Document 91pnzLVZqMYE4O2yypOmXR0xR

I .tention lo statis cctly. Get statis- show you where .--.causes it. . : can stimulate because deep man honestly beood as somebody how it. he meeting is ad- 1::. Occupational Diseases PLAINTIFF'S!^ EXHIBIT FRIDAY MORNING SESSION October 9, 1936 * The session was called to order by the chairman. Dr. Hart E. Fisher, Vice-President for Health, National Safety Council, and Chief Surgeon. Chicago Rapid Transit Co.. Chicago, who presided, introducing The speakers. The Lesser Known Facts About Common Occupational Diseases By DR. ROBERT B. HUNT ' , Medical Advisor, American Mutual Liability Insurance Co., Boston Probably the leader in the parade of industrial diseases is an acute or chronic inflammation of the skin which we call dermatitis. This disease may present it self in any t>pe of shop, factory or foun dry. Any paste, powder, gas or liquid which comes in contact with the em ployee's skin, even the water supplied by the town in which he lives or works, may be the potential cause of such a skin disturbance. The wide diversity of causes together with the varying susceptibility of differ ent individuals makes the problem of control difficult. Much investigation is under way to determine why one person may be sus ceptible to a certain substance while arvothcr is not. It lias been proved many times that a poisonous substance formed within the body has been able to prolong the action started by some external influ ence. A printer developed a marked dermatitis from ink which persisted for two years. Finally food tests were made and showed that he was susceptible to lettuce, which, when removed from his diet cleared the skin. He returned to his usual occupation without a return of symptoms. The poisoning of allergic substances is usually an accumulative process. It takes time to produce a manifestation of dis ease, but let any other substance cause the disease, and the irritating food may be of sufficient strength to magnify its action. All cases of dermatitis cannot be cured by eliminating offending foods, but fur ther investigation along these lines may give us a clue with which to lessen the loss of time from work and the discom fort now produced by industrial derma titis. Lead Metals The distribution of lead poisoning is quite extensive. . The skin of the body is a protective covering, and as long as it remains in tact it docs a good job except ir. the case of tetraethyl lead, which is used in blend ing gasoline and which is readily absorbed . through the skin, having a tendency to create changes in the nervous system. The effect of other forms of lead, through that avenue of entrance, is practically nil, which explains the extremely low poisoning rate in typesetters, painters and others who continually come in contact with metallic lead. Lead in any form, introduced through the mouth, acts rather slowly when com pared with the inhalation of lead dust or fumes. However, no matter what the portal of entry may be, lead is acted upon by the body fluids and so converted that it may eventually be deposited with in the bones. . Those bony safe deposit vaults may retain their lead contents for days or for years, and if the exposure is removed, may also free the employee of all signs im um iii* distillation arc frequently combined tii those from coal tar to form valua chemical combinations. They have n placed on the market so rapidly t medical science has been unable to others' of the danger. Even if removed from the poisonous gas at that period, the damage actually done by the gas may result in permanent physical damage. ermine their physiological effect upon health of man. We have known that Infection no of these chemicals arc capable of ating changes in the liver, and only ently in a city in Massachusetts one licse newer products caused the death two employees and a battle to retain among two others. The skin is a protective covering of the body against infection and is ex tremely efficient as long as it remains in tact, but allow it to be broken or punc tured, introduce bacteria, and a battle ensues between the offensive agencies of infection and the defensive powers of the Carbon Monoxide mi remember the adage. "Where body. The winning of such a struggle may determine the presence or absence of incapacity. Infections are common e is smoke, there is Arc." We might throughout industry, hut two types are to that, "Where there is Arc there is particularly prominent -- infection result ion monoxide." ing from anthrax and infection among Ins odorless but poisonous gas may ir in any industry or in any borne, but poorer the ventilation the better the :cc of producing physical incapacity, nee the advent of the motor car, se exhaust pipe may pour forth as as C% of carbon monoxide, we are exposed to that gas, particularly in ded cities. The ordinary passenger liberates about two cubic feet per ite, and one can readily estimate the ical damage that may he done if a motor is allowed to run within the s of a poorly ventilated garage or . Fortunately, serious eases of such ming arc not common among those oyed in public garages, hut many of employees arc likely to complain adachc and faintness at the end of a work, especially in colder weather i doors ami windows remain closed, the steel industry, where gas is used ic heating agency in the blast