Document OEedNV9X1JKz4jo5Q6nqpggjj

FILE NAME: Kohler (KOH) DATE: 1932 Nov DOC#: KOH118 DOCUMENT DESCRIPTION: Conference Proceedings - Industrial Commission of Wisconsin - Effects of Dusts Upon the Respiratory System INDUSTRIAL COMMISSION OF WISCONSIN F red M. W ilcox Commissioner, Chairman R. G. K nutson Commissioner Voyta W rabetz Commissioner A. J. Altmeyer, Secretary H arry A. N elson, D irector of W orkm en's Compensation Proceedings of Conference Concerning EFFECTS OF DUSTS UPON THE RESPIRATORY SYSTEM THE LIBRARY Or TiiE FEB 5 1934 . UNIVERSITY OF ILLINOIS Held at Medinab Athletic Club, Chicago November 16-17, 1932 PLAINTIFF'S e EXHIBIT J SC-WI-01001 CONTENTS ` ''. ' Page Wednesday, MomiBEB 1 6 ,1B32--MoaNiHC Session ' . . Fred M. Wilcox, Chairman, Industrial Ccnunbailon of W isconsin Preliminary rem ark s__________________________________ 8 Address e l Dr. Leroy U. Gardner, Director o f Saranac Labo - . ratary for study of tu b ercu lo sis...___ ________ . . . . . . . 8 Wibnesoay, N oycmba 16,1632--ArnsiNOON S ession . : Address ot Dr. W. Irving Clark, Medical Director of Norton ' Company, 'Worcester. M assachusetts . . . ______ . . . . . . . 60 - Discussion ________ :_______ ____ ,____. __ . ______ 00 ' Contlnustion of address of Dr. Gardner__________________ 70 ' Address of Donald E . Cummings, A ssistant Director of Sar anac Laboratory for Study of Tuberculosis__ ___. . . -- 81 . Discussion - ___________________ :__ : __________________103 TnunsDAT, Novemboi 17, 1932--Mobninc S ession Discussion of addresses of D r. G ardner and Mr. C um m ings.. 112 Address of Dr. H. S. Willis, Pathologist of Wm. II. Maybury Sanatorium, Detroit, Michigan __ .-.-- . . . . ---------124 Address of J . J . Bloomfield, S anitary Engineer, U. S. Public - i Health S e rv ic e ______:------------------- ----- . . . . -----------13C a T hursday,. Noycubek 17, 1932--Af t b n w n Session Address of D r. Albert E . Russell, Surgeon, U. S. Bureau of 167 IBB A rrsum cas APPENDIX A.--Biographical sketches ------------------------ 208 APPENDIX B.--L ist of persons who attended conference. 213 164 as sandstone is also a harmless dosage, may be good arith metical reasoning but may lead one into a serious error. My suggestion iB that we should determine the permissible limit of dustiness for each individual dust In the interim, for those dusts that we do not have any basic data of threshold dosage we can demand from in dustry that it maintain conditions in the workrooms equal to those already found in the best plants of a similar in dustry in actual operation. I' shall now be happy to answer any questions that may have suggested themselves to you during the course of my remarks. Dr. Schlomovitz : Did you make any study of the dust in the air passing through respirators? Mr. Bloomfield: We have conducted studies on posi tive pressure masks and helmets as used by sandblasters during actual work in a sandblast room but we have not conducted studies in the held nor in the laboratory on the efficiency of respirators. Excellent work on respirators has been done by the United States Bureau of Mines and a t Professor Philip Drinker's, laboratory at the Harvard School of Public Health. Dr. Schlomovitz: You don't happen to know the size of particles that pass through the mask? Mr. Bloomfield: Last month Professor D rinker.pre sented a paper at the National Safety Congress in Washing ton, in which he stated that a careful measurement of the size of dust particles entering and leaving respirators shows a slight but important reduction in average size of the dust particles. In fact, there are now respirators on the market which on testing by Professor Drinker were found to have efficiencies in excess of 90 per cent against silica dust of a size less than 2 microns. So that apparently some respirators do filter out the small particles. Mr. Wilcox: Is there any recognized activity among these manufacturers of protective devices, respirators and so forth, to try to develop something that will give relief? Mr. Bloomfield : Very much so. The manufacturers of equipment and protective devices are quite active. In sage, may be good arithone into a serious error. i^ B n in e the permissible dm ^d u st. that we do not have any ve can demand from in i in the workrooms equal it plants of a similar in r any questions that may >u during the course of ake any study of the dufet itors? mducted studies on posias used by sandblasters it room but we have not in the laboratory on the int work on respirators :es Bureau of Mines and >oratory at the Harvard happen to know the size mask? Professor Drinker.pretyfi^gress in Washingsf^Measurement of the eaving respirators shows in average size of the now respirators on the sor Drinker were found 1per cent against silica is. So that apparently small particles. ognized activity among devices, respirators and ' ig that will give relief? o. The manufacturers is are quite active. In 1S6 our sandblasting investigation we found equipment being sold today which is capable of keeping the dust count to a concentration of less than 2 million particles per cubic foot of air at the breathing level. Mr. Wilcox: That is where the air is fed by tubes? Mr. Bloomfield: Positive pressure masks and helmets are now being sold, which if properly maintained and sup plied with a sufficient volume of dust-free air will pro tect a worker fully inside a sandblast room and in addi tion there are now on the market sandblast cabinets, tables, barrels and other equipment, which if maintained in a proper state of upkeep, will also give ideal protection to a worker without the use of masks or positive pressure de vices. We have found Buch conditions during the course of our sandblast investigation. MR. Knutson: Have you any suggestion to offer with regard to safety devices that might be used in connection with the sandblasting of castings weighing several tons? MR. Bloomfield: One can.sandblast such castings in large rooms, exhaust the rooms properly and furnish the worker a good positive pressure respiratory device. There are installations of the automatic type which do not neces sitate working inside the blasting zone, but such equipment is not practical for huge castings. BIBLIOGRAPHY 1 Bayley, W. S .: Non-Metallic Mineral Products. Henry Holt i Co. ' 2. Thompson, L. R., Brundage, D. K_, Bussell, A. E. and Bloomfield. J . J .: The Health of Workers in Dusty Trades. I. Health of Workers in a Portland Cement P la n t Public Health Bulletin No. 176. (1928) . . ^ 3. Heffernan, Patrick: Exposure to Silica Dust Without the Oc currence of Silicosis. Journal of Industrial Hygiene, Vol. 8, No. 11, Nov., 1926. , 4. Russell. A. E., B ritten, R. H., Thompson, L. R-, and Bloomfield, J. J.: The Health of Workers in Dusty Trades. 11. Exposure to Siliceous D ust (Granite Industry). Public Health Bulletin No. 187. (1929) . 6. Brundage, Dean K., and Bloomfield, J. J.:T he Pneumonia Problem in the Steel Industry. Journal of Industrial Hygiene, Vol. 14, No. 10, Dec., 1982. 6. Bloomfield, J. J . : The Dust Content of the Atmosphere in Va rious Dusty Industries. Published Nov. 18, 1982, in the United States Daily, Washington, D. C. I 166 7. Owens, J . S.: J e t Dust Coanting A pparatus. Jo u rn al of In dustrial Hygiene, p. 522, April, 1623. 8. H atch, Theodore, and Choate, Sarah P .: Statistical Description of the Particle Size Properties o f Non-uniform P articulate Substances. Journal of the Franklin Institute. March, 1829. 9. Green, H enry: A Photomicrographic method fo r the D eterm ina tion of Particle Site of Paint and Rubber Pigments. Journal of th e Franklin Institute, Vol. 192, No. 6, p. 637, Nov., 1921. 10. Moir, J.: Report on a Specimen of D ust from Silicotic bang. General Report of the Miners' Phthisis Prevention Committee, P reto ria, 1916, Appendix 9, pp. 138-140. 11. W atkins-Pitchford, w .: The Situation, Outline and Dimensions of Mineral Particles Visible by Polarized L ight in Sections of Silicotic Lungs, mounted in Canada Balsam. General Report of the M iners' Phthisis Prevention Committee, Pretoria, 1916, Appendix 8, pp. 135-136. 12. D rinker, Philip: The Size-Frequency and Identification of Cer ta in Phagucytosed Dusts. Journal of Industrial Hygiene, Vol. 7, No. 7, July, 1925. IS. Mavrogordato, A.: The Value of th e Koniraeter. Publication of the South African Institute of Medical Research. No. 17. 14. Fehnel, William J .: A Study of Silica Dust in H ard Rock Drill ing in New York City. Journal of Industrial Hygiene, Vol. 11, No. 2, Feb. 1929. 15. Badham, Charles, Rayner, H. E. G., and Broose, H. D.: D ust Sampling in Sydney Sandstone Industries. Report of the Director-General of Public Health, New South Wales. Decem ber, 1927, p. 74. . 16. Greenburg, Leonard, and Bloomfield, J . J .: The Im pinger D ust . Sampling Apparatus os Used by the United States Public Health Service. Publie Health Reports, Vol. 47, No. 12, March 18, 1932. 17. Legge, Robert T.. and Rosenerantz, E sther: Observations and Studies on Silicosis by Diatomaceous Silica. American Journal of Public Health. Vol. 22, No. 10, October, 1932. 18. Winslow, C.-E. A., and Greenburg, Leonard: A Study of the D ust H azard in the W et and Dry Grinding ShopB of an Ax Factory. R eprint No. 616, Public Health Reports, October 8, 1920. 19. H atch, Theodore, Kelly, George, S., and Fehnel, J . W illiams: Control of the SilicostB H azard in the H ard Rock Industries. II. An Investigation of the Kelly Dust Trap for Use w ith Pneu m atic Rock Drills of the "Jackham m er'' type. Journal, of Industrial Hygiene, VoL 14, No. 2, Jan ., 1932. 20. Bloomfield, J . J .: A Study of the Efficiency of Dust-Removal Systems in Granite-cutting Plants. R eprint No. 1324, Public Health Reports, Oct. 18, 1929. 21. H atch, Theodore, Drinker, Philip, and Choate, S arah P .: Control of the Silicosis Hazard in the H ard Rock Industries. I. A Laboratory Study of the Design of Dust Control Systems for Use with Pneumatic Granite-cutting Tools. Journal of Indus tria l Hygiene, Vol. 12, No. 3, March, 1930. I inting Apparatus. Journal of In>ril, 1923. ' S g ^ t P .: Statistical Description a ^ ^ f to f Non-uniform Particulate l^ V k lin Institute. March, 1929. graphic method for the Determina nt and Rubber Pigments. Journal 'ol. 192, No. 6, p. 831, Nov., 1921. men of D ust from Silicotic Lung, rs' Phthisis Prevention Committee, pp. 138-140. Situation, Outline and Dimensions by Polarised Light in Sections of Canada Balsam. General Report vention Committee, Pretoria, 1916, -equency and Identification of Cer'ournal of Industrial Hygiene, Vol. re of the KonimeteT. Publication ute of Medical Research. No. 11. of Silica Dust in H ard Rock Drill m al of Industrial Hygiene, Vol. 11, E. G., and Brese, H. D.: Dust stone Industries. Report, of the iealth , New South Wales. Decern- infield, J . J . : ` The Impinger Dust sed by the United States Public Ith Reports, Vol. 47, No. 12, March rrantz, Esther: Observations and maceous Silica. American Journal No. 10, October, 1932. iburg, Leonard: A Study of the nd Dry Grinding Shops of an Ax . Public Health Reports, October i f f and Fehnel, J. Williams: ___ the H ard Rock Industries. .-ennPpBrfuuist Tran for Use with Pneu- "Jackham m er' type. Journal, of No. 2, Jan., 1932. ' >f th e Efficiency of Dust-Removal Plants. R eprint No. 1324, Public l. ip, and Choate, Sarah P.: Control the H ard Rock Industries. I. A sign of Dust Control Systems for i-cutting Tools Journal of Indos1, March, 1930. 167 November 17, 1932. Afternoon Session Dr. A lbert E. R u sse l l , Surgeon, United States Public Health Service; Surgeon, U. S. Bureau of Mines. It is a great pleasure to be here with you and to take part in the discussion of this very interesting and intricate subject. What has gone before has been very interesting and seems to have brought us up now to a consideration of the physical condition of the worker and the clinical pictures produced by the effect of inhalation of dust. It has been my pleasure to work in the public health service in a study of the dusty trades. Beginning in 1924, we made observations in the cement industry, the granite industry, coal mining, both bituminous and anthracite and other dusty trades. We have found a number of very interesting things and two of these studies have been pub lished in bulletins No. 176 and No. 187. In the report of j cement study we made the statement that although in most I of these dusty trades fibrosis of the lungs was produced, : we were of the opinion that this fibrosis, even though it wss similar to that produced by other dusts, did not repre sent the same degree of disability. I think our subsequent studies and observations of workers in other dusty trades, have borne that out. I will show you today a number of slides of X-rays from different industries showing reaction to dust as shown in X-rays and we will discuss it more at length at that tdnje. In doing our studies we started out with a program which would include dust counting and dust analysis, - records of absentees from work and finding out the reasons for absence. We were greatly interested in the sickness and longevity, and the amount of time lost from work due . to sickness. A complete physical examination with special attention given to the chest conditions, was made on all employees where it was possible. First, I will take up ' some of our findings in the morbidity records produced by exposure to dust Second, you will recall that Mr. Bloom field discussed that we had groups of people exposed to different concentrations of dust. Our most extensive study . was made in the granite industry in Barre, Vermont, and it was my pleasure to be there and to have charge of this 168 study throughout its course. Our sickness records and later our X-ray and other findings,- seem to divide the workers into certain groups according to results we were getting and later when Mr. Bloomfield made his dust counts we found a very close correlation of dustiness and the amount of sickness and disability and deaths in direct proportion to the concentration of dust. With the first slide we will start considering the morbidity. This slide (see Plate S. p. 10, Bui. No. 187, U. S. P. H. S.) is a photograph of a man a t work cutting stone. You have heard a lot about different methods of du6t counting, but this will reveal the fact that the worker is exposed to quite a bit of dust which can be seen with the naked eye. This tool is the hand pneumatic tool which vibrates very fast and in working on the hard granite rock he bends over looking a t his work and brings his nose closer to the dust he is creating. The general atmosphere in that plant was rather high and is not shown in the photograph, nor do you get it in visibility unless there are direct rays of light shining in the plant. You may walk through it and it does not seem to be very dusty. That is where the dust counts tell more accurately as to the extent of the dustiness. This slide (see Fig. 2, p. 20, BuL No. 187, U. S. P. H. S.) shows the different occupations th at we had in Vermont. ii These bars indicate the intensity of exposure. Our groups divide themselves into the first and second group, ten to twenty million; then from twenty to sixty were the two wseacsonadbgoruotutpws.entYy omu icllaionnsepearthtieclgesenpeerarl'cpulbainct faotomtoosfphaeirre. iii There were a number of occupations with comparatively low exposure. Keep that in mind in considering the mor bidity records which we will discuss later. The South African standard of permissible dustiness is indicated in the black bar at the bottom. The groups I told you about we called A, B, C, and.D, This next slide (See Fig. 17, p. 88, BuL No. 187, U. S. P. H. S.) is a graph which shows the number of persons with and without silicosis in the four dust groups indicated in the other graphs by length of service. The bottom line indicates length of service and each line indicates a certain group of workers. Almost invariably by the end of fourteen I I! Our sickness records and ngs, seem to divide the Irding to results we, were loomfield made his dust counts relation of dustiness and the sability and deaths in direct .tion of dust. With the first ng the morbidity. 0, Bui. No. 187, U. S. P. H. S.) a t work cutting stone. You rent methods of dust counting, that the worker is exposed to n be seen with the naked eye. natic tool which vibrates very * hard granite rock he bends d brings his nose closer to the neral atmosphere in that plant shown In the photograph, nor nless there are direct rays of You may walk through it and lusty. That is where the dust 3to the extent of the dustiness. 