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FILE NAME Insurance Industry INS DATE 1940 June 8 DOC INS036 DOCUMENT DESCRIPTION Article from The Weekly Underwriter Underwriting Aspects of the Industrial Dust Hazard by Dr. Lanza TheThe Weekly June 8 1940 Vol 142. No. 23 Underwriter Underwriter Underwriter Mee Underwriter 5.00 per year : 4 3 , af Fao as PY; . va. . ISTERING HEAT REMINDER Vacations were in the mind of most New Yorkers the past few days due to the heat wave that suddenly hit the metropolis Over the past week folks were going about wrapped in overcoats but this excess attire was quickly retired to mothballs as the first days of the week produced the initial heat wave of the season Soon thousands will be enjoying their annual holidays at the shore or in the mountains The manner in OF FAVORITE VACATION which motorists gamble with the family purse by taking long trips without adequate liability insurance makes the underwriter familiar with accident possibilities shiver Personal accident protection is another sonal demand sea- Live agencies everywhere change their business solicitation campaigns with the seasons and reap many premium dollars by their enterprise The above scene is in Yosemite wy SPOTS 1412 Monthly Life Insurance JUNE 8 1940 The Weekly Underwriter . Department Underwriting Aspects of the Industrial Dust Hazard By A. J. Lanza M.D. Assistant Medical Director and R. J. Vane Statistical Bureau Metropolitan Life Address Before Medical Section of American Life Convention Colorado Springs Colo June 6 UR knowledge of health hazards re- O sulting from kinds of dust exposure to in industrial various occupa- tions is based on observation and clinical studies of workmen exposed to these dusts and upon noting the results of the action of these same dusts upon experimental animals The former method goes back for centuries and our earliest conceptions of the harmful properties of dust were based on first hand observation Many of these conceptions were erroneous It is only in the past twenty years that anything like a comprehensive knowledge of dust diseases has been attained first to the perfection of the ray as a means of diagnosis and the development of successful laboratory technique for conducting tests on experimental animals Now we have arrived at a point where intensive studies both clinical and experimental conducted in this country and in other countries have resulted in a crystalization of our ideas In the English speaking world the outstanding contributions to our knowledge have come from the South African Institute for Medical Research and the Miner's Phthisis Prevention Committee in Johannesburg from various official agencies in England and Australia in Ontario Canada and in this country especially the United States Public Health Service the United States Bureau of Mines and the Saranac Laboratory In presenting this discussion of industrial dusts their effects on workmen exposed to them and the bearing that this subject has on life insurance underwriting we have attempted to summarize what should be the insurance attitude based on the present state of our knowledge Briefly the present concept regarding industrial dust hazards is as follows Organic dusts of which the dust arising in textile operations is an example do not cause any specific pulmonary disease There is no clinical nor experimental evidence to the contrary Coal which is an organic substance is considered in connection with mineral dusts Organic dusts at times may cause an allergic reaction and also irritation of the upper air passages They do not cause protracted disability nor death In this classification may be included cotton wool silk sugar flour starch wood tobacco and leather It is true that some occupations in which is involved exposure to organic dusts manifest a tuberculosis mortality rate higher than the average Formerly it was thought that this undue prevalence of tuberculosis was due to the occupational dusts but the dust studies of recent years have demonstrated that mostly organic particles are too large to penetrate to the pulmonary tissue and when they do they are absorbed without producing any specific inflammatory reaction Nor is much credence given nowadays to the idea that organic dust particles convey tubercle bacilli to the lungs and thus cause tuberculosis Metallic Dusts Here the situation is not unlike that of organic dusts The prevalence of pulmonary disease among workers in certain occupations exposed to metallic dusts gave rise to the theory that metallic dust was a fruitful source of tuberculosis Such diseases as grinder's rot were recognized clinically long before the era of modern diagnosis and laboratory research Metallic particles in the form of fumes may cause such reactions as zinc chills or brass founder's ague which are more in the nature of an allergic reaction The pulmonary disease which afflicts grinders and buffers is silicosis and not in any way a result of exposure to metallic dust Metallic dust