Document Qkzg7eegbv2gdZe7qr7G82YRL

1934 NSC Id f? Before experimenting with fancy methods for the pre vention of occupational der matoses. why not try simple methods of personal and e n v i r o mnental cleanliness ? Try Clean liness First By W. R. REDDEN, M. D. BwUf\ \Vi<ahr<iciMtam Co. {\ , ;:S ANY employees suiter from skin ; H affections because of contact " ' with cutting oils, dust and other irritants. In fact, industrial dermatoses head the lists of industrial diseases when ever reported. Yet the real trouble may Le dirt--both the ordinary dirt that we recognize as "dirty" and the general kind that is merely "matter out of place." My own study and the experience of numerous industries convinces me that in many cases the best preventive is keeping clean. Personal and environ mental cleanliness has definitely cut down the number of cases of dermatitis sskin inflammation! with only simple and inexpensive measures based on soap and water. Of course, many circumstances give rise to skin irritations (dermatoses) but they are all subject to similar principles of origin and control. For instance, many young persons of adolescent age sutler embarrassment and distress be cause of greasy skin, blackheads and pimples. These skin conditions are the result of radical rhanges going on with in the body as the child develops into an adult. An examination of more than a million * Dircf'tur, KMrst Aid. X`*w York <'mutty * "h;i inAmuriiNin Keri c1rn<j=. FEBRUARY. 1934 persons from 14 to it) years of age in England during the period 1922-25--as these boys and girls came up for certifi cates of fitness for work- shows that for every 100 reasons given for condi tional and definite rejection, .54.71 were for skin disease. A large number of these adolescents reach adult life with a skin particularly sensitive to external and internal reactions. !.n other words, there is an individual variation and sus ceptibility to skin reactions, irrespective of the cause. Skin irritation and skin diseases are nmmon to all who rub in dirt, grime, or other foreign materials. After years of traveling, we, who have a normally clear skin, find that we have many blackheads about the nose after a whole day on a train, especially in warm weather. After a number of years of observation, we find that the ordinary dust and dirt which is stirred up in train travel lodges on the face. We rub it in a hit - and the dirt clogs the oil gland openings. This causes itching. In i reused rubbing or even scratching on our part almost invariably results in a i rop of blackheads and pimples about the nose, \s surgeon to the hotels at Yellow time Park for a number of seasons, we had occasion to treat 300 nr 400 patients with boils during a four months' sum mer season each year - chiefly among bus drivers and the group of 85 or 90 motorcycle patrols who regulated traffic. We were well aware of the fact that these boils had no relation to bad blood, since years before it had been demon strated that boils were an infection of hair follicles. This infection was due chiefly to dirt and bacteria that had been ground or rubbed into the open ings of hair follicles where they caused an irritation which was relieved by scratching with finger nails or by the part of the garment in contact with that part of the skin. What are some of the factors in the development of industrial dermatosesr1 Anything from hot water and mild soap, which are harmless, to pitch, tar, and arsenic, which are definitely poison ous. may cause a skin irritation with resultant inflammation if these materials come in contact with the skin in suffi cient quantities over a sufficient length of time. It is well known in medicine that if ,t person is exposed to certain substances repeatedly, at first nothing may happen to the skin or to the body in general, oui gradually or even rapidly this re peated contact may make the skin or body sensitive to the material and result 16 in a dermatosis or even a general body reaction. This might well be the case with workers in sugar, gardeners who handle hyacinth bulbs, or even house wives who fondle the beautiful blooms of the Japanese primrose. We are speak ing of specific cases which have been personally observed. It is quite possible that certain persons who suffer from "rubber itch." "bakers' itch." etc., might fall under this group, even though we know that at least the hexamethylenetetramin used in the rubber industry is of itself toxic. Individual Susceptibility Season, temperature and humidity, working conditions, and kind of skin piav an important part. It has been observed that when workers in industries in which cutting oils or dust of various kinds are found, become soaked with perspiration, there is an increase in dermatoses; and that dry-skinned per sons and persons troubled with excessive oil 'seborrheal are more susceptible than normally oily - skinned persons. Probably part of the answer in regard to heat and perspiration lies in the fact that more dirt is taken up by the perspi ration; that the person in an attempt to keep the sweat out of eyes and off the hands, brushes his hands and arms acros> each other, across the forehead and the hark of the neck, thus rubbing in the dirt. If the substance is toxic in itself, so much the worse. Moreover, if work clothes are filled with dust and dirt, then become soaked with perspira tion or oil. every movement of the body us well as the rubbing with the hands grinds in the grime and irritating sub stances. Apparently the oil on the skin is the first line of defense against irritants and other dermatoses producers. I fence, if the natural skin oil is frequently removed by gasoline, benzine, kerosene and other grease solvents, the skin becomes dry, harsh, and cracked, and the first barrier to dermatosis is destroyed. The same holds true when pumice, harsh and abra sive cleaners, and stiff brushes are used. That this natural skin fat is an important factor in the prevention of cancer is indicated by the following: 1,.molin applications to the skin alternated with synthetic tar delayed tumor development. Where hmntm was applied twite as utter., cancer did not appear. The -ivnthetir tar used was many times mure potent than sh.de oil, the most