0, Bui. No. 187, U. S. P. H. S.) ions that we had in Vermont, isity of exposure. Our groups irs t and second group, ten to t ^ f e y to sixty were the two *^general' plant atmosphere articles per cubic foot of air. xupations with comparatively mind in considering the mor i discuss later. ird of permissible dustiness is at the bottom. The groups I B, C, and D, This next slide 187, U. S. P. H. S.) is a graph ti persons with and without rroups indicated in the other e. The bottom line indicates line indicates a certain group ably by the end of fourteen 169 years practically all of the workers in the higher dust counts had evidence of silicosis. Some of it was rather slight in the X-ray and very little in the physical and other characteristics, but with the X-ray there was almost in variably evidence of silicosis at the end of that period. You have seen this slide (See Fig. 22, p. 118, Bui. No. 187, U. S .P . H. S.) before today when Mr. Bloomfield dis cussed i t It carries out the line of thought the incidence of sickness or absences was lower in these groups of work ers beginning with group C and D in the low exposure line and higher in groups A and B. The tuberculosis death rate for males in rural Vermont is indicated here. Group B was less than that and is perhaps due to the small num ber erf people. Group C is about the same, but groups A and B ate quite a bit in excess. This graph (See Southern Med. Joura. Sept 1982, pp. 919-927) shows the frequency of disability lasting longer than one week on account of sickness, exclusive of acci dents or from respiratory diseases in industry. The in dustries are specified. The industrial groups; the first group is gold mining in the Black Hills of South Dakota. Their rate was 208. General manufacturing is shown and is more or less an average. That includes industries in a number of northern states. This would seem to indicate that that group of workers had that much sickness in ex cess of what we might call the normal. The respiratory disease, the incident of sickness in the lower part with granite cutting in Vermont heading the list. Gold mining in the Black Hills second, Portland cement third, anthracite fourth, with general manufacturing, which we might say is about an average at this point, you can see in those four industries the incidence of sickness is this much in excess of average. I might say in relation to the gold mining in the Black Hills in South Dakota th a t we do not know the extent of the exposure to dust because no dust counts were made We might compare it to dustiness in other mining, hut we don't actually know what it is there. It is evident that there was an excessive amount of dust which was practically pure quartz. The reason why we haven't as much tuberculosis among the gold mining, 1 think, is because of the fact that the labor turnover is 170 rather high and these workers develop silicosis and become partially disabled and go to their homes before developing tuberculosis. The workers in Vermont remain a t their homes inasmuch as granite cutting is a skilled trade. The labor turnover in granite cutting is very little, whereas in gold mining it was very high. That will explain many differences that may follow. The gold miners head the list in the incidence of influenza; cement workers second, anthracite coal mining third, and granite cutting four, and general manufacturing a t this point. In bronchitis, acute and chronic, anthracite coal miners head the list, Portland cement second, general manufacturing third, which would indicate that the cement workers had a slight amount in excess of granite and anthracite coal miners had still more. This is a continuation of the same group of workers. Respiratory tuberculosis only is considered in the in dustries we have been talking about Granite cutting in Vermont heads the lis t gold miners in the Black Hills second. I have explained that the reason why I think this isn't greater is because of the labor turnover; anthra cite coal mining third, and general manufacturing a t this point. It would seem there is this (pointing) much in excess of tuberculosis in the three industries above. In the iron and steel and Portland cement plant it seems to be about the same as general manufacturing. In the inci dence of pneumonia, workers in iron and steel head the list; granite cutters in Vermont second and general manu facturing third. We would think that the excess was not as great as in some of the preceding diseases. I might say a word about the economic conditions. The iron and steel workers are not paid as well as granite cutters. Their living conditions are not as high and th at may be a factor in considering tuberculosis and other diseases, particularly those of the respiratory tract. The granite workers in Vermont made $1.00 an hour. They worked eight hours a day, forty-four hours a week; this was the minimum wage at that time. The highly skilled workers made more. The ones able to carve and cut statues made up to $20.00 a day. They lived well. The best group of industrial workers I have ever seen. The incidence of tuberculosis among them was not an economic factor. era develop silicosis and become > homes before developing ; ^ ^ /e rm o n t remain at their cutting is a skilled trade. The cutting is very little, whereas high. That will explain many w. The gold miners head the luenza; cement workers second, ird, and granite cutting four, l a t this point In bronchitis, cite coal miners head the list, general manufacturing third, die cement workers had a slight : and anthracite coal miners had >f the same group of workers, only is considered in the inting about. Granite cutting in rold miners in the Black Hills that the reason why I think i of the labor turnover; anthraI general manufacturing at this re is this (pointing) much in h e three industries above. In -tland cement plant it seems to :al manufacturing. In the inci:er^tfi iron and steel head the m ^^pecond and general manud think that the excess was not ie preceding diseases. I might omic conditions. The iron and id as well as granite cutters. ; not as high and that may be jberculosis and other diseases, respiratory tra c t The granite : $1.00 an hour. They worked ur hours a week; this was the oe. The highly skilled workers ; to carve and cut statues made lived well. The best group of : ever seen. The incidence of ?as not an economic factor. 171 This brings us down to the petrographic analysis of the dust. In silver polishing the total silica percentage varied according to different occupations and different materials used, and the quartz content varied likewise. Mr. Bloom field showed a graph this morning in which the dust count in these particular occupations was quite low, I think about five million particles at the greatest. In cement industry the total silica is expressed as 21% in the raw cement, but the quartz content of finished cement is less than one per cent It is stated to contain 6% before passing through the kilns but the burning process reduces the amount. In coal mining the rock dust is quite high in quartz because the overlying stratum was sandstone. Quartz content of coal is 1.2%. In hard coal we have the same explanation here with 1.6 silica in the coal with 81% quartz in the rock dust The granite we have explained has a total of 70% silica with about half of it as quartz. There is a point I wish to mention here. In the United States most of the hard coal as anthracite is found in an area in a few counties in Pennsylvania. Bituminous coal is scattered pretty well throughout the country. In the state of West Virginia there are areas where overlying stratum is sand stone and others where different rocks make up the over head rocks. The silica content of these rocks varies tre mendously in different localities, which makes it impractiable to compare the results from the study of one group of coal miners to another. The amount of Bilica in the rock dust to which he might have been exposed should be stated. It is very difficult to say that one industry is comparable to another or that one part of the same in dustry represents the same conditions throughout. We don't know until we have made careful analysis of the dustiness in the various occupations. This slide gives us an average dust count under ten microns in certain dusty trades, of which we will speak later. Cement dust aver ages about twenty-five million. In granite cutting there are fifty million particles per cu. ft. for the upper two groups and sixteen million for the lower two groups and in anthracite coal mining one hundred twenty four million for the miners and 11,000,000 for attendant labor. Bitumi nous coal mining has one hundred and two million and. 3.3 172 million for the attendant labor. In the silver manufactur ing 4.1 million and 800,000. I think these dust counts are very interesting and we believe that they correlate well with our findings which we will bring out as we go along. This is a graph (See fig. 8, p. 53, Bull. No. 187 U. S. P. H. S.) expressing the incidence of sickness from all causes in these four dust count groups in the granite cutting industry in Vermont. It is by length of service and the absences are eight days or more and the rate is per thou sand- Here we have a group with less than ten years ex posure, with the four groups starting a t about the same point. . Group C and D with lower exposure average about sixteen million. As they grow older the total incidence of sickness seems to diminish. The upper groups, whose exposure to dust averaged about 50 million, their rate of i sickness increased in proportion to the length of exposure \ to d u st This slide shows the prevalence of tuberculosis, and we considered only active pulmonary tuberculosis, by length of the service and dust count groups. This is based on physical examinations, and X-ray to determine the presence of. the disease. Here we have group C, starting with a higher rate than groups A and B. We think perhaps there may be an economic factor here. The attendant labor did I not have as good living conditions as did groups A and B. l Up to ten years' exposure there isn't much significance but after ten years you see these two groups of workers having increased incidence of tuberculosis in direct pro portion to the length of service. After thirty to forty I years exposure, it seems to reach its peak; taking for granted that a man is about twenty years old when he starts to work we would expect that the group of workers having tuberculosis would be around fifty years of age. 1 believe that our average for the age at that particular study was a little over forty-nine years. This slide I am showing is about an average chest. Sometimes we get a very good presentation of this slide, and it shows more than at other times, due to illumination. This is what is usually found in a more or less average per son, that is a person who has not had tuberculosis, sili cosis, or any of the other chronic pulmonary diseases. Those r. In the Bilver manufactur- I these dust counts are e^TOiat they correlate well ill bring out as we go along, p. 53, Bull. No. 187 U. S. P. :e of sickness from all causes oups in the granite cutting jy length of service and the >re and the rate is per thou- with less than ten years ex starting a t about the same lower exposure average about ow older the total incidence i. The upper groups, whose out 50 million, their rate of on to the length of exposure ience of tuberculosis, and we nary tuberculosis, by length t groups. This is based on ray to determine the presence /e group C, starting with a ( B. We think perhaps there ire. The attendant labor did ions as did groups A and B. bec^isn't much significance h ^B tw o . groups of workers 1 tuberculosis in direct pro vice. After thirty to forty reach, its peak; taking for . twenty years old when he ct that the group of workers around fifty yearB of age. I the age .at that particular line years. is about an average chest, d presentation of this Blide, er times, due to illumination, n a more or less average per is not had tuberculosis, silitic pulmonary diseases. Those *73 of you who are not physicians and not familiar with an average chest should bear this in mind as we go along and you will be able to follow changes indicated by X-ray. No tice that the diaphragm curves with a regularity on each side. This is the hilus of the lung of which Dr. Gardner has spoken, and the light areas are the functioning portions. (X-ray No. 4, case No. 397, near p. 92, Bull. 187, U. S. P. H. S.) I called your attention to the regularity of the diaphragm in the preceding one. >I want you to see the irregularity in this case. You will notice that through the lung fields there are linear markings spreading out toward the periphery and we think that it was due to the inhalation of dust. This man was a granite cutter who had cut stone about fifteen years. In writing up our report of granite study in Vermont you will recall we didn't at tempt to classify our cases of BilicoaiB by the then existing one classification which was the South African one. Our cases did not seem to fit into that classification. This man, since thiB picture was made in 1924, has developed tuber culosis and died of clinical pulmonary tuberculosis. This is another granite worker who had been working about twenty-three years in cutting stone; it shows an in crease in the shadows with further evidence of disease. You will note in this slide, as in the ones which follow, that there is more pathology indicated in the right lung. That has been attributed to the fact that the right bronchus is a little larger than the left and it curves at an angle.of about twenty-four degrees, whereas the left bronchus bends at a little sharper angle and is.slightly smaller. You will no tice in this case the diaphragm is fairly regular. In the preceding one there were evidently pleura] adhesions caus ing irregularity in the contour of the diaphragm. It is possibly due to a latent tuberculous condition in addition to the effect of dust. The next slide. The two cases preceding have been cases of silicosis uncomplicated by tuberculosis. You noted in those cases that the apex and upper portion of the lungs were fairly clear. Most of the pathology was in the middle and lower portion. This case (X-ray No. 43, case No. 195, Bull. 187, U. S. P. H. S.) is one of pulmonary tuberculosis in a granite 174 'worker. You will notice the apices are fairly clear. There is quite a lot of pathology indicated by the markings in the lower portion of the lungs. The man had a cavity a t the base of the right lung. We checked most of these cases for sputum analysis and almost invariably we found they were positive- These granite workers all expected to have tuberculosis; they were rather averse to having sputum analyses. This (X-ray No. 45, case No. 32, Bull. 187, U. S. P. H. S.) is another worker showing similar condition with an ac tive tuberculous process determined by physical examina tion in the lower portion of the right lung. The usual mark ings are present and he had the usual symptoms of tuber culosis. The next slide. This is still another granite worker. l wThitihs stlhideeusshuoawl sretahcetitohnicktoendedu'spt leaunrda tion ttuhbiseracruelaoutsogientfheecr tion. You will notice in the earlier cases the shadows were linear, and that they spread out to the periphery from the hilum in each case. The markings here are more conglom erate and less distinct in character. This (X-ray No. 40, Case No. 174, Bull. 187, U. S. P. H. S.) is a very interesting case in that there seems to be a pneumonic process here. The man had clinical and phys ical signs of active tuberculous disease and he died a short time after this picture was made. You will note a little irregularity in the diaphragm at this point and the con tour of the diaphragm on the other side is not clear. There seems to be an adherent mass a t that point. This (X-ray No. 46. case No. 194, Bull. 187, U. S. P. H. S.) is a very interesting case. He was working and de veloped a condition which is quite like pneumonia physi cally. Quite a bit of pulmonary tissue became consolidated, which on physical examination gave all the signs of pneu-. monia. - He was intensely dyspneic, but