Document KJmY0K2QRaEpxaVRGxL92VO2x

FILE NAME: New York State & NY Times (NY) DATE: 1952 DOC#: NY003 DOCUMENT DESCRIPTION: Journal Article - Occupational Disease Diagnosis [Author - Dr. Mayers of the NY Dept of Labor]  ^ X b . a t W . M. V- ' k/'sy- . .u.-al tho preventive upaiumnl accidents or Occupational disease diagnosis ,r sale working rotidi* jV^tYv R.-,MM ayYeERrSs, MWi..Dw., N ew York C ity ** , i s.iictv department, ,,,.comes entirely curer>ing the process and * ^ M e d ic a l Unit, Uivirion of Industrial Ihjgune and Safety S t a M , Neu, 1 irk Slate ^^[ty^orrttmmtennt of Labor) j A engineers respon- ;,ml safety in the final . or fluoroscoiie, as industrial inspection devices; f u(.i we can eliminate T . , [ luippv to have u few minutes to discuss the inadequate or improper illumination with glare, | leave tho drawing 1 occupational diseases with u group of innetie- etc. The industrial environment is, indeed,, as , ,,,.nt willi its specialist nhvsicians. Curiously enough, such oppor- coiuplex and as fluid us modern technologic internal medicine, " i t i e s are relatively infivquent since these research and development itself. n;l,,is to the research' i Sseases tend to 1* resentd, almost -xclusi.il>. For the individual worker health hazards will [inim*er in cooperation r K U r m l health meetings. Ami few medical vary from industry to industry, from plant to control laboratory .rds in his project. ^ Petitioners atteml such meetings because the l there tends to be on the industrial plant, from workroom to workroom, and often from one process to another in a single workroom. to the medical depart.,,volved and possibility * Environment ami its control rather than upon Since Inlxir is highly mobile, workers tend to go *? ,1 medicine. The fact remains, however, from one industry to another and from one type l )ur tnaleruds control iT w h c n a worker gets sick, he first consults of work to another in various parts of the country. ,1, reeled ill a new proty lilown doctor, so that this doctor ts really m the Accurate evaluation of their occupational ex- M11g mercury which ia V t line when it comes to the need to recognize imsures, particularly on any long-time basis, inay ,,om temperature. Was ^occupational (lisease clinically and to make a therefore present difficulties. ~ive process involving a ,1,.- Mereurialism be- \ V . p r o f e s s i o n tl.e occupational For some reason the occupational diseases have ^ Nation claim. The projilmn two months, while S J L s are always somewhat l.aHhng Ix-ausc T ^ h -iv e their origins in environmental con- alwavs held a place somewhat removed from the rest of clinical medicine.' The fact of their so- ludied the problem and P 1 E o s which are unfamiliar. Unlike the couiin,Mit the degree of risk m " tl"` v environment where the medical problems called "common etiology," the occupation, has iKTliaps carried with it a subtle implication that the project was allowed they represent a cohesive group in which there ` i m" aiLiys largely epidemiologic m character. is a relatively limited immlier of fairly clear-cut hcmlcal engineer became * industrial environment, Isung i.uin-inade, clinical entities and that these are, on the whole, electroplating he had / E n t s problems in fields somewhat urtl.ei characterized by distinguishing earmarks which c a> a demonstration of a r moved from the physician's cuuvcntnma traui- suggest particular occupations. Actually, the c. among other essential , .vnle and nickel carbonyl, ' S "d experience, fields such ms mdnstnal occupational diseases range over much of the eie alluring since plating ^ ^There ^re ter.dly thousands of | M>tciitially hours to minutes. Our I chemicals which are either lieing im nlum l in entire field of clinical medicine since they reflect all of the physiologic, hioehemic, and metabolic ,, dangers of satisfactory changes which develop in the body in re*pdnse 'onoMdc; they were not ^?Ctrv or are l>eitig used in the production oi to working conditions which are inimical to ,,,nvl hazard. The Indus- ^ ^ o d s with new ones living addtd all the health, including many compensatory responses nguieer were satisfied that J * U ,e ,, ,r A,,.le I,.,; -k,,, initiated by