Document EdMvGZjRkRrzbEXME6QeqDE3R

FILE NAME: Mobil (MOB) DATE: 1961 DOC#: MOB002 DOCUMENT DESCRIPTION: Published Conference Proceedings with Donor List Proceeding' THIRTEENTH INTERNATIONAL C O N G R ESS ON OCCUPATIONAL HEALTH LIST OF DONORS 1003 T h e follow ing corporations, governm ental agencies, labor unions, professional societies, and individuals contributed to the financial support of the Congress: A F L /C IO T he Alcoa Foundation AMF Foundation Addressograph-Multigraph Corporation Allegheny Ludlum Steel Corporation Allis-Chalmers M anufacturing Company America Fore Loyalty Group American Brake Shoe Company American Can Company American Cast Iron Pipe Company American Cyanamid Company American Industrial Hygiene Association (N orthern California Section) American Medical Association American Metal Climax Foundation, Inc. American M utual Insurance Alliance American President Lines Ltd. American Telephone and Telegraph Company American Viscose Corporation Armco Steel Corporation Armour and Company Atlantic Refining Company J. T . Baker Chemical Company Bausch and Lomb Optical Company Baxter Laboratories, Inc. Bayuk Cigars, Inc. Bethlehem Steel Company Boeing Airplane Company Bristol-Myers Company Budd Company Burlington Industries, Inc. Burroughs Wellcome and Company California Texas Oil Corporation Campbell Soup Company T he Carrier Foundation, Inc. Carson, Pirie, Scott and Company Caterpillar Tractor Company Celanese Corporation of America Champion Paper and Fibre Company Chance Vought Aircraft, Inc. Chase M anhattan Bank T he Chemstrand Corporation Chesapeake Corporation of Virginia Chrysler Corporation Cities Service Company Clevite Corporation Colgate-Palmolive Company Columbian Carbon Company Consolidated Edison Company of New York, Inc. Continental Can Company, Inc. Continental Oil Company Corn Products Refining Company Corning Glass Works Crouse-Hinds Company Crown Zellerbach Foundation Cummins Engine Company Curtis Publishing Company Deere and Company Detroit Edison Company Dodge Manufacturing Corporation Douglas Aircraft Company Dow Chemical Company E. I. D upont de Nemours and Company Dupont, Mr. Irenee East Ohio Gas Company Eastman Kodak Company Electric Storage Battery Company Endicott Johnson Corporation E quitable Life Assurance Society of U.S. Esso Standard Esso Research and Engineering Ethyl Corporation Fairchild Camera and Instrum ent Company Fawcett-Dearing Printing Company Federal-Mogul-Bower Bearings, Inc. Federal Paper Board Company, Inc. Federated D epartm ent Stores, Inc. Firestone T ire and Rubber Company Food & Drug Research Laboratories, Inc. Ford Motor Company The Garret Corporation General American Transportation Company General Aniline and Film Corporation General Dynamics Corporation General Electric Company General Foods Corporation General Mills, Inc. General Motors Corporation General T ire and Rubber Company Globe-Union, Incorporated Goldman, Sachs and Company 1004 LIST OF DONORS T h e B. F. Goodrich Company The Goodyear Tire and Rubber Company Gulf Oil Corporation Gulf Research and Development Company Harnischfeger Corporation Hazleton Laboratories, Inc. Helm, Mr. H arold D. H. Hercules Powder Company, Inc. Heyden Newport Chemical Corporation H ine, C. H., M.D. Hinman, Mr. John H. The Hoover Company Hoffman-La Roche, Incorporated Hope N atural Gas Company Geo. A. Horm el and Company Hughes Aircraft Company Humble Oil and Refining Company Industrial Medical Association Inland Steel Company International Business Machines Corporation International Harvester Company International Minerals and Chemicals Corporation International Resistance Company International Telephone and Telegraph Corporation Iranian Oil Consortium Johns-Manville Corporation Johnson and Johnson S. C. Johnson & Son, Inc. Jones & Laughlin Steel Corporation Miles Laboratories, Inc. M ine Safety Appliances Company Monsanto Chemical Company N ational Biscuit Company National Dairy Products Corporation National Institutes of Health, Public Health Service, D epartm ent of H ealth, Education and Welfare National Lead Company New Orleans Public Service, Inc. N ew port News Shipbuilding 8c Drydock Co. New York Life Insurance Company New York State N atural Gas Corporation New York State Society of Industrial Medicine T he New York Times T h e News, New York N orth American Aviation, Inc. Norton Company Ohio Oil Company Olin Mathieson Chemical Corporation Otis Elevator Company Owens-Corning Owens-Illinois Glass Company Pan-American W orld Airways, Inc. Param ount Pictures Corporation Pennsylvania Railroad T h e Peoples N atural Gas Company Pepsi Cola Company Pittsburgh Steel Company Procter and Gamble Company Provident Life 8c Accident Insurance Co. Kaiser Industries Corporation Kennecott Copper Corporation Kimberly-Clark Corporation Koppers Company, Incorporated LaSalle Steel Company Legge, R. T ., M.D. LeTourneau-Westinghouse Company Lever Bros. Company Liberty M utual Insurance Company Life Extension Examiners Eli Lilly and .Company Thomas J. Lipton, Incorporated The Magnavox Company The Mead Corporation Medical Society of the State of New York Meigs, J. W., M.D. M etropolitan Life Insurance Company Radio Corporation of America Raytheon Company Republic Steel Corporation Revlon Foundation, Incorporated Reynolds Metals Company R. J. Reynolds Tobacco Company Richfield Oil Corporation Jo h n A. Roeblings 8c Sons C orporation Joseph E. Seagram 8c Sons, Inc. Shell Oil Company Simplex Wire and Cable Company Sinclair Refining Company A. O. Smith Corporation Socony Mobil O il Company Sonoco Products Company Sperry Gyroscope Company Standard Oil Company (California) Standard Oil Company (Indiana) LIST OF DONORS 1005 Standard Oil Company (New Jersey) and affiliates Standard Oil Company (Ohio) Standard Railway Equipment Company Foundation Standard-Vacuum Oil Company Stauffer Corporation Studebaker Packard Corporation Sugar Beet Products Company Sun Oil Company Sunstrand Corporation Swift and Company Sylvania Electric Products, Inc. Tampax, Incorporated Tennessee Corporation Texas Company Texas Instruments, Inc. Tidewater Oil Company The Michael T odd Estate Trans W orld Airways The Travelers Union Carbide Corporation Union Oil Company of California United Artists Corporation U nited States Atomic Energy Commission U nited States Rubber Company U nited States Steel Corporation U nited Steel Workers of America Universal Oil Products Company Upjohn Company VAW--International Executive Board Washington Steel Corporation W eirton Steel Company Western Electric Company, Inc. Westinghouse Electric Corporation Wilson, Mr. Charles E. Wilson & Toomer Fertilizer Company Wiremold Company Woodard Research Corporation Wm. Wrigley, Jr. Company Union Bag-Camp Paper Company Zenith Radio Corporation 4 > -i pfc -Vju :.V v i 1 \ *31 m t THIRTEENTH CONGRESS ON July 25-29, i9 6 0 Copyright 1961 by the U. S. Executive Committee of the Thirteenth International Congress on Occupational Health ALL RIGHTS RESERVED Library of Congress Catalog Card Number: 58-32683 P u b lic H ealti GIFT DESIGNED BY HARV EY SATEN STEIN M ANUFACTURED IN T H E UNITED STATES OF AM ERICA BY BOOK CRAFTSM EN ASSOCIATES, IN C ., NEW YORK /fC 965 A i Jibs' /<? (o V 'P u b ! t o H e a d Hsu Li bra r (j EXECUTIVE COM M ITTEE C h a irm a n .......................... L . W a d e , M .D . V ice-C h a irm en ..........................L . G r e e n b u r g , M .D. S. E. M i l l e r , M .D. Secretary-G eneral.......................... R . E. E c k a r d t , M .D. T re a su re r..........................H . E. T e b r o c k , M .D. E x e c u tiv e Secretary.......................... J . W . M u c k e l l E. R . A s t o n , D.D.S. C. U. D e r n e h l , M .D . T . E l y , M .D. B. S. F o x J . L a u er , M .D . H . L. M a g n u so n , M .D. H . B. N a c h t ig a l l , M.D. N . N e l s o n , P h .D. M . N . N ew q u ist, M .D . L. T . R o b e r t s o n , M .D. I. R. T a b e r s h a w , M .D. S. P. W a g n e r , R .N . 940 REPORTS OF ORGANIZING COMMITTEES In addition, many others visited points of interest to them either before or after the Congress. W hen the debris had been cleared away and the hubbub had subsided by Saturday, Ju ly 30, the paid registrations figures for the Congress were as shown in the following tabulation. N U M B E R O F R E G IS T R A N T S -- BY C O U N T R IE S Country T o ta l A fghanistan ........................................... 1 A lgeria .................................................... 1 A rgentina .............................................. 19 A ustralia ................................................ 3 A ustria .................................................... 8 B ahrein .................................................. 1 Belgium .................................................. 2 Bolivia .................................................... 1 Brazil ...................................................... 5 B ritish G uiana ..................................... 2 C anada .................................................... 54 C hile ........................................................ 4 C olom bia ................................................ 9 C uba ........................................................ 5 Czechoslovakia ..................................... 1 D enm ark ................................................ 4 F in lan d .................................................. 62 France .................................................... 39 G erm any ................................................ 36 Greece .................................................... 1 I n d i a ........................................................ 5 Indonesia ................................................ 1 Ira n ........................................................ 2 Irelan d .................................................... 1 Israel ...................................................... 2 Italy ........................................................ 21 Country T o ta l Ja p a n ...................................................... 20 L uxem bourg ......................................... 3 Mexico .................................................... 6 Morocco .................................................. 1 N e th e r la n d s ........................................... 16 N etherlands-A ntilles .......................... 2 N o rth ern Rhodesia ............................ 1 Norway .................................................. 13 Pakistan .................................................. 1 Peru ........................................................ 4 P hilippines ........................................... 5 Portugal .................................................. 5 R om ania ............................................... 1 Spain ...................................................... 5 Sweden ................. 29 Switzerland ........................................... 6 T h a ila n d ................................................ 1 T rin id a d ................................................ 2 U nion of South A f r i c a ...................... 9 U n ited Kingdom ................................ 94 U n ited States ........................................1040 U ruguay ............................................... 2 U.S.S.R...................................................... 1 Venezuela ............................................. 7 Yugoslavia ............................................. 4 T o ta l .............................................. 1568 One hundred and ten people paid and registered but were unable, for one reason or another, to attend. T h u s the total actually present, exclusive of wives or guests, was 1458. I t is the im pression of the O rganizing C om m ittee th at the Congress was an overw helm ing success. C ertainly the n um ber and q u ality of th e scientific papers delivered was outstanding. Dr. Irving Tabershaw and his whole Program Com mittee deserve a special note of thanks for the h ard work entailed in bringing such an excellent program to the Congress. I t is the hope of the Organizing Committee that all those who attended, especially those from foreign lands, not only learned m uch from their attendance at the Congress but found our land and our people friendly and hospitable. We hope that new friendships were made, new understand ings reached, and that the memories of the T hirteenth International Congress on Occupa tional H ealth will linger long. Speaking for all members of the O rganizing Com m ittee, it was a pleasure and privilege for us to plan the Congress and welcome all who attended. K IV IL U O T O ml of the buffer described in Appendix 1, and continue as in Appendix 1. Normally for blood specimens the final washing must' be performed four times, instead of thrice as for urine specimens. APPENDIX 3-- COPROPORPHYRIN E ST IM A T IO N T o 5 ml freshly voided urine in a stoppered test tube add 0.2 ml 3 per cent hydrogen peroxide solu tion, 1 ml glacial acetic acid and 3 ml ether. Shake gently, release pressure, and place in a lightproof box overnight. Observe the red fluorescence under u ltra violet light, and grade the specimen 0- q. + + + by degree of fluorescence. A PP E N D IX 4-- H EM O GLO BIN D ETE R M IN A T IO N T ake 0.05 ml blood, and make up to 9 mis volume with 0.4 p er cent am m onium hydroxide. Measure absorption on a colorimeter, using a standard filter (EEL 404), and convert the reading to hemoglobin percentage to the nearest even number from a pre pared calibration graph. APPENDIX 5-- PUNCTATE BASOPHIL COUNTS Make a thin blood smear on a slide of 0.8-1.0 mm thickness, fix for about one m inute in methyl alcohol, allow to dry and stain for 30 seconds in Sellars stain (1 g methylene blue, 6 g sodium bicarbonate in 100 ml deionized water). Wash in tap water u n til the slide is a sea green color. Using a dark ground condenser and an Ehrlich eyepiece set to a 6-ram square, count the^punctate cells in ten consecutive fields. (Although in counting, the punctate cells are classified as large, medium, small, very fine, or polychrome, according to the size of the in tra cellular structure, this differentiation is for further reference on an individual case, and normally only the total count is given.) Close the eyepiece to a 2-mm square, and count the R.B.C. in this square. Repeat both counts five times on different parts of the slide, to give a punctate count of 50 large fields and an R.B.C. count of five small ones. Calculate punctate per 1000 R.B.C. NONOCCUPATIONAL ASBESTOSIS R a im o K iv il u o t o Roentgen D epartm ent of the Central H ospital of N orthern Karelia Introduction Pleural reaction is very often observed in asbestosis. In the advanced cases of this pneumoconiosis pleural fibrosis has been almost always found, and a clear correlation between pleural changes and the severity of the pulmonary fibrosis has been observed by several investigators. Observations on the occurrence of pleural calcification in asbestosis have also been made. Reports of pleural calcification as a roentgenologic sign or complication of asbestosis have especially been made by the German authors (1). In addition to advanced cases of asbestosis, special cases have been presented in which pleural calcification has been the chief finding (2). Except in asbestosis, pleural calcification has also been observed among workers exposed to talc and mica (3,4) or to various dusts including a short exposure to asbestos (5). T h e diagnosis of pneumoconiosis is prim arily based on occupational exposure to dust. Only very few re ports of pneumoconioses without occupational exposure may be found in the literature (6,7,8). In Northern Karelia, Finland, during few past years interest has been attracted by the high incidence of cases of pleural calcification showing a rather curious and characteristic roentgenologic picture, very similar to that observed in pneumoconioses. T h e cases have been mainly found among the residents of a certain area, and in these cases no previous history of adequate pulm onary or pleural disease could be elicited. T h e occupations of the patients showed no uniformity, and the main part of the patients had no clinical symptoms of p n eu moconiosis. A study of the areal distribution of cases revealed that they were grouped round two anthophyllite-asbestos mines. Asbestos constituted the common external factor sought. Even from a solely roent- genologic p oint of view, asbestos dust inhalation had been considered the most probable etiology. Pleural calcification resulting from hemothorax, tuberculosis, or empyema usually occurs unilaterally and is situated on the visceral pleura. In most cases marked pleural thickening and displacement of the intrathoracic organs is observed. T h e calcification re sulting from dust inhalation usually occurs bilaterally and is most often situated on the parietal pleura. In advanced cases calcium deposits are found in the lateral parts of the chest, basally and mediastinally. T he calcium deposits take various forms-- large con fluent plaques, bizarre figures, or roundish spots. T he R oentgenologic and Clinical Picture of Cases Observed in N orthern K arelia In the advanced cases calcium deposits are found bilaterally in the central parts of the diaphragm ; on chest walls, especially anterolaterally but also dorsally; and on the m ediastinal surfaces. In the incipient cases the calcium deposit takes place either on the antero lateral chest wall, more often on the left, or in the central parts of the diaphragm, apparently more often on the right. Pericardial calcification is sometimes present. T he calcium deposits are located on the parietal pleura. In a series of 150 cases no interlobar calcium deposits were observed. The parietal location has been demonstrated by diagnostic pneumothorax examina lions, and it has also been noted in some autopsied and surgical cases. Using a tangential roentgen beam, the parietal location of solitary plaques may be observed, these plaques having their bases toward the inner chest wall or toward the diaphragm . In advanced cases the lack of soft tissue mass between the calcium deposit 312 M EDICAL PRACTICES and in n e r chest w all d u e to th e p a rie ta l location is apparent, and diagnostical pneum othorax exam ination is seldom needed. T h e m ajo rity of cases of pleu ral calcification d e scribed above have been clinically symptomless. In a series of 150 cases th e o rd in a ry chest ro en tg e n e x a m in a tion by P-A and lateral projections revealed pulm onary fibrosis, corresponding to th e an tep rim ary o r prim ary stage of p u lm o n a ry asbestosis in only a b o u t 14 p er cent. Even the m ain p art of these cases had no sub jective respiratory symptoms. T h e series m entioned above has been selected solely according to the roentgen diagnosis w ithout reference to other factors. T h e concentration of the cases around two asbestos m ines in K uusjarvi an d its neighboring com munes has as yet been the only way to confirm the roentgen diagnosis. T h e m ajority of 25 cases living outside this area had previously lived there. According to these facts, any o th er etiology would be very d if ficult to credit. In very few cases a previous occupa tional exposure to asbestos dust has been observed, which lends slight support to the roentgen diagnosis. T h e diagnosis has as yet not been confirm ed by other m ethods. In th e sputum of 20 cases no asbestos bodies were found, an d asbestos fiber in one case. Small am ount of anthophyllite asbestos was found in the lung of an autopsied case and in the lung of a cow from the vicinity of the asbestos m ine. D iscussion T h e total n u m b er of cases of pleural calcification aro u n d the two asbestos mines am ounts to over 800, as previously re p o rte d by th e a u th o r. T h is n u m b e r of cases was found in