had no temperature nor toxemia, and as this cleared up bacilli appeared in the sputum about three weeks after. I believe somebody said that we didn't have any case of mottling of the lungs similar to the South African cases among the Barre workers. This b an exception. It is the only case we had which presented this type of picture. The apices are fairly clear. There ^ B t e d by the markings in the ^Wie man had a cavity at the : checked most of these cases lost invariably we found they ; workers all expected to have her averse to having sputum o. 32, Bull. 187, U. S. P. H. S.) similar condition with an acirmined by physical examinaeright lung. The usual markthe usual symptoms of tuber- still another granite worker, id pleura in this area together lust and to tuberculous infecearlier cases the shadows were out to the periphery from the rkings here are more conglom.racter. =No. 174, Bull. 187, U. S. P. case in that there seems to be 'he man had clinical and physus disease and he died a short 'e. You will note a little t this point and the con:r side is not clear. There s at that point. No. 194, Bull. 187, U. S. P. ase. He was working and de s quite like pneumonia physitry tissue became consolidated, on gave all the signs of pneu;pneic, but had no temperature red up bacilli appeared in the ter. at we didn't have any case of r to the South African casesrhis is an exception. It is the nted this type of picture. The linear shadows are not present as in your other cases of silicosis. There is a great similarity in this picture to what we see in Africa in gold miners. Just why this case has this same marking I am unable to explain. He weighed about two hundred pounds and was one of the finest look ing chaps I ever saw. He had no symptoms, except a little dyspnea on exercise. I saw Dr. Pancoast after I had been doing that study and he showed me the only other slide like this of a granite cutter with this particular character istic and he said it was given to him as being a typical granite cutter in Vermont This is the only one I have with these particular markings. This man was exposed to the same intensity of exposure and same percentage of silica as the preceding case. Dr. Gardner: For how long? Dr. Russell: Twenty-three years. This man was a Scotchman. In Barre they have a nice variety of national ities, Italians, principally the Northern Italians, French- Canadians, Scotchmen, American and New England Yan kees, few Spaniards and quite a few Scandinavians and a few other nationalities. A Voice: What was the subsequent history of that man? Dr. Russell: I don't know. Two years later he was still well. I hope to go back and check up on some of these people this coming year. This (X-ray No. 63, case No. 18, p. 182 near, Bull. No. 187 U. S. P. H. S.) is a case of an Italian who cut granite twenty-five years. Eleven years prior to the time this Xray was made he had been living on a farm in Vermont and the reason he came to me was that he was getting to be quite dyBpneic and he was worrying about his condition. We took X-rays and this is the picture. He had been in dust-free atmosphere eleven years on the farm. HiB dyspnea increased and two years after this tim e he had a fulminat ing tuberculosis; he was past fifty years of age. This is another case (X-ray No. 62, case No. 299, BulL 187, U. S. P. H. S.) with a similar history. This man was Irish, cut granite 26 years; thirteen years immediately prior 176 to the time this picture was made he had been a night watchman in an insane asylum; a dust-free occupation. You will note that he had deep markings in the bases of his lungs. It has lost that linear character and is more the cottony or confluent type. He was very dyspenic, and was 64 years of age. He found it quite difficult to do any chores around his home and his occupation was quite seden tary, no strenuous work to do and yet he was bothered with dyspnea. The superintendent of the hospital was quite interested in him and very much interested in our work, and about three years after this picture was made he wrote me that the man's dyspnea had increased and that he had toxic symptoms, and tubercle bacilli in his sputum. This (X-ray No. 68, Case No. 339, Bull. 187, U. S. P. H. S.) is a case with a similar history; a New England Yankee. He cut granite 17 years, then went to Oregon i and cultivated apples, and he had been out of dust about fifteen years. He came back to Vermont and cut granite for one year and he began to have some difficulties and this is what the X-ray revealed. He later developed a ful ! minating type of tuberculosis, and like most of those i granite cutters with tuberculosis, he did not last so long. This slide is of an X-ray of a potter. The man had spent more than twenty years in the pottery industry. I think potter's clay contains about 35% silica, about the same amount we have in granite. With a picture like this, I think we can safely say that the man was exposed to too much dust. The fiocculent shadows are possible, due to a super-imposed tuberculosis. The next one is a case of a potter with earlier stage of the silicosis. You will note that the markings are more of a linear type and spread out at the hilus toward the peri phery and to this portion, with the enlarged hilus glands. There are a few calcified tubercles, in the area. He had been a potter twenty-six years when this picture was made. . I don't know much about acute silicosis, but I am pre senting this slide as a case of early silicosis with rather short exposure. This man's occupation was that of a fore man of tunneling work, and he was exposed to dust for about a year. This tunnel went through pure quartz rock .vas made he had been a night A lu m ; a dust-free occupation. ^P(> markings in the bases of his near character and is more the He was very dyspenic, and was md it quite difficult to do any 1his occupation was quite sedento do and yet he was bothered tendent of the hospital was quite i much interested in our work, this picture was made he wrote , had increased and that he had :le bacilli in his sputum. se No. 339, Bull. 187, U. S. P. imilar history; a New England 17 years, then went to Oregon he had been out of dust about ick to Vermont and cut granite n to have some difficulties and led. He later developed a fulilosis, and like most of those ulosis, he did not last so long, of a patter. The man had spent i the pottery industry. I think ut 35% silica, about the same ie. With a picture like this, I the man was exposed to too adows are possible, due to a if a potter with earlier stage of : that the markings are more of ut at the hilus toward the periwith the enlarged hilus glands, tubercles.in the area. He had years when this picture was it acute silicosis, but I am pree of early silicosis with rather s occupation was that of a foread he was exposed to dust for went through pure quartz rock 177 and he was in it quite often during the working hours. You will note that he has quite an increase in the linear mark ings. He had perhaps an old tuberculosis condition in this hilus with a few calcifications. He had no disability. This is another tunnel worker with rather extensive pul monary fibrosis together with a little interlobar pleurisy at that point. The exposure of this case was something of about a year. I have seen autopsies from cases from that same tunnel with exposure of a year or less, which pro duced a fatal silicosis. This is perhaps an acute silicosis. This is a slide showing s man who had been a lena grinder, grinding pure quartz lenses for a period of eight months and he was disabled with silicosis at the time the picture was made. He was in a tuberculosis sanatorium and the staff physicians were unable to demonstrate the presence of tuberculosis. The patient's complaint, like most silicotics, was that of shortening of breath. The hiluses seem to be greatly choked up. The shadows are rather dense and no doubt he has silica deposited in the lung. He has not had time, in the course of eight months, to develop the fibrosis indicated in the preceding X-ray. This brings us up to the consideration of pneumoconiosis of a different cause. You remember what I said in the be ginning, that you couldn't look at fibrosis in one case and say that was comparable to that of another. You will see this worker has quite a bit of lung markings and yet he has no disability, or apparently not much to worry about in the future. He was a soft coal miner. ' This is another soft coal miner who had been getting a little rock dust We believe this irregularity and the mark ings are more of a linear character and more discrete than in the previous one. I must admit there is very little path ology there. I am showing it to contrast with the preced ing one. This is an X-ray of an anthracite coal miner. Appar ently the anthracite coal miners have more rock dust ex* posure than the group of bituminous workers at large. This case is interesting, because of the interlobar pleurisy shown at thiB point (between upper and lower lobes). It is the only One I have ever seen like that. You will note that he has quite a bit of pathology indicated in both lungs, yet the 12 I character of the markings is different from that of silicosis which I have shown you before. Dr. Willis: Would you mind commenting on the drop heart? Dr. Russell: We don't know so much about drop hearts, but we have an idea that cases having drop heart have some remote old tuberculosis. I t has been the experience in South Africa that workers with drop hearts developed silicosis and tuberculosis much more rapidly than workers who did not have it. You will note in the preceding case the heart had a greater curve to the left than this; notice that the border of the heart in this case is almost perpen dicular. This is another anthracite coal miner showing different markings. You will notice the contrast in this heart and the preceding one. This case and the preceding case had miner's asthma. This is another miner with still a little different picture. You will note that the markings in these cases don't seem to be parallel. You will note the character of .these mark ings are suggestive of the presence of silica, because of the rather uniform distribution. This is an X-ray of a cement worker, a man who had been working in a cement plant about ten years. You will notice that it has different characteristics. Notice the light that seems to be coming through in this area with more or less clouding at the areas to the outer portion. There are fine linear markings underneath. I wish to call your a t tention to the fact that these workers were exposed to about one per cent quartz in their dust. The dust counts, I think, averaged 25 million particles. ! | Following this there will be some slides of marble work ers. Cement dust contains a lot of calcium or lime. The marble workers were exposed to dust which contained about 88% calcium carbonate, and I think the company's analysis ! of the dust stated that it contained less than one per cent of i quartz. Our analysis was taken from quite a different place and we found practically no quartz in the marble dust. This is an X-ray of a man who had been cutting marble twenty-two years. You will note the increased shadows lifferent from that of silicosis commenting on the drop wso much about drop hearts, *ses having drop heart have . It has been the experience 3 with drop hearts developed h more rapidly than workers ill note in the preceding case 3 to the left than this; notice in this case is almost perpen- eoal miner showing different he contrast in this heart and and the preceding case bad still a little different picture, ngs in these cases don't seem the character of.these roark.resence of silica, because of on. tent workeT, a man who had nt about ten years. You will aracteristics. Notice the light in this area with more or outer portion. There are ath. I wish to call your atvorkers were exposed to about ist The dust counts, I think, ; some Blides of marble worklot of calcium or lime. The to dust which contained about think the company's analysis aned less than one per cent of in from quite a different place lartz in the marble dust, who had been cutting marble note the increased shadows 179 around the hiJus and around the larger bronchi. But you will note the light areas which indicate there is quite a lot of good functioning tissue. He had absolutely no disabil ity and no evidence of tuberculosis or any other chronic pul monary condition. You will note in these slides of marble workers there are quite a lot of calcifications. This one hasn't as much as the other. These workers were the Bame age as the granite workers, occupations very much alike and the dust concentration little less in the marble than gran ite plants. We found no case of active tuberculosis among the marble workers. Dr. Rogers of the Vermont Sani tarium for tuberculosis stated he never had a marble worker as a patient unless they had also worked in granite. These marble workers had quite a lot of calcification of the costal cartileges. This is another marble worker. You will note the cal cification of the hilus of the lung and Borne increase in fibrosis. This case, like the others, had no disability. You will note the calcification here. Those pictures weren't as good as. we would like to have had them, but the best we could do out in field work. Field work is quite different than in institutions. We work under handicaps in so many places. In this picture the calcifica tions are present with quite a degree of fibrosis. The con stant exposure to dust over a long period of time carrying bacteria in the lungs'would produce fibrosis no doubt, but not necessarily a disabling fibrosis. Marble dust does not seem to predispose to any chronic disease. Mr. Tarrell: Did you follow that patient up to see how soon it was he became disabled? Dr. Russell : Did I say he was disabled ? Mr. Tarrell: You said he was not disabled when you took the X-ray. DK. Russell." That has been a year ago and he was all right when we took it. We haven't heard anything. This is a marble worker and the calcifications of these costal cartileges are indicated in this picture. I am showing this next slide because of the calcification of the cartileges with apparent calcification of the pleura. JL 180 This man was a slate worker. His history is that he lived in the area of this slate and that for most of his life, aside from fanning, that had been his sole occupation. The slate workers in one plant which we observed were not exposed to any quartz. The plant adjacent to this mill had about 3% quartz in the slate it used. You will note in considering slate that the silica content of slate varies in different areas so we can't say that slate has a definite amount of silica without determining it first The same holds true for gran ite. There are certain granites which have much less than 35%. I think most of the Vermont granite contains about 35% quartz. You can see the futility of trying to compare X-rays of the lungs from workers in one industry to those of another. This is an X-ray of a slate miller. You will notice be has a few pulmonary markings, with quite a bit of fine linear fibrosis. We found in the group of slate miller workers one case who had an active tuberculosis. He had been in this slate mill about six years and apparently the tuberculosis was just incidental and not a result of his occupation. Other Blate workers showed hilus thickenings with a few calcifications. Still other slate workers showed a different picture but not extensive pathology. This is an X-ray of another slate worker showing quite a bit of shadows in the lower portion of the right lung with a few calcifications. This is the X-ray of a man who bad, or has, asbestosis. His occupation was that of cleaning and restoring the as bestos on pipes in one of our government hospitals. He had been working a t the trade about six years, I think, and you will see, he has fibrosis of both lungs. The character of the fibrosis is quite a bit different from th a t of the gran ite workers. He had disability and the government com pensated him for it. This is a graph showing classification of silicosis. The first classification was made in South Africa. They started out classifying their cases a&primary and secondary stages, and as they learned more about the disease they had to add to this classification. They learned th a t they had a stage earlier than primary and it was called ante-primary, t His history is that he lived at for most of his life, aside is sole occupation. The slate 1we observed were not exposed adjacent to this mill had about >d. You will note in considering of slate varies in different areas has a definite amount of Bilica . The same holds true for granaites which have much less than Vermont granite contains about :he futility of trying to compare vorkers in one industry to those late miller. You will notice he ' kings, with quite a bit of fine ! 