Document Rp46ZQmE3E41Ro85kRvr4z8na

t, * * * V, r- / *' / \\ AIR HYGIENE FOUNDATION OF AMERICA, Inc. V FIFTH ANNUAL MEETING.OF MEMBERS PITTSBURGH. PENNSYLVANIA NOVEMBER 12-13, 1940 01100 mr-547 ..ir . A* . ( r- The enclosed Proceedings o f the Foundation1a f i f t hI t annual meeting is in the naturo o f a " to x t book" on in d u s tria l hygiene. is doubly inpor< te n t now when the health o f workers is os v it a l as health o f s o ld lo rs . The Proceedings is an "annual re p o rt" to your company on what the Foundation has 1 a o o XX 4 4 o' XI u s5 as C > n 01 4* Q 0. ae. o xt nto 4o*j| a a SE a o 4* O IS a a a o -r* U 4* .0 4* 4* its 3 a o X a PS 4* *3 Oo 3Vi -a> 9_ O 4* O 1-4 -r4 O -5 tn H -P h. *o* o a 0 Vi > 4* 0 0 Oh *0 *0 * a a m 2 1 S a i3 0. s Ko s a 3 a CO .0 0 a o 2 p. H 4d* r4 K 0H 4* aa o0o ao ^ S4 o 0O 0O *4 4 gg a s p. S' Q s a 2 *8 00O e a O a 4>*4 ag. .0 4* N a0 XX 01 H 9 a 04 s 0 0 *O5 O -4 St a a a 0 0 oo S . VI <o A Sg > o-4 O00 w O w W o 0O 19 . foe d0. "* - 0 xs jb 4* 0co CO 44 0 ?8 4* 4 P. aos0 0 PROCEEDINGS OF FIFTH ANNUAL MEETING OF AIR HYGIENE FOUNDATION OF AMERICA. INC. NOVEMBER 12-13. 1910 % 01102 r <* r \ iimii r~ i *`* - CONTEXTS Introduction-- Rogir A. Hltchina ................... Foundation Activities in 1940-- H. B. Metier _______________ Report of Membership Committee C. E. Ralston.....-...... -........... Report of Preventive Engineering Committee-- Philip Drinker Foundation Researches at Harvard Universit}'-- Significance of Particle Size in SilicosisControl of Fumes and Cases from Are Welding vrith Coated Rods --_:-------------------------------------------------------------------------Design of Lateral Exhaust Hoods for Industrial Tanks...,. Pace 1 10 12. Report of the Medical Committee-- A. J. Lanza, M. D.______________ 17 Foundation Study of Sick Absenteeism in Industry- Dr. W. M. Gafafer......--.... ............. ....... . 20 Foundation Research at The Saranac Laboratory- Individual Susceptibility to Toxic Dusts-- Leroy U. Gardner. M. D. ............... 28 Foundation Research at University of Pennsylvania- Further Developments of the Observation of the Reaction of living Tissue to Silica Granules in the Living Mammal Eliot R. Clark, M. D. and Darrow E. Has gens S8 Discussion ....... ............ .. 39 Review of Recent Occupational Disease Legislation-- Theodbre C. Waters _____________------------ 42 i Activities of U. S. Public Health Service bt the Defense Program-- P. A. Neal. M. D 88 Health of Electric Arc Welders in the National Defense Program- Cordon G. Harrold, Ph. D: Stuart F. Meek, M. D; and Carey P. McCord. M. D.; 83 Industrial Hygiene and the Nary in National DefenseCaptain Ernest W. Brown (MO U. S. X.------------------------------------- 77 Absorption and Excretion of Volatile Solvents-- Howard W. Haggard. M. D.____ __ -..... ..... ....... 85 Health Requirements on Government Contracts, Including Importance ' of Good Working Standards in National Defense, ana Health Requirements under the Walsh-Healey Act-- L. Metcalfe Welling 92 Protection of Civilians in War-- W. P. Tent __________________ 102 f OllQAc ^P57*". -- IJI \m .jfcjii, T5S ;Wl!E7W7irNW i t i4.1tltWgWC?TlWI?W9ATa g 1Bti 1 ^ IIV0BP|ns;ii..qyp C T ff4 ^e a jtf^iy . y i ^ ny| t iMutM'iimj.iwjBie.iiT.n'i' r REPORT OF THE PREVENTIVE ENGINEERING COMMITTEE t, i Ef i PROFESSOR PHILIP DRINKER, Chairman During the past fiscal year of the Foundation, on* followship has boon maintained at the Harvard School of Public Health. Tha incumbent is Bernard D. Tebbens, who is a candidate for tha Doctorate of Science Decree at Harvard. He has worked on two problems, one involving a study of par* tide size in relation to silicosis, and the other comprising a study of the gases and visible fame evolved in arc welding with coated rods. L For the studies on particle size end silicosis, dust samples of finelyground flint, 99.3ft SIO. were prepared as follows: SJS, 2.7, LO, and 0.0 microns. As stated in our 1939 Report, the object of Mr. Tebbens' work with sized particles was to study the relationship of slza to potancy (with respect to silicosis). It was generally admitted that the potency increased as the size decreased, but,'so far as we know, no studies bad been made (and cer tainly none published) which attempted to answer this question with patho logical proof. We are indebted to Dr. R. Z. Schulz, of the Department of Pathology; Harvard Medical School, for his cooperation in this work and wish to make dear that he will be joint author with Tebbens of a paper detailing the complete stsdy. For each size group, nine rabbits were seed and each received 400 milligrams of dust in saline suspension injected in two equal doses at threemonth intervals. No animals died from the injections. One animal from each series was sacrificed at about three-month intervals. Histological sections of the liver of animals sacrificed early in the exper iments showed differences ia liver damage. After the first throe months, animals receiving 0.6 and 1.0 micron dusts showed small though definite evidence of scarring. Microscopically, they hud small areas of necrosis and fibrosis distributed particularly in the portal areas of the liver. On the other hand animals injected with 1.7 and &3 micron dusts showed no gross pathological changes. On microscopic examination, only numerous macro phages and giant cells were found scattered throughout the organ. As the experiment progressed further, gross pathology became increas ingly evident in the animals which had received th* two finer sizes, and even to some extent in animals having l.T micron dust. This pathology was par ticularly evident as fine wrinkling of the liver surface, merging into dearlydefined nodulation end white areee of fibrosis. A gradual enlargement of liver end spleen was also noted. In the last group of animals, such striking gross pathology was evident that there Is no doubt as to the relative importance of these dust fractions in producing tissue damages. These animals had lived about 17 months since the original injections. The animal receiving JJ micron dust had slight enlargement of liver and spleen with negligible other appearance of pathology. Those receiving 1.7 micron dust had vtry noticeable enlargement of the organs, end the liver was coarsely nodular with white fibrosed areas. The L0 micron animals showed complete fibrosis of about *4 of tho liver, the remainder being distinctly nodular. The spleen was enlarged about three or four times normal, but was otherwise not remarkable. 9 The O.C animal functioned on about \i of the liver, which iulf m coarsely nodular. The remainder of lirer tinsuo had boon completely oii anted by fibrosis. The apleen was enlarged several times and showed wt; miliary tuberculea over its surface. Other organs, such as lungs aad hu marrow, showed distinct evidenea of fibrosis. Kidneys of all ta. appeared normal throughout. Engineers are concerned with particle size in the causation of see: because ere, and not the physicians, are responsible for duet control aad i making estimates or counts of dust concentrations. From the resdu . Tebhens and Schulz, it 1* evident that methods and appantus designed ; abate dustiness or to estimate dust concentrations should be directed esp< daily against the particles well below end not above 1 micron in size. IL A part of 2Ir. Tebbens' fellowship work has been devoted to e stud, of the natnre and quantity of the fumes and gases liberated during v` welding with coated rods. Not all electric welding today is done with matt, rods, but their use is increasing rapidly. In tha case of alloy steels sad el non-ferrous metals, coated rods an the rale and not the exception. -fc general, the primary purpose of the coating is to shield both the are and tihot metal from reaction with constituents of the air. Time would not permit studying the full lift of the coatings used os modern welding rods or the products they give off in the arc. With the help of welding experts from the General Electric Company, who supplied aS the equipment needed for this atody, we selected a number of represeetzdTv rods, of which the makers generally furnished the approximate analyse*. Is those few cases when analyses were not available. It waa not dffflcsft & determine the essential ingredients snd to cheek them against the prefaces of combustion In tho are. Every effort has been made not to divulge say trade or manufacturing secrets regarding tha exact nature of tha coatings. A. Low-Carbon Steel Electrodes: Seven different electrodes were stud ied in three sizes, 5/32", K", and 5/16'. Tlia costings contained the following: -- -- Ferromanganese, the 3In serving ts a deoxidizer. Various silicates. Including asbestos, with small amounts of free sura. Sodium silicate as binder. Titanium dioxide as an are stabilizer. Carbohydrates to furnish a reducing atmosphere. B. Steel Alloys and Non-Ferrous Alloys: The costings of these rods all contain fiuorides. usually carbonates, and some silicates. The coating cf rods for welding aluminum contained chlorides, while one alloy rod, a 96 Cu 4 SI rod, contained borates. In general, all rods and all costings rave off e visible fume or sack* of which the qualitative composition waa predictable from the analyses ef the reds. In addition, we looked for any volatile fluorine compounds, as veil as carbon monoxide, chlorine or hydrochloric add, and especially oxides ef nitrogen. Welding was done in a gas chamber equipped with a spedal exhauster and a hood placed near the welding work. Beads were welded across trail metal plates and the gases and fumes from the are were drawn Into the hood by the exhauster. Samples of gss and of the visible fame were takes from the flue pipeand analyzed. From t considerable series ofsuch analy- i ses, it was possible to construct a tabte: j .. j 01114 1 9r Is mV 'mmm  % ( r i If welding was done at various distances from th hood it teas poisiL to deUrmin* at wbat suction velocity, measured at the arc, all visible fJe and ffM entered the hood. It was also possible to predict, with fair accums.the cm and fumo concentration after a definite time when welding under' particular condition. It follows, therefore, that one may write spedfieauoa for the necessary ventilation to bring about any desired condition. In general, we believe that modern electric welding Is a safe Job, pm viding that the worker observes certain simple rales: He must avoid ultraviolet light from the are and bis skin, tspecisC; hands, face and aerie must be protected. We have no fault to find with lU conventional safety practices with regard to these items. Ha should not weld in confined spaces, like tanks, unless they are w" ventilated, or unless he is supplied with an air mask. If the concentration of visible fumes Is kept within reasonable limki by means of appropriate ventilation, there will be no risk of poisoning fret NOj. This does not mean that ICO. gas and visible fumes are given off in acr constant ratio. They are not. But low concentrations of visible fumes, such as 20>25 mgs./cu. nu, preclude any possibility of harm from breathing gas. eous impurities. We had formerly a second fellowship, held by Leslie SQvermsn, bee this was stopped at my suggestion because Mr. Silverman was appointed Instructor in this School and had to devote a large part of his time to teaefc* ing and not to the research In which the Foundation was interested. Hew. ever, his original thesis work, made possible by the Foundation's generality, will be published. The purpose of Mr. Silverman's work was to study the faetors affecting hood design for singleslot unheated tanks, such as those used for coldplating, pickling, add-dipping, alkali baths, and wash tanks. The effect ef temperature and of solvent characteristics on ventilation requirements, together with the performance' of deuble-slot hoods, is bring studied further. Ventilation requirements (Q) of unhested tanks with lateral exhausts were found to vary aa follows: Unfianged hoods _ Q = ZZ (width)1-1* (length)0-** (velocity)1 Flanged hoods____ Qr = US (width)1-* (length)*-1 (velocity)1 The optimum height of fiangt is that equal to tank width and the opti mum flange inclination is the maximum allowable without interference with industrial operations. Slot velocity or slot width art unsatisfactory criteria of hood perform ance. The important factor is the quantity of air handled. The depth of liquid surface below the slot does not affect greatly the characteristics of hood performance, but may have an important effect on evaporation and entrainment of liquid. I am assured that one fellowship snd perhsps two will be continued at Hirrard, and I should favor, in this case, departing from perhsps our straight engineering and including something that is a little more biochem ical, particularly a problem on how the humnn system handles solvent vapors when exposed to a compound such as carbon tetrachloride. That is, if an individual is exposed to a certain concentration, how soon does his blood become saturated at that concentration, and if he leaves, how soon does he 01116 -- i ------- "... - ,, ~,|-iT-- - - - - - - - - - - - - - i become desaturated 7 The fundamental data on such matters now are badly lacking. X am also Informed that our Engineering Committee next jrear will b able to make the surrey of exhaust systems which wa projected last year and which wa were unfortunately prevented from making purely by lack of funds- I am informed that such fluids will be available this year, and we shall go fotward with that as projected in our annual report of a year ago. The Foundation has liberally continued its support of ths Journal of Industrial Hygiene and I think I can say to the mutual advantage of the Journal and of the Foundation. From my standpoint, as editor of the Jour* nal, it is s most desirable cooperative effort. We exchange data all the time and each helps the other materially in the abstract work, thereby considerably reducing the cost of the combined effort. Thsre is one item in which I would bespeak your support if it should coma up. In the general Held of industrial solvents, particularly of common organic solvents, new ones are being introduced continually. Every now and than a lawsuit such as tills wiQ arise: An Individual, unknown to himself, has a tubercular lesion. Ha receives an exposure to some solvent vapor or perhaps an irritant gas as from electric welding. He doea not know that ha has tuberculosis at the time, but a month or two or three later he breaks down and Is examined by a physician and is found to bo fat sa advanced stage of tuberculosis. Human nature being what it Is, he looks about for some one on whom be can pin the blame and be picks on the employer at that time. That is perfectly natural. You have experienced such salts. We may hare our opinions about those things, but to prove them is a very difficult matter. I can number in my own experience two or three such occasions. The proof of the thing is highly embarrassing, even if the firm has worked in the utmost good faith and is of the opinion that it has kapt working conditions ms' they should be.-- -- . The enswers to vexing problems like that might well be obtained by research, especially at Saranac Lake, of the type time Gardner has done so successfully with dusts, namely, the treatment of experimental animals inoculated with tuberculosis virus In accordance with Gardner's technique: treatment of animals with known concentrations of solvent vapors such as we would permit our workmen to have in their ordinary work, and then seeing whether their condition is adversely affected. You may say that legally you cannot draw inferences from animal experimentation. I'd like to say that you can and it is being done with great success in defending unjust claims. It is the one way you are likely to be able to answer the problem with even s shadow of success. I think that the Foundation could very well interest itself in that prob lem. It is one which is most vital to the engineer, because sometimes we are called upon to take responsibility for a ventilation Installation which we have put in in the utmost good faith. Later we And that the Individual for whom it was designed, perhaps, is s little below par. tubercular, if you wish, and be breaks down and then they say. "Well, the engineers didn't ventilate this job. If they had done it the way they should this fellow should be all right." I don't think it Is our fault, but nonetheless they hnnt around for blame and they pin it on us, sometimes with s good deal of success. I note in the program that at the conclusion of what T have to tar, and we have reached that point, the meeting is open for discussion. If I or col leagues in the audience can answer questions on these matters, we will be glad to do so. 13 I 01117 I**^/*,'* DR. MILES: When you discussed the effect of these Ane dust partk on the liver, in whet way did you say the dust was cot Into the rabbi: Injected T PROFESSOR DRINKER: Yes, into the ear vein. That is an old to nique that has been used for many years in the study of toxicity of van. types of dust. Of course you can produce fibrosis from silica in various pa of the body. Putting it in in that way it can bo done with precision : with quantitative accuracy. The reason ere didn't dust these by \ air-breathing route is because the samples of 0.8 micron dust were measm literally by the milllfrara and not by the gram and we didn't have enoo dust to permit inhalation experiments. DR. WILKIE: I'd IQcs to ssk Mr. Drinker if he did find anything in t lungs. PROFESSOR DRINKER: Not of any consequence. They showed slij evidence, macroscopieally, of fibrosis. DR. SELBY: If it is so difficult to make this fine dust does it actus: exist in industry? PROFESSOR DRINKER: Yes. That is a very good question and e vr practical ona. Tbs trouble is that fins end costs# particles art .intimet* tied together, and what wo wanted were the individual sharply defined t: tions. In any place like a foundry or mint, all air*Aoatad dust will conta plenty of the 0.8 micron dust. We wanted to get it by ths milligram, gram if wa could, and to get it and separata it from ths other sues extraordinarily difficult. It is very tenacious. They Just stick together. ' DR. MILES: In your conclusion, then, while you actually examined t: liver you would say that there was an analogous change in the lungs, mean it would causa fibrosis in the tongs were it breathed in. PROFESSOR DRINKER: I am sura it would. DR. MILES: But then would be no liver change? PROFESSOR DRINKER: "If you breathe it in, the most imports: damage will be in the lungs, whereas if you taka it Intravenously ths impor ant damage is always in tha liver. MR. BAILEY: The Inference is that the dost particles larger thin I microns are harmless? PROFESSOR DRINKER: That is certainly what I think--not tout harmless but, compared to the others, yes, thay are harmless. MR. BAILEY: Isn't that something new? PROFESSOR DRINKER: I don't think so. I think sit we have doc Is put a hunch that everybody bad on a slightly more quantitative basis. DR. LEROY U. GARDNER: May I say a word about this ? This subject (toxicity of fine particles) that Professor Drinker ha reported this morning is ono that we have investigated also. You eonfits the findings that we have already made with tha exception that wa felt tbs if you allowed particles up to three microns in diameter to set long enooy thsy would produce definite and progressive changes in ths liver. I ha*> forgotten how long your maximum observation was. PROFESSOR DRINKER: A year and s half. 01118 iv*' '.J ** _r* . ^ t *. < .w ^ *TrgVe; DR. GARDNER: We found that in a year's tint* tha particular quartz with which w worked was active. TV'e act three microns aa tho upper Unit of activity. Four microns to six microns wen inert. We all agree, I think, that the smaller the particle the more active it is and the more rapidly it produces chances In various organs. The liver that Professor Drinker has osed as a test organ is one that ere have used also. When you come to apply this knowledge to Inhalation, how ever, you have got to consider whether particles under a micron or a half a micron, perhaps, are going to remain in the lung in sufficient quantities. We tried some years ago an inhalation experiment with some exceedingly lino silica, whose average particle size was said to hava been of tho order of 20 angstroms. This material was prepared and measured by a method that I am not in a position to discuss Just now. Tho point I want to make is that when we made animats bresthe this exceedingly fine silica we didn't get what we expected, that is, almost Immediate death, within a few weeks. We found that relatively little of it stayed in tho lungs. Thor* was enough there to product some changes in the phagocytes, the formation of giant cells, and what not, but no fibrosis developed. Thar* was not enough of tho very fine i silica in the lungs to cause any death of tissue. While it Is perfectly true 4 that the finer the quartz particle or tha silica particle tho more active it is, it seems to me that our application of this finding must also be conditioned I by what can be expected to remain in tha lung after inhalation. i I quite agree with you that tho engineer ought to bo prepared to trap the finest dust that is In the atmosphere and that he needn't be much con cerned about anything over three microns, even though tho lung may contain some ten micron particles. Those three to ten probably are pretty inactive. Whether it is going to be 1.5 or 3,1 cannot say, but I certainly feel that it is la that range that we are going to define the upper limits of activity. PROFESSOR DRINKER: I think that engineers feel that we trap tho t fine dust, but I don't think that we feel that we measure it when we go out into a plant. I think if we catch the l's and 3's we will catch the OJ's too. But certainly, if we make estimates of relativo hazards of ono Job and another, we don't come anywhere near laying the emphasis on the fine mater ial that we ought to. In defense of my having infringed on tho Hold which Dr. Gardner has so well covered, I should like to say that we were guided in our choice by the fact that in the -experimental work which he cited. I am distinctly under the impression that he stopped at three microns- He said that the others were more toxic, but his published data, quantitatively, are on the three microns and over. That may seem like splitting hairs to you gentlemen, but it isn't to me. HR. FRAZIER: I should tike to ask if you have actually correlated the different rates between the size particles on those particular animals you hava experimented with. In ether words, by 0.5 on up. PROFESSOR DRINKER: You mean correlated in a mathematical sense? I i MR. FRAZIER: Yes. PROFESSOR DRINKER: You can't. I don't think we would ever be able to. You can't do much more than get the results and Just present them as you see them, either in gross preparations or histological size, and say * 15 r X } 01119 r ii that one is *o much worse than tho other. To make any precise mathemat ical correlation I am afraid is beyond any skill that we have. DR. FEAIiY: Does that not Imply that tho examination and duet count* Ing ahould be done on a dark field rather than light field? I understand you can't get much under one micron on bright field. Some dusts which look very well if you look only in the bright field become very bad if you look only in the dark field. ' PROFESSOR DRINKER: In defense of the present coanting technique, which is light field end does pay particular attention to material that U higger than one micron, tho results of such counts, when they show high dustiness, correlate fairly well with such data as we have on incidence of silicosis and tho like. After all, dost counting as it is done today is not to measure how much dust la in the air. It is to astimata what the silicosis risk is, and from tho presont way of looking at things the two haven't a whole lot in common. From the standpoint of precision. I agree very warmly with Dr. Frary. From the standpoint of public health, perhaps the present counting technique will do. DR. RUSSELL: Have the pathological effects of amorphous silica dust and dlatomaceous earth been datarmined by experimentation! PROFESSOR DRINKER: We haven't tried any. Dr. Gardner can answer that much better than L DR. GARDNER: We have tested the effect of diatomaceous earth by this method and found that it is capable of producing a progressive fibrosis that looks very much like that caused by quartz. That is the only form of amorphous silica that t know of that wilt produce this reaction. It has boon suggested that the reason for the greater activity of this particular form of amorphous silica Is due to the tijmendous surface exposed to contact with the anihmls. The diatom shells are pierced by tremendous numbers of exceedingly fine tubes and as these particles are brought into con* tact with the tissues the tubes' surface is added to that of the outer surface. All the other amorphous silicas that I know of are incapable of producing a progressive reaction. A few of them cause a little chronic inflammation, but that tends to subside rather than progress. PROFESSOR DRINKER: A year or to ago. at the last Saranac Silicosis Symposium, Dr. King, from England, took me, among others, pretty severely to task for the unscientiAe way in which we made dust estimates. His language was diplomatic, but the implication was that we were somewhat stupid and that the British method of thermal precipitation, which caught very easily the fine materials of 0.5 microns, was superior to ours. Dr. King said that their technique deliberately ignored the bigger sizes, say above three, and took the finer ones, whereas the impinger did its beat work beginning at shout two microns and going on up to ten. Ho took us to task, and I think with reason, for the unscientific methods we were using. On the other hand, we cap maintain with some justification that with such as we have we can control silicosis and measure the degree of our control fairly satisfactorily. DR. MELLER: The next section of the program is in charge of Dr. Lanza, Cliairman of the Medical Committee. IS 01120 '5*e i + `1/ 4 ( RETORT OF THE MEDICAL COMMITTEE A. J. LANZA, 3L D.. Chairman Darin; the year we have succeeded In getting our studies on sick abseo- teeism in industry well under way. Fifteen firms are now cooperating with the Foundation and with the United States Public Health Service fas putting into effoct what will be a comprehensive record whieh will show the extent and nature of sick absenteeism in industry. The importance of this is self-evident when we consider the enormous economic loss involved. We will hear In detail of this activity from Dr. Gafafer, who is on oar pro F gram today. The Foundation has continued to sponsor research activities at the Saranac Laboratory and this very Important piece of work will be described to you by Dr. Gardner, who Is also on oar program. We also hare continued to rapport the extremely interesting studies on <j othfePeefnfencstyslvoafntioax, iwchmicahtewriialllsbeondethscerilbiveidngtotiysosuueincadreriteadilobnyaMt trh.eHUanagiveenrsseitay. As you know, the studies on x-ray which have been carried out at the Uni versity of Pennsylvania have been completed and are available to the mem bers and to the public in bulletin form. For the coming year we propose to carry on our studies fat sick absen teeism, in cooperation with the United Statu Public Health Service and with those member firms who have requested participation fat this under ; taking. Wo also propose to carry on Dr. Gardner's studios at Saranac and Dr. Clark's and Mr. Haagensen's studies at the University of Pennsylvania. I should like to discuss very briefly recent advances fat the status of tbs industrial health program throughout the country. The American Medical Association, through Its Council on Industrial Health, is continuing its various efforts in this field. The Council not only carries on educational and informative activities at Ita headquarters in Chicago, but has inaugurated a broad campaigwof education through the state and county medical societies all over the country, having in mind par ticularly the needs of small plants wherein, as you know, some eighty per cent of all our industrial wage earners are employed. The activities of our own Air Hygiene Foundation are well described in the program of today and tomorrow, but I should like to emphraize for your attention that this Foundation is the only national association including in its membership all types of industries which is actively supporting and financing fundamental research in industrial health problems, without which continued progress in the field of indostrial health is not possible. A committee composed of Mr. Aheara, Professor Drinker, Dr. Crunch and myself, representing the Air Hygiene Foundation, recently went to r^: Washington and had an interview with Governor MeXott, who is at the head, as you know, of the Social Security branch of the Government. We went to ,<*- see Governor McNutt because the Public Health Service, whose interest we were endeavoring to elicit, is now in that division of the Government. One of our objects in talking to Governor McNutt was to try to make the respon sible people in Washington appreciate the importance of industrial health work in industry and in prevent as far as possible industrial physicians, Industrisl hygiene engineers, industrial safety men, and other technicians 17 01121 3gS hth ( li '- r 5 i being diverted from their activities in industry into some other form ernmcntal service. Furthermore. we also hoped that the industrial physicians, the far!