a mass survey of ab o u t 10,000 ad u lt in h ab itan ts and may include cases w ith previous occu pational exposure to asbestos dust. In the history of the m ain p a rt of cases exam ined at th e C entral H os pital of N orthern K arelia th e lack of occupational ex posure has, however, been apparent. Some of the patients have not had any idea how the dust inhalation could have h appened; th e same cases have presum ed that the dust rising on the roads m ight be responsible. In N orthern Karelia the roads (highways) do not have p avem ent. W ith o u t m ineralo g ic e x a m in a tio n s it is, of course, im possible to decide w hether these calcifications are resulting from inhalation of anthophyllite-asbestos dust originating from th e asbestos m ines or from su r face deposits of other fibrous dusts, such as trem oliteasbestos, w hich is a very com m on m ineral in N o rth ern Karelia. T h e first alternative seems to be m ore p ro b able. In occupational pneum oconiosis some authors have called attention to the absence of pulm onary fibrosis besides the prom inent appearance of the pleural calci fication (2,5); on the other hand, a clear correlation has been observed between the severity of pulm onary fibrosis a n d p le u ra l calcification (9). In n cn o c c u p a tio n a l asbestosis it is a p p a re n t th a t extensive calcification may occur w ithout any roentgenologically detectable p u l m onary fibrosis. It seems possible th at even very small am ounts of asbestos fibers may cause p leu ral calcifica tions. A n th o p h y llite is m ore stiff th a n se rp e n tin e asbestos. In anim al tests brittle m ineral fibers have not caused pulm onary fibrosis (10), b u t fibrosis has been observed in w orkers exposed to an th o p h y llite-asb e sto s du st (11, 12). F u rth e r studies are needed to reveal th e p a rt possibly played by asbestos as an etiologic factor in pulm onary fibrosis am ong residents aro u n d the two asbestos mines. Some investigators have pointed out the difficulty of attrib u tin g the calcification to inhalation dam age in view of its parietal location, few, if any, changes being observed in the lung or the visceral p leu ra (2,5). It seems possible that the asbestos fibers move w ith the lung and visceral pleura in relation to the parietal pleura, thus causing capillary hem orrhages on this only, as previously presented by th e author. T h e hem orrhage coagulates and organizes, form ing a col lagenous plaque which slowly calcifies. T h is theory could explain the course of the process resulting from inhalation of small quantities of fibrous m ineral dust. T h e clinical significance of the pleural calcification seems to be slight, the m ajority of cases showing no clinical respiratory symptoms. F u rth er investigations on this point are needed. From roentgenologic point of view, this endem ic p le u ra l calcification is of some significance. T h e r o e n t gen diagnosis is in typical cases easy b u t in some cases difficult. Early pleural changes on the anterolateral chest wall may sim ulate infiltrations, an d large calcified plaques may cause difficulty in in te rp re tatio n of p u l m onary changes by hiding infiltrations. T h e high kilovoltage technique can hereby be especially recom m ended. In chest roentgen exam inations of workers of asbestos m ines in N orthern Karelia and of O utokum pu Copper m ines located in the same area attention m ust be paid to the fact that even extensive bilateral p leu ral calcification does not have to be a sign of severe pulm onary changes resulting from occupational dust exposure. REFERENCES 1. Jaco b , G .f an d Bohlig, H .: D ie r n tg en o lo g isch en Kom plikationen der Lungenasbestose. Fortschr. R n t g e n s t r 83:515, 1955. 2. M uller, H .: U ber schwere Form en d er Asbestose. D ie S ta u b lu n g e n erkra n k u n g en , B a n d 3, W issen schaftl. F orschungsberichte 66. D ietrich Steinkopff V erlag, D arm stad t, 1958. 3. Siegal, W .; S m ith , A. R.; an d G re e n b u rg , L.: Study of talc m iners and millers. In d u st. B ull., 22:434, 1943. 4. Sm ith, A. R .: P leu ral calcification re su ltin g from ex p o su re to certain dusts. A m . J. R o e n tg e n o l., 67:31b, 1952. 5. Fehre, W .: ber doppelseitige Pleuraverkalkungen infolge beruflicher Staubeinw irkungen. Fortschr. R n tg e n str., 85:16, 1956. 6. E isen b u d , M.; W a n ta , R . C.; D u sta n , C.; S tead m an, L. T .; H arris, W . B.; a n d W olf, B. S.: N onoccupational berylliosis. A m . J. In d u st. H yg., 31:282, 1949. 7. Goyal, R . K.: Pneum oconiosis in th e n o n -in d u stria l population of R ajasthan. ]. Indian M ed. Ass., 30:19, 1958. 8. K iviluoto, R.: P leu ral calcification as a r o e n t genologic sign of non-occupational endem ic anthophyllite-asbestosis. A cta radiol., su p p l. 194, 1960. 9. Bohlig, H .; Jaco b , G.; a n d M u ller, H .: D ie A sbes tose der L ungen. Georg T h iem e Verlag, S tuttgart, 1960. 10. V orw ald, A. J.; D u rk an , T . M.; a n d P r a tt, P. C.: Experim ental studies of asbestosis. A rch. In d u st. H yg., 3:1,1951. 11. N oro, L.: O n th e histology of asbestosis. A cta P a th o l, et m icro b io l. Scand., 23:53, 1946. 12. W egelius, C.: C hanges in th e lu n g s in 126 cases of asbestosis observed in F inland. A cta radiol,, 28:139, 1947. 326 M EDICAL PRACTICES A REVIEW OF RECENT DEVELOPMENTS IN OCCUPATIONAL PULMONARY DISEASES OTHER THAN SILICOSIS Leo Noro, M.D. F in la n d At the Tw elfth International Congress on Occupa tional H ealth held in H elsinki three years ago, the French Professor M archand. presented a review of the subject m entioned in the title, a large and com prehen sive bibliography being attached to his presentation. T h e Organizing Committee has at this tim e asked me to present a review of the same subject from the last several years. It m ust at once be said th at the com pil ing of such a bibliographic review has not been an easy task. M ore th an ever before, research w ork has been focused on occupational pulm onary diseases. T h e problem has been discussed at national and in te rn a tional meetings, the last tim e being only tw o m onths ago in M ilan. From the literature which has been at my disposal, I have found alm ost 316 articles from th e recent years dealing w ith this subject, and yet I cannot have h ad access to all the articles from this field p u b lished in the world. I shall follow, w ith some excep tions, M a rc h an d 's classification. T h e r e is reason to state at th e onset th a t th e co n sta n t in d u stria liz in g is causing th e a ir we b re a th e to become more and more polluted. G reat masses of people, even the peoples of th e so called less-developed countries, are changing their breathing air through th eir m ovem ent from agricultural to industrial centers. I am here thinking specifically ab o u t the huge in d u s trialization process right now taking place in India and China. B ut m an's breathing organs, and especially his lungs, do not come in contact w ith hazardous in fluences only in the working environm ent. T h e most common pollutant of our breathing air--tobacco smoke -- is rap id ly triu m p h in g all over th e w orld w ith th e rising standard of living, in spite of the efforts we doctors take to warn m ankind of its danger. T h e auto m obile industry is producing cars in a rap id tem po to p o llu te th e air of the traffic roads. W ith th e grow ing population centers, and their increased use of fuel for pow er and heating, more pollutants enter the air. Bacterias, viruses, sponges, and other small organism s have not disappeared either. T hus, the environm ent of m an, w ith reference to lungs, is ch an g in g co n tin u o u sly . W hile the great enemy of th e lungs, tuberculosis, is gradually disappearing, new diseases are arising, giving new im portance to the air im purities. C hronic b ro n chitis, asthm a, emphysema, and lung cancer are already m uch m ore im portant diseases th an tuberculosis in countries w ith highly developed industry and a high living standard. M an him self and the changing of his reaction to the environm ent also require attention. Allergies are one problem , for example. T h e danger of allergens affect ing organisms through the respiratory and digestive organs and the skin is continuously increasing; new m edicines, foods, cosmetics, etc., are com m on allergens. Allergic reactions are im portant when we consider the breathing organs and their obvious connection w ith the air im purities. Many of the chronic occupational diseases of the lungs occur only after a long exposure tim e. W e are gradually, however, observing th e signs of these diseases am ong those occupational groups which have been exposed for some length of tim e. O ur knowledge of m any factors influencing the lungs is already fairly com plete: I am th in k in g only of asbestosis; those many chemicals causing acute lung injuries, such as chlor or nitrous fumes; and the diseases caused by bacteria, sponges, or viruses. O ften o u r know ledge is still very restricted , a n d th e in te r p re tations in m any ind iv id u al cases are difficult to make: th is is tru e of allergic diseases an d c h ro n ic b ro n ch itis, lung cancer, em physem a, and fibrosis on th e whole, and especially of the role of nonprofessional and pro fessional environm ents in th eir occurrence. Yet we have, w ith special ap p re cia tio n to G re at B rita in 's ex cellent vital statistics, im portant evidence at our dis posal of the relationship between occupation and certain pulm onary diseases, such as chronic bronchitis. A fter this general survey, now let us study the details. Since silicosis will be discussed in an o th er connection, I shall begin w ith asbestosis. A sb esto sis T h e m ajor part of our present knowledge concerning asbestosis is contained in the excellent G erm an book th a t appeared some m onths ago. Die Asbestose der Lungen by Bohlig-Jacob-M iiller. T his book contains, in a d d itio n to 700 of th e ir own cases, references to practically the entire world literatu re in this field (som e 650 references). T h e re is n o th in g basically new about th e pathogenesis, clinic, prognosis, and preven tio n of this disease. F u rth e r in fo rm atio n is, how ever, obtained about the frequency of clinical sym ptom s as well as roentgenologic and bronchographic observations from the authors' careful exam ination on their m aterial of 700 cases. T h e relatio n sh ip betw een asbestosis and lung cancer is still statistically in determ ined. In spite of this, "asbestos cancer" exists, and th e au th o rs give th eir own specification to it. Does asbestos dust have sim ilar nonoccupational affect as, for exam ple, beryllium ? T h is is a problem th a t h as b een exposed th ro u g h th e o b serv atio n s of 126 nonoccupational pleural calcification cases (so-called n eighborhood cases) th a t h ad been found in th e p o p u lation living around two open asbestos quarries, p u b lished by the Finnish Dr. Kiviluoto. According to this study, the details of which the au th o r will present him self at this Congress, m ore th a n 800 p le u ra l calcifica tion cases were found in th e m in u te x-ray investigation of farm ers, w orkm en, an d th e ir wives, w ho never h ad any occupational exposure. Calcification was usually located in p arie tal pleu ra, as it is also m ost often in occupational asbestosis. In m ost instances it occurrecT bilaterally on th e in n er chest wall. Basal and m edi astinal calcification was also often observed, a p u l m onary fibrosis being found only on a few cases. T h e calcification was noticed to appear slowly. T hese roentgenologically noticeable changes gave insignificant clin ical symptoms. T hese observations m ake it evident th at m easures m ust be taken to prevent the air pollu tion of the environm ents surrounding the factories and asbestos q u arries. T h e resu lts of D r. K iv ilu o to 's w ork are m otivation for sim ilar investigations in other coun tries to certify these observations. NORO Other fibrotic lu ng diseases and "benign p n eu m o coniosis" caused by silicates, m ixed or non-silica dusts (Glass wool, sericite, sillim anite, talc, anthracol, c a rb o ru n d u m , cement, F u lle r's ea rth , ch in a a n d ball clays, graphite, gypsum , kaolin, lim estone, m arble, m ica, T hom as (basic) slag, etc.) I shall pass this group w ith a brief m ention of talcosis and g raphite lung, w hich are still objects of continuous research. W ith great enough exposure, u n d o u b te d ly , th e d u sts of th is g ro u p have th e ir afEect in the occurrence o f fibrosis. However, it is evident th a t w ith im proved hygiene these types of pulm onary changes will become m ore and m ore rare. P neum opathies due to toxic chem icals and m etals G ases, F um es and V apors (C l, N O z, S 0 2, bo ran s, desm odur, hydrocarbons, oils, kerosene, etc.) M etals (A lum inium , antim on, barium , beryllium , cadm ium , chrom , cobalt, fluor, gold, iron, manganese, nickel, osmium, platinum , selenium , sulfur, tungsten, titanium , vanadium , wolfram , zirconium , etc.) T h e am ount of toxic chemicals and m etals influenc ing the lungs is continuously growing. V anadium , chrom , and beryllium have been subjects of research, especially in Sweden and in our host country, the U.S.A. T h e im p o rta n ce of v an a d iu m is especially i n creasing. It is necessary, however, to bear in m ind th at w ith the expanding use of oil heating, the crude oil coming from various parts of the world contains vanadium in very different amounts. T h e role of the acic sulfur com pounds in the ashes is also to be rem em bered. For a detailed study of beryllium , X would refer you to the proceedings of the conference held at th e M .I.T . in 1958 (A M .A . A rch. In d u st. H e a lth ); a com prehensive list of references on b e ry l liu m is co n tain e d in a p u b lic atio n on these p ro ceed ings. W e in Europe, to my knowledge, do not have the big problem s w ith beryllium which seem to exist in th e U.S.A. It is impossible, in th is short presentation, to nam e all the new chemicals w ith irrita n t effect on the lungs. W e industrial physicians have special difficulties a t tem pting to evaluate the aftereffects of acute irritants to th e lungs (n itro u s fum es, C l, S 0 2, etc.), especially with reference to etiologic differential diagnostics in chronic bronchitis and emphysema. P neum opathies due to organic dusts, allergens and p n eu m o m y co ses (Actinomycosis, aspergillosis, cocci dioidomycosis, cork (suberosis), cotton (byssinosis), drugs, dyes, feathers, flour, grain, gum acacia, h air, hay (fa rm er's lung), histoplasm osis, ju te , le a th e r (cannabosis), linen, m oniliasis, nocardiosis, sporotrichosis, sugar cane (bagassosis),-tobacco (tabaccosis), tropical woods, etc.) T h e agricultural population has received increased atten tio n d uring the last few years in the investigation of th e re la tio n sh ip betw een w ork an d h e a lth . " F a rm e r's lung" and o th er pulm onary diseases found in agricul tu re have proved surprisingly common upon closer investigations. U nfortunately, so far there have not been powers to investigate these conditions in the countries w here the agricultural population works u nder the worst hygienic conditions. We have not enough know l edge about the pulm onary diseases of the w orkers in th e old Asian rice m ills, for example. T h e effect m echanism of most organic dusts is still unclear, and we are also in a difficult field, w here bacteriology an d allergology will be of m uch help in several cases. W h at factors effect in different conditions --acute, subacute, chronic; proteins, alcaloids, irritating m echanic factors, toxic, allergic, bacteria, the silica included--are questions that are still w aiting to be answered. In addition, for example, the experience w ith byssinosis is still contradictory in different coun tries. T h e interesting research results of Dr. Schilling of England m ake one think th at this disease has not yet disappeared as has been contem porary th o u g h t in my own country. In fectio u s and parasitai p n eu m op ath ies (Amebiasis, anchylostomosis, anthrax, bilharziosis, brucellosis, hydatitosis, leptospirosis, ornithosis, tuberculosis, tularaem ia, etc.) W ith the diseases of this group there are continuous difficulties in etiologic diagnostics: w hen is the infec tion to be considered due to work and when not? T he q u estio n is very im p o rta n t, fo r ex am p le, w ith tu b e r culosis. O f course, the relationship between tuberculosis and pneum oconioses is u n d er constant study. Lung cancer due to occupation (A rsen, asbestos, chrom ates, isopropyl alcohol m anufacturing, nickel, radioactive substances, etc.) T h e Secretary General of our Congress, Dr. Eckardt, handles the role of working conditions in the occur rence of cancer in his book Industrial Carcinogenesis m ost variedly and with good criticism. Yet it is to be suspected th a t in industry many other substances also have a cancerogenetic effect. O ur knowledge in this field, how ever, is still very lim ited, and although ex perim ental cancer research has gone far, we still lack in practice necessary facts. It is hoped th a t th e wellendowed cancer organizations and research institutes will m ore than before concern themselves w ith the occupational aspects in th e etiology of cancer. T h e results from th e investigation by U.S. P ublic H ealth Service concerning the hazards of radiations to m iners are expected with great interest. W hether the cases of Schneeberg an d Joachim stal w ill get successors in th e very w idespread u ra n iu m m in in g is a q u estion th at will presently be answered. P neum opathies caused by radiation T h e influence of radiation as the cause of cancer has already been referred to above. O ur knowledge about the other effects of radiation on the lungs are very sm all. In co n n e ctio n w ith th e ra p y , large doses (10002000 r.) have been found to cause changes in the lungs in th e form of pneum onitis and fibrosis. From East Germ any there comes the report of a chronic p n eu m onia case of a chemist, w hich led to death; the cause of death being considered the breathing of radioactive dust over a period of 20 years. C onclusion T o our present knowledge, we already have a foun d atio n for th e technical prevention of these diseases. W e are as yet in a w eaker position as to th eir m edical prevention: we know too little about why one person gets them and one does not. T his question requires much research. W e have already reached far in the roentgenologic diagnostics of the pulm onary diseases, and there we are m aking constant progress. W e are also aware, however, of the difficulties therein as to several of th e disease g ro u p s referred to above. T ogether w ith the roent genologic exam ination we m ust develop other clinical 328 M EDICAL PRACTICES exam ination m ethods, especially the physiologic lung function diagnostics. In its most advanced form , we have to apply it not only in laboratories but, above all, in the field exam inations to the exam ination of population groups exposed to different exposures. Above all, we need also in this field keen in te rn a tional collaboration to solve o u r com m on problem s and to exchange inform ation so th a t each of us in his own country could apply in practice the knowledge we already possess to the betterm ent of our w orking population. BIBLIOGRAPHY G eneral 1. P neum oconiosis A bstracts, Vol. I l l , L o n d o n , 1959. 2. Sance spciale consacrl l'tu d e des p n e u m o pathies professionelles (Silicose excepte). A rch, m al. prof., 75:255-354, 1957. 3. A lbahary, C.: Les asthm es professionelles: p r o b lmes poss p o u r leur rparation. A rch. mal. p rof., 75:41,633, 1957. 