1 in the group of slate miller ! an active tuberculosis. He had ! ut six years and apparently the ! dental and not a result of his red hilus thickenings with a few late workers showed a different athology. h e r slate worker showing quite am&T portion of the right lung an who had, or has, asbestosis. f cleaning and restoring the asour government hospitals. He ade about six years, I think, and s of both lungs. The character different from that of the granbility and the government com' t classification of silicosis. The *in South Africa. They started a primary and secondary stages, about the disease they had to They learned that they had a and it was called ante-primary, 1B1 and as it developed there was still another condition before they could be considered as ante-primary so they called that "more fibrosis than usual." They took an average chest of the average individual as more or less a standard, and there were a number of cases having more fibrosis than the average person and yet not enough fibrosis to be placed in the classes mentioned. When they diagnosed a case as having ante-primary, primary or secondary sili cosis, their arrangement is that the man is entitled to com pensation and he is removed from his dusty occupation. This is the original classification of silicosis. In Australia, they used a slightly different classification. They called their chests normal instead of. average. In Dr. Moore's paper he gives the reason for cases having more fibrosis than usual, tuberculosis, that is, latent tuber culosis, or healed tuberculosis; cardiac conditions, and dust. The stages are called early and advanced. Their advanced cases seem to be considered more or less in two phases. At the International Silicosis Conference this classification into first, second and third stages was recom mended. The South Africans have their classifications written into their laws and they have to stick to it, although they said a more workable or reasonable classification should be adopted and adhered to. The classification of stages designated as negative or average chest, more fi brosis than usual, .first, second and third stages was rec ommended. Tuberculosis complicating any one of these stages would automatically place it in third stage. The first stage of silicosis with tuberculosis would therefore be considered as the third stage. This slide represents a case which would more or less come under the stage of "more fibrosis than usual." How ever, the density in here iB getting a little beyond that stage, but you will note that the slide illuminates well, in dicating that there is apparently quite good aeration of the lung. He was a sand blaster working for the United States Government and he had been in this occupation foe eight years. He was a colored man and he had several masks. He not only wore one but two masks neither of which were good. I took this X-ray because a man work ing in the same place he was had died of tuberculosis. They 182 had filed a claim with the employees' compensation com mission for silicosis for this deceased sand blaster. There was an X-ray of him at the hospital where he had died, and apparently he was entitled to receive compensation, and it was so recommended. This particular case had been working along with him. This picture was taken in 1926; he later developed tuberculosis and died, and in 1929 the widow filed claim for tuberculosis and silicosis. This stage I consider "more fibrosis than usual" and if he had had tu berculosis and more fibrosis at that time it would have been considered a third stage case. ThiB is a slide of a granite worker I'm showing to bring out the point that when a tuberculous infection exists the rate of progress of silicosis seems to be augmented. I find that I have left out the slide that Bhould follow, but I be lieve that I can describe the stage. In the right lung there is quite a lot of fibrosis, more than in the left lung. This picture was taken in 1925; last year, in 1931, I X-rayed this man again. This condition was about the same, but he has apparently developed tuberculous infec tion in this lung and there was undoubtedly much more fi brosis in this lung than in the right lung. Ordinarily and in the preceding cases the disease has seemed to develop a little more in the right lung than in the left. . You have perhaps seen our beautiful Union Station in Washington. This is the X-ray of the man who carved two of the five beautiful statues which surmount the entrances on the outside to the Union Station. He was. one of the most skilled granite workers. This is the right lung. He has quite a snow storm appearance in this portion, lower right. At the time this picture was taken he had rales after cough, afternoon temperature and loss of weight, positive sputum, and the usual signs or symptoms of tuber culosis. (See Southern Medical Journal, Sept. 1932, pp. 919-927, for X-ray.) This next slide is from another case from Vermont. The man had apparently in this spot an old smoldering tuber- culosis. This case is not typical of onr other cases, some of which I have shown you in preceding slides, in that they have bilateral fibrosis. He bad this conglomerate affair with little pathaiogy indicated in the other lung. Because ^nployees' compensation com* ^ ^ c e a se d sand blaster. There e hospital where he had died, tied to receive compensation, This particular case had been his picture was taken in 1926; sis and died, and in 1929 the iiosis and silicosis. This stage n usual" and if he had had tu s at that time it would have : case. e worker I 'm showing to bring uberculous infection exists the seems to be augmented. I find e that should follow, but I bedie stage. In the right lung is, more than in the left lung, t 1925; last yiar, in 1931, I This condition was about the y developed tuberculous infeewas undoubtedly much more fi.he right lung. Ordinarily and .isease has seemed to develop a than in the left. >ur beautiful Union Station in of the man who carved two ich surmount the entrances \ Station. He was. one of the s'. This is the right lung. He >earance in this portion, lower icture was taken he had rales iperature and loss of weight, tal signs or symptoms of tubertdictd Journal, Sept. 1932, pp. other case from Vermont. The spot an old smoldering tuberrpical of our other cases, some in preceding slides, in that they i had this conglomerate affair :ed in the other lung, Because 188 it was different I observed him very closely for a period of two and one-half years while there. I visited in the place a year later and found that he had not been sick nor lost one day from work. I was baric in Vermont in 1931 and as I was interested in him we took an X-ray and this is the result This area has spread pretty well all the way to the periphery together with a tremendous increase of the amount of pathology in the other lung. He was feeling pretty well except that he was very dyspneic be cause so much of the normal functioning lung had been displaced with fibrous tissue (X-ray No. 14, Case No. 189, Bull. 187, U. S. P. H. S.) This is the man's photograph. He doesn't look particu larly bad. As long as these cases do not have active clinical tuberculosis they look quite well. This is an actual photograph (Plate 17, Case 37, p. 150, Bull. 187, U. S. P. H. S.) of the lungs of one of our cases in Vermont. This is the apex of the lung at this point. You will notice dark areas through th ere The lighter areas at the bottom are tuberculosis. I want to call your atten tion to the density of the pleura. The pleura, as you know, is a very small mucous membrane, many times likened to the mucous membrane of your lip. In these cases there was great thickening of the pleura. I believe it is due to the fact that we have an exposure lasting over a long number of yearn and the possibility that the majority of the cases have a smoldering tuberculosis along with it. That is, I believe that the tubercle bacilli is perhaps a factor in this tremendously thickened pleura. I have seen a number of lungs of silicotic patients who had a shorter exposure to a much higher silica dust than were the gran ite workers and the pleura was not thickened to the ex tent of the Vermont cases. Pleurisy pain is one of the symptoms of silicosis which we will consider in the dis cussion of the diagnosis of silicosis. One of the few com plaints which the workers have is pain in the chest It js more or less trivial and not usually disabling. They seldom complain of it and don't often stop work. It bothers thorn more in damp weather. F uns in the chest with shortness of breath is about all that these Vermont workers complained of in the course of silicosis until they 184 begin to develop signs of active tuberculosis, that i6, tem perature, loss of weight, increase in the amount of cough with productive sputum, etc. This slide is one showing the death rate in rural Ver mont from pulmonary tuberculosis beginning about 1900. In the granite industry in about 1894 they introduced the hand pneumatic tool which is activated by compressed air, as an instrument for cutting granite. You will note that about that time the death rate of granite cutters from tu berculosis began to increase. We think that is caused by the excessive amount of dust which is generated in cutting of stone with this hand pneumatic tool. (Fig. 26, p. 180, Bull. 187, U. S. P. H. S.) . I might say a few words about the diagnosis of silicosis. I am frequently asked to speak of the diagnostic points of silicosis. It seems to be the practice of so many people to draw their own conclusions from the X-rays alone. We believe that in the scientific practice of medicine, all points should be considered in making a diagnosis and certainly this should be done when there is the matter of extent of disability to be decided on. In Vermont we had complete physical examination, history of the case which included the entire occupational life, and that with any symptoms he may have had. As I said before, very few of them have many complaints. They even forget that they have a little hacking cough which is perhaps due to mechanical irritation of the upper respiratory tract. Ordinarily, un less they have a cold or infection, they do hot produce sputum. They may complain of an occasional pain in the chest and usually of a slight shortness of breath. One of them expressed it to me in this way--"I am beginning to get so I can't get my second wind." When the reserve is called upon they seem to be unable to get their "second wind." Another phase in the diagnosis of silicosis is the consid eration of respiratory diseases. they may have had. I showed you in the Blides that this particular group of workers had more respiratory disease than the usual indi vidual. The physical examination of these workers is frequently disappointing. You may listen to the chest, and hear very little and when you see the X-ray you are but- 9 ac>ttiivvee ttiuberculosis, that is. tem k^ease jn the amount of cough ng the death rate in rural Vertereulosis beginning about 1900. . about 1894 they introduced the i is activated by compressed air, ing granite. You will note that rate of granite cutters from tuse. We think that is caused by ust which is generated in cutting neumatic tool. (Fig. 26, p. 180, Is about the diagnosis of silicosis, speak of the diagnostic points of the practice of so many people dons from the X-rays alone. We fie practice of medicine, all points staking a diagnosis and certainly , there is the matter of extent of In Vermont we had complete jtory of the case which included Lfe, and that with any symptoms I said before, very few of them They even forget that they have a : ^ is perhaps due to mechanical ^ k r a t o r y tract. Ordinarily, un^ i n f ection,. they do not produce plain of an occasional pain in the light shortness of breath. One of in this way--"I am beginning to iecond wind." When the reserve , to be unable to get their "second diagnosis of silicosis is the considdiseases they may have had. I les that this particular group of ratory disease than the usual indi examination of these workers is You may listen to the chest, and en you see the X-ray you are sur- 185 prised a t the extent of pathology present, but even bo th at is no reason for omitting the physical examination. The chest expansion is almost invariably limited in these work ers and we find it almost in direct proportion to their length of exposure and which would be, of course, according to the progress of th disease. The granite workers were a husky robust type of people and you would reasonably expect them to be capable of at least 2Vi to 3 inches expansion, whereas, most of them had one inch or less. They seem to have an abdominal type of breathing rather than thor acic. I found that examination by palpation was quite disappointing, the fremitus was not usually increased in the same proportion that it is in fibrosis of tuberculosis. Tu berculosis produces a more or less localised fibrosis, where as, in silicosis it iB more or less generalized, and that may explain the difference in the fremitus in the two conditions. The breath sounds in these cases in Vermont were not changed to any particular variety. There seemed to be more softening of all the sounds. The fibrosis of tubercu losis produces more definite changes in breath sounds than does silicosis. I saw some cases of silicosis recently which had developed the disease after very short exposure and they had breath sounds which were quite different from the Vermont cases. In the acute cases, which I saw recently, the principal portion of fibrosis and infiltration were in the upper lobes of the lungs. The lower part of the lungs were emphyse matous. The upper portion seemed to be functioning very little. In the silicosis cases in our Vermont study, rales were not heard unless infection was present. When tu berculosis complicates silicosis, almost invariably rales can be heard after the patient coughs, as in tuberculosis in non-silicotic people. A great amount of fibrosis may con ceal the presence of rales to a certain extent in silicotic patients. Our cases in Vermont had very few signs, symp toms or complaints until they began to develop an active tuberculosis. That was a very definite point with them. They then complain of increased shortness of breath, pains in the chest, loss of weight, afternoon temperature, pro ductive cough and the usual other signs of active tuber culosis. These patients seemed to have pulmonary hemor- ii 186 rhages more than most cases of tuberculosis. We had sev ra] deaths from hemorrhage of the lung and the doctors there told me about other cases that had died there of it prior to our study. One of them had died on the lawn of a doctor's office trying to get help. Hemorrhage is the result of ulceration of these tuberculous areas. One of the cases of acute silicosis was giving me his his tory recently, and he was quite perturbed because after he had a coughing spell his chew of tobacco was gritty. This is a new angle on the elmination of dust. He didn't mind the cough, but he didn't like to have his chew of tobacco spoiled. I think th at it is the result of ulcerations and erosions of these silicotic and tuberculous lesions and dust was eliminated along with other debris. The tuberculous complication of all the cases in Vermont other than the pulmonary type of tuberculosis, were com paratively rare. Most of these cases developed a fulminat ing type of tuberculosis and did not live so long as the uncomplicated case, thereby .lessening the chances of com plications. We had one man die ninety days after he quit work and most of the other cases died within a year. We had only one man who lived two years after he stopped work. I think that the comparatively short period of time they lived after developing tuberculosis, would perhaps pre clude the development of other tuberculous complications. There