Document Zna62rBmZm6oBnxKdbyxmMBeL

FILE NAME: Baldwin (BALD) DATE: 1940 Aug DOC#: BALD069 DOCUMENT DESCRIPTION: Conference Presentation - Occupational Disease Hazards--Their Cause and Control - from the Proceedings of All Ohio Safety Congress Div. of Safety & Hygiene Resource Center PROCEEDINGS of All Ohio Safety Congress Held Under the Auspices of THE INDUSTRIAL COMMISSION OF OHIO ' and the direct management of THE DIVISION OF SAFETY A N D HYGIENE Published under the authority of The Industrial Commission of Ohio Deshler-Wallick Hotel Columbus, Ohio April 16-17-18 1940 DANNER PRESS, Inc. A kron, Ohio 1940 OCCUPATIONAL DISEASE HAZARDS -- THEIR CAUSE AND CONTROL Wednesday Afternoon Session April 17, 1940 This Section of the All Ohio Safety Congress devoted to Occupational Disease Hazards--Their Cause and Control was called to order at 2 o'clock by Dr. Sidney McCurdy, Director, Medical Division, Industrial Commission of Ohio, Columbus, Ohio, Chairman. Chairman McCurdy: Our meeting will now come to order. We have to discuss a subject that is really momentous. In the state of Ohio recently we have entered a new phase of taking care of people. We have placed the burden upon industry for practically all diseases that are peculiar to the industry in which a man works and which he customarily would., not meet and would not be subjected to elsewhere. The history of our occupational disease law up to this point has been that we have carefully selected specific diseases easily capable of proof and named them, and' no others were applicable to compensation. I think that was in 1921. In 1928 or 1929 we added six or seven in the same manner, by making them specific, and we went on rather slowly, and somewhat discouragedly, until 1937, when we took our place with others who had been ahead of us in recognizing, % specifically, silicosis. Apparently with some fear and trembling we did that, because we stuck around that law some safeguards to limit what might be classed as a previous accrued liability. In any event, we took on silicosis with those safeguards that seemed to protect fairness and merit and in some instances, I fear, we were a bit unfair to the claimant. But there had to be a starting point and we made it in 1937. In 1939 we threw all discretion to the winds, burned our bridges behind us, and took on all diseases not classified hithertofore by name, and which, of course, in this modern day and age is a step in advance. It also introduces the Industrial Commission very definitely in Ohio into the business of preventing diseases as well as accidents. We have done something that is a little bit peculiar in our section. Perhaps it might be classed a trifle experimental. When we took on silicosis, we set up a Board of Medical Referees. Those referees were to be men especially versed upon the subject of silicosis and with special knowledge of it, two of whom could be most any specialist that we desired to choose, but one of whom had to be a roentgenologist. Their opinion was not final, but the cases had to be submitted to them, before the Commission could allow or disallow the claim. As a matter of fact, that silicotic board is made up, I believe, of three as good men as we could get in Ohio, and who have been so recognized in the communities in which they practice. I believe from working with them, that they are dealing with the cases fairly and honestly, but upon a scientific basis. That Board has been obliged, of course, to turn down some, but it has been, I believe fairly liberal in passing those cases that had merit. Remember that Board was not final. But when we took on the additional number of twenty-three other diseases, we set up again a new principle in Ohio and, I think, a new principle everywhere, 558 559 m that each claimant who was d is^ tio f^ upon medical facts, had a right to appeal fact, and upon the i n d e n t ^ * 2 Ihey were final, on medical fact T W -at. . j ruling of the Commission, ^^ : "- 0" * . ' be case would be decided. had occasion to Use that new Board'. / L ^ V l t t m p t e i f 7' W6 basis-specialists in each of the larger cihC! Set rt. UP on this field that we can expect to meet so that if ' ^verJn8' Practically every Toledo-or Dayton or ColumbuT we 1 ? * u r Cincinnati or disease controversary, we can do it without ^ * SP6Clal Board for a skin made it necessary t ' ^ 7 1 f ^ ^ T1" ` forty-four. I think one of the proudest moments in our'r `he "Umber is wrote to these men, requesting that ," 0Inents in our hves was when I telling them frankly that I couldn't tell t h U T t h a H i ^ h could pay them, but telling them what T th * tm e how much we the list of those that I was .l i n t L d" ot ,,,,. d " " ^ th" > most of them wrote, thanking us for the + 01311 turned us dwn, and in behalf of this new principle. We speakTf" th T ^ l ` l r8"de'' th<!ir service so labelled here, as "Occupational S e ^ ^ h public health matters, it is spoken nf aa j " af ards- When you get into their terminology is better than ours, b ec^ se l i t e r Z l V P8rhapS arise out of, or in the course of employment With t b ' 1tJ eSe.. cases must now have, I think the word "industrial" -,,1H n hberaIlty th^t we word "occupational." At the beginning of tw ^ ^ th<2 plaCe f the going to discuss first occupational Hie & thlS symposium today, we are the word "o c c u p a t i o n ^ r S l ^ l r : - " !" 7 '^ ' he has been with thT head of their Occupational Disease foi"0"^ l eXprience in that V T f years> at the moment, but I want to state first the ruies of'th ^ lnf . duce hlm in a is through, I will throw it open to HiTM game` After each sPeaker stand upon his feet and announce h t name"' d ^ discussant wouId if he represents anybody I wTh bo TM u \ ^ he CmeS from a*d He mUst d0 that as man; times a i h r s p l k ^ r i r 1;? he cares to discuss, five minutes and T ' I , sha allow anyone who " "P. because others may want t,, ta S L limited. I will rap upon L table o" L 7 ` " T 1 the " `" " V " mre " s r ~ ~ ;r patiT C ; : : r ' state D-- ' f t h e o c c u r r e n c e o f o c c u p a t io n a l d i s e a s e s IN OHIO By Kenneth D. Smith, M. D. medical aspects of Occupational D ia s e s ^ t l d f l s T t n the nskwasm^ certain topics which color the picture of th e^ H - ^ 1 ShouId review seldom seen in print and'which T Z i t l often neglect" ^ ^ present status of these diseases. Therefore this di m aPPraisi*g the -inereiore, this discussion will be more or 560 less a hodge-podge of miscellaneous information. I shall not burden you with many statistics. If there are any of these data that you desire in actual figures they can readily be obtained from either the Industrial Commission or the Ohio Department of Health. . Whenever it has fallen to my lot to discuss a subject I have usually consulted the dictionaries for two reasons: I wanted to be sure that I knew what my subject meant to me after I had read' the definition given by those who were experts and qualified to tell me; but more important has been my desire not to give an entire discussion which