particles are mostly large and heavy that is comparatively speaking consequently do not penetrate to the lung in many instances and when they do they are either absorbed or remain fixed and inert in the tissues From an underwriting standpoint then the hazard of metal dust is the hazard of such silica dust as may be associated with it Coal For many years there has been a belief that coal miners had less tuberculosis than the average for wage earners and on the other hand miner's asthma has been recog- nized as an occupational disease of coal miners Here again recent studies have clarified the situation to a considerable ex- tent Bituminous or soft coal miners do not have an occuptional pneumoconiosis of a disabling quality Their lungs become pigmented from coal dust but they do not develop a true fibrosis For anthracite miners the picture is quite different and the reason is that anthracite mining includes exposure not only to coal dust but also to silica Disabling miner's asthma was shown by the United States Public Health Service study of 1935 to be a type of silicosis to which the term anthra^ois properly applied Anthracite seams are often found in country rock which contains a considerable amount of free silica and as in other silica dust exposures the development of pulmonary fibrosis was found to be proportionate to the amount of silica in the coal dust and the length of exposure The incidence of tuberculosis among anthracite miners is very high Clinical pulmonary tuberculosis was found in 15 per cent of those with early anthracosilicosis and in 43 per cent of those with advanced anthraco Service upwards of twenty to twenty years was associated with a tuberculosis rate of 14 per cent among regular miners and 37 per cent among those with a number of years as rock workers Animal experimentation with both bituminous and anthracite coal dust free from associated silica produced no specific reaction Siliceous Minerals There is no evidence that siliceous minerals produce any pulmonary disease Gardner at the Saranac Laboratory tested upon animals such substances as diamond aluminum oxide rutile marble gypsum galena chalcopyrite iron sulphide zinc sulphate fluorite and dolomite The sulphides and dolomite proved toxic but this affect is outside of our present discussion silice- ous minerals proved inactive in animals and there is no clinical evidence of specific disease among workers exposed to this type of dust Artificial Abrasives Experiments with artificial abrasives demonstrated the incorrectness of earlier ideas that dust caused injury to the lungs proportionate to the hardness and sharpness of the particles Artificial abrasives are among the hardest substances known Neither silicon carbide nor aluminum oxide produced any reaction resembling silicosis in experi * ental animals nor do workmen exposed to ese dusts show any clinical symptoms or -ray appearances suggestive of silicosis Silicates asbestosis but most of the fatal cases have been complicated by other disease such as cancer and diabetes so that the extent to which the asbestosis was responsible for death is not clear A considerable number of silicate dusts The pathology and ray appearance of we been studied and their effects upon ex- romental animals both by inhalation and jection noted They produce little or no action in the body tissues and what little action some of them do produce does not nd to progress An exception should be ted here regarding asbestos which is con- dered separately Nor is occupational exposure to silicate ists accompanied by any such clinical picre of disability and death as is found in ea dust exposures The Public Health ervice studied some talc mines in 1935 ily 66 men were exposed Tuberculosis orbidity and mortality rates were very high the county where the mines were located d the dust exposure was exceedingly sere running into hundreds of millions of rticles Eight men showed advanced pneu- asbestosis are cutirely different from silicosis and in the absence of a definite history of exposure over a considerable period of time to asbestos dust the diagnosis is difficult A great deal of success has been attained in controlling dusts in the plants where asbestos is fabricated so that it is not likely that asbestosis will ever become an important industrial disease as far as the number of cases is concerned The scarcity of clinical data on asbestosis makes the prognosis doubtful We have had a small group of cases under observation for about ten years and some of these show a definite but slow progression as far as can be judged from the ray films However what the outcome may be remains to be seen These men are all working and showing no signs of any disability comosis but tuberculosis was also present most of them It is conceivable that exsure to tremendous quantities of any minal dust regardless of silica content might overwhelm the lungs that they could not al with the invading substance Irritan inflammation and probably infection uld follow