the laxly for purposes of self-pres ,1 but the internist and T Intact workers are exposed to many of these ervation. .... prove of the use of nickel 1 : E L g e s in the form of dusts, gases, fumes well-substantiated b or mists which U'come disseminated Nor d<x*s the individual clinical picture neces e voluble, colorless liquid The project was ^ T S i'e air of the workroom. While inhalation h far the most Important source of injury sarily suggest the existence of an occupational etiology. Far less does it [joint to any* s[)ectfic occupation as the etiologic factor. This-a in ei elopmental and product health from exposure to toxic chemicals, part due to the fact that many of tlie same toxic eon d for satisfactory func- I* a, absorption, and eve., ingestion my !>'">' chemicals and the same abnormal environmental ptogiaui. The success or w mt,.s under eertum eircuinstum es. conditions are t.f lie found in greatly diverse i i-iel iu io selling his pro ^Less familiar, [terhaps, are a variety of other industries and occupations. More important, '. ultimately bused on his ,, i;i;rt in the working environment however, is the fact tliat many occupational ,0,1 Uness at a minimum. S are equally serums as potential health dis^use* ure clinically from ; h ntaiiager prefers to see P' , Aside from dangerous machinery there similar diseases which are nonoccupational m -ev. ritv rules deeline than ^ T t o m u t l temperatures and humidities; ,r ,live surgery or to read an origin. Only the etiology is different. However, ,e, tor on I'd proved eases of - fred and ultraviolet light , compressed air m i ^ e l construction; continuous v.hrat.on m its recognition may provide the only opportunity for saving the patient's life. , exposure. T L of pneumatic t.K.ls; excessive noise, even Aplastic anemia or leukemia, for example, are i E e sti|>ersonie ranges; radiation, as in radnm. (lie same hematologic entities whether they are ,/, / iip I sec the l i J E m l i n g operations, or the use of the x-ray idiopathic in origin or have Ixxm contracted in a 17.1 At till- mall Aitniil M-fUn* ,,f 1*** Ml"">'! factory worknxim as a result of exposure to lien a SUU of New Yu. k. New York City. Sect........" zol or'exeessivc radiation. Epitheliomata of the B: Medicine od Surgery. ,\Uy 10. 1962. 21181 ' . J r " : ^r ; l ` ! t I- >' ; - *"; >>-.- V"t'.v '>;*jfci-' y<` **Vt jirV 4 -yv;v* A A A "*> iiJ!i A kl tr! i M;! -1i : \y i ' il' A v, A/.Il y.', t/.l /'.'ViN I |N. N. SlaO- .1. Al- October 1. 10.VJ * ! > * bladder produced by e.i|H>Mirc t<> 1>eUtiiiv|>liUiybi- minc/m the manufiytutu of aniline dyes mot Ik- differentiated from tViioccupationul epttheln*- limt i of the J>Li*Uler, either clinically, on >*'" ,,.,,.Ai examination, or m muyoseopic sc.-tcm. Kvcrt their Vlmv clinical coawo m ' ...... Asthma ami dermatitis venenata, whelhei "I occupational origin or not, are clinically the sam.-. Onlv the precise antigen responsible may I- one which is characteristic of a particular occupation, as in the case of the paraphenylene diamine dyes to which fur workers are exposed. 3omc of the irritant Rases present similar difficulties in differential diaRiiosis. Ammonia las for example, is so highly irritating that few persons would voluntarily remain in its pu s . ei.ee Io.ir enouRh to inhale a toxic dose An ' accidental break in a pi|>ehnc m ild ^`hjccl workers to sufficient absorption to l"'(Mbice a pneumonitis, pneumonia, or even edema of the lumps however These conditions are not pathog nomonic for ammonia Ras. Only an occupa tional history will reveal what happened am provide necessary Riddance for the manaRe.ncnt time jaundice develops it may te too laic to save his life. This has occurred lu cxiiosure to carbon tetrachloride one e particularly impressed by the great differencein individual s.is.-eptibllity. A drink of alcohol m:,v make the difference tetwern life and death. These marked differences in individual su.-eeplil.ililv are not well understood. I hey are n> ,,o means eonlined to the oeeupatioiial disease Imt (s-rvade the whole of clinical medicine. In poliomyelitis epidemic, for example, almost every one is exposed, but relatively few contract tla disease. Nevertheless, physieians are prone to assume that If no one else m a plant is sick his patient's illness cannot te due to his occupa tion. This is contrary to all experience. 