value of Quantitative Studies Industrial hygiene is above all a practical field and there is no place in it for elaborate testing procedures and methods of analysis unless they aid materially in the solution of practical problems Field experience during this year as in the past has demonstrated that systematic quantitative study is of direct value in a highly practical way For example it was our privilege during the year to investigate a large plant in which records of dustiness and medical records extended back for a period of twenty years These data combined with our own investigation made it possible to provide fairly definite answers to the questions which were put to us After this prolonged period of systematic effort to eliminate the hazard how good is the present control and if further improvement is needed how can our efforts be expended most effectively The experience of the company is outstanding proof of the practical value of quantitative study In fact this company was so far ahead of the parade that when they started a systematic program of dust control its scope was seriously limited by the 30 lack of adequate counting instruments and techniques That was 25 years ago In another project involving the systematic study of some 28 plants over a year period only three were found to have a silicosis hazard The fact that 25 were operating with a high degree of safety demonstrates clearly that adequate protection is practical The reasons for failure in the three were not obvious and the most effective and therefore least costly improvements were made only after quantitative study to determine the exact causes of failure Still another illustration comes from a study of heat exposure in which fundamental analysis revealed that the major heat source was radiation rather than simple air temperature From this it was evident that ventilation the common method of control was not the method of choice and would produce relatively little benefit from the money expended One of the most valuable items in the year's experiences was a request to investigate a new process while still in the pilot stage and to determine the probable control requirements for the final manufacturing operation so that proper plans could be made in advance This represents the highest appreciation of the value of quantitative analysis and is a procedure highly to be recommended Design of Ventilating Systems and Other Control Measures Analyses of industrial ventilation systems and other control measures during the year have shown as in the past that full advantage is not being taken of all of the basic engineering knowledge which is available to assist us in the design of control measures It is particularly disturbing to find inadequate performance after the expenditure of considerable money Thus in a comparative study of two plants doing the same work we found the poorer results in the plant having the more expensive system of ventilation and using the higher rates of ventilation _ Plant engineers will undoubtedly agree that the design of control equipment generally takes a secondary place in the engineering organization and they frequently complain that not enough time or money is appropriated for basic engineering analysis Thus they are forced to resort to empirical design data which too often results in inadequate performance Too much money and effort is being spent by industry to improve working conditions without securing the desired results The solution lies in fuller utilization of existing engineering data and the systematic development of additional basic information In our experience such an approach pays for itself It is the function of the Foundation to assist in this development Appraisal of Dust Hazards and of Dust Control Measures It is of great practical significance that dust continues to occupy the major place in the entire array of industrial problems with which we are concerned The dust studies have taken us into many industries in which systematic correlations between incidence of lung damage and nature and magnitude of exposure have not been made Thus it has been necessary to draw heavily upon the experiences gained in a few industries for which such correlations exist in order to make the best possible appraisal of each new situation In reviewing this work one is impressed with the need for 31 the much more extensive information than we now possess Investigators warn against generalizing from the experience of a few studies and emphasize that the silicosis problem of a given industry is characteristic of that indus- that try and relationships which obtain may not apply to another indus- try Thus it is proper to inquire critically into the universal applicability appraisal of our techniques and yardsticks Some progress has been made refining in techniques through improvements in the determination of dust composition The new procedure reported at the 10th Annual Meeting has continued to give interesting and valuable data Other improvements in appraisal methods are currently being investigated industry We are impressed with the significant difference between the silicosis problem in and the far more general nuisance dust problem It is necessary to distinguish between them since more often than not the dust more nuisance is the more spectacular and is likely therefore to receive attention Situations have been encountered in which an exposure has been judged hazardous through incomplete study and appraisal and and effort expended for control which could have been better spent onmolensesysspec- pec- tacular but more hazardous operations Another aspect of the dust problem which has interested during One year has to do with the different criteria of dust control approach the apply to control measures to all processes which are o viously producing without dust regard to the relative contribution of each to the total hazard The other is to weigh each source of dust by proper quantitative techniques and set up the control program accordingly Under the latter procedure certain others operations receive secondary consideration compared with which appear less dusty Such a course has resulted in misunderstanding in certain instances Recommendations governing the control of silicosis silicosis should distinguish between hazardous and nuisance dusts Summary This summary of technical work during the year serves point selected for some of the highlights which have been facilities emphasis Extensive State for quantitative investigation are available in the several Divisions of Industrial Hygiene and an increasing number of industries are setting up their own facilities The work of the Foundation supplements agencies and provides a medium for broad investigation and research sthhiepserepresents wide coverage of American industry which the member 32 DR LEROY U. GARDNER A. LANZA M. Mr. Chairman Ladies and Gentlemen My associates in the Industrial Hygiene Foundation have asked that I pay a tribute to Dr. Gardner He was only 57 years old when he died He was a native of New Britain Connecticut and graduated from the Yale Medical School in 1914 During World War I he was an officer in the Army Medical Corps For two years he was an instructor in Pathology in the Harvard Medical School He then went to his Alma Mater as Assistant Professor of Pathology for several years while there he broke down and went to Saranac He became Director of the Saranac Laboratory in 1927 and later was made head of the Trudeau Foundation and the Sanitarium He was also active in civic affairs He was a Trustee of the Village of Saranac Lake and a member of the Village Planning Commission In 1935 he received the Trudeau Medal for his work in the pathology of