with disability in proportion ich isolated instances do not invalidate the nclusions stated in the previous paragraph Silicosis It may be said that there is a very general accord among the leading investigators and research authorities in the opinions and conclusions presented in the international conferences on silicosis Such differences of opinion as may be expressed from time to time do not seriously affect the general agreement on the basic factors affecting the cause incidence effects and prognosis of Asbestos . Asbestos is the only dust of combined ica which is known to cause a definite Imonary fibrosis which may result in disility and death Most of the asbestos fabated in the United States comes from the nes in Quebec Asbestosis however is t found among asbestos miners most of om work in open quarries or pits nor rong men engaged in milling operations ereby the asbestos is prepared for shipnt and bagged but among workers in bricating plants Only recently has an exnation been offered for this anomaly It uld appear that not only is asbestos an eption in that it differs from other silie dusts in its ability to cause structural anges in the lungs but its action appears to mechanical and not chemical like the ac- silicosis The effect of silica upon the lungs depends on the nature and extent of exposure That is to say upon the quantity of dust in the air breathed by workmen the amount of free or uncombined silica in the dust the size of the dust particles the presence of other substances in the dust which may modify the action of silica and the length of time or duration of exposure The individual himself must also be considered Previously existing disease of the lungs especially a tubercle infection will influence his reaction to inhaled silica There may be other phases of susceptibility about which we know little or nothing but in the main it may be stated that individual susceptibility to the action of silica dust is an acquired rather than a con- genital condition 1 of silica If asbestos is crushed to fine ticles it will not cause asbestosis in eximental animals nor will asbestos produce reaction elsewhere than in the lungs If action were in the nature of silica the ct would be more pronounced with smaller ticle sizes Consequently Gardner condes that the relatively long spicules of astos produce their effect because the lungs nover at rest and the constant movement wokes the fibrous reaction ike silicosis asbestosis develops slowly senting the characteristic symptom of ortness of breath The number of cases asbestosis that have come to autopsy is all but there are several cases on record which death was due entirely to the astos and not to any associated infection or er condition There does not seem to be pronounced tendency to tuberculosis in In industry we find different types of silica hazards The severity of a silica hazard is estimated on the amount of dust in the air and this is expressed in millions of particles per cubic foot The particles counted are those under ten microns in size though the present opinion is that it is the particle be- tween half a micron and three microns that is mostly responsible for causing the discase Exposure to excessive quantities of pure silica dust that is where the dust count is in the hundreds of millions of particles per cubic foot is now rare Isolated instances may be found as in the case of a sand- blaster improperly protected Such exposure produces a severe type of silicosis in upwards of five years even sooner in extreme cases With such extensive silica damage to the lungs tubercle infection is almost inevitable though cases will be seen occasionally that proceed to a fatal termination without infec- tion Exposure to moderate amounts of silica dust where the particle counts are in excess of ten million does not occur frequently at the present time though it is only in the last few years that silica industries have endeavored to cope with their dust problem and effectively reduce the amount Such exposures produce definitely disease in from eight or ten to twenty or more years in proportion to the actual quantity of dust The incidence of tuberculosis is high and of those who die of their pulmonary condition 75 per cent are tuberculous It is also possible to find degrees of silica exposure which while producing definite silicosis evident on rays will not produce disability or death in an average working lifetime Mortality statistics are not broken down by industry to an extent sufficient to make available definite figures by degree of exposure We must rely then on the clinical results obtained in industrial investigations which are conclusive enough for those industries studied Our own impression is that even where the silica hazard is of a mild type the incidence of tuberculosis will be higher than the average It has been stated that where silica dust contains caustic alkalies also the action of the silica is intensified very considerably The evidence here is meager Other