4. A ltsh u ler, B.; Y arm us, L.; Palm es, E. D.; an d Nelson, N.: Aerosol deposition in th e hum an respiratory tract. A.M .A. Arch. Indust. H ealth, 75:293, 1957. 5. Anders, W.: Soziale Problem e bei allergischen Erkrankungen am Beispiel der Asthm a bronchiale^ Off. Gesd. dienst, 79:488, 1958. 6. A nderson, W. H., and Schm idt, W . F.: E valuation of disability in coal m iners w ith chronic p u l m onary disease. J.A .M .A ., 777:145, 1959. 7. A ntw eiler, H.: M astzellen u nd H istam in nach Injection von Staubsuspensionen. Arch. Gewerbep a th ., 76:607, 1959. 8. B aader, E. W .: E inige n e u e P ro b lem e d e r G ew er bepathologie (Lungenem physem, Kadm ium , Des m o d u r). B eih . z. Zbl. A rb eitsm ed ., H eft 3. D arm sta d t, 1956, p. 172. 9. B erkson, J.: T h e statistical in v e stig a tio n of sm ok ing and cancer of the lung. Proc. Staff M eet., M ayo C lin., 34:206, 1959. 10. B e rlin , R a g n ar: Y rkespneum okonioser. Svenska L h a rtid n in g e n , 33:3157-31-71, 1956. 11. B ernard-G riffiths, M m . G.; C h am p eix , J., an d B aldini, A.: A sthm e professionel p a r contact avec des m oisissures (a propos de 24 observations). A rch. m al. prof., 75:272, 1957. 12. Bugyi, B.: B eitrge zu r F rage d er S ta u b re te n tio n s fhigkeit d e r Lunge. M u n ka vd elm , 3:49, 1957. 13. C ancella, L. D e C.; B aader, E. W .; C h oux, J. De; F rouchtm an, R .; Lffler, W .; W o rth , G.; and Zorn, O.: In d u strial diseases of th e chest: a com m entary on cu rren t problem s. Dis. Chest, 32:683, 1957. 14. C arstens, M.: D ie asth m atisch en R e ak tio n en d er B ergleute. A rch . G ew erb ep a th ., 75:45, 1956. 15. C arstens, M.: Z ur F rag e d e r K au sa litt von Emphysem und Bronchitis der Bergleute. Arch. G ew erbepath., 75:285, 1957. 16. D a u tre b a n d e , L.; B eckm ann, H .; a n d W a lk e n horst, W .: L ung deposition of fine dust particles. A .M .A . A rch. In d u st. H e a lth , 76:179, 1957. 17. Davies, C. N.: D epositio n of d u st in th e lungs: a physical process. In the Sym posium on Industrial P ulm onary Diseases, ed. by King and Fletcher. L o n d o n , 1960, p. 44. 18. D n n e r, L.: K linisch-rntgenologische D iffere ntialdiagnose der Lungenkrankheiten. Stuttgart, 1958, p. 362. 19. D n n e r, L.: E m physem bei S tau b lu n g e n erk ran kungn -- Emphysem als selbstndige Berufs -- k ran k h e it. Zbl. A rb . m ed., 7:137, 1957. 20. D n n er, L.: Pneum oconiosen o d er S tau b lu n g e n er krankungen der Lunge? K ritische B etrachtungen und Vorschlge zu ih rer Entschdigung. Zbl. A rb. m ed., 9 :12, 1959. 21. F erin, J., and U lehlov, V.: U eber d ie Selbst reinigung der Lunge von Staub und ihre Bestim m ung in T ierversuch. A rch. G ew erbepath., 76:630, 1959. 22. F letcher, C. M.: D isability an d m o rtality from chronic bronchitis in relation to dust exposure. A .M A . In d u st. H e a lth ., 75:368, 1958. 23. Fletcher, C. M.: R adiological diagnosis of p n e u moconiosis. In th e Sym posium on Industrial Pulm onaiy Diseases, ed. by King and F letcher. L on don, 1960, p. 72. 24. G ernez-R ieux, C.; Balgairies, E.; F o u rn ie r, P.; and Voisin, C.; An often unrecognized m anifesta tion of pneumoconiosis in miners: aseptic lique faction of pseudotum oral form ations. Semaine h o p . Paris, 54:1081-1089, 1958 (in F rench). J A M .A . , 767:2140, 1958. 25. Gersing, R.: D ie frhen R eaktionen der Lunge auf verschiedene Stau barten im vergleichenden T ie rv e rsu c h . B eitr. Silikoseforsch., 4 2 :1, 1956. 26. G lm m e, J., an d Swensson, .: O m a n d ra p n eu m okonioser n silikos. N ord. M ed ., 58:1973, 1957; N on-silicotic pneum oconiosis. Proc. X II Congr. In d u st. H e a lth , 5:165, 1957. 27. Goetz, A., an d T suneishi, N.: A Bacteriological Irritatio n A nalogue for Aerosols. A .M .A . Arch. In d u st. H e a lth , 20:167, 1959. 28. G rau b n er, E.: Classification System of th e P n eu moconiosis. Pracooni lekarstvi, 70:109, 1958. 29. G ronem eyer, W .: Das gew erbliche A sthm a. D tsch. m ed . W s c h r 5:30, 1958. 30. Gross, P au l: C u rre n t concepts of pn eu m o co n io sis. P ath o lo g ical aspects. J.A .M .A . 772:546, 1960. 31. Gross, P aul: An im m unologic ap p ro ach to the pneum oconioses. A.M .A. Arch. Indust. H ealth, 27:228, 1959. 32. Gross, P aul, an d Sm ith, K. W .; T h e to pographic distribution of m ineral dusts in some pneum oconiotic lungs. Dis. C hest, 3 5 :140, 1959. 33. H iggins, I. T . T .; C o ch ran e, A. L .; G ilson, J. C.; and W ood, C. H.: Population studies of chronic respiratory disease. A com parison of m iners, foundry workers, and others in Stavely, Derbyshire. B rit. J. In d u st. M ed., 76:255-268, 1959. 34. H olstein, E. (H erausgeber): H a u b lungenerkran k u n g e n . L eipzig 1958 (T a g u n g in E rf u r t, 1956). 35. H o lt, P. F .: Pneum oconiosis. In d u s tr ia l Diseases of th e L u n g Caused by D ust. L ondon, 1957. 36. H yde, Leroy: Diffuse p u lm o n ary fibrosis. P ost grad. M ed ., 26:208, 1959. 37. J tten , K. W ., an d K losterktter, W .: D ie S ta u b lu n g e n erk ra n ku n g e n , B an d 3. D a rm sta d t, 1958. 38. K h v ap il, M.: B iochem ical m e th o d s in assessing the effect of industrial dust on th e organism . H igiena T ru d a , 4(4): 28, 1960. 39. K h u k h rin a , E. V.: M ethods u sed in th e stu d y of the pneum oconiosis incidence-rate. H igiena Truda 4(4): 7, 1960. 40. King, E. J., and F letcher, C. M. (eds.); A Sym posium on Industrial P ulm onary Diseases. T h e P ostgraduate M edical School of L o n d o n , 1957 and 1958. C hurchill L td., L ondon, 1960, (273 pages). 41. King, E. J., and H arriso n , C. V.: R eactio n of the lung to dust. In the Sym posium on Industrial P u lm o n a ry Diseases, ed. by K ing 8c F letc h er, L o n don, I960, p. 37. 42. K leinfeld, M., and G iel, C. P.: Pneum oconiosis. J. C hronic D is., 9:117, 1959. NORO 329 43. Klosterktter, W.: Tierexperim entelle U ntersu 64. Rein, H .f and B rinkm ann, O: Bekommen H ohl chungen ber das Reinigungsvermgen der Lunge. glasblser ein Lungenemphysem? Berufskrank Arch. Hyg., 141:258, 1957. heiten in der keramischen Industrie, Heft 6. 44. Kovnatsky, M. A.: Silicatoses. Moskva, 1957 (179 W rzburg, 1959. pages). Reviewed: Higiena Truda, 2(3):60, 1958. 65. Sander, O. A.: C urrent concepts of pneum oco 45. LaBelle, C., and Brieger, H.: Synergistic effects of nioses--clinical aspects. J.A.M .A., 172:1587, 1960. aerosols. II. effects on rate of clearance from the 66. Sander, O. A.: Newer concepts of the pathogenesis lung. A.M .A. Arch. Indust. H ealth, 20:100, 1959. of the pneumoconioses (The 1958 Ramazzini O ra 46. Lagze, M. P.: La maladie asthm atique et ses tion). J. Occup. M ed., 1:1, 1959. limites sur le plan mdicale. A rch. mal. prof., 67. Sano, T ., and Osanai, H.: Types of pneum o 18:255, 1957. coniosis and their pathogenesis. Reports of the 47. Lane, R. E.: Chronic bronchitis and occupation. Inst, fo r Science of Labour (Tokyo), 55:27, 1959. Brit. J. T u b e r c 52:11, 1958. 68. Sartorelli, E., and Scotti, P.: Studio sperimentale 48. Lawther, P. J., and W aller, R. E.: Atmospheric pollution and lung cancer. Trans. Ass. Indust. Med. Off., 9:5, 1959. 49. L upu, N. Gh.; Velican, C.; and Olinescu, V.: T he action exerted by certain pneumoconiotic factors upon the acid mucopolysaccharide contents of pulmonary macrophages. Brit. }. Indust. Med., 76:244, 1959. 50. Lblich, H. J.; Koch, W.; Sffge, K. H.; and N ordm ann, M.: Die Resorption einverleibten Staubes. Feinkrnige Stube (Kalkspat, Spateisen stein, T alk, Rutil). Beitr. Silikoseforsch., 50:1, 1957. 51. Lblich, H .-J.; Koch, W.; and N ordm ann, M.: Die Resorption einverleibten Staubes. Die Au fnahm e von Kieselgur. Beitr. Silikoseforsch., 50:11, e statistico sull' incidenza della bronchite crnica e dell' enfisema polmonare nella popolazione operai di una miniera di pirite. Med. Lavoro (Milano), 45:704, 1957. 69. Schneider, H.: Untersuchungen zur Frage des berufsbedingten Emphysems und der berufsbedi ngten Emphysembronchitis der Glasblser. Berufskr. in d. keram. u. Glas-Ind., Heft 2. Wrzburg, 1958. 70. Schneider, H.: Die berufliche Erkrankung der Atmungsorgane, in F. Koelsch: H andbuch der B erufskrankheiten, 2. Auf!., Jena, 1959. S. 620 (Literaturverzeichnis S. 1109). 71. Schneider, H.: Die Staublungenerkrankungen in Bayern in den letzten 50 Jahren. Staub, 20:1, 1960. 1957. 52. M archand, M.: Pneum opathies professionelles non selrogenes. Essai de classification. Proc. X II In 72. Schrenk, H . H.: Status of the pneumoconioses, environm ental factors. A.M.A. Arch. Indust. H ealth, 75:365, 1958. ternational Congress on Occupational H ealth, 73. Srmek, J. and Srtek, J.: Chronic industrial in Helsinki, 1957, 1:157 (Bibliography post 1950, pp. flammations of the respiratory tract and pul 170-191). Vide: Marchand, M.: Les pneum opathies monary emphysema. Prac. lk., 70:156, 1958. professionelles. Arch. mal. prof., 75:260, 1957; Les pneumoconioses non selrogenes. Arch. Hig. Rada 4:402, 1953; Hygine et securit du Travail, Fase. IV. Lille, 1955 (Bibliography pp. 28-54). 74. Strecker, F. J.: Die intraperitoneale Gewebstreaktion auf SiO.-freien Lungenkohlestaub und ihre Abwandlung durch geringe Quarzbeimengungen. Beitr. Silikoseforsch., 43:21, 1956. 53. Marks, J., and Nagelschmidt, G.: Study of the toxicity of dust with use of the in vitro de hydrogenase technique. A.M.A. Arch. Indust. H ealth, 20:383, 1959. 54. Mayer, E., and R appaport, I.: Bronchitis and Emphysema. J.A.M .A., 165:1221, 1957. 75. Targam adze, K. S.: On the intracheal method of introduction of dust to animals. Gig. Truda, 2:56, 1958. 76. W orth, G.; D urben, H.-H.; Ellersick, W.; Gast haus. L.; and Nerreter, W.: Zur Frage von Bronchialspasmen bei Kohlenbergarbeitern im 55. Morrow, P. E.; Mehrhof, E.; Casaret, L. J.; and U ntertagebetrieb. Beitr. Silikoseforsch., 45:1, 1956. Morken, D. A.: An Experim ental Study of Aerosol Deposition in Human Subjects. A.M.A. Arch. A sbestosis, fib ro tic lu n g diseases, and " benign 1 Indust. H ealth, 75:292, 1958. pneum oconiosis" caused by silicates, m ixed or 56. Motley, H. L.: Pulmonary function im pairm ent n o n -silica d u sts in pneumoconioses. J.A.M.A., 772:1591, 1960. 57. Nagelschmidt, G.; Nelson, E. S.; King, E. J.; 1. Coal W orkers Pneumoconiosis. A.M .A. Arch. In Attygalle, D.; and Yoganathan, M.: T h e recovery dust. H ealth, 75(6), 1957. of quartz and other minerals from the lungs of 2. A delbahr, G.: Lungenvernderungen bei einem rats. A.M .A. Arch. Indust. H ealth, 76:188, 1957. Korundschmelzer (Berufskrankheit oder Suicid). 58. Nesis, A. J.: Methods of x-ray exam ination in M schr. Unfallhk., 60:65, 1957. i pneumoconiosis. Gig. Truda, 3:22, 1959. 59. N ordm ann, M.; Koch, W.; and Mder, E.: Die 3. Ahlmark, A.; Bruce, T .; and Nystrm, A.: Pneumokonios (talkos) vid bearbetning av tljsten. Resorption einverleibten Staubes. Sptstadien rein N ordisk M edicin, 52:287, 1958. f er gemischter Stube: Kieselgur und Quarz. 4. Ahlm ark, A.; Bruce, T .; and Nystrm, A.: Pneu Beitr. Silikoseforsch., 63:21, 1959. moconiosis in iron foundries. Proc. X II Int. ; 60. NOereunmsotecionn, ioAsi.s. J.:MeUdlitciimnaas dIenlvesTtirgaabcaijoon,es24s:o1b9r0e, 5. ACohnlmgra.rkO,ccAu.;p.BHruecael,thT, .H; ealnsdinkNi,ys5t:r36m5,, 1A9.5:7.Pneu- 1959. mokonios hos kiselgurarbetare. Nordisk Medicin, 61. Pemberton, J.: Chronic bronchitis, emphysema 59:289. 1958. j and bronchial spasm in bituminous coal workers. 6. Alvisatos, G. P.; Pontiakis, A. E.; and Terzis, B.: An epidemiologic study. A.M.A. Arch. Indust. Talcosis of unusually rapid development. Brit. ). H ealth, 75:529, 1956. 62. Pendergrass, E. P.: T h e Pneumoconiosis Problem Indust. M ed., 12:43, 1955. 7. Bobileva, A. T. e al.: T h e Amount of Dust in with Emphasis on the Role of the Radiologist. R esidential Districts of Asbest and its Effect on Springfield, 111., 1958. the Childrens H ealth. Gig. i Lan., 25(9), 1958. 63. Princi, Frank: Status of the pneumoconioses. In 8. Bohlig, H.; Jacob, G.; and Mller, H.: Die J; troduction. A.M .A. Arch. Indust. H ealth, 75:361, Asbestose der Lungen. Stuttgart (Thieme), i960 1958. (166 pages). 330 M EDICAL PRACTICES 9. Bohlig, H .: Schw ere M ischstaubsilikose bei einem SchwerspatmIler. Proc. X II In t. Congr. Occup. H ea lth , H elsinki, 3:310, 1957. 10. Bridge-D avis, S.; a n d N ag elsch m id t, G.: A re p o rt on the absence of pneum oconiosis am ong workers in p u re lim estone. B rit. J. In d u st. M ed., 13:6, 1956. 11. D juricic, I., and Savic, V.: L a m ic ro h e m a tu rie des ouvriers dans une m ine et une usine d'asbeste. Proc. X II Int. Congr. Occup. H ealth, Helsinki, 3:324, 1957. 12. E h rh a rd t, W ., an d H eid e m a n n , W .: Z u r K lin ier und Pathologie der Ockerstaublunge. Arch. Gewerb e p a th . G ew erbehyg., 17:504, 1959. 13. F ehre, W .: U eb er d o p p elseitig e P leu rav e rk a l kungen infolge beruflicher Staubeinw irkungen. Fortschr. R n tg e n str., 53:16, 1956. 14. G attn er, H.: D ie R uss-L u n g e in ih r e r A bgrenzung von der A nthrakose. Proc. X II In t. Congr. Occup. H e a lth , H elsinki, 3:356, 1957. 15. G lm m e, J., an d Swensson, A.: N on-silicotic p n e u moconiosis (Graphitosis, Kaolinosis). Proc. X II In t. Congr. O ccup. H ea lth , H elsinki, 3:166, 1957. 16. Gross. P.; W estrick, M. L .; M cN erney, J. M.; Schrenck, H. H.; and Srsic, R. P.: T h e pulm onary effects of synthetic silicates derived from diatomaceous earth. A.M .A. Arch. Indust. H ealth, 16:317, 1957. 17. H u d so n , J . H.: D ust from C em ent W orks. M ed. Officer, 98:351, 1957; J.A .M .A ., 166:1358, 1958. 18. H b n e r, O., a n d M u ller, G.: M ineralogische u n d physikalisch-chemische U ntersuchungen an einer Talk-Staublunge und an T alk-H autgranulom en. A rch . G ew erbepath., 440, 1957. 19. K am m er, A. G .: O cc u p atio n al h e a lth p ro b lem s of the bitum inous coal m iner. A.M .A. Arch. Indust. H e a lth , 13:466, 1957. 20. Koelsch, F.: Z u r F rage d er "G ra p h itsta u b lu n g e " . Zbl. A rb . m ed., 8:1, 1958. 21. Koelsch, F.: Die S taubgefhrdung d u rch Flusspat. Zbl. A rb . m ed., 9:153-157, 1959. 22. Kiviluoto, R.: P leural calcification as a ro en t genologic sign of non-occupational endem ic antophyllite-asbestosis. A cta R a d io l., S u p p l. 194, 1960, (67 pages). 23. L iichtracht, H .f and Schm idt, K. G.: U eber T alkum u n d Steatit, ihre Beziehungen zum Asbest sowie ihre W irkung beim intratrach tealen T ie r versuch an R a tte n . B eitr. Silikoseforsch., 61, 1959. 24. L blich, H . J.; Koch, W .; Sffge, K.-H.; and N ordm ann, M.: D ie R esorption einverleibten Staubes. Feinkrnige Stube. B eitr. Silikoseforsch., 50:1, 1957. 25. Massione, R., and L uvoni, R.: Silicosi da Mica? Rass. m ed. In d u st., (T o rin o ), 23:1, 1956. 26. M eiklejohn, A.: C arbon an d pneum oconiosis. Proc. X II In t. Congr. Occup. H ealth, Helsinki, 3:335, 1957. 27. Messite, J.; R e d d in , G.; a n d K leinfeld, M.: P u l m onary talcosis, a clinical and environm ental study. A .M .A . A rch . In d u s t. H e a lth , 20:408, 1959. 28. M ongelli-Sciannameo, N.: Su la patologia da polvere di cem ento rilievi clinico-radiologici su 350 cem entisti. Folia M edica, 42:469, 1959. 29. N ordm ann, M.; Koch, W .; and M der, E.: D ie Resorption einverleibten Staubes. Sptstadien reiner und gem ischter Stube: Kieselgur, Quarz, K ieselgur u n d Q uarz. B eitr. Silikoseforsch., 63:23, 1959. 30. P attle, R. E.; W edd, G. D.; and Burgess, F.: T h e ac u te toxic effects of black smoke. Brit. J . In d u st. M ed., 16:216, 1959. 31. P rosperi, G ., an d Barsi, C.: Slle p n eu m o co n io si dei lavoratori del cemento. Rass. m ed. indust., (T o rin o ), 25:16, 1957. 32. R aik lin , N. T .: M aterials ch a racterizin g th e n a ture of pneumoconiosis in the coal m iners of the K arag an d a Basin. G ig. T r u d a , 3(4):48, 1959. 33. Sadkovskaya, N. I.: A co m p arativ e h y g ie n ic ev a lu ation of the dust factors in plants producing dif feren t types of cem ent. Gig. T ru d a , 3(1):39, 1959. 34. Sander, O. A.: R o en tg en R esu rv ey o f C em ent W orkers. A .M .A . A rch . In d u s t. H e a lth , 17:96, 1958. 35. Schm idt, K. G., an d L ch tra th , H .: Die W irk u n g von frischem und gebranntem Kaolin auf die Lunge und das Bauchfell von R atten. Beitr. Silikoseforsch., 58, 1958. 36. Seeler, A. O.; G ryboski, J . S.; a n d M acM ahon, H. E.: T alc pneum oconiosis. A M .A . A rch. In d u st. H ea lth , 19:392, 1959. 37. Sepke, G.: Z ur T alk u m stau b lu n g e. ulosearzt, 14:247, 1960. Tuberk 38. W atson, A. J.; Black, J.; D oig, A. F.; a n d N ag el schm idt, G.: Pneum oconiosis in C arbon Electrode M akers. B rit. J. In d u st. M ed ., 16:2,74, 1959. 39. Vyskocil, J.: D ynam ische V er n d e ru n g e n d er Lungenfunktionen bei Zem entarbeitern durch w iederholte Untersuchungen nach 5 Jahren erwie sen. P racovni lk., 5:85, 1956. P n eu m o p ath ies due to toxic chem icals an d m etals I. Beryllium Disease and Its C ontrol. Conference held at M assachusetts In stitu te of Technology Sept. 30-Oct. 1, 1958. A .M .A . A rch . In d u st. H ea lth , 19:91-267, 1959. 2- A m d u r, M ary O.: T h e re sp ira to ry response of guinea pigs to sulfuric acid mist. A.M .A. A rch. In d u st. H ea lth , 18:407, 1958. 3. A rchangelskaja, L. N. & B orisenkow a, R . V.: U ntersuchungen ber die hygienische Bew ertung von Industriestaub aus M etall-Legierungen. J. H yg. E pid. M icrobiol. Im m u n o l. (Prague), 1:441, 1957. 4. B aader, E. W .: L u n g en sch d en d u rc h Isozyanate. M ed. Sachverst., 32:128, 1956. 5. Baader, E. W.: H artm etall-L ungen. In Die Staub lu n g e n erk ra n k u n g en , B a n d 3. E d. by J tte n & K losterktter, D arm stadt, 1958, p. 531; Zbl. A rb . m ed., 9 :33, 1959. 6. B aader, E. W .: Neues b er die w ichtigsten B eru fskrankheiten. Sichere A rb eit, 1:23, 1960. 7. B arth, G.; Frik, W .; an d Scheidem andel, H.: D ie A lum inium lunge. D tsch. M ed. W schr., 57:1115, 1956. , 8. Becklake, M. R.; G o ld m a n n , H . I.; R ae-B osm an, A.; and Freck, C. C.: T h e long-term effects of exposure to nitrous fum es. A m . R ev. Tuberc., 76:398, 1957. 9. Benoist, C. P., and F ran t, R .: M edical experiences w ith argon-arch welding. Proc. X II In t. Congr. O ccup. H e a lth , H elsin k i, 3:387, 1957. 10. B ister, F.; Klavis, G.; K h ler, H .; a n d W ittg en s, H.: Zur Gewerbetoxikologie von Anstrichsstoffen auf Zinkchromatbasis. A rch. G ewerbepath., 16:567, 1958. I I . Bloom, G., an d Swensson, A.: T h e reaction of the thrombocytes to intravenously injected suspen sions of subm icroscopic particles. Acta M ed. Scand., 162:42,3, 1958. 12. Boccia, D.: Patologia de la so ld ad u ra elctrica. M ed. T rabajo, 23:16, 1958. 13. B o n n ell, J. A.; K azantzis, G .; a n d K ing, E. A.: A follow-up study of m en exposed to cadm ium oxide fum e. B rit. J. In d u st. M ed ., 1 6 :135, 1959. NORO 331 14. B r ch n e r, L. & M a u tn er, B.: BTonchographic picture of pneum oconiosis in welders. Pracovni lekarstvi, 77:233, 1959. 15. Boot, A. C.: V erg iftu n g m it V anad iu m p en to x y d . N ed. T sch r. G eneesk., 101:2124, 1957. 16. B reslin, A. J., a n d H arris, W . B.: H e a lth p ro te c tion in beryllium facilities. Summary of ten years of experience. A M .A . Arch. Indust. H ealth, 19:596, 1959. 17. Buess, H ., an d L erner, R.: U eber A sthm a b ro n chiale und asthm oide Bronchitis in der chemischen In d u strie . Z. P r ve n tiv m ed . (Zurich), 59, 1956. 18. C am pbell, Ire n e R .; Cass, J . S.; C holak, J .; an d Kehoe, R. A.: A lum inum in the E nvironm ent of M an. A M .A . A rch. In d u st. H ea lth , 15:404-406, 1957. 19. C em ber, H .; W atson, J. A.; an d G rucci, T . B.: ' P ulm onary effects from radioactive thallium activated clay particles. A M A . Arch. Indust. H ea lth , 75:449, 1957. 20. Cholak, J.: T h e analysis of traces of beryllium . A .M .A . A rch. In d u st. H e a lth , 19:205, 1959. 