pulmonary disease and in 1940 he received the Knudsen Award from the Association of Industrial Physicians and Surgeons for his outstanding work in industrial medicine and also in 1940 he received an honorary degree of Master of Science from Yale So much for the record which does not tell us very much about this extraordinary man have known Dr. Gardner for over 20 years and was not only very closely associated with him in various projects in which we had mutual interest but also I was a very close friend of his He was a very versatile person and a brilliant figure in the medical research world Early in his Saranae Laboratory career he became interested in the possible connection or relationship between occupation and tuberculosis and from that stemmed his famous studies in silicosis and other pneumoconioses At the same time he became more and more identified with industry which was most fortunate and fitting because all of us who were interested in the industrial field as far as health was concerned felt that industry merited the very best kind of service technical and professional that it could get in order to help it solve the problems that faced it in dealing with occupational hazards And out of that necessity there grew up the really very unusual work of the Saranac Laboratory which has not been duplicated anywhere in this country Dr. Gardner brought to his work an unusual character as well as ability He followed and was associated with a remarkable group of men I don't know how many of you have ever been to Saranac those of you who have been there have always been impressed by the earnestness the sincerity the honesty of the group of men who have made Saranac possible They were a remarkable group starting out of course with Edward Trudeau who initiated in this country the outdoor treatment of tuberculosis followed by Dr. Baldwin who though retired is still alive and active at the age of 82 in Saranac Dr. Lawrason Brown and Don Cummings now dead and their associates These men were pioneers They had enormous courage as well as * Chairman Medical Committee Industrial Hygiene Foundation 33 D sound medical education and good technical ability They had the courage that it takes to fight a long uphill battle against not only the circumstances surrounding them but against their own disabilities their own ill health They all had certain qualities in common qualities of leadership and devo- tion to their work I made the comment the other day in Saranac that having known Dr. Gardner for 20 years 20 years of a fairly active lifetime my summary of his character I thought could best be expressed by saying that he was the most unselfish man that I have ever known He never gave thought to himself or his own troubles and handicaps always he was working for the project in hand aiming at the target ahead of him and driving himself with unsparing energy and enthusiasm I won't attempt to go into his technical accomplishments there isn't time enough to even detail them Suffice it to say that he was the first one who was able to induce silicosis in experimental animals by dusting processes and thereby helped to take the clinical knowledge of silicosis and its pathology out of the realm of speculation and bring it within the confines of fact and for that alone he was universally recognized both in this country and abroad I could go on for an indefinite period on his professional accomplishments He had a laboratory there the Saranac Laboratory where the roentgenologists and the pathologists and the chemists and laboratory technicians and nearly all the staff that was necessary to carry out the large amount of work that that laboratory turned out were patients of the Sanitarium As far as I know from my dealing with them there were but few excep- tions and all of them were actuated by the same motives and by the same high purpose I just want in closing to read a couple of quotations from an editorial in the New York Tribune it is quite long and I am going to read only one paragraph The Tribune editorial writer said this The gallantry that can transform a personal affliction into a benefit for mankind has seldom been more dramatically exemplified than by the career of Dr. Leroy Upson Gardner Stricken by tuberculosis as he was planning to resume his position as Assistant Professor of Pathology at Yale after service in the First World War Dr. Gardner established himself at Saranac Lake New York and began to study the part played by the inhalation of dust a hazard in many occupations in diseases of the lungs He cured himself and in the process laid the foundation for a lifetime of work devoted to the prevention and cure of similar illnesses in others And then the local paper at Saranac Lake " ... for Dr. Gardner like Dr. Trudeau brought unusual gifts to the work of fighting the good fight to free humanity from needless pain and waste and loss Each was a pioneer a sufferer a victor Each was a great man among men a great spirit in the battle for a better race 34 SUMMARY OF MEDICAL CONFERENCE C. RICHARD WALMER M. D. Medical Director Industrial Hygiene Hygiene Foundation At the Medical Conference which was held yesterday the following topics comprised the agenda 1 A discussion of beryllium 2 A discussion of chemical injuries to the eyet 3 Selective job placement 4. Specific job training The conference was one of complete informality limited to physicians from member companies having as stated before an agenda rather than prepared papers A round discussion was the order for each topic Beryllium was the first topic on the agenda Some of the salient points were reported as follows by George W. Wright M. an associate of the late Leroy U. Gardner at the Saranac Laboratory 1 Beryllium a toxic substance is and has been used in the manufacture of fluorescent lighting as an alloying material by inference in atomic energy in radio tubes etc. 2 Two large companies in the past few years had a series of painful experiences resulting in a relatively high mortality rate 3 The question of etiology is still in doubt however beryllium is under close scrutiny in the medical and toxicological laboratories One point which might be mentioned here is that the injuries to humans have not been reproduced in animals The second topic dealt with chemical injuries to the eyes of this paper appears elsewhere in this bulletin A summary The third and fourth topics selective job placement and specific job training were combined There were a number of things we hoped to bring out under these two headings However we started with job analysis and seemed to remain there We did want to discuss job standards physical standards mental requirements and various other points These will be considered at a future Conference SUMMARY OF ENGINEERING CONFERENCE PROF PHILIP DRINKER Chairman Preventive Engineering Committee This was the second of the Engineering Conferences Our first was held last year and this was held in the same spirit of informality and general give and take and argument that makes such discussions stimulating The first item we had in the morning's discussion was on radiant and convectional heat control in hot industries a topic of intense interest to all those there and I think the immediate result was an expression of what we lacked and what immediately might be done to help get knowledge which we all want Then general atmospheric pollution particularly in relation to member * Held November 6 See page 89 for full report 35 company problems was discussed in some detail and I think I can say that all those present learned a lot from it The afternoon sessions included illuminating discussion on dust collection control of fumes from metallurgical electric furnaces