01 two workers having an identical exposure teiuol at a woikteiu-h one may die of an aplast anemia and the other te unaffected. \iiiniig the pneumoconioses silicosis is |>eiiiap the most familiar. Physicians are teconmu; increasingly adept at r e a liz in g the v . o -.hadows of first, second, and third stage siteo.-i.te-KS familiar, (H-rhaps. are the pneumoeumo^ priKluced underappmpnate coudit.onsol expo.im of the case. . The nitrous fumes from weld.nR o|s-rat oils !,v other tv|>es of dust such as astest.. talc, e.-ifhorundum, or mica. The extent t., which then estxteially in enclosed spa.-es as ... the holds of ships, are more insidious U'eause they are less obviously irritating. As a result, relatively large amounts may lie inhaled without warning. However, after an interval of eight, ten or even twelve hours their caustic action in the tings may su it in death from pulmonary edema. The long latent period tends to ol.seurc causa relation unless one is familiar with this type o situation and inquires into the occupational mav te fundamental differences m (.atholou response to dust inhalation is also not sufficiently appreciated. For example. asteMosis and the inhalation of certain of the chromate dusts a|> 1icar to (.lav etiologic roles in the pnNluetio.i " lung cancer whereas silica dust docs not Ire" dust will produce characteristic x-ray sluulow of "siderosis" without a(.parently injuring til lungs at all. Pulmonary granulomatosis pro dueed by the inhalation of beryllium indicates a exposure. Standard procedure for saving a totally different mecbanism at work. Whaieve i worker's life is to put him to ted immediately the pulmonary pathology, however, and no matter s following a known exposure to nitrous fumes bow ebaracteristie the x-ray shadow sinay te, it - even in the complete absence of any dmieal prettv well accepted at the 1'resent tune , manifestations of injury to health. that the x-ray pictures are never pathognomonic In carbon tetrachloride poisoning one is usually The resemblance between third stage sihi ns dealing with a toxic hepatitis, a nephrosis, or a and miliarv tutero.ilosis may te truly striking, combination of both There is nothing m the tervllium granulomatosis may '^ read.lv ni clinical picture, howevcf, which s|>ec.l.e:.lly taken for Boeck's sarcoid. More fibre, i (joints to carbon tetrachloride as the etiologn than usual" or pleural cale.hcat.o.is are par agent or, indeed, suggests that one is dealing ticularly difficult to interpret without a history with some occupational disease. If the patien of exiHisure. . ... , ' is jaundiced when he first consults h.s physician, Here again, then, an investigation of theocrupa .obstructive, catarrhal, or infectious jaiin.tee tional history of the patient is mdts,.e..sa > immediately come to m.nd 11. T o te of real value, however, ties o c cu p a tio n .; of a toxic hepatitis is usually the last to U m sidered and is often not consulcred at all. In the early stages, however, there may te no jauu- history must te carried teyo.id the pat.e.ite ,.resent job to include the whole of bis worhmk life in so far as |x.ss.ble, for the pneumoco.i.o^ dice, and the patient comes to Ins physician com are el.io.iic diseases which may take many yeai> plaining only of vague gastmmtestma symp .level..,.. Occupational eaneer or end poison* toms In the atesence of an occupational historv of exposure to a licpatotoxic d.c.nicnl the patient ing an- in the same category. 1 addition. . imiiortaiit to appreciate the fact that a particu may te given a cathartic and dismissed. IJ> U job diuwifieation d,,, precise information apational exposure. 1 is a "foundrymaii." Unless one know- wh, i handles sand, uhel!-1 which an- toxic, win i whether he o|-rates flaws in finished ea-i plete occupational h.