-. hyciene engineers-, the safety engineers, and others, who carry enormously important work, which la just as essential a part of ev dafenae aa carrying a gun, would receive some credit or sou# rcv~- so that they might not feel that they had not been doing their pert U general defense program. " I might say that Governor McNutt gave us a very sympathetic Ui and I think some advantage may come out of our visit. The National Association of Manufacturers is continuing its scant? stimulating and educating its member firms. This association also is phIts emphasis on the needs of smalt industries. On the official side, we have the Division of Industrial Hygiene * United States Public Health Service. I don't have to talk to you shoe: importance and far reaching activities of this division, which have bees a. ifeated by the energy and thoroughness with which they have been tor mental in setting up divisions of industrial hygiene in some thirty r. governments. Every phase of health in Industry is covered in the acini, of the Public Health Service. The Department of Labor, through the Bureau of Labor Standard- ? the Bureau of Statistics, is continuing its important activities in the &>.industrial health, both through field work and educational publications. ; How comes a new factor in the field, and I am referring to the Cer-! on National Defense. Industrial health is a major portion of tha at~.defense program and is contained under the Health and Medical Coss-. of tha Council. The Health and Medical Committee includes a sub-cossri on industrial health, the importance and acopo of whoso activities can:.;? overestimated. Two members of the Medical Committee of the Air Hjr-i Foundation are also members of this Industrial Health Committee cl r Council on National Defense, gpd one of thorn. Dr. Selby, is the Chairau? the Industrial Medical Committee of the National Defensa Council j This committee is tied in with the National Research Council on tia -j hand and with the military services on the other. Liaison officers have *.? detailed to work with the committee by the. National Research Coc=c tr by the Surgeons Generel of tho Army, tho Navy, and the Public E/-1 Service. 5 At no time in our history has the health of the industrial whether he may be employed in plants owned by private industry or in jir operated by tho various departments of the national government, reet-e- so much careful consideration as at tha present time. It is safe to say as a result of the national defense program and its coordinated scthif- industrial health and hygiene will be established on a firm and perms.*^ foundation throughout the United States. r In conclusion I wish to make just a few more comments on the L*t$ phase of tho national defense program. J Physical selection to an integral part of the program, applying ta v*v ton at well as military forces. The present employment examincur-Jr becoming more thorough and thereby more vaioable for diagnosis and *-*'- for therapeutic purposes. The public health, to inestimable. importance of this, from the standp^^ 18 Many men with minor and even major defects must be utilised is ^ 01122 f. m ... j - .t- - * \T^- *- f,- vi -v i 7rm\ *" . . ifcfa/rv* Q: defeam Industries, both in the general Interest and in. their own interest. { Men must work where work is available, and it is the function of industrial medicine to see to tt that those who present special needs or problems secure j the help and supervision that win enable them to koep on with their work. Zt j Is Important that those who are concerned in the administration of private i and governmental industries keep well in mind that the function of a physical selection program is not to bar men from work but to determine what kind of work they can best do and to provide adequate medical supervision, while they are at work. It it extremely important that those who are found unfitted for work-- and I am thinking particularly of those who will be found to have tubercu* losls and other general organic disuses--receive adequate care, care that will have for one of its objects as far as possible physical rehabilitation. The defense program provides for our national security. As an essential part of that program physical selection and medical supervision must eon- { tribute a positive force for health that will serve to raise the general health ( standard of the entire Industrial population. That is our goal, and we must j strive toward it. i * I DR. LANZA: We will continue our program. The next paper wfll ho by Dr. Gafsfer, the Senior Statistician of the United States Public Health Service, who will speak on the sick absenteeism study. : I i 19 01123 3 ( U-yi -,u a~.ir.iwl...- r. . .-.-niAa .[ISESiiiiS c u . i .. i u\ r DR- LANZA: The next paper is by Dr. Gardner, dealing; with hi research at Saranac Laboratory. INDIVIDUAL SUSCEPTIBILITY TO TOXIC DUSTS DR. L. U. GARDNER* I am joing; to talk to yon this afternoon on on* phaoar of the activities at tha laboratory which I believe may have some practical significance. Ii is tha one qaestion as regards silicosis which I still believe needs further clarification. We have a good deal of information now on this subject. If we coaid pot that information to work in most places we would be abla to control silicosis pretty effectively. However, when funds art not sufficient to insti tute all of the methods of control that an known, wa an pretty apt to have soma silicosis persisting;. For that nason I believe that it would ba important for us to know whether then is such a thing as individual susceptibility to tha action of sOica dust, and, if It exists, whether we an abla to detect It by any method. If this wen true, it might be possible in tha pn-employment examination to discover the individuals who an unduly susceptible to silica dust and its action and to place them in Jobs when tha exposure would not ba as gnat. Than seems to ba non or less evidence for thinking that reaction to silica dust, like reactions to other environmental conditions, may not be tb* same in every individual. It is pretty common experience that out of ar.y group exposed to silica dust only a small proportion of that group will react. With the high silica exposures of hard rock mining, we find that pntty much tha world over only about a quarter of groups, as a whole, develop demon strable silicosis. It is also true when we break down exposures for Individual groups that we find that the longer men hare worked the more of the particular group will be involved. It Is'also true that the higher the concentration of silica in the atmosphere, the greater percentage of the group will be involved. Even with these reservations, we find that there are some men who have worked all their lifetimes under conditions that seem to involve pretty severe exposures and yet they have escaped. It la also true that there are some individuals who seem to be exposed to relatively slight amounts of silica 'dust and yet in a very short period of time, long before any of their fellow workmen, these Individuals develop advanced stages of the disease. Slide No. 1--Classical nodular silicosis in the lungs and lymph nodes of a granite cutter employed in Barre for 12 years. . Slide No. 2--No evidence of silicosis in the lung but some nodulatlon in the lymph nodes. This subject had worked for 2S years in the same Indus* try with apparently equal opportunities for inhaling granite dust but no pulmonary disease developed. Slide No. 3--A higher magnification of the lung shown in slide 2 to indicate the localisation of the dust ceils in the walls of the bronchioles ar.d blood vessels. Director. The Saranac Laboratory- 26 F 01130 *sE i- La...,.--I- .y..-----------,<r i^v-~ _____- : : 35* . Slid* No. <--A. itiU higher magnification from the same lung to demon* atrate the quantities of dost in cells collected in a blood mill walL The shadow* of such perivascular accumulations are responsible for tha pattern of exaggerated linear markings scon in an x-ray film of the lungs. Slid* No. 5--'Th* usual picture of the modified silicosis seen in iron miners who have drilled in rock formations. History of such drilling for 30 years. Slid* No. 6--Minimal silicosis, too slight to be demonstrable in ante mor tem x-rays, in an iron miner employed in the same mines, at th* aama Job, for 30 years.. Host of the reaction consists of fod of pigmentation without fibrosis. Only 2 or 3 minute nodules of silicotic fibrosis are soon in this entire section. Slide No. 7--A localized focus of tuberculosis in another part of the ammo long shown in slide 6. Her* the presence of preexisting tuberculous reaction has caused tha retention of unusual amounts of inhaled silica and iron resulting in localized silicotic nodulation. The silica, acting on th* latent infection, has caused it to progress after a time. The section demonstrates a focus of active tuberculosis which is about to break down and form a cavity. During lift an x-ray picture would demon* strate only the overshadowing tuberculous changes. Slide No. 8--*Another instance of th* effects of inhaling silica dost into a lung with a latent focus of tuberculosis. Occupation: sand miner for IS years. Death from tuberculosis which progressed fairly rapidly after once it had become reactivated. Evidence of silicotic nodulation largely confined to parts of lungs about the old focus of infection. Slide No. 9--Another section representing conditions in other parts of tho lung whose apex is shown in slide No. S. Here the ehsnges are very largely due to tuberculosis and only a few of the smaller nodular areas are silicotic in origin. An associated lymph node reveals axtansive silicotic changes. Presumably there was insufficient fine, silica dust generated in this occupation to have affected o~normal subject. The individual Illustrated retained effective quantities only in the region of a partially healed tuberculous locus. In this location, however, the dust was dangerous because it presumably caused a latent infection to become progressive. Slid* No. 10 shows the complete absence of silicosis in the lung of an individual exposed to dust containing calcined gypsum and quartz. Thera is a alight amount of pigmentation about tha lymphoid tissues within the lungs but no fibrosis. In the lymph nodes at the root of tho lungs are clusters of silicotic nodules. In spite of a theoretical silica hazard which caused us considerable concern in surveying the plant where the man had worked, no effect is apparent in his lungs. He has no scars of old tuberculosis and his lymphatic system has drained away such silica as he has inhaled. Only hi* lymph nodes show evidence of reaction and in this location th* effect is harmless. Slide No. 11 comes from the lung of a man with a history of exposure as a sandblaster for 7 years--part of the time with improper protection. Ho had been previously employed for 8 years (n a railroad ahop and before that had worked 8 years as a coal miner. An ante mortem x-ray of his chest showed no evidence of nodulation. This section, typical 27 01131 I t.- f 'minit ------ t-~lk-- * " -- -w ^ i- -^-^gs^.vegyyy of the rest of his lungs, reveals only minute areas of black pigments, tion without fibrous reaction. There is oo evidence of sillcotie nodula- tion. Apparently his previous exposures bad conditioned his lungs to the silica subsequently inhaled ia sandblasting so that they did not reset by forming fibrosis. While there had been some dyspnoea the man eras well along in yean and it is doubtful whether inhaled silica was the causa. The slides just shown are examples of the absence of generalized reac tion In the lungs of individuals exposed to concentrations of silica dust that are theoretically hazardous. In most cases the exposures an known to have produced silicosis in other men exposed. In these cases they have either caused no silicosis or only localized reactions about anas of infection. Ia the last, two cases the influence of other minerals in tbs dust wen probably responsible for inhibition of the silica, in No. 9 the effect was prohabtv chemical inside the lungs and in No. 10 atmospheric phenomena presumably- pnventsd silica from being inhaled. Slide No. 12 is an example of the reverse when silicosis develops rathe rapidly ia only an exceptional member of-a group. This young msa, still alive, had worked for 5 yean in several tale mines when evidence of typical silicotic nodiilation Is never found. He then begun drilling k a hard rock mine but was not examined until 3 months later. At thst time his chest film showed a well developed generalized silicotic node- lation. It is true that the drilling iu hard rock might readily have pro duced silicosis but not after 3 months* exposure. Appanntiy the prev ious exposun to tale had conditioned his huge so that they reacted with surprising npidlty to subsequently inhaled quartz. Out might alia . imagine that his tissues wen unduly susceptible to silica for others k his location with similar histories ban not had the same experience. j Then an various theoretical explanations which have been offered far ; these appearances. It Is generally considered to be the case that these indS- j viduals who do not develop disesse. in spite of their appannt exposun, hast j worked in parts of the plant when they do not get as much dust as their i fellows. Somotimrs that may be the case. Sometimes it may be true that j the modifying action of other minerals associated with the silica in the ` atmosphere may have prevented these individuals from gstting as much 1 dust. But it is pretty hard to understand why these protective actions. j about which we know a little, should be exerted on one individual and not ; on all members of the group. -- j The other possibility that we have to think of is modifying host factors. Lehmann, as you recall, proposed the hypothesis that some individuals had J better noses than others. In some instances the nose would filter out a good : deal more dust than another and prevent its being inhaled. He made some S rather elaborate measurements of the amount of filtering action of the upper | respiratory trset and thought he was sblt to correlate the amount of poW monary reaction with the effectiveness of the nose as a filter. j Professor Drinker and his students made a similar study among granite t cutters. They were not able to confirm these findings of Lehmann's as full? t as they would like to have done. $ Another possible host factor is that of coincident infection of a chrock Z nature. We all know that scars in the lung of old tuberculosis tend to beli a and retain a good deal more dust than normal lung tissue does. It is a very r 28 01132 j- 1 v * . yw".. familiar experience to all pathologists to find in the top of the lung* old can that are deeply pigmented by the soot and coal that most city dwellers inhale. It is also common experience to find variations in the amount of dust that is eliminated from the lungs by the lymphatic drainage system and deposited in these lymph nodes. Presumably, then. Infection may have two effects. It may hold the dust in the lung locally. The infection may also disturb the function of the lymphatic drainage system end prevent effective elimination. Then there is, finally, s third general possibility. That is that the tis sues of some individuals are basically more abie to react to the stimulus of silica than the tissues of other individuals. The Saranac Laboratory, during the post year, has been carrying on a more or test detailed investigation of these possibilities to And out whether any of them are capable of absolute proof. Wo have ia the laboratory, as you know, dusting chambers where we ean control pretty well the atmos pheric concentration of dust to which all members of tha large group ef animals are exposed. We are making dust counts at vary frequent intervals In different cages and ia different parts, of these rooms, so that we know just about what the dust exposure is. In spite of those controlled conditions we find that normal animals exposed for the same periods of time do vary ia their capacity to react. This Is especially true of animals with long trachess. Uko the rabbit. It is not so true of the smaller rodents, like white rats and guinea pigs. In the next slide which you will see I want to show you the variation in the reaction in rabbits after four and a half yean* exposure to a concentra tion of one to three micron quartz particles averaging 144,000.000 per cable foot. The amount of dust varied from time to time, but the concentration throughout the different parts of the room was essentially so similar that I don't think the differences were significant. We will see in the animals' lungs differences In reaction. I will any that there are thirty rabbits in this experiment and these represent the variations in the picture which one sees. They all have been exposed to the same quantity of quartz under as nearly identical conditions as we could produce. Slide No. 13--This one has a heavy generalized discrete nodulation through out bis lungs. Anothsr on this slide has a slighter degree of the same reaction, and another has nothing that I could identify as silicotic. Slide No. 14--We determined the amount of quartz in these animals' lungs, using x-ray diffraction, which we have been doing recently, and we found that the amount of quartz is comparable to the amount of reac tion present. Here is the first animal, with the two quartz Uncs showing very strongly, corresponding to the heavy reaction. The second animal has a smaller amount of quartz. The third shows just a faint sugges tion of the heavier quartz line. It is very, very slight in amount. Some animals vary in their response even though the concentration of dust in the atmosphere is pretty constant. We find that the amount of variation is greater as the quantity of silica from the atmosphere decreases. We found with our mixture of calcined gypsum and quartz that not more than a quarter or perhaps s third of the animals developed any silicosis. This type of observation seems to Indicate that host factors rather than environmental factors must be responsible for this variation. In the animals 29 OII33 i ( W. c*. *c . T y\ T\ f vF! w: li*. I x if ?* r4' r.. I % that I have just shown you the factor of Infection has been excluded. \ haven't discovered whether there is any variation in the structure of upper respiratory tract in these three rabbits or others liko them. It ii pretty difficult thine to do. We have tried to find out, but without b. success. Wc have thought of the influence of difference* in tha efficacy of t lymphatic drainage system of different animals. We are attacking ti problem by comparing the relative amounts of silica in the lungs and lrny aodes of animals exposed for the same period of time under practical Identical conditions. We have also considered the- possibility that the dig* enc* in the amount of disease may be due to variations in fuadamezt capacity of tissues to react. I shall show a few illustrations of our wcj In these fields. In Slide 15 you see an example of the effect of a healed tuberculous scar; retaining dust within the lungs. The sear, which extends from pleura to the root of the lung, is heavily pigmented with iron &L SimOar effects hsre been illustrated by tha eases with more active iz fection just shown. I have indicated that possibly such retention is due to interference %rthe function of the lymphatic system. We can see in this case that tr. fibrosis involves the lymph nodes draining tha pigmented part of the 1st: Possibly the central obstruction In tha noda or tha pressure on the deiic. lymph vessels inside the lungs has prevented elimination of the inhaled d:- These effects all have to do with ehronie infections but the acute are also puzzling. One frequently sees very little dust in the lungs of *mals dying of an acute pneumonia at the end of a dust exposure pf 2 er: years* duration. The infection lias apparently lasted only a few days i> eould have exerted no effect upon the dust inhaled previously. Was r* infection present in latent form from the time when the animals were pl:>t' in the dust room, or did these particular individuals possess some peculiar ties which prevented dust from accumulating la their lungs 7 Slide Mo. 16 illustrates the effect of subacute bronchitis in white rats excluding dust from the lungs. It demonstrates tho effect of exports to quartz dust in four of these animals. Two with no trace of infect^ present well-developed silicotic noduiation; two more with subac.|'- purulent bronchitis show none. Apparently the secretion in the bror-i.; has prevented effective quantities of silica from entering their lucni In view of such observations'in animals It is possible that the chrevr bronchitis of which human silicotic subjects complain may t* i P- tective mechanism. . | We bave also considered the possibility of variation in innate capar^'* of tissues to react to silica. To make certain that the same quantity quartz particles reached the tissues of every animal we have employed >-. intravenous injection technique mentioned by Professor Drinker tiiis mvr^i lag. We have substituted guinea pigs for rabbits because we could jt. to use s much larger number of animals. First w determined the nsini=--2 effective dose of quartz that would produce reaction by this pathway. we injected 100 of these animals with a measured quantity of a suspe*^`-s of carefully graded 1 to 3 micron quartz particles. All of them win be after one year and their spleens, livers and lymph nodes will be acalp-'^t individually for their silica content and dcgTte of tissue reaction. 