21. C hristensen, F. C., and Olson, E. C.: C adm ium poisoning. A .M .A . A rch. In d u st. H e a lth , 16:8, 1957. 22- C o tter, L . H .: T re a tm e n t o f cadm ium poisoning w ith edatham il calcium disodium. J A M A ., 166:735, 1958. 23. C repet, M., and G affuri, E.: A proposito della m alattia da navadis nei pulitori di caldaie a n afta . L avoro e. m e d 10, 1956. 24. C urtis, J. K.; Bauer, H elene; Loom ans, Sallie; an d Rasm ussen, H . K.: P ulm onary diffusion capacity studies. I. a sim plified technique of carbon m onoxide breath-holding. A m . J. M ed. Sei., 236:53, 1958. 25. D alham n, T .: C hlorine dioxide toxicity in anim al experim ents and industrial risks. A M .A . Arch. In d u st. H e a lth , 15:101, 1957. 26. D eichm ann, W . B.; K eplinger, M. I..; and Lanier, G. E.: A cute effects of nitro-olefins u pon experi m ental animals. A.M .A. Arch. Indust. H ealth, 18:312, 1958. 27. D rsche, H .: Z u r F rage der S tau b g e f h rd u n g in den Sinteranlagen saarlndischer E isenhtten werke. A rch. G ew erbepath. Gewerbehyg., 16:666, 1959. 28. D n n er, L., an d H ardy, R.: P neum oconiotic and non-pneum oconiotic lung lesions due to inhaling dust and S 0 2 fum es from burn in g coke. Clinical, x-ray and m orbid-anatom ical studies. Arch. G ew erb ep a th . G ew erbehyg., 16:644, 1959. 29. E hrlicher, H ., an d Pibz, W.: Industriehygienische und arbeitsmedizinische Massnahmen bei der V erw endung von Isozyanaten (Desmodur). Arbeits sc h u tz, 276, 1956 & 7, 1957. 30. F ischer, R . E.: G ew erbliche V ergiftungen d u rch Cadm ium , Quecksilber, Arsen und ihre V erbind ungen. Uebersicht ber die Verffentlichungen 1946 bis 1956. C lausthal-Z ellerfeld, 1958. S ch riften d. Gesellschaft D eutscher M etallhtten- und B erg leu te e.V ., H eft 6 (202 pages). 31. F riebel, H ., a n d Gross, E.: Z ur T o x iz it t von reinem Phtalsureanhydrid und Rohprodukten aus der industriellen Phtalsauresynthese. Arch. G ew erbepath., 14:465, 1956. 32. F rieb el, H ., a n d L c h tra th , H .: G esundheitssch den durch neuartige Lacke u nd Schaumstoffe. D tsch. m e d . W s c h r 81:980, 1956. 33. F rieb el, H ., an d Stein, A.: Z u r Genese des d u rch einfache Chem ikalien hervorgerufenen Asthmas. Versuche m it p-Phenylendiam in. Arch. Gewerbe p a th ., 16:620, 1959. 34. F rib erg , L .: E d a th a m il calciu m -d iso d i m in cad m ium poisoning. A M A . Arch. Indust. H ealth, 13:18, 1956. 35. Friberg, L.: D eposition and d istrib u tio n of cad m ium in man in chronic poisoning. A M .Ai Arch. In d u st. H e a lth , 16:2,7, 1957. 36. F rib erg , L.: C h ro n ic cad m iu m poisoning. A .M .A . A rch . In d u s t. H e a lth , 20:401, 1959. 37. Gage, J. C.: T h e toxicity of epochlorhydrin v ap o u r. B r it. J. In d u st. M ed ., 16:11, 1959. 38. G aly, P.; R o ch e, L.; B ouvier, J.; an d P errin , L . F.: P neum onie ch ronique in terstitielle diffuse volution m ortelle chez un m etalliseur au zinc. A rch. m al. prof., 75:301, 1957. 39. G lm m e, J., a n d L u n d g re n , K.-D.: H e a lth hazards from chlorine dioxide. A M .A . Arch. Indust. H ea lth , 76:169, 1957. 40. G lm m e, J., an d Swensson, A.: T ie re x p e rim e n te lle U ntersuchungen ber den Staub in der A rbeit satm osphre von Ferrosiliziumwerken. Staub lu n g e n erk ra n ku n g e n , B and 3. H erausg. J tte n & K lo sterk tter, 1957. 41. G lm m e, J., an d Swensson, A.: Cases of siderosis, alumiosis and pneum oconiosis in the tungsten carb id e tool in d u stry . Proc. X I I I n t. Congr. Occu p . H e a lth , H elsin k i, 3:166, 1957. 42. Gom bos, B.: P u lm o n ary n o d u la tio n by in h a lin g b a riu m d u st. P racovni L eka rstvi, 9 :399, 1959. 43. G ray, E. LeB.: Oxides of nitrogen: th eir occur rence, toxicity, hazard. A M .A . Arch. Indust. H ea lth , 19A 79, 1959. 44. H aglind, O.: L ung changes in electric welders. Proc. X II In t. Congr. Occup. H ealth, H elsinki, 3:169, 1957. 45. H am a, G. M.: Sym ptom s in W orkers Exposed to Isocyanates. A .M .A . A rch . In d u st. H e a lth , 16:%S2, 1957. 46. H am lin, L. E.: Siderosis. J. Occup. M ed., 7:79, 1959. 47. H am lin, L. E.: Siderosis: add itio n al observations over a period of eight years on sixty-nine foundry cleaning room employees. J. Occup. M ed., 7:79, 1959. 48. H ardy, H . L., and Stoeckle, J. D.: B eryllium d i sease. J. C hron. Disease, P:152, 1959. 49. H asegava, K. (and T eisinger, J., discussion): D iag nosis of chronic su lp h u r dioxide intoxication. Proc. X II In t. Congr. Occup. H ealth, H elsinki, 3:271, 1957. 50. H usten, K.: H artm etall-F ib ro se der lunge. A rch. G ew erbepath., 76:721, 1959. 51. Iannacone, A., and M azella di Bosco, M.: Intossicazione acuta da anhidride maleica in lavoratori del p o rto . Lav. u m a n o (N apoli), 5:404, 1956. 52. Johnstone, R. T .: Toluene-2.4-D iisocyanate. clin ical features. In d u st. M ed ., 26:33, 1957. 53. K arpov, B. D.: A ngaben zur toxikologischen C harakteristik von M ethylchlorakrylat. Gig. i San. 22:144:74, 1957. 54. K asparov, A. A.: P ro b lem e d e r A rbeitshygiene bei der H erstellung von Vulkanisationsakzeleratoren (T iu ra m , K aptaks). Gig. tru d a , 7:24, 1957. 55. Klavis, G.: A m m oniakvergiftungen u n d ih re Fo lgen u n ter Bercksichtigung neuer Kasuistik. A rch . T o x ic o l., 77:155, 1958. 56. Klavis, G.; Khler, H .; and Bister, F.: Die Ursache der Thom asschlackenpneum onie unter besonderer B ercksichtigung der Vanadin- und m anganhaltigen Schlackenbestandteile. A rch. Ge w erbepath., 75:355, 607, 1956-1957. 57. K leinfeld, M., and Giel, Ch. P.: Clinical m anifes tations of ozone poisoning: report of a new source of exposure. A m . J. M ed. Sc., 237:638, 1956. 58. Koelsch, F.: G esundheitsschden d u rc h M e tall k arb id e u n d H artm e talle. Z bl. A rb . m ed ., 9 :33, 1959; J. p ro p h yl. M ed. Soz.-hyg., 3:1, 1959. M ittle r, S.; King, M.; an d B u rk h a rd t, B.: T o x ic ity of ozone. A .M .A . Arch. Indust. H ea lth , 75:191, 1957. K unkel, A. M.; M u rth a, E. F.; D ikem us, H .; Stabile, D. E.; Saunders, J. P.; and W ills, J. H.: Some pharm acological effects of diborane. A .M .A . A rch. In d u st. H ea lth , 13:346, 1956. M ogilevskaya, O. Ya.: An ex p erim en tal study of th e effect of rare m etals ore dust on the respira tory organs. Gig. i san., 25:30, 1960. M oschinski, G.; Jurisch, A., an d R einl, W .: Die Kutschera, W.: Ein eigenartiger Fall einer V ergi ftu n g durch Dissousgas. M itt, sterr. San venu., 57:228, 1956. Lungen Vernderungen bei S i n t e r h a r t m e t a l T A r bei tern. A rch . G ew erbepath., 76:697, 1959. M olitor, L.; M osinger, M.; B arthel, J.; H eyart, 61. L achnit, V.: Z ur T h e ra p ie der R eizgasvergiftung. Zbl. A rb. m ed., 8 :177, 1958. L eicher, F.: Z ur D ifferentialdiagnose zwischen A lum inium lunge und M orbus Boeck. Fortschr. R ntgenstr., 84:571, 1956. Levinskas, G. J.; Pollis, A.; and Novick, W . J., Jr.: D istribution and excretion of poranes. A.M .A. H .; and Peri net, G.: Recherches su r les poussires de lam inoir et leur capacit pathogne. Les sidroses p u lm o n aires. L u x em b o u rg , 1957 (127 pages). M oschinski, G.; Jurisch, A.; an d R einl, W .: Die Lungenveranderungen bei S interhartm etallarbei tern . A rch. G ew erbepath., 76:697, 1958. A rch . In d u st. H ea lth , 74:346, 1956. 64. Lewis, C. E.: T h e biological effects of v an ad iu m . A .M .A . A rch. In d u st. H e a lth , 19:497, 1959. 86. N ak an isk i, S., an d N am iki, S.: Sym ptom s in w o rk ers exposed to isocyanates. R dkagaku, 34:980, 1958. 65. L in d g ren , S. A., a n d Swensson, A.: Y rkesm edicinska synpunkter pa fram stllning och bearbet- 87. N ebelung, W.: A kute V ergiftung m it D im elhylsu lfat. A rch . G ew erbepath., 75:581, 1957. nin g av plaster. Sv. L ka rtid n in g en , 55:2227, 1958- 88. O y an g u ren , H .; H ad d a d , R.; an d M aass, H .: .vvrvi V .v - . .................. . 66. Lingen, M arie-Louise, an d Sundeli, C. G.: Lungfrn d rin g ar iakttagna efter in a n d n in g av oljeh altig luft. N ordisk M ed icin , 58:1974, 1957. 67 Lowe, H . J., and F reem an , G.: B oron h y d rid e (borane) intoxication in man. A.M .A. Arch. In Stannosis. Benign pneum oconiosis owing to in h alatio n of tin dust and fum e. I. environm ental and experim ental studies. Indust. M ed., 27:427, 1958. 89. Pefialver, R.: Diagnosis and trea tm e n t of m a n dust. H e a lth , 16:523, 1957. 68. M achabeli, M. E.; Gdzeldze, E. G.; a n d M geladze, ganese intoxication. R eport of a case. A.M .A. A rch . In d u st. H ea lth , 76:64, 1957. T . G.: Clinical picture and work capacity in m anganokoniosis. Gig. T r u d a , 4:48, 1960. 69. M ann, B. T ., an d L ec u tie r, E. R.: A rc w eld e r's lung. B rit. M ed. J., 2:921, 1957. 70. Marks, J., an d N agelsch m id t, G.: Study of th e toxicity of dust w ith use of the in vitro dehydro genase technique. A.M .A. Arch. Indust. H ealth, 90. Portela-G om es, F.: La reactio n d e l 'alvole p u l m onaire quelques produits industriels. Proc. X I I In t. Congr. OcCup. H ea lth , H elsinki, 3:311, 1957. 91. von Post-L ingen, M arie-Louise: L u n g sk a d o r efter inhalation av olja eller oljchaltig luft. Nordisk M e d ic in , 59:290, 1958. 20:383, 1959. 92- P oteryaeva, G. E.: T h e toxic p ro p e rtie s o n a n ti 71. M assm ann, W .: E xperim entelle U ntersuchungen mony pentachioride. Gig. T ru d a , 2:22, 1958. b er die biologische W irkung von V anadinver 93. Q uilligan, J. J.; Boche, R. D.; Falk, L. H .; and b in d u n g e n . A rch. T o xic o l., 16:182, 1956. K lotin, P.: T h e toxicity of ozone for young chicks. 72. M assm ann, W.: T ierex p erim en telle U n tersu c h u n A .M .A . A rch . In d u st. H e a lth , 18:16, 1958. gen b er die toxikologische W irkung von R a u c h 94. O ettel, H .: G esundheitsgefhrdung d u rch K unst en, die bei Schweissen m it kalkbasischen Ele stoffe? A rch , exper. P ath. P h a rm a k., 232:77, 1958. ktroden entstehen. Arch. G ew erbepath., 14:291, 95. R einl, W.: U eber die E rkrankungen d u rch T h o 1956. masschlacke, Vanadinschlacke und V anadinver 73. M assmann, W.: U ntersuchungen b er die biologische W irkung des Polyaerylnitrils. Z. exper. b in d u n g e n u n d ih re U rsachen. Sta u b , 75:143, 177, 1958. m M ed., 727:407, 1956. 96. R obertson, A. J.: Pneum oconiosis due to tin 74. M assm ann, W ., and P ilgrim , K.: Das V erh alten des Lungengewebes nach intratrachealer Injektion von M angan IV-Oxyd und Chrom -III-O xyd. Arch. oxide. In the Sym posium on Industrial P ul m onary Diseases, ed. by King and Fletcher. L on d o n , i960, p. 168. G ew erbepath., 75:203, 1956. 97. Rogers, W . N.: C hronic b ery lliu m poisoning 75. M cLaughlin, A. I. G.: Iro n and o th er rad io opaque dusts. In th e Sym posium on Industrial P ulm onary Diseases, ed. by King and Fletcher. tre a te d w ith co rtico tro p h in . L a n cet, 273:267, 1957. 98. R ohrs, L. C.: M etal-fum e fever from in h a lin g zinc oxide. A M .A . A rch . In d u st. H e a lth , 76:42, 1957. L ondon, I960, p. 146. 99. R oschtschin, I. V.: Das V anadium als industrielles 76. M eiklejohn, A., an d Posner, E.: T h e effect of the use of calcined alum ina in china biscuit placing on the health of the workman. B rit. J . Indust. M ed., 14:229, 1957. 77. M elnikova, E. A.: A ngaben zur B estim m ung des zulssigen Kadmium- und V anadium gehaltes der L u ft in Industrierum en. Gig, i san., 21:25, 1957. 78. M ozentseva, N. V.: H ygienic ch a racteristic of in dustrial aerosols of wolfram . Gig. i San., 22(4):25, 1957. Gift. J. H yg. Epid. M icrobiol. Im m u n o l. (Prague), 2:492, 1958. 100. R oschina, T . A.: A n ex p e rim en tal in v estig atio n of the action of the chromom agnesite and magnesitochrom ite refractories dust on the body. Hig. T ru d a , 3:28, 1959. 101. R o sm an ith , J.; Volf, J.; an d K n p felm ch er, E.: R espiratory disease in workers producing sul p h u ric acid. P racovni lkarstvi, 9:411, 1957. 102. R o sm a n ith , J ., an d K n o p feim ach er, E.: A case of BaSO., pneum oconiosis. Proc, lk., 9 :140, 1957. 79. M inden, H .; B ruckner, Ch.; an d S im on, J.: B ei trag zur Cadmium vergiftung. Arch. Gewerbepath. G ew erbehyg., 77:531, 1959. 103. R o u sh , G ., Jr.: T h e toxicology of th e boranes. ] . O ccup. M ed., 7:46, 1959. 104. Row e, V. K., et al.: T o x ic ity of p ro p y len e oxide 80. M itchell, J.: P ulm o n ary fibrosis in an a lu m in iu m determ ined on experim ental anim als. A M .A . IlM R M H p P 'J M w orker. B rit. J. Indust. Safety, 75:123, 1959. A rch. In d u st. H e a lth , 13:228, 1956. NORO 333 105. R uiz, R . F., a n d Irib a rre n , R . R.: N eu m o p atias por querosn. T h e M edical B ulletin (Standard Oil Co., N .J.), 20:35, I960. 106. R um yantsev, G. T .: O n th e question of barytosis. Gig. i San., 23{4): 17, 1958. 107. S arai, S.f a n d U eno, K.: E le ctro n m icroscopic views of dust produced in electric steel m elting. Broc. X I I ln t. Congr. Occup. H ealth, Helsinki, * 3 2 5 , 1957. 108. Schepers, G. W . H .; D u rk an , T . M .; D ela h an t, A. B.; R edlin, A. J.; Schm idt, J. G.; C reedon, F. T .; Jacobson, J. W .; and Bailey, D. A.: T h e biological action of fiberglas-plastic dust. A.M .A. A rch. In d u st. H e a lth , 18:34, 1958. 109. S chneider, H .: U eb e r Siderose. ZbL A rb . m ed ., 7:142, 1957. 110. S chechter, W . H .: H ow toxic are h ig h energy fuels? N a t. Safety N ew s, 77:28, 1958. 111. Schler, P ., et al.: Stannosis. II. clin ical study. In d u st. M ed ., 27:432, 1958. 112. S c h le r, P., et al.: M a n g a n e s e p o is o n in g . E n v ir o n m en tal an d m edical study at a Chilean m ine. In d u st. M ed ., 26:167, 1957. 113. Serenko, A. S.; Stanislavsky, Y. M.; K hazan, G. L., et al.: S an ita ry conditions of w ork a n d p e c u lia ri ties of pneum oconiosis in workers at the Iron ore A g lo m e ra tin g plan ts. G ig. T ru d a , 2:17, 1958. 114. Soriano, M.: A sthm e e x p rim e n ta l p a r l'acroline. Sem . h p ., 34:3213, 1958. 115. Sim, V. M., a n d P a u le , R . E.: Effect of possible smog irritan ts on hum an subjects. J.A.M .A., 165:1908, 1957. 116. Sjoberg, S. G.: V an a d iu m du st, ch ro n ic b ro n c h itis and possible risk of emphysema, Acta med. S cand ., 154:381, 1956. 117. Sjberg, S. G ., an d R ig n r, K. G.: B esvr fran luftvagar m.m. hos sotare i oljeeldningsanlaggningar. N o r disk M ed icin , 58:1973, 1957. 118. S m ith, J . S., a n d K ench, J. E.: O bservations on urinary cadm ium and protein excretion in men exposed to cadm ium oxide dust and fum e. Brit. J. In d u s t. M ed ., 14:240, 1957. 119. S m ith , J. C.; K ench, J. .; an d S m ith , J. P.: Chemical and historical post-m ortem studies on a workm an exposed for m any years to cadmium oxide fum e. B rit. J. In d u st. M ed., 14:246, 1957. 120. T eb ro ck , H . E., an d M achle, W .: A dvances in the m anagem ent of chronic berylliosis. Proc. X ll h it. Congr. Occup. H ea lth , H elsinki, 5:167, 1957. 121. T h o m a s, D. L. G., a n d Stiebris, K.: V an ad iu m V ergiftung in der Industrie. M ed. J. Australia, 43:607, 1956. 122- T h o m a s, M. D.; H endricks, R . H .; G u n n , F. D.; and Critchlow , J.: Prolonged exposure of guinea pigs to sulfuric acid aerosol. A .M .A. Arch. Indust. H e a lth , 17:70, 1958. 123. T im o k h in , D. I.: P roblem s of in d u stria l hygiene in em ploym ent of m agnesium -torium -cobalt catalyzer, H ig . T ru d a , 2:42, 1958. 124. T u r , J.: L iderosis p u lm o n u m . M ed . Pracy., 10:33, 1959. 125. Vallee, B. L.: Zinc and its biological significance. A .M .A . A rch. In d u st. H ea lth , 75:147, 1957. 126. V orobjeva, R . S.: T h e q u estio n of th e toxicity of cadm ium oxide. }. H yg. Epidemiol. M icrobiol. I m m u n o l. (P ra g u e ), 2:244, 1958. 127. Z app, J. A.: H azards of isocyanates in p o ly u re thane foam plastic production. A.M .A. Arch. In d u st. H e a lth , 15:324, 1957. Pneum opathies due to organic dusts, allergens and pneum om ycoses 1. B rin g h u rst, L . S.; B yrne, R. N., a n d G ershonCohen, J.: Respiratory disease of m ushroom w orkers, fa rm e r's lung. J .A .M .A ., 171:15, 1959. 2. Bugyi, B., and M olnar, L.: L ungenschaden durch R eisstro h stau b . B eitr. Silikoseforsch., 51:37, 1958. 3. Bugyi, B.: O n Conionm ycoses. Prac. lekarstvi, 10:200, 1958. 4. C h in ac h o ti, N ., an d T an g c h ai, P.: P u lm o n a ry alveolar m icrolithiasis associated w ith th e in h a la tion of snuff in T h ailan d . Dis. Chest, 32:687, 1957. 5. DaSilva H orta, J., and De Carvalho Cancella, L.: r E xperim entelle K orkstaubkoniose (Experim en telle S u b e ro se ). A rch. G ew erbepalh., 15:319, 1957. 6. D nner, L.: Pneum okoniosen durch S taub von G etreide und Saaten. In Staublungenerkrankun g en, B and 3, ed. by J tte n an d K lo sterk tter. D arm stad t, 1958, p. 541. 7. Dickie, H. A., an d R a n k in , J.: F a rm e r's lu n g , an acute granulom atous interstitial pneum onitis o ccu rrin g in a g ric u ltu ra l w orkers. J.A .M .A ., 167: 1069, 1958. 8. F ran k , R. C.: F a rm e r's lu n g --a form of p n e u m o coniosis due to organic dusts. A.J. Roentgenol., 79:189, 1958. 9. Frost, J., an d G eorg. J.: T ae rsk erlu n g e. U geskr. Laeg., 775:1383, 1956. 10. G roetschel, H ., an d T ren se, E.: T o d eines D ru c k ers an Asthma bronciale nach U m gang m it N asszerstu b em itteln . A rch. G ew erbepalh., 16: 375, 1958. 11. G u p ta, A. S.; Ferris, B. G .; an d R ao , M. N.: Oxygen consum ption of male Indian jute workers. A M .A . A rch. In d u st. H e a lth , 20:96, 1959. 12. K lunker, W .: Zur Frage d er tiologie u n d P a th ogenese des sogenannten Bacher- und M llerasth mas. Schw eiz, m ed. W schr., 87:714, 1957. 13. K yung, V. A.: D ust of th e k u k k ersite shale as an etiological factor of occupational pneum oconiosis. Gig. T ru d a , 3:44, 1959. 14. Lowry, T ., an d S chum an, L. M.: "S ilo -filler's disease"-- a svndrom e caused by nitrogen dioxide. J.A .M .A ., 762:153, 1956. 15. M u rray , R .; D ingw all-Fordyce, I.; a n d L an e, R . E.: An outbreak of weaver's cough associated w ith tam arind seed powder. Brit. J. In d u st. M ed., 77:105, 1957. 16. Pestalozzi, C.: F eb rile G ru p p e n e rk ra n k u n g e n in einer M odellschreinerei durch Inhalation von m it Schimmelpilzen kontam iniertem Befeuchter wasser (Befeuchterfieber) . Schweiz. M ed. Wschr., 89:710, 1959. 17. Poliak, K.; G th e rt, H ., an d S chanzenbach, H.: Experim entelle Untersuchungen zur Frage der G etreidestaublunge. Arch. Gewerbepalh. Gewerbehyg., 77:519, 1959. 18. R o ach , S. A., an d Schilling, R. S. F.: A clinical and environm ental study of byssinosis in the Lancashire cotton industry. B rit. J. Indust. Med., 77:1, 1960. 19. Schilling, R . S. F.: T h e epidem iology of byssino sis. In th e S ym p o siu m on In d u stria l P u lm o n a ry Diseases, ed. by K ing an d F letcher. L o n d o n , 1960, p. 185. 20. Schilling, R . S. F.: T h e epidem iology of byssino sis-- ad v e n tu re an d m isadventure., J . O ccup. M ed ., 7:33, 1959. 21. Stott, H .: Pulm onary disease amongst sisal w ork ers. B rit. J. In d u st. M ed ., 75:23, 1958. 334 M ED IC A L PRACTICES 22. Sm etanin, N. I.: T h e m axim al perm issible con cen tratio n of the loess d u st in th e a ir of cotton sp in n in g p la n ts. G ig. T ru d a , 5:53, 1959. 23. T iller, J. R.: An investigation of byssinosis in a rayon m ill. Trans. Ass. In d u st. M ed. O ff., 7:157, 1958. 24. T o tte n , R. S.; R eid, D. H . S.; D avis, H . D.; an d M oran, T . J.: F arm er's lung, re p o rt of tw o cases 5. B aetjer, A. M.; D am ron, C.; and Budacz, V.: T h e distribution and retention of chrom ium in men and anim als. A .M .A . Arch. Indust. H ea lth , 20:136, 1959. 6. B aetjer, A. M.; Low ney, J. F.; Steffee, M .D.; an d Budacz, B. A.: Effect of chrom ium on incidence of lung tum ors in mice and rats. A .M .A . Arch. In d u s t. M ed ., 20:124, 1959. in which lung biopsies were perform ed. Am er. J. M ed ., 25:803, 1958. 