would be erroneous because I had erred in my understanding of the words. I made no exception when the title of this paper was given to me. However, when I read the many defini tions of "occurrence" I found among them this: "The act of occurring." Obviously this definition, although correct, takes us to the word "occur" where we find first "to befall, to happen, to take place." Again a correct definition but inadequate here because we do not know the exact number of workers who suffer from occupational diseases because of faulty diagnoses and the wide-spread lack of reliable statistics. The next definition was more to my liking for it stated, "To exist as to being able to be found or seen; to be found; to come under observation; . . . ." Here was some thing to sink my teeth in for we can discuss only those things which are found or come under our observation. Definitions which adequately and accurately tell us just what occupa tional diseases are have been the cause of more headaches to the industrial hygienists than the diseases themselves, and I have finally come to the conclusion that these headaches are the most prevalent of occupational diseases. If we consider occupational diseases from a medical standpoint, a defini tion would appear to be obvious. Unfortunately, however, except for those specifically occupational illnesses such as certain poisonings, the pneumo conioses, and some infections (such as anthrax), we encounter erroneous reasoning bases on a priori reasoning. Diseases now classified as "partly occupational," "industrial illnesses," and other such terms must be clarified. Weyl insists on the inclusion as occupational diseases not only those illnesses generally caused by the personal activity of the worker, but any frequent manifestation of symptoms affecting a given occupational class. This definition follows closely that of Van den Borght who believes that "occupational diseases are the consequences of long continued exposures to harmful effects in the exercise of a calling, and that they arise exclusively or with particular frequency amongst the workers in a given industry." Gilbert believes that "those diseases which appear in any given calling with an incidence exceeding the normal, as well as those obviously due to occupa tional risk," should be considered occupational. Certainly these definitions are open to criticism. The inclusion of the statement that the exposure must of necessity be over a long period of time renders those definitions fallacious when one considers wool sorter's disease. We must remember that time is relative and whether we call afflictions which follow short exposures accidents or acute specific occupational diseases, the pathology is none the less dangerous and the occupational etiology remains unchanged. I can't agree with those previously mentioned definitions for two reasons: One is that I saw a case of lead poisoning in a dairyman and a case of silicosis in a hog sorter. Each of these were proved to be correct diagnoses. The dairyman had been soldering milk cans, holding his face 561 Z L S 0." " ' had b6en at thlS Wrk f0r QUite some me. The hog sorter w h e e l m a stock yard situated on the lake front. The ground and floors e covered with sand and the constant milling of the stock had created an extremely dusty atmosphere. This worker had been employed for many ButrSof bV1U y >, 6 man inCUrred his silicosis the result of his job t ' Urf : ' i g sorters usually don't develop silicosis. Am I correct r. Bloomfield, that we were shown a case of a tap dancer who developed silicosis when we were in Washington in 1936? P Mr. Bloomfield;: Perhaps so. I don't recall, Doctor. Dr Smith: If I recall correctly, this chap had incurred his silicosis by breathing the dust from the sand that was sprinkled on the stage when iroouutWineCenttailed deep TbrUea\thidnagn,Cer f0r S6Veral years and the exertion of his wwhihchi iensfisst ithaf t ran occupationaasl,aid?i.sreeapseeatmtuhsat tb1e coannenowthiacchceii,st a frequent manifestation of a certain calling or that it must arise exclusively, or w" h a particular frequency within a certain industry. "Wool sorters' disease " or more correctly, Pulmonary Anthrax, proves that the exposure need' not necessarily be of long duration. _ D+r Hayharst has long since stated that "an occupational disease is any affliction which is the result of exposure to an industrial health hazard " *nd. I, read a PaPer which had been given by an attorney stating that this definition was too loose. From the standpoint of the legal mind perhaps that is true. I don t know. As a medical man it is not too loose to me. Certainly we have no quarrels over the definition of the word "disease " Iu is universally accepted to mean any state of the living body in which the nature! functions of the organs are interrupted or disturbed, either by defective or preternatural action, without a disruption of the parts bv violence, which is called a wound. I often wonder if we are not in the posi tion of those, if I must use a hackneyed, expression, who cannot see the forest for the trees. I believe that an occupational disease, after all is a disease that can be proved, after the exclusion of any reasonable doubts, to have occured as a result of hazardous exposures which the worker encoun tered m no other place but his place of employment. To me that is adequate and all inclusive. It may seem that I have taken an undue amount of time to discuss what diseases we can blame on the working environment alone, but it is good for us to take the time occasionally for such thought in order to appreciate the problems that confront our compensation boards and' courts and well as the worker and his employer. ' The next; question, obviously, would be: What are the hazards which cause occupational diseases? I shall skip that until later in order to discuss the difficulties which face us when we attempt to determine the exact relation between cause and effect, and pass on to the next questions that would arise. Without exception we all want to know two facts. How many workers are exposed to hazards that might produce occupational diseases and how many cases of occupational diseases occur? No less important is the question: What, specifically, are these diseases. We know from the last census that there were approximately two and a half million gainfully employed people in this state, almost a million of whom were employed in the manufacturing, and mechanical industries and 562 in extraction of. minerals. These three groups are usually known as the heavy industries and health hazards are known to exist in them , _ It would seem that if the state required that these diseases be reported m the same manner that contagious diseases are handled our problem of occurrence would obviously be solved. Theory and fact are often not the tt reportlng of ay disease believed due to occupation to the State -Health Department has been a requirement by law in Ohio for 26 years- compensation has been paid for industrial accidents since 1912, and