-i difficult to obtain I" plexities inherent in : of patients to present well-informed ehemi-t tional diseivse in his la : give a complete list he handles, althoueiknows exactly what ; to be selccti.p, listm. suspicious. Memory years back obvious: problem, but if one j history is usually fur- Wlien it is discoxc working in a dusty ency to concentrate evidenres of a pnen many dusts never re. particles are larger : getting that such ,1 highly irritating to the upi>cr respirato: further that it is tl. substance rather tic tend to determine t; Thus, inhalation of cause cancer of the the lungs. Similar; dust or fumes, rear but it does not in stead, it is carried : causes lead poison; of the industrial so, halation, but their where. Carlx.ri t. . for the liver and k, topoietie system. <-;. system, etc. Zinc flue particles of un branes of the upper there is an anapi i referred to as "zinc Skin contact similarly, produce without a local <1. absorption. Unlih pounds tetraethyl through the skin :, central nervous ; . -- \ . Y. .Siall' J. M. 1 --- r* October 1, 1952) VCijyjy^iWi OVCUPA T/OXA L DISK. ISK D!.\GXOSfS 2383 it may U' tun ate to ||Y ^ classification does not necessnrily provide r. hi ri'il fei precise information ns to the nnturc of the occu- ,.,u ii,|iai'lili>riili' one it K* pational exposure. To learn that one's patient av lilt- great ililToi-once* l i , "foundryman," for example, means little av. A 11rink ill alcohol unless one knows whether he is a "moulder" who ,. U'tutvn life ami death. handles sand, whether he pours molten metals , in individual susrepti. rrhich are toxic, whether he is a sandblaster, or ,,i,'r-(ii,l. Tlu-y are by ii whether he operates an x-ray machine to detect iU' iiri-ii|ialiimal disease gsire in finished castings. Accurate and com a viimi al uu'ilii'ine. Int plete occupational histories of patients are often . ,i i'\aiii|'lc, almost ever). difficult to obtain because of the technical com- . ,iivriy ic" ri intract the plenties inherent in the subject and the failure iliv-u'inii- are prone r; jd patients to present the whole story. Even a i'i'i* in a plant is sick, f well-informed chemist who contracts an occupa- a . U ' line to his uecup*. L'[ jiunaldisease in his laboratory will not necessarily , m all experience. 0( jive a complete list of all of the substances which i, ,li-111 u :i1 exposure to be handles, although unlike most workers, lie .a may ilie of an aplastic knows exactly what they are. He tends rather UialTeetcd. to be selective, listing only those of which he is .no ,-io- .llieosii is perhaps mepicious. Memory failure for occupations . -iaii> are iK'eominjj -- re back obviously further complicates the irinaiiiziiii: the x-ray problem, but if one persists^ useful occupational . ain1 tliinl stage silicosis, {story is usually forthcoming. an- the pneumoconioses I. When it is discovered that a patient has been lie i niiiliiiimsof exposuie li! working in a dusty atmosphere, there is a tend- -,ih as a-liestos talc, car. tncy to concentrate attention solely upon x-ray f!.e I'xieiit to which there evidences of a pneumoconiosis, forgetting that .i,li<-i<11i-i" ill pathologic m*nv dusts never reach the lungs at all since the 11,,ii i> a I".' mil sullieientlj articles are larger than 5 microns in size; for- ,:,,,ie. a-lio'iosis and the irtting that such dusts may, nevertheless, lie ; I|,r | |;I Iiinale dusts np. ? highly irritating to the nose and throat or to .in- in tin- priKluetion of the upper respiratory passages; and forgetting .., a iiut does not. Iron. 3further that it is the toxicologic properties of a .ia,'ii`iistic x-ray shadows ijubatance rather than the portal of entry which nppari'iitly injuring th blend to determine the site of injury in the laxly. tiianuloiiialosis pro. '"Thus, inhalation of betanaphthylamine dust can a, ,,f U-ryUiinn indicatess reuse cancer of the bladder but never cancer of .in-in at work. Whatever llhe lung3- Similarly, lead, whether inhaled as vv, however, and no nuttier ii-dust or fumes, reaches the alveoli of the lungs, x-ray -hadows may lie, its ''but it does not produce lung pathology, ln- | at Ilie present tin^ teadi it is carried away in the blood stream and arc iicn'i pathognomonic. lead poisoning, a systemic disease. All ..wi ll thud static silictgjj |he industrial solvents enter the body by in- may lie truly striking. mav I1 readily ink. fr.ktion, but their toxicologic effects are else -ai-oid. "More fil where. Carbon tetrachloride has a predilection :a1 . ah ilicalions are psr. jor tht liver and kidneys, benzol for the hema- 5 icpok'tic system, carbon disulfide for the nervous .I.t without a history f*vsteMi etc. Zina fumes cause a deposition of i,,.