7. B idstrup, P. L.: O ccupational causes of lung cancer. T ra n s. Ass. In d u st. M ed . O ff., 9:2, 1959. 25. T u ffn e ll, P. G., and D ingw all-Fordyce, 1.: A n investigation into the acute respiratory reaction to the inhalation of tam arind seed preparations. B rit. J . In d u st. M ed., 14:250, 1957. 8. B ohlig, H ., a n d Jacob, C.: D ie H u fig k eit des Lungenkrebses bei deutschen Asbestarbeitern. Proc. X U In t. Congr. Occup. H ealth, H elsinki, 5:308, 1957. 20. Wassermann, M.; B ugeag-M ihail, G.; and Iosubas, S.: R echerches ex p erim en tales co n c ern an t " la m aladie des fileurs et des tisseurs de chauvre". Proc. X II In t. Congr. Occup. H ealth, Helsinki, 5:374, 1957. 27. W egm ann, T .; G alletti, P.: and A m rein, H. P.: Baum wollstaublunge. Schweiz. M ed. W schr., '5:437, 1958. 28. Z annini, D. (and W asserm ann, M., Discussion) : A propos de la "Fivre des cereales" des travalleurs des silos. Proc. X I I In t. Congr. Occup. H ea lth , H elsinki, 5:386, 1957. 9. B ra u n , W .: K rebs an H a u t u n d in n e re n O rganen, hervorgerufen durch Arsen. Dtsch. M ed. Wschr., 55:870, 1958. 10. B row ning, E th el: H a rm fu l effects of io n isin g r a diations. Elsevier M onographs: Industrial Toxic A g en ts. A m sterdam , 1959. 11. C em ber, H .: B ronchogenic carcin o m a fro m ra d io active particulates. Second United Nations Con ference on th e Peaceful Uses of A to m ic Energy. G eneva, 1958. P aper A /C onf. 15/P /900. 12. C h iu rco , G. A.: L avoro e tu m o ri. A rch ivo di M edicina M u tu a listica , 4:Vol. 14, 1959 (372 pages). Infectious and parasitai pneum opathies Vide also: Proc. X II ln t. Congr. Occup. H ealth, H elsinki, 147, (Fr.), 139, (Engl.), 1957. 1. D ra n k in , D. I., an d G erasim ova, M. M.: B ru ce llo 13. Davies, D. F.: A review of th e evidence on th e sis and occupation. Gig. T ru d a , 2:8, 1958. relationship between smoking and lung cancer. 2. Gross, P.; W estrick, M. L.; M cNerney, J. M.; and J. C h ro n . Dis., 77:579, 1960. P ittsb u rg h , M. P. H .: E x p erim e n ta l T u b e rc u lo - 14. D oll, R .: O ccu p atio n al lu n g cancer. In th e Sym pneum oconiosis. A.M .A. Arch. Indust. H ealth, posium on Industrial P ulm onary Diseases, ed. by 19:320, 1959. K ing and F letcher. L ondon, i960, p. 208. 3. 1H7a3r:r7i0s,9,H1.9J6.0:. T re a tm e n t of Brucellosis. J.A .M .A ., 15. BDroiltl., JR. .I:n dOu sctc.uMp aetdio.,n a7l6:1lu81n,g 19c5a9n.cer: a review. I 4. Ju n a k , G.: L ep to sp iren in fek tio n en bei K a n a la r 16. Dvizkov, P. P.: O ccu p atio n al cancer. G ig. T ru d a , b eitern. A rch. G ew erbepath., 15:565, 1957. 4(3): 3, 1960. 5. K the, J.: D ie L eptospirose als B eru fsk ran k h eit. 17. E ck ard t, R . E.: In d u stria l Carcinogens. N ew York A rch . G ew erbepath., 17:316, 1959. an d L o n d o n , 1959. 6. K ing, E. J.: R ecent R esearch in In fectiv e P n e u 18. E ilin g er, F.: M edical R a d ia tio n B iology. Spring- moconiosis. Proc. X II In t. Congr. Occup. H ealth, field, 111., 1957, p. 224 ff. H elsin k i, 1:283, 1957. 7. K ing, E. J.; Y og an ath an , M.; H arriso n , C. V.; 19. E spinos-Prez, D.: C ancer p u lm o n a r y neum oco- and M itchison, D. A.: E xperim ental infective niosis. M ed. y seg. trabajo, 5:5, 1957. P neum oconiosis. A .M .A . A rch . In d u st. H e a lth , 20. F in k el, M iriam P.: In te rn a l em itters a n d tu m o r 16:380, 1957. induction. Proc. ln t. Conf. Peaceful Uses of ? 8. R am say, J. H ., an d Pines, A.: R esults of tr e a t A to m ic E nergy, G eneva, 1955, Vol. 11. N ew York, m ent of pneum oconiosis com plicated by tu b e r 1956, p . 160. I culosis. B rit. M ed. J., 2:345, 1959. 21. G allego, J. D.: P ulm onary lesions in p n eu m o 9. S ch p p ert, R.: L u n g en tu b erk u lo se als B e ru f pathies due to dust. Proc. X II ln t. Congr. Occup. H e a lth , H elsin k i, 5:378, 1957. skrankheit bei M etzgern und bei in L andw irt schaft beschftigten Personen. Z. rztl. F ortbild., 22. G oldblatt, M. W .: O ccupational Carcinogenesis. 52:417, 1958. B r it. M ed . B u ll., 74:136, 1958. 10. Spink, W . W .: C u rre n t statu s of th e ra p y of brucellosis in hu m an beings. J.A .M .A ., 172:697, 1960. 23. Grosse, H .: M ischstaubinduration d e r H iluslym phknoten und Lungenkrebs. Frankf. Z. Path., 67:220, 1956. 11. T e rz in , A. L.: Psittacosis-- o rn ath o sis-- m a m 24. H ad d o w , A. (ed.): C ausation of cancer. B rit. M ed. m alian pneum onitis (POM P) viruses in m an, B u ll., 74(2), 1958. 3 m am m als an d birds. ]. H yg. E pid. M icrobiol. 25. H arris, W . B.; Breslin, A. J.; G lauberm an, B.; Im m u n o l. (P ra g u e ), 2 :129, 1958. a n d W ein stein , M. S.: E n v iro n m e n ta l hazards associated w ith the m illing of u ran iu m ore. L ung cancer due to occup ation and radiation A .M .A . A rch . In d u st. H e a lth , 20:365, 1959. 1. C ausation of C ancer. B ritish M ed . B u ll. 14(2), 1958. 2. A sk-U pm ark, E.: B ronchial carcinom a in p rin tin g w o rk trs. Dis. Chest, 27:4, 1955. 3. A zhbel, S. I.: O n cancer diagnosis in p a tie n ts su f fering front toxic pneumoscleroses. H ig. Truda, 5:11, 1959. 4. B arborik, N . et aL: Carcinom a of th e lungs in electrolytic chrom ium plating. Prac. Lkarstvi, 10:413, 1958. 26. H ueper, W . C.: E xperim ental studies in m etal cancerigenesis. X . cancerigenic effects of chrom ite ore roast deposited in muscle tissue and pleural cavity of rats. A.M .A. Arch. Indust. H ealth, 75:284, 1958. 27. Irm scher, G.: U eber einen T odesfall an chro nischer Pneum onie nach Inhalation von alphaund betastrahlenaktivem "Industriestaub" vor ru n d 20 Jahren. Das Deutsche Gesundheitswesen, 52:1732, 1958. NORWOOD 335 28. Jam es, W . R . L .: P rim ary lu n g cancer in South W ales coal-workers w ith pneum oconiosis. B rit. J. In d u st. M ed ., 12:87, 1955. 29. K ennaway, E., an d Lindsey, A. J.: Some possible exogenous factors in the causation of lung cancer. B rit. M ed. B u ll., 14:124, 1958. 30. Koelsch, F.: D er A rsenkrebs. Z bl. A rb eitsm ed ., 5:129, 161, 1958. 31. M cL aughlin, A. 1. G.: Iro n as a C arcinogen. In the Sym posium on Industrial P ulm onary Diseases, ed. by K in g a n d F letcher. L ondon, 1960, p . 162. 32. Puccini, C.: L e p ro b lem a della cancro-silicosi. M ed. L avoro, 51:18, 1960. 33. R inck, H .: D er C hrom atkrebs der Lunge als B e ru fse rk ran k u n g . M ed izin isch e, 142, 1956. 34. Sepke, G.: Zum Schneeberger L ungenkrebs. Zbl. A rb . M ed ., 7:114, 1957. 35. S m ith , R . A.: L u n g C ancer in C oal-M iners. B rit. ] . In d u s t. M ed ,, 16:318, 1959. 36. S underm an, F. W .; D onnelly, A. J.; W est, Bob; an d K incaid, J. F.: N ickel poisoning. A .M .A . A rch . In d u st. H e a lth , 20:36, 1959. 37. S u n d erm an , F. W .; K incaid, J. F.; D onnelly, A. J.; and W est, Bob: Nickel poisoning. A.M .A. A rch . In d u s t. H ea lth , 16:480, 1957. TREATMENT OF PLUTONIUM DEPOSITION IN HUMANS WITH DTPA -- EFFECTIVENESS OF LONG-TERM ADMINISTRATION AND ORAL ADMINISTRATION * W . D a g g e t t N o r w o o d , M .D . M anager, H ealth O peration, H an fo rd A tom ic P ro d u cts O peration, o p erated by G eneral E lectric C om pany fo r th e A tom ic E nergy C om m ission R ichland, W ashington T he recom m ended m axim um permissible am ount of soluble p lu to n iu m (P u 239) in the h u m a n b o d y is 0.04 m icro cu rie -- 0.6 /g (1). R igid control m eth o d s are necessary to lim it body deposition to this extent. For instance, allow able concentrations in air are lower by a factor of m illions than the com parable allowable concentrations of m any of our most toxic chemicals. T h ere w ill be increasing p o tential for exposure to such isotopes w ith the expanding use of such m aterials in industry, defence, and medicine. H ence it becomes m ost im portant to have the safest, best, and m ost con venient m ethod possible for treating the individual who has accidentally acquired a deposition of P u 239 w hich exceeds the m axim um permissible lim it. T re a tm e n t, here, of five em ployees w ho h ad h a r bored small q uantities of Pu 239 for some years in d i cated that intravenously adm inistered diethylenetriam inepentaacetic acid (DTPA) was m uch the most effective agent discovered to date for increasing the u rin a ry elim in a tio n o f P u 239 (2). T h e present study was m ade to im prove know ledge of th e effectiveness of D T PA in elim inating P u 239 via th e u rin e w hen tre a tm e n t is exten d ed o ver a p e riod of m any m onths. I t was also directed tow ard determ ining the effectiveness of D TPA in increasing elim ination of Pu 239 via the urine and feces w hen adm inistered orally. Long-Term A dm inistration of DTPA An employee who had accidentally received a d epo sition of a b o u t .4 m icrocurie of P u 239 som e 30 m onths previously was treated with DTPA intraven ously. In itially the daily urinary o u tp u t of P u 239 was a b o u t 665 d isin teg ratio n s p er m in u te p er 2 4 -h o u r specimen of urine (T able I). It was considered advis able to cautiously continue treatm ent over an extended period unless evidence of kidney irritation or other untow ard effect appeared during the treatm ent. T his * T h e D T P A fo r th is stu d y xvas kin d ly su p p lie d by Dr. M urray W einer, Geigy Pharmaceuticals, P.O. B ox 430, Yonkers, New York. R . H . W ilson was most help fu l in coordinating sam ple collection and assisting in the interpretation of results. G. D. Brown and staff perform ed the bioassays o f the many samples. w ould serve the dual purpose of elim inating a fair am ount of Pu 239 and indicating w hether or not there was .a change in effectiveness of this ag en t w hen used over an extended period. T able I EFFECTIVENESS OF INTRAVENOUSLY AD M IN ISTERED DTPA IN INCREASING U R IN A R Y EX CRETIO N O F PU 239 W H E N GIVEN FOR M ANY M ONTHS W eek of Treatm ent Dose-- D T PA in G ram s Per W eek A verage D aily U rinary Excretion of Pu 239 Expressed as D isintegrations Per M inute Effectiveness Expressed as % of Initial Effectiveness 1 2 665 100 2 1.6 610 92 N o treatm ent for period of 5 weeks 12 -- 11-12 1.6 481 72 13-14 2 495 74 N o treatm ent for period of 5 weeks 15 -- 26 2 496 74 27 2 436 66 33 2 246 37 46 2 190 29 50 2 125 19 A verage daily elim ination of Pu 239 for periods preceding and follow ing the above treatm ent was 12 d isin te g ra tio n s p er m in u te in 24 hours. E x cep t fo r m in o r changes as show n in T a b le I , the em ployee was given 1 g of D TPA intravenously, in the M anufacturing Area Medical Center, on M onday and 1 g on T h u rsd ay of each week for three successive weeks. Such periods of treatm ent were alternated w ith periods of three weeks of no treatm ent. T his was con-  *I i- ; m 610 SOCIAL AND LEGAL ASPECTS d e m e n t above th e loss of wages th e lo n g er he was off work. T h is case illustrates how an individual deliberately perpetrates his disability on a subjective basis in order to increase th e size of h is m o n etary se ttlem en t. Case No . 3 -- A 37-year-old trainm an was injured w hile standing too dose to a slowly m oving train when his arm was struck by a grab iron, causing him to spin around and strike his head against the side of a car. H e received a 5-cm vertical laceration across the m id d le of his forehead. T h e m an was stu n n e d b u t re m ained on his feet. T h e laceration was repaired at the plant dispensary. X-rays of the skull were negative. , T here were no other injuries except for a slight con tusion of the right upper arm. Neurologic exam ina tion was entirely negative and rem ained so thereafter. No treatm ent was indicated other than analgesic m edi cation for pain. T h e patient did not work his next tu rn and was seen again the following day. T h e previ ous night he had a m ild headache bu t was now asym ptom atic. Exam ination was again negative. T h e patient was seen again four days after the accident. T h e sutures were removed, and adhesive bridges were applied. His only com plaint was occasional frontal headache which was relieved by aspirin. H e had not returned to work; and when questioned as to why, he gave some vague com plaints of soreness in his rig h t arm and upper back. Exam ination was again negative for objective findings. It seemed to the physician that the m an believed he could and should be w orking but for some reason had not done so. H e was form ally ap p ro v ed for w ork an d was so advised. T h e p a tie n t returned to work six days after the accident and worked for several hours b u t then reported off because of headache. H e was seen again the follow ing day, com plaining of headache, dizziness, and soreness of the u p p e r back and rig h t arm . T h e laceration was healing well. E xam ination results were negative once again. H e ap p aren tly did n o t intend to w ork; h e was treated sym ptom atically and seen again one week later, at w hich tim e his condition was unchanged. Fol low ing this visit he was not seen again for another two weeks. It was then 24 days since the injury. T h e patient had taken his vacation in th e interim , for which he had received vacation pay. H e offered no com plaints, and the exam ination was again negative. T h e m an finally retu rn ed to work 30 days afte r this injury and rem ained at work thereafter. H e instituted litigation against the com pany, because he dem anded co m p en satio n ab o u t seven tim es h is a c tu a l loss of earnings, and the com pany refused to g ran t the claim. Each tim e this p atien t was seen d u rin g the 30-day period it seemed that he really believed he could work and th at he actually w anted to. H e was phys ically able and was not considered as having posttraum atic neurosis. W hy then did he not work? T here appeared to be several reasons. W h ile th e p atien t was being treated in the dispensary shortly after the acci dent, a company representative rem arked that it w ould be good if he did not miss w ork, since his work group had gone for an unusual length of tim e w ithout a lost-time accident. T his was in terpreted by the p a tien t and his fellow workers as com pany interest in avoiding lost tim e rath er th an the em ploye's welfare. R esentm ent was incited and led to deliberate lost tim e. T h e p atient was also encouraged to miss work because he had a head injury which required suturing. A nother factor which played a part was encourage m ent by certain parties to deliberately perpetrate u n necessary lost tim e for the purpose of establishing a claim against the com pany for incom e greater than his regular earnings. T h is case illustrates how m anagem ent action, work group standards for lost tim e, and litigation practices in work groups interfere w ith the m edical m anage m ent of the injured employe and create unnecessary disability leading to excessive m onetary gain. Sum m ary In sum m ary, I have outlined certain socio-economic factors th at have a negative influence on the disabled em ployee. T h e discussion has dealt w ith why and how such factors interfere w ith the individual's recovery from an occupational injury, w ith the thought that a clearer understanding m ust precede any effort to do anything about them. BASIC PRINCIPLES FOR PRECAUTIONARY LABELING E dward J. H ogan Vice-Chairm an, Labels and Precautionary Inform ation C om m ittee, M anufacturing Chem ists' Association, Inc:; Packaging Coordinator, A llied C hem ical C orporation, New York, N. Y. I t is an hon o r and a privilege to speak to you, as a representative of the M anufacturing Chemists' Association, regarding one if its activities. T h e M an u fa c tu rin g C hem ists' A ssociation is an in c o rp o rated national trade organization composed of more than 180 com panies engaged in th e m a n u fa c tu re an d sale of chemicals. These com panies account for more th an 90 per cent of the chemical production capacity of the U nited States. F rom its founding in 1872, th e MCA has been concerned with the many problem s accom panying the grow th of the chemical industry. P rom inent among these has been the prom otion of safety, and the Asso ciation is p ro u d of its co n trib u tio n s to th e record of chem ical m a n u fa ctu re rs in th is reg ard , w hich is am ong th e best in ail industry. T h is achievem ent is the m ore notable in view of the in h eren t hazards in many of the industry's processes and products. T h e A ssociation's in te rest in safety goes far beyond that of its m em bers' em ployees to include those transporting, handling, and using its products. T he objectives are prom oted in a num ber of ways, but I shall discuss at this tim e only th at phase concerned w ith the labeling of chemicals to instruct those h an d ling or using them how to do so safely. In the early days of the industry both the chemicals distributed and the trades using them were lim ited in num ber and each had been long established. Cus tom ers were so accustom ed to th e use of th e existing com pounds th a t specific instructions seemed unnec essary, an d such w arning labels as w ere used on industrial chemicals were lim ited to the stronger HOGAN 611 ad d s and alkalies, and extrem e poisons. T h ere were, o f course, th e 1927 Federal C austic Poison Act and a num ber of state poison and pharm acy acts, b u t these were chiefly directed to th e labeling of house hold packages. In m ost cases they w ere p ointed tow ard the hazard of ingestion and relied solely on th e w ord " P O IS O N '* to w arn th e user. T he expansion of the industry and the broadened use of its products brought recognition of the need for m ore com prehensive labeling. One of the early steps in this d ire c tio n cam e in 1934 an d covered th e uniform precautionary labeling of six products or product groups u n d er a series of voluntary agree m ents between the m anufacturers of these products and the Surgeon G eneral of the U nited States. T hese agreem ents served a very useful purpose u n til they were discontinued by the U nited States Public H ealth Service in 1952 because specific labels for th ese p r o ducts w hich had, in the m eantim e, been developed u n d e r th e M a n u fa c tu rin g C hem ists' A ssociation's program were considered m ore appropriate. As chemical products, especially in the organic group, m u ltip lie d and grew m ore complex, the need for fu rth er steps becam e evident. T h is was em phasized by a survey conducted by th e Association in 1936 which resulted in distribution to its m em ber executives of a printed book titled "A Confidential R eport on A dequate Labeling-- Its Im portance to the Chemical M anufacturer." T his report persuaded many com panies to em bark upon their own w arning label program s or to expand those already begun. W orld W ar II greatly accelerated the grow th of our industry. N ot only did established companies ex pand their production of well-known chemicals, but they developed innum erable new ones. M any cor porations from other segments of industry, as well as com pletely new concerns, began chemical m an u facture. A nd--most im portant of all, from the point of view of precautionary labeling--thousands of in dividual companies, large and small, and m illions of workers began to operate processes using chemicals entirely foreign to any of their previous experiences. T h e need for a comprehensive program of education in the safe han d lin g of chemicals was obvious. Early in 1944 MCA considered the problem at a m eeting of its m em ber executives. It was decided th at the best m ethod to reach the m an in the shop u sin g chemical products was by means of instruction labels, and the form ation of a "Labels and Precautionary Inform ation C om m ittee" was accordingly authorized. T h e LA PI Com m ittee, as it has since been popularly called, m et for th e first tim e on May 17, 1944. T o insure a broad view of the problem , the members selected included those w ith chemical, m edical, legal, research, adm inistrative, and sales backgrounds. Since th at date, this has been a continuing and active com m ittee. T h e w ork o f L A PI is well know n to industry and adm inistrators of health and safety p ro grams through its publication "W arning Labels--A G uide For the Preparation of W arning Labels for Hazardous Chemicals." T his m anual, frequently re ferred to as the "LA PI M anual," is now in the review stage, w ith a F ifth Revision scheduled for publica tion this year. It m ight be assumed that, having agreed upon the need for precautionary labeling, the w riting of labels w ould be sim ple. All one need do, you w ould say, is to m ark a hazardous product POISON and add the d o 's a n d d o n 'ts. U n fo rtu n a te ly , th e p ro b lem is m ore involved than that. W hat are the m eanings of the term s used? Chem i cals m ay be h arm fu l in a variety of ways. A product w hich may th reaten your life solely by ingestion should not be labeled the same as one that may kill by a b so rp tio n th ro u g h th e skin. O f course, th e re is also the m atter of degree. How shall we distinguish between the vapor or gas which asphyxiates and one w hich causes cyanosis? W h at really is a "poison"? T h ere is the difficulty of language. Statem ents m ust be brief b u t accurate. T hey m ust be expressed in term s that ordinary workm en understand. N ot only m ust the statem ents help avoid accidents, b u t if such occur, first aid should not be delayed w hile someone hunts an in terp reter. In the case of trade-nam ed chemicals or p ro p rietary com pounds, w hat is o u r responsibility to the doctor who may be asked to treat persons injured by them? As a result of these and many sim ilar questions, the following principles were adopted. These principles are set forth in detail in and comprise Part I of the LAPI M anual. 