compen sation for certain scheduled occupational diseases has been in effect since 1921. Wherever compensation is paid for occupational diseases, more cases are reported. In* Ohio 2,575 cases were reported from the date of the first leport (May .15, 1913) to the date when compensation began (August 4, 1921), or an average of 322 cases a year. From the date that compensation began to January 1, 1939 (17.4 years), 23,409 cases have been reported, or an average of 1,245 cases a year. The increase in the number of cases reported when compensation is paid is further shown by the cases of silico sis reported immediately prior to and following the advent of compensation for that disease in Ohio. The law which placed silicosis in the list of com pensable diseases became effective July 31, 1937. In 1936, nineteen reports of silicosis were received; in 1937, forty cases, and in 1938, one hundred and forty-one cases. If we analyze these figures several facts are impressive. Apparently all cases are not reported because of incorrect diagnoses, lack of knowledge concerning reporting, and other reasons, or there must be an extremely small number of actual health hazards in proportion to the great number of workers in this state. It cannot be denied that the influence of compen sation on the number of cases reported decreases the value of statistics based on them. Actual field studies have shown that but a small portion of cases are reported. In spite of these disadvantages, reporting is of the utmost importance and should be continued'. The field studies, just men tioned, prove that many cases exist unrecognized although work done in large companies proves that the actual incidence is not as great as we would expect. On the other hand, many illnesses are reported as occupational diseases which, on investigation, can be easily proved to have no relation to the work place. When compensation for silicosis was paid, many cases of pulmonary pathology were reported as silicosis and I have received reports wherein the causative agent was given as marble dust, limestone dust, grain, and almost every other substance that is capable of existing in the form of dust. It is an oddity that such a small amount of consideration has been given to occupational diseases in medical schools, meetings, and public health work. Especially so, since they are not of recent discovery. A discussion of the history of occupational diseases, although interesting, is not of im portance here today except- to mention that Hippocrates, the father of scien tific medicine, called attention to them almost five hundred years B. C., and many other physicians have described, from time to time, some of these afflictions which result from the work processes. Although silicosis is generally considered to be of recent discovery, it was discussed by Georgeous Agricola as early as 1556 and a severe outbreak of the acute type occurred in this country in the. early part of this century. Extremely noteworthy is: the fact that Ramazinni published detailed and amazingly accurate descriptions :of the diseases found in more than a hundred occupa- 563 but almost two an^half centurieTago^' ^ ^ PaSt feW decades- tional facilities and inforrativTmateril6! tack*of i n t e T T f inadequate amount of statistics' It h ' ... u t fc' and ur relatively diseases did not touch pubiic appeal btause ", Z sz r ]y ai be denied. The suddeness of occurrence'the S T " C r "* that gather, the immediate and ohvim, j ' excitement, the crowds that the Silicosis Disaster that occurred at G^nley HWeVer' mgs m New Jersey because of ^ ndge and the radium poison- press, awoke public consciousness thaT^* PU^ 1Clt^ glven them by the consequences occurred Misconceiving ru^unfortunateiy, c ^ occupational diseases of tragic Z S L entirely by those two environment Z 7 Z J important"f^t f' an individuai man is influenced almost ^ chara' teTM `t a and his ^ *l " 1 disorders, fLl! ? - ^ i s S ^ 5 srS5 S about eight hours and I tI s itZ ^ ^ eV ag" S TU; ng fte WOTtM' extra-curricular activities has n o t ^ C ^ r ^ I T l S l t L Z m our consideration of an individual's r e s is ta n e T Io a h a z a r d that T , might encounter at work. As a concrete example I might state that tf fM worker spends -much of his time in the corner b e e T S r l o r d f ?obml e r e teh am0U" \ 0f ^ be"di"S h' has TM business Work!" Z job where he may be exposed to many substances used in industr?. It " n t T Z k 5 5 * 3 ! : f l evident `thereTorfT t " Other factors which play important voles in the development of occuna onal diseases are age, long hours of fatiguing work, hard work entailing deep breathing, uncomfortable postures and all tW e f Q,,f entailing usually piace in our safety 5T JS5L 32 to occupational diseases. The previous medical history of a worker S of importance also, for instance we Wduld not want to place an empbye in a job where he would have the slightest amount of lead exposure if we knew that he has recurrent gastric ulcers.iThe individual's suscentibrlitv or an .,,creased sensitiveness to-even small amounts of I c S s u S n " 564 C' a5i0"S f r POiSO"ingS aml * * * * * * r derma . ,J .r" llZe lhat `"any of you Possibly expected me to devote a great deal this discussion to various specific occupational diseases with a detailed oZccur"reedd.0,1l tkn"owwSrthtatt0ma Sffeawndoff you have expe"ctded`mee Tto wintherere^latZe r1tl specific occupational diseases with the so-called "partly occupational dis eases " quote industrial complaints and conditions and therelation^ of cirtata industries and occupations to increased incidents of c e r Z d i s e Z n i ordinarily considered as of occupational origin. However, because of the hmitations of time and the title of my paper, it is impossible for me to discuss anything but specific occupational diseases. If we were to d iv e r t into the subject of the entire field of industrial health, we could hold as many sessions and have as many meetings as the program of this Safety Congress contains, and then we would have merely scratched the surface We have previously stated that the requirement of reporting of occuna t onal diseases is of great assistance in solving the problem of their preven- mm f- M T? g hese rep0rtS are inadequate and the diagnoses often questionable. It is natural to ask why we do not study these industries and . e workmen therein, thus giving us a complete picture of not only specific hazards but aiso their effects upon the employees. This is probably the dream of every person interested in industrial health. However, the magni tude of such a procedure renders it impossible for such a study to Jive ` hentlc results unless we had the services of hundreds of scientists It would be necessary to take specific and detailed scientific analyses of the ork places for all the hazards that might possibly exist there. It would e necessary for the physician to examine each individual worker, to take a complete medical history, and to do the necessary labratory and X-!ay examination. In addition, when