dangerous com mercial ml. f'he occupational dermatoses are not primari ly caused hv iiifmmri uf the skin, when the skin becomes irritated, when haetem from the skin are carried bv dirt, grease, uori-poisonuus or poisonous substances in the openings about the hairs, the way is open for infection. When itching causes scratching with bacteria-iaden finger nails, ut rubbing with dirty hands, arms, or clothing, the skin is broken and germs find an open door to a fine incubator. SVhen the skin is wiped with coarse burlap, waste, or cloths which contain minute particles of dirt and metai, or when a skin covered with oil and dirt is rubbed with clean waste or dean cloths, the surface is broken and the greatest defense of the skin against infection is destroyed. With these preliminary statements we are now ready to consider the preven tion of dermatoses and their control in industry. Obviously, for materials like acids and alkalis, including chromium, which destroy the skin oil and skin, there are two answers: provide closed equipment wherever possible: provide workers with adequate protective covering. In other words--keep these skin destroyers off the skin. Require a pre-employment physical examination for every applicant and a periodic examination of all employees when there is to Ire an exposure to a known toxic substance. Exclude those with skin disease. In the case of paraffin workers, there should Ire a daily skin examination. Do a patch skin test on all who are to be exposed to toxic materials and also on all who develop 'a dermatosis during employment. The skin patch test is simple. Soak a piece of sterile gauze about one inch square in a solution of the substance to be tested: apply this to the skin of the inner surface, of the forearm and hold it in place with adhe sive and allow it to remain 24 to 4S hours. Redness at the end of this time indicates a positive reaction. I crop of small blisters indicates a more positive reac tion. N'o special change is a negative. Avoiding Contact Whenever it is evident that a worker has it susceptible skin, whether this is due to a systemic condition, to a natural dryness of the skin, or to sensitization of the skin following repeated exposure, the person should he transferred to a non-exposure task. In addition, it is important to keep as much of this toxic material as possible away from contact with the worker. This is done by use of a dosed process as far as this is possible and by the use of protective materials such as gloves, aprons, snug fitting clothes tight at neck, wrists, waist and ankle. ft is just as important to remove these substances as rapidly and as effectively as possible from the skin. An illustra tion of how the American Cyanamid Company solves its problem will help. It was found that the most satisfactory results were obtained as follows: 1. Workers change from street clothes into dean work clothes at the beginning of the day. 2. They bathe thoroughly before leaving the plant. :>, They make a complete change of work clothes from the skin out after the wash-up. 4. Men unloading cars of evanamid are fur nished with dean underwear and outer clothing. 3. Soap dispensers were installed in the locker rooms containing the following solution: Glycerine ............................ 96u grams Alcohol .............................. 69 J grams .Salicylic Acid ..................... >40 grams This solution is applied to the face, neck, wrists and hands after bathing and seems to keep the skin soft and pliable. 6. Plant hospital records showed 221 cases of dermatitis treated during 1920. During the next year, after the above system was put into effect, only 29 cases were treated, and these fell within the first five months. Fungus Infection Fungus infection has claimed more and more attention during the past few years, because of publicity given to cures for so-called "athletes foot". This has been helpful to industry because it has unearthed cases of dermatitis due to fungi. Since the United States Public Health Service estimates that as high ns SO million people in the United States have this ringworm infection each year, it is obvious that many of these wises must appear in industry. Recently it was recognized that ,i person with ringworm infection in one part. like the toes, may develop a derm atitis elsewhere without spread of the infecting agent to that part. In . it her words. a toxic substance may cause this distant dermatitis. Fungus forms of dematitis have not been studied suffi ciently to warrant further discussion at this time, but this form should be kept in mind when dermatoses are considered. Before you try any of the innumerable methods for the prevention of industrial dermatoses, give the simple methods of personal and environmental cleanliness a thorough trial under adequate super vision. Then add to these the proper handling of oils for re-use. For cutting oils and compounds, then, the primary preventive measure rests squarely upon supervised washing with a mild soap, a soft individual scrubbing brush, running hot water, and the use .if a personal towel. To this we add, wear leather aprons to prevent abdominal irritation and wear a simple, clean band about the forehead ,->uch as is used by tennis players to keep perspiration from pouring down into the eyes and to prevent contact of the arm NATIONAL SAFETY NEWS 17 or xiileti hand to wipe away this pers piration. Such a procedure calls for plenty of clean protectors made of old. Hift. doth. Keep all work clothes dean and dry. The frequency of washing the clothing will depend upon the amount of contact with dirt, oil, or perspiration. Some groups have found it pays to set up a laundry equipment to handle under clothes and outside work clothes and the towels of the employees. Washing Facilities < crtain it is that work clothes should always be. changed for street clothes, etc., and should be kept in locker rooms where they will thoroughly air and dry. The re-used oil should be freed from metallic materials and should be steri lized. The workers should be taught never to use waste to wipe oils from the hands because waste contains bits of metal and dirt which may break the skin and open the way for infection. It has been found that a magnet will pick up plenty of such particles when the skin is wiped with waste. The workers should be taught to rinse off the oil, etc., under running hot water with the use of mild soap rather than to use the cutting compounds for cleansing purposes. This holds true for the use of kerosene, gasoline, etc. as be fore mentioned. Dr. Gray.