1. E ach chem ical p ro d u c t p resen ts a d istin ct p ro b lem and m ust be treated individually in the light of its own characteristics. Conclusions regarding the hazards of a product cannot safely be draw n either from the properties of th e m aterials from which it is form ed or by analogies based upon chemical struc ture. M ixtures of two or m ore chemicals may have properties that vary in kind or degree from those of the individual com ponents; any w arning label for m ixtures should be based on the properties of the finished product. Im purities may contribute hazardous properties and should not be overlooked. 2. All statem ents on w arning labels should be brief, accurate, and expressed in sim ple, easily u n d er stood terms. 3. P re ca u tio n ary la b elin g sh o u ld be used o nly w hen and to the extent necessary. T h e language should be practical, not based upon the inherent properties of a product alone, b u t directed toward the avoidance of hazards resulting from such use, handling, and storage as may reasonably be anticipated. T h e use of w arning labels for relatively harmless products or the use of unnecessary words will develop a disregard for labels and defeat th e ir purpose as surely as will failure to give adequate notice of hazards. 4. O n labels of different products uniform ity in la n guage to indicate the same hazards and same degrees of hazard is most desirable in order to gain greater understanding through standardization. 5. T h e following subject m atter should be con sid ered fo r inclusion on a w a rn in g label; (a) nam e of p ro d u ct; (b) signal w ord designating degree of hazard--DANGER!, W A RNIN G !, or CAUTION! (c) A ffirm ative sta te m e n t of hazard s; (d) p recau tio n ary m easures covering actions to be followed or avoided; (e) In stru c tio n s in case of co n tact o r exposure w here advisable. (N O T E : u n d er some laws antidotes are re q u ired w hen th e w ord "P O IS O N " is used.) In stru c tions for the handling and storage of containers should also be considered for inclusion on the label. T his is inform ation relating to characteristics of the con ta in e r as well as those of its contents.* 6. T h e inclusion of the w ord " PO ISO N " and the skull and crossbones on a label should be lim ited to those cases w here th e p ro d u ct is a poison according 612 SOCIAL AND LEGAL ASPECTS to a definite toxicity stan d ard or w here such use is prescribed by law. W hen used, this legend should be in addition to the other label warnings and should not take the place of the words DANGER!, W A RN ING!, and CA U TIO N !, which are designed to show the relative degree of hazard.f 7. A nondescriptive code designation or trade nam e should not be used as th e only identification of a h azardous chem ical. I f th e co m plete n a m e is n o t shown, the label should clearly state the type of chem ical--e.g., " Corrosive A cid", " Lead C om pound". 8. W a rn in g statem en ts sh o u ld be g ro u p e d to g e th er in a prom inent location on the label and should be p rin ted in easily legible type which is in contrast by typography, layout, or color w ith other printed m at ter on th e label. T h e label should be affixed firmly to and in a conspicuous place on the container. In accordance w ith the principles just stated the usual w arning label includes: (a) a "signal" w ord-- " D A N G E R !", "W A R N IN G " , o r " C A U T IO N "-- to give a gen eral in d ic a tio n of th e severity of h azard ; (b) a statem ent of hazard or hazards--such as "V apor Extrem ely H azardous", "Causes Burns," or "R apidly A bsorbed T h ro u g h Skin" ; (c) precautionary m easures --such as "Do not breathe vapor," "Keep away from heat and open flame," or "Avoid contact w ith skin and eyes"; and (d), w here appropriate, instructions in case of accident, as "In case of contact im m ediately flush sk in or eyes for 15 m in u tes; for eyes g et m edical attention." Using these or sim ilar statem ents, a typical label may read: A N IL IN E DANGER! HAZARDOUS LIQUID AND VAPOR RAPIDLY ABSORBED T H R O U G H SKIN Do not get in eyes, on skin, on clothing. Avoid breathing vapor. Use only with adequate ventilation. In case of contact, im m ediately rem ove all contam inated clothing, including shoes, and flush skin or eyes w ith plenty of w ater for at least 15 m in u tes; get m edical a tte n tio n . W ash clothing before re-use. POISON *A u th o r 's N o te: T h e M a n u fa c tu rin g C hem ists' Associa tion has available at its office, 1825 Connecticut A ven u e, N .W ., W ashington 9, D.C., at nom inal cost, a series of individual Chem ical Safety Data Sheets on the properties and essential inform ation for safe hand ling and use of 79 chemicals, M anuals on Standards and R ecom m ended Practices on the use and handling of specific containers, and an outline of recom m ended general precautions for handling and storage of cer tain classes of containers in the M CA LAP1 M anual. T h ese data w ill serve as excellen t g u id es in th e d evel opm ent of applicable phrases for container handling a n d storaOge statem ents. f A u th o r 's N o te: T h e w ord ",P O IS O N " has been used indiscrim inately in the past, and its m eaning has been ill defined. For labeling purposes the M CA M anual recognizes poisonings by three modes of entry--viz., ingestion, inhalation, and absorption through skin-- but lim its use of the word to those cases w here th e toxicity has been dem onstrated, either by hum an ex perience or laboratory animals tests, to exceed certain defined lim its. Parts II and III of the LAPI M anual contain several hundred illustrative labels such as th e one shown. T hose in Part II are for industrial chemicals. Ex am ples included are generally for those products most im p o rta n t com m ercially, and, as a w hole, they take in a broad range of hazards. T he labels in Part III cover the m ajority of pesticides sold in large volum e. T h is section was added following the passage of th e Federal Insecticide, F ungicide, an d R o d e n tic id e A ct in 1947. T h e latter requires adequate w arning labels for this im portant group of chemicals, and the MCA labels have the inform al approval of the U nited States D e partm ent of A griculture and are consistent w ith its I n te rp re ta tio n 18, R evision 1. How successful is the LAPI Program ? As may be expected, the LAPI principles have the broad support of MCA m em bers, who, as stated earlier, represent 90 p e r cent of th e U.S. p ro d u c tio n of in d u s tria l chemicals. In fact, chemical m anufacturers, both in and out of the Association, fully supported these principles. T h e very fact that such a program exists an d is su p p o rted exerts a persuasive force u p o n th e m anufacturer who m ight otherwise neglect proper labeling. T h e latter knows that, should he be called to court because of claimed injury by one of his inadequately labeled products, the opposing counsel would surely cite the w arning statem ent used on sim ilar com petitive products. W ithin m onths after the organization of the LAPI C om m ittee in 1944, its chairm an was asked to serve as advisor to the State of C alifornia, w hich su b sequently becam e th e first of several states to regulate the precautionary labeling of hazardous chemicals. Besides California, the ensuing years have seen sim ilar regulations or laws adopted by C onnecticut, Oregon, Hawaii, Illinois, Texas, New Jersey, New York State and New York City. All have been based upon the MCA principles. Reference has already been m ade to the Federal Insecticide, Fungicide, and R odenticide Act, and to the fact th at LAPI labels com ply w ith th e regula tions issued pursuant to it. At m eetings of the International Labor O rganization, held in Geneva, Switzerland, th e M CA's p rec au tio n ary labeling system was endorsed an d m uch of its content adopted for ultim ate use by ILO on a w orld w ide basis. A com m ittee of the International Association of G o v ern m en tal L ab o r Officials, w h ich consists of U.S. and Canadian state, provincial, and federal adm in istrators, has developed a "Suggested D raft for U ni form Rules and Regulations relating to the Labeling for Use, H andling, and Storage of C ontainers H old ing Substances H arm ful to the Safety an d H ealth of Employees." T his draft adheres to LA PI principles and was the foundation for th e current regulations in New Jersey and New York State and City. In this highly regulated era--when all of us, and industry particularly, are subjected to m any restrictive laws and regulations--it is to th e credit of th e chem ical industry that its adequate labeling practices began as a voluntary program and th a t the labeling legis lation of recent years has been in support of the in d u stry 's p rin cip les ra th e r th a n co n tro v e rtin g th em . F u rth e r evidence of th e L A P I C o m m itte e 's i n fluence is the fact that definitions for " P O ISO N " sub stantially identical with that of its m anual were w ritten into the regulations under the Federal In secticide Act and have also been substituted in the K L E IN 613 Interstate Com merce Commission R egulations for the fo rm e r d efin itio n of " Class B. Poisons.'1 A gain, L A PI has been instrum ental in obtaining the acceptance of the word "flam m able" by ICC and other public agencies as less likely to be m isunderstood th a n "inflam m able." Its rep u ta tio n has extended so far th a t in 1953 th e A ssociation of B ritish Chem ical M a n u factu rers, w hich is M CA 's B ritish c o u n te rp a rt, sent representatives to this country solely to study the LAPI program and subsequently adopted one p ar alleling it. T h is p rogram is receiving additional im petus from o th er trade associations, which have been most gener ous in their cooperation. As already indicated, the LA PI objective is prin cip ally aim ed at in d u strial chemicals. W hile the principles are generally accept able to all groups, their application may vary in detail for different segments. A com m ittee of the Chem ical Specialties M anufacturers Association has prepared a m odel law for the labeling of household products. Directions for use are usually an im portant addition to sm all household packages and may convey inform ation for proper use which supplem ents the precautionary statem ents. Similarly, the A m erican Pe troleum Institute recently published a m anual of pre cautionary labels for petroleum products as distinct from petrochem icals. Both associations support LAPI principles. T h e com m on aim of all these groups is the adequate and uniform labeling of the hazardous substances w hich they p ro d u ce. U n ifo rm ity is essential fo r th e free flow of com m erce an d im p o rta n t in educating people to understand the significance of label w arn ings. T h e public m ust be led to recognize th a t chem i cal products may, on occasion, be hazardous and re quire care in handling, just as experience teaches us th a t care in h an d lin g is necessary w ith edged tools and w ith electrical and m echanical devices. U nlike the latter, w hich seldom carry w arning labels, chemicals will always require some precautionary labeling, because their properties can seldom be deter m ined by visual inspection. In conclusion, I should like to em phasize th a t any precautionary labeling program based upon the p rin ciples set fo rth by th e M a n u fa c tu rin g C h em ist's Asso ciation could not be considered experim ental. T h e concept on which such a program was based has been tim e-proven and accepted in sim ilar program s in ter nationally. W ith such a program you have not only taken out insurance on the future of your products, b u t you have provided a necessary adjunct in the fundam ental obligation to w arn of the health hazards involved in the use of either new or established products. I thank you! THE CARDIAC CASE IN WORKMEN'S COMPENSATION I ryin K l e i n , M .D . M edical D irector, W o rk m en 's C om p en sation B oard, State o f New York It is my great pleasure to be able to address this th irteenth Intern atio n al Congress on O ccupational H ealth . It is significant th a t com mon problem s know no national boundaries, and together we have sought remedies in different countries of the world for over 30 years. I t is a p p a re n t th a t this is th e only sound m e th o d by w hich we can solve these problem s. I t is of additional significance that we are thus able to set a good exam ple of the way in w hich other m atters may be disposed of. T his afternoon we are to consider the cardiac case in w o rk m en 's com pensation. T o m erely dism iss it w ith th e w ave of th e h a n d is u n w o rth y of th e talent and intention of this organization. A search into the causes and results in this area is necessary and im p o rtan t. T h e re is a continuing an d grow ing interest in the cardiovascular episodes during and in the course of em ploym ent. Recently great attention has been paid to the increasing num ber of these cases w hich have come before the workm en's com pen sation boards for evaluation and adjudication. In N ew York S tate for th e years 1947 to 1957 th e figures h av e risen fro m 167 com pensated cases to 545. F or th e first six m o n th s of 1960 u p to 150 cases w ere closed w ithout award for m any reasons (failure to prosecute, w ithdraw al of claim , and failure to m ake out a proper case after trial). T h e most frequent involvem ent has been the coronary arteries resulting in postocclusive angina, failure, pulse irregularities, and infarction. I t is not necessary at this tim e to review the var ious skills involved in th e diagnostic procedures, nor is it necessary to review the need for p ro p er history and record keeping. W e can safely assume th a t the tra in e d physician is fully aw are of th e need for these. T here rem ains, therefore, only the consideration of the relationship of the pathologic process to the work load and the proper rehabilitation of the p a tien t. It is suggested th a t th e exact m echanics involved in the closure of a coronary vessel and the resultant myocardial infarction are not fully understood. It m ust be further conceded that the sclerotic process begins fairly early in adult life and this, undoubtedly, plays a large part in the occurrence in industry. It has been the philosophy that the working man is h ire d for his ab ilities alo n g w ith all of his d is abilities, w h eth er m anifest or h id d en . I t is therefore incum bent upon the physician to be th e first to rec ognize this in industry. O thers should be cognizant of th is as well. It ap p ears to m e th a t no defenses can be set up on the th o u g h t th a t in a given case w ith any degree of sclerosis the clinical end result w ould have occurred in any event. W e m ust recognize that this type of reasoning leads nowheres, since general izations have little value in th is area. It is best to be prepared to take an attitu d e which appears rea sonable to ordinary analysis an d be ready to review each case on its own m erits. R ecognition th a t we do not have a full explanation at this tim e should not preclude us from draw ing a conclusion. It is im p o rtan t to keep in m ind th a t th e legal process is th e d o m in an t factor w hen the cardiac case in in d u stry is discussed. T o o o ften th e physician becomes involved in a case to a point beyond his medical sphere. At th at point he attains the status of an advocate in the proceedings for w hich he is not train ed , for w hich he is obviously ill p rep ared and 988 M A X IM U M A LLO W A B LE CON CEN TRA TIO N S daily work w ithout intervals (which are not considered in stating MAC either) perform ing physical work w hich requires average m in u te lu n g vo lu m e of 12:1 (or 10:1; low er volum e could be considered only for entirely sedentary work). From this calculation it was evident th a t a w orkm an absorbs 3.4 g (or 2.8 g) of trichlorethylene in eight hours, modifies it into 850 mg (700 mg) of tric h lo ra ce tic acid a n d in to 1897 m g (1412 mg) of tric h lo re th a n o l. It is difficult to say how g rea t is th e p h arm aco lo g ic effect of daily adm inistration of 3 g of trichlorethylene, due to the fact that it does not occur in such doses in medical practice. In the past years I ml was adm in istered per case in cases of angina pectoris or neuralgia n.trigem ini, four tim es a day m axim um . Beforehand, however, we can suppose a hypnotic effect especially if we Lake in to co n sid eratio n th a t th e in te r mediary product in the m etabolism of trichlorethylene is chloralhydrate. T h e ascertain ed daily dose of t r i chlorethylene corresponds, according to the Am erican MAC, to 4.3 g of ch o ra lh y d ra te . It is w ell kno w n th a t th e c u rre n t h y pnotic dose is 1-2 g, an d it is also known that chronic intoxication w ith chloral is not very rare and is sim ilar to ch ro n ic in to x ica tio n w ith trichlorethylene. It is also possible to see to the effect of tric h lo r eth an o l, w hich is the p rin c ip a l m etab o lite of tric h lo r ethylene and, in our opinion, it is prim arily responsible for the symptoms of intoxication. Owing to the fact that pharmacologic literature does not often m ention this substance, we can com pare it with tribrom ethanol. N arcosis is a tta in e d by th is su bstance a fte r a dose of 3.5-5.6 g in a m an w eighing 70 kg. In o u r case there form s 1.9 g of tric h lo re th a n o l daily. I think that these considerations result in the fact th at the American MAC is rath er too high. If it was created from experim ents w ith anim als, it is necessary to declare that anim als are not suitable in trichlor- eth y len e cases because they have g reat d esatu ratio n s by lungs and have entirely different ways of m etabolizing trichlorethylene. T