windowless factories and a general discussion on hood design Frankly I think as an engineer I derive as much from these informal meetings and discussions as anything I can get from the Foundation and I speak wholly selfishly If you attend engineering meetings at any of our societies you usually listen to formal papers formally presented in which discussion is limited we don't go in for that much in this country and I think it is a shame we don't In informal gatherings like this when the topics are well prepared and the discussion is limited to a comparatively few minutes men are tempted to get up and say what they think and come away with many refreshing new ideas I am sure this type of meeting is going to be a fixture in the Foundation and one which again from purely selfish motives it is well to attend SUMMARY OF CONFERENCE ON CHEMISTRY AND TOXICOLOGY Industrial Hygiene Foundation held its first round Conference on Chemistry and Toxicology in connection with the Eleventh Annual Meeting of Foundation Members Forty chemists research directors and toxicologists from Foundation companies attended The discussions were informal but the following is a summary of subjects covered on the agenda 1. Comparative Toxicity of Chlorinated Hydrocarbons maximum Maximum allowable concentration was defined s the con- centration that a man can inhale for a long period of time without injury to health It was stressed that exact information of this nature is available for only a few substances Therefore our present tables of M. A. C.'s will be changed frequently as experience dictates In the interim our present tables of limits serve as quasi limits and are valuable for progress in control The order of toxicity of the more common chlorinated hydrocarbons was discussed from the viewpoint of recent toxicological research 2. Warning Labels Upon Hazardous Chemicals It is of primary importance that there be uniformity in labeling hazardous chemicals so that the exact type and degree of danger will be presented The Manufacturing Chemists Association Manuals L and L provide guidance For mixtures only the dangerous constituents need be mentioned Under no circumstances should chemicals be labeled . e the degree of hazard should not be exaggerated Held November 8 36 3. Evaluation of the Hazard of Siliceous Dusts Data on the variation of composition of dust with particle size were presented It was of interest that similar to silica uranium becomes sig nificantly toxic only when the particle size is fine comparable to that of hygienically active quartz New techniques provide data on composition of borne dust in relation to size that more closely parallel the effects of dust in the human lungs 4. Chemical Burns of the Eye Techniques for saving the sight of eyes damaged by chemicals were described See Dr. McLaughlin's paper page 60 of these Transactions It was stressed that many neutral chemicals can damage eyes as severely as acids or alkalis The treatment however is identical for all chemicals 5. Skin Penetration of Chemicals Extensive contact of certain chemicals with the skin for relatively once short periods of time can have fatal issue Removal from the skin at is therefore imperative and because of availability of water it should be used copiously Contaminated clothing should be removed immediately 6. Evaluation of Hazard of Contact Dermatitis by Experiment Techniques which have been used successfully by one Member Company were described The methods are particularly applicable for study of chem- icals destined for use in the cosmetic food or textile industries This Conference will be continued annually and your suggestions are invited as to subject matter and mechanics of procedure that will insure the maximum benefit It is hoped that rather than a day meeting once a year the Conference will become a year around source of information and a vehicle for the exchange of data between Member Companies The Conference is sponsored and directed by the Foundation's newly formed Committee on Chemistry and Toxicology COMMITTEE ON CHEMISTRY AND TOXICOLOGY H. F. SMYTH JR Ph D. Chairman FRANCIS R. HOLDEN Ph D. Secretary DISCUSSION Foundation C. F. KUTSCHER M. Consultant Industrial Hygiene : If one were to examine textbook after textbook on diseases of the eye he would find a certain uniformity First they are uniform in telling us what to do we take out all visible portions of the alkali then wash the That is taken care of in a line or two eye Then we have page after page of how to handle complications Practically of course that is what you men are most interested these cases under the old treatment were of months and duration even years During this interval of time the employee could not work because of the extreme pain You ended up by paying in a great number of these cases for a loss of industrial vision Dr. McLaughlin's large practice among chemical workers forced him to find the answer What he did was to do exactly what was recommended but he proved many points he proved that we did not know how to handle these cases we did not know the distribution of the chemical within the layers of the eyeball and he proved that we did not adequately irrigate the eye A most significant contribution made by this group is the fact that following exposure to alkali much of the chemical remains in an active state Lying between cells in the deeper reaches of the the chem- ical resists removal by cursory irrigation cornea . This explains way when a person spills alkali in his he fine for a day or to only to be confronted at a later etyieme wigtehtsa avleornyg serious condition The work that D. McLaughlin has done certainly has been thorough it has been painstaking and it has consumed a tremendous amount of his time but his statistes prove that he has the answer to the alkali burn He shows 91 of his cases getting well in 48 hours It simply means that those cases were either minor burns or he kept them minor by the speed with which treatment was instituted and the thoroughness of his treatment There is no way for me nor for anyone else to compute what constitutes a serious eye burn when first seen but we certainly know in a series of 500 cases a great number of them are potentially lost eyes and when with this treatment 91 of them are well within 48 hours we know efficacy of this tre tient has kept them from becomingabssoelruitoeulsy etyhee problems You might contain contain because this treatment takes a half or three- quarters of an hot and keeps the worker away from his job That is nothing If that alkali that patient to be a blown keratitis or inflamed eye from A spend day after day at the ophthalmologist's office only to end up wi ou people paying the bill 64 LEGAL DEVELOPMENTS RESPECTING OCCUPATIONAL HEALTH THEODORE C. WATERS changes During the past year only a few of the State Legislatures have been in regular session with the result that there have not been many in state legislation relating to occupational health In a number of states codes of industrial hygiene have been prepared and have been proposed hearings thereon have been held and in several instances such codes have been adopted and have become effective The general trend of court decisions construing compensation statutes has continued to be liberal with the result that the hability of employers to pay compensation for occupational injuries has been extended On behalf of our Committee I would like to review briefly some of the legislation that has been enacted during the past year and to call the atten- tion of members to State Codes of Industrial Hygiene that are presently effective in those states in which our member companies are operating This subject has and will assume increasing