30 01134 Stido Xo. 17 shows th dcgri-t of variation in the amount of silicotic fibrosis observed in three of the guinea pijs used in the preliminary test to establish a proper dosage. Reaction is illustrated in the livers S months after the injection of 50 mg. of 1 to 3 micron quartz. One of them has barely visible foci of reaction scattered through it. The second has somewhat larger ones and in the third the nodules are very obvious. Chemical analyses indicate that these quantities of silica in all three livers are eppareatly adequate to have produced a maximum reaction. Confirmation of these results in a much larger series of animals would indicatt that more subtle variations in capacity to react to silica are responsible. We have tried to find out wherein these differences might lie. We have felt that possibly the diet of the animal might affect its capacity to react. It has been claimed that in the presence of a vitamin C deficiency scar tissue forms less readily than on an adequate diet. As a consequence we have put some enimals on a C deficiency diet, exposed them to quartz, but we have found fi difference in tbeir capacity to react. For this reason, I think we can exclude C deficiency. Than we tried vitamin B and its effect. We did this because some one bed shown that feeding high vitamin B diets would prevent the development of cirrhosis of the liver by various irritants. We were getting cirrhosis of the liver by injecting quartz into the blood stream, as Professor Drinker . showed you this morning. Feeding vitamin B did not do very much. . It prevented the most widespread end destructive changes in the Uver, hut It did not prevent the formation of these nodule* in the liver, such as you have seen here. This work is still in' progrw*. It looks to me now as if Uie variations which animals and human beings undoubtedly do manifest were pretty largely due to host mechanisms rather than environmental factors. It looks to me as if possibly the effectiveness of the upper respiratory filtering mechanism were very important in determining whether one individual got more dust than another. I also feel, however, that tha effectiveness of the lymphatie drainage mechanism has to be taken into account, that old healed infections may alter the effectiveness of drainage and allow more dust to tay in the lungs. Just what this last observation wQI eventually turn out to mean I don't know. We are going ahead and as soon as these hundred snimals have had a year's contact with quartz we wiU make our analysis and draw our con* elusions. Whether we will be able to apply any of this work in pr-employ ment examination I do not know. But it does suggcst_that respiratory infec tion, even though it is inactive, may be of importance. I have illustrated one line of-research which has been going on with your assistance at the Saranac Laboratory. There are meny other subjects that I could hare chosen to discuss. Perhaps some of them would have inter ested you more. We have work progressing in the field of asbestosis, which I think is going to be of definite significance as to the etiology of this disease. The fourth year of this program is just about completed. There Is still more to do. We have been studying the effect of carbon arc ash of low concentration, similar to that to which motion picture booth operators may be exposed. Nothing has happened, as one might anticipate. We have been working on the effect of inhaled gla* wooL Apparently 31 \; -- OiiSS i \ ~\ I i < i > A r'i TyTW-1.. . even the finest textile glass set up as an atmospheric dust it not inhaled appreciable concentrations and does not produce any dangerous effects a>* the lungs. As Professor Drinker indicated this moraine, I believe there is a m field for investigation of the elfects of various respiratory irritants an-.' tuberculosis. I have been so impressed myself, as probably most of have, with the growing imporrimee attached to tuberculosis in indmtr- that we has*# proposed this year, in place of the regular silicosis symposia* which wc have held from time to time in Saranac Lake, to offer a sympo.iss on tills subject. There seems to be a very considerable interest in the pit*, lem and I think we can assemble a croup of speakers who would i definite contribution. The symposium might be developed atone the following Knes: An introductory review of the fundamentals of tuberculosis sad fci diagnosis; the routine methods of control; a discussion of the biown facti influencing tuberculosis susceptibility, theoretical as wall as practical. Than a presentation of conditions in diffarent industries whore statistics! evidence indicates that the tuberculosis rata is high; an analysis of than industries to discover whether industrial factors are responsible. Finally, a discussion of the subject of control from Insurance and cos. pansation angles. If there seems to be a sufficient interest for such a program the Saranac Laboratory probably will offer it some time during the early part of June. DR. LANZA: We will now have a discussion of this paper.. X do hope that you will ask Dr. Gardner such questions as may appeal to you. DR. DAVIS: I should Kke to ask If in the development of this writ there does appear to b# another illustration of what Jerome Alexander ba> spoken of as the "optimum cotloidality." Ho points out that a great mat? phenomena, when plotted against particle size, as you go down in partci size go up in intensity. As I understand the discussion this morning, yr: get a marked increase in the silicosis effect when you reach a particle six* of three microns or less. Than away over on the other side you bar* practically none at zIL I wonder if that might represent a method of ausck or if it has already been proved or disproved. A further factor that seemed to occur this morning is this. I wonder if there is an item of crystallinity in our silica. We know we have siScs occurring in different forms. Cristobalite is the only one I happen a remember now. I was wondering if*the effect had been associated with sac or other or is it independent of the crystalline forms of the silica presented. Are there manifestations that that may be a suitable attack T I personally would be greatly interested if you could outline, if possible, those materials which when added to quartz, such as quartz and asbestos, which you mentioned, give silicosis reaction and some similar material.1 which do not give it. I hope I haven't covered too much ground. DR. GARDNER: The first qcestton dealt with variations according * particls size, such as Professor Drinker discussed this morning, f thici % that is unquestionably true. The smaller the particle injected into the tif* |! the more active it becomes. As far as inhalation is concerned, presumably there is an unestablished tower limit of particle size beyond which we do w* 32 01133 . i -jt; - - "-*;3j--a-wv ... -- ir&""V \ have to be concerned, because the particles smaller thnn this minimum size will be exhaled sjruin about as fast as they axe inhaled. But In the inhala tion experiment which I was discussing I don't believe that the matter of particle size was responsible, because we have made size frequency determin ations of the dust In the atmosphere in these rooms and we And a sufficient quantity of flue particles at ail levels in aur dust house to produce disease. The cages are not over five feet above the floor in any place and the lowest one is about eighteen inches above the floor. Furthermore, the animals are moved around from time to time, so that they have exposures at different levels. I therefore feel pretty strongly that it is a difference in host factors that is responsible for the variation in the animals* lungs that you saw rather than any difference in the atmosphere or in any dust in the atmosphere. All this dust has been ground Ant and all of it Is agitated In a hopper. The room is not over eight feet square and eight feet high. The chances f6r variation in atmospheric concentration are pretty slight. Does that answer that phase of the question? DR. DAVIS: Yes. DR. GARDNER: Would you mind repeating your second question T DR. DAVIS: Crystallinity. DR. GARDNER: We have tried a great variety of free silicas to see what their effect might be by injection techniques that already have been discussed. We have found that normal quartz, the cryptocrystallina free silicas and the vitreous silicas, cristobalite and the other invenion form, tridymite, are all equally active; that of the amorphous silicas only diatomaceous earth produces a silicotic type of reaction. Opal, which is now reclassified as cryptocrystalllne rather than amorphous, as they used to tell us, will produce & moderately severe type of reaction when ground. All of these tests werv made with materials ground to one to three micron particle size end all injected in the same dosage. As far as I can see any inversion forms of quartz are just as active as the normal quarts itself. Then you had one other question. DR. DAVIS: Are any of the silicates-- DR. GARDNER: None of the silicates, by the injection tests, have given a significant degree of reaction. A few of the clay minerals will pro duce a chronic inflammation but this is not generally s severe one and does not progress to the formation of scar tissue. I think there is. however, a very real and urgent excuse for doing an inhalatlbn experiment upon the days, because clays have such a varied industrial use and because so many roentgenograms come to us of men who have been exposed to clays either in refractories industries or in potteries. These roentgenograms show shad ows. The roentgenologist is quite sure that the industrial exposure is responsible.. There have been no autopsies reported on human beings ex posed to day alone. We don't know the basis oC these shadows. In many instances the exposure has been not only to the day but to flint and various ether forms of free silica. We may be seeing the effects of combined expos ures to quartz and days. I am quite sure that were it possible to do inhalation experiments with pure days, both of the refractory group and those used, in the potteries, we W 01137  I ( r* : * j i' i<r, t - - .. t I V *.. t"rx V^.l 'tiSSSi ( * *rjj**- r Ti iT - would have some valuable information. I think probably what wocU h pen, ax the result of our experience with injection*, would ba that we w*. xce in the lung* evidence* of sllrht amount* of ehronic infiamracrion ; that thexe chronic inflammatory changes would not bo associated with dnlta fibrosis; they would not give rise to conditions which were disabli: However, this needs verification and needs proof. The only way I taow getting it is to do it by inhalation rather than by injection. Of course' we do have too the effects of mixtures of the subttaoc. mixtures of free silica with other materials. like days and many oth things, that will modify the picture. 1 wa* talking at lunch this naan to group interested in iron oxide and recounted an experience which we bad lu. Wa injected one group of animats with a mixture of equal parts of bsmati and quarts ground together dry in a ball mill. Injection of a. saline sosp* sion of this material caused no reaction whatsoever. In the second expe; mant we ground the two substances separately, then mixed the suspessio: of particles together and injected the same quantities. Wo now got progressive silicosis. The same amount of quests was there in both instances, but the nethr of treatment in tha first case had neutralized the quartz. It had simp: plastered the surface of every quartz particle with a layer af ho oxide, which had prevented reaction. It is obvious tliat effects like this may occur In the process of gtiadia is industry and that Inactivation of quartz does occur, so thatth* story isn' aa simple as just having a given amount of quartz particles af a given sir and a host exposed to It. MR. ROUTSONG: I was very much interested in the slide which sad *. do with the sand blaster's lungs end his previous industrial history. Yc. said that the previous history had conditioned tha long to resist silcasi* Could you expand that a little for ns ? DR. GARDNER: I wish I could. I was trying to cover my igntner' with a phrase. I don't know what happened. Ail I know is that that facr had, by chemical analysis, a very appreciable and what I felt was rigrefleae: amount of quartz in it bat there was no evidence of specific rcsctxm -that quartz. Now it might be that through the mechanism of the body eel-, the coal dust became applied to the surface of the quartz grains and to* quartz no longer reacted. Years ago Dr. Haldane called attention to the same thing. Ha had seer a few eases where men were exposed first to coal dust and than to qzare. and nothing happened. He thought chat the effect was dua to stimnaticz of phagocytes which carried the quartz out of tho lung, because the com had stirred up these dust cells to carry tho stuff out. Tha effect to*t at simple as that, because we know tho quartz is in this lung. Chemical ssaly* sis shows it is there, and yet no reaction .has developed. It may be that we hare something taking place in tho body compzab!* to that coating of the quartz that I just described by mechanical griaficz We know that tha body tends to bring inhibitory substances into the sacs locations as the quartz, which prevents irritation. We have done a bit of work, which I have discussed here before, with aluminum hydroid* as inhibitor. Wo can pnt quartz in tho body by one pathway and nlunoscz hydroxide by another and, provided the pathways are such that the t*-' substances get into the same organ, inhibition results in no silicosis *=:- 34 01138 tiV v ..1 .fv -Vv a^-* * "-T* mmL uiiaiis^b soever. I presume tint something like that hat conditioned this sand blast* er's lung. UK. KUJILER: Dr. Gardner, do tea have to chance our eountinc tech* nique in the ease of silica in order to more accurately estimate these three to one-half micron sizes! DR. GARDNER: I doubt whether we wilL As Professor Drinker said this moraine, our method of control seems to work. Probably it is sulHdestir accurate to establish what we need to know about dust in the atmos phere. If these very fine particles which can only bo seen by dark flekl or some other technique are actually retained in the lumr the scientist would like to know how many of them there are there, but the enriaeer probably doesn't need to know because his present rules of thumb seem to taka can of the situation. We know, sa a ceaeral rule, chat rather constant ratios exist between dark field and lirht field counts. Generally the dark field count Is three to four times that of the lichc field count. We still use dark field counts for our experimental work and in some other places. If we find a disturbance in that ratio and then arc many times more dark field partidcs than those observed by light field, we think there Is sanitary signiftcance to the variation. But I doubt whether it is necessary to chance. DR. HAYTHORX: X should like to add one comment. I hare sees a number--I wouldn't say a crest number, but I have seen several luncs from the coal mines around Pittsburgh which show practically the same picture that we have' Just discussed. That Is, there is plenty of pigment there coal pigment, I think, largely. Wo incinerate the sections and pat them \ under the petrographic microscope. There aro plenty of silica crystals there and yet there is no nodulatioa in the lung. 1 That has caused me to wonder what is the difference--the actual differ ence--between silicosis that is prominent, as Dr. Lanza himself has shown In his surreys, in the anthracite mines in tho east and. the bituminous mines that we have in this district. We do get the silica inhaled and we do get the carbon then in large quantities. While I have seen men of it sines they have been sending in a good many lungs on account of compensation than I did previously, the actual silica nodalation is act common in this dis trict in coal miners' lungs, as compared to those that are reported from the eastern part of the stata. On the other hand, we just had a sand blaster's longs, within the last two weeks, that is ms typical a case of silicosis as I have seen. There Is something in connection with that soft coal'dust-inhalation and the pres ence of silicosis in tho lungs and its effect. DR. GARDNER: I suspect. Dr. Haythorn. that some day we will havw a method of determining the physical relationship of the silica to the other minerals and perhaps we will find a way to discover whether mating effects actually exist or not. I really believe that is the explanation. How it comes about I don't know. DR. LANZA: Are there any more questions ? Thank you very much. Dr. Gardner, for your paper and your discussion. The next paper is the account of the research that has been carried on in the University of Pennsylvania, by Mr. Haagemen. 35 01139 J.JUKJJ iij in FURTHER DEVELOPMENTS OF THE OBSERVATION OF THZ REACTION OF LIVING TISSUE TO. SILICA GRANULES IN TIIE LIVING MAMMAL ELIOT R. CLARK, M. D-* nd DARROW E. HAAGENSEN, 2L S. During the past year additional work on th observation of tha reactioa i of living tissue to silica granule* in th* Sandison-Clark rabbit ear chamber * baa been carried oat along two lines. j First--A more detailed study of cellular reactions has been recorded, j particularly with respect to macrophages and giant cells. j Second--An additional sample of silica obtained through the courtesy of i Dr. L. U. Gardner, Director of the Saranac Laboratory, has been used. Thu . sample was 100% SiO- of particle size 3a or less in diameter. j The results may be illustrated by a nuihber of slides considered a bt 1 representative of the large anmber of photographic records obtained as the past 12 months. I Series A j This series of slides st a low magnification illustrates two points: { Slide 1--The vascular pattern was growing downward. This exposure was taken immediately prior to insertion of the silica particles la tha chamber. Slide 2--Four days later the blood vessels and the connective tissue have grown downward leasing one of the silica fields in a vascularized era. Slid* 3-*-Nine days after the insertion of the silica particles the blood vessel pattern had started to grow through the large central field of. silica. This field of silica had been inserted purposely in a lower region contaiaicg only extravasated material, the result of the original insertion of the cham ber in the car. Slide 4--On the 18th day, the large field was above th growing edgt. However, as the first point, the growth of blood veasols and connective tissue had not been influenced by the presence of the silica in this eestral field. If the silica particles had through some mechanism caused rapid connective tissue growth the growing edge would have been uneven ia the central region. This was not the case. Slide 5--On the 6Sth day the chamber connective tissue bed bad a dear space because of the retraction of the tissue near the growing edge. Slide 8--On the 93rd day this space was completely filled in by the production of connective tissue fibers through the activity of the fibroblast* normally found in the living tissue. For the second point of interest, wbZr the rapid tissue growth took place to fill in the space, there was no indica tion of unusual connective tissue growth in the region of the large cratial silica field during the same period of time. Series B However, this series of slides at a much higher magnification Bustrates tissue response to a relatively small field of silica. Department of Anatomy. School of Medicine. University of Pennsylvania. (Read hy D. E. Haacensen. > 38 0114-0 Slide 7--In this slide the particles were seen 7 days after placement in the chamber. They were widely dispersed, mostly within the phagocytic cells. Slide 8--On the 34th day the grouping effect of these silica-tadcn cells was seen. This point has been checked a number of times in other chambers. Slide D--On the 96th day the field of ceils was dispersed. The connec tive tissue pattern was not influenced by the presence of the silica field and there was no indication of a concentric arrangement of connective tissue fibers. Series C Slide 10--This series illustrates the tissue reaction with a larger field of silica in the same chamber. In this slide the field was on the 7th day fairly evenly distributed. Slide 11--On the 45th day the field was in the stage of aggregation of the living cells with their contained silica. Slide 12--On the 96th day the field was again in the dispersed phase. There was no indication of a specific response on the part of the fibroblasts. ' Series D For contrast this series illustrates the tissue reaction to a comparatively very large field of silica particles varying widely in size, however, of which 87.5 Vi were under 6 in diameter. Slide 13--Fifty days after insertion the connective tissue bed along the periphery of the field was uniform from left to right. Slide 14--On the 71st dsy the field appears relatively stable. Slide 15--On the lOSth day the connective tissue formation in this region was not greatly changed. The silica field wss dispersed. Slide 16--The same day another exposure In a region free of silica was taken. The connective tijsae differentiation from left to right appeared similar to the field of the previous slide. Series E Slide 17--For purposes of comparison 2 slides are shown of the reac tion which followed the use of the 2 silica samples. This slide from a cham ber in which silica sample A was used was taken 151 days after insertion of the silica. _ Slide 18--This slide from a chamber in which we used silica sample B obtained from Dr. Gardner indicates the tissue response 153 days after Insertion. Series F For a period of 3 weeks the movements of a large multi-nucleated giant cell containing a number of small silica particles were recorded. Slide 19--On the 46th day the cell was rather faintly visible with the previously ingested small silica particles. Slide 29--On the 7lst day the ceil was larger in diameter and the silica particles were more clearly defined. The ceil had moved upward over a large venule. * * 37 01141 ( * mfj <kT i tit *^T Slide 21--On the 82nd diy the cell showed sipu'of degeneration. The bounder]: was indistinct and a number of macrophages were sticking to the periphery of the cell. Slide 22--On the I08th day the cell was obliterated. The silica parti* cits which had been ingested 3 weeks-previously were then either deposited on the connective tissue bed, or taken up by phagocytic action of macro* phages. There is no evidence of any irritating residue left by the degener* ation of the giant celL Motion Pictures Several references In the llteratnre on sOicosis indicate the sticking of leucocytes to the endothelial cells lining the blood vessels in regions where silica particles are present. The film about to bo shown waa. taken of a silica field in the livinr tissue of a rabbit ear chamber. The incorrectness of that conclusion reached from dead tissue studies of rabbit ears is evident from the film. The silica had been placed in the chamber several weeks previously. The but part of the film was taken of enothcr chamber by Dr. Clark. This illustrates sticking of leucocytes caused by artificial means and net by the presence of silica particles. Conclusions It may be concluded from observations for a period as long as 370 days following a single insertion of silica granules In a scries of rabbit car cham bers that the following points art evident: The endothelium of the very extensive complete vascular system found la various chambers does not show increased growth or differentiation into epithelioid cells. The granular leucocytes do not show s specific response to the sfliea particles. Neither the lymphatic capillaries nor their contained cells show a spe cific response to die presence of the silica particles In the living connective tissue. Visible reaction to the silica has been almost exclusively confined to mscrophsgts. As described last year, these cells take in or phagocytixe the silica granules in varying numbers, and retain them for weeks or months. They become very sluggish in their movements and show a pronounced ten dency to form permanent groups in the tissue spaces. Such groups have been followed for nearly a year without showing any significant changes. Daring the first few weeks, before grouping has occurred, and in lesser degrees in later stages, there are seen many giant cells. They do not develop undl after the macrophages have taken up most of the sfliea, and are prob ably formed from macrophages, either by coalescence or by nuclear division, is W. H. and M. R. Lewis have described. While they may contain large numbers of silica granules, the evidence indicates that these pwnules have been taken up by the individual macrophages, and not by the giant cells themselves. Giant cells may persist for days or weeks, during which time they may manifest a very slow amoeboid movement. They may then dis integrate, the remains being taken up by new macrophages, or the silica granules may be left in the tissue or Incorporated in connective tisane fibers. Following the disintegration of giant cells there is no visible evidence of a deposit of any Irritating residue. , It should be pointed out that giant cells are invariably observed in the 38 01143 &- V -n?-: .