substances apparently have some inhibiting effect upon the action of silica affecting the pathological as well as the clinical picture Prognosis The prognosis is fair for a silicotic whose lungs are not extensively damaged and who is free of infection Such persons have an increased susceptibility to infection and if brought into intimate contact with a case of tuberculosis are very apt to become tuberculous also The outlook for the tuberculo- silicotic is poor Many cases are essentially chronic and may live for years Others show rapid progression and die in from one to two years after their infection becomes active The importance of tuberculous infection among persons exposed to silica dust brings up a very important underwriting consideration that is where the worker in a silica occupation is in contact in his home with an open case of tuberculosis The question is frequently asked whether men who had worked in silica dust at one time but later changed to a job there was no exposure to silica considered standard risks for life in which might be insurance if they passed the usual insurance physical examination While there are no insurance statistics to prove the point one way or the other there is every reason to believe that a group of such men will not give a standard mortality The usual type of physical examination will not detect silicosis The only way to be sure is to secure rays of the lungs of such applicants and have them interpreted by some one who has specialized in reading films of this kind Silicosis is gradually coming under control The aggravated cases seen twenty years ago Continued on Page 1417 June o 1740 SURPLUS FUNDS 309,717,567 309,717,567 1. Metropolitan ........ 309,717,567 2. Prudential eee Life 209,392,460 3. New York Life 2 6. 125,639,022 4. Equitable N. +41,762,658 5. Jal~-n Hancock 87,961.337 23. 24. 25. 9 26. 27. 28. 29. 6. Travelers ' 64,902,795 30. Mutual 7. Northwestern .. 57.186.343 57.186.343 31. 1,852,202 8. Mutual Life 9. Aetna Lafe Y. o..... 0. 1,852,202 36,855,402 32. 33 10. Penn Mutual 11. Mutual Benefit 30,044.720 30,044.720 34. 30,314,767 35. 12. Western & Southern 28.583,923 36. 13. Mass Mutual ......, 27,050,794 27,050,794 37. 14. Provident Mutual 15. New England Mutual 0 19,874.280 19,010,803 19,010,803 38. 39. 16. Life Ins Co. of Va 16,950,930 40. 17. Amer Natl Tex 15,583,244 41. 18. Conn General 14.428,687 14.428,687 14.428,687 14.428,687 42. 19. Conn Mintual Lafe .. 13,020,498 43. .. 20. Union Central Lafe 1,84,15 11,848,155 44. 21. Bankers Life a . 11.599,788 45. 22. National Life ..... 1,24,92 11,224,492 46. 47. t Includes Includes 128,801,620 128,801,620 contingency re- 48. National Life & Acc Lincoln National ..... Equitable Life Ia Mutual State ......0, Phoenix Mutual . 2. Southwestern Life ..! Kansas City Life Fidelity Mutual ..... Jefferson Standard ... Bankers Life Neb Pacific Mutual .. National Northwestern National Guardian Life oo... oe Reliance Life Pa Great Southern ...... Monumental Life Home Life N. Occidental Calif Casualty Life & Continental Ill Central Life Ia Columbian National Acacia Mutual ...... Calif Western States Acc Provident Life & Mutual Trust Serve 10,453,570 8,941,165 8,777,602 8,625.381 7,844,962 7,840,000 7,205,984 6,468,839 6,300,000 5,799,129 5,672,956 5,457,918 5,269,459 5,171,096 4,788,020 4.569.137 4,300,635 4,152,034 4,077,235 3.922,443 3,878,551 3,529,068 3,412,797 3,295,000 3,283,576 3,281,718 49. Wash National ....., 50. Minnesota Mutual ... 51. Sun Life Md 32 Columbus Mutual .. 53. Ohio National ....... 54. Guarantee Mutual . 55. Midland Mutual ..... 50. Amer United Ind 57. North Amer Reassur 58. Commonwealth ....., 59. Western Life Mont 60. Home Beneficial .... 9 61. = 62. 63. 64. Continental Amer Mass Sav Bank Pilot Life N. ... American Life .. 65. General American ... 66. Old Line Wis 67. Baltimore Life . 68. Ohio State Life 69. Presbyterian Min . 70. Alliance Life ....... 71. Berkshire Life ....... 72. Farmers & Bankers 73. Business Men's Mo 74. New World Life 3,263,833 3,066,705 3.045,994 2,708,398 2,672,773 2,578,074 2.370,341 2,500,000 2,413,961 2.383,858 2,350,000 2,348,435 2,348,435 2,321,712 2.293,596 2,285,976 2.244.524 2.244.449 2,211,278 2,154,771 2.074,617 1,863,971 1.859,775 1,840,918 1,834,668 1.808.949 1,799,790 9 75. 76. 77. 78. 79. 80. $ 82. Amer Mutual la Colonial Life ....,. Industrial L & H. Ga Protective Life Ala Country Life Ill | American Standard Indianapolis Life .... Amcable Life ....... 83. Paul Revere Life 84. Franklin Life Ill Colo 85. Capital Life .. 86. Union Labor Life 87. Oregon Mutual ...... 88. Monarch Life Mass 89. Loyal Protective 00 Southland Life .. 91. National Reserve .... 02. Illinois Bankers ..... 93. Volunteer State ..... 04. Atlantic Life Va 95. Girard Life Pa 96. Great Amer Texas 97. United Life & Acc 98. Northern Life ..... + 99. Mass Protective ..... 