h e dose req u ired by Swedish au th o rs, 50 mg of trichloracetic acid in urine, corresponds theoretically only to th e Soviet MAC-- th a t is, 9 p p m ab o u t 50. From our previous experim ents, where we consid ered only trichloracetic acid in sm aller percentage, 16 p e r cen t was fo u n d th a t in low er co n cen tratio n s of tric h lo re th y le n e in air (up to a b o u t 400 g p er lite r-- th a t is, 75 ppm ) th e ra tio of trich lo racetic acid in m g to tric h lo re th y le n e in /g in 1 I of a ir is a b o u t 1:2. T h is ratio was decreasing w ith the increas ing concentration of trichlorethylene. Several obser vations from practice bear witness to this fact. From o u r recent experim ents results th a t the ratio is th e o retically 1:1 (Souiek-V Iachov^, B a rto n iiek ). I th in k th a t it is n o t possible to give m o re accu rate d irectio n s for practice, due to the great difficulties occurring in practical work and thus we can conclude th at this ra tio lies w ith in th e m en tio n e d values 1:1 o r 1:2. On the basis of literature data th at a great part of working people have health disturbances after a lo n g -tim e w ork at 50 m g o r 100 mg of tric h lo ra ce tic acid in u rin e p e r liter we see th a t it w ould corre sp o n d w ith 100 to J 200 of tric h lo re th y le n e in air. T h is co n c en tratio n in a ir corresponds w ith 100-200 of trichlorethanol in urine. For the purpose of solving the question of MAC values in the most im portant industrial poisons there ought to be available a great num ber of carefully m ade observations in practice. It is also necessary to investigate, in laboratory experim ents, the absorption, m etabolism , and elim ination of these substances. For m edical th in k in g it is acceptable to consider the actually absorbed dose. Experim ents w ith anim als are suitable only for the orientation of newly in tro duced chemical substances. SCIENTIFIC BASIS FOR THE ESTABLISHMENT OF TOLERABLE LIMITS ADOPTED IN THE UNITED STATES FOR THE PRINCIPAL INDUSTRIAL TOXINS C h a r l e s R. W i l l ia m s , P h .D. Assistant V ice President, Liberty M utual Insurance Company, Boston, M assachusetts In the U nited States, hygienic standards (tolerable limits) for inhalation are developed for the purpose of providing guides to be used for controlling expo sures to toxic m aterials in industry. T hese guides are dependent on the basic philosophy that for most such m aterials there are levels of exposure w hich can be tolerated w ithout adverse effect. T h e p rin cip al excep tions to this philosophy are those w hich are applied to carcinogenic and sensitizing m aterials. So little is known of the processes of carcinogenicity and sensitiza tion th a t the tendency is to consider th a t levels of known carcinogenic and sensitizing m aterials should be kept as close to zero as possible. T h e problem , th e n , is to develop in fo rm a tio n w hich can p ro v id e a valid basis for establishing levels of toxic m aterials which can be tolerated in th e industrial environm ent. TE R M IN O L O G Y In order to avoid confusion it m ust be p ointed out th at there are differences in term inology w ith refer ence to acceptable values for exposures to potential toxic m aterials. T h u s we find such term s as "M axi mum Allowable Concentration," which certainly has the broadest usage; "M aximal Acceptable Concentra tion," which has been utilized by the American S tan d a rd s A ssociation Z37 C o m m ittee (1); and "T hresh o ld L im it Values," w hich is used by the A m erican Conference of G overnm ental In d u strial H ygienists (2). All of these term s have th e sam e basic im plication--nam ely, th at these values are allowable or acceptable or that there is a lim it w hich denotes a fine line between toxic and nontoxic. As a m atter of fact, the users of these term s rarely accept the im plied connotations. T h e problem is one of sem antics. In 1949 th e C o m m ittee on C hem ical A gents at th e 9th A nnual Congress on O ccupational H ealth (U nited States) recom m ended that the term "H ygienic G uide" was m uch m ore descriptive of the actual utilization of th e num bers. In Septem ber, 1955, th e A m erican Ind u strial Hygiene Association began publishing its W ILLIAM S 989 " Hygienic G uide Series" using the term "Recom m en d ed M axim um A tm ospheric C o n cen tratio n (8 h o u rs)." In 1956 Sm yth (3) p ro p o sed th e use of "H ygienic Standards for Daily Inhalation." For some tim e th e w rite r (4) has been u rg in g th e gen eral accep t ance of the concept of "Hygienic Standard" or "H ygienic G uide," since these term s express much m ore accurately the actual purpose of the application of such criteria in th e occupational h ealth field. ORGANIZATIONS In the U nited States th e establishm ent of hygienic guides is carried on by groups of com petent in d i viduals operating w ithin existing organizations and utilizing available technical inform ation. T h e Am er ican Standards Association, a p riv ate1 organization representing American industry, has been sponsoring developm ent of standards in the occupational health field since 1941, chiefly through its Z37 Com m ittee. T hese "Am erican Standards" include the scope and purpose as well as general physical-chemical and toxic properties, " M aximal Acceptable C oncentration," and sam pling and analytical m ethods and references. Since th e ir sta rt 19 such sta n d ard s h av e b een p u b lished, an d th e C om m ittee is co n tin u in g to be ex trem ely active in the field. T h e basis on w hich this Com m ittee operates is set forth in the introductory sta te m en t p ro v id ed w ith all of th e ir stan d ard s, as follows: "The M eaning o f M axim al A cceptable Concentration" (1 ) I t is generally recognized th a t there are levels of concentration of atm ospheric con tam inants to w hich a person may be exposed w ith o u t know n ill effects or discom fort. In view of the im practicability of m aintaining uncontam inated air in most industrial envir onm ents, it is necessary to establish accept able concentrations of atm ospheric contam inants encountered in industrial operations. T hese concentrations in themselves do not represent a scale of relative toxicity; they represent the concentrations of contam inants below w hich ill effects are unlikely to be experienced by any but hypersusceptible indi viduals. T hese concentrations are usually based upon data obtained by one o r m ore of the following procedures: (1) L ab o rato ry tests on an im als (2) L ab o rato ry tests using h u m a n subjects (3) E n v iro n m en tal an d m edical in v estig a tions in plants A com m on fe a tu re of these p ro ced u res is that the experim ental exposure shall cor respond . to the norm al work pattern. T his should be taken into consideration also in the application of m axim al acceptable concentra tion values. T h ree criteria have governed the establish m ent of these concentrations: (1) O rganic o r o th e r tissue changes (2) F u n c tio n a l reactio n s w h ich h av e no discernible un to w ard effects on h ealth bu t cause im pairm ents, such as in-co ordinations and increased proneness to accidents (3) D iscom fort o r adverse sensory effects In those cases in w hich the concentrations have been established on the basis of organic changes, it is logical to assume th a t repeated exposure to concentrations significantly in excess of the acceptable concentration p ro b ably would produce injury. W hen the level has been established on the basis of a func tional change or discom fort, it is logical to assume th at exposure to concentrations not greatly exceeding the acceptable concentration w ould not produce m aterially in ju rio u s effects. H ence it is im p o rta n t to u n d erstan d th e cri teria upon which any such m axim al accept able concentration has been established. T hough the purpose of the acceptable con ce n tratio n is to m inim ize h e a lth hazards, its im m ed ia te use is for g u id an ce in estab lish in g engineering procedures to prevent objection able concentrations of toxic or noxious m a terials from being present in the air of work places. Com parison of the results of air analyses w ith those concentrations indicates acceptable conditions or otherwise the need, extent, and urgency of control measures. Sampling and analysis should be carried out by com petent personnel using an acceptable m ethod which will provide a reliable m easure of exposure. A ir analyses in conjunction w ith acceptable concentrations of such atm ospheric contam inants as are encountered in industrial opera tions serve as a m easure of exposure-- not as a m eans of diagnosis of occupational disease. Diagnoses should be based on a consideration of all factors including results of clinical and physical exam ination as well as of air analyses, m eans of assessing am ounts of m aterials in the body, and a knowledge of toxicologic effects of the m aterials in question. In the application of the standards, it should be kept in mind that: (1) T h e accep tab le co n cen tratio n s serve as standards of good practice. (2) T h ey serve as en g in eerin g guides. D e sign and operation should aim at m a in taining all concentrations below the acceptable m axim um . (3) T h ey sh o u ld be ap p lied an d in te rp re te d by com petent individuals with a full understanding of the basis and lim ita tions of the inform ation from w hich th e standard has been developed. (4) It is advised th a t these sta n d ard s a re considered to be guides toward good industrial hygiene and are not intended as legal req u irem en ts. (5) T h e levels are ap p licab le only to ex posure to a single substance. In the case of exposure to m ixtures, the effect may be increased or decreased, and con trols should be based on the specific situation. T h e American Conference of Governm ental Indus trial Hygienists began its work in the standards field in 1947. T h ey p u b lish a n n u a lly a list of th e m aterials, w ith values, which they call "threshold lim its." T h e values which are given represent the concensus of a com m ittee of qualified experts in the occupational health field. T hey are reviewed an d brought u p to date each year. T h e most recent published list dated 1959 (2) con tain s values fo r 169 gases an d vapors; 71 toxic dusts, fum es, an d m ists; 11 m in e ra l dusts; an d a list of 21 so-called te n tativ e values. T h e basic philosophy of this group is set forth in p aragraphs preceding its listing of values: "Threshold Lim it V alues for 1959" (2 ) T h re sh o ld lim its sh o u ld be used as guides in the control of health hazards and should 990 M A X IM U M A LLO W ABLE CO N CEN TRA TIO N S not be regarded as fine lines betw een safe and dangerous concentrations. They represent conditions u n d er which it is believed that nearly all workers may be repeatedly exposed, day after day, w ithout adverse effect. T h e values listed refer to tim e w eighted average concentrations for a norm al work-day. T he am ount by which these figures may be ex ceeded for short periods w ithout injury to health depends upon a num ber of factors such as th e n atu re of th e contam inant, w hether very high concentrations even for short periods produce acute poisoning, w hether the effects are cum ulative, th e fre quency with which high concentrations occur, and the duration of such periods. All m ust be taken into consideration in arriving at a decision as to w hether a hazardous situation exists. Special consideration should be given to the application of these values in the evaluation of the health hazards which may be associated with exposure to com binations of two or m ore substances. Threshold lim its are based on the best avail able inform ation from industrial experience, from experim ental studies, and, w hen pos sible, from a com bination of th e two. These values are based on various criteria of toxic effects o r on m arked discom fort; thus, they should not be used as a com m on denom inator of toxicity, nor should they be considered as the sole criterion in proving or disproving diagnosis of suspected occupational diseases. These limits are intended for use in the field of industrial hygiene an d should be em ployed by persons train ed in this field. They are not intended for use, or for m odi fication for use, in the evaluation o r control of com munity air pollution or air-pollution nuisances. These values are reviewed annually by the Com mittee on T hreshold Lim its for changes, revisions, or additions as fu rth e r inform ation becomes available. T h e Com m ittee welcomes the suggestion of substances to be added to th e list and also com m ents, references, or reports of experience w ith these m aterials. In addition to these two groups, the A m erican Industrial H ygiene Association has, since 1955, been publishing the Hygienic G uide Series. T o date guides have been p u b lish ed for 97 substances. In m any respects this series is sim ilar to th e reco m m en d atio n s o f Sm yth in his rep o rt to th e A .I.H .A . in A p ril 1956. In fo rm atio n is provided fo r each m a te ria l rela tiv e to the recommended m axim um atm ospheric concentra tions; severity of th e hazards (both h ealth a n d fire); the short-exposure tolerance; atm ospheric concentra tions im m ediately hazardous to life; physical and chemical properties. In addition, un d er the heading of "Industrial Hygiene Practice," brief statem ents are given as to recognition, evaluation of exposures and recom m ended control procedures. Also, u n d e r the heading "Specific Procedures," b rief descriptions are given of first aid, prophylactic m easures, an d special m edical procedures. F inally, a list of references is given. It is also significant th a t in each case, u n d er the heading of "Recom mended M axim um Atmospheric C oncentration," a statem ent is m ade as to th e basis of th e recom m endation. T h is approach represents by far the most desirable way of dealing w ith the problem of establishing hygienic standards. M ere lists of num bers leave m uch to be desired. It is extrem ely im portant th at all available inform ation relative to the establishment of the standard be included w ith it. BASES FOR THE ESTABLISHMENT OF HYGIENIC GUIDES T h e establishm ent of num bers for "tolerable lim its" in th e U n ited States is based prim arily on tw o kinds of inform ation: anim al experim ents and hum an ex perience. T h e scientific research w hich produces the basic d ata is carried on by private industry, u niver sities, research laboratories, and governm ental agencies. T h e results of such investigations are published in m any U nited States technical and scientific journals. In some cases, particularly new chemicals, th e tech niq u e of applying analogy w ith other well-known chem ically sim ilar m aterials has sometimes been used until valid data have been accum ulated. T h e com m ittees o r organizations referred to above utilize all available published and unpublished data in arriving at their judgm ents as to the kinds of levels which will provide a basis for safeguarding employee health. Anim al E xperim ents T h e technique of evaluating toxicologic and physiologic responses in anim als as a m eans of pre dictin g possible effects of toxic m aterials, physical agents, or other environm ental conditions on m an has long been a routine tool in the occupational health field. Iri* sp ite of th is, how ever, th e re h as been little attem p t m ade to provide a standardized approach to investigative techniques in industrial toxicology. In m any respects this is fortunate, for in dealing with the effects of a toxic m aterial on a biologic system considerable flexibility is req u ired in applying estab lished criteria. Usually early tests will indicate the course of fu rth er study. T h e m agnitude of acute leth al doses an d th e effects on different organs will indicate the severity of the acute hazard and the im portance of various routes of absorption. Corollary inform ation relative to species variability, sex, age, and possible synergistic effects can be obtained at this tim e. All of this inform ation will then provide a basis for future, m ore extensive long-term studies. In th e case of new substances, th e first step which is generally adopted by toxicologists o r industrial laboratories in th e d eterm in atio n of toxicity is the utilization of screening tests on experim ental animals. T hese are usually followed by detailed studies of acute effects resulting from single injection, ingestion, or inhalation experim ents. In addition, irritating effects on skin an d eyes are evaluated. In 1956 a com plete com pilation of acute toxicides for an extensive series of m aterials was published u n d er the auspices of the Aero Medical Laboratory (5). T h e p u rp o se of th is vo lu m e was to b rin g to g e th er available data on "acute toxicity of various substances for several species of com m only used laboratory anim als as determ ined by oral or parenteral adm in istration, o r inhalation, of fatal doses." In the in tro duction to this volum e the various significant con ditions influencing th e acute toxicity for any given com pound were discussed. T hese include th e dose, the rate of absorption, route of adm inistration, site of injection, and o th er influences, including disease, environm ent, tem perature, h ab it and tolerance, etc. In addition, it was pointed out th at the toxicity of chem icals will vary w ith species of anim als an d some tim es even w ith different strains of th e sam e species. W ithin the same strain the toxicity may differ with age, w eight, sex, and general condition of the animals. WILLIAMS 991 Because of all these variables it is virtually impossible to be certain that all experiments are conducted in precisely the same way. In fact, only rarely does one find detailed discussion of all such factors involved in an experiment. Following accumulation of data on acute effects, long-time chronic effects are then studied through inhalation, feeding, injection, and skin-absorption ex periments. T h e nature of these is determ ined by the results of earlier screening tests. At a conference on T he Toxicological Basis of T hreshold Limit Values in 1959 (6) V. K. Rowe and his coworkers presented an extensive summary of the kinds of observations which had been made over a period of more than 20 years by several industrial groups. T his discussion summarized and tabulated observations on mortality, food intake, body weight, organ weights, gross p ath o l ogy, micropathology, hematology, blood urea nitrogen, clinical urine analyses, central nervous system, and cholinesterase. Tables I-IV summarizing the frequency with which particular effects were observed under various circum stances give an indication of the significance of sev eral biologic and biochemical determinations. T he significance of growth studies and cholinesterase in Tables I and II and the significance of the liver and kidney in all of these studies are well dem onstrated in ,T ab les III and IV. T he authors (6) point out that there is increasing pressure for more and more precise kinds of measurements in the biochemical and toxi cologic fields as a means of establishing valid threshold limits. They point out, however, that while this is an excellent objective and one toward which all should strive, it is essential th at one make the most practical use of available manpower and funds to obtain the most meaningful information. The criteria which are set forth in this paper are those which are most widely used and certainly accepted by all workers in the field. T h e best hope for increasing our fund of knowledge derived from animal experiments must come from the development of new