we realize that these examinations of bolh the worker and his work place must be checked not once but many times at specified intervals to determine an average, we begin to see the impossibility tthhee ffaacttt LthTatb obotbthTtbhe worTkingrePenevai-reodnmChe6nCtkSan^d thneeCre6sSiSsataryncien otfh*thfeacweagoe? e^ner. varies from hour to hour, day to day, week to week, and season Jo However, we can measure the potentialities of our health hazards by taking a cross section of industry and by what one might call observation! learn the processes where one might expect the possibility of hazardous exposure. This procedure must be done by a scientific sampling process Jo secure a proper balance of plants which had good environments to counted act the opinions formed from those establishments which did not have healthul environments. It was my privilege to participate in such a survey when th 5 ^ Departmef t of Health made a study which covered more than 3,000 establishments m the heavy industries and analyzed the working environ- ^' V P tential health hazards- This study also included the recording of control measure when present, welfare facilities such as full time or part time physicians, plant hospital, nursing service safetv directors, shop committees, insurance service and others. ' r, f Ti e, advantagf ,f such a survey are that we are able to evaluate the potential hazards by listing them as exposures, and to know where danger ous exposures may occur. The greatest value is in the fact that one who has been warned concerning a danger is much more apt to be on guard. 565 Please keep in mind the word , . encounter trouWe in a great number of t a y s ^ tbat Wrd We couId often forget that n ^ a A m ^ w as^m ad^to^ *1 be published>is that readers sure to any material listed and the n * the extent of the expo- only that the worker is employed to an e n Z L ^ t ^ v ? Ps"res " cate are used or created. One should keen in minw ! V " WhlCh SUch substances cise medical engineering- and -i, -P , d at aI1 times that only by nre worker. of the workplace ami 6 tent of the exposure or its effect upon the - whlhh t e a r the amount of actual hazard that m ig h A e uresent evaluation of the of the inadequacy of occupational diw P * m 0hl Indastries. Because of information obtainable no one knows* hnw ^01^ r6Ceived and the Paucity eases occur from day to day H oweTi 7 SPedfiC OCCUpatioTMl dis ported each year, and never m o " Z 2^ T * U" ,mmb`!r that is ~ by flve or ten times, it is at once obvtons t h a t ^ h e r ^ ' V " 1 epidemiological standpoint is not great in ! ^ -th importance from a half million workers in the state. comparison to the two and one- because of c o m p a r a t i ^ ^ t y ^ w ^ S t n o t T ^ severe or fatal nature is a tragedy to that great importance of occupational disease is an opening for better industrial health ~ r T th n0t ^ important6Very case of a ^ dPendents` The S a wedge that makes disaster and the New S s e T raiu m 1 7 TM TM ' ? t0k the GauIey Brid^ the same manner poisoning fa o ft n fonow^Tbv ^ PUbIic- In health of workers. The benefits of such n * programs to lmprove the axiomatic that healthy workmen do move are manifld. It is that a healthy worker is less accident & 7 Wrk- We also klJ0W profits, there is less chance of l i t i g a t A ' ^ T ', the employer makes better ways great in an unhealthy enZ n Z t c T * ! tUraover is a1' expense entailed in training new * CertainIy industry realizes the workmen have spent years fn training.' S t e S h " eXpert paid for themselves both in monev and hatin' a ,programs have always programs that we can hope ? ,, t a c r S s e 7 " 7 " iS 0"ly thTM * h s"ch tional diseases and of those adverse envl nW, Gdgre f the partly occupa- favorable influences L health conditions which exert un- discu^sATthe iacVtorsa whichCare t h e ^ ^ aI1 tted t0 me in cupational diseases, I hope I have not given you' t^ CUTrence 7 SPecMc C` almost nothing concerning them T h l Y the pmion that we knw there is much to be learned in all the^methe " " er, *>r that we must have a Z r LerstandTng ?'' tT "7 7 ,S we discuss these diseases. Another f the dlfflcul.ties facing us before which sometimes cloud the picture is that w T ^ '*JVe linfi on the difficulties of the difficulties that face S e c o m n e Z \ ` aereed on the the true relationship b f Z t c l l T Z Z c t " * " " ta In discussing the specific occupational diseases frnm , , . and effect it is natural that one should properly classify3 f which are responsible. An acceptable classification ? anous hazards an acceptable definition of the term "occupatioua, diseases'-. 566 w h ^ ta S " ^ z^ T * ^ ^ " chara" s healtK W o ^Iaslfif atlon that 1 am presenting the first item includes any health hazard which can be classed as a material substance. In other words it consists of matter. We can subdivide this classification into two main sub firSt WhlCh We might cal1 the non-Iivin& substances. Here nd the poisons, irritants, and asphyxiants, such as gases, fumes mists vapors dusts, liquids, and solids. Some of these may act as true poTons when they have been absorbed into the body. Various types of gases are good examp es of the difference in actions. For instance, one gas, such as hydrogen sulfide, is a distinct tissue poison, another, carbon monoxide is a chemica! asphyxmnt in that it displaces the oxygen ordinarily carried by the asnhvxiauf7f > f 11^ ' TMethane- would be classed as a simple mechanical asphyxiant if it replaced the oxygen in the air to the point where the oxygen supply was not high enough to sustain life. Material substances can also cause occupational diseases because of pressure and friction, causing in the case of pressure, prepatellar bursitis, or "housemaid's knee". The poisons encountered which may cause occupational diseases belong to a group of materia1 substances and exist in one of the forms mentioned above It is probably timely to mention that there are two very important considerations that we should discuss at this time. Industrial poisonings occur chiefly as the result of entrance of the toxic substance responsible into the body through the respiratory system. Poisoning resulting from absorbtion through the skin is probably next frequent and those poisonings resulting from ingestions of toxic compounds are least frequently encountered. The other consideration is the fact that the clinical symptoms displayed in most cases of industrial poisoning are usually almost entirely unlike those symptoms seen in acute poisonings where large doseS have been swallowed or breathed, for example with ;suicide intent. A good example of this can be seen by comparing the symptoms which follow the ingestion of a large amount of a mercury com pound such as bichloride of mercury. Our patient here presents almost im mediately the picture of profound shock with a fast and thready pulse, cold and clammy skin which is pale. The patient is usually in collapse with dull and apathetic mental reactions. In "Hatters' Shakes" a chronic form -of mercury poisoning