fur . care must he used to provide r ventilation. Within the mines, meat packers and fishermen. Many of our fur, hair or wool-covered animals may contract anthrax. The germs of that disease defy the ordinary methods of sterilization and may linger on hides, bristles or hairs for long periods of time. Tanners, wool sorters, and hair or bristle workers may introduce the anthrax spore beneath their skin and undergo much physical suffering and sometimes death. Infections arc frequently found among meat and Ash packers ami those engaged in deep sea Ashing. Although death rarely occurs, the loss of Angers, hands and nasty septic wounds arc the result. Punctured wounds, cuts, abrasions, burns and scratches arc potential avenues of entrance for bacteria which would seem to be waiting everywhere at all times for such a break in the skill. Early medical treatment might often save later ' surgical interference, not to nlvnlion the accompanying discomfort, incapacity and perhaps the loss of an essential body part. ers arc warned to allow1 enough time ving blasts for the escape of this ug a colorless, odorless and taster pas, quick of action within the hti- hody, the manifestation of the very symptom may he too late to save a nan from partial or total incapacity rhnps death. ausc the exposed person suffers from motor paralysis, In: may be to help himself or even to warn Ibusiness' ? 2. flow will your' piodwit affect the bealii: of ::i.v enffdoyew? ^-Thai employer is to honest wti j>i:rs:oh>g?e:d csa!ii:n.vmr:;H of the (ji.wstiO'Wi'W product. That mr.imf-ir.-nec should lie held responsible for the ills produced by the use of bis product and unless he can guarantee its safety, it lias no place in industry. Too many lives have been lost nr jeopardized by too little knowledge of a product's action upon those who handle it. The incidence of lost time due to ill ness and injury in industry has been greatly lessened by the many agencies working along lines of safety. When in dustry has been made tool-prod iy t le substitution of non-toxic preparations for those now found to be harmful, aid when each employee is imbued with the 'idea that constant thoughtfulness and care are most 1 necessary for the maintenance of health and happiness, then, and not un til that idealistic stage has hern reached may vigilance and perseverance to main tain and preserve health, limb and life he lessened. Pre-Employment Examination as an Aid to the Control of Industrial Diseases By DR. W. C. TEMPLER Medical Director, Corning Glass Works, Corning, N. Y. We may well ask whether or not phy sical examination is of any value to the world at large, rather than limit the dis cussion to the control of industrial di seases. In the conservation of life and health much progress has been made in the eradication or control of such diseases as occur in epidemic form, as well as that type of disease which is not truly epidemic, but occurs in such frequency that general health programs are neces sary. Much has been done to control such disabling illnesses as heart disease, artcrio-sclcrosis, kidney disease and dia betes; and something has been accom plished in the control of morbidity, which tends to, at least, make people happier through good health, even though an in creased span of life is not gained. I'liysical examination has played a large role in accomplishing these things, be cause it was through physical examination and physical observations that investiga tors were led to exert themselves to And a remedy for the cause of such condi tions. Small-pox is no longer prevalent, due to such observations, which led to its control by vaccination. Malaria and yellow fever have been brought largely under control, and knowledge is now available in the control of venereal di seases, if the proper physical examination and laboratory methods arc used to arrive at a diagnosis. We arc all familiar with the results obtained in decreasing the death rate due to tuberculosis. In fact, in (lie treatment of all epidemic-typo diseases that have so far been eradicated, the examination of patients to determine the severity of symptoms and the im provement has been of foremost value. Knowing that the average span of life lias been increased eight years in the last quarter century and assuming that the above mentioned factors have had some hearing on it, could we decry the value of physical examinations for tjie general population? If we know that examinations made by insurance companies and their associating examining institutions, the clinics run l>) the United States Public Health Service, and the great mass of physicians, who all carefully examine their clientele, have been of value in the control of disease, may we not assume that examinations In industry will help control the incidence and extent of industrial disease, particu larly when the life expectancy of in dustrial workers is less than that of the general population? In fact on April 14, 1936, at the Na tional Conference on Silicosis and Similar Dust Diseases, called by the Secretary of Labor, Dr. R. 11. Sayers of the United States Fublic Health Service said, `Tre liininary and periodic physical and rocnl gcnological examination should he madof all employees engaged in industrial processes where there is a potential i' I actual exposure to excessive concen sus of silica in