were, however, a few cases of glandular tubercu losis, one case of infection of the inguinal glands, and a tuberculous elbow with adenitis of the axillary glands. A few children in these families of granite cutters developed tuberculous meningitis. I think you people are particularly interested in in formation relative to the point where a silicotic becomes disabled, or where he should be compensated. In our cases in Vermont we had no disability from silicosis unless they developed tuberculosis. I don't recall, and I don't believe we have recorded a single instance of a case with disability without the disease. Our cases had from 15 to 30 and 35 years of exposure. I don't believe that you can estimate the disability from the X-ray alone and that is why I urge that cases be studied not only by X-ray, but by physical observations as well. X87 !fl of tuberculosis. We had sev- of the lung and the doctors es that had died there of it >f them had died on the lawn o get help. Hemorrhage is the This slide is a case of a man who was the lens grinder who had been exposed to silica only eight months and was disabled, yet from the X-ray it didn't appear he had any disability, but he was bedfast. I believe I spoke of the fact that I have seen a number of disabled cases of silicosis re cently. The greatest amount of pathology was in the upper tuberculous areas, silicosis was giving me his his- psiotertioton wofhatht ewleunsgawin itnheVseercmasoenst,. wMhicohstisofditrheecstely roepcepnot I uite perturbed because after he cases were exposed to silica dust less than two years, and ;w of tobacco was gritty. This have disability, whereas, in Vermont the workers were tation of dust. He didn't mind exposed over a period of many years. ce to have his chew of tobacco There is one other thing I might speak of and I. think - the result of ulcerations and Mr. Bloomfield touched on it this morning, and that is ad tuberculous lesions and dust about the so-called anti-silicotic dusts. There is one thing ther debris. that Mr. Bloomfield didn't bring out, that I wish to men non of all the cases in Vermont tion at this time. The original report which started the .ype of tuberculosis, were com discussion of anti-silicotic properties of dust, did not in iese cases developed a fulminat- clude dust counts to show that a hazard really existed. id did not live so long as the There have been no scientific studies made on the subject, ' lessening the chances of com- but rather a lot of surmising. If there is an antidote for n die ninety days after he quit silica dust, we should make every effort to learn about it. - cases died within a year. We It would alleviate much suffering and save many lives as ed two years after he stopped well as much expense to industry. The author of this article paratively short period of time did not show that enough dust was present to produce sili . uberculosis, would perhaps pre- cosis, and because the workers didn't get silicosis, he con ther tuberculous complications. cluded the clay kept them from getting it. He gives the teases of glandular tubercu|th e inguinal glands, and a is of the axillary glands. A ies of granite cutters developed analysis of this dust and the total percentage of silica in the material was 88 or 84%; the total percentage in silica in Vermont is 69% with much less quartz than his dusts seem to have had. The following table shows that granite dust contains less particularly interested in in- silica and more of the so-called "anti-silicotic'' elements oint where a silicotic becomes than what is found in the materials used in brickmaking. ( be compensated. In our cases oility from silicosis unless they on't recall, and I don't believe istance of a case with disability ases had from 15 to 30 and 35 believe that you can estimate iy alone and that is why I urge nly by X-ray, but by physical Avalyeia of "Dark Barre" Granite S ilic a ___________________ 69.89 A lu m in a _____ __ . . . . . . . 16.08 Iron o xide--- ------------------- 1.46 Iron Sesquioxide________ 1.04 Magnesia (M g O ) _______ 0.66 Soda __________________ 4.73 Lime __________________ 2.07 Potash (K.O) __________ 4.29 W ater uncombined (H .0 a t 110) _______ 0.31 W ater combined (EUO) (ig nition) ____ _____. . . . . . 0.23 Phosphorous p e n t o x i d e (P.O.) Trace Report of Granite Area of B arre, 1902. George I. Finlay, State Geologist of Vermont. Materials Used in Briclcmaking Contents of Sample Brick Factory A Silica ________ Alumina -------Ferric oxide____ Manganese, mag nesium and tin oxide ______ S o d a _________ Lime ________ W ater and Loss. 8B.90 7.42 0.16 0.44 1.49 0.00 2.49 Brick Factory B 84.90 9.88 0.19 0.86 084 0.34 380 Heffemail, Journal of Indus tr ia l Hygiene, November, 1926. No study has been reported in which accurate duBt counts were made and where it was shown that a silica hazard existed and has been a very definite curative or preventative dust mixed along with it, thereby preventing the development of silicosis. I hope that somebody will give us such a study. I wish Dr. Gardner and Mr. Cummings much success in their endeavors along this line, and I am sure if anything can be brought out as an antidote for silica, they will do it. There are, perhaps, a number of other things th a t will come up in the discussion. I believe that is all for the present. Mr. Doe: Dr. Russell, in your discussion of the surveys that you have made, where there was a high silica con tent and where there was a low silica content, you referred to the presence of fibrosis in both cases. Yesterday I got the impression from Dr. Gardner, that in the non-silicotic dusts there was no formation of fibrosis in the same sense that there was in the case of silicotic dusts. Is it your view that in the non-silicotic dusts the pathology is the same or different? * D r . R u s s e l l : I think it is different In silicosis, you have formation of silicotic nodules as shown by Dr. Gard- M aterial V ted tn Brickm aking Brick Briek Contents ol Factory Factory Sample A B 3 Silica ________ 88.90 84.90 16 Alumina _____ F erric oxide___ 7.42 0.16 9.88 0.19 M Manganese, mag 6 nesium and tin ?8 oxide ______ 0.44 0.86 n S o d a _________ 1.49 0.84 3 Lime ________ 0.00 0A4 ft W ater and Loss. 2.49 3A0 >3 of Heffeman, Journal of Indoay, tria l Hygiene, November, 1926. ported in which accurate dust tere it was shown that a silica een a very definite curative or long with it, thereby preventing is. I hope that somebody will i Dr. Gardner and Mr. Cummings savors along this line, and I am brought out as an antidote for ber of other things that I believe that is all for will tbe in your discussion of the surveys re there was a high silica con- ^ low silica content, you referred in both cases. Yesterday I got Jardner, that in the non-silicotic ion of fibrosis in the same sense of silicotic dusts. Is it your view sts the pathology is the same or it is different. In silicosis, you nodules as shown by Dr. Gard- 189 ner. In non-silicotic dusts the silicotic nodules are not present. It is more of a generalized type of fibrosis. Mr. Dob: What I wanted to know was whether it was fibrosis, or whether it was merely the presence of dust that was retained in the lung tissue? . Dr. Russell: I think the X-ray penetrates roost dusts. I don't believe many shadows are recorded on the film due to dust particles. Mr. Doe: You don't think that most duBts are radio opaque? Dr. Russell: I don't think that roost dusts are. Mr. Doe: Are they radio opaque? Dr. Russell: I think they are n o t MR. Doe: So that in the cases of marble workers th at you showed, the markings are not the dust, in your opinion? Dr. Russell: I think they are calcifications. That is, combination of fibrosis and lime. Mr. Doe: Then they are partially dust and partially a reaction of the tissues themselves? Dr. Russell : Yes; calcifications are present in tubercu losis. Mr. Doe: When you have a non-silicotic dust Buch as marble dust, for instance, do you think, Dr. Russell, that the mere presence of those dust particles in the tissue in the manner that you have described, have any predisposing effect in relation to tuberculosis? Dr. Russell: Marble dust? MR. Doe: Perhaps I don't mean to limit it to marble dust, but to any non-silicotic dust. Dr. Russell: I think th at they might predispose to tuberculosis in this way, not directly, but indirectly. In most dusty trades there is an increase in the amount of respiratory diseases and I think it is reasonable to presume that a repetition of respiratory infections certainly would tend to aggravate a smoldering tuberculous condition. 190 . Certainly the tuberculous condition would be better off without having these concurrent infections. Mr. Dob: If a man had a history of two or three pneumonias and a couple of pleurisies, it might be signifi cant? Dr. Russell: Yes. And influenza. Mr. Doe: Would there be any difference in th at respect v with regard to whether the man had an old tuberculous condition or never had had any tuberculosis? Dr. Russell: I thought you said with an existing or latent tuberculosis. Mr. Doe: I am asking you the question both ways. Whether it is in the one case or isn't in the other, or whether both would be the same. Dr. Russell: 1 think the incidence of respiratory dis eases of any kind, a repetition of them, a number of them, more or less predispose to tuberculosis. We have many patients giving a history of their break down from influenza, etc. Of course, we don't know in those cases whether they had latent tuberculosis or whether it is a new thing. Most of us I think, believe it is latent. Mr. Doe: Is there any way of telling in a particular case? D r . R u s s e l l : Well, the X-ray might reveal the pres ence of it, but it doesn't always show up on the X-ray. It depends, of course, bn the extent of the original infec tion. . Mr. Dob: Well, when you have an individual who has been exposed to non-silicotic dust who becomes tuberculous, are there any means of telling whether the fact that he is tuberculous is associated with the dust? Dr. Russell: I think different cases would vary a lot individually. There might be some characteristics--I think it would be difficult to tell whether or not the case was associated with pneumoconiosis, so to speak. Mr. Dob: In your studies have you made any compari son between the incidence of the disease of tuberculosis 191 condition would be better off ^grent infections. & history of two or three f pleurisies, it might be signifi- id influenza. be any difference in that respect te roan had an old tuberculous ! any tuberculosis? t you said with an existing or among the population of the locality and in the dusty trades? I notice you had in the Barre survey the incidence of disease in rural Vermont. In other studies have there been similar comparisons? i Dr. Russell: Not entirely similar. We have in the anthracite coal the death rate for the county in which we made our study, and the death rate from the coal miners ii in that area. Ms. Doe: And you had a high percentage of silica at least in the rock drilling, didn't you? Dr. Russell: Yes. : you the question both ways, Mr. Doe: Have you made any such comparison. Doctor, case or isn't in the other, or in the non-silicotic dust studies? same. Dr. Russell: I don't believe we have. I don't think :he incidence of respiratory dis- there has been anything published. :ion of them, a number of them, > tuberculosis. We have many their break down from influenza, Mr. Doe: In the marble study there was no comparison of incidence of tuberculosis with the civil population? know in those cases whether Dr. Russell : Not in the report There were no cases s or whether it is a new thing, of tuberculosis among the workers at the time we were it is latent there. There is a low death rate (from tuberculosis) for way of telling in a particular . rural Vermont Mr. Doe: Are you satisfied that in the case of the j^C-ray might reveal the pres- marble study you made, the incidence of tuberculosis was ^ ^ y s show up on the X-ray. i no higher than it was among the rest of the population? he extent of the original infec- ! Dr. R u ssell : I think it is quite conclusive that it was not higher among marble workers. 'ou have an individual who has c dust who becomes tuberculous, ling whether the fact that he is I Mr. Doe: Would it be your opinion that that would also { be true of other non-silicotic dusts? ith the dust? Dr. Russe&l : I made the statement in the beginning Afferent cases would vary a lot be some characteristics--I think I whether or not the case was iosis, so to speak. es have you made any compariof the disease of tuberculosis that you couldn't compare fibrosis of one case of pneu moconiosis with that of another. I think each one of these groups of workers is unique in itself. I think with the marble workers, whatever happens to them we couldn't say the same thing would happen to slate workers or any other group. We might hazard a guess but one guess is about as good as another. 192 - Mr. Doe: Do you believe that there is any marked dif ference between the silicotic cases and the non-silicotic cases in that regard? Dr. Russell: Of tuberculosis? . Mr. Doe: Yes. Dr. Russell: Yes. Mr. Doe: Well, you have made certain studies of non silicotic dusts. One is marble and one is slate where .silica content was nominal. Is it your conclusion from those studies, that the incidence of tuberculosis is as low as that of the rest of the population in the community? Dr. Russell : I said it was for marble. Mr. Doe: What is the fact as to slate? Dr. Russell : About the same. The same as the popu lation. Mr. Doe: How does the frequency of respiratory infec tion compare with that? Dr. Russell: We didn't make morbidity studies of the marble workers nor slate workers. According to our his tories I think the slate workers have more respiratory disseases than marble workers. I haven't the figures. Mr. Doe: But you wouldn't conclude from that that the tuberculosis rate would be higher? Dr. Russell: The amount of tuberculosis we found among workers was not higher than that of the general population. Mr. Doe: Doctor, will you tell us a little something about what you have found with regard to secondary heart conditions in silicosis? Dr. Russell: I don't believe we have any cases of sec ondary heart conditions due to silicosis in Barre. Cer tainly it was not indicated in the X-ray, that there was undue cardiac enlargement, particularly the right Bide of the heart Mr. Doe: Did you form any conclusion as to whether that it is common or uncommon, that there could be a 1 e that there is any marked difcases and the non-silicotic ulosis ? ve made certain studies of nonble and one is slate where .silica it your conclusion from those i of tuberculosis is as low as ulation in the community? was for marble, fact as to slate? e same. The same as the popu- .*frequency of respiratory infec- 't make morbidity studies of the workers. According to our his.`kers have more respiratory diss. I haven't the figures. uldn't conclude from that that higher? t of tuberculosis we found ligher than that of the general you tell us a little something 1with regard to secondary heart elieve we have any cases of seclue to silicosis in Barre. Cerd in the X-ray, that there was t, particularly the right side of m any conclusion as to whether common, that there could be a 193 secondary heart condition due, we will say, to third stage silicosis? | Dr. Russell: I think it is possible. Quite possible. ; You have to take into consideration the person's previous condition, his heart condition before the onset of silicosis. A lot of people have a heart disease, and it occurs in and out of dusty trades.