seen in the manufacture of felt, we see an entirely different symptom complex. Symptoms do not usually appear until within five years of: exposure and are characterized by psychic or emotional changes, muscular tremors, and inflammation of the mouth. . I believe it pertinent to mention at this time that Silicosis which as we all know .is the result of long exposure to free silica in the form of a fine dust may be classed as the result of exposure to a hazard belonging in this group,; We may further state that all evidence seems' to show that the cellu lar response to silica is probably due to a chemical reaction rather than becausevof the sharp edges of the dust particles. Evidence of this can be seen :the.fact that diamond dust and the dust of the harder artificial abrasives 4?; flae: ^ . f r ^ ^ t i o n .of pathology,such as seen in silicosis. ; - Other harmful exposures that are classed as living material substances are .the ;ba.cteria, fungi, and parasites.... . ... next agent in our classification of potential causes .of occupational diseases-is thermal :m character. Here we find extremes in temperature,:ex tremes temperature* change,: and: ppssibly,;:temperature:and hnmidity. . : 567 to radtan? e n e 'r T H ? . f " i 03" 6? J` *hat * po.ure infr_ * r gy` In thlsr we can include visible spectrum, ultra-violet ravs might atoTndude nyo";e ' ^ radi-aCtive substances' and possibly one w o r t e r TM ^ ae S i v r f PKSSTM \ suc1' as o-'oootored by divers and caisson worKers, and relatively frequent changes in atmospheric pressure such easeT ? aTM t" 3 " ay be TM VTM Ue als f <* aPe=Wo occnpationai d" Fatigue, particularly from rapidly repetitive motions is responsible for TM ? s 1 T JZ S t e t t s r eetins the elbows f air -- i- su ss r t r r ; ; = ; i -- " we have actually had reported in Ohio. As a basis for the frequency I shall use a summary of reports received during the decade 1928 to 1937 by the Ohio ftrriiaal TCcoZmmissioHneainIthv'-iew116o3f6 tWhe6rfeacCtht3h6"atrabtohtehr t<h*e" compenfsraobmle thanedInndouns"reportsSo? * * * * * * included. This group is comprised of almost 13,000 Sleged too tbe ZdueTto occupa+tSieoanSeaSl,thioguegthhenroWt citohmspeevnesraabllehuantdtrhedat dtiismeaeseTahle most outstanding feature in our review of these cases is that dermatitis ompnses about two-thirds of all cases reported. I believe that at this point we have reached the best time to call attention to the difference betwen the requency of a disease and the severity of it. I am informed by the Indus- ihat themT S1T " nearly a11 CaS6S f dermatitis reported to it indicate that there has been no time lost by nearly all of the workers afflicted. On the other hand, a patient suffering from manganese poisoning is conceded expI enrse r Leaid poison^ianyg wreams aninex3t11ininfVreaqliduenf cry mwiatnhy aylmeaoTMst mfifetueernrinhgunmdurecdh cases and m turn was followed by tenosynovitis of the wrist with approxi mately the same number of cases. Chromo ulcerations headed the remaining compensable diseases reported with the small total of less than 400 or about three percent. It is pertinent that during that period no cases of glanders, manganese dioxide poisoning pneennLsaabi !ier dd-isPe0a1sSe0snmgxNroWeevraelruaPti0orntedcaanlthb0eUmghadteheoyf Wtheereococnurtehneceliostf osifliccoosmis. S t V , ; / Ue 6 eaormouis increase hi. reports following compensability f this disease, as well as, the erroneous agents blamed for this disease in o o r t e d ^ n v 1 were. r e iv e d . Of the remaining occupational diseases re ported m Ohio, poisonings comprise a total of less than 900 for the ten yea- period Not one of these agents caused one hundred cases. They ranged . from 68 cases alleged to be due to benzol or its amino, or nitro- derivatives down to 2 cases alleged to be due to phosporus. It is interesting to note that for many years no reports were received on anthrax until recently when two cases were reported. Among the infections tularemia is increasing m numbers, most of the cases being found in butchers. Please bear in mind that these reports were received during the period when Ohio had a scheduled list of diseases which were compensable. What the future will bring, in the face of our new all-inclusive Act is not known. ' Since we have a little time left, Dr. McCurdy, I am wondering if you want me to say anything about silicosis. I think a great many of the men 568 here are vitally .interested in this and there are a great number of miscon ceptions concerning this disease. Chairman McCurdy: I think all the men would be interested in it if you will speak up good and loud. ' Doctor Smith: I believe that we should mention first that various types of reactions are produced by the different kinds of. dusts. Toxic systemic lseases may follow the inhalation of poisonous dusts such as lead, cadmium and arsenic. Allergic symptoms may follow the inhalation of certain dusts A good example of this reaction may be found! in the occurrence of asthma m workers who inhale cotton dust. Although some writers include metal fume fever, or founders' shakes" as the result of the inhalation of zinc fumes and class fumes as a dust, I have never liked fumes being classed as dust. Technically, perhaps, that is true. To me the dusts, as we think of iem in industry, are generated mechanically and fumes are the result of subjecting the metals to heat. Any dust, if the concentration in the air be comes great ^enough may cause irritation of the upper respiratory system and bronchitis. We are not concerned with any of these dusts, however, and shall not mention them except here. They are of no importance in a discus sion on silicosis except to call attention to them in passing. The first and foremost thing that we should remember about silicosis is that it can only be produced by free silica. Silica, or silicon dioxide, has the chemical formula, Si02, or in other words two atoms of oxygen have united with one atom of silicon. When we speak of silicosis we usually refer to the chronic form that follows many years of exposure to the dust. In oun ry workers, for example, the disease does not usually manifest itself until the worker has been exposed to a harmful concentration fifteen, twenty or thirty years. The words, "Pneumoconiosis" and "Silicosis", have often been used interc angably, although incorrectly. Pneumoconiosis means a dusted lung or a disease of the lungs caused by breathing dust. Therefore, it includes sili cosis as one of the pneumoconioses. Asbestos is also a pneumoconiosis. . are.a11 famillar with the definition of silicosis that is given in our aw: Silicosis shall mean a disease of the lungs caused by breathing silica dust (silicon dioxide) producing fibrous nodules and distributed through the lungs and demonstrated by x-ray examinations or by autopsy." Obviously, only dust from material composed in whole or in part of free silica can cause the disease. Quartz is almost synonymous with silica Sand is almost one hundred percent silica. Sandstone and granite contain vary, mg