the atmosphere." must be correlated as to time spent in the hazard, although a period of one year aurally in the early work of industry, is, perhaps, proper for persons who feel basic materials were used, ingredients in good health and have no complaints, not arrived at a state of development or who arc not working in toxic sub complexity, when intricate chemical stances or with other materials which omuls and other toxic mate.rials were would under some conditions impair their known of, much less Used. At the health anil usefulness. ut time over 500 materials are listed The objectives of pre-employment and )i can, under certain conditions, cause post-employment examinations arc the trial disease and the list is hy no same, that is: the establishment of a ; complete, inasmuch as experimental physical standard in which (he employee is being done by the personnel of can pursue his trade or labor; having no ieally every plant or industry to im- discomfort or ill clTcct due to industrial or enlarge its manufactured products exposure to harmful products. .Such king advantage of the great amount products and materials arc, as we have mwledgc science has given us. mentioned, of great number and variety. lustrial examinations arc of two Attempts have been made to classify . First, the pre-employment cx- workmen as to age, sex, color and na itiou, which consists of a very carc- tionality. Whether or hot any of these istory, not only of the family, Init of the previous occupations with li of service in each, previous health classifications arc of value, it still remains that the primary effort is to have healthy workmen and the benefit is of as great llnesses and present habits. Naturally a history is of no value unless truthgiven and a reasonable amount of value to the workman as to the industry. The benefits of individual and community good health arc numerous and obvious; must he taken to acquire details, i arc often vague in a workman's or considered by him to be uninint. The physical examination, of e, varies with the type of industry, hould be given with the knowledge at the man's exact occupation is to id by a physician familiar with the trial processes in which he is to be ycd. In this way selected employcan lie obtained for men who have basic disqualification for one job, Inch docs not impair their ability eful employment and the conserving dth iii another. physical examination must he igh. ft should include all methods termining a latent disability or one s already present. Many examinaorms are available from insurance mies or other health services, which been designed entirely for Industrial It has been the experience of men sted in this work, that all the special , of the body must be tested as well measurement of motion in all joints. :ardio-vascular system is of great tance as is the respiratory and -intestinal tract. examination and periodical checks, ,`c of particular industrial hazards, and the benefits of good health to industry arc equally important. The employee will he more productive, receive higher wages and be happier. The labor turn-over rate because of poor health will, be lowered as will the costs of insurance. The working personnel will be more efficient and con tented. and will dislike to be exposed to the overt acts of people who arc epileptic, insane or who disregard communicable disease, ami will use their endeavors to work safely among hazards they have been taught to respect. Tlic harmful exposure to each hazard is, of course, different, ranging from a few days as, for example, an acute poisoning from toxic gases, to that of 15 or 20 years in some of the less toxic dusts; therefore the period before re-examination for each class of employee will be dif ferent. However, individuals differ also and it is bard to stale a definite period which may be satisfactory for each em ployee in a single class of hazard. Super visors can often he of great value in send ing employees out for physical examina tion whenever there is a change in ap pearance or work ability, or when they have been off on account of some illness, such as those self-diagnosed as common cold, lagrippe, cough, sore throat or skin irritation. Such observations should be considered, where there is not a full-time physician, and they arc of the greatest value in the early determination of a susceptibility to or the beginning of an j industrial disease. We are fortunate in having had a large : amount of research work done on in- (lustrial diseases, until at the present time, materials from acetaldehyde to zinc arc. listed, together with the processes in which they arc used and the .symptoms which they cause, and an estimate of the amount of exposure in nearly every ease necessary to produce symptoms. It is really not too much of a problem for an interested physician to accumulate a sup ply of such knowledge, particularly when he kno-.vs the processes involved during the manufacturing procedure of his in dustry. ft (/ms becomes relatively a routine matter of observation, together with examination for specific signs or symptoms at the time of the periodical re-examination, to obtain some degree of control of the hazard. We cannot discuss the benefits of pre employment examination and periodic rc. examination without mentioning some of the objections to it. If a man has a dis