</. -. - r~~ . rh th ra iled JTOr- : of on f * Hi .tut ks Dr. . UBS lays am- and Into ilica spetivo I to the the. tentnre s. sser clop robion, trge iavo jells ime diiillca ea i of the chambers in the rabbit's ear whether or not silica granule* are present. It should also be mentioned that the supply of macrophage*'is probably inex haustible, since they undoubtedly eonte from the large mononuclear leuco cytes of the blood stream whoso number remains constant normally, with replenishment to excess following depletion. The pattern of the connective tissue growth In the neighborhood of the silica Injections shows no noticeable difference from that In other regions, or In chambers without silica.. Whether the groups of silica-containing ceils are large or small, nothing has been seen, either in oar living specimens or la those of oar preparations which hare been Axed and stained, which indi cates even a tendency toward die appearance of the typical silicotic nodule. DR. LAN'Z-V This very interesting paper will now be discussed by Dr. Eliot R. Clark. t DR. CLARK: The results of these experiments are not considered by us to be necessarily in conflict with tha resalts of tho injection experiments of the many inresdgators who have described the .formation, in rabbits and guinea pigs, following intravenous (Gardner, Simpson and Strachan), intraperitonsil (Sayers and Miller) or subcutaneous (Fallon and Banting) injec tions of silica* of characteristic nodules closair resembling the silicotic nod ules found in the lungs in cases of silicosis; and who failed to And nodules of similar character following injections of many other types of granules. Rather It seems to us that tho absence of tho typical reaction in the particular set-up of our experiments furnishes an unusual opportunity to investigate tho various possible accessory factor or factors which apparantiy must be added to the simple long-time presence in the tissue of silica gran ules, in order to produce typical silicotic nodule formation. That the complete explanation has not yet been found is evidenced by the variety of unproven hypotheses which have been proposed. Theso in clude among others: (1) the possible slow dissolving of the silica with pro duction of colloidal silica which may have an effect upon the tissuea; (2) some sort of slowly developed direct toxic action of tho silica which eventually injures the cell; (2) the production by tho cell of a phospho-lipid which becomes the irritating subseance; (4) tho suggestion that tho silicotic nodule is produced not in reaction to silica alone but to silica along with something else: living bacteria such as tubercle bacilli or their products, gaseous substances, or various other chemical substances. Each of these hypotheses is held by one or more setive investigators or group of active investigators st the present time. All of them an in need of crucial testing. In anticipation of the desirability of having available an arrangement by which, in addition to having access to the living tissue for the insertion of granular substances, we might have a container, open to the tissues, we have developed a combination chamber which makes this possible. Without mechanical disturbance to the tissue, we can place in the container any desired chemical substsnee, can leave it, as long as desired, in contact with the tissue, and can then recover the contents of the chamber for chemical analysis. The device, which is tn adaptation of one in successful use for some years in our laboratory in the hands of Dr. Abell, solves the problem of a way to subject tissues to the prolonged action of fluid substances, which * fFallon and Bunrlnr describe ikkIiiIm formed In the enr* of nibbles six month* after sincl* subcaumevu* Infection* nf silica. and <-autln ncalnot the u*e of too targe a dost--In which case the sranntar*ina*e *eem to act only a* foreign bodies.; 39 e>*r.i--iiiiM.'A-.AiyN!- > ^* 11 11 1 11 **Se sy-arer-o.-- 01143 sTr? 1 am not l* achieved satisfactorily by subcutaneous, intravenous er intraperitoneal injections. ( With this new chamber we can. for example, subject to a new test the question of the reactions of living colls and tissues in the living animal to a combination of long-retained silica granules and freshly introduced colloidal or dissotrod silica; we can study the reactions to phospholipids; we can observe the effects, on the cells with long-retained silica granules, of living or dead tubercle bacilli or their extracts--to mention only a few of the possi bilities. A rabbit with this new chamber installed is on demonstration at this meeting. There is reason to hope and to expect that, building on the foundation already laid la the studies which have been reported today and at last year's mooting, wo may bo able to make further contributions toward an under standing of some of the puzzling problems presented by the reactions of living tissues to silica dust. DR. LANZA: Is there any discussion now or any question on either of theso two authors' remarks! DR. GARDNER: I show this slide to illustrate different stages in the reaction to direct injection of larger quantities of 1 to 3 micron quartz particles. The early phase consists of a tubercle-like collection of macro phages or dust cells filled with quartz of the same size used by Dr. Clark. After about 2 or 3 weeks the center of this mass breaks down with the liberation of fatty material demonstrable by special staina. After S months the center of the area has become soft and semi-fluid so that It has fallen out in preparation of the section. Surrounding it, however, is a definite layer of more or less concentrically arranged fibroblasts (connective tissue cells). One year after exposure the whole area has been replaced by a mass of silicotic fibrosis, so dense that the tissue is torn In preparing the section. I cannot remember the exact doeege in our experiments but they were of the order of 0.1 ec. of a 1 per cent suspension, which means an enormous number of particles of the size employed. I believe that the fact that so many observers have obtained silicotic reactions on injecting excessive amounts of silica directly into the tissues while Dr. Clark has failed to do so with smaller quantities Indicates an indirect mechanism as the cause of the injury. Fallon proposed the hypoth esis to which Dr. Clark has referred, L e, that in silicosis the primary irri tant was silica. This substance acting within the phagocyte poisoned it. liberating non-specific phospholipids. Phagocytosed tubercle bacilli might have a similar effect and likewise liberate phoapho-lipid. It was the Utter eubstance, non-specific in character, which then acted upon the connective tissues to produce the nodular type of reaction which characterizes both silicosis and tuberculosis. * -- TTe are testing thi hypothesis at the present time. Dr. Clark has an exceptional opportunity in the method that he has developed to'study the further stages of the reaction to silica and to test the Fallon hypothesis. I shall watch with great interest the further developments of his work. DR. HAYTHORN: I should like to produce at this time an unpremedi tated hypothesis. Repair and reparative processes, and I think that the nodule of silica is a reparative process, depend on some injury or destruction of the circula tion. Dr. Gardner's dosage, aside from considering the quantity of silica. 40 0ll4f [ was larps enough to injure the local circulation. \V can see from the doses used in the ear, in these motion pictures, that the circulation was still intact. It might not amount to anything, but I should think there was a chance that those, when introduced, should injure some of the vessels. DR. GARDNER: I think. Dr. Kaythora, that you are undoubtedly right. I think that there ia an effect on the circulation, but I think it is a specific one, because the same dose of the same size particles of aluminum oxide, for example, will not have this effect.' Nor will the nodule be formed if you coat your quartz particles with aluminum hydroxide or with iron or with any of the other known antidotes. I think the injury is the result of soluble silica continuously deposited on the surface of the quartz grain and that that injury manifests itself on the cytoplasm of the phagocytic cells, dost cells. I quite agree with you that there is an effect on the circulation, because we see the vessels swell out with these big doses. DR. HAYTHORN: On the other hand. If we make a cut with a razor that destroys the circulation, we will get a scar at that point. DR. GARDNER: Surely. DR. CLARK: I should like to say In connection with Dr. Gardner's dis cussion that we have been very much disappointed that we didn't hare nice silicosis nodnles develop with our method. We thought Zhat here was a chance to watch the development of the nodules, perhaps add something to the mechanism. Then If we could get them produced we would have a chance to experiment with substances that might prevent the development of the nodules. - I think that we should go on and use more massive doses, although, as you saw from some of the pictures, for the amount of tissue involved some of oar doses were pretty large. I still think that the.fact that sfiiea gran ules, in the doses that we used, can remain in this environment for months without producing say specific response does furnish s basis for a series of experiments in which we may see what it is when added to that silica-- maybe it is more silica that may be the answer--that does lead to the result of this specific reaction in the connective tissues. DR. MELLER: This is where we have planned to stop for the day. I want to call your attention to the symposium on industrial health defense scheduled for tomorrow, which will be intensely practical. I am sore hone of you will want to miss it _ The meeting is adjourned until tomorrow morning. 41 01145" 22*C -- ^t- - - - - - - J* *m*t inri-y "k- 5i WEDNESDAY SESSfON NOVEMBER 13. 1340 Tf. *'- Tho Wednesday meeting of Air Hygiene Foundation of America, Inc, was called to order at 10:00 A. M. by Dr. K. B. Mcller. DR. MELLER: Mr. Water* i detained in court this moraine so we will ask Mr. J. Dewey Dorsett to be kind enough to read Mr. Waters' paper. 4 -- #i * REVIEW OF RECENT OCCUPATIONAL DISEASE LEGISLATION THEODORE C. WATERS* The maintenance of the health of workers engaged in industry has become an essential part of the program for national defense snd, during the past year, there has been extensive activity on the part of Federal, State and private agencies to perfect the methods for health eontroL These programs havo created new responsibilities for employers, and I have been requested to submit, on behalf of the Foundation's Legal Committee, a report dealing with current developments relating to the legal liability of employers for hesith injuries sustained by employees. Far this purpose I have selected the following subjects for discussion: ' I. Slate Legislation L Occupational Disease Compensation Acts introduced in State Legislatures in 1940. 2. Legislative Resolutions authorising the appointment of Recess Committees to study the problems of occupational disease, and submit reports to the 1941 State Legislatures. 3. Activities of Stats Bureaus of Industrial Hygiene. IL Important Court decisions construing compensation statutes. L STATE LEGISLATION 1 Occupational Disease Compensation Acts Introduced in State Legislatures in 1940 No additional States, during 1940, enacted new occupational disease com pensation statutes and, therefore, there arc now twenty-four* States and the 3i H i! i l .<2 !su? \ & ill * Member Legal Committee: Chairman. Maryland Occupational OUeaaes Commlulon. L Arkinm-UU Calltorn la-1913 Connectlcut-is:? DeUware-133? Maho-lSSS lUInrlt-lSSS jnd lntie-133? Kcntuckr-lSS* L District ot Colambla-tJtS Maryland-133? Massaetiu*:ts-I33 MIchl can-1337 M(etourt-l?3i MlnnoA-;?I7 NVlmtla-IMS New Jerer-l93l New Yorle-1319 42 North Carollna-UJS North Dakota-1333 Ohio-1331 Pennsylvania-!?*? Rhode InlaM-1511 Wa*hincton-l?3r We*t nratR!*-l3SS TOsconsin-1313 . t *-~T-ac } '< 01146 f i '.-r.LT "* iiV Wiika-M i .* wi I 1 * r; *1 **w . - Ju, - A ;3\T` v!*.` District of Columbia* where occupational diseases arc specifically compcti* sable by statute. The State of Arkansas, included in this number, enacted Its occupational disease law in 1939, but this law will not become effective untit approved by referendum at the time of the general election this falL* During the past year, bills that would have made occupational disease injuries compensable were introduced into the State Legislatures of Louis* iana and Virginia, but failed of enactment. In Xew Jersey, several bills were offered to make the pneumoconioses compensable, but up to the present time none of these bills have been favor* ably acted upon hr the Committees to which they were referred. Xew Tori; State enacted an important amendment to the section of the statute providing compensation for the dust diseases. Prior to the 1940 amendment, compensation for partial disability from these diseases was dsnied, and a limitation of monetary liability of an employer was established in the amount of S300.00, accounting from Juno L 1930, with progressive in* ereases at the rate of $30.00 per month until a maximum of $3,000 was reached. That maximum would have been reached in August of 1940. but this amendment increased the maximum limitation of liability to $5,000. the progressive increases at the rate of $30.00 per month continuing until the maximum is reached in December, 1943. This amendment also provides for I the appointment by the Industrial Commission of a board of export con . I : - I sultants on dust diseases, consisting of three members, who an required to .! examine claimants in all controverted claims. The findings of this board of I expert consultants are then filed with the Commission and become presump tive evidence upon the hearing of the claim. * i During the coming year, the Legislatures of all the States will bo in session, except those of Alabama, Kentucky, Louisiana, Mississippi and Vir ginia. and it is highly probable that bills will bo offend to make occupational diseases compensable in some of the States when they are not at present compensable, while in other States efforts will be made to liberalize the laws Ia and extend the benefits of compensation thereunder. I would suggest therefore, that the members of the Foundation follow carefully these legislative programs in the respective States in which they are engaged in business. 2 Legislative Resolutions Authorizing the Appointment of Recess Committees to Study the Problems of Occupational Disease, and Submit Reports to the 1941 St&te Legislatures During the year 1940, legislative resolutions authorizing the appoint ment of Recess Committees for the purpose of studying the compensation laws and recommending revisions thereof have been passed in the follow ing States: ' Louisiana Oregon Michigan . Tennessee Xew Hampshire Texas Utah In Louisiana, House Resolution Xo. $14 and Senate Resolution No. 387 provide for the appointment of a Commission, to study the workmen's com pensation law and to draft a new Act for that State. To data this Commif- * This law was approved In th JCorember. 11-10 election. 43 wArmtmm 01147 tea vm W;., ion does not seem to have been active nor to have prepared any report. In Michigan, House Resolution Xo. 52 and Senate Resolution No. 38 provide lor the appointment of a Committee to study the Workmen's Com pensation Law. No personnel was appointed, and the Standing Committees terminated upon the adjournment of the Legislature. The State Bar Associ ation of Michigan appointed a Committee upon Legislation and Law Reform to study the proposed revision of the Michigan Workmen's Compensation Law. This Committee has been active and, while its (Inal report has not boon submitted, it has prepared and submitted a progress report which includes the following reference to occupational diseases: "Tour Sub-Committee has under consideration and has tenta tively agreed upon the following general proposition, detailed recommendations as to which will be included in our Anal report: . . "We believe the law should cover accidental injury which may be definitely located as to time when and place where the accident occurred, as well as occupatior.il disease clearly due to the nature of the employment. We recommend that the schedule of occupa tional diseases be eliminated from the statute and that the term 'injury' or 'occupational injury' be clearly defined by statute in such manner as to include accidental Injury as indicated above and occupationnl disease peculiar to and resulting from the employ ment. Such definition should clearly exclude disabilities common to members of tho public generally, except where it is clearly aggra vated by the employment." In Mew Hampshire, Joint Resolution No. 04 provides for the appoint ment of a Commission of nine men to study occupational diseases. This Commission has been appointed by the Governor but to date has not pre pared its report. In Oregon, House Joint Resolution Mo. 13 provides for the appointment of a Committee of five members to study the Workmen's Compensation Law and the advisability of including occupational diseases under the set. This Committee is now actively engaged, but to date has not prepared its pro posed report. In Tennessee. Joint Resolution Xo. 42 provides for the appointment of a Committee to study the Workmen's Compensation Law *nd presumably to consider the recommendation for compensating occupational 'disease injuries. A Commission of three men has been appointed recently by the Governor." -- In Texas, House and Senate Resolution Xo. 258 provides for the appoint ment of a Committee of five members to investigate the operation of the Workmen's Compensation law. I am advised that this Committee has not been ective and probably will not prepare or submit a report because of the lack of an appropriation to carry out its work. In Utah, Senate Resolution Xo. 249 directed the State Board of Health, is cooperation with the United States Public Health Service and the Indus trial Commission to make a survey of industry in Utah, and to determine the nature and extent of the occupational disease problem in that State. It ia The Governor's appoint**! r* as follows: Or. Roy Cnrrlsnn. IVv-ll*nt of PeSitwty Collecc of Nohrin*. L#r Lortnr. Lni*>r Lr.vtrr of Mrtnplil*. W. T. Kcnn*rl*r. s Knoxvlll* attorney. 44 0114-8 >*V. w 4 **> :*aT;t j. -VStrs..igBu*^i - assumed that th* State Board of Health will submit to die proper Legis lative Committees a report dealing with this problem at the 1941 session. 3 Activities of State Bureaus of Industrial Hygiene State Industrial Hygiene Units have been established and are now active la thirty-one States. To this report is appended a list of these units with the names and addresses of their directors. During the past year there have been many instances where the services of these units hare been made available to industry for the purpose of assist ing {a the control of specific occupational disease problems. The utilisation of these services should be of material assistance to small Industries with- . out medical or engineering departments qualified to advise them in the methods of control of disease hazards. The Divisions of Industrial Hygiene in several of the States, during 1940. have promulgated Codes and Rules for the protection of employees from occupational disease injuries. In Xew Vork State the State Depart ment of Labor has submitted to the Board of Standards and Appeals for approval three proposed industrial codes relating to the following subjects! 1. Control of dust, fumes and gases in foundries. 2. Control of silica dust in the stone crushing industry. 3. Control of silica dust in the stone cutting and stone flushing industry*. These Cods* were prepared pursuant to Section 29 of the Xew York Labor Law end include standards of dust concentration* permissible in the given industries. Public hearings upc-a the Codes were held during the past summer and closed on August 1. 1940. The Codes are now beforo the Board of Standards and Appeal* for fmel action and, upon their approval. wiU have the force and effect of law. The Xew York State Department of Labor is t now giving consideration to five additional Codes as follows: L A Code on temperature, humidity and ventilation. It Is believed that this Code will be very narrow in its scope and will apply solely to underground operations. i 2. Revision of Code No. 12 on dust, fumes and gases. This matter < is being studied by the Department and additional data is being obtained to lay the groundwork far the new Code. 3. A Code to control dust in the Ceramics industry. The basic i data is now being procured for the preparation of this Code. 4. Code on respiratory protection. The need for the approval of respiratory equipment has come to be recognised and the use of such equipment may be approved aad recommended In certain type* of industrial operations 5. Carbon Monoxide Code. The proposed study of this subject is i being planned by the Department. i Xo Committees have as yet been appointed to draft these Codes, and the present departmental activity is confined to accumulating information relat ing to these su'rfetts for the purpose of submitting such, in formation to the Code Committees when appointed. In Maryland the State Department of Health and the Department of 4$ OII49 1, .. Health of Baltimore City hare recently promulgated rules relating to per* miasibla concentrations of vapors, fumes and gases hazardous to the health of employees. These rules have been advertised for public bearing on November 25th, after which they will he adopted or amended.* The proposed rules are patterned upon the Connecticut Code for similar control. IL IMPORTANT COURT DECISIONS CONSTRUING COMPENSATION STATUTES During the post year there have been many Interesting Court decisions relating to the legal liability of an employer for health injuries sustained by employees in the course of employment. Some of these derisions bars construed the Workmen's Compensation Acts to cover what appear to be occupational disease Injuries under the theory that such injuries are acd* dents; others construe general coverage occupational disease compensation statutes as purporting to provide compensation for many of the human ills to which we may all be subject, unrelated to our employment or the Indus* trial processes ia which wo may be engaged; while others relate to the estab lishment of the date from which the period of limitations runs for the filing of claims for* occupational disease injuries under the compensation statutes. In the time given to me it is impossible to discuss many of these decis ions or to discuss even a few of them in detail; however. I believe they are so indicative of judicial trends in construing an employer's liability for such Injuries, that l would like to call your attention to those that to me seem most important. The case of Neill McRae v. Unemployment Compensation Commission of North Carolina. (1940). 9 S. E. (2d) S95. was a workmen's compensation Tbs follnwiug rul** and regutathMui to apply both to the State and City: uppmvwnl At ths hearing Xorerator SS Regulation 1. General. Xu firm, cwporatfant nr other employer shall use or permit to be u*-d in thr conduct n< his business. munufneturing estaldith- ment or other place of employment, any piwnw. material or niothod of rUur known to havr an adverse effect on health, unices arrangements have been made to maintain the oo-upstlnnal environment In euch a manner that Injury to health shag not result. Regulation 2. Threshold limits. Exposure* to dusts, fume*, mists, rupee*, gases, or any material* that may affect health shall be kept below tbo foUowto* concentration limits, as determined hr accepted procedure: Material Concentrations . Penxene <Cento! >___ H part* per million Carbon Tetraehlorldc lou part* per million Carbon Monoxide __ I#d ports per million Chlorine _____ t part per million Chromic Add Formaldehyde Caroline Hydrogen Cyanide . Hydrogen Chloride Hydrogen Flnndde Hydrogen Sulfide _ Lend . *.l mg.per cubic meter - Jlparts per million ___ im parts per million _____ ;nparts per million _____ jnpart* per million _____ ;ports per million _____*d parts per million .IS mes. per ruble meter Methn-.m __ IS<parts per million Xlirogen Oxide* Phosgene ________ Sulfur Dlocldf . _ _____ - Idparts per million 1part it million Idparts per million This regulation, a* It relate* to Chromic Add. shall he construed to apply only tn that branch of Industry concerned trlch Chromium plating. Exposure to other materials not Included la thr above shall he kept bd**w Injurious ror.rentratlnn*. Dusts of mlncmlnctral romonelthm und *rranlr dusts shad not sxceed ennrentratlnn limit* which shall he stipulates!. depending on the nature of the dust. 4G Oil SO -A? r Vfe IM 1 ' t W \ claim /or tuberculosis alleged to have been contracted as the result 0/ work* ing with a fellow employee suffering /rum this disease. The claimant was employed by the State Unemployment Compensation Commission, and evi dence teas offered to show that its offices were crowded and tiiat, during February, 1939, the claimant, with a /allow employee named Tyson, were placed across from each other at a very narrow table te do their work; that on or about February IS, 1939, Tyson, who was sufferinc from active pulmon ary tuberculosis, coughed into the /ace 0/ the claimant on several occasions; that, thereafter, the claimant, who had previously been strong and healthy, commenced to suffer bodily fatigue and general debility; and that, on June S, 1939, upon physical examination, his case was diagnosed as being pulmon ary tuberculosis. An award in favor 0/ the claimant was mode by the Cora* mission on the theory that the injary so sustained was on accident within the meaning 0/ the Xorth Carolina Workmen's Compensation Act. Upon appeal, the Court sustained the award, holding that the tubercu losis suffered by the claimant was directly attributable to his infection when his fellow employee involuntarily and unexpectedly coughed into the claim ant's face, such coughing being "untoward, unfortunate and unusual in Its proximity to and its effect upon the plaintiff," thus constituting an accident within the meaning of the compensation statute. ; i The case of Vogt v. Ford Motor Co, St Louis Ct of App, (April 2.1940), 13S S. W. (2d) 634, was an appeal from a decision of the lower court affirming * ; an award of the Workmen's Compensation Commission in favor of the i claimant Vogt who had applied for compensation for injuries, holding that his contraction of bronchial asthma, allegedly due to cold air, dust and paint fumas, to which he was exposed during the course of his employment was i an accident compensable under the Missouri Compensation Law. The evidence showed that the plaintiff worked in the "trim room" where he assembled parts and put them upon ears as they passed along a i conveyor