--a certain amount, just like tubercu losis in the general population. Mr. Doe: You didn't feel in the Barre survey then that there was any evidence of a secondary heart condition that was attributed to the disease of silicosis? Dr. Russell: No. Mr. Doe : Have you found any such factor in any other study? . Dr. Russell: That was the most extensive silicosis study 1 have done. I would rather you would consult the literature of others who have reported on that to give you their opinion. Mr. Doe: From the studies you have made, Dr. Russell, what would be your opinion as to the advisability or in advisability of continuing a man in a dusty atmosphere after the presence of silicosis is detected? Suppose you. . had a "more fibrosis than usual" finding. Would it be your judgment that that man should be excluded from a dusty ! occupation as soon as that was detected ? i Dr. Russell: If that were done it would take them out very rapidly. You would have tremendous labor turn over. Mr. Doe: Would it make any difference as to the num- ber of years that he had been employed before the "more fibrosis than usual" finding was discovered? j Dr. Russell: I think it would. Mr. Doe: Would it be your view that all such cases should bd excluded from dusty employment, if possible? I don't mean to state an impractical situation. Dr. Russell: I think it would be better to clear up the dust than to have to be constantly thinning employes IS i 194 out Dust can be prevented and you would have to take men in many dusty trades who are skilled operators. At least they know their trades. If you keep taking them out how would you retrain them for other occupations? It is much cheaper and a better policy to eliminate the dust than to be constantly turning over employes because they develop fibrosis. Mr. Doe: That might be the ideal situation, if one could do that, but assuming that after the best has been done that we are capable of in the present state of know ledge, you take a man with more fibrosis than usual, your idea would be that he should be gotten out of employment ? Dr. Russell: If there is an excessive incidence of tuberculosis in that particular occupation. It depends a lot on the extent of silica in the dust. I don't think I could, or anybody else, lay down a definite policy that would be applicable to all instances where you have silica rang ing from one to one hundred per cent. Some coal miners show more fibrosis than usual, and yet history of bitum inous coal is that they don't have excessive amounts of tuberculosis. It would be folly to take those people out. It would depend entirely on the industry involved and its past record. Mr. Doe: Well, would the quantity of silica, in the dust be the determining factor, for instance, if you had a marble worker with more fibrosis than usual, would your recom mendation be different than if he were a granite worker ? Dr. Russell: Yes, it would be, of course. Mr. Doe: Mow, then what-do you say would be a reasonably safe maximum and when I say safe, I mean safe from the danger of tuberculosis complication, first, as to silica content? Dr. Russell: I can only give you our experience in Barre. I think it is the only dusty trade where that was well worked out. Groups C and D were exposed to less than twenty million particles of dust, the death rate from those people (from tuberculosis) was about the same as rural Vermont and the death rate in the groups exposed to more than twenty million particles was greatly in excess nd you would have to take skilled operators. At ^ ^ o u keep taking them out >r other occupations? It is olicy to eliminate the dust over employes because they the ideal situation, if one at after the best has been the present state of knowre fibrosis than usual, your gotten out of employment? an excessive incidence of occupation. It depends a the dust. I don't think 1 a definite policy that would /here you have silica rang er cent. Some coal miners, and yet history of bitumhave excessive amounts of / to take those people out. ; industry involved and its uantity of silica, in the dust nee, if you had a marble ual, would your recomwere a granite worker? be, of course. ; do you say would be a when I say safe, I mean rculosis complication, first. ive you our experience in i usty trade where that was . I id D were exposed to less : dust, the death rate from s) was about the same as ate in the groups exposed tides was greatly in excess 196 of rural Vermont. I can give only my practical experience, as approximately less than twenty million particles per cubic foot of dust containing 35% silica. If a man has evidence of tuberculosis with more fibrosis than usual, I don't think it would be advisable to continue even in that dust. Mr. Doe: Would that have a limitation as to the num ber of hours--for instance, if you had an occupation that showed less than twenty-five million particles and, say, no greater silica content than you had at Barre. would that employment be safe for that individual for an indefinite period of hours? Dr. RUSSELL: It seemed to be true there; they continue in that occupation for many years. Mr. Doe: Nothing in the studies you have made since has effected that conclusion? . Dr. Russell: We haven't done any studies since that time of silica dust. Most were other types of dust. What is applicable to the granite industry I can't say definitely would be applicable to other industries. We believe, how ever, that men can tolerate twenty million particles in that much silica, (35%). MR. Doe: Suppose you found a case in your marble survey, of an individual who had been exposed to a dust containing a very nominal percentage of silica, compared to the granite, and that he had been exposed to that dust for a relatively short period of years, say ten years, and he developed tuberculosis, would you say the development of tuberculosis in such a case was secondary to the employ ment? Dr. Russell: In the marble? Mr. Doe: Yes, in the marble. Dr. Russell: No, I don't think so. Mr. Doe: Would there be any means of, in the present state of our knowledge, connecting a case where the ex posure to silica was less than 35% and the number of particles less than twenty million, any means in connecting 196 up a tuberculosis with such a case with the industry that you know of? Dr. Russell: I think it would be difficult. You have to take into consideration a certain percentage of people have tuberculosis, regardless of occupation. Mr. Doe : That is, in every community there is a certain I incidence? Dr. Russell: Yes, certain incidence of tuberculosis. Mr. Dob: Is there any criterion upon which those indi viduals in that community can be classified as to whether their disease is industrial or not, if the silica content is lower than granite and less than twenty million? ' Dr. Russell: I don't know of anything. If we haven't the characteristic silicosis proceeding with tuberculosis, I don't see how you' can say positively that it is. Mr. Doe: What is. the proper method of taking an X-ray to Bhow the characteristic findings of silicosis; is there a proper technique as to under and over exposure being avoided; can you tell us your views on that? Dr. Russell: Personally I like X-ray of one character and other people of another character. It is more or less a personal standard. You realize that there is a big variety of X-ray equipment at the present time. I am using a portable X-ray machine, but I would much prefer to have a larger and better one, a hospital unit. The technique I use for this portable machine could not be used for a hospital. I don't believe there is a standard technique for it, although it has been urged that a certain technique be promulgated and used throughout the country, but with the big variety of X-ray equipment I don't see how it can be easily carried out. Mr. Doe: In a hypothetical situation where you had, say, not a portable machine, but a variety that might be available in the large centers--can you give us any criterion by which we can tell whether an X-ray is properly exposed, not too little and not too much? Dr. Russell: I think the X-ray picture itself would tell you that. ' h a case with the industry that it would be difficult. You have a certain percentage of people as of occupation. ery community there is a certain tain incidence of tuberculosis. criterion upon which those indi ' can be classified as to whether or not, if the silica content is s than twenty million? ' now of anything. If we haven't proceeding with tuberculosis, 1 positively that it is. e proper method of taking an ,`teristic findings of silicosis; is as to under and over exposure 1 us your views on that? .ly 1 like X-ray of one character ;r character. It is more or less realize that there is a big variety *e present time. I am using a M I would much prefer to have ^h o sp ital unit. The technique achine could -not be used for a here is a standard technique for ged that a certain technique be ughout the country, but witli the iment I don't see how it can be etical situation where you had, le, but a variety that might be s--can you give us any criterion er an X-ray is properly exposed, nuch? the X-ray picture itself would 197 Mr. Doe : What are the signs by which we would know ? Dr. Russell: If it is over exposed it is difficult to de scribe. It is easier to demonstrate, if you will, the softer or less intense exposure brings out the finer shadows. You can give more exposure and these fine lines are obliterated. Mr. Doe: Dr. Russell, what is your view on the path ology of the higher incidence of tuberculosis in silicotics? Dr. Russell: I think you had better refer to Dr. Gardner on pathology; he has been discussing that yester day and today. Mr. Doe: Suppose we accept Dr. Gardner's hypothesis at the moment, that the phagocyte is killed and that ne crosis sets in and that is something in the nature of poison which results in the tuberculosis, do you give any compar able situation to that when the dust is non-silicotic in character? Dr. Russell : I don't think it has been shown. Mr. Doe: Dr. Russell, has the Public Health Service done any work in iron mines or has the Bureau of Mines done anything in iron mines with which you are familiar? Dr. Russell : The Public Health Service hasn't and the Bureau of Mines hasn't reported anything. Mr. Doe : That is alL Mr. Tarrell: Dr. Russell, in answering the question of Mr. Doe, as to the standard or the given quantity of silica under which a man might work with safety, you have reference to a group of men have you? Dr. R ussell : Yes. Mr. T arrell: And in one section do you refer to any particular individual person? DR. Russell: No, they were groups we studied. Mr. Tarrell: If a man has a breakdown of the upper respiratory tract, a breakdown in the line of defense against the inhalation of dust particles, should he work under conditions with twenty million particles in less than 35% silica? A 198 . Dr. Russell: How are you going to determine the breakdown? Mr. Tarrell: Well, it is a fact isn't it, that the inhala tion of dust particles tend to destroy the mucous membrane of the respiratory tract? Dr. Russell: Yes. Mr. Tarrell: That has all been covered. But if a man does have a breakdown and the mucous membrane is de stroyed, can that man safely work in an atmosphere of twenty million particles? Dr. Russell: I don't think we said the mucous mem brane was destroyed; the ciliary action was limited. The only way you can determine whether or not the cilia are gone is to get a section of the mucous membrane of the trachea to determine that. Mr. Tarrell: The resistive powers of some individuals differ from others? ' Dr. Russell : Yes. Mr. Tarrell: Then there isn't any definite standard you can set up for separate individuals under which they may work? Dr. Russell: No. The presence of tuberculosis pre disposes to silicosis. I told you about this case developing more fibrosis in the right lung and later having a tuber culous infection in the other lung, and the rapidity with which the combined disease developed on that side. Most of such cases in Vermont were the case of father and son, the father'had tuberculosis, the son lived with him and pre sumably became infected. These younger chaps in cases of that kind, seem to develop silicosis more rapidly than the others. MR..Tarrell: The amount of dust necessary to produce a nasal disease in one individual is not the same in all individuals? Dr. Russell: I think the upper respiratory tracts in different individuals vary a lot. Deflected septum, sinus disease, chronic tonsilitis, would alter the efficiency. I 199 you going to determine the Mr. Tarrell: Does that statement apply equally as well to non-silicotic dust? TM fact isn't it, that the inhaladestroy the mucous membrane *11been covered. But if a man the mucous membrane is de fy work in an atmosphere of ink we said the mucous memiary action was limited. The whether or not the cilia are the mucous membrane of the Dr. Russell: 1 think a person in a non-silicotic dust with a deflected septum, would be more apt to have a res piratory condition than if he didn't have it. ' I Mr. Tarrell: What influence would that have on the development of tuberculosis? Dr. Russell: Well, 1 think it would be indirectly, as I spoke of before, that that would perhaps have an undue amount of respiratory disease of different varieties, and that in this way it might predispose to tuberculosis. Mr. Tarrell: And by respiratory disease you mean bronchitis, pneumonia-- Dr. Russell: Influenza. ive powers of some individuals Mr. Tarrell: Asthma and influenza? Dr. Russell : Yes. e isn't any definite standard individuals under which they presence of tuberculosis pre'ou about this case developing : and later having a tuber ung, and the rapidity with developed on that side. Most re the case of father and Bon, le son lived with him and pre.'hese younger chaps in cases p silicosis more rapidly than t of dust necessary to produce I dual is not the same in ail Mr. Tarrell : That is all. Dr. Ogden, of the Illinois Steel Company: Dr. Russell, in ail of your slides which showed a true pneumoconiosis other than asbestosis, do you think that there was a possi bility of ruling out silica as a determining factor? Dr. Russell: You mean in all of them? Dr. Ogden : Yes, could it be ruled out as the determin ing factor, causing fibrosis other than asbestosis? Dr. Russell : I don't think so. Dr. Ogden: There was always free silica present in each one of those in varying degrees? Dr. Russell: In practically all of them there was some silica present. Dr. Ogden: It couldn't be ruled out as being the de termining cause? - upper respiratory tracts in lot Deflected septum, sinus ild alter the efliciency. Dr. Russell: No doubt the presence of silica with other dusts help to produce fibrosis. The reaction to silica is much more violent than it is to other dusts. I "1 200 Dr. Ogden : You didn't show any slides of true pneumo coniosis in which there was no silica, with the exception of asbestos, is that correct? Dr. Russell: No, I don't think so. I think there was maybe one per cent in roost of them. That brings us up to the point of mixed dusts. Practically all dusts are mixed. These tunnel workers were exposed to almost one hundred per cent silica; there were less of the other ele ments with it. Dr. Ogden : That cement slide. Dr. Russell: That was the finished product; about one per cent quartz. Dr. Belknap, Milwaukee, Wisconsin: I would like to ask if there is any known clinical functional test that you can give a roan with a certain amount of pure silicosis by which you might determine his disability, say, he com plained of a certain amount of dyspnea? Dr. Russell: You mean like a tuberculin test? Dr. Belknap : No, to get an estimate of disability from pure silica? Dr. Russell: I don't know of any, no. I think in es timating disability you have to take into consideration the whole picture, the man's history and his background, his present condition and the X-ray. Dr. Belknap : I meant definitely on dyspnea. Dr. Russell: In our Vermont study we recorded, by use of the spirometer, the vital capacity. Our statistician said that we couldn't do much with it statistically, but it seemed to me that these men when they had silicosis, had a marked decrease in vital capacity and most dyspneic pa tients had a marked loss of vital capacity. One of the slides I showed you, I think the second one--his chest in dicated quite a bit of pathology and be had one of the best vital capacities of the' whole group, because he was the best golfer in that area; he had built up a reserve. You can practice with a spirometer and increase your vital capacity. show any slides of true pneumono silica, with the exception of n't think so. I think there was st of them. That brings us up ists. Practically all dusts are :ers were exposed to almost one >ere were less of the other ele- it slide. is the finished product; about e, Wisconsin: 1 would like to clinical functional test that you ain amount of pure silicosis by le his disability, say, he comit of dyspnea? 