100. Lutheran Mutual 1417 1417 1,759,905 1,681,064 1,637,757 1,611,338 1,601,145 1,519,383 1,512,306 1,490,457 1,440,425 1.439,902 1,373,668 1,344,335 1,318.523 1.309,121.3409,124 1,301,507 1,301.167 1,300.877 1,294,833 1.289,179 1,256,692 1,242,820 1,174,325 1,093,817 1,082,901 1,068,910 1,052.766 INDUSTRIAL DUST HAZARD Contouued from l'age 1413 are rarely seen now and the clinical picture has changed with the progress of dust con- trol measures The trend is towards a lessoned incidence of new cases of silicosis This improvement depends upon the maintenance of constant vigilance in detecting unsuspected hazards and in supervising the eficiency of dust control methods after they have been put into effect It cannot be expected that this improvement will be reflected in insurance mortality until a considerable period of time has elapsed The conclusion seems warranted from clinical and laboratory experience then that the only dusts which of themselves might have sufficient effect on the mortality of workers exposed to them so great as to require an extra premum charge for life insurance are silica and possibly asbestos Life insurance men naturally will turn to mortality statistics for confirmation of a finding so at variance with the common belief long held that exposure to all kinds of dusts is productive of a high incidence of respiratory tuberculosis To the layman it seems only reasonable to suppose that the difficulty in cathing he experiences when exposed to large quantities of dust must in some way affect his health and that filling the lungs with foreign particles must have injurious effects on them The writings of eminent students of occupational mortality statisties have surved to strengthen this belief Nearly all such statistics show the mortality from respiratory tuberculosis among workers exposed to a wide variety of dusts to be well above the average for all workers included in the study But when these figures are refined so far as is practicable to make allowance for factors other than dust which may mlluence the mortality from tuberculosis of men employed in these occupations the importance of many dusts as causative factors becomes less evident There is a surprisingly large number of factors other than dust any one of which may be responsible for the high mortality from tuberculosis among men in dusty trades Some dusty occupations are carried on by men recruited from the lower income classes among whom it is now known that apart entirely from exposure to specific occuptional hazard the death rate from tuber- culosis is considerably higher than among persons in the higher income groups The selection of certain kinds of work by the less robust workers is reflected in the high mortality from tuberculosis of men in other callings Racial and nationality groups tend to enter certain occupations with the result that the peculiar susceptibility or relative immunity to tuberculosis of these stocks colors the mortality picture of men in such occupations These are but a few of the many circumstances for which allowance must be made before conclusions can be drawn as to whether a particular dust is or is not the responsible agent in the high mortality found among men in a dusty trade Unfortunately there is for the United States no considerable body of mortality statistics sufficiently detailed to permit of evaluating separately some of even the most important conditions affecting the mortality of men in specific occupations Perhaps the best statistical demonstration of the effect of different types of dust on mortality from tuberculosis is supplied by two British authorities Dr. Edgar L. Collis and G. Udney Yule These authors selected for study from theoccupations reported upon in the Registrar General of England and Wales ixport on Occupational Mortality covering the years 1921-1923 two groups of occupations exposed to silica dust and the other to silica inorganic dust The groups were so chosen that each had as far as possible the same amount of dust exposure physical effort exposure to heat or to weather or any underground environment Part of the authors comment on the results as regards respiratory tuberculosis is quoted : For all ages 20 to 65 the comparative mortality figure this figure is defined as the number of deaths that would have occurred in the Standard Population at the rates ruling in the occupation of the Silica Group is no less than 5922 against 1635 for the Standard Population i e the mortality is more than three and a half times the normal For the silica Group the Comparative Mortality Figure although actually slightly higher than normal at first sight hardly seems to differ significantly from the normal; nor would one's judgment be much affected if instead of making comparison with the Standard Population one had used the Social Groups III and IV for which the re- spective Comparative Mortality Figures are 159.8 and 164.2 But the summary figures conceal interesting changes with age A glance at the figures shown on Table 4 of their study shows that in the Silica Group the ratio of mortality to the normal though greater than unity even in the lowest age