amounts. I should mention, too, that the silica in granite is present as tree silica mixed with the other constituents and not joined chemically When free silicon dioxide, or silica, joins and forms a chemical compound by unit ing with sodium potassium, aluminum, and the other bases, we know these compounds and combinations as silicates. At the present time only one sili cate is known to cause a disabling fibrosis of the lungs. This silicate is asbestos and the disease resulting is called asbestosis. It is interesting to note that silica enters into the composition of many rocks and that about sixty percent of the crust of the earth is composed of these. I believe that it is certainly of importance to name a few substances which we have had reported to us on occupational disease report forms and which have never been known to cause the disease. Among these are marble limestone, carborundum and other artificial abrasives, rock wool, glass wool gypsum, cement, coke, and soapstone. Coal, either anthracite or bituminous', 569 will^not cause silicosis without an admixture of hard rock which contains t i c J t T ff the dust particles is of great importance. Only those par in g / an t6R microns (a micron equals approximately 1/25,000th i w T , f 1" port1ance and il has been stated recently that probably only tides r n miCrnS are f importance- The smaller these par t cles are, the greater is the hazard increased. Of equal importance is the milHon t" lf Particles in the air' l t is generally conceded that five million particles of a diameter not to exceed 10 microns per cubic foot is the upper safe limit m the case of pure silica. However, if the silica is but a p&rt of the composition of the dust, this limit is increased as the percentage th/rnm " d*Cr^ f d as a eneral rule- We do not yet know what effect that the composition of the non siliceous dust, or rather I should say that portion tthhee aacc6ttiiooUn o7f ^th1eChJffee nstilicfar.ee SiHCa' haS " the -- N ation or inhibition o5 Let us take a look at just what happens when dust is breathed. First nature bas given us other protective devices in addition to our natural re- mmafyv Tactt aBs fttrhaptsh.e SIThnaPaed,difti-othne, tnheSeciSlinadtetdhemmuUcoCu0sUSmienmtbhreanneosoef atnhde twhrinodat pipe responds automatically when the smallest foreign body touches it and ose microscopic finger-like cilia contract rhythmically to force the particle up so that it is coughed up. It is believed that only about half the dust that enters the nose reaches the lung. If the particle is small enough to enter the air sac it stimulates the at tack upon it by the "dust cells" or "wandering cells" which pass from or through the wall of the air sac. These phagocytic cells are capable of inde pendent motion and their function is to ingest or surround any microscopic foreign body. After the cell has ingested the silica particle it makes its way through the wall of the air sac and enters the lymph channel. The ymphatic system has been called the sewage system of the body and the dust cell proceeds along with the flow of the lymph. The lung possesses two of such systems which are often called the third circulatory system of the body. One system drains to the pleural surface, this membrane which covers the lungs. The other system, following the blood vessels drains to the hilum o the lung, or that structure near the heart in the center of the chest where the bronchial tube divides into smaller tubes and where the large blood vessels enter the lung. After the dust cell has proceeded along this channel it is killed by the action of the silica and the formation of scar tissue begins at that point. The irritation which has been set up causes a tissue increase in this area resulting m what is known as an exaggeration of the peribronchial markings since the lymphatics surround these tube and blood vessels. This reaction can be seen in the X-ray but is not limited to the silicotic process and occurs whenever there is an irritation or infection in tissue. The fibrous tissue, or scar tissue, which forms where the dust cell dies is characteristic, owever. The scar tissue cells form in a circular nodule, the appearance of which under the microscope is not unlike the layer formation one sees when an oqion has been cut through. As more dust is breathed and more dust cells die m the lymph channels the flow of the lymph is disturbed until when the flow- is blocked no more dust cells can enter the channel. Instead of enter ing the lymphatic channels the dust cells die on the walls of the air sacs and the fibrous noddle forms there. All these nodules tend to grow and in time due to their overlapping or fusing, we find massive areas of scar tissue. Due 570 to the encroachment of this scar tissue on the tubes which lead to the air acs, we find a condition called emphysema which is due to the otherwise normal air sacs between the scar tissue expanding in size. All this process takes many years to reach the stage where we find the large conglomerate areas of scar tissue. Death is usually due to an intercurrent infection in e lungs such as tuberculosis or pneumonia. In fact death from uncompli cated silicosis is so rare that it is considered an oddity and some investigators declare that it does not occur. Other investigators have claimed! that the large masses do not form unless there is infection, although general observa tion does not show this to be the case. . There are no characteristic complaints or findings on physical examina tion that are not found in many other diseases. The patient must show an exposure to silica for several years and an X-ray examination is considered to be the most important factor in establishing a diagnosis. Post mortem examination of the lungs clinches the diagnosis, of course. If one understands the underlying changes that take place, he can readily understand the changes seen in X-rays taken at various intervals of time. In the X-ray film we note the hilum, which I previously mentioned, in the central part of the chest near the upper part of the shadow cast by the heart. We can understand the changes that occur as the. disease begins and progresses if we compare the appearance of the films to the changes which occur in bushes or trees when spring comes. In the healthy chest we see the hilum giving the appearance of the trunk of the tree where the large branches appear. These branches, in turn divide as they pass outward into the lung tissue until they fade entirely before they reach the pleural portion of the lung. In early, or first stage silicosis, we find an increase in the trunk and a generalized irregular exaggeration of the linear markings of the smaller branches together with the appearance of tiny discrete nodules of uniform size and evenly distributed throughout the central portions of the lungs. These nodules are not unlike the appearance of tiny buds on the tree. In the typical cases the extreme top, or apex of the lung; the outer areas; and the lower portion, or base, characteristically show