with the enactment importance of enabling statutes granting powers for control of potential hazards to also requested Bureaus of Industrial Health The Managing Director has that our Committee include in our report reference to the subject of health clauses in Union Contracts 1 OCCUPATIONAL DISEASE COMPENSATION STATUTES ENACTED OR AMENDED DURING THE YEAR 1946 1. New Occupational Disease Compensation Laws Georgia has enacted an occupational disease compensation law schedulewdhich became effective April 30 1946. This act made compensable a list named of diseases caused by exposure to twenty chemical poisonings diseases caused by exposure to ray or radioactive substances and the dis- eases of asbestosis and silicosis With respect to the named dust diseases there is of monetary effective 500.00 limitation date liability of employers in the amount of upon the of the act with monthly increases at the rate of 50.00 until full benefits of the compensation act are attained The act created a Medical Board of renders five decision from proposed physicians appointed by the Governor a list of nominees by the Medical Association of Georgia Provision is made that bers of the board is required to examine the claimant and file of findings with the Medical Board The Board then one of the mem- a report his its in the case from which an appeal may be taken to the State Board of Workmen's Workmen's Compensation provided however that the findings of the Medical Board sufficient the upon the questions of medical fact may not be disturbed except upon findings ground that the Board acted in excess of its powers or that its evidence competent were procured by fraud or that there was not in the record to warrant the Medical Board in making the decision com- plained of or that the decision of the Board was contrary to law * Mullikin Stockbridge & Waters Foundation chan Legal Committee Industrial Hygiene Hygiene 65 oo Another interesting feature is the requirement that the State Board of Workmen's Compensation shall within thirty days after the effective date of the act designate by order the specific occupations found subject to exposure of hazards of silicosis or asbestosis and shall notify the employers of the necessity of compulsory examinations provided under the law Thereupon it becomes the duty of every employer in the named occupations to provide prior to employment or within thirty days after employment a medical examination of all new and prospective employees to determine if they are in any degree affected by silicosis or asbestosis Failure of an employer to provide such examination constitutes a misdemeanor and is punishable as such In cases of silicosis or asbestosis the term disablement means the event of an employee becoming actually incapacitated because of silicosis or asbestosis from performing his work in the last occupation in which injuriously exposed to the hazards of silicosis or asbestosis or from performing any work in any other occupation for remuneration Disability means the state of being so totally incapacitated B. Amendments to State Workmen's Compensation Acts New York State amended its compensation act to increase the maximum aggregate compensation payable for total disability or death due to silicosis from 6,500 to 7,500 The act contains the escalator clause increasing the total amount of compensation payable for disablement or death at the rate of 50.00 per month C. Summary of States Wherein Occupational Diseases are Compensable There are now sixteen states the District of Columbia one territory and Federal jurisdiction wherein the Longshoremen's Act is applicable providing general coverage for all occupational diseases There are seventeen states and one territory wherein schedule coverage is provided for named occupational diseases Therefore in thirty states as well as the District of Columbia Hawaii and Puerto Rico occupational diseases are now compensable Compensa- for Compensation is also provided by the Federal Employees tion Act and the Longshoremen's and Harbor Workers Act Under the laws of eighteen states compensation payable for dust diseases is limited with respect to the employer's monetary liability and in twelve states compensation the dust diseases is payable only for total disability or death 1. California Connecticut Florida Illinois Indiana Massachusetts Michigan iMnigntnoensaontda WMiissscoounrsiinNebraska New York North Dakota Ohio Oregon Wash- 2 Hawaii 3. Arizona Arkansas Colorado Delaware Georgia Idaho Kentucky Maine Maryland New Jersey New Mexico North Carolina Pennsylvania Rhode Utah Virginia and West Virginia Island 4. Puerto Rico 5. 5. Arizona Arkansas Colorado Florida Georgia Idaho Maryland Michigan Minnesota New Jersey New Mexico New York Massachusetts vania Rhode Island Utah and West Virginia Oregon Pennsyl- 6. Colorado Florida Idaho Maryland Massachusetts Michigan Jersey New York Ohio Pennsylvania and Utah Minnesota New 66 II CODES OF INDUSTRIAL HYGIENE In any discussion of legislative provisions dealing with compensation the of occupational diseases there has been considerable controversy as to form of legislation providing such compensation However upon one sub- ject there seems to be general agreement among employers employees and their insurance carriers this is that occupational diseases can be and should be prevented Industry has become health conscious and realizes that it has become good business to prevent the incidence of disease rather than to pay compensation for such injuries Since the enactment of occupational disease compensation statutes there has been increased activity among State Departments of Health State Departments of Labor and Industrial Commissions to effect the regulation and control of occupational hazards - to prevent disease Various State Codes of Industrial Hygiene have been promulgated and in many instances adopted and it is probable that in all of the industrial states necessary legislative provisions will be enacted to enable proper state agencies to establish such codes Mr. J. J. Bloomfield of the United States to submit a report at this meeting outlining hygiene in the various states I would Public Health Service is going in detail the codes of industrial like to make general reference to authority adoption these codes and to discuss briefly the legal for their their scope and bject matter with brief comment with respect to admin- istration There are thirty states that have codes of some type which are attempt presently effective None of these are uniform They represent the of individual State Departments to promulgate rules and regulations for the control of occupational hazards in a manner that seems proper to the applicablpear- ticular state agency involved In form some of these codes are aplicable only to specific industries as for example the codes in New York perSmtiasstieble permisble other states the codes are inclusive of all industry establishing permissible concentrations of dusts fumes gases and vapors without specific reference to a named industry codes I think it may be fairly stated that many of these while well intentioned were adopted without full consideration of the various problems of industry to which they would apply In many instances they establish arbitrary standards of permissible concentrations of toxic dust fumes exce ding gases and say to industry Thou shalt not permit concentrations exceeding a stated limit In most instances the codes do not attempt to advise industhat try of the way and means to accomplish compliance It is submitted assist one of the functions of Bureaus of Industrial Hygiene should be to assist industry to control occupational hazards and to find the best method for compliance