1like a tuberculin test? :t an estimate of disability from now of any, no. I think in esz to take into consideration the istory and his background, his py. ^finitely on dyspnea. ennont study we recorded, by >ital capacity. Our statistician och with it statistically, but it m when they had silicosis, had opacity and most dyspneic pa<f vital capacity. One of the : the second one--his chest inogy and he had one of the best le group, because be was the had built up a reserve. You leter and increase your vital . , : ! I ' . . 201 Mr. Wright: In the cases that come for litigation, the spirometer is of very little value because we need full and perfect cooperation of the patient in order to get true vital capacity. You spoke of response to exercise, didn't you; or did you? You spoke of chest expansion. Do you put any stress on the movements of the diaphragm? Dr. Russell: Well, chest expansion and respiration is along the same line as result from the spirometer. It is .more or less voluntary. Mr. Wright: But I find that very often in examining patients they may know about vital capacity; they may mot know what you are looking at when looking for the movement of the diaphragm in the dark room. They may not know what you are getting a t One thing is response to exercise and another thing is holding of the breath. I find when you don't get cooperation in any of the other tests a man may hold his breath for a normal length of time, which is a very valuable thing. In other words, wouldn't you use the same tests to determine the man's dis ability in this lung condition that you would in any other tests of his ordinary physical capacity? Dr. Russell: I would. Exercise is quite valuable in de termining vital capacity. I think it is really more accurate than the spirometer. I used to meet patients a t a certain place and walk up the stairs with them to an office for X ray and I counted their respirations at the bottom of the stairs and the top. It gave a rough index as to what we might find with the X-ray. The stairway had a landing half way up, and the more advanced cases of silicosis would stop there for a few extra puffs, and that is something they can't control. You can determine your own respirations before and after and compare them to his. I think it gave a fairly good index, and of course, other exercise is similar. Mr. Doe: Dr. Willis asked for an opportunity to cor rect a portion of what he said this morning. I would like to have him given that opportunity. Dr. Willis: This morning the question came up right at the last concerning the concentration of dust and dust counts which were the limits of safety. I think I said 202 that I would recommend five million. What I wanted to follow that up with was this: That is pretty nearly a com promise between Dr. Russell's data which he held a t ten million, as I remember it, in his publication from the gran ite industry, and the earlier investigations in South Africa, which made it anywhere from five to eight million. Mr. Doe: Dr. Willis, when you refer to a safe limit are you assuming a certain silica content in the dust? Dr. Willis: That was a 35% level because there is really no other basis to go on except those two well es tablished figures. . Ms. Doe: Is there any method of getting a combina tion classification; for instance, we will say that five to ten million of 35% silica is safe from the standpoint of any hazard of contracting tuberculosis. Can we make any similar classification, doctor, with reference to other quantities of silica? Dr. Willis: You mean 50% or 10%? Mr. Doe : Exactly. Dr. Willis: Well, it certainly sounds like you could logically, but there is no established fact that you can. It is perfectly logical to assume that it ought to require a higher concentration of 10% silica to produce pneumo coniosis than it would a 50%, but aside from the range which Dr. Russell has shown, I don't know of any well worked out authenticated data. Mr. Doe: It is the general conception, is it not, Doc tor. that the higher the silica content, the more rapidly the disease will occur? Dr. Willis: His work would certainly indicate that. MR. Doe: But there is no definite graduated scale which one can apply? Dr. Willis: No, there is no definite graduated scale which one can apply. Mr. Doe: Was it your view that in the classes C and D where the incidence of tuberculosis was not above that i million. What 1 wanted to iat is pretty nearly a com m lata which he held a t ten is publication from the granivestigations in South Africa, . five to eight million. 1you refer to a safe limit are content in the dust? 35% level because there is on except those two well es- lethod of getting a combinanee, we will say that five to safe from the standpoint of tuberculosis. Can we make ctor, with reference to other 0% or 10%? -tainly sounds like you could stab!ished fact that you can. ;ume that it ought to require )% silica to produce pneumo- but aside from the range 1 don't- know of any well ta. ral conception, is it not, Doci content, the more rapidly the would certainly indicate that, no definite graduated scale is no definite graduated scale dew that in the classes C and iberculosis was not above that 203 ; of rural Vermont, would you say that if one of those men J exposed to the degree of concentration that was involved j in those cases, which as I recall was sixteen million, had j contracted tuberculosis, would there have been any means j of attributing that to the industry, in your opinion? ; Dr. Willis: That is a hard question. I believe that unless you can illustrate that the concentration was auffi- cient to produce silicosis that it is only an assumption that that bad a deleterious effect oh tuberculosis. Again there is no absolute proof. Mr. Doe: Doctor, in your statement this morning and - now, do you use in making a statement you just made, the terms silicosis and pneumoconiosis as interchangeable? Dr. Willis: Pneumoconiosis would in that case mean silicosis. Yes. Mr. Doe: Assume a dust which contains less than 2% silica. From what you have just said I assume that the concentration might be very much higher with safety, than it could be if the dust contained 35% silica. Can one classify dusts into-silicotic and non-silicotic dusts by say ing that a dust that contains as little as less than 2% dust falls into the non-silicotic groups of.dust? Can you give us any guide as to the margin of safety in that group of . dust containing less than 2%? ! Dr. Willis: We can only cite the data available for j coal miners and cement workers. In other words, in coal ! miners the silica content is perhaps one and one-half per I cent and in cement it varies from one to about five. In | cement work the count is terrifically high. I think it was ! fifty million or so. When the silica percentage is low the ! dust count must be extraordinarily high to accord a hazard that a low count with high percentage would accord. Mr. Doe: Has any work been done with which you are familiar that gives any comparable result to the Barre | study of silicotic dust, with relation to non-silicotic dusts? I Dr. Willis: No, except these several pieces of work i that Dr. Russell has mentioned. : Mr. Doe: There are here a series of X-rays. 204 Mb. Tarrell: I want to ask Dr. Willis his qualifica tions as a roentgenologist Mr. Doe: I will ask you Dr. Willis, how many chest films do you see annually? Dr. Willis: I suppose about 3500. Mr. Doe: You are the director of a tuberculosis sana torium at present? . Dr. Willis: I am on the staff. Mr. Doe: How long have you been engaged in tuber culosis work as a specialty? Dr. Willis : Well, I should say since 1920. Mr. Doe: What did you do at Johns-HopkinB relating to this subject? Dr. Willis: Well, I.did a fair amount of experimental work on the question of anthracosis and silicosis in animals and I also, from time to time, saw clinical cases of pneumo i coniosis, and I wrote a review on the subject of pneumoco niosis, particularly as it relates to tuberculosis. As I said. I don't mean to qualify as an expert witness in X-ray work. I thought this was just a question of opinion. Mr. Doe: Yes. Now, Dr. Willis, what were the con clusions that you reached on the experimental work you did on coal miners? Dr. Willis: That inhalation of coal doesn't have any appreciable effect within the limits of experiments ; it does not produce any fibrosis of the lung and in animals -so exposed are not more susceptible to tuberculosis than other animals not so exposed. Mr. Doe : Your other study ? Dr. Willis: The other study was a study of silicon car bide produced by the factory which Dr. Clark represented yesterday. That was an experiment in which animals were exposed td inhalation of dust over three years and the re sults were essentially the same as those with the inhala tion of coal dust. 1 didn't know that this was going to be . taken as actual evidence in the case. ask Dr. Willis his qualifica- Willis. how many chest .bout 3500. irector of a tuberculosis sana- staff. e you been engaged in tuber- id say since 1920. do at Johns-Hopkins relating a fair amount of experimental racosis and silicosis in animals , saw clinical cases of pneumow on the subject of pneumocotes to tuberculosis. As I said, expert witness in X-ray work, lestion of opinion. r. Willis, what were the con n the experimental work you ^ ^ o n of coal doesn't have any limits of experiments; it does the lung and in animals so tible to tuberculosis than other idy? udy was a study of silicon car/ which Dr. Clark represented eriment in which animals were t over three years and the re ime as those with the inhala:now that this was going to be the case. 205 Mr. Taxrell: Before I consent to have your statement I want to ask some more questions. j Mr. DOE: I thought this might be of great interest to j have him tell us. Mr. T arrell : I thought 1 heard Dr. Willis say this morning, or two of the other doctors, that from X-ray alone you could not reach a conclusion. Now, I understand you propose' to submit an X-ray and have him reach a con clusion on th a t Mr. Doe : No, I haven't asked him anything about any films y e t Now, with reference to this man, Bruno Rhode, his age was 42, his exposure was six years, the silica con tent of the abrasive wheels which he used as a grinder was 1.5% and the concentration was 1.1 millions; this man undoubtedly has an active pulmonary tuberculosis. Now, have you anything to say whether there is any evidence on that picture of dust inhalation? That is one of the series which cover an interval of roughly one year--if you care to you may look at the entire series. Dr. Willis : In the first place, there is quite a good deal of diffuse fibrosis throughout the lung. There is evidence of spotty infiltration in several places with questionable cavitation which would certainly indicate a tuberculosis. These diffuse fibroses and shadows are not the common ; finding in an ordinary tuberculosis. How old is the man? i | Mr. DoE: Forty-two. i Dr. Willis: He has been occupied at the job six years? j Mr. Doe: As a grinder. ! Dr. Willis: Before one could pass on that one would certainly want to know a good deal more about the man's previous occupation and previous history, that would all come in. The fact is as Dr. Russell brought out, from i the film alone you cannot arrive at an ultimate conclusion, - because it is one of several bits of evidence, but it looks like there is tuberculosis there. There is this interesting ; fact too, that these shadows here in the course of a year ; haven't changed as much as you might have anticipated if : that were tuberculosis superimposed on a silicosis. The 206 two films are not quite comparable and that brings up also the question of absolute reliability of films. Mr. Doe: I show you another film, Dr. Willis, this was taken on March 10, 1932. MR. Tarrell: Which case is that, Mr. Doe? MR. Doe: This is the Prahl case. Dr. Willis : In this first film there is very definite evi dence of tuberculous infiltration with cavity in the left upper and With quite a bit of diffuse areas of presumably tuberculosis. In a film like this here there might have been at an earlier time, some other markings, but the tu berculosis has supervened. It is awfully difficult to pass on the other markings and I wouldn't want to make an absolute statement as to whether all this below and on the other side is tuberculosis or is an occupational infil tration. Mr. Doe: That is all. Mr. Tarrell: No questions. MR. Doe: I would like to ask Dr. Gardner some more questions. I would like to ask you. Dr. Gardner, whether in the case of inhalation of dust containing less than two per cent silica, do you believe you can assist us any on the question of whether there is any necrosis such as described in the silicotic nodules? Dr. Gardner: In none of our studies has there been any necrosis except in the case of free silica. Mr. Doe: Does that have any bearing on the conclu sion of the relationship between non-silicotic dusts and tu berculosis in your opinion? Dr. Gardner: It has always been my belief that the necrosis produced by silica was responsible for the sus ceptibility to tuberculosis. That is at the present time a hypothesis, however, and one on which we are working to attempt to prove this association. Mr. Doe: That is all. \ ble and that brings up also m liiity of films. >ther film, Dr. Willis, this was e is that, Mr. Doe? ahi case. film there is very definite eviation with cavity in the left if diffuse areas of presumably e this here there, might have le other markings, but the tuIt is awfully difficult to pass I wouldn't want to make an hether all this below and on .is or is an occupational infil- ons. :o ask Dr. Gardner some more ask you, Dr. Gardner, whether dust containing less than two ^^kyou can assist us any on the ^ K y necrosis such as described of our studies has there been ase of free silica. ve any bearing on the conduveen non-silicotic dusts and tu- lways been my belief that the : was responsible for the susThat is at the present time a me on which we are working sociation. j . j ! I :i 207 Fred M. Wilcox, Chairman, Industrial Commission of Wisconsin: To have had an opportunity to give intensive and sustained consideration to a subject of this kind as we have done is just another demonstration of how much better it is than to have to submit these issues in court to a jury made up of the butcher, the baker and the candle stick maker. I need not say more. I urge upon you who represent industry, you who represent insurance carriers and all those who are interested in the administration of workmen's compensation to keep in touch with the men who have been here, and to remember the counsel of Mr. Cummings and Mr. Bloomfield and the doctors as to the many things we ought to have in mind when we make our studies. When we do undertake a study let's tabulate everything that is available. And there is another thing that I wish to impress upon you because of the delicacy of the situation. Families of deceased workmen do not want post mortem examinations. After all when death has overtaken an employe who has been exposed to a condition which may or may not produce silicosis, or perhaps a superimposed tuberculosis, we should do our best to dissuade the family from the feeling that they have and prevail. upon them in the interests of a better understanding of this whole subject to consent to a limited post mortem examination,--at least of the lungs. Too often when these matters are in issue we play on the feelings of the families to induce a settlement of a case by compromise. Rather than go through the post they settle. It should be approached from an entirely different point of view,--the interest of all in a better understand ing of the effects of our employment. We have just got to take a firm, yet sympathetic stand. Thanks again for your attendance and your contri butions. 