-l ualioli "f the oecnpsJ , | ,.it H-iit i- imlis|KMisabl !., ni i1\ i1, tills occuputioi ,.. .i Im\ i,11,1 the patient' t in' u hole oif Ills workij^ , the piieiimoconir a, i, ma> lake many yeaj, mil Ialiii'i III' lead |HMS l.-c.-ry. In addition, it's , Ii,1 ; n't that a particity ;joe particles of zinc oxide on the mucous mem'jfunesof the upper respiratory passages to which Wifie is an anaphylactic reaction, commonly inferred to as "zinc chills." gkin contact with toxic chemicals may, Similarly, produce systemic disease with or without a local dermatitis when there is skin ^absorption. Unlike the inorganic lead com^pounds tetraethyl lead is readily absorlred ?through the skin and has a predilection for the k(totral nervous system. Nitrobenzene on the skin can produce a dangerous cyanosis i with methemoglobinemia. Where there is exposure to a combination of chemical substance*, re gardless of precise portals of entry, the principle of synergism enters to complicate the clinical picture further. j Among the gases carbon monoxide is always good for a full day's session as soon as qomeone raises the question of "chronic carbon mouoxfdi poisoning." Actually, whether or not there * a clinical entity such as "chronic" carbon monoxide poisoning is entirely a matter | f definition. That varying degrees of anoxia may l>e present in persons exposed to concentrations of this gas which are insufficient to produce acute asphyxia is well known to all students of the subject. In industry cases of acute asphyxia are relatively rare. More often, workers are exposed to rela tively low concentrations for long periods of time. The typical picture, as one sees it in garage workers, for example, is that of an extremely intense and throbbing occipital headache, usually associated with dizziness, nausea, nervous in stability, psychologic susceptibility, insomnia, and gastrointestinal symptoms. There are two strik ing points about the headache: (1) Clinically, it immediately suggests a bruin tumor, and (2) it continues for a great many hours after the carbon monoxide lias, obviously, Ix-en eliminated from the body. It is an important cause of absen teeism among garage workers. Yet it is thin continuation of the headache, even into the fol lowing day, which always causes doubt to lie thrown upon carbon monoxide as a possilde cause. When one considers the pathology, tins seemingly puzzling situation becomes perfectly clear. Trephine operations oa animals exposed to carbon monoxide gas have demonstrated the presence of edema of the brain associated with increased intracranial pressure. This immediately ex plains the clinical similarity lietween the carbon monoxide headache and brain tumor. On the other hand, while carbon monoxide is rapidly eliminated from the body, usually within the first hour or two, edema of the brain takes manv more hours to subside. The headache continues during all this long period., Incidentally; quanti tative determinations of carbon riionoxide in blood are often carried out hours after exposure when the patient finally reaches a hospital. Obviously, these can be of little value singe practically all of the gas has long since dp- appeared. Another point not sufficiently appreciated is that a worker with a 40 per cent oxygen displace ment due to carbon monoxide is suffering from a far greater degree of anoxia for practical purposes than is an individual with a 00 per cent hemo globin and a corresponding oxygen lack due to 81 *HP : ift p i 1 a. - j. ,, A I' ' I i ;lwmftlt ^ 'a a ^ s s s s s m ^ im W-*-.<i'*-r-<_'>-?. '_V1 iiuSutiiifciau .,, w .^ rte a tv y frAfafeiS iuy'lrV -** . i fl , :; , i M.\ V/i'/i.S 2384 anemia, for example. Tins .s Weanse <>"' "x>gl!n dissociation curve with carl .on monoxide is such that what oxygen is present is far less readily available. A garage worker may eollapse on sudden exertion under such circumstances, while the patient with the corresponding anemia still has a considerable ready reserve of oxygen There are a iiiirnWr ..I indu.