Authority for Codes The legal authority for codes may be found either in the constitution authorizing of the state or specific legislative provision the creation of Bureaus of Industrial Hygiene and the grant of authority to such Bureaus 1. Alabama ACnlaaebrsaomolatianIdaahoSouth DaIlkinooista Dakota Tennessee Pennsylvania New Mexico New SMiochiuganth CNaorrot-h Carolina Arizona Alabma Massachusetts Arizona Arkansas California California California Colorado Colorado Colorado Indiana Kentucky Maryland Connecticut Maschusets , Mississippi Missouri Nebraska Michigan Michigan Flor-Flor- MinMichigan Dakota Dakota Ohio Oregon Pennsylvania Island Wisconsin Wisconsin Vermont Virginia Washington and Wisconsin 67 oN Depart- to formulate codes or the powers incident to the functions of State ments of Health Labor or Industrial Commissions Most of the codes establish maximum allowable concentrations of toxic materials with penalty provisions for failure to comply Enforcement is generally given to the State Departments of Health Labor Bureaus of Mines or Industrial Commissions In most instances no specific provision is included for methods by which industry may attain compliance In the administration of these codes it would seem desirable for the administrative agency to cooperate with industry in the attempted solution of industry's problems by educational processes rather than by police enforcement of the penalty provisions - poration and the United Automobile Workers CIO we find the following incorporated as paragraph 146 of that agreement A report of physical examination and any laboratory tests made by physicians acting for the Corporation will be given the personal physician of the individual employee involved upon the written request of the employee Again in an agreement dated March 13 1945 between Carnegie Illinois Steel Corporation and the United Steelworkers of America- CIO we find Industry has accepted its responsibility to provide its employees safe places in which to work and safe tools with which to work Management is not indifferent to health hazards and is seeking to attain effective enginerring methods to control hazards Many problems are presented in the perfection of such methods and these cannot be and will not be solved overnight Changes in industrial processes and newly developed uses of chemicals and other toxic materials will continue to create new problems for the con- trol of hazards Some large industries have adequate engineering and personnel to study these problems and control potential hazards small industries do not have available personnel for this purpose staffs Many The primary object of Bureaus of Industrial Hygiene is to correct hazardous conditions in industry and by assisting management in the discovery correction and control of hazards this purpose will be achieved If admin- istration takes the form of an educational program I believe that industry will gladly cooperate and the results obtained will be more effective than any other manner It is unfortunate that there is not greater uniformity in the state codes presently effective Under the leadership of the United States Public Health Service it should be possible to prepare some uniform code that would be suited to industry of all industrial states If this were done the codes now effective could be repealed and the proposed model code enacted With the cooperation of employers employees and the state agency administering the codes occupational hazards could be reduced to a minimum and diseases practically eliminated III HEALTH CLAUSES IN UNION CONTRACTS This subject is one of increasing importance and emphasizes the role of industrial hygiene in labor relations Perhaps detailed discussion of the subject would be more appropriate in meetings that are devoted to a con- sideration of industrial relations It is not the purpose of our Committee to recommend the inclusion or exclusion of clauses of this type and we believe it will be of interest to members to consider certain provisions that have been included in contracts which have been published and are fairly representative of the trend of clauses now being considered by Departments of Industrial Relations In the agreement dated March 19 1946 between General Motors Cor- 68 Section 12 dealing with safety and health provides as follows The Company shall continue to make reasonable provisions provisions for the safety and health of its employees at the plant during the hours of their employment Protective devices wearing apparel and other equipment necessary to properly protect employees from injury shall be provided by the Company in accordance with the practices now prevailing in each separate plant Proper heating and ventilating systems shall be installed where needed a In the agreement dated July 6 1945 between Industrial Silica Corpor- ation and the United Steelworkers of America we find the following sections under Article 14 dealing with the subject of physical physical examinations Section A. Conditions of Examination It hereby mutually understood and agreed that the Corporation shall have the right from time to time to require employees at its own expense to submit to medical and physical examinations by physicians or specialists of its own choosing and to terminate or suspend employment of any employee or transfer him to another department with safety at the time which could if such examination shows that said employee cannot satisfactorily continue the kind of work he was doing of such examination or is suffering from any disease be communicated to the other employees Section B. Effect on Employee No such employee shall be permanently laid off suspended or transferred as the result of any such examination until he has been given five 5 days written notice of the intention of the Corporation so to do and the records of the Corporation with respect to any such examination shall be open to inspection by the employee's personal physician upon the written request of the employee In certain instances representatives of labor have made public statements in opposition to requirements by employers for employment physical examinations as a prerequisite to employment Similar opposition has been expressed with respect to recurring annual physical examinations You will recall previous reports of our Committee pointing out statutes of various states under which in certain occupations employment physical examinations were required by law and in which annual recurring physical examinations were similarly required Certainly in those industries where potential hazards to health exist one of the most effective methods of con- 69 trol of the incidence of disease is the use of physical examinations to determine whether or not the claimant may be suffering from or peculiarly susceptible to a given occupational disease and for his own protection and that of his fellow workmen it is desirable that he should be excluded from such employment Furthermore the use of annual physical examinations in certain industries may well develop information as to the incidence of occupational diseases and protect employees against potential disability or ultimate serious illness While the use of physical examinations may have been and be may abused they are certainly desirable for the promotion of programs of medi- cal control With respect to the employment of physically handicapped employees such examinations are essential to the proper placement of these individuals so that their ability may be evaluated and they may be assigned to do those jobs where they are best fitted Conclusion During the year 1947 the Legislatures of all of the States of the Union will convene except Kentucky Louisiana Mississippi and