ability, he naturally is anxious to keep it to himself, and in some eases we find ; that the workman is disinterested to a point that lie would rather not know of a disability even though he has it. Ccrtain social groups regard each man as i entitled to employment whether lie is physically fit or not, on the assumption 1 that industry hires labor, lint health, and that rejection because of physical dis ability causes a class of artisans to become ; prejudiced against and become charity 1 eases. It is also alleged that the quality | of medical service in industry is such ; that the results of examinations are inisleading and of no value. Another objcctinii is voiced hy labor unions, it being claimed that pre-employment cxnminat ions are used to discriminate against , labor union workers or members. Many ! labor leaders realize, however, that pre; . employment examination and periodical ; check-ups are the only means of prevent ing disability from certain industrial ; hazards. Competent and honest medical ; service renders all these objections quite impotent; for if an endeavor is made to properly place employees, such a small percentage is finally rejected, and that percentage is so obviously unlit to w..rk, that no fair-minded person can fall to sec the justice of it. These objections, however, are being noticed hy legislative bodies, and in one State a law is In force which snis: "It is hereby declared to he the policy of the legislature of this State, in enacting this article, to prohibit through every law ful means mailable, any requirement as a pre-requisite to employment which com pels an applicant Cor employment in any occupation coming within the purview of this article to undergo a medical examina tion." This statement is in a paragraph labeled, "I'revenlion of Silicosis and Other Dust Diseases," and the logic of it is entirely noil-understandable, even though at the present time there is no lawful means available to enforce the staled policy. If physical examinations are of benefit to the population at large, they certainly must be to the industrial workers, who may be exposed to special hazards; periodical - check-up examinations arc necessary in any hazardous work or trade, in order to protect the workers as well as the industry; and the benefits to the workers of proper and fair-minded ex aminations, in all ordinary cases, outweigh the objections. I have purposely omitted any reference to the economics of pre-employment and periodic re-examination, which apply either to the individual or the industry. However, one of the great public health problems of today is the question of the cost of medical care. If industry assumes some of this cost hy periodical examina tion in connection with the prevention of industrial disease, it relieves the individual of this responsibility and allows more room in his budget for the care of his family. The benefits to industry, of course, arc those of a better personnel and a lower rate of insurance. This rate, due to industrial disease hazards, is in many States very high and the logical conclu sion is that the real remedy lies in the prevention of industrial disease hy any method, otic of which, I believe, is preemploymnet and periodical examinations. : 9. What Can the Engineer Do to Eliminate the Hazards of Occupational Diseases? By REUEL C. STRATTON Supervising Chemical Engineer, The Travelers Insurance Co., Hartford, Conn. K I were asked, "Can the engineer prent tlie majority of occupational disease ses" my answer would be, "yes." Obmsly, with the exception of those -eases brought about through a sudden accidental contact with a poisonous itcrial or a virulent disease-producing nanism, if the exposure were controlled engineering technique, then there mid he no occupational disease. The engineer must rely upon the :dical director to place individuals i.ihlc of working in hazardous occupans and to assist hint in controlling sc individuals through periodic physical iminations when the men arc exposed occupational disease hazards; but the mincer alone is responsible for reducing leration of harmful substances and for control of employees' contact with -ccsscs using harmful materials. I'hc ascribing of many and new occupal.al diseases to industrial environment produced a problem for him. The ;iuccr generally works with materials ich he can see, but the study of in -trial disease control ntay require the idling of invisible materials. It is a imon fault to focus attention upon one ect to such an extent that others of al importance may thereby be relccd to obscurity. Today safety en ters and industrial hygienists are contrating their attention upon diseases red by the inhalation of dust, but I not believe the safety engineer is war ed in confining himself to the prevenof diseases caused by dust alone. His iidcration should extend to include all e-rials produced in any manner that may cause an effect upon a worker, question of whether a material exists gas, a vapor, or a dust is but one of iclc size and chemical make-up. e must not forget that many such iscs arc produced by exposure to >rs and gases as well as to dust, and the control of these industrial diseases be brought about by the application -rtain fundamental principles common l. . While the problem confronting indi vidual safety engineers varies according to the