-trial chemicals whnl< are capable of producing psychonci.mscs, psy choses, and even neurologic conditions whin cannot always be distinguished from those- which an- nonoccupational in origin. Ix-a.-t scnoii. iierhaps, are some of the less toxic solvents winch ire nevertheless, narcotic in their effects. Workers exposed to trichlnrethyleiie, for example, at his immediate disposal. . . may under certain circumstances Income drowsy, I will not attempt to discuss lead poisoning irritable, and restless, and they may complain except to point out that most of the difficulties of vague gastrointestinal disturbances which are in diagnosis arise from failure to differentiate not easv to verify on physical examination. In between lead absorption and lead poisoning and the manufacture of rayon, workers exposed t failure to visualize the medical findings in terms toxic concentrations of carbon disulfide hau of a constantly shifting metabolic balance be developed mild to serious psyclioneuroses ana tween absorption, storage, and excretion. These psychoses which for a long time were not recog difficulties are (culiarly characteristic of a nized as Wing due to this exposure, and main kvholc group of occupational diseases which de were confined to psychiatric hospitals. A clunac- velop as a result of exposure to cumulative teristic Parkinsonian syndrome may develop m poisons. In an effort to 1 brief, one might manganese poisoning In the manufacture <' say that diagnosis rests upon three pillars. fur-felt hats workers are exposed to low roncen- (1) evidence of significant exposure, (2) a charac trations of mercury .for long l*-riods of time. teristic clinical picture, and (3) laboratory data, HHeerroe, iinnsstteeaadd owf tihe severe r*e-*n*al d~.a..m.. .age with , particularly quantitative data as to the lead possible uremia which one sees in a patient who content of the urine a|id the blood and the hema has swallowed some bichloride of mercury tablets. tologic picture. Sound clinical medicine re we find an intention tremor and romrirknldy 1 quires that the fiqdihgs in all three categories complicated personality changes. The M'. * must bd interpreted together. The laboratory Hatter in Alice in Womhrlmul Is a true ea;i.s-ie . i * data canmot be interpreted without the others. industrial mercury' poisoning! And so it i i "Evidence of significant exposure" stresses the highly important at this time to caution a[Pgainst need for accurate information as to dosage. jumping to conclusions that what the patient Dosage in industry *8 ffu`U; !IS 'm|K>rtant is needs is a psychiatrist. in a doctor's prescription. The fact that a person works with a toxic eliemical or that he has Wen exposed to radiation, for example, does not per se indicate that his health has been injured thereby. The question Is always, " How much. Frequently the only way in which this can be answered is by a technical evaluation of the industrial environment. This may require dust counts, chemical air analyses, radiation or noise measurements, or the application of a variety of other measuring sticks to the particular prob lem at hand. These findings can then lx; com pared with accepted safe standards, the so-called Maximum Allowable Concentrations (M.A.C.), always taking into account individual differences in susceptibility among people. The practicing physician is obviously not equipped to make such Summary . In conclusion I would say that most patum are workers. Few workers nowadays succeed in escaping the hazards to health which modern technofog;has put in theirpath Toxic cheme cals not only arc to be found in industry, but the arc used in the home and in many hobbies as well Carbon tetrachloride is a popular cleaning fluid with the housewife; benzol is a common con stituent of rubber cements, and potentially toxic moth proofing materials and insecticides arc in common reason, a use by history- almost everyone For that of exposure is of the es>cnrf; One must never fail to consider the P'vssibiht of an occupational etiology in every differential tests. In New York State he can always call upon the Division of Industrial Hygiene m the Department of Labor for assistance. The serv ices of its