Virginia It is to be anticipated that legislation relating to amendments to existing workmen's and occupational disease compensation acts will be introduced and in many states enacted Our Committee suggests to members that it will be to their interest to follow these legislative sessions with care to see that whatever provisions may be adopted are reasonable and suited to their industrial operations The promulgation of codes by the various states will proceed and it is reasonable to expect that Bureaus of Industrial Hygiene will increase their activities in an attempt to eliminate potential hazards and assist industry in effecting control of health conditions Much has already been accom- plished in the field of industrial hygiene Much remains to done Let no member company minimize the importance of this subject and let con- stant care in your operations be your watchword so that industrial accidents and diseases may be kept at an absolute minimum 70 CODES FOR THE PREVENTION AND CONTROL OF OCCUPATIONAL DISEASES J. BLOOMFIELD One of the major causes of lost time in industry is workers ill health some of it caused by physical conditions in the job environment Although industrial hygienists now have the techniques to prevent almost any kind of occupational disease unfortunately the application of this knowledge has not progressed as rapidly as it has been acquired The problem then is the promotion of industrial hygiene techniques so that they reach every industry in the country One effective means of disseminating and applying information en good industrial hygiene practice has been through the promulgation and administration of reasonable rules and regulations designed to set forth systematically the principles involved in such practice Such rules and regulations or codes as they are sometimes called can be of significant aid to industry in achieving safe and healthful working conditions if they are based on scientific fact are practical and adequate It is the purpose of the present discussion to examine the subject in the light of recent trends in the enactment of codes by the States The major features of a code are also discussed on the principle that their aim should be to inform management what its responsibilities are and how safe and healthful working conditions may be achieved Present Legislation on Prevention One of the inherent weaknesses of nearly all occupational disease legislation enacted to date in the United States is the omission of any provision for the prevention and control of occupational diseases In nearly every instance with but three or four notable exceptions the desire has been to provide compensation for occupational diseases whereas the prevention and control of such diseases should really be one of the prime considerations As a matter of fact even in those States where the laws make some provision for the prevention and control of occupational diseases unsatisfactory conditions exist simply because the powers and duties in this field are assigned to several state departments In many instances the laws are so worded as to be vague and indefinite and what is most discouraging they do not provide the essential machinery for an effective control program Everyone will concede that no matter how well a code has been developed its provisions are completely nullified unless the State has set up a tech- nical agency to administer such a code Such a technical agency is one staffed with trained industrial hygiene personnel who can develop the necessary standards based on scientific fact investigate the working conditions in industry in the light of such standards and then aid industry in attaining these standards In view of these facts it may be well at this point to examine the development of industrial hygiene in this country and the part which industrial hygiene divisions have been playing of late in the promulgation of industrial health codes Assistant Chief Industrial Hygiene Division U.S. Public Health Service 71 departments The growth of industrial hygiene activities in our state governments has been phenomenal during the past decade largely through the given to this program among the states by the U. Public impetus which has assisted the states both Health Service financially and through technical con- sultation services At the present time there are 41 states with time industrial hygiene activities several large cities and counties as well as territories In all we have 52 industrial hygiene units and unquestionably there will be industrial hygiene services available to industry in state and territory in the Union within the next every year or two Since industrial hygiene in its broad interpretation is conceded to be an integral part of public health the development of such services in this country has been largely in state health departments At present there are 50 industrial health units in health departments and two in labor If we examine Table I see pages 80 81 82 which summarizes indus- trial hygiene activities and the trend in the development of industrial hygiene codes we will note that the basis of authority for carrying industrial hygiene activities in the 50 health on between departments is evenly divided specific legislation and that emanating from the broad given to health departments in their organic act With powers labor departments specific legislation has been enactedregcahradrgtiongthethtewsoe departments with the responsibility of carrying on certain activities in the industrial hygiene field We also find that among these 52 industrial agencies only 35 have promulgated rules and hygiene regulations or codes for the control and prevention of occupational diseases Codes Variable in Nature A close study of these 35 codes shows a visions It is obvious that great divergence in their pro- large industrial concerns operating in several states must find it difficult to develop a policy on safeguarding the health of their employees In 17 states obviously there are no guides to follow while in the 35 states which do set up certain criteria we find that these are variable in character For example a study of Table II which is an analysis of the 35 code provisions shows that most of the codes make some reference to maximum allowable concentrations of atmospheric contami- nants In 49 of the states these M. A. C. values have legal status while in 51 they are merely suggested guides Only 6 of the states deal with prevention of disease through skin contact while none of the codes so far examined by us deals with the prevention of infection from certain materials employed in industry Forty contact with of with the subject of illumination and 37 percent the codes deal have some provision as regards temperature humidity and air movement Only 6 of the codes deal with the subject of noise while not a single one covers the effects of on health Twenty percent of the vibration codes deal with the subject of excessive pressures 12 with radiant energy 34 discuss the personal protective equipment and 57 subject of housekeeping The two subjects receiving most attention in the 35 codes which have come to our attention are ventilation which is a subject dealt with in 72 of the eral sanitation which is found in 83 of the codes and gen- codes It is patent therefore that the entire situation with trial hygiene codes leaves much to be desired in the way of ruengiafrodrmtiotyinaddues-- quacy and preciseness as to administration In summing up the entire Sy subject the major weaknesses of present codes as we see it are 72 TABLE II ANALYSIS OF STATE INDUSTRIAL HYGIENE ACTIVITIES CODES AND THEIR PROVISIONS Total number of industrial hygiene units 200000000... . 