208 Appendix A BIOGRAPHICAL SKETCHES Dr. Leroy U. Gardner was graduated from Yale Col lege and from the Yale School of Medicine, receiving de grees of B. A. and M. D. in the years 1912 and 1914 re spectively. He spent three years in post-graduate study of pathology under Dr. P. B. Mallory a t the Boston City Hospital, and during the last two years of this period he was also ranking instructor in pathology at the Harvard Medical School. He then accepted a position as assistant professor of pathology at the Yale School of Medicine, when it was being reorganized by Dr. M. C. Winteraitz. After a brief period of teaching there, it was necessary for him. to come to Saranac Lake. As soon as his health would, permit, he became associated with the Saranac Laboratory for the Study of Tuberculosis. In 1919 they started ex perimental investigation of the study of the inhalation of dust as a predisposing factor in the production of tu berculosis. These studies have been in progress since that time. In 1928 he was made Director of the Saranac Labora tory, and since that time they have expanded their work in the held of pneumoconiosis, associating themselves with others in various parts of the country who have been simi larly interested. Today the whole Laboratory is organized for the investigation of this problem and they are devoting the major portion of their time to it. Mr. Donald E. Cummings was graduated from the U. S. Military Academy in 1920 and entered a School for the Instruction of Officers, as a first lieutenant, immediately following his graduation. He remained in this school for one year, at the end of which time he resigned and entered the Massachusetts Institute of Technology. He was gradu ated from this institution in 1923 with the degree of B.S. in chemical engineering. He then accepted a position as instructor in the Massachusetts Institute of Technology under Dr. Warren K. Lewis. It was then necessary for him to come to Saranac Lake and after recovering his health he became an instructor in physics and chemistry  . SKETCHES graduated from Yale CoV1 of Medicine, receiving de he years 1912 and 1914 re bars in post-graduate study Mallory at the Boston City two years of this period he , pathology at the Harvard pted a position as assistant ale School of Medicine, when >r. M. C. Wintemitz. After .e, it was necessary for him. .s soon as his health would vith the Saranac Laboratory In 1919 they started ex he study of the inhalation tor in the production of tu been in progress since that ector of the Saranac Laborahave expanded their work in associating themselves with country who have been simi- le Laboratory is organized >lem and they are devoting le to it. /as graduated from the U. S. ad entered a School for the first lieutenant, immediately remained in this school for time he resigned and entered ; Technology. He was gradu1923 with the degree of B.S. : then accepted a position as etts Institute of Technology . It was then necessary for Ice and after recovering his tor in physics and chemistry 209 in the high school at Saranac Lake for two years in order to assure his complete recovery. Early in the year 1928 he became associated with Dr. Gardner in research work, dealing with pneumoconiosis in the Saranac Laboratory. He has been made Assistant Director of the Saranac Lab oratory and has continued research work in pneumoconiosis until the present time. He has been a Consultant in the U. S. Public Health Service under Dr. Leake, and at present, an instructor in the Trudeau School of Tuberculosis. He is a member of the National Tuberculosis Association, American Chemi cal Society, and a special committee of the American So ciety for Testing Materials. He has had an opportunity to make several field investigations in industries having a known dust hazard. Dr. H. S. Willis graduated from the University of North Carolina in 1914, obtained his M.D. a t Johns Hopkins Uni versity in 1919, and his M.A. at the same University in 1920. From 1919 to 1922 he was Assistant and Instructor in Medicine; from 1922 to 1928 was Associate in Medi cine; from 1928 to 1929 was Associate in Clinical Medicine; from 1929 to 1930 was a lecturer in Clinical Medicine at Johns Hopkins University. In 1929 Dr. Willis was placed in charge of Dows Tuberculosis Laboratory of the Johns ' Hopkins Hospital, and during the period of his connection with the University was Assistant Visiting Physician and Dispensary Physician at the Johns Hopkins Hospital. From 1928 to 1930 he also conducted a general practice in ' the City of Baltimore. In 1930 he came with the Wm. H. Maybury Sanatorium, which is the Detroit Municipal Tu berculosis Sanatorium, at NorthviUe, Michigan, aB a pathologist. He has done a volume of clinical work in in ternal medicine and tuberculosis, and several years of experimental work on tuberculosis and pneumoconiosis. He has made numerous publications on these subjects in the American Eeview of Tuberculosis and in tbe magazine Medicine. At the present time he retains his connection with the Maybury Sanatorium, where he is still pursuing clinical work in pneumoconiosis in conjunction with his other duties. 14 . 210 Dr. W. Irving Clark received his medical education a t Columbia University, New York City, where he received the degrees A.B. and M.D. Following this he served as interne a t the Roosevelt Hospital, New York City, from 1904 to 1906. Moving to Worcester, he became connected with the Worcester City Hospital, where he worked on tuberculosis in the out-patient department and later became the Secre tary of the Worcester Tuberculosis Relief Association which carried on active field work among the tubercular pa tients in Worcester. He was later appointed assistant surgeon a t the Mem orial Hospital, Worcester, and in his private practice he did considerable chest work, dividing his time between this and genera] surgery. ! During the war he served overseas with the American Red Cross and later as Captain of the Medical Corps of the United States Army. In 1911 he was appointed in charge of medical service of the Norton Company, Worcester, a large manufactory of artificial abrasives, grinding wheels and grinding ma chines. He has been connected steadily with this institu tion until the present time and has made a special study of the effects of the inhalation of abrasive dusts on the lungs of the workmen! These studies have been published in four papers'on the Dust Hazard in the Abrasive Industry. Dr. Clark has also written an article on the effect of inhaling artificial abrasive dusts for Occupation and Health Encyclopedia of Hygiene, published with the Inter national Labor Office, Geneva, Switzerland. He has also published an article on Industrial Medicine in the Oxford Medicine, and a similar article for the Nelson Loose-Leafe Medicine. Since 1919 he has been connected with the Harvard School of Public Health, first as an instructor in Industrial Medicine, and for the last two years as assistant professor in the same Subject. Mr. Bloomfield was graduated from the University of New Hampshire in 1920 with the degree of Bachelor of Science in Engineering, and immediately after graduation 211 became affiliated with the United States Bureau of Mines at the Pittsburgh Experiment Station. During the three- year period at the Bureau of Mines, Mr. Bloomfield con ducted extensive studies on problems related to toxic gases, fumes and dusts. A considerable portion of this time was devoted to the development of protective devices for use in contaminated atmospheres. From April, 1923, to the present date, Mr. Bloomfield has been attached as Sanitary Engineer to the Office of Industrial Hygiene and Sanitation of the United States Public Health Service, devoting his entire time to prob lems dealing with the industrial environment as related to its effect on the health of the worker. The health haz ards associated with radium dial painting, lead storage battery manufacture, the use of tetraethyl lead gasoline, chromium plating, and the pneumonia problem in the steel industry are a few of the problems which Mr. Bloomfield has been engaged on during the past ten years. The larg est portion of his time, however, has been devoted to studies of the dust hazard in various industries. Mr. Bloomfield has conducted detailed studies of the dust ex posure of workers in connection with every one of the many dust studies carried out by the United States Public Health Service, and is co-author of the Bulletins issued to date on the studies of the health of workers in the cement and granite cutting industries. He was also affiliated on the study of the dust hazard in the sandblasting industry, which was conducted jointly by the United States Public Health Service and the National Safety Council. In addition to the studies concerned with the nature and concentration of dusts in industry, Mr. Bloomfield has also made many studies on the efficiency of dust removal de vices and other equipment used for the protection of the worker. Mr. Bloomfield is author or co-author of more than 30 papers on various subjects pertaining to health hazards in industry. . Following the graduation of Dr. Albert E. Russell from Medical School he became Resident Physician of the Waverly Hills Sanatorium at Louisville, Kentucky, in 1918, 212 which position he held until 1919. He then entered the em ployment of the United States Public Health Service as a member of the Staff of Service, Hospital No. 26. at Greenville, South Carolina, where he remained in service, specializing in the treatment of tuberculosis during 1920 and 1921. From 1922-23, inclusive, Dr. Russell acted as Assistant Chief of the Tuberculosis Hospital Section of the U. S. Veterans' Bureau. From 1924-30 he was in charge of field studies as to the health of workers in dusty trades for the United States Public Health Service. In 1930 he was appointed as official representative of the United States a t the International Silicosis Conference at the League of Nations at Johannesburg, South Africa, of which he acted as Vice-Chairman. In 1930 he became Chief Surgeon of the U. S. Bureau of Mines. Dr. Russell has made numerous contributions to medical magazines, and has written many reports for the U. S. Public Health Service, covering particularly the field of pulmonary diseases and more specifically those diseases. resulting from the inhalation of dust 1919. He then entered the em > Public Health Service as rvice, Hospital No. 26, at where he remained in service, :t of tuberculosis during 1920 .nclusive. Dr. Russell acted as >erculosis Hospital Section of i. From 1924-30 he was in the health of workers in dusty *s Public Health Service. In official representative of the ational Silicosis Conference at ohannesburg, South Africa, of airman.- In 1930 he became Bureau of Mines, terous contributions to medical .1 many reports for the U. S. ering particularly the field of ore specifically those disease m of dust. I ! 213 Appendix B LIST OP PERSONS WHO ATTENDED CONFERENCE CON . CERNING EFFECTS OF DUSTS UPON THE RESPIRATORY ! SYSTEM HELD BEFORE THE INDUSTRIAL COMMIS- | SION OF WISCONSIN AT CHICAGO, ILLINOIS, ON NOVEM BER 16-17, 1932. ' Butinea ; Nuntt AJJreis Pmjcsstcm Connection Andrews, Asa A---- Chicago, 111........................................Lumbermens Mu tual Casualty Co. Atkinson, F . ...........Milwaukee, Wis............ .................... Liberty Mutual Casualty Augst, R. A ............Montreal, Wis..................... ..............Montreal Mining Co. Banyai, Dr. A. L .. . Milwaukee, Wis. Physician.............Clinic Director, . Muirdale San. Belknap, E .L . M.D.281 W. Wis. Ave. Medical Director Globe Union Mfg. Milwaukee, Wis. Co. Beilis, Dr. G. L____Wauwatosa, Wis.............. .................. Supt. Muirdale San. Berlin, Dr. D. S.......Chicago, III___________ ________ .Augustine Heap. Biever, E. J _______Kohler, Wis------- Mech. Engineer .. Kohler Company Bloomfield, J . J ___ Washington, D. C--........................... U. S. Public ' Health Service Britton, Dr. J. A ... Chicago, III..........Medical Director International Harvester Co. Brown, Wm. E.........Milwaukee, Wis. .Lawyer.................Allis-Chalmers ' Mtg. Co. , Clark.Dr. W. Irvine Worcester, Mass..Physician______ Norton Company . Harvard School j Cottingham, M. D. Kohler, Wla......... Medical Director KohlerCompany I CummingB, D. E.. _.Saranac Lake, , N .Y _________ Ass't Director Saranac Lab. J DeBloia,Lewis____ NewYork.N.Y. ______________________________ i__________ DickBOn, L. E _____ Chicago, HI---------------------- ------ .Standard Equip ., m ent Co. ; Dobbins, Dr. Thos. Kenoaha, Wis.___; ........................... N ash Motors Co. ' Doe, Arthur B.......... B25N. Broadway, Lawyer.................Employers Group i Milwaukee, Wis. Earlywine, 1. L .___ Chicago, n i____ _____ _________ ________________ French, G. E_____ Chicago, HI--------------- --------------.Liberty Mut. Cas. ' Ford, Dr. W B.___ Milwaukee, W is.. Physician............Ass't Chief T. B. Div. Health Dept *214 fiutino! Sanu AJdrsts Profusion Connttnon Candrey, A llnd R. Milwaukee. Wl*. .Law yer.................A u 't City Ally. Nowak, C. A............Chicago, 111.......................................... III. Ind*. Com. O'Malley, Dr.T. S. 238 W. Wi. Ave., Surgfon............................................... Milwaukee, Wi*. . Ogd.n. Dr. C. H ... .Chicago, III.............. ......................HI. Steel Cu. O t|en,C .J. Milwaukee. Wia. .A ttorney..............Liberty Mutual Ina. Co. Pa/riah. L. J ............MMwaukee. Wla................................... A. 0 . Smith Corp. Pltrport, Dr. D. C. .Ironwood. Mich........................ ..... ..Plekanda, Mathar Co. Rtid. M. A.............. Hurley, Wlt.......................................... Montreal Mining . Co. tOdanah Iron Co. Reynold!, Paul T. . .Cleveland, Ohio.................................. Montreal Mining Co. Ringo, Dr. U. F.......Montreal, V ii......................................Montreal Mining Co. Rueaell, Dr. A. E__ Waahiogton. D.C. Surgeon.........'...U .S .P ublle Health Sendee Sander. 0 . A............300 Empire Bldg................. ............ Employe Mut. Milwaukee, Wia. .. Seppingfon, Dr. C. 0.. .. .Chicago, III........ Cunoullanl . . Ind. Mod. Sehloroovtat, W. fieni. H.......... 210 Empire Bldg.. In tern et Milwaukee, Wie. Sector. Jam** M....Milwaukee, Wlt..................................Employer* Mut. Story. H. W............. Milwaukee. Wl*..................................Allla-Chalmer* Tarred, L A............ Milwaukee, Wl*. .A tto rn e y ......................................... Tharinger, E. L.___Milwaukee, Wlt. .Palhologiat............. ..................... Warfield, Dr. t Louit M............... Milwaukee, Wl*. .In tern lat............ White. Wm. W........Cleveland, Ohio..................... '.......M o n tre a l Mlnlnt . Co. WIIeoa, F. M........... Mtdiaon, Wi*........Chairman............. Wla. Indue. Com. Willi*, H. S...............Detroit. Mleh...................................... Detroit Publie Health DepL Ooldtchmidt, W. J. Milwaukee, Wit. .A tto r n e y ....................................... a n e i,O r .S .3 ...... Chicago. Ill........... Medical DJreelor 111.Indu*. Coro. Gray. A. W............. 324 E.Wla.Aee., Medical..........,, ..PrivatePrtctlee . Milwaukee, Wl*. 213 Vamr Asklrtu Pioftuian fiuttneat Cunnecnon Guillen, F.............. Chicago, III......................................... Eye Shield Co. Guire, Peter, Jr.. ..Chicago,III......... Commiaaioner....lll. Indu. Com. Ilahhe, Dr. J. E...... Milwaukee, Wit. .Roentgenologltt.................................. Ilensel, H. 0 . . . . . Chicago, III..........Solely Director ..Y ouncitow nSht. & Tune Co. Huth,GordonC. ..Chicago,III.. .. ................. ..U nivertalA tlas Cement Co. Ireland, Walter__ Kohler, Wit.. . Employment Mgr.Kohler Co. Jenter, W. W..........Milwaukee, Wla............... ...............Seaman Body Corp. knutson, R. G........ Madlion, Wia.....Member...............Wis. Inaut. Com. Kuechle, B. E.......... Bot j ; , Wausau, W it................ Inaurane........... Employer* Mut. Kuhn, Dr. Leroy P.. Chicago, 111....................................... Lumbermen* , Mut. Cos.Co. Lavlch, J. L............ Chicago, III.......................................Lumbermens Mut. Cas. Co. Lols. O ta r ....... 324 E. Wit. A, Medical...............Private Practice Milwaukee, Wl*. McIntyre, M. D. Cleveland, Ohio.............. J .. . . . . ..Plekanda, Mather Co. MeLaren, U r .J .ll.. A|i|iltlun, Wia... Phytlclan........C hiefSurgeon, . ` Kimberly-Clark Curp. Mellum, H .J. . Kemwlia, Wla. . .. . . Naah MnlnraCu. Mitoelavich, Dr. . ` - Edw. L................ Milwaukee, Wia.. Palhuloglel........... . ................ Ne.laon, Harry A.. Madiann, W it.....Director, Work* - , men's Cemp^ Wie. Indu*. Com. WrabeU, V o y u .. .Madison, Wis...... Memocr................Wls. Indus. Com. Wright, C. B...........Minneapolis, Minn................In tern ist.................... ...................... Zinn. fi. r . ..............IraamaaJ, tieh................................. Plekanda, Mather Co.