group rapidly increases as age advances In the silica Group the comparative mortality is actually below normal up to age 35 it rises just above normal in the following age group but as ages over 45 it is conspicuously above normal The facts regarding tuberculosis were not published in this report for each of the six silica occupational classes included in the study We have however determined by reference to the report of the Registrar Gencral that each of the silica occupations had over twice the expected number of deaths The extraordinary high ratio of 1,150 per cent was recorded for tin and copper miners while sandstone masons cutters and dressers had a ratio of 441 per cent On the other hand only the limestone masons cutters and dressers of the five occupations considered in the silica group exhibited a high ratio 191 per cent Like the English tin and copper miners American metal miners are exposed to a serious silica hazard and have an inordinate mortality from respiratory tuberculosis as will be seen by reference to Table 1 In this table are given the ratios of actual to ex- pected deaths from tuberculosis for a num- her of occupations exposed to dust and reported upon in the Joint Occupation Study 1928 and in the Occupational Study 1937 both published by the Actuarial Society of America and the Association of Life Insur- ance Medical Directors In the period 19151926 the number of deaths from respiratory tuberculosis among metal miners was over eight times the number expected on the basis of death rates by ages prevailing among standard ordinary lives in the same years In the latter study covering the years 1925 to 1936 the ratios were even higher 11 times as many deaths were recorded for metal miners as were expected on the basis of death rates among standard lives in these * years While the actual number of deaths for each separate metal mining class was rather small in both investigations and consequently the ratios are subject to a large margin of Continued on Page 1420 1420 The Weekly Underwriter INDUSTRIAL DUST HAZARD Continued from Page 1417 7) error nevertheless it is interesting to ob- serve that they were quite uniformly high for copper miners gold and silver miners and lead and zinc miners pol- The situation as regards iron miners is contain interesting because it was thought for a long time that they had little or no exposure to silica More recent studies show that there deaths is actually a moderate degree of silica hazard which produces sileosis in upwards of twenty years However in both insurance favorable studio there were too few deaths from respi- ratory tuberculosis to permit definite quantitative conclusions therefrom A great many workers in mining occupations it must be borne in mind are common laborers among whom we should expect a much higher mortality from tuberculosis than among standard ordinary policyholders From the limited data available for unskilled study in the United States than that of granite cutting Long recognized as a dan- gerous trade it has been found time and again to take a heavy toll in deaths from tuberculosis The amount of free silica in the dust breathed by these workers is very large In the years 1925 to 1936 the mortality from tuberculosis among granite and sandstone cutters for any of the was the highest recorded groups of insured lives studied There were more than 25 times as many deaths from tuberculosis as expected whercas in the earlier years there were expected nearly ten times as many deaths as based on small exposure Marble and lime- stone cutters did not show anything like as high a ratio as the granite and sandstone cut- ters There were ten deaths where one was expected in the years 1925 to 1936 It can be but regretted that there are so few mortality statistics for occupations exposed to dusts other than silica Grinders is indicated by the higher mortality from tuberculosis among exposed workers after age 45. About all that can be said on this point from the limited American life insurance company experience is that the tuberculosis death rates for grinders metal ishers and buffers who are exposed to inorganic dusts most of which do not a large percentage of silica are not high having in mind the economic status of these workers as compared with the average ordi- nary policyholder Lime cement and artificial stone workers had a quite mortality The very high ratio for marble and limestone cutters however may be suggestive of some untoward influence Dr. L. U. Gardner at Saranac Lake found that animals dusted with marble dust by inhalation developed little reaction but became temporarily more susceptible to infection with tuberculosis The increased susceptibil- ity was not marked workers from these studies it would appear that the tuberculosis death rate for this class of workers runs between two and three times the rate of standard ordinary business Thus it is clear that even when allowance is made for the important factor of economic class the death rates for the