line. He was stationed near an open door lending into a paint spraying room from which a fan blew paint spraying fumes through the a door. Medical testimony was offered that the claimant had allergic bron f. I chial asthma; that the working conditions to which he was subjected had esused this asthma. i The Court affirmed the opinion, finding that there was sufficient evidence g to justify the Commission's finding that the clainient's condition was the result of his employment. It was further held that, since the claimant's r condition was due to an allergy, it was not an occupational disease, since "asthma is not a disease, which from the common experience of humanity, is known to result to others engaged in the same work; in other words, the disease Is not a general concomitant or the result of the work which he was doing" and was not a disease known to be incidental to that particular em ployment. However, the Court found that the injury sustained was an acci dent because it was "an unexpected and unforeseen event happening sud denly and violently with or without human fault and producing at the same time objective symptoms of an injsrr" found in the set. It was further found that the claimant could not have expected or foreseen that In his phys r ical make-up there was a dormant allergy to the particular dust and fumes .of his employment. % r The case of AVolfe v. Brohmsn (Sept. IS. 1940), Supr. Ct. App. Div, 22 X. Y. S. (2d) 403, was aa appeal from nn award of disabiticy compensa tion and death benefits in favor of the widow and minor child of the deceased 47 01151 5r 'Mm Jb X = - i I * f V , ; . * employee, mode by the State Industrial Board under the Workmen's Com* pcosauon Law. The deceased employee was engaged as a batcher and meat cutter, which occupations required him to go in and out of a refrigerator cooler, thereby subjecting hiuiclf to sharp variations in temperature. On March 20, 1937, ho was compelled to remain in the eooicr longer than usual sad longer than he Itad over remained on any previous occasion. While in the cooler he suifered a severe chill and was sent home tnd a doctor called. Pneumonia developed, from which he died. The State Industrial Board found that-this pneumonia was the result of sn accident and was also an occupational dtseaae, which opinion was affirmed by the Court. There ere several cases wherein appellate courts construe occupational disease ecu, which ere of particular interne The case of Bleeeingame r. Southern Asbestos Co, et aL, N. C. Supreme Court (March 6,1940), 7 S. . (2d) 478, was sn appeal to the North Carolina Supreme Court from an opinion of the Superior Court, affirming an award by the Workmen's Compensation Commission in a claim for death from lobar pneumonia, allegedly due to asbestosis. The claimants decedent had worked for the defendant for a period of seven years, and died on April 1, 1937, a few days after having driven to the State of Georgia for a vacation, end suffering with a heavy cold at the time of bis trip: An autopsy was performed on May 10, 1937, and medical evidence was offered showing he wae effected with the early stages of asbestosis. Notice end claim wero made ont July 19 and filed on July 20, 1937. The claim was referred to the mem* ben of the Advisory Medical Committee under the North Carolina Compen sation statute, whose testimony established that asbestosis was not a factor in causing the decedent's death. The case was first heard before one mem ber of the Commission, who denied compensation. The full Commission then reversed the decision of the individual Commissioner, finding, as a fact, that decedent's asbestosis lowered his resistance to the pneumonia. This decision was affirmed by the Superior Court and inter affirmed by a four-three deci sion of the Supreme Court of North Caroline. The two phases of this case that are of particular interest to this dis cussion are ss follows: 1. The findings of the full Commission reversed the deasion of the individual Commissioner to the effect that the decedent's asbes tosis was a contributing cause of death, because of his lowered resistance to pneumonia, even though the Advisory Medical Committee had testified that the decedent's asbestosis had played no part in his death. Therefore, the majority members of tile Compensation Commission, in fact, overruled the medi cal findings of the Advisory Medical Committee. 2. The North Carolina Occupational Disease Act, Sec. 50-*.; (o), provides: "Unless written notice of the first distinct manifestation of an occupational disease shall be given to the employer .... or to the Industrial Commission within thirty (39) days after such manifestation, and. in case of death, unless also written notice of such'deatli shall be given to the beneficiary hereunder to the employer or the Industrial Commission within ninety 48 011S2. i i r r ; ' -a (DO) day* after occurrence. . . .*" the right to compensation for disability or death shall be barred. In tltia case it will be noted that death occurred on April I; that the autopsy was performed on May 10th. and that notice and. claim were not made until July 13th. The Court found that the notice given was timely, on the theory that notice of death had been given within ninety days after the widow dis covered her husband was suffering from oxbcstosu, even though the atatuta established that aucli notice should be given within ninety daya after death. The majority opinion based its con dosion on the ground that the want of notice did not prejudice the employer. The case of Moffett r. Xlarbison-IValker Refractories Co., 14 AtL (2d) 111, decided June 14, 1340, by the Supreme Court of Pennsylvania, was an appeal from an order sustaining a statutory demurrer to plaintiff's state ment of claim in a common law action against his employer for alleged par tial disability from silicosis. The Pennsylvania Occupational Disease Com pensation statute denies compensation for partial disability, and plaintiff's dadaration alleged, such partial disability sustained while in the defendant's employ. The plaintiff contended that, sines the injuries sustained by him were not compensable under the occupational disease compensation act, ha retained his right of action for such injuries at common law. In denying the right to the plaintiff to maintain his action ths Court said: "It la common knowledge that in the early stages silicosis Is difficult to detect. A Commission on Compensation for Occu pational Diseases which reported to the Governor in 1033 recog nized that silicosis and miner's asthma, because of their slow development, presented the 'greatest difficulties as administra tive problems.' The Legislature recognized the difficulty of the subject and provided. In relief of the possible burdens on the employer, that the Commonwealth would contribute $100,000 for the purposes specified in Section 7. It also provided, in the circumstances stated in Section 10, for the appeintment of a Medical Advisory Board to report to the com pensation authorities on silicosis cases on trial tad in Section 11 for the `entry of any physician, surgeon, or expert upon the premises of the defendant employer in erJer to ascertain the facts in any case arising under this act.' We think it is dear, therefore, that the legislature intended to bring all silicosis sufferers, whether partially or totally disabled, under the Act and that by accepting the provisions of the compensation acta, an employee agreed to look solely to the Act for compensation and to giva up any remedy he might otherwise have had." In the case of Peter Tomsic r. H. C. Frick Coke Co. dedded by the Workmen's Compensation Board of Pennsylvania on September 6, 1940, ths claimant filed a petition on January 17, 1939, alleging total disability resulting from silicosis or anchraco-silicosia, which he contracted duringhis employment with the defendant. The claimant offered medical testimony that he was suffering from chronic bronchitis, better known as "miner's asthma," and admitted that he was not suffering from silicosis or asbestosis. The Act of July 2. 1937 (P. L. 2714. Sec. 2), which was the Occupational Disease Compensation Act effective during the time of the claimant's em- 49 01153 1/ t 1 t ployment. di<! not provide compensation for miner's asthrau. That act was amended by the Act of June -1, 1939, the amendment -defining compensable occupational diseases to Include "silicosis or anthraco-silicosis (commonly known as miner's asthma and hereinafter referred to as anthraco-silicosis)." Ths Board held that since this act did not take effect until October 1, 1939, It was not retroactive and that, therefore, the employer was not liable for the eompensation sought in this ease. I would like also to eall to your attention two decisions of the Missouri Appellate Courts, establishing the time from which limitations run for the iUinr of occupational disease claims under the Compensation Statute. < In the case of Cleveland r. Laclede Chriser Clay Products Company, 129 S. W. (2d) 12, claim for silicosis injuries was mads. The claimant operated a truing machine for the purpose of grinding and Anlshing tile. He was Arst employed in 1928 and in 1923 began to develop symptoms of chest pathology. He was attended by a physician on January 30, 1936, and advised to discontinue work. He laid off for a period of Ave weeks during which time roentgen examinations were made of his chest. At the end of Are weeks he returned to work, but his condition became gradually worse and he discontinued work on June 22. 1936. He was again examined on January 7, 1937, and advised by his doctor on that date that he had silicosis, this being the Arst time that he was told the name of ths disease from srhich he was suffering. Claim was Alcd on January 2S, 1937. \ The Compensation Commission awarded compensation, which sward was reversed by the lower Court, the reversal being sustained by the Court on appeal, because the claim had not been filed within the six months period required by the statute. In passing upon this point, the Court said: "According to his own testimony, claimant knew more than six months prior to the filing of his claim, that ho had this trouble in lus chest, and that he had been treated for it. He f. knew that the chest txouhle was the causa of his inability to do 1 his full work and that the nature of the work aggravated this condition." The Court further said: .* "This section (Section 3337) has been construed as a limita tion on, and an extinguishment of the right itself to maintain the action when not exercised )>eforc the six-mor.ths period of limitation has run against it. It seems to be the well settled rule in respect to latent injuries that-the six-months limitation for filing claim for compensation commences to run from the time it becomes reasonably apparent and discoverable that the employee has sustained a compensable injury." The case of Renfro r. Pittsburgh Plats Glass Company. 130 S. T7. (2d) 165, indicates the attitude of the courts with respect to a construction of the six-months limitation period in a manner as favorable to the claimant as possible in order to protect his claim. That case involved a claim for sili cosis, the claim having been filed September 1, 1937, alleging that disabBity began January 4, 1937. The Commission found, at a matter of fact, that disability began Janssry 4, 1937. On March 11, 1937, ths employer and employee had entered into an agreement providing for voluntary payments to the employee, such payments, however, not to be construed as an admit- 50 01154 V * > I I I t i I) i u li- tT at ad its Is- ii<\n of liability on the part of the employer for compensation. Payments were made to the cmploveo under this agreement until December 12, 1937. In passing upon the question of limitations, the Court said: "If we were to adopt the employee's view in the ease st bar. that tho Commission's award as for an injury in December, 1933, is correct, although there was no disability or loss of earn* ing power until January, 1937, then a proper resard for tho law would require us to hold that the employee's elaim herein is barred by the six-month* statute of limitations, because his claim was not died until September 1, 1937. It is extremely Important that we should not adopt a rule which would result In elaim* of employees being barred by the Statute of Limita tions under such circumstances as appear in this ease. We are of tho opinion that tho statute nf limitations is not involved at all under the evidence herein because we are holding that the Commission's award of compensation, based on an injury as of December, 1933, is incorrect.. Such award as for permanent total disability contradicts the Commission's own findings of fact that there was no disability until January 4, 1937, and is not supported by the evidence. Furthermore, the evidence show* that the employee's claim was filed 'well within six months from the date of last payment* as provided by Section 3337 R. S. Mo. 1929." CONCLUSION' It Is apparent that the trend of judicial opinion is toward a liberal interpretation of our compensation statutes, in providing compensation for those injuries to health that are peculiar to the employment, and may be aggravated by conditions of the employment. It is also apparent that in those States having general coverage occupational disease compensation laws, compensation will be awarded for health impairment that is common to every-day life, provided there is medical testimony in the case expressing the opinion that the injuries so sustained may have been caused or aggra vated by the conditions f employment. If this tendency continues substan tial unanticipated expense will be imposed upon employers and their insur ance carriers because of awards for tuberculosis, pneumonia, asthma, and other similar respiratory diseases. Daring the State legislative sessions of 19-11. we will find, undoubtedly, that many hills relating to this subject will be introduced and pressed for enactment, proposing to liberalize benefits and -broaden the scope of com pensation coverage. These developments emphasize the fact that it has become and will continue to bo good business for industry to concern itself with the protec tion of the health of industrial workers and. in giving consideration to the legal responsibility that arises from injuries to that health, we come to the full appreciation of the importance of comprehensive programs for industrial hygiene. 61 OllSS" rti-rii STATE INDUSTRIAL HYGIENE UNITS STATl AMO CXCCUTIVK ALABAMA Dr. John IL Cain. Director, Division of Industrial Hygiene, Department of Public Health, Montgomery. Alabama.' CALIFORNIA Dr. J. P. Russell Chief. Industrial Hygiene Service, Department of Public Health, 2002 Acton St, Berkeley, California. Dr. V'. A. Nasatir, City Health Department, Los Angeles, California. COLORADO ' Robert J. Owens, Industrial Hygienist, Division of Industrial Hygiene, Colorado State Board of Health, State Office Building, Denver, Colorado. CONNECTICUT Dr. A. S. Gray, Director, Bureau of Occupational Diseases. Connecticut Department of Health. Hartford, Connecticut. IDAHO Dr. E. L. Berry, Director, Division of Public Health, Boise, Idaho. ILLINOIS Dr. M. H. Kronenberg. Chief. Division of Industrial Hygiene, Department of Public Health, 1800 Fillmore St. Chicago, Illinois. " -- INDIANA Dr. Louis TV. Spolyar. Director. Bureau Industrial Hygiene, Indiana State Board of Health, Ind;anapolis. Indiana. IOWA P. J. Houser. Industrial Hygiene Engineer. C L. Campbell Chemical Engineer, Department of Health. Division of Public Health Engineering and Industrial Hygiene, Dcs Moines, Iowa. E2 RKMAMK4 oiijre STATC AND XCCUTIVC ftCMARKS KANSAS Dr- Enitil Doyce. Engineer it Director, Diction of Sanitation, State Board of Health, Marvin Hall, University of Kansas. Lawrence, Kansas. MARYLAND Dr. John 31. McDonald (Medical Department) , Director, Bureau of Occupational Diseases. City of Baltimore only Dr. Mllmer H. Schulze, Director, Sanitary Section, Baltimore City Ilealth Department, Baltimore, Maryland. MASSACHUSETTS Manfred Bowditch, Director, Conducted in a cooper Bureau of Occupational Hygiene, ative, joint approach to 1 Department of Labor and Industry, Boston, Massachusetts. problem by labor and health departments MICHIGAN Dr. Kenneth E. Msrkuson. Director, ' Bureau of Industrial Hygiene, : Department of Health, D11e5t1roTita, yMloirchAigveannu. e, : MINNESOTA Dr. A. J. Chesley. Executive Officer, Department of Health. 469 Stats Office Building, St. Paul, Minnesota -Service available after January 1, 1941 MISSISSIPPI Dr. J. IV. Dugger. Director, Industrial Hygiene Factory Inspection, Stato Board of Health, Jackson, Mississippi. Data service will be available not yet an nounced MISSOURI Dr. Harry F. Parker. State Health Commissioner, State Board of Health, Division of Engineering, Jefferson, Missouri. Is MONTANA Dr. Lloyd M. Earner. Director, Division of Industrial Hygiene, State Board of Health. - Helena, Montana. * NEW HAMPSHIRE Frederick J. Vlntlnner. Industrial Hygienist, m Industrial Hygiene Unit, State Board of Health. Concord, New Hampshire. 9JSfm 8 53 5*3 01157 It -.tx. are TT-nr J. * ~ ' ~ "`-'I nT'iri--ii 1 I i: ii t; li I < ITATt ANO CXCCUTIVK RXUAAKS NEW YORK Or. Leonard Gd-cnbi/r^. Executive Director, Division of Industrial Hygiene, Department of Labor, 80 Contra Street, New York. New York. NORTH CAROLINA Industrial Commissioner. North Carolina Industrial Commission, Even though the Divi sion of Industrial Hy Raleigh, North Carolina. giene is a deportment of stato health depart ment, Industrial Com mission allocates cer tain funds to it. r . OHIO Dr. J. B. Kistler, Chief, Adult Hygiene Division, Ohio Department of Public Health, Columbus, Ohio. OKLAHOMA Dr. G. F. Mathews, Commissioner of Health, H- J. Darcey, Chief Engineer. Director, Bureau of Sanitation, State Health Department, Oklahoma City, Oklahoma. PENNSYLVANIA Ur. John J. Shaw. Secretary of Health. Department of Health, Commonwealth of Pennsylvania, Harrisburg, Pennsylvania. RHODE ISLAND Charles L. Pool, Chief of Division, Division of Sanitary Engineering, Department of Health, State Office Building, Providence. Rhode Island. SOUTH CAROLINA Dr. Harry F. Wilson. Director, Division of Industrial Hygiene. State Board of Health. Columbia, South Carolina. TENNESSEE V'. C. Williams. Commissioner Department of Public Health. State of Tennessee, Nashville, Tennessee. TEXAS Dr. C. A. Nau, Director, Division of Industrial Hygiene, State Department of Health, Austin, Texas. 54 01158 tatk ancj axacunve UTAH J. L. done*. M. D.. D. r. H-. Director, Industrial Hygiene, SUC Board of Health, Salt Lake City, Utah. VERMONT Harold U', Slocum, Director, Tuberculosis Division of Industrial Hygiene, Department of Health, 348 College Street. Burlington, Vermont. VIRGINIA R. T. Homewood, Engineer, Bureau of Induatrial Hygiene, Department of Health, Richmond, Virginia. - WEST VIRGINIA Dr. Arthur E. McClure. State Health Commissioner, Department of Health, Charleston, West Virginia. WISCONSIN Dr. P. A. Brehm, Supervisor, Division of Induatrial Hygiene, State Board of Health, Madison. Wisconsin. RCMAftKS The following City Health Departments also have industrial hygiene divisions: Flint, Grand Rapids. Newark, Saginaw and St. Louis County. DR. MELLER: Thank you very much, Mr. Dorsett. Is there any dis cussion ? We go then to the Symposium on Industrial Health Defense. Professor Drinker will preside. .- _ PROFESSOR DRINKER: Regardless of our jobs or our political affili ations, the general topic of this symposium is oat of enormous interest to us. We have the advantage of haring with us, as participant* is this sympos ium, several men whom we have never had the pleasure of hearing at these meetings and some of whom have not attended the meetings at all before. The flrst speaker. Dr. Neal, who Is no longer acting chief bnt is chief of the division of industrial hygiene, (s the successor of our very good friend and ardent supporter. Dr. Sayers. It is especially pleasant for us to have him here with us today. His subject and the activities of the Public Health -Service in the national defense program are perhaps one of the chief guiding points for those of us whose professions lie in industrial hygiene. We look to them constantly for advice and for direction. It is especially pleasant for us to have the chief of the division with us today. 55 01159 ACTIVITIES OF THE I'CRLIC HEALTH SERVICE IX THE DEFENSE PROGRAM PAUL A. NEAL, M. D.* On* of ch* outstanding development* of the present national defense propan has been the recognition on the part of the lenders of our Nation that health is an essential element of preparedness. On September 19, 1940, the President approved an order establishing a Health and Medical Committee to advise the Council on National Defense, and to coordinate medical and health activities affecting national defense. This Committee consists of the following members: Dr. Jtrvip Abell. Chairman: the Surgeon Central of tha Army; the Surgeon General of the Navy; the Surgeon General of the Public Health Service: and the Chairman of the Division of Medical Sciences of the National Research Council. This Committee and its many sub-committees have the responsibility of advising the Council on National Defense regard ing the health and medical aspects of national defense, and of coordinating health and medical activities affecting national defense. One of the import ant subcommittees set up by the Health and Medical Committee of the Council on National Defense is the one on industrial medicine. Inasmuch as the program for national defease has already served to emphasize many problems pertaining to the public health, the Surgeon General of the Public Health Service. Dr. Thomas Pawn, called a special conference of the State-and Territorial Officers on September Id and 17, for the purpose of reviewing plans and agreeing on a program of action. Dr. Parran enunciated the keynote of the conference in the introductory para graph of his address. He said: "The most impelling problem which we face today is that of maintaining the safety of this country and its institutions. For their aggressive defense, we are gearing up governmental methods, mobilizing resources and manpower. For the first time in all his tory, world events have thrust upon us the concept of a total war. In preparing a total defense, all factors ultimately rest upon the one fundamental resource of the country, manpower. Medicine and public health, through the centuries, have been devoted to the con servation of manpower and its socially constructive use." - In any discussion of methods planned for effectively carrying out a pro gram it Is essential that the problem to be solved be definitely outlined. The various health problems confronting the Xa'tioa-ss a result of the present emergency were clearly defined at the Conference of State and Territorial Health Officers meeting with the Surgeon General last September in Wash ington. These may be briefiy summarized as follows: EMERGENCY HEALTH PROBLEMS Rehabilitation One of the pressing problems we are faced with is the physical rehabili tation of registrants disqualified for duty with the armed forces. Based on the experience of the last World War, we may expect approximately 25 per cent of those examined to be rejected, with about 55 per cent examined hav ing one or more defects. Of the 17.000.000 registrants, probably 0,000,000 Chief. Division of Industrial Hygiene. National Institute of Health. 50 01160 <" l/TEgNj agq-Td A t e r if It f *f ra nd ng .