industry, there are certain funda mentals common to all such problems which provide a workable basis upon which an occupational disease prevention program may be developed. Once these fundamentals arc set in motion toward a safe working environment, continuance is much the same whether the engineer is engaged with a large organization or with a small one. The fundamentals follow this sequence: (1) An occupational disease inventory is required. (2) A plaii for correction of the ex posures shown by the inventory requires development. . (3) A concentrated attack upon the major exposures first, following through until all arc corrected or eliminated. An inventory of all materials used in a plant will astound the average engineer. He will find many items about which lie may have little or no knowledge. He may be confronted with items he had not recognized previously, even though lie has been associated with the plant perhaps many years. When this inventory is com plete, he should card index it, placing against the name of the material the health hazard associated with it both from a . material and a process viewpoint. Such a card index should contain the com ponent parts or constituency of com pounds. . Process exposures should he studied in conjunction with hazardous materials. Assistance in compiling such data may he obtained in the bulletin "Occupation Hazards and Diagnostic Signs," prepared by Dublin ami Vane of the Metropolitan Life Insurance Company, and in a publi cation of the United States Public Health Service, Public Health Bulletin No. 216, "The Potential Problems of Industrial Hygiene in a Typical Industrial Area in the United States." In addition the engineer should obtain all available information upon the ma terials he is required to study. New chemicals, solutions, dusts, degreasing agents, condensation products, paints, lac quers, dyes, abrasives, and other products the open air docs not always eliminate tiic danger; in fact, it may increase the number of workers affected. `* too numerous to mention arc being placed Process Revision. To .reduce transpor upon the market daily, and the average tation of materials and exposure to harm engineer's knowledge of their possible ful subst'anecs it is desirable to have all effects upon health is slight. Academic processes mechanically continuous and, if research determining the effect of these possible, enclosed. When this cannot he new materials upon humans is progressing accomplished, suitable physical divisions slowly, and serious injuries may lie sus should he provided. The engineer should tained in industrial application long before consider the substitution of wet processes the toxicologist is able to determine the for dry processes, providing at'the same properties of the material and the maxi time for the disposal of the moist col mum permissible amount to which a lected material in a safe place. He should worker may be exposed. In seeking this consider the substitution of automatic information it is essential to dclcrmiiic in so far as possible (lie maximum per missible amount of contaminants which operations for hazardous hand work or machine work. A change of abrasive material will often reduce the quantity of may exist in a work place without causing an occupational disease. Armed with this information, thfc en gineer is in a position to locale properly in his own plant the process and the operation in which the exposure may exist. The engineer should study together with the plant physician the length of employ ment of exposed individuals and they should jointly determine the normal ex pectancy or average length of employment for the specific exposure. From such data may be developed a factor of safety, and the maximum allowable period of em ployment in certain areas may he assigned. Naturally this study should, he focused upon the more hazardous locations first, and when these arc corrected, attention turned toward minor conditions. Housing. One of the most important considerations in attempting to control oc cupational disease is housing. Whenever practical, any hazardous manufacturing process should lie separately housed and isolated; every effort should he made to arrest harmful substances--dust, vapors, or gases--at their source of generation. dust produced. f can cite an example of how a little thought can cure a hazardous machine operation with little or no expense: A plant producing a finely pulverized material created large amounts of dust in bagging (lie material, using porous sacks. This high concentration of dust, not neces sarily toxic, inconvenienced the workers. The cost of ventilating the department would have been prohibitive. Bv careful study the engineer determined that the fall of the material into the sacks forced the air out through the interstices of the material, carrying with it a quantity of the pulverized product. Ilis problem, thus, was to provide a means whereby this air could he harmlessly expelled from the sack prior to filling. Study led him to suggest and apply the use of a collapsed paper hag which contained little or no free air. The problem was solved. Du-.t generation was practically eliminated bv this simple change. Many hazardouproccsscs in ordinary manufacturing opera tions may he cured in like maimer if tinengineer exercises his ingenuity. Buildings should