few nodules. As the disease progresses the nodules increase in size and the linear markings are intensified by contrast. When the nodules exceed 6 millimeters in size and when conglomerate masses are seen, we have advanced, or third stage sili cosis with some loss in the appearance of the lateral markings. In our tree we can say that the buds have burst forth into leaves and the clusters of the leaves have obscured the branches in some areas. I might state, too, that the conglomerate areas can assume almost any shape and appear in almost any area of the lung. They can extend outwards from the hilum, or be wedge shaped and extend in from the pleura, or they can appear as tumor-like masses deep in the lung tissue. All these changes described can occur in uninfected, or properly called simple, silicosis. Infection can occur during any stage and I shall not attempt to discuss it for the experts are quite often misled by the many forms and patterns that can occur. Neither shall I discuss differential diagnosis except to say that many diseases such as miliary tuberculosis, certain fungus infections, cancer, multiple calcified nodules of healed tuberculosis, and; others may simulate the appearance. Simple, or uninfected silicosis, does not produce fever, however. We have been speaking of the chronic silicosis which we designate sili cosis unless specified otherwise. In the Gauley Bridge tunneling cases we had what is usually called acute silicosis although we prefer to call it rapidly .A ;W 571 seen in pneumonUs ^ t L s e l ^ r Z v e l Z e 'd a ' `"n8s was m0K like that than many years. Some men have expressed the Pf 1<'d.o months ra`1> ' S r L h 11"!- " T * thCy were' 1 .0 "` k n o T 10" ttey "rere a" ruions infection h n r t h \ t ^ o * a * l t L l n " `r 1" mre S"SCeptlble `uberus are convinced of this, h o w ev erw L T a , Th Z * d"e ` ifc N ` " of appraised carefully. I might mention that S ' eVldence 13 l>rouSht out and used. Silieotuberculosis means tt t a e h S V TM *W0 terms fte" sn i^ s^ " 0; : ^ " ^ ^ is ^ s r t n " assue that in the susceptibility to p n e ^ S ' o u T ^ t e fe lt ^ P`ayS pneumonia is considered usuallv tn h +1, f-u J St factor m resistance to is independent of T 7 " t " * of the Wd which the lymphatic channels, wMch are T l J Z ^u ^ the f Of any tissue, plays any great part I caunnf " 6 resistance to infection of the disease is influenced by the scar tissue^e 1 S ' Whether the outcome with the resultant loss of tha lunVtis J e d replacing normal lung tissue the expanded air sacs that ^ been tle^nTurt and" etTnlt h f^^exp sire ""T O r r ' b" ""' Whlt -- o and ^ 1 ^ S T `~ " ^nX " to repeated examinations of other w t SS e^a" matlons have been compared What protective d e l e s were used ^ had the saie exposure? functioning efficiently? The answer" toTh^ mamtamed ProPerly and `he f n ^ n S n " ^ the^ ausT T f1'change hi Ms most of the important.medical S " T . the'plctare "4 S T H that we should k" p o L t a T s in t ^ Z T ' " " f ^ " y d te "3si"' control of the occupation Z T S L Z ' Z j Z Z dT B7 `a m With " will clear up those points that are troubling you M d PTMbably Of arranging J r an occupational" dkease k w ^ " T * J 3 Whle business was present at its birth. I would' like to be fi T * nIy SIr6d rt' but he the occupational disease law as it stands tod^ UP^ ? e evolution of Donnelly, Secretary of the Ohio Federation of LabTr ' Mr' Tm r t" -~ T e r b~ compensation. " " P" 1* dw a se law emotcownhnaetcttio*n with workmesn:'s b e g i n ^ g t r " : ; ^ ^ w H at m a n y* * * abTM` A, forcing L e mv ^ye r Tncol tcoLmppenisrattinigr frorddiseeadselsortJhaitli^really wheadwnoouldrelbae- 572 tion to the silicosis, because we wnU k pneumonia and a number of f r " " "" P" and Act reached its greatest strength, I S ie v e ' t S S n ? aboat the tlme th there was a manner in which they could' take Y^" Prfossion discovered the X-rays they could show whethei the 1 * X`rays f ,unBS *nd from causing the disability or from someam T . 7 " S"ffcring &"> silicosis the old hand tool days, with the small ,,hi *?' N,W f 1 Presume in had gone into different chemical indusMes and " <> hefore we kinds of metals in industry, that there w , d ? USed so many Afferent uch as we know it today. t Z T J T ^ httle. OCCUP^ional disease Federation of Labor, it has been m v d u tl f repf Sentatlve of the Ohio State tion laws in Ohio changed from S m e t o L * ? TM " t0 W the cTMPensa- we thought required the application of w / t t0 f* "eW situations which to disabilities and deaths. I am rather at l ^ S, compensati<m principles that I have had a great Passion"ver a number T ^ 7 T t0 Say' excePt tatives of industry and labor together her 7^ TS t0 bnng> the rePresen- There is really no excuse for ^ qU*Stin f IeSisIati- when industry and the representativL0^ ^ 011^ ?jS?aSe Iaw we ^ot in 1921, upon a real occupational disease co m p en sa tio n ^ ^ 7 " h&Ve agreed served the history of this country as well ^ tb v * * yU have ob- certamly must-have observed the progressive sidTof tV ^ ^ yU mg generally from the side of Labor It h t 5 ^ propositlon> speak- because it was the laboring people that were7 by industrial accidents and by is not working in those places and doe f T " th Sde f and * * * * * kiU<* NaturalIy the man who as progressive, you might say in trvine- T * Cnt*act those things, can't be of Ohio laws that will compensate nor^wiP 7 7 ^ cases t0 see that these hazards the General Assembly over th T u S d 8S tages fn d T e r f h ! " b e e ^ ^ ^ ** we had compensation fo r it I serve/ 6*1 & 7 * 1 f 11 registered since m ittee, some few years a g o ' in which J "* & committee> governmental com- of these dust diseases, Z ^ Z f V n Z T * * 7 ^ ^ extent controlled and to some extent e l / 7 / * 2 7 ' 0311 be to a large ^ave to bear the cost of compensating f o / a lot o / d i s e ^ ^ not by dust. s or a lot of diseases th at are caused hope" Z " :,,uag n T m t S ,, l 1 dV iliCand'lSl- A* 1 I I hope to live long enough that when th e -f/ 7 ^ t0 the end of the road-- some situations as have come un in b , . . aWare put .n the statute books, men's compensation, perhaps unemnl 6 7 occuPational disease, work- e.Se, that the . f " g Man^ ;" -- r opening ta lk is opened fo r discussion" byT nybod'y ? ' Donnelly- Now the With our Board of Health, perhaps will' open the 573 Dr. Hayhurst: Dr. McCurdy and t w . . Prepare anything or see the l Pf Sent: 1 haven>t had time to that Dr. Smith gave to his subject ^ ^ Iarge C0Vera&e of his points, is that occupational di* y g eral exPerience, if I got one cated. The specific o c c u p a t S L S are n0t Sequent as he indi partly occupational are prettv " r r&ther rare< Those that are and through, whether more thin twentvfive 1 taldng {t aI1 through T w ? ? for instance- T m T Z J t T ntyi is:ht per cent * S that there are from 70 to 75 per cent of , d elop sll`Cosis, which means develop it. As persons get older^ partic,,l,ri eXP0Sed who ^ `1 not Pt to get it, so that we find as many T E h they are *** 00 1 ^ 1 years of age