-as the asfor ire of nilitty. iters hese-ater loos er* 11- eanaia is ill be annel (JScers' ollowissary it and avities 16L T TTi tV^iX tdmml In military and industrial mobilization areas." The Conference further urged the coordination of activities pertaining to industrial hygiene and stressed the necessity for supplementing the efforts of the States. Industrial Hygiene It is now a well established fact that military mobilization and expan sion it impossible without industrial mobilization and expansion. Tho present industrial expansion has /ilready brought In (ta wake many new problems in employee health. To insure maximum physical fitness, tho industrial worker needs to develop a high sense of personal responsibility. Industry must continue and accelerate Its (forts to protect and promote physical welfare among workers, and the various health agencies, both gov ernmental and private, must give every possible assistance through scientific research, through the expansion of community sanitation measures, and' { ttrheraotumghentthoef adpispelaicsaet.ionDeosfpioteurcodnetvineuloepdmpernotgsreisns binoththethefielpdreovfenintdiounstarinadl > hygiene, we still have in. this country 17.000 occupational deaths from acci dents every year; 75.000 permanent disabilities; and 1,-00,000 temporary dis abilities. Recent surveys conducted in Industry show that the working en vironment of about 1,000,000 persona requires investigation by trained Indus trial hygienists to determine whether or not the presence of silica dust in the air constitutes a health hazard. The conditions of work of 800,000 persona handling lead and its compounds also need study. Similar information is available on many ocher potentially hazardous exposures. For example, it is well known that many millions of workers art exposed to materials which, if improperly used, are capable of causing skin diseases. Furthermore, it la well known that industrial workers have higher rates of physical defects than non-industrial workers and that the death rate from all causes among unskilled workers is 100 per cent or more in excess of the death rate among agricultural employees. The many studies of illness among workers recently completed show that the average worker in this country loses 10 days a year on account of sickness. In fact, general illnesses have been found to account for 15 times as much time lost ns that duo to both accidents and occupational diseases. This problem of lost time from disability among workers is of vital importance now that our industrial machine U playing such a prominent role fat the defense effort. Our recent studies have also shown clearly thac although industry is cognizant of the problem and is making progress, much still remains ta be done. For example, only 25 per cent of our workers have full time safety direction services, only 15 per cent have full time medical services, and only 33 per cent have nursing sendees, engineering studies have also brought out the fact that protection against exposures to hazardous materials and conditions is still far from adequate. The present industrial activity on defense orders has already augmented these problems in industrial hygiene. Able-bodied men are being mobilized into oar armed forces and these will have to be replaced in induttry by older men, by young adults and, in some cases, by women. Many of these newly tnducted industrial workers will not be as physically fit for arduous tasks, nor will they be as skilled. The problem of fatigue, so Important in tho first World War. will again reappear as the result of the rapid tempo of indus trial production. Many hazardous chemicals. both old and new, will be intro duced into industry. We may expect crowding in factories and we must fight the tendency to relax in the vigilance so necessary to prevent accidents and diseases among worker*. Dr. Parnin has stated that our industrial machines art rated to b tht most efficient in the world, and he rightfully Insists that the men and women who operate these machines should have a comparable efficiency. These, in brief, art same of the problems facing us today in oar health preparedness procram. The Committee on Health and Medical Preparedness recently established by the President, and its many subcommittees, are already copinr with these various problems confronting us. Tha work of coordinetinc existing machinery both as to public health and medical facili ties is under way. Insofar as industrial hygiene is concerned, the ground work laid by research daring the post quarter century and the machinery developed daring the put several years for the application of this restarch by the States and by industry finds ns better prepared to cope with indus trial health problems than at any time in our industrial history. Wo know that every job can be done safely If we only apply our present knowledge. THE PROGRAM With reference to those activities on health and medical preparedness concerned with the civilian population and our armed forces while in train ing, the Public Health Service is working very closely with the Army, the Navy, and the State and local health departments. The Surgeon General of the Public Healch Service has already appointed medical and engineering liaison officers to each of the Army corps aroas. for the purpose of expediting the solution of the various problems discussed herein. Reconnaissance surreys are even now being made by the Public Health Service and State health department personnel in the various areas to determine the exact needs in each locality. Fortunately, the industrial hygiene program could be launched Immedi ately, in view of the fact that the various States in organising their Indus trial hygiene services had already made detailed surveys of the problems in each locality. The States arc therefore in a position to know where these services are needed. Furthermore, many of the research activities of tho Divi sion of Industrial Hygiene, which are carried out during pence time, furnish us with the key to the solution of problems of a military nature and some of our findings can also bo applied to emergency problems !a Industry. For example, the study this Division recently completed on the fatigue status of truck drivers has furnished us with a great deal of information applicable to fatigue problems which may arise in industry as a result of increased activities. The industrial medicine subcommittee established by the Health and Medical Committee of the Council on Motional Defense has already been assured the fullest cooperation of the Industrial Hygiene Division of the National Institute of Health. All of the facilities of this Division will be put t the disposal of the committee, and a greatly expanded employee health program is being developed in close collaboration with the 31 State indus trial hygiene units, with industry, labor, and numerous official sod unofficial agencies. In other words, a program has been developed for coordinating .the work of ill the Federal and local agencies, of industry, of labor, of the .medical and engineering professions, and of all organizations vitally con cerned with industrial health. Insofar as the Division of Industrial Hygiene of the National Institute' of Health is concerned, its functions may be considered as partly adminis- 59 trative, concerned with coordinating all activities both at the Federal aad State level, and mostly concerned with the promotion of industrial hygiene services in Stato and local health departments, and with scientific investign- tlons conducted both at Its laboratories and in the held. The Division of Industrial Hygiene Is already carrying out urgent research directly related with defense and it Is working very closely with both the Army and the Navy. In addition to fundamental laboratory research on toxic materials i of direct importance to national defense, same of the Division personnel at* it I being employed ta supplement the work of these States which have been con fronted with emergency problems toe great for successful handling by their own efforts. If the necessary funds for this phase of the work ere obtained. .11 It is planned to have at least IS units in the field, each consisting of a trained t pthheysSictiaatne, iannduesntgriianleehrygeinedneteucnhnitsicaolnsuepmpeorrgt,enfocyr pthreobpleumrpso.seSoefvearsasl istutienhg it units are already doing work with the States. In brief, the work which the Industrial Hygieae Division is already per i forming, and which It hopes to expand, may be summarized as follows: L Industrial hygiene services to Government arsenals and ether Federal projects. a 2. Assistance to the States on Industrial hygiene problems in defease industries. :] 2. Toxicological research on defense materials. 4. An appraisal of the fatigue status in relationship to the national defense program. :t 5. The determination of methods for the absorption of handi capped persons into vital Industries for national defense. "i :i 6. The preparation and disseminatiou of Information on varioas -: toxic materials and processes, including approved designs of I exhaust systems for the control and elimination of atmospheric contaminants. y Practically all of the States haring industrial hygiene divisions have 4 already submitted programs to the Public Health Service for assisting indus 5 try in maintaining healthful working conditions and healthy workers. These programs differ in no way from those already practiced by the States In the past, except that emphasis will be given to directing their efforts to indus tries engaged on defense contracts. In other words, tha work in the States will embrace the following activities: t. The evaluation and control of the various health hazards aris ing from exposure to dusts, fames, gases.and vapors. 2. Advice to industry in the construction of new plants and in the renovation of old plants In the interest of safety and health. J. The promotion of physical examinations aad medical services to workers by Industry. 4. The promotion of measures for the control of communicable disease, sueh as syphilis, pneumonia, tuberculosis, and others. 5. The preparation aad dissemination of information on various toxic materials and processes, including approved designs of l exhaust systems for the control and elimination of atmospheric i contaminants. z Industry is thoroughly convinced of the fact that it pays to control acci i dents. In reducing the frequency, severity and monetary losses involved in 40 wjutunqiisna r 01164 Industrial accidents industry attacked the problem from two viewpoints: First, by the provision of well guarded equipment, and second, by the educa tion of workers in safety measures and practices. U'e arc thoroughly con vinced that the same tactics will materially aid in reducing lost time from occupational diseases aad other Illnesses. In other words, first, we must pro vide a sofa and healthful environment, and second, we must educate the worker in safe practices and healthful living. It la quite evident that insofar as public health and medical prepared ness aro concerned, plans have been created which are not emergency impro visations. but arc designed to be an integral part of our national Ufa In the future. This la especially true of our Industrial hygiene program, and it is hoped thAt we will not forfeit the gains tre have nude so far for the sake of expediency. Ail of us, be we public health workers, private medical practi tioners, engineers, chemists, industrial managers, or factory workers, must assume leadership and responsibility and coordinate all of our efforts, so that the men and women in our Industrie* will attain a high level of efficiency and health. PROFESSOR DRINKER: I am sure that Dr. Neal will be glad to answer question* as to the matters which h* has brought out. AIR. CONNOR: I should like to ask the speaker whether or not ha can tell me this. I have about sixty young men of draft age who arc receiving regular routine treatments for syphilis. They are continually asking me if when they ore called the government will continue their treatments in active service or whether they will be rejected. I can't tell .them. I'd like to have some help. DR. NEAL: I can': speak for the Army, naturally, on that. My opinion would be, and I think it is the present thought, that each individual case is decided on its own merits in connection with this communicable disease, as others. If the men are not disabled, and we assume these are not-->in other words, they don't have cardiovascular disease--they will receive the same treatment they are getting now after they are inducted into the service. Whether they will be inducted into the service or not I don't kaow. I think It will be decided on etch Individual case. PROFESSOR DRINKER: Dr. Ssyers, I think we should all be glad to hear a word from you. DR. SAVERS: I tm very much Interested, as yoa know, in the program that has been outlined by Dr. Neal for you and to you. It is one that has been developing for a matter of years. There arr many of you sitting around here who have been associated with us in the development of that program. Most of you in the room have had something to do with iL The program is not new and it is not a program that la jast for defenae alone. As (n all industry, as in all the work that we are going to do, it must' be speeded up if it is going to accomplish the purpose we are to have. In answer to the question, if I may expand a little on Dr. Neal's state ment, I think that whether any individual who comes up is Inducted or not will be determined by your local draft board to a great extent. I don't think we need to worry very much about those people with syphilis. They will receive treatment. They will no longer be communicable from one to another in the army. I don't tfciak we need worry too much about it. I do think that we all have a real problem In regard to Industrial 61 01165 r*--> *C>. - * Vill if --------------- * Lt=/.- .*-. - > r -, , --r. S'.. hygiene. I think we all mint cat behind it and push it. We cannot aoccead In this war unless hava our worker* in good health. Whenever a man ia away, it doesn't uaka any diiTercnce whether it U occupational disease, accident, or just Alness that causes him. to bo away, it Interferes with pro* duction, and production Is important to us today. It is a very serious thine. Again, wo art not hers to scare anybody. We just want to work alone efficiently, and scared peoplcare not efficient. We have a job in front of us, and it is a big job. Wo must ail work. I hope we can support all tho croup. There are several here on this medical defense who belong to the Advis ory Committee, I believe, of the Medical Defense Commission--or la It tho Defense Council? You know tho Defense Council is made up of secretaries in our cabinoc. There is an Advisory Commission to the Defense CouneiL Then they have special committees in the Research Coascii that advise them, and the Medical Committee is one of that organization, as I understand the present croup. Then there is a sub-committee on industrial hygiene. The procram is being worked out, I believe, expeditiously. We cannot work too fast The groundwork baa been laid la the period of yean that has gone by and part of that groundwork is within this organi sation here. Dr. ifeal has emphasized to you the importance of cooperation and coordination. That must bo had If It is to be-efficient. It Is a great pleasure for me to bo here with you today. I thank you alL PROFESSOR DRIMKER: If there are no further question* wo will proceed with the next paper. Thank you very much. Dr. Neal. Our role as a nation In this present emergency, whether we are helping the Allies or whether we are simply helping ounclvcs, is distinctly up to tho present time one of production--production of armaments. It has boon said by those in position to know that there is probably no sinclo operation that is more important to the production program than welding, both electric welding and gas welding. Dr. McCord, with his colleagues, for somo time has been engaged ia the study of the health aspects of are welding. The first paper that they have published on this subject appeared recently In the Journal of Industrial Hygiene. Perhaps some of you hare had tho oppor tunity to read the paper. It is particularly pleasant for us. therefore, in the Foundation, to have had Dr. McCord accede to our request that he come and talk to us today on his own work. I have much pleasure in introducing to you Dr. Carey P_ McCord. Director of the Industrial Health Conservancy Laboratories. 62 01166 r- ,*v Vv-- \i~mt nofa THE HEALTH OK ELECTRIC ARC WELDERS IX THE XATIOXAL DEFENSE PROGRAM GORDON C. HARROLD, Ph. D..* STUART F. MEEK. 31. D.,' and CARET P. McCORD, 31. D.t Introduction Arc welding in itself cannot defend a country or win war, but neither of thesu national enterprise* well mar be prosecuted without reliance upon arc welding for many essential lubrications. The exteat of arc welding In tin's country may be gauged by the fact that in 1939 152,363,400 pounds of welding electrodes were utilised, with a corresponding figure fur the fine six months of 1940 of 66.644AO0 pounds. From another source has como the statement that the total production of welding rods, including automatic welding rods, was, for the year 1939, 157,430,206 pounds, of which 129,050,211 represented heavily coated carbon steel rods, with only 10,154,166 pounds of bars washed or dost coated rods. These figures indicate that less than 4*.# of the country's arc welding is carried out with ban rods. However, this marked shifting to heavily coated rods la not true for all Industries. In ana automobile plant, when the greater portion of welding Is accomplished by spot or pressure welding, thus calling for no electrodes, more than a million pounds of ban 'welding rods were applied in a recent 12 months' period, but of this total poundage of welding rods only 0.8'r was roprasonted by costed rods of all varieties. Every modern standard automobile possesses more than 5,100 welded points with, however, only some 140 arc welds, but several of these arc welds an many inches long. This year of 1940 saw the first all-welded ocean-going steamer, the 17,000 ton Exchequer, launched in 3fississippi in June. Commercial naval construction technology of this war period in sorno measun may become symbolized by this first ill-welded freighter. The extent of welding, with out at this lima specific reference to arc welding, again is nflected by the fact that about 200,000 welders are now employed in the United States. To express this in military terms, these welders represent an army of approxi mately 23 stream-lined divisions or seven army corps. As welding applications increase, more and more the need is for a better understanding ol the hygienic exposures that may arise. The world of Industrial hygiene is not in a happy position in its knowledge of the nature and extent of exposures for arc welders. ^Apparently many of us are hampered by too much reliance upon traditional standards, particularly with regard to nitrous gsses. Examination of th* original publications upon which some of these much advocated standards are based reveals a scantiness of evidence far in disproportion to th* significance long attached to them. In facing th* actuality of Industrial hygienic shortcomings with regard to th* exposures connected with arc welding, several things contribute to th* obvious complexity#! th* situation. First, the quantitative determination of somo welding gases, such as the several nitrogen oxides and ozsne Is far more difficult than for many other substances. Second, th* costing materials applied to welding rods are so diversified and so rapidly changed as to baffi* almost any attempt to beep abreast of developments. Third, alloyed steels. Chrrtler Industrial Hnriene Laboratories, t Industrial Health Conservancy Laboratories. 63 01167 A such as nickel-chrome steel. or mttal.i that have been coated, such aa In gal vanizing. ar introducing new difficulties in connection with welding opera tions. As a result, the attending industrial hygienic situations are far from simple. In general, the potential sources of injury from arc welding other than from trauma and thermal effects, seemingly may be grouped in the following categories: Oxygen deficiency. Carbon monoxide. Nitrone gases. Ozone. Metal fume from alloyed steel. Metal fume from the metal electrodes. Silica from welding rod coatings. Harmful substances other than silica in rod coatings. ' Injurious substances coated on to the metal being welded. Radiations. Possibly other gases such as cyanides theoretically produced in the electric arc. From fairly extensive first hand experimental work and medical depart ment experience with several hundred welders, we havg reached a number of conclusions soon to be presented, but unfortunately space does not permit adequate presentation of the evidences upon which these conclusions are based. Before entering upon any further discussion of some arc welding exposures, it is here emphasized that arc welding does not preempt the field of possible injuries related to welding and that gas welding in particular )t may provide dangers under fortuitous circumstances. i % Brief Review of Our Recent Experimental Work with Bare Iron Electrodes1 In our welding experiments, welding was carried out for six hours a j day, five days a week, in a metal gassing chamber 10x10x10*. In these experiments, the welder was located on the outside of the chamber perform ing welding with arms inserted through portholes. Animals in. rages protected against ultraviolet light from welding were exposed for six and one-half hours n daily. The exhaust system of this exposure chamber was dsmpered to less than two changes per hour. The rate of-welding was represented by Use maximum number of rods that might be burned in a unit of time. In one experiment with a voltage of 44 and an amperage of 300-000. 43 to 50 bare rods were burned in 24 minutes of every hour, which aggregated approxi mately 19 pounds per welding day. In four major experiments, limited to uncoated welding rods, 230 animals (rabbits and albino rats), including ST controls, were observed over a period of 20 months with the longest experi ment continuing 9 weeks (45 exposure days). These experiments established that nitrous gases (reported as nitrogen dioxide [NO-]), Increased with every increase in voltage across the art as utilized. At*27 volts (130-200 amp.) the average ppm. were 29; at 31 volts (200-225 amp.). 33 ppm.; at 33 volts (250-275 amp.), 40 ppm.: and 44 volts (300-350 amp.). 70 ppm. While the average concentrations found were as just indicated, concentrations at times ranged much higher, averaging 97 <4 oils# / l ppm. under some conditions with an extreme maximum of a single suinple ot 135 ppm. with a duplicate of 127. While suitable tests were made for carbon monoxide, excess carbon dioxide, oxygen deficiency, excessive temperatures, chlorine, etc, chief deter* ruinations made were the quantities of nitrogen dioxide, ozone and metallic fume. Nitrogen dioxide waa determined through the nitrate method and samples collected throughout the day, immediately at the cessation of over? welding cycle, 4", 10' and 16' thereafter, that is, in every hour there were two welding cycles, each with welding continuing for 12*14' and sample taking from 16*18'. Thus, in a single hour, as many as 6 samples for nitro gen dioxide alone at times won collected. In the aggregate, approximately 2/100 determinations wen made for welding gases and fumes. The quantity of particulate inn present as a fume and arisieg from the arc ranged from 33*395 menu, per cubic meter of air. The quantity of iron fume constituted no measun of the quantity of nitrous gases present. Likewise, the quantity of feme stands in no fixed relation to the voltage across the are. Ozone (0,) both has been affirmed and denied as existing in the atmos* phen about the electric arc. In our experience, from 10*32 ppm. wen found within 1* of the ere, from 0-5 to 9 ppm. 4' from the arc and from 04 to 1 ppm. in the center of the chamber, all samples being taken during the flam ing of the arc. Unlike nitrous gases, inenase in voltage apparently did not create increased quantities of ozone. No product of this experimental welding, regardless of voltage or of the prolonged duration of exposun produced any obvious changes chancteriscic of the action of nitrous gasis. With a voitage of 44. the experimental ani mals were exposed for 125 hours to a concentration of 70 ppm. of nitrogen dioxide, including 33 hours in tho aggregate at 84 ppm. of nitrogen dioxide and with the exception of a portion of the first hour of every welding day, no exposure to nitrous gases during the 40 days of eiapsed time was lower than 46 ppm. In ail experiments, the survivors exceeded S0r.i of the animals at tho beginning of the exposures, not including those deliberately sacrificed at various intervals. Death rates did not exceed those for control groups. In general, we sought to produce as high quantities of nitrous gases as were possible under any conditions resembling practical arc welding. We utilized voltages well above those .commonly utilized in practical welding. We burned rods at a much higher rate than any welder is likely to do. We carried out such experimental welding in a confined`area as represented by a thousand cubic feet with only about one change of air per hour. Notwith standing, we were unable to produce any gases or fume from bare welding rods that brought about*any readily obsvrva&le injurious action on exposed animals except for the formation of methemogiobin, the significance of which Is discussed in a later section. In view of the significant absence of pathology after several weeks of exposure to nitrous gases in excess of those quantities regarded as harmful for even brief exposures, we are disposed to question the standards that are now widely accepted and promulgated. While a few hours hare been spent by humans of our own group in the gassing chamber with concentrations of nitrous gases at 84 ppm. for 3 hours, 93 ppm. for 40 minutes and 103 ppm. for 3 minutes, and white many scores of casual observations have been mode upon practical welders, it is to be recognized that our outstanding evidence 65 011(9 u to the action of nitrous gases originating in arc voiding ia limited to anU mala. Within these limitations, we oru disposed to regard arc welding in open arena carried out with hare mild atccl roda on uncuatcd common types of atccl aa little associated with practical dangers front nitrous gases. Coated Welding Rods Thus fsr we hare hsd opportunity to expose animals to tho gases aad fumes of but one coated welding rod. This rod presented the following approximate analysis: Moisture and volatilematter________ 8.44 SiO.20.20 HOI ---------------------------------------------- 43.12 JIn<5.i 11.00 CaCt5--------------------------------------------------4.37 Mg,(P04);(theoretical)____________ 13J0 100.43 The last item is open to considerable question. It is known that phos phorus is present, but in wbat quantity and in what fora has proved to be difllcslt to establish. The miid steel on which this eoating has been applied has not been analysed, but it believed to conform to the common type of steel rod with approximately 0SC> of iron and the remainder being made up of the following: Carbon0.13-0.1Sr* Manganese- O.SO-O.GO'i Silicon0.06 Cc maximum Sulfur0.04 '* maximum Phosphorus - 0.04 ','e maximum This coated rod was burned in simulated welding at a voltage of 45 at the rate of 46 rods per welding hour or 23 pounds per day (ignoring rod stubs). Forty animals (rabbits aad albino rats) were exposed for 6.5 hours daily, 5 days per week, for 45 days. The chief atmospheric determinations were for nitrous gases and ozone. At this voltage the bare- rods burned at the same rate yielded an average concentration of. 70 parts of nitrogen dioxide per million. The arc shielded by the gases from this particular rod led to the formation of considerably less nitrogen dioxide, the average quantity being 33 ppm. It appears to bo gehernlly true that the shielded arc is associated with the formation of smaller quantities of nitrous gases. Insofar as nitrous gases are tho offending agents ia are welding, a prefer ence may be expressed for the coated welding rod. At this time, unusual interest exists in the nature of the coating mater ials for welding rods. Many partial analyses have been published, but some of these are highly confusing since the findings on addition may tctal from 40 to 140fi. The chemical nature of many rods is still a well guarded secret, but it ia known that an almost unlimited variety of substances hare been tried out as welding rod coatings. The number includes silica, asbestos, other Inorganic silicates, organic silicates, titanium, calcium, magnesium, manganese, fluorine, aluminum, columbium, nickel, iron, barium, chromium, phosphorus, borax, wood meal, cellulose, gum arabic. sage, tea leaves, asphalt, cotton, jute, paper, cereals, string, starches, sugars, etc. Whatever 66 01170  * constituent.' enter into the rod, it it generally conceived that they serve some of the following purpose*. 