he so constructed that Ventilation. Proper ventilation is oi accumulations of dust may be avoided. When physical separation of depart ments is required, such physical divisions should he dust or vapor tight. Floors should he tight to prevent transfer of materials to floors or departments below. The engineer should give study to the complete enclosure of machinery or process units as individual units and, if so required, vent each one separately. The transfer of hazardous operations into paramount importance in the control ol any occupational exposure. Most of the chief occupational diseases other than dermatitis arise through the inhalation oi the ingestion of foreign material. If veil tilatiug equipment can reduce the conceit tration of contaminating materials to safe limit, the problem is solved. The cn ginccr should study each process sop aratcly and ventilate each separately. 1 is seldom wise to rely upon general veil Twenty-fifth National Safety Congress tilation. Instead, high velocity ventilating apparatus should be installed, functioning as closely to the point of generation of the harmful substance as is possible. __ Individual machines should be so equipped if possible. Baffles may be in troduced to prevent air stream disturb ances or to increase the intake efficiency at the nozzle. Down-draft systems should be preferred for the collection of dust or gases of high specific gravity. Even after the installation of exhaust systems, the engineer must study the type of maintenance required to keep them operating at peak efficiency. Noz zles should not be permitted to become covered nor moved out of proper posi tion. Exhaust piping must be kept dust tight. Blower efficiencies must be con stantly checked to insure that intake ve locities are proper. The best ventilating system is a false protection if it does not function properly or if it is so poorly maintained that it falls below its designed rating. The engineer must exercise ex treme care to provide a clean source of replacement air for the work place. He may find it necessary to install filtering and heating devices. The engineer must study the proper disposal of the collected or expelled material to be positive it will not drift back into the w'ork place. Employee Protection. While the pri mary engineering means of protection against possible occupational diseases should be mechanical correction, the en gineer will find instances where even the best systems must be supplemented by individual protection. He must carefully study such exposures to provide the high est efficiency of protection, yet obtain a device easy for the operator to wear con tinuously. When the engineer has been successful in obtaining such a device, he must educate workers to use it. Sanitation. Clean washing facilities and toilets should be provided. Lunch rooms should be not only clean hut also well lighted and attractive and should be un der the supervision of the plant physician. Scientific Tests. Up to this point the engineer has deduced that an exposure exists, and from accumulated data has devised his means of prevention. How ever, the engineer interested in ascer taining not only exposure but also effi ciency of control should realize control cannot be fully effective nor the efficiency of any protective device determined with out scientific tests. Assumption, guess work, unscientific procedure or apparatus have no place in an engineering program. The engineer must test each step unless it has been previously proved, carefully cal culating in advance to avoid false protec tion. He must be familiar with dust counting, air sampling, and chemical analysis tech nique. having such determinations made by established and proper methods. If such tests are beyond the scope of his ability or equipment and if the engineer considers such tests absolutely essential, then his executives should permit him to obtain experts qualified to make such sur veys as his problem may require. The need for an accurate engineering approach to any control measure cannot be over emphasized. Conclusion. Every engineer realizes control of any industrial disease expo sure is divided, part of such control fall ing within the jurisdiction of the indus trial physician and part within his own engineering province. Medical knowledge is invaluable in the detection of early symptoms and in the administration of suitable preventive treatment. The en gineer should gladly obtain the services of an industrial physician to make a study of the plant, to assist in the classi fication of the hazardous operations and working locations. By such coordination he will speed control of the exposure. Each individual occupational disease exposure must be studied, analyzed, and controlled individually. While general data may be available upon common ex posures, the solution can be found oniy in individual treatment. Such exposures cannot be compared to ordinary safety engineering efforts. A "circular saw is a circular saw wherever it may be operat ing, hut industrial disease exposure varies within plants and certainly varies between different manufacturing establishments, even though they may produce a like product or article. ADJOURNMENT Th Chaii free tific winacrii cost mar. tha: unit' F and into Mafoui gem of . dat. safe str. whl reqi aci 1,:.>. rea lo'.:m- \\ testtiot om be!"