52 Agencies conducting industrial hygiene activities Health departments 00.0000 ccc cece cee cceneteeecertetnee 50 Labor departments o....0ccccccceeeeeeee 2 Authority for carrying on industrial hygiene activities Health departments Broad a power beets a . 25 b Specific legislation ...0000000... 25 Labor departments Specific legislation ......... Total number of codes ........... 35 Code provisions 1 Maximum allowable concentration Percent a Legal status b Guide oo... btetetttttteetsts 2 Skin contact 0. . rn 49 bee ce eeeeee 51 Lette 6 3 Infectious material 0 4 Illumination cec cee ce eee eens voletenerteees 40 5. Temperature humidity air movement 0.000000. 37 6 Noise ccec ccc ceeetce cec vetteuertvinarvareesse vetevetevatenessieess 6 7 Vibration ccc cette ceersecrssvessvssesevesvssevertees U 8 Pressure ccc ccc cee ene nsesteetessevaveanretaveeeveeeecse: 23 9 Radiant energy cece ccc ocec eecsetevetteceseeces en 12 10 Ventilation 72 oo cccccccsceeeesensscssneseeeeeestevcesees 11 Personal protective equipment See ceb cee epee te eteeeeettitecee 34 12 Housekeeping oct eee eenee cetee cece cet ntvaeveseeees 13 Sanitation cece cca eceeetee cece se ve cetsenseeetsireevees . ... o 1 our present state laws give authority to several agencies in the field of rule making and enforcement which makes for confusion and at times duplication and conflict among the several agencies 2 17 of the states have as yet not set up guiding principles to assist industry in achieving good working conditions and 3 the codes which have been promulgated to date are inadequate in providing any specific information which would show industry how it can comply with the rules and regulations promulgated What we need in industrial hygiene today and we need it badly is a code which would be patterned after the U. Public Health Service Stand- ard Milk Code This particular code which was developed after many years of arduous effort contains but one page in the way of an enabling ordinance but approximately one hundred pages of detailed and specific information which shows clearly what the milk industry must do to comply with the ordinance For these reasons it may be well to consider the possibility of orienting our thoughts regarding codes in industrial hygiene as to their purpose and content Principal Features of a Code In our opinion the main purpose of a code is to provide reasonable guides or principles which would enable industry to maintain the health of its workers at a high level If a code is to accomplish this purpose it must also be reconciled with the chief aim of industry which is to turn out and services in the most efficient goods way possible so as to achieve maximum production at minimum cost To accomplish all this a code of the envisaged in this discussion should contain rules and regulations for the tpyrpee- vention and control of occupational diseases This should be the first section of the code and should be brief and the terms well defined of the code would be in greater detail and would The second part repeat the rule state the public health reason behind it and then show industry how it can satisfac- torily comply with the rule by an informative discussion of the subject at hand Perhaps this will be made clearer if we indicate some of the contain principal features which such a code should In the introductory material to the code itself there should be a definite statement indicating the authority or law behind the code The the code should be stated and the industries to which the code purpose of code should contain a statement as to who is to administer it inaoptphleireswoTrhdes the enforcement agency should be named It should also contain a provision for appeal or a modification of any of the rules when conditions such action and a penalty for violation of of the rules warrant any This material should be followed by clear definitions of the various major terms throughout the entire code employed What Rules Should Cover The rules themselves should cover the following subjects which be conveniently divided into two parts Part one of the rules can with those regulations pertaining to environmental hygiene whileshtoheulsdecdoenadl part should deal with the hygiene of the individual In this way all factors involved in industrial hygiene practice will be treated Under environmental hygiene regulations the rules should cover such subjects as 1 maximum allowable concentrations for atmospheric contaminants 2 skin contact with hazardous materials 3 infectious materials 4 illumination 5 1. Public Health Service Milk Ordinance and Code 1935 Service Public Health Bulletin No. 220. July 1935 U. Public Health 74 temperature humidity and air movement 6 noise 7 vibration 8 ab- normal atmospheric pressure 9 radiant energy 10 ventilation 11 per- sonal protective equipment 12 housekeeping and 13 sanitation Part two of the rules dealing with personal hygiene should contain material on 1 first emergency services 2 prompt and early treatment of all illnesses resulting from occupational exposures 3 impartial health appraisals of all workers 4 recording and reducing absences due to all types of disability and 5 health education programs The last part of the code and the one which will require considerable detail and needless to say careful thought effort and much labor will be that portion dealing with the legal interpretation of the rules or better still information of the most date character which would actually show how these rules can be met through good industrial hygiene practice Controversial Features Perhaps one of the most controversial features of present codes has been the matter of maximum allowable concentrations and the divergencies in the limits set among the various states which have labored with this subject It seems to us that one of the first considerations among those whether responsible for the development and promulgation of codes is we are going to consider merely the toxicity of substances when setting a limit or if attention will also be directed to their nuisance aspect This is espe- cially applicable to those fumes smokes gases vapors and dusts that are not necessarily toxic in nature and to other contaminants which may be present in nontoxic concentrations We as industrial hygienists feel that our job is not only to prevent injury to the worker's health but also to make him reasonably comfortabalned efficient in his work environment It is in this border stage that the most controversy exists that is where there are incipient poisonings of physiological responses causing discomfort and unpleasantness but not necessarily injury to health Enlightened management finds it good operating practice to control the working environment so that even the mild physiological responses that are causing discomfort are kept at a minimum In fact it is a good practice to keep them at a minimum because quite frequently such uncomfortable conditions make a worker accident as for example when a worker becomes inebriated from inhaling trichlorethylene or petroleum solvent vapors Certainly no one in industry has questioned for example the standard universally adopted in this country for chromic acid mists resulting from chromium electroplating operations These mists do not cause systemic injury but do produce under certain conditions irritation of the mucous membranes and destruction of a part of the nasal septum Through| educational efforts within the electroplating industry itself it has been a relatively simple matter to obtain good operating techniques so that chromic acid levels are kept well below the point where these minor injuries and discomforts can occur At the present time there is a committee within the American Conference of Governmental Industrial Hygienists