1.To provide a slag coating of the metal weld during the period of freezing. 2. To furnish alloy material not present in the metal core in the rod in order that the wold itself mn>* conform to the original metal 3. To confine or stabilize the are itself so that the size of the ore is within reason constant and the flow of electric power essen tially uniform. 1 It it usually stated that the shielded are excludes atmospheric nitrogen and oxygen. This possibly may be doubted and in- . stead possibly the shielded are alters the action of ultraviolet rays upon the atmospheric gases. To meet those various purposes served by the rod coating, highly differ ent substances enter into the coating mixture. Thus, to produce visible cloud ' about the arc, there may bo present such ingredients as cotton lint, paper, powcered coke, etc. For the protecting slag layer immediately over tha weld ing point; inorganic substances chiefly art used including borates, barium, calcium, aluminum'and manganese compounds along with many other*. In order to make up the deficiencies of the welding rod itself la relation to the metal to be welded, manganese, chromium, lead may enter into the coating Itself." Lastly, it is necessary to bind these ingredients on to the rod, which calls for another class of materials, some of which in addition to- being binders are gas generators. The number includes asphalt, resin, casein, ethyl silicate, sodium silicate, etc. By way of practical objections to the use of heavily coated rods, welders have indicated that it is difficult to (1) observe the weld being made because of the overlying slag: (2) the cleaning of welds made with heavy coated rods is more difficult than the bare rod; (3) the increased visible elouds from the coated rods are disturbing and unwanted. A somewhat representative analysis of the coating for rustless steel rods Is the following: Organic material.'------------------------- 19.2 ft Silica (SiO-) ------------------------------- 22.02ft Fluorine --I14.4 ft Calcium oxide and carbonate--------- 30.1 ft Iron oxide1.? ft ilanganese oxiie ...... -....--...... -- 2.46ft Aluminum oxiie----------------------------- 11.1 ft 100.93 ft An analysis of a similar coaria; material for high chromium nickel rods as furnished by Captain Brown, the next speaker, is as follows: ao-3Sft Sodium fluoride Ferromanganese ....... .. sntin ,, .......... 30-35 ft 6- 7ft - Tft Sodium silicate Cellulose --....... lift 4ft a: 100ft 67 01171 "*" ii i-----~ 'SX^CZz. ) From the larnt source *'rt obtained analyses of coatings for carbon steel rods: Cellulose30% Asbestos............. 15',< Ferromanganese . 12% Titanium dioxide __________ 12% Sodium silicate........ 30*3 Lime ______________ Iron oxide - Ferromanganese ... - Asbestos _____________ Feldspar (silicate)30?/ Sodium silicate _________________ Pyrolusite (MnO.) _____________ % 5- 8% 20-25'/ 15-20'/} 3% 11% 3% ~ 100% While many of the varied substances that enter into the coating: of welding rods veil may be looked upon with suspicion as sources of injury to welders, our personal observations and conclusions are restricted to four items related to only one type of coated welding rod, namely: L The shielded arc apparently diminishes the quantity of nitrous Cases. 2. Significant weight and growth deviations occur. 3. The quantity of free silica present in the dust from arc weld ing with coated rod* containing free silica appears to be insuf ficient to stimulate any proliferative reactions on intraperitoneal injections. 4. Methemoglobin is produced in the blood of animals exposed to the products of welding with coated rods. (This statement does not imply that methemoglobin is not formed from the products of welding with bare rods.) The last two items above have been made the object of farther comment in two sections now following. Methemoglobin *" -- Methemoglobin and methemoglobinemia long have been associated with nitrous gases and at least casually with welding. In our early experiments, no opportunity arose for any blood counts or methemoglobin determinations. In the sixth of the series of exper iments already mentioned, methemoglobin determinations were made with the Puifrich-Zeiss photometer, standardized respectively for male and female rata and rabbits, at the end of 45 days of exposure when the con centration of nitrous gases avenged 25 ppm. and when the voltage utilized was 45 (300-350 amp.) Table I presents the quantities of methsmogiobin found in 10 male nts. together with results one week after the cessation of exposura. However, on other occasions, subsequent to exposure, the per centages of methemoglobin were in some instances higher, but always within the limits of experimental error. At the time the experimental animals were 58 01172- X ) TABLE I METIIE.MOGLOUIN IX MALE RATS PrunM(t lb*fl lUt ItfiAtifleitUn >13*40 AfUr 43 Cxpaaura Daya (33 IIihm Osya) ta 13 ppm. NOf tram Caatad Kmi S-16-40 avaaa Days AKtr Lut bptwrt Oat* 1935 21.7 2.7 1933 17.3 L3 1980 10.6 U 1978 14.7 4J 1957 11.5 3J 1969 10.0 4^ 1936 ! 16.3 0.0 1992 10.4 0.7 1988 13.0 SJ 1963 ! 18.7 i U I t Controls at UflntlflciilM runtaga Matktm|laMa 1943 0.0 (8-13-40) j 4^ (8-27-40) 1985 j 0.0 (8-13-40) I 33 (8-20-40) 69 01173 i. .?*f \ iLclXj. tested {S-13--10) iwo control male rats presented no measurable trace of methemogiubin. but on other occasions mclhemogiohin hat been detected in control rau up to a maximum of 4.2. However, this figure embraces the probable error circa m277. The assumption was that the occurrence of methemoglobin was in nowise peculiarly associated with coated welding. rods, which caused us to repeat for a few days an earlier experiment with bare rods using a voltage of 45. Table II presents methemoglobin percentages just prior to exposure, at the end of one day of exposure, and thru* days aftar the cessation of a throe day welding period. Although the results shown are sometimes within the limits of experimental error, the uniformity of results suggests that one day of exposura may increase the blood content of mcthcmoglohin. which quickly disappears by the end of the third day after exposure. During this period the average quantity of nitrous gases was 70 ppm. In the case of four welders, samples of blood collected during the period of welding work revealed respectively *5. 3, Z3 and 2.6 per cent of methemogiobin. - One humnn control yielded no methemoglobin at this dm*. Of 13 determinations for nitrous gases made in connection with the possible exposure of these welders, the highest was 13.3 ppm. of nitrogen dioxide in a sample collected from an automobile body in the course of construction. The inference is that some metheraoglobin formation is a common result from mild exposures to welding gases. This statement scarcely applies to experimental rabbits, which animal appears to be more resistant to rnechemoglobin formation.' Should the need arise, it may prove possible to utilize the occurrence of methemoglobinemia aa qualitative proof of exposure to welding gases. In the absence of other sources of methemoglobin causation, the presence of any considerable quantity* of this substance in an arc or gas welder suggests exposure. The nature and physiologic significance of methemnglobin in the blood is far from clear. In congenital or familial methemoglobinemia, as much as 40C1*4 has been reported as continuous and little associated with any evi dences of ill effects. However, in many publications dealing with clinical methemoglobinemia, the method of demonstrating the quantity present may be open to question. It has been stated that methemoglobinemia up to 60715-* of saturation is compatible with life. Other publications indicate that tho behavior of the body in the presence of methemoglobinemia con forms in general to the pattern that governs carbon monoxide hemoglobin.T- Ls.io.it. ia.is.ii.is It is frequently asserted that methem'oglebin is a precise antagonist to cyanide action and that its presence in the blood ia cases of cyanide poison ing is a fortunate occurrence. It has been claimed that methylene blue os a treatment for cyanide poisoning is efficacious from its causation of methe moglobinemia. which substance in turn combines with the cyanides with resulting body protection through the prevention of Internal asphyxiation. Thus if it be true that some cyanides may be produced is connection with arc welding, the presence of some methemoglobin may serve a beneficent rather than detriment*! purposed Granting some possibility of on anti-toxic action of methemoglobin under some circumstances, it may not be Inferred that the oxygen requirements of the tissues of the body may bo met in the presence of any high percentage of methemoglobin, since the combination of methemoglobin and oxygen provides littla or no available oxygen for tissue use. It is here emphasized that the present state of evidence is far from conclusive.1 e.iT.u 01174 TT e^i ) `S n a n ta rm O T * ti rr c t \ TABLE II } METIIEJIOCLOUIN IN 3IALE RATS t *. Pmmuta Minuin)iMiii t -4~0 j 1-4.40 r flat i t.~M (1 a'dacK) (* a'clack) 1 Oar* Attar UantiffcaUan Mac ta Attar I Oar at Attar 1 Oar* Cxpoaura j Kxpaaura Caaaatiaa at htanira ta TO pom. faOf I ta ro tan. NOj Cxoaaura tram Bara flaoa^tram Bara flaOa 2078 0.5 2.4 2J 0.0 *r i 2009 2.0 3B 2.4 0.0 t"- fcZ 2082 0.6 3.0 3.5 0.0 i r 2065 0.0 2.1 3.1 0.0 * 2034 0.0 L0 3.6 0.1 2071 0:4 0.0 3.1 0.2 ** * Control* flat Identification Ptrctntoo* Mattafflegratin * 1964 0.5 s: 2069 0.0 < 2055 L5 > * 1981 L8 r.\ . 01175" | tK*r~ t * to - i ( 'f 1 1 1 i,,4 -4 1 r;. f:.' t*-- t'- * . i b r> f? i ml m rncsacr1:. MMdMiU Intrapcritoneal Injection "ith Welding Oust after Welding with Silica* Containing Coated ICikU. Large numbers of coated rods contain silica or silicates. The prime cue of silicates is as a binder for other coating materials. Organic silicates are used for this same purpose, but this use is limited. The high temperatures (circa 6,500* F.) of the electric are may convert the greater portion of combined silicon to silica. In the analysis of rod coating materials used in one of our scries of experiments, the SiO. ranged between 17 and 2Q'i. It has been computed-that from the -burning* of a single 14", 5/52' coated rod more than 150 mgms. of fine particulate matter is introduced into the atmos phere. While this figure in itself is of little significance. It leads up to tha statement that are welding it or may be a dusty operation. Because of a maximum content of 20'} of free silica of tha total weight of the electrode of the one rod ucilizcd by us, we collected with the electrical precipitator sufilcient quantities of this dust for intraperitonea! injections. On analysis, this dust proved to have a content of only S1< silica, a larger percentage consisting of iron dust from the mild steel rod on which the coat ing was implanted. This material in 0.2 gram amounts suspended in saline solution was introduced intraperitonenlly into six rats, using the technique described by Miller and Sayers,1* and extensively used by us in ether expertmeats.?*-?' For comparative purposes, injections were made of similar quantities of free silica, iron oxide and saline solution. Between the 60ch and 70th day, these animals were sacrificed and examined. The silica ased for control purposes created the expectable typical proliferative nodulation, the iron oxide induced only an inert reaction with deposits on the anterior peritoneal surface in the omentum, on the genitalia, etc.; the collected weld ing dust proved to exerr only an inert reaction closely resembling that from the iron oxide. There was no suggestion of proliferation.. It was concluded that dusts from coated rods containing silica or silicates, of the type used In our experiments, are unlikely to constitute any practical threat of silicosis. Welding on Steel Alloys and Welding Rods of Other than Mild Steel In arc welding, it is frequently but not necessarily desirable that the constituents of the welding rod conform to that of the materials being welded, that is. both the metal being welded and the rods themselves may give rise to greater opportunity for injury to welders than in the case of essentially pure steel welded with mild steel rods. In addition to alloyed steel, the same type of problem may arise if the metal to bo welded pre viously bas been coated, such as in galvanizing. The outstanding example of the adjustment of welding rods to an-alloyed steel is to be found in the relatively high percentage of chromium and nickel in welding rods for use on rust-proof steel. Such a rod may present the following approximate analysis: Carbon- 0.05 rt Manganese 1.1 7 Phosphorus o.o3 v:. Sulfur --____ ____ -- 0.09 T- Silicon______ ____ __ - 0.43 Ve Nickel 9.4 r* Chromium 19.7 7, Copper ....---------------- 0.05 % Vanadium ______ _ 0.03 Tr Remainder Iron 72 01176 ten- tut ires . of 1 in It rod tostht ght icai KU. tr sat> line quo riflor th .sed Ion, nor ridom ded sed sis. the ing ray of red reple the see ate A typo of welding rod widely used In welds on cast iron is represented by the following: Carbon - o.n ft Manganese ..... - 1.70 ft Phosphorus 0.03 ft Sulfur 0.018ft Nickel 63.52 ft Cobalt 38.5 ft Iron L2 ft 100.3 ft An analysis of another rod designed for use on chrome-nickel steel has been borrowed from the work of Captain Brown: Carbon Manganese Sulfur Silicon Nickel Chromium Remainder Iron 0.00 ft 1.54 ft O.OOSft 0J1 ft 21.14 ft 26.04 ft In view of the high temperature of the welding arc almost any con stituent of the metal being welded or the welding rod, to say nothing of its coating, may be introduced into the atmosphere to some degree. Among other possibilities are line cadmium, manganese, chromium, nickel, copper, molybdenum. Iron, arsenic aluminum, phosphorus, selenium, silicon, titan ium, vanadium and tungsten. Without intending to culpate any of these metals or in the cass of coatings, non-metal material, it is pointed out as obvious that many of these substances ara dangerous and that somo of them art present in the atmosphere about welding operations in quantities suffi cient to induce harm.-- Thus when welding is carried out upon galvanized steel more than 75ft of the fume may consist of zinc oxide. In general it Is believed that in this domain may be found tho truly disturbing situations connected with arc welding. Already some complaints are arising over the possibilities of chromium from chrome-nickel steel; lead may be measured in the atmosphere near to welding on leaded steels.?1 However, as yet there is no reliable case record clearly associating injury with either of these metals in welding. A few deaths have been eeonefted with welding on gal vanized steel, but to associate these deaths directly with the galvanizing or any other individual aspect of welding certainly is not warranted at this time. Practical Applications and Implications 1. In our experience and from our appraisal of the literature, it does no't appear that the health of arc welders as a class may be set apart as especially different to metal workers in general. Although occasional records of deaths appear associated with some aspect of welding as the eause, we have no evidence of any prevailing diseases characteristic of the work of the arc welder (radiation effects excepted). 2. In our experimental studies, with the rate of rod burning much hifrhcr than in practical welding, and with welding confined to a compara tively small chamber of 1,000 cubic feet, with at times only one air change 73 OII77 per hour, we have not bn able to find any jugecstion of oxygen deficiency. 3. Thu much discussed point of ozono formation in the welding are has in our experience resolved itself as follows: JXuch ozone (10*32 ppm.) is produced immediately in the are, hut quickly is diminished (1-9 ppm.) a four inches (4') away from the ore and in the center of the chamber the residual is not more than 1 ppm. of ozone. Although this exceeds the somewhat accepted threshold of injury of 0.4 ppnu, no injury from this gas has been determined by us. 4- Kum>rous tests for carbon monoxide have been made under various conditions--always without any significant results. 8. Other things being equal, low voltage and amperage are desirable in are welding, since it appears to be true tiiat low voltage is conducive to the low formation of nitrous gases. 8. Our best efforts to produec from are welding.sufficiently high con centrations of nitrous gases to induce injur;* to animals after long exposure were not successful. Practical arc welding in open areas seldom leads to higher concentrations of nitrous gases than 20 ppm. 7. It is our observation that concentrations of nitrous gasos near the widely accepted threshold of 39 ppm. are quite harmless to laboratory ani mals after prolonged exposure and farther that double this quantity for. prolonged exposures and treble this quantity for limited exposure! likewise are without discernible ill effects on animals. Human beinrs exposed to such quantities as 84 to 103 ppm. of nitroas oxides for a few hours (throe) suf fered no ill consequences. 8. We possess some evidence that methomogiobin is formed both (n laboratory animals and human beings exposed to welding gases, but the quantity of this methemogiohin appears to be without injurious propensities and further there is theoretical evidence that comparatively low percentages of methemogiohin in the blood may under some circumstances serve benef icently. 9. Limited experimental observation is unfavorable to any belief that silicosis may be brought about from silica dust exposures incident to are weldinr. 10. The heavy iron content of the air incident to animal exposure in welding has not hcen shown, from clinical, x-ray and sutopsy observations, to produce any injury beyond pigmentation.,. 11. Apparently coated rods are to be favored over bare rods insofar . as the production of nitrous gases is concerned. 12. Finally, in appraising are welding ss an industrial procedure essential to national defense and with particular reference to hygienic prob lems we at least are convinced that some over-emphasis in the past auy have been placed on the significance of nitrous gases, carbon monoxide, ozone and iron fume. To the contrary, if there be practical hygienic problems related to arc welding (in addition to the obvious ultra-violet emanations) these may be expected in the little explored field of the constituents of coat ings on rods, coatings on metals, and special constituents of the metal weld ing rod nr the metals being welded. 01112 y. re at In ic. 1.4 us !e to Mi tre to the .ni- for '(se aeh af- 1R the ties ti tef- fcst sre In ns, >fa.r lore mbna? .one imi ins) ost- eld- CITATION'S I. Harrow. G. C.: Meek. S. K.: tttl McCord. C. r.: A Chemical ami Ph)<aMclvt im-nilimUMi of Electric Arc Weldlns: L Bore. Washed WVIdltir Rode. J. Indite. firs- * Tox. 23: 147 (Get.) 1310. 1 Ilculmcr, W.: Formation at Msthstr.osrloWn. J. pharmncaL lOt 173. 1337. 1 HlizenbesTer. IC: Antitoxic Cyaaoele (Intrafflabutar methcatofflvbtnemls). Wien. Arch. Inn. Med. 23: . 1332. . Hensley. E. IT.: tlhen. L. J.: and Mills. E. S.; Familial Uiopdthic Meekest*- (Milmmix. Quart. J. Med. 7: 333, 1313-14. J. Ito--tilxrx. V. X.: The tVt'.xtfylnc Action of MethemesMbln Forming Anna la Sodium Aside Polsonln*. J. rhysloL ((.*. S. S. R.J 12: lit, 1337. f. IJpechllx. IT.: Aromatic Xlcro and Amino Compounds os Blood Poisons. Zener. Gevertiehyir. I nfslirerhur tei u. 7. SotandL O. M.: SotandL D. V.: Roes. E.: and Gerard. R. TT.: Metbemotrlobln and Methylene Htue as Cyanide Antagonist*. Proe. Soc. ExpfL Biol. Med. it: U9, )!m. I Hasrovlts. F.: XtX. JItlimoidob(n and Its Combination with Itydrecee Per oxide. with Cyanides. Fluoride* nod Suiltdea. Z. PhysloL Chest. 232: lHr. 1333. S. Rue. E.: and Morenal. A. 1: The Fixation of Hydrocyanic Acid by Erythro cyte* t'eiitainlnx Melhemectobin. Compc. rend. eoc. bloL 1t4: H 1333. 13. Wnrlm.ff. O.: Kubowitx. F.: and Chriatian. W.: The Cxtslrtlc Action of Meth ylene Jilue la XJviae Cells. Blochera. Z. 227: SIS. 1330. 11. Moller. K. O.: The Slcniflcanre of Methemorlnhln Formation In the Detoxica tion of Cyanic Add by Methylene Blue and Sodium XTtrue. Sfcaad. Arch. PhysloL 73: 317. 12. WendoL W. B.: Oxidati-n* by Erythrocyte* and the Catalytic Induesee of Methylene ITIue. II. M-tle-nindobln and cite Kifect of Cyanide. J. BioL Cheat. 102: 373. 1333. II Ksnolk. V.; Rozhkov. V.: .ind Vlnocradovm. t\: Preventive Action at a Me themoelohlnixirc Acrnt. Sodium Xlirli-. in Fluoride Poisoaiuc. Compt. rend. SOC. bloL lit: C07. 19X3. M. VlnOKradora. O. C.: and IToxhkoy. V.: Melhemnclobln Bonders as Antidotes la Fluoride Poisoninff. J. PhysloL (C. S. S. R.) It: S33. 1333. IS. Krlcfeld. H.: Svhlletro. A.: and Ludwlnoarsky. IL: Helot Bodies and >tethmo xltihln Formation In Poisontnr by Compound* Containlnff Amino and Xltro Croups. Folia UnematoL Mi 333, 1337. K. Roche. J.: Physiological Action of Mether-malobin Formation In the Blood. Arch. Intern. Phnnnacodynamle 37: 333. IMW. 17. Itabbeno. A.: and Rnppetri*I.ewer. S.: MetheinocioMnltinff Effoft at 'Sodium Xllrite in Vivo. Boll. xoc. icoL bloL" *|ier. 51: 34. 11m. IL Heflin. D.: and Rartree. E. F.: Rrartlon of Xltrlr Oxide with Hemoglobin and Melhemofflobtn. Nature U: HI. 1337. 13. Miner, J. TV.: and Sayers. IL R.: The Phylolofflcal Response of Peritoneal Tissue to Duets Introduced s* Foreim Bodies. C. S. Pub. Health Rep. 4lt 1?3L 3t. McCord; C. P.: Fltmlnr. R. L.: Alnt*-. H.: end Johnston. J.: The Measuremenc of the Harmfulnes* of Oust* lor Human* Through the Afftncy of Animal Reactions. Stuff.. C>ne. acd OhsteC. U: T33 (Au(.) 1233. 21. McCord. C. P.: Kasper. J. A.: and Broeiu*. IV. T-: A Blnbvric Text for the Determination of the Fibevs-neslc Proi-ertlc* f DusL Ohio State LoL J. 23: 231 (Aprlll 1327. 23. Fabre, R.: and Kahane. M. K : A Tnclcoloeieal Rrudy of the Prlnvlral Constit uents of 3|yelal Site!*. Arch. d mal. prot. 2: hr. (Special No.) (Mhyi 1319 CFrenchl. 23. Halley. J. V.: and Martin. E. D.: I^ad-Reariitc Steel*: Control of Possible Het.Ith Hazard* Durlnr Fabrication, Metal Proe. 17: 413 lAprll) 134a. 75 0117 9 * (' 1 V PROFESSOR DRINKER: We welcome any dMCussian on UiU paper or question* to Dr. McCord. DR. SANDER: I should like to ask Dr. McCord what he meant by the possible protective action of methemoglobia formation. DR. McCORD: I am very glad to so >n* that, but I do want to confess that nobody can be sure of that situation and instead of relying upou my own offhand comment here I wish to refer to my note* in that connection. In the first place, methcmoflobin may not be highly dangerous in itself. There are several cases on record of familial methemoglobin anemia which, according to methods that were used for testing, and some of those may be doubted, yielded up to forty per cent of methemoglobin in the blood without any apparent disturbance to the owner of that particular congenital defect. In a much larger number of eases the quantity of methemoglobin contin ually present has been on the order of twenty or thirty per cent. From the work on methylene blue In the trestraent of cyanide poisoning and that type of poisoning, it apparently has been established or may be established that the only good or die chief good that the methylene blue does is to form methemoglobin, and the methemoglobin in turn acts as a direct antagonist to the cyanides. We have no proof yet that cyanides or uitriles, which are about the same, are produced in connection with welding, but we bare some vague belief that such is the case. On the assumption that theso cyanides or nitriles may arise we believe that they might be overcome or destroyed because of their combination with or because of an antagonistic action of methemoglobin. which apparently readily combines with cyanides and that type of chemical in the body. PROFESSOR DRINKER: One of the largest, if not the largest, em ployers in the country today, in the factor)* sense, is the United States Navy. The Army will shortly be. if it is not already, in just about the same cate gory. In the production program and the accomplishment of our desire to have a two ocean navy, our navy yards have necessarily become enormous ~ producers and enormous employers of labor. Their industrial hygiene prob lems are therefore just those that would be created by such a huge expan sion necessarily made without as much time and preparation as we would like. I personally have had the pleasure of knowing the next speaker. Cap tain Brown, for e number of year*. In industrial hygiene matters I first met him in connection with the dismantling of ships ar.d the industrial hygiene problem that that created. Now he-is in charge of the medical aspects of one of the largest yards in the world. It is a great pleasure to cs to have her* today Captain Ernest W. Brown, of the Medical Corps of the United States Navy. 76 01280 X H.EE? .