metal miners are extremely high Coal miners in different sections of the country present an interesting contrast Among the bituminous miners exclusive of the Pennsylvania miners the mortality from tuberculosis was over 1 times that on standard ordinary miners a low ratio for this type of worker Pennsylvania miners on the other hand most of whom were em- ployed in the anthracite field had a very high ratio of actual to expected deaths- miners well over 300 per cent Anthracite as we have stated are exposed to an appreciable amount of silica dust which accounts for their relatively unfavorable position No dusty trade has received more careful of metals most of whom for many years have been using composition wheels in place of the old sandstone wheels and consequently have had a little or no exposure to free silica experienced a relatively low extra mortality from tuberculosis in both studies based however on a small exposure An interesting point to be noted here is that this occupation also offers exposure to metallic dust It would appear that neither the dust from the composition wheels nor the metal dust has produced excessively high death rates from tuberculosis Buffers and polishers a somewhat similar group also appeared to have a low extra mortality from tuberculosis in the years 1915 to 1926 Cement and Lime Workers Cement lime and artificial stone workers were reported upon in both the Joint Occu- pation Study and the Occupational Study but the number of deaths from tuberculosis was in each instance less than the number required for separate tabulation This fact in itself is significant although it does not The three occupations in which there is exposure to organic dust had from two to two and half times the number of tuber- culosis deaths expected Even allowing for the economic position of these groups as compared with ordinary policyholders generally the mortality is high It is difficult to see in the light of present clinical knowl- edge how it is possible to account for the excess mortality on the score of damage to the lungs caused by such dust Mortality findings then are still not in complete harmony with clinical and labora- tory findings But from a practical under- writing standpoint it may be said that the only dust which of itself might so affect the total mortality by increasing the incidence of tuberculosis as to require an extra premium charge for life insurance is free silica We have no mortality data for asbestos workers but it may well be that ex- posure to asbestos will also be found tality dust in large quantities to produce a high mor- Underwriters mean necessarily that the death rate from tuberculosis was below the average Never- agency managers office men For the first time the whole subject of safeguarding life insurance proceeds has been reduced to readable form and substance for easy assimilation and theless from the facts presented in these studies it is quite evident that the tuberculosis death rate for this occupational class was comparatively low Three groups of male workers exposed to organic dusts are included in the table BALDWIN'S NEW YORK INSURANCE LAW ANNOTATED Perpetual Revision Edition practical application Safeguarding LIFE INSURANCE PROCEEDS upholsterers cotton mill operatives and woolen mill operatives The ratios for all of these classes run about 200 per cent based on small exposures is the one authority on New York Insurance Law It contains By W. J. Wheeler and T. L. Todd It must be admitted that these occupational The Insurance Law Here in simple fashion are ex- plained the desirable objectives to be attained by safeguarding life insurance estates as well as approved practical plans of distribution of insurance pro- ceeds In the interent of clarity many jects are condensed into simple charts stituting graphic outlines which explain lump sum payment coordination of payment cies etc. sub- con- the poli- Although not a salesbook it with powerful selling ideas underwriter to absorb into his equipment equipment equipment is for own packed every salos mortality statistics are meagre and do not 2 permit of very definite conclusions regarding the effects of specific dusts So far as they go they fully substantiate clinical and labora- tory findings regarding the injurious char- acter of silica dust The death rates from respiratory tuberculosis for men in occupa- tions where there is a serious exposure to silica dust are so high as to leave no room for doubt that silica is the offending agency Contrary to clinical and laboratory find- All miscellaneous statutes relating to Insurance Exhaustive annotations Insurance Department rulings Attorney General opinions Common index Kept to date Price 20 Including 1940 Supplement 2.50 Postpaid The Weekly Underwriter 80 Maiden Lane New York ings however the mortality statistics presented by Coltis and Yule suggest that long continued exposure to siliceous inorganic dust has an injurious effect on the lungs as The Weekly Underwriter 80 Maiden Lane New York