which is concerned with developing maximum allowable concentrations which can be adopted by all the states This committee recently inquired into the subject and at the moment has received replies from 24 states and three cities as to maximum allowable concentration values Table III shows the variation of maximum allowable concentration values among these 27 jurisdictions for some 21 75 Number Number Number Number ee Value SIT 300 300 thir ttirad Value Number wee ee wee Number REPOTING || || | || Reporting Value ppm 1000 1000 500 1911811 CITES Value 1000 1911811 3 Agencisof STAES Number AlConocweatbraei24 Number 06 62 Number 13 | TT 16 16 12 23 1 14 Number an Value 'SR 500 2288 2 8 Value Value 5000 5000 1700 2288 2 8 5000 and VALUES Reportd Maximu Number Number Number 17 20 [| 128 III Values Value ppm 100 1000 1000 Number CONETRAITABLE Number Value * Value 400 500 100 Value 2080 2080 ALOWBE volume values reported 13 21 mr 20122 651 by repotingvalues No air of . - . MAC parts Established Established Established values MAXIU Agencis values | 224 215 21 22 22 milon OF Established per ....... SUBSTANCE acetate ff disufide Formaldehyde chloride oxides dioxide VARITON | chloride dioxide subtance bromide SUBSTANCE acetate terachloid SUBSTANCE acetate bromide chloride dioxide SUBSTANCE acetate bromide dioxide of SUBSTANCE SUBSTANCE BP utah nol o Carbs on p Fluorine MGaesoh tlehneanPoli hNaophthsan pNitrPobenzenhhoPsihe posnhpihiennee Naphtha Nitrogen Sulfur Parts Amyl Ethyl Fluorine Methanol Naphtha Phosphine Turpenti Xylen Carbon Amyl Phosphi Phon sphe ine Methyl * 76 2. commonly used substances in industry In most cases the variations are not too great and it is felt that perhaps too much emphasis has been placed on this point In those instances where there is a divergence the error has been on the safe side For example in dealing with the highly toxic substance of benzene of the 27 jurisdictions which have reported to the committee 25 had established values and two had none Of the 25 which had established a value for this substance 17 used the American Standards Association value of 100 parts per million while & used the slightly lesser value of 75 parts per million Again with regard to carbon tetrachloride a substance which has received considerable attention of late and one on which it has been difficult to obtain unanimity on a threshold value we find that only one of the 27 jurisdictions has no value for this chemical while 26 have established a criterion Of these 26 14 employ the value of 100 parts per million five use 75 and seven use 50 parts per million Altogether there are not too many substances which we find have variable limits among the states whereas on the other hand there are many materials for which there is complete unanimity Among some of the commoner toxic substances employed in industry such as lead mercury TNT zinc oxide and cadmium there is complete unanimity among the states as to maximum allowable concentrations for these substances See Table IV Realistic Approach It is our desire to emphasize the need for a reanstic approach to this whole subject To begin with we feel that there is a definite responsibility upon the governmental agencies administering industrial hygiene to establish M. A. maximum allowable concentration values only after a great deal of study and thought have been given the subject So far on the whole these have been established in such a manner as to cause no serious handicap to industry Furthermore administrative agencies should realize that the determination of whether a working condition is safe or unsafe depends on other factors besides that of maximum allowable concentrations in the atmosphere Of late more and more reliance has been placed by industrial hygienists upon the exposure determinations alone without regard to other factors in the working environment It seems to us that before an industry is told that it should make certain provisions to control a condition suspected of being inimical to health a complete health survey is in order Such a health survey should involve at least two criteria in determining the safety of an operation First it is essential that the health of those workers exposed to a certain material or condition should be carefully inquired into This may involve not only an examination of the worker's health record but also an examination of the worker himself Second careful environmental studies should be made which would not only include certain determinations of the atmosphere but also a thorough sanitary survey and occupational analysis All these put together should yield data of real value in helping to control industrial health hazards Developing Standards At the present time we have several agencies concerned with the development of standards on limiting atmospheric contaminants All of us are familiar with the splendid work of the American Standards Association on this subject The American Conference of Governmental Industrial Hygienists whose membership consists of those responsible for administering indus- 77 TABLE IV MAXIMUM ALLOWABLE CONCENTRATION VALUES FOR ange WHICH GOOD AGREEMENT EXISTS Gases and Vapors Number Substance Agreeing Acetic acid ooo. 3 Number Disagreeing 0 oo... Acrylonitrile cece. 12 0 ooo Ammonia cccccccccseeeeee 21 0 Aniline oo ccccsscseseecece.. 22 0 Arsine ccc oo cccl scescasees. 21 1 Carbon monoxide ......... 27 0 Chloroform ......... 9 1 nitropropane |... 4 0 Cyclohexane ................ . 3 0 Dichlorobenzene 21 0 1 Dichloroethane q 0 Dichloroethane ... 16 0 Dichloroethyl ether 13 0 Dimethylaniline 000. 11 0 Hydrogen chloride .. 24 0 Hydrogen cyanide 25 0 Hydrogen fluoride 25 0 Hydrogen selenide ...0 Hydrogen sulfide / 0 Monochlorobenzene 15 | Mononitrotoluene ccccececcessece. Phosgene Lc 9 0 23 0 Propyl ether . w 3 0 Styrene ccc ceecsceeceees 102 Tetrachloroethylene Toluene oo... w 1022 .. 1022 Trichlorethylene .... 24 1022 Percent Agreein 100 100 100 100 95 100 90 100 100 100 100 100 100 100 100 100 100 100 100 94 100 100 100 92 100 92 92 M. ppm 10 20 100 5 1 100 100 20 400 75 100 100 15 5 10 20 3 0.1 20 75 5 1 500 400 200 200 200 trial hygiene in this hemisphere has recognized the importance of the sub- ject of codes and has a committee working on the development of a uniform code one which could be adopted by all the states The Industrial Hygiene Division of the U. S. Public Health Service which is intimately concerned with the activities of this Conference as well as with the state agencies administering industrial hygiene is urging the development of a code of the type outlined in the present discussion Such a code will several years of effort although a considerable amount of ipnrfoobrambaltyiontakies already at hand for inclusion The main problem as we see it will be obtain unaniniity among the various states It is felt that if such a codteo is based on scientific fact and is so worded that it takes into consideration the various social and economic aspects of the problem then it should meet with great favor among the state agencies and the public This will be especially true if it is administered in a spirit of cooperation with ment and labor manage- Toxic Dusts and Barium peroxide ........... 6 Cadmium .............. 24 Chlorodiphenyls 12 Chromic acid 23 Dinitrotoluene .. Lead oo. 7 . 26 Mercury .............. tester. 22 Tetranitromethylaniline ....... 10 Trinitrotoluene Zinc oxide oo... see Asbestos o.oo. Fumes 0 0 1 0 0 0 0 0 0 1 0 Mt 100 100 92 100 100 100 100 100 100 95 100 Parts of substance per million parts of air by volume Milligrams of substance per cubic meter of air t Millions of particles of substance per cubic foot of air . 0.5 0.1 0.1 0.1 1.5 0.15 0.1 1.5 1.5 15.0 51 78 79