techniques and new criteria. In summary, the authors of this paper state: In spite of the fact that there are many new criteria being developed and tested today, the data presented herein emphasize the high value of certain of the older criteria. It would seem only prudent to make use of those studies which experience has shown to be most productive. This does not mean that only those criteria showing a high degree of efficiency in the series of investigations re ported herein should be used, but certainly it suggests that they should be basic to any toxicological study designed to determine a threshold limit for repeated exposure. One other set of criteria which is attracting more and more attention are those physiologic studies which can be made on animals as well as on humans. In the symposium m entioned above. Dr. John A. Zapp, Jr. (7) discussed the importance of utilizing physiologic observations such as systolic and diastolic T able I FREQUENCY W ITH W HICH A PARTICULAR EFFECT WAS OBSERVED AT THE LOWEST DOSAGE LEVEL AT W H ICH ANY EFFECT WAS OBSERVED (6) Criteria of effect G row th Hematology Clinical urines CNS Cholinesterase Oral 64 (172) 1 (79) 1 (7) 4 (109) 8 (10) D ata from 1952-1959 4. % Vapor % 37 16 (38) 42 1.3 1 (21) 5 14 0 (7) 0 3.7 1 (32) 3.1 80 D ata from last 22-25 years All routes a % 152 (410) 37 5 (170) 2.9 2 (43) 4.6 5 (141) 3.5 8 (10) 80 Number of positive findings (num ber of observations) T able II FREQUENCY W ITH W H ICH A PARTICULAR EFFECT WAS THE SOLE EFFECT AT THE LOWEST DOSAGE LEVEL AT W HICH ANY EFFECT WAS OBSERVED (6) Criteria of effect Growth Hematology Clinical urine CNS Cholinesterase Oral A 25 (172) 0 (79) 0 (7) 4 (109) 4 (10) D ata from 1952-1959 Vapor % % 15 2 (38) 5 0 1 (21) 5 0 0 (7) 0 3.7 1 (32) 3.1 40 Data from last 22-25 years AH routes A % 44 (410) 11 1 (170) 0.6 0 (43) 0 5 (141) 3.5 4 (10) 40 Number of positive findings (num ber of observations) W ILLIAM S 993 term s of the significance of such inform ation in application to hum ans. H um an Experience W hile anim al data provide some basis for judgm ent ab o u t the possible levels of toxic m aterials w hich may be used safely in industry, they cannot be extrapolated to hum ans w ith com plete confidence. T h e ultim ate criteria m ust come from hum an experience. T he v alidity of such criteria is based on the am ount of experience in term s of both num bers of exposed people and tim e of exposure, on the m ethods of evaluation of the effects of the toxic m aterial on people, and on the completeness of the evaluation of exposure levels in the environm ent and correlation of these levels w ith hum an exposure. D ata with reference to hu m an effects are obtained from both controlled experim ents and industrial environm ent exposures. In th e case of irritants, for exam ple, such factors as odor detection, sensory response, and levels of exposure w hich are irritatin g to eyes, skin, and u p p er respiratory tract have been studied quantitatively in hum ans under controlled conditions. In general, such studies, com bined with experience gained w ith actual p la n t use, provide an adequate basis for establishing or confirm ing hygienic standards for such substances. It is m uch m ore difficult to provide a sound basis of hum an experience for substances which require rela tively long periods of tim e before producing evidence of inju ry . W hereas the acute effects can be evaluated relatively rapidly and by sim ple procedures, long-tim e detailed studies of controlled groups of industrial w orkers are required to provide adequate evidence in th e case of those substances w hich may produce chronic injury. T h e kinds of inform ation which are available from in d u strial experience w ith various chemicals fall into th re e basic categories. O ne of these is lim ite d t& com plaints associated generally with the sensory response or w ith m ore severe forms of acute irritation reactions affecting skin, eyes, or upper respiratory tract. T he second kind of data result from clinical exam ination of exposed workmen. T h e third is the result of hum an toxicologic or physiologic studies. T o be of value in establishing hygienic standards such medical inform a tion m ust be correlated with adequate data relating to the concentrations to which workers have been exposed. In his pap er "Im proved Com m unication. Hygienic S tan d ard s fo r D aily I n h a la tio n " Sm yth (3) review ed 238 values from th e 1956 A m erican C onference of G o v ern m e n t! In d u s tria l H ygienists list, to g e th er w ith his in terp retatio n of these values. He has also eval uated the nature of the supporting data--animal and hum an. An analysis of the four kinds of sources of hum an data indicates the role of such experience in establishing hygienic standards in th e U nited States. Of a total of 238 values which w ere analyzed hum an d ata w ere utilized in 108*, d istrib u ted as follows: Clinical Exam ination of W orkm en Was Correlated W ith T h eir Exposure 34 Industrial Com plaints or Observations Less Q u a n tita tiv e T h a n C linical O bservations 33 H um an Sensory D ata 42 H um an Toxicologic or Physiologic D ata 10 *O f the 119 values d istrib uted in th e above tabulation there w ere 11 duplicates w herein th e sam e m aterial appeared under two or more headings; thus there were actually 108 separate substances analyzed. In such an extensive list as this there are m any m aterials w hich are so little used th a t th e re is negligible industrial experience available to assist our sta n d ard s people. F or such m a teria ls relian ce is placed prim arily on anim al experim ents and th e use of analogy as guides in setting lim its. For the m ore common in d u strial chemicals many years of experience in using them has provided the necessary background to verify existing standards. Such experience is generally of a negative nature. W here it is supported by clinical or physiological data correlated w ith levels of exposure, as in the case of the ten-year study of butyl alcohol by Sterner and his colleagues (10), th e in fo rm a tio n is m ost significant. Such m edical program s are designed to evaluate the general physical condition of em ployees and to include specific physiologic tests which may be expected to provide early evidence of injury. Studies of this type are by far the most valuable for establishing valid hygienic standards. SUMMARY AND CONCLUSIONS In summary, it can be slated that hygienic standards for inhalation in the occupational health field in the U nited States are based on the application of the best known biochem ical, toxicologic, physiologic, and pathologic techniques to anim als and to hum an experience. Investigations are carried on by private industry, universities, research laboratories, and gov ernm ental agencies. T h e analysis of such data and in te rp re ta tio n in term s of h y gienic stan d ard s is d one by standards groups composed of com petent scientists representing every facet of the occupational health field. T h e valid ity of these sta n d ard s is d em o n strated by the low occupational disease attack rate in the U nited States. Verified cases of such injury are the result of exposures far above the established limits. Many approaches are being made to the problem of establishing hygienic standards in the occupational health field. It became obvious some tim e ago th at research people in various parts of the world were in some cases utilizing varying techniques. As a result, values for some substances differ by as m uch as an order of m agnitude. In an attem pt to get some u n i fication in the basic approach to the problem and to provide a m echanism to perm it a much broader exchange of inform ation and data am ong occupational health workers, the Perm anent International Com mission on Industrial M edicine set up a Subcom m ittee to study this problem . T h is Subcom m ittee held a symposium on M axim um Allowable Concentrations of T oxic Substances in Industry in Prague, Czechoslo vakia, on A pril 14-17, 1959. T h e Transactions of the Symposium, which appeared in four sections, deal w ith general areas of agreem ent am ong the delegates. T h is statem en t of p rin cip les is an im p o rta n t first step in establishing international cooperation in this im p o rtan t field. O n th e basis of this work it is hoped not only th a t we can look forw ard to the developm ent of a series of internationally acceptable hygienic standard values but that agreem ent can be obtained w ith regard to general principles and to m ethods and procedures which will be utilized in the establishm ent of such stan d ard s. T h e p rese n t Sym posium , w hich is the second under the auspices of the Subcom m ittee will, I hope, crystallize even fu rth er the thinking of those in the occupational health field concerned w ith establishing sound standards to be used in assuring safe industrial environm ents. Index o f Authors A dam s, C. A., 93-98 A granoff, B arb ara, 351-353 A hlm ark, A., 201-203, 653-656 A lbahary, C., 203-214 A nderson, W illiam H., 656-661 Ashe, W illiam F., 835-839 A shm an, George R., 351-353 A skey, E. V incent, 62 Axelsson, B engt, 201-203, 977-980 Balkanyi, N., 465-466 Bam bino, C. F ., 281-283 B arhad, B ernard, 661-663 B aselga-M onte, M., 663-668 Bauer, Louis H., 85-86 B aughn, W illiam L., 668-672 Bayonet, N atalio, 214-217 Belding, H. S., 839-845 Belknap, E lston L., 217-226 B enitez, Julio Cesar, 531-532 Benoit, Joyce N., 266-270 B enton, Jo se p h G., 314-316 B erdan, C., 845-847 B ernath, Zoltn, 227-230 Bielecka, W., 795-798 Biggs, M. W ., 147-150 B issonnette, Grace, 230-232 Blatz, H anson, 463-465 Block, D uane L., 678-679 Bloomfield, John J., 98-101 Bojin, S., 677-678 Bolis, L., 817-818 Bonjer, F red erik H., 672-675, 848-850 Bonnell, J. A., 93-98 Bordes, H. J., 850-857 Boudene, C., 209-214 Box, A rth u r, 298-301 B rand, M orris, 603-605 B randaleone, H., 937-939 B reitenecker, Leopold, 675-676 B rennan, M iriam C., 314-316 B rieger, H einrich, 730-735 B rinkm an, Geoffrey L., 678-679 B ronstein, Lewis H., 232-237 B rouha, Lucien, 857-862 Brown, J. R., 862-864 Brownlow, Jam es A., 605-607 Bruce, T., 653-656 B rykalski, D., 800-801 B u rg er, G. C. E., 864-869 Burney, L. E., 63-64, 101-104 C adariu, Gh., 237-238, 676-678 Cancella, Lopo de C arvalho, 56 C ataldi, R., 181-182 C avagna, G.f 770-772 Cavigneaux, A., 203-209 C harsha, R. C., 580-585 Churchill, A. G., 281-283 Ciuhandu, Gh., 237-238, 676-677 Coates, E. Osborne, Jr., 678-679 Cobo de Bias, Eliseo, 238-240 Collins, S. K., 281-283 Colonna, F rancis L, 241-242 Conrad, Reuben, 869-870 Cotabish, H a rry N., 544-551 C racuin, O., 679-681 Crisan, V., 237-238, 676-677 C ruickshank, W. H., 105-106 D ankner, A., 237-238, 676-678 Daw, H. T., 86-87, 106-110 Deichm ann, W illiam B., 871-872 Dervillee, P., 242-243 Desoille, H., 209-214 Didonna, P ietro, 110-114 D inatale, P eter J., 244-245 D inischiotu, G. T., 343-345, 679-681 Dohan, F. C., 182-184 D'O nofrio, V irgilio, 181-182, 958-959 D ossett, B urgin E., J r., 656-661 Dror, K., 245-246 Duffner, Gerald J., 939-942 D unlap, M. K., 281-283 D unster, H. J., 114-118 D urham , Thelm a J., 246-249 Dutkiewicz, Tadeusz, 681-686, 795-798 998 E ckardt, R obert E., 7-10, 64-65 Eckhardt, W., 850-857 Elkins, H ervey B., 981-983 E rh ard t, J . Th. G., 850-857 E stadella-B otha, S., 663-668 ' F abre, Ren, 686-692 Felton, J. S., 413-426 F erence, A nne M., 12-14 F erra n , G. H., 486-503 F iandaca, S., 353-359 Finulli, M., 770-772 Fischer, R., 872-876 F isher, R. . W., 250-256 Folsom, M arion B., 72-82 Form nek, J,, 714-721, 872-876 Fornells-M artinez, E., 663-668 Forssm an, Sven, 68-72, 257-258 F ortuin, G. J., 258-259 Fournier, E t., 694-698 F rad , G., 259-260 F ran tik , E., 714-721 F rantikov, D., 872-876 F riberg, Lars, 201-203, 977-980 F riedland, I. G-, 692-694 Gabor, Sylvia, 465-466 Gasque, Mac Roy, 260-263 G aultier, M., 694-698 Georgescu, A. M., 343-345 Ghosh, P. K., 426-427 Gillquist, B., 257-258 Glorig, A ram , 699-700 Goldman, Rose, 314-316 Goldstein, Bernard, 263-266 Goldstein, David H., 266-270 Gorospe, A lfredo A., 636-639 G radina, C., 700-702 G rant, E llsw orth S., 118-120 Greene, K atrine R. C., 314-316 Grim aldi, Jo h n V., 607-608 Grimlund, K., 703-707 Gross, Paul, 707-712 Gucciardi, G., 259-260 Guymer, R. F., 270-275 G uyotjeannin, Ch., 694-698 Gwozdz, B., 795-798 H am ilton, G ilbert L., 656-661 H argreaves, M a rg a re t S., 275-278 H arris, E . S., 281-283 H arris, W illiam B., 466-472 H atch, T. F., 839-845 Hayes, W ayland J., Jr., 120-122 H ertig, B. A., 839-845 Hinchcliffe, R., 712-714 Hine, C. H., 281-283 INDEX OF AUTHORS Hinkle, Lawrence E., Jr., 283-288 H ipps, John G., 608-610 Hogan, Edw ard J., 610-613 Holden, F. R., 281-283 Holm, A., 257-258 Holm quist, C arl-E ric, 122-126 H olstein, E rn st, 278-281 Holtz, John, 783-785 Horiuchi, K azuya, 288-289 H orvth, M,, 714-721, 872-876 H ueper, W. C., 473-486 Hughes, Jam es P., 879-882 H y att, E. C., 486-503 Inoue, Toshi, 289-290 In tern atio n al Labour Office, 721-724 International Symposium on Maximum Allowable Concentrations of Toxic Substances in Industry, 33-39 Iorga, M., 341-343 Jensen, C. R., 486-503 Juin, Grard, 942-947 Jullien, Georges, 724-726 K am m er, A. G., 427-428 K antor, M., 753-755 K azantzis, G., 290-298 K eatinge, Gerald F., 298-301 K eenan, R obert G., 503-506, 783-785 Kehoe, R obert A., 126-129, 433-436 Kesy, Irena, 726-730 K illens, Richard, 783-785 King, E., 301-311 K ingston, Jam es R., 911-917 K itagaw a, Tetsuzo, 506-512 Kiviluoto, Raimo, 311-312 Klein, Irvin, 613-615 K lutas, E dna May, 428-431 Kopp, John, 783-785 K ru g er, D aniel H., 615-621 K rger, P. D., 971-973 K ubota, Juko, 313-314 LaBelle, Charles W., 730-735 Lachnit, V,, 947-950 Laham , Souheil, 686-692, 735-738 Lam m ers, B., 876-878 L andry, A. S., 512-519 Lavergne, Rafael, 214-217 Lehm ann, Gunther, 878-879 Leoca-Radu, Mina, 349-351 Letavet, A. A., 431-433, 891-892, 983-987 Liber, A m our Fiscus, 738-740 Lieben, Jan, 316-319 Lienhard, Wendell F., 879-882 Lillis, R ,, 679-681 Linch, . L., 580-585 Lind, A. R., 882-887 Liniecki, J., 800-801 L ittler, T. S., 712-714 Lubin, Isador, 621-622 Lund, O.-E., 740-741 Lundervold, A rne, 887-891 Lutier, J., 401-402 Lutz, E arl F., 184-186 McCallum, R. I., 741-745 M cClintock, R. S., 879-882 M cKerrow, C. B., 745-749 M cNerney, Jam es M., 707-712 M agnuson, H arold J., 129-131 M alysheva, A. E., 891-892 M anheim er, R obert H., 314-316 M atthew s, Jam es, 131-134 M atuoka, S yukiti, 893-902 Maxfield, M ary E., 857-862 M eiklejohn, A., 134-138 Meila, I., 677-678 M etzner, F ra n z N., 316-319 Michon, R., 902-904 Mihaila, I., 904-908 M ikaelian, Michel, 320-322 M ikisha, A., 714-721 Milijic, Bosko, 950-951 Miller, S. E., 937-939 Milox, M., 908-911 M inard, David, 911-917 M iskolczy, W ilhelm, 322-324 M itchell, R. N., 486-503 Moise, Gh., 676-678 Molfino, F., 952 Monaco, A lfred, 749-753 M orris, G eorge E., 324 Morrow, C. S., 753-755 Moscovici, B., 341-343 Moss, N. H enry, 182-184 M otley, A rth u r W., 623-624 M ountain, John T., 783-785 M oyer, B urton J., 519-522 Muica, N., 679-681 M urray, R obert, 139-145 N adudvary, George, 465-466, 755-757 N ale, Thom as W., 625-628 N am ba, T atsuji, 757-758 N estorescu, B., 679-681 N ew nham , C. T., 324-325 Niebroj, I., 795-798 Nixon, Jam es, 699-700 Noro, Leo, 326-335 N orviit, Lem bit, 952-957 Norwood, W. D aggett, 335-338 N ystrom , A., 257-258, 653-656 Olloqui, Fernando Flores, 628-631 Oyanguren, H ernn, 227-230 INDEX OF AUTHORS Pafnote, M aria, 845-847 P aggi, Edoardo, 758-767 Pancheri, Giovanni, 145-146, 767-768 P ark er, H. G., 147-150 P atrasc u , M., 465-466 Payne, W illiam W., 473-486 P endergrass, E ugene P., 768-769 P endergrass, H enry P., 768-769 P erales y H errero, N arciso, 631-632 Pernis, B., 770-772, 817-818 Pes i, Giuseppe, 958-959 Petrescu, Leonid, 661-663 P ettinati, L., 348-349 Petrovic, Lj., 338-341, 368-371 Phillips, A. M., 553-556 Pietschm ann, H., 947-950 P ilat, L,, 341-343, 679-681 Piotrowski, J., 780-782 P iscator, M., 201-203 Plum b, C arl S., 260-263 Plum m er, N orm an, 283-288 Poleti, D., 338-341, 368-371 P otter, A. Lloyd, 150-155 Powles, W illiam E., 351-353 P radel, J., 522-531 Preda, N ,, 343-345 Princi, F rank, 433-436 P u ertas, Benito N ogales, 633-634 Q uer-B rossa, S., 663-668 Q uigley, J . A., 65 Radcliffe, J . C., 65-66 Rdulescu, I. C., 343-345, 679-681 Rae, Stew art, 772-776 R ainsford, S. G., 345-348 R asetti, L., 348-349, 359-361 Raucher, K arl, 349-351 Reeve, A. Louise, 634-635 Renker, K., 917-921 Riedesel, M. L., 839-845 Riegrt, A. L., 819-825 R igner, K. G., 257-258 R isquez-Iribarren, R afael, 155-158 Rogan, John, 772-776 Ross, W. Donald, 351-353 Rossi, M ario, 960-961 Rossier, P. H., 776-780 R o tta, C., 353-359 Rubino, G. F ., 359-361 Rye, W. A., 361-364 Sakai, Yoshimichi, 158-162 Salmowa, J.,''780-782 Sands, Frederick W., 531-532 S antillan, Jose S., 636-639 Sarfeh, R., 436-438 S aruta, Namio, 532-535 999 1000 INDEX OF AUTHORS Savicevie, M., 338-341 Saw yer, W illiam A., 438-441 S can setti, G., 348-349 Scheel, L ester D., 783-785 ' Schepers, G. W. H., 786-795 Scherm erhorn, W., 850-858 Schiller, H ans, 961-962 Schind], K arl, 364-365 Schmidt, H einz-G nther, 365-367 Schmidt, M arjorie D., 367-368 Schm idtke, H., 921-923 Schulte, H. F., 486-503 Schunck, K arl-H ans, 377-378 Schw artz, Louis, 639-642 Seles, L., 237-238 S erati, A., 963-965 S herrill, S. S., 281-283 Shipm an, Thom as L., 642-645 Shoib, M. O., 85, 162-166 Sick Absence S tatistics Com m ittee of nent Committee and International on O ccupational H ealth, 40-55 Silverm an, Leslie, 441-448 Simpson, H. M arjorie, 448-452 Simu, George, 755-757 Sm ith, Paul E., Jr., 857-862 Sodergren, David, 122-126 Sox, E llis D., 281-283 S pett, K., 795-798 Spiers, F. W., 535-540 Spioch, F. M., 795-798 S tankovic, M., 338-341, 368-371 Staskiel, L. J., 753-755 Steele, E a rl C., 371-373 Steele, M a rg a re t L., 66-68 S teiner, S. D., 373-377 Stokinger, H erb ert E., 540-544 Stopps, Gordon J., 857-862 Stowell, Thom as E. A., 186-191 S trange, Jo h n P., 544-551 Sum ner, Philip, 314-316 Sym anski, H.-J,, 798-800 Szpakowa, T., 800-801 Szymczykiewicz, K., 801-805 the Perm a A ssociation Udel, M elvin M., 397-401 U rsoniu, C., 676-678 Vacher, J., 401-402 V alentin, H., 816-817 Van der Velden, W., 850-857 V an Liew, H ugh D., 911-917 V an V alzah, H. J., 678-679 V igan, C., 965-971 V igliani, E nrico C,, 87, 452-457, Viles, Frederick J., Jr., 556-563 V illarroel, Sergio, 227-230 Viola, P. Luigi, 818 Voelz, George L., 564-569 V osburgh, B. L., 931-933 770-772, 817-818 W ade, Leo, 7, 61, 88 W ald, Neil, 569-572 W alker, Mildred I., 167-169 W alsh, R ichard F., 645-648 W arnock, D orothy M., 402-404 W asserm an n , M., 572-580 W eaver, N eill K., 381-387 W echselberger, F., 191-194 W ells, R. Lom ax, 170 W estrick, M arian L., 707-712 W etherhold, J . M., 580-585 W heatley, B. M., 585-587 W hipple, G. H oyt, 171-178 W hitney, L. H olland, 283-288 W iecek, E., 801-805 W ieland, H., 740-741 W illiam s, C harles R., 988-994 W illiam s, K atherine, 587-590 W illiam s, M ay M., 194-197 W illiam s, N., 819-825 W illm an, Helvi, 404-405 W inter, K urt, 405-410 W o rth , G., 826-827 W yndham , C., 924-931 T abershaw , Irv in g R., 11-12 T aylor, Edm und W., J r., 182-184 Teisinger, J., 987-988 Teso, G. A ., 359-361 T haxter, M. D., 147-150 Thom , W. F . J . M., 379-381 Thoma, George E ., 569-572 Thompson, A. R., 301-311 Thorpe, John J., 381-387 Tom pkins, P aul C., 551-553 T ripsa, Rodica, 806-810 Troisi, F o rtunato M aria, 387-397 T ru h a u t, Ren, 33-34, 39, 209-214, T ucker, F. E., 553-556 686-692 Y ingling, Doris B., 457-459 Yoder, John D., 590-592 Y oshim i, S., 827-828 Y ount, H ubert W., 649-650 Zahorski, W itold, 828-832 Z anetti, Ennio, 767-768 Z annini, D., 971 Zielinski, John F ., 592-600 Zorn, 0., 971-973