* 76 ? r . ft a f. h. KJ It t. 1* c be a* he ue or ed of At ra. industrial hygiene and the navy IN* NATIONAL DEFENSE CAPTAIN ERNEST W. BROWN (MC), U. S. N. 1. Introduction On of the moit important concerns of th Medical Department of the Navy today is industrial hygiene and especially in Navy Yard practices This is a situation of ever increasing moment in view of the present era of enormous expansion in naval construction, unparalleled in the history of this country. This is bringing about a vast increase in the industrial force of our Navy Yards and, in all probability, new problems in industrial hygiene will emerge, incident to new materials and processes. It should be remembered in this connection that the policy of the Navy Department is to allot new navel construction on an equal basis to govern ment and commercial yards, ft follows that the commercial establishments are also undergoing rapid development with an enormous rise In industrial personnel- They trill therefore be confronted with the problems of industrial hygiene similar to many of those arising in Navy Yards. Industrial hygiene is a field which is sow undergoing rapid development This appears to be due to certain significant trends, the most important of which has been the recent setting up of many Industrial Hygiene Units in state or city Departments of Health through funds released by the pas sage of tl^e Social Security Act. These trends, in fact, particularly that just mentioned, reflect a definite renaissance of industrial hygiene as a phase of public health in the United States. This movement is receiving increasing recognition in naval industrial circles, and industrial hygiene is now listed as a specialty of the naval medi cal officer'along with other specialties outside of the purely clinical Holds, such as aviation medicine, submarine medicine, chemical warfare medi cine, etc. Those just mentioned, however, are concerned primarily with naval personncL Industrial hygiene, on the other hand, is largely occupied with federal industrial personnel. It therefore follows that the status of the Senior Medical Officer of a major Navy Yard in relation to the Industrial Department is analogous in many respects to that of the Medical Director of a large commercial industrial plant. The object of this paper is to pre sent an outline of the administration of industrial- hygiene in Navy Yards which are the chief industrial units of the Navy. Mention should be made tn this connection of the Sub-committee on Industrial Hygiene of the Health and Medical Committee of the National Defense Council which has recently been established. The Surgeon General of the Navy is represented by liaison officers in conjunction with this Sub committee. Important recommendations pertinent to the Nary and Indus trial health will result and many of them will undoubtedly be put In effect. . The term, industrial hygiene, as applied in the present discussion, la used in the specific sense of the prevention and control of occupational disease. The fact may be of interest that the first compensation law for occupational diseases in this country was or.e passed in I90S by Congress for U. S. Civil Service employees. Compensation laws for industrial'diseases have lagged far behind legislation covering accidents. Only 16 states of the Union pro- 77 01181  . ( Aim vidcd compensation /or one or more occupational disease* up to the year 1037, although all but two provided legislation fur accidental injuries. 2. The Industrial Organization of Navy Yards The mission of a Xavy Yard is primarily the construction, maintenance and repair of naval vessels. Tlio central administration of Xavy Yards, and in fact, of all industrial shore stations of tho Navy, is vested in the Assistant Secretary of the Navy, in whose office is the Shore establishments Division of tho Xavy Department. There are eleven Navy Yards located as follows: Portsmouth, X. H.; Boston: Xew York City; Philadelphia; Washington, D. C.; Xorfolk, Ya.; Charleston. S. C: More Island. Calif.; Puget Sound, Wesh.; Pearl Harbor. Hawaii; and Cavite in the Philippines. In addition, mection should also be made of the following specialized industrial plants: for the building of submarines at Portsmouth. X. K. and Mare Island, Calif.; the Xaval Gun Factory t the Xavy Yard. Washington, D. C, for the production of high caliber naval guns, torpedo tubes and accessories; the torpedo factories at Newport, R. I, and Alexandria, Va, for the manu facture of. torpedoes: the powder plant at Indian Head, M<h. for tho produc tion of Xavy smokeless powder; the aircraft factory at Philadelphia for experimental air craft construction and fepair: the naval armor plant at Charleston. W. Va.: and the Xaval Clothing Factory at Brooklyn, X. Y. Organization of the New York Xavy Yard: The organization of the Hew York Xavy Yard may be taken as typical of a major yard. It falls under two departments, i. e., the Industrial Department headed by n naval captain of the engia-rori.-.:.- branch and an Operations or Military Depart ment under the direction of a naval line captain: As a conservative esti mate it may be stated that 90Cr of the activities of a Xavy Yard are industrial. Under the Industrial Manager there arc at present twenty-three shops of different types with a force per shop varying from 30 to 3,200 men. The total of civil employees of this yard is now 17,000. This is rapidly rising and, it is estimated, will exceed 20,000 in 1941. 3. Extent of the Civilian Industrial Force of the Xavy The combined industrial force of all Xavy Yards is now approximately 100,000. In view of the pending program of naval construction it is esti mated that this will reach 130,000 in 1941. If inclusive of all shore stations this would probably be close to 160,000. -- In addition to the industrial force of Xavy Yards we should also con sider the employee volume in the commercial naval ship building plants such as the Newport Xews and Dry Dock Co_ the Xew York Shipbuilding Corpor ation at Camden. X. J- and the Bethlehem concern at Quincy, Miss., which now employ from 12.000 to 13.000 men each. It is a conservative estimate that the combined industrial personnel of all such plants on both east and west coasts will retch a peak of over 100,000. 4. Organization of the Medical Department of a Xavy Yard The medic*! staff of the Xew York Yard consists of 10 medical officers. 5 dental officers. 1 nurse, 43 enlisted men and 2 civilian clerks. The chief activities with reference to industrial personnel may be summarized as fol- 4 73 l 01382  / ( l * -f f. -Jt, * ( rr-M.--i .U > > 'yi$yr -i. V.V.V lows: (a) Pre-employraent physical examinations: all applicants for federal jobs are examined physically, although the standards for acceptance Tory to some extent for different occupations, (b) Periodic physical examinaHons: these, of course, arc conducted with the object of medical supervision of certain groups of employees exposed to definite potential health hazards, as foundrymen and spray painters, (c) Physical examination of federal employees for retirement: this is for evaluation of degree of disability and opinion as to disposiHon when total disability is alleged, (d) Diagnosis, treatment and disposition of industrial injuries and occupational diseases, (e) Administration of compensation cases, (f) Industrial hygiene and plant sanitsHon. 5. The Industrial Medical Officer An officer of the medical staff of the Xavy Yard is specifically detailed for industrial hygiene administration subject to the direction of the Senior Medical Officer. The accompanying slide outlines' the scope of his activities. (a) Advisor to the Safety Engineer: The adequate practice of industrial hygiene in Xavy Yards, as In civil industry, is dependent upon the close and efficient correlation of the safety engineer and the industrial medical officer. It is essential to obtain a grasp of the functions of both of these officers in order to properly visualize industrial business administration. (b) Inspections: The industrial medical officer is responsible for the rencral supervision of plant sanitation. L e,, ventilation, illumination, water supply, general cleanliness, adequacy and condidon of sanitary facilities, etc. He also conducts shop inspections for occupational health hazards and their measures of control. He cannot expect to evaluate working conditions and thereby detect occupational health hazards early unless he makes periodic inspections through the plant. In this way he can observe the adequacy of existing measures against specific hazards and whether such methods are being prop erly utilized. These inspections also have a psychological value in that they create greater respect for the medical service in tho minds of the employees. (e) Supervision of Special Physical Examinations: pre-employment esses when the applicant reports previous exposure to potential industrial health hazards such as lead fumes or foundry dust: periodic examinations of groups exposed to such potential occupational hazards, as spray painters and landblasters; examination of cases referred for transfer to other shops where there is a question of occupational disability;_clinicai studies for a decision as to industrial origin in obscure cases. ~ (d) Medical surveys of occupational groups: this will be discussed later. (e) Administration of the medical aspects of compensation claimed for occupational disease pending before the U. S. Employees Compensation Com- mission. (f) Supervision of preparation of accident and occupational disease reports for the Xavy Department. 6. The Sefety Engineer A civilian Safety Engineer is stationed at the Xavy Department as the advisor to the head of the Shore Establishments Division. A naval officer is assigned to each Xavy Yard as the safety engineer. (l) Accident and unsafe practice control: Safety engineering is one of 70 the divisions ol the Navy Yard orgoniiutioni. The Safety Enlistee conducts an investigation of all loit-tlme accidents with a view to fixing cho cans* and advising as to measure* to prevent their recurrence. The basic feature* of approach to the safety problem in Navy Yard* arc provision of safety devices, such as mechanical guarding, and the safety education of workmen and their supervisors. Another important aspect is the competitive approach which has proved very effective in stimulating Interest in accident prevention. The Navy Department publishes the comparative safety scores of all Navy Yards monthly. The accompanying slide emphasises the advance made by the Navy Department In accident reduction beginning with an intensive safety cam paign in Navy Yards in 1926. We And the frequency accident rate lowered from 20 to practically 10 per year in a 12 year period; the severity rate reduced from Z2 per year to 0.3. On the other hand It will be noted that the total man hours worked during the peried increased to 115 mllCon from 55 million per year, the average number of employees rising from approxi mately 30,000 to 36,000. (2) Occupational Health Control: The control of occupational disease in Navy Yards naturally lies within the sphere of both the safety engineer and the industrial medical officer. Although the safety engineer is adminis tratively charged with this task, the medical officer is actually coordinate with him in this phase. As a matter of fact, the medical officer is the key man in the prevention of industrial disease in Navy Yards, in that he usually discovers its exis tence. The diagnosis having been made, the occupational history and the pre-employment examination record are carefully reviewed in order to teach a decision, if possible, whether the hazard can be traced to present or past employment. If ascribed to, or aggravated by environmental conditions, the medical officer confers with the Safety Engineer and an industrial hygiene survey is usually recommended to the Commandant. 7. The Industrial Hygiene Survey Such a survey is of course a combined medical and engineering task. (a) The Nedical Survey. This consists of a complete clinical study with detailed occupational histories of all exposed personnel as a case Anding procedure' under ths supervision of the industrial medical officer. Although not directly responsi ble beyond the matter of the medical survey.'tt ia important that the medical officer have a reasonable grasp of the entire problem so that he will be In a position to utilize all data that have any bearing on the interpretation of his medical findings. In addition, he may act in an advisory capacity to the safety engineer with respect to certain technical phases in the planning and conduct of the engineering aspects of the surrey. (b) The Engineering Survey. The engineering phases of an industrial hygiene survey in a Navy Yard fall, naturally, under the direction of the safety engineer. As in a commer cial industry, this embraces essentially a complete story of the occupational duties, physical conditions of work, and the materials, processes, ar.d equip ment of the individual shop, in other words, the environmental conditions. Laboratory facilities: There are no facilities provided for technical 80 * * > (t i t K ' i f i 1 r t f l i i 5 a T t-# a a-sra r n .mss il Ia a U A d. d rtl f- ml >v<^: ry - (u<Iir. in thu Navy Yard organization and titer* is no centra] laboratory unit iu Washington ivliich could supply industrial hygienists for Add studios. 1 hi* is an urgent need and recommendations have recently been mado to dt* end of setting up such an agency. Tlio Department has been most fortunate In the past in securing th* services of the Division of Industrial Hygiene of the Public Health Sorvico to conduct such technical studies much in the same tray that Industries in the states utilize the facilities of State Bureaus of Industrial Hygiene. Tho safety engineer formulates the control program of the health haz ard on the basis of the data of the surrey. After oil. once the etiology is disclosed prevention of occupational diseaso is largely an engineering problem. S. The Reporting of Industrial Accidents and Illnesses An important advance in accident prevention by the Navy was initiated on July 1st of this year when the Secretary directed that a report of each accident and illness, both '`lost-time** and "no lost-time," occurring among civil personnel of Nary Shore Establishments be made to tha Barcau of Medicine and Surgery. The report of each accident is submitted on a form, known as F-C, shown in the accompanying slide. This presents the diag nosis of the injury and the essential details as to tha causa. Punch cards an made up from these records for mechanical tabulating and Indexing through a sorting machine. This provides facilities for the statistical analysis of these accidents and diseases, and the data obtained promise to bo a farreaching contribution to the subject of accident control. Prior to this system a crude form of accident reporting to the Department was in effect but it was not adapted to statistical analysis. 9. Occupational Health Hazards in Nary Tards Th* chief potential occupational health hazards in Navy Yards will now be considered, th* data being based chiefiy on reports to the U. S. Employ ees Compensation Commission over a series of years. It hardly requires emphasis that industrial medical officer* must be constantly on the alert for new hazards. (1) Dust Diseases. (a) Silicosis: Important units of all Navy Yards are iron, steel and brass foundries. The dust control problem is a major conocm.jn these plants as in civil industry. One of th* difficulties mot with in combating th* foundry dust problem in navy yards is the fact that silicosis dust is not particularly irritating or obnoxious in concentrations which may ultimately lead to pulmonary dam age. As a result we find a tendency to an indifference on the part of tits workers and even supervisors and executives, which must be overcome in order to eccomplfsh effective end permanent dust control. Another reason for this attitude is th long period of time necessary' for those foundry Work ers exposed to only moderate concentrations of dust, such as molders, to develop silicosis. A medical survey of the foundries of the Navy Yard, Washington. D. C, was conducted by the speaker in 1939: of 525 men x-rayed, approximately 6OCJ had s record of 10 years or over; and 3G71 a record of 20 years or over SI oilgr -tr- -sr--v: 'V-.-cesr -- f+ ^rfr' of total foundry employment. Twelve ease* of silicosis were found or 2.4'i of the total--all in Stage I or IT; these data leading to recommendations for Improved dust control methods. Industrial hygiene surveys in foundries other than the Washington Jfavy Yard hare not as yet been carried out but would. In all probability, disclose a certain Incidence of sillcoeis, even if not of disabling typo. Tbo medical control of slUcosie in the naval establishment consists of an x-ray of the chest before employment and an anaual radiograph of all men exposed to the higher silica dust concentrations such as sandblasters and shake-out men. It is believed that medical surveys of foundries in all Navy Yards will soon be required. (b) Asbestosis. This is a potential occupational disease hazard from the inhalation of asbestos dust among workers engaged in the manufacture of asbestos inaulatihg covers for flanges, valves and high temperature steam turbines. The spesker recently conducted a medical survey of the workers of the Pipe Insulating Shop of the Xew York Yard inclusive of x-ray studies, ths maximum working period of exposure being 17 yean. Xo asbestosis cases were found. Similar findings have been reported from two other yards but the study should be extended to ell men in this trade. Medical control eoasista of an x-ray of the lungs annually. Ths asbestos Is moistened and localized exhaust ventilation is installed over ths work area. A respirator is worn during the dustiest aspect of the process. (2) Lead and Lead Compounds. Lead poisoning has become comparatively infrequent in recent years both among industrial and service naval personnel; apparently due in part to changes in materials and methods, and partly to improved measures of control. Zinc and titanium paints have- largely replaced leaded material for ship interiors. Red lead paint is still in use as the priming coat on hull exteriors but the finishing coats contain either no lead or a greatly reduced proportion. All painters regularly handling Seed-containing paint are exam ined semi-annually for evidences of lead absorption. (3) Volatile Organic Solvents. Lacquer spray painting occurs .on an extensive scale in Navy Yards and therefore demands rigid medical supervision. Another important applica tion is in degreasing measures. All spray lacquer personnel arc subject to semi-annuai physical examination. __ _ (4) X-ray and Eadium Hazards. The x-ray and radium are continually utilized for the detection of fiaws In castings and pipe welded joints for high pressure steam installations. Radium has an advantage in the small size of the equipment in that it is adapted to tests in the confined machinery spaces of ships. The question of protection from irradiation of the operating and other personnel working in the vicinity of the apparatus has received thorough study, the practice of the Bureau of Standards being generally followed. Complete blood counts of all technicians are conducted quarterly and special pre-employment examinations arc prescribed. Another potential hazard of radium is that of ingestion incident to radium painting of luminous dials, more especially for fire control instru- 82 01186 TT "tr_v. . jaAi Mmfm ment* and aircraft The control measures edviscd by the Public Health Service are generally in force, plot certain local regulation*. (8) Welding. Tha hygienic supervision of welders Is another outstanding feature of medical responsibility. Approximately 2L5GQ welders were on the rolls of the combined shore establishments as of January 1, 1940, including 683 at New York. This number has progressively increased and will continue to rise. The immense volume of work la confined spaces Is characteristic of naval welding. A battleship of 35,000 tons displacement under construction contains approximately 500 compartment! la which electric welding is mandatory, certain of these spaces being extremely small and forcing the welder to work in very cramped positions. These conditions complicate the question of effective preventive control of the hazards. The chief hazards which have to be considered et present ere "nitrous fume" poisoning, zinc fume fever, as it la popularly termed, and actinic ophthalmia from ultraviolet radiation of the welding arc. "Nitrous fume** poisoning, while comparatively rare, is a serious condition. No accent need bo placed on the fact that these Injuries would be Stitt further reduced la number if the control measures provided were properly utilized. It may be of interest to note that of 317 cases of actinic ophthalmia reported et the New York Yard in 9 months of the current year, only 20 Ct occurred among welders; the remaining 80ti among men exposed in spaces adjacent to the welding are but not utilizing available protective goggles. Chronic poisoning among naval welders from manganese, fluorides or silicon, which might be escribed to inhalation of these metallic or mineral oxides in the welding fumes originating in the rod coatings, has not been reported. Such e possibility, of coarse, cannot be denied. The limitation of time prevents mention of additional hazards. 10. Annual Examination of Crane Operators, Enginemea (Hoisting and Portable) end Locomotive Engineers These desses of workers are physically examined annually with special emphasis on blood pressure, hearing and vision. In view of the nature of their duties, physical failure, such as sudden collapse, might involve critical injury to themselves and others; and in addition, damage to material. If corrective measures are impracticable the worker is retired or transferred to some other type of employment for which he may be suitable. A crane operator, for Instance, presenting a marked hype rtensiortT would be referred to hie private physician and transferred to other duties. 11. Time Loss from Industrial versus Non-Industrial Disabilities In a limited study of 116 industrial companies in various parts of the United States conducted by the American College of Surgeons a few years ago, it was found that tha time loss from non-industrial types of illness was approximately 15 times that Industrially connected. The speaker in his capacity as Senior Medical Officer of the Washington Navy Yard made tha following observations for the calendar year 1933: Total industrial force. 7,000; number of days lost from industrial accidents. 0.14; number of days lost from non-industrial illness or accident, 5.20. The number of (lays loss from non-industrial disability was therefore 37 times that from industrial t 0117 . .................... -- cauci. A similar <tudy by tlio speaker at the New York Yard for 1059 revealed tliat the non-iudu*trinl loss was roughly four times the Industrial figure. The possible factors in the difference between the two yard* hare not beon analyzed. Disparities of the same general order hare lieen reported in recent sta tistical studies by certain large commercial industries and reflect an enor mous economic loss. Much of this, non-industrial illness b preventable. It if believed that in the naval estaldishmeats this wastage of preventable Hines* can be greedy reduced, if the problem is attacked by an annual physi cal examination of all employees, referring cases requiring corrective treat* ment to their private phyeieisne or other agencies. This would require a heavy increase in medical staffs but it would be a profitable Investment by naval industry in the saving of man power for national defense. It b a question worthy of being explored. PROFESSOR DRINKER: We were informed the other day in Wash ington that the Navy is now In the mining business and b confrontsd with the conventional mining hazards as welL Therefore ws can say that their hazards are about'all thosa we meet in ell of our industries. I am surs that Captain Brown trill ba glad to answer questions. ' UR. WEIL: I should like to ask Captain Brown what his eye teat con sists of for his men in so-called key positions. We are uaing a keystone and ws are a littls at a loss as to, how to interpret some of the findings. CAPTAIN BROWN: I didn't get the drift of that. UR. WEIL: I want to know what the eye examination consists of and what is your experience in interpreting the keystone test, if you ase it. CAPTAIN BROWN: I don't think we have had any contact with that particular test. We simply use the ordinary southern test, with definite standards. PROFESSOR DRINKER: A teacher always judges the value of a book, first, by his ability to keep it in his own library or in hb own laboratory. They have a way of disappearing, particularly if your students are eager for it. One also Judges the value of a book by the general appearance of the cover, whether it begins to fall apart after a month or two. Haggard's "Noxious Cases" Is tho standard-book throughout tho Eng lish-speaking world on the subject. I am on my fourth copy. I don't know how the rest of yoa are doing. Two of mine have been stolen, one h worn out, and the one I have has been rebound once. The University also has a number of them at the Medical School end st the Engineering School Libra ries. I state this to show you how eager we are to use it and how much we do use it. It b pleasant to welcome to our group--at least it b for me as a pro fessor at Harvard--a- professor In a sister university and one with whom we have friendly rivalry of all sorts. In this east I Here to admit, with a good deal of professional jealousy and very sincere admiration, that there Isn't any rivalry. Tho lead Is entirely with Yale. It b to me, therefore, a great personal privilege to be able to introduce to you Dr." Howard W. Haggard, of Yale University, who will speak on the "Absorption and Excretion of Vobtile Solvents." Oils?