professional staff of physicians, chem ists, and engineers are always at his disposal /w ish to stress again the fact that ascertaining the occupational etiology in a given case, where it exists, may be the only means of saving the patient's life, since no amount of treatment wdl be effective unless he can be immediately re withoutcharge. . , . . . ,, moved from further exposure. Beyond that 1 In these days when everyone is paychiatrically would like to direct your attention to the fac i minded, there is an increasing tendency to refer that recognition of the occupational etiology i workers showing personality changes to a psy- contributes to proper reporting of occupational chiatrist without stopping to consider the pos- diseases, thereby making more accurate the k aibility of a toxic etiology, possibly occupational. {. Slate J. M. October 1, 1952) OCCUPATIONAL DISEASE DIAGNOSIS 2385 . Iii'iniuils which neuroses, psy- ..inlitions which ,,,ui those which b ust serious, , -ulvents wliich , their effects, i. iii-, for example, . IH-come drowsy, . may complain l. iiavs which are , Nomination. In :krrs exposed to disulfide have . ,-honcuroses and were not recog , .sure, and many .tuls. Aeharac- 11,:iy develop in manufacture of , to low coiicenji. riods of time. , mil damage with ii, a patient who i mercury tablets, ami remarkably ' m, - . The Mad a true ca.se of ' And so, it is caution against .- l.nt the patient ocnijiational disease statistics available. Very few people realize that we have no reliable data at the present time as to the statistical incidence of any of the occupational diseases, principally because physicians fail to recognize them. With the best intentions in the world a physician will not report a ease of "aplastic anemia" if it does not occur to him that it is occupational in origin. Practicing physicians, therefore, have a great contribution to make, as individuals, in the matter of prevention in that they can provide public health agencies with accurate morbidity and mortality statistics which are the building stones of all public health programs. 80 Centre Street mn most patients .-.vadays succeed ,,i ., wliich modern ,i T o x i c chemi ..,,ln-try, but they : 1,,,1.1lies as well. , , -.r cleaning fluid ... a common con,.1 |i,itcntially toxic i:iM-ctieides are in \ nil!*. For that - i.| t ic essence. : the possibility \ <ry differential t*:;it : seertairiing J1Veil case, where III' of saving the '1 ire itment will iuumdiately re ntal that I miun to the fact ,;,atioiial etiology ui cctipational accurate the ANNOUNCEMENT PRIZE ESSAYS The I.ucicn liowe Prize and the Merrit H. Cash Prize will lie open for competition at the next Annual Meeting of the Medical Society of the State of -New York, May 4 to 8, lit*>3, in ltuiT.-ilii, . The Lucirn Howe Prize of $100 will be presented for die best original contribution on some braiieh of surgery, preferably ophdinlmology. The audior need not be a member of die Medical Society of the State of New York. ` The Merrit II. ( 'ash Prize of $100 will lie given to die audior of the beat original essay on some medical or surgical subject. Competition a limited to the members of the Medical Society of tho State of New York who at die time of the competition are resi dents of New York State. The following conditions must be observed: t Essays shall he typewritten or printed with /he name of the prize for which the essay is submitted, and the. only means of identification of (he author shall be a motto or other device. The essay shall be accompanied by a sealed envelope having on llie outside the same motto nr device aiui containing the name and aildrcss of the writer. ; If tile Committee considers that no essay or contribution is worthy of a prize, it will not be awarded. ( Any-essay that nuiv win a prize automatically becomes die property of the Medical Society of die State of New York, "to be published as it may direct." > AHessays must be presented not later than February 2, 1053, and Bent to the Chairman of the Committee on Prize Essays of the Medical Society of the State of New York, 3SG Fourth Avenue, New York 16, New York. ^ ' M ather C leveland, M.D., Chairman Committee on Prize Essays f j !1 i `