* Director of the Bureau of Industrial Hygiene of ( onnecticut, says. "We feel that if proper washing-facilities are provided and someone of authority be delegated to see that they are used, that oil dermatitis can be readily con trolled. "Dr. Taylor. Director of the .Medical Department of the General Electric Plant of Bridgeport, has eliminated oil dermatitis from the plant by insisting on proper washing and banishing harsh cleaners and abrasives from the wash ing rooms," The purely mechanical action in plug ging skin openings, causing a backing up of skin oil with distension of the oil ducts and subsequent irritation is well illustrated by zinc oxide. This non - toxic, non - irritating sub stance causes what is known in the in dustry as "zinc pox". Just as with other dust that is rubbed into the skin open ings, zinc oxide causes itching and as the dust is rubbed into the gland ducts it carries with it body dirt, waste and bacteria. The itching results in scratching with *!>r, Albert F <Srav, -*>nal ctiminmi lent ion, FEBRUARY. 1034 11. 1 !S1. dirty finger nails or rough, soiled cloth ing. Frequently, a purely mechanical irritation is turned into a secondary in fection. The gland ducts plugged with dirt and skin waste offer a splendid chance for bacterial development in an incubator with automatic control. When the tops of the pimples are sc ratched off and the material is squeezed out. itching is relieved. The condition is found most frequently in the pubic region, scrotum, and inner surface of the thighs; that is, where there is continuous exposure of the body and clothing to zinc oxide during work periods. This is aided by free perspira tion (greater in parts of skin rubbed together). The prevention of this type of derma tosis is simple: 1. Exclusion of rmc oxide dust by using a dosed system as far as possible. 2. Lise of special work clothes--close weave, snug neck, wrist, waist and ankles. s. Frequent cleaning of work clothes. 4 Thorough washing of muslin and collect ing bags before they are mended. x, Provision of adequate and suitable bathing facilities so that workers sail bathe at the end ot the work day. 0. Instruction of the workers m personal hy giene which rt-allv amounts to instruction in personal cleanliness This matter of personal cleanliness is the prime factor in prevention, for even the workmen themselves say that the disease depends entirely upon personal cleanli ness. and that it they take a daily bath there is no trouble. " Reporting of the skin disease should he made compulsory. K. Bathing should he tinder supervision and a serious attempt should he made to develop an esprit de corps among the workers that will automatically swing new workers into line and beep old workers in line. General Preventive Measures Because dermatoses form such a large proportion of all occupational diseases and are often disabling, one should be familiar with at least the more important occupations that are exposed to skin irritants. Complete lists are almost impossible because almost any foreign substance can become a skin irritant if it is in continuous contact with the skin. But it is .always possible to have in chart form a complete listing of all chemicals used in your plant. To this list should be added a complete chemical analysis of all new materials as they are intro duced into old or new processes. Against such a list, it is then possible to ' heck up on the substances that are known irritants or that are known to t a use dermatoses. Substitute a non irritating substance for a known irritant wherever possible. Give the worker every possible pro tection against contact with a known irritating substance. In addition to the use of protective clothing, the length of time of exposure each day should be reduced by a system of alternation of work wherever this is possible. Provide for cleaning down machines, walls, benches, and other surfaces. Make this cleaning frequent enough to keep the equipment and the air as free as possible from scatterable dust and to re duce to a minimum the contact of the worker with oils, dyes, and other sub stances used in the operations. Make doors impermeable and keep them clean. Paint walls so they will show up dirt and so they can be thoroughly cleaned and have them cleaned regularly. Wherever possible, have machinery painted to show up oil and dirt, and keep it clean._______________________________ I'nt the workers in washable uniforms provided by the company and laundered by either the worker or the company. The American Rolling Mill Company tried this out with men handling sheer metal- and found it paid. Have adequate handwashing and other toilet facilities readily available in com fortable places and provide ample shower heads to take care of peak loads. Either supply soap and towels, or provide a routine whereby each worker has his own. if a scrubbing brush is indicated, make it a part of required equipment but be sure brushes are not harsh. Supervise handwashing, bathing, and the change from street clothes into work i iothes and work clothes into street clothes. Put. all toilets, washrooms, and locker moms in charge of a cleaner who does nothing but keep equipment and rooms * Dan. Many plants have used for years a "worker scrubber" who handles humans as laundry instead of clothing. These m rubbers scour the skin of workers who have been exposed to dirt, dust, or oils during the work day. Give the workers sufficient time for the routine clean-up on company time; you will find it does not take long once a svstem is established. You will find :hat reduction in lost time will more than pay for the effort. Before you try fancy methods for the prevention of industrial nr occupational dermatoses, try the simple methods of personal and environmental cleanliness, for there is no industrial disease that can be prevented and even cured to a higher degree by this simple method.