beginning to work with Silica who a th,Se Wh are over forty allowed ns to say a word about the ^ P * 1 wi>h without mentioning something which I think * featare- 1 can't sit down, that we must have pre-employment and 18 ^ essentiaI' and that is we can control the health problem in in ,Pe,riodlc health examinations, before ease problem, but the health problem. ^ "0t nly the occuPationaI dis- whether f a r ^ X " I s r f T s f f f America: 1 wondered any effect upon the respiratory s y ste m / ' " mStanCe iron oxMe- hove Chairman McCurdy: Dr Dr. Smith: There have been vJ that at this tim? dust, whether it is health hazardouTor n T " m " y dUSt as a nuisance dust up to a hundred million particles per c u b iW ^ f ^ ^ " the nuisance upper respiratory irritation, and of broncbiK ' WG rUn the dan^er of entered the field in another way The " w t HWGVer' iron oxide has of chest of electric welders, electee l i d J r , X`ray pictures Ensler reported that the pictures were n ^ a U.Slng bare electrodes. Dr. they fooled the experts. The nodules are6not , P1C*Ures of silicosis; in fact, a deposit of pigmentation of the iron No d,, hiTM SC&r tisSUe' but due to of these cases. The case I am thinkine- of * Sable" ent. has ever followed any an accident or an intercurre/t d i e t ? * 1 *" * Ues that answer your question? ' Mr. Benedict: Yes. to l e i n T a n i r a ^ h e i : Cm eforth with an^ Questions of things you want a deposit or th H ffe c T o fthl 't ^ ndulation caused by ' a simiIa* Adulation to theTil c l c 7 * m o n ^ 'tl* y U StatGd' * resuIts * more susceptible to a subsequent i l t e o n " l 7 f ^ the one affected deposit ? I prohabiy worded" " a silica Chairman McCurdy: I T ,, the last article upon the subject se e m ^ /tn ' .lf,.eVerybody aSrees with me, upon the lungs which appeared like s i l i c o t / thlS arC welder's dust other words it did not s e L to be I cause of de T ^ ^ Silicosis- In T the action of ^ as aluminum oxide exptsur^f wWcrtheUtentleUt WdderS' bUt as far have been made which indicate there 8 ^ " ! E S asked about' studies the lungs associated *** of 574 Chairman McCurdy: Recently in talking with the Medical Director of Ontario, I discovered that they are experimenting with aluminum in an en deavor to diminish the activity of silica dioxide. That might be all right, but in the present state of our knowledge, it probably will be wiser to pursue the course that Dr. Gardner recommends, get rid of the dust and then you won't have to give something to overcome the possible ill effects of the dust. Have we other questions on this general subject? Dr. Smith: Dr. McCurdy, isn't it quite an explosive hazard in the way they use that dust as a protective feature, or not? Chairman McCurdy: That I can't tell you. Chairman McCurdy: Will you give us your name please? Philip Carey: I was just wondering if you had any experience of pneu monia from a sudden dust condition such as an explosion, where you might have dust for a minute or two, possibly hot dust ? Dr. Smith: I believe there is such a thing as dust pneumonia. As I mentioned, the acute silicosis cases are probably that. I don't recall, except cadmium salt, but we know that many irritating fumes and gases cause pneu monia. We know, for instance, that a person who had been overcome by carbon monoxide which was a part of smoke, quite often developed pneumonia afterwards during his recovery.. Does that answer your question? Mr. Carey: Yes, sir. Mr. Gordon Richardson: Can cases of silicosis be permanently stopped if the patient is taken from the dust-laden atmosphere? Dr. Smith: I don't know that you could say. In general they usually tend to progress, probably, from the start. Dr, Hayhurst could probably answer that question. Dr. Hayhurst: Yes, for two years. Mr. Shaffer of Dayton: The thing that is given the greatest attention is the occupational dermatitis. I think if Dr. Smith would just give us an idea of what he would classify as an occupational dermatitis, and how we can differentiate that from other skin ailments we come in contact with, it would be a big help. A few years ago we put great faith in the patch test. Now I am told by the skin specialists it isn't worth the trouble of going through it. What are you going to believe? You have something diagnosed as eczema. There is no such thing as eczema. In industry it is' all occupa tional dermatitis. I am at a loss, being in this work, to know how you are going to come to the conclusion of what is a skin occupational disease as such. Dr. Smith: I imagine the first procedure would be to remove the person from that job to see if the thing disappears and then put him back on it to see if it recurs again. That would suggest itself first to me. I am re minded of a series of cases, I believe McCord reported, in which a whole group of employees of one company developed a dermatitis. They looked everywhere and couldn't find any cause for it in the plant. It developed these men had started a community garden and they were getting it from materials used in the garden. It is easy to be misled, I will grant you. Dermatitis is a headache, all right. Chairman McCurdy: Are there some other questions? Mr. Donnelly: I would like to ask one question in relation to dermatitis. It is well known but it might be well to bring it out. Isn't it true machine 575 dermatitis, through The use oi'cutttog oh"' " ZfZZJ'X'&Z l thinT'there which use oils over ^ I f '" T f `h`S dermatitis' industrial ` ^ ^ 5 2 5 Ki T tw T ^ " machinery were kenl u T Z Z \ ' f nelther workmen nor the but what we allT eel that thT; - T T ' , IJthink there is <W=Mon from cutting oils. There is no qTeTtlTabou'tTt rmatSeS WWch do cTM e years^dermaW sfT: 7 Z U ^ T f " T " ? 37 *"d " "f t where they had an outbreak of d e S t i ! X r T - - - `nt faC`rie3 oil has been steriliVeH w i! several of these clear up, after this ns * ,, n steriIlzed- We know unquestionably that there is bacteria in sultingTrG,, T t ; f s PL WOnder * `here " ' W r " " d of * aasa f - - - because you have to h f e T f c t p f s e n t . " hTre le fa in fy T h o flT lft b` ^ " tc T T c S rfu tT u f t hhaandnlinSgtoff"sp"ice,`"inVtroddu"ce' "silicyonU dhioaxTMideT. af TM t " a l ,, f g T t l i ,, hea'T t h e Dr. Smith: Now it is my turn to ask a question. I would like to know -f anyone here has had much experience in the use of sodium siL ate " I c i e l T ma Cr P f CaSeS f pl'lmoriary disease blamed on it. The first T T c re" 8t r " parhc"lan- I believe Dr. Kistler saw it with me but IS chap had prominent lesions that were almost typical of a very advanced uberculosm. We made the remark at the time * was unusual he Z i T e any ever and that it wasn't a picture of advanced tuberculosis also from the symptoms. I saw another one later. I asked Dr. Gardner at the time if he had any experience with sodium silicate and he said yes as soon s e injected it in any of his animals, it knocked them off right away and t Thi / T 6 a"y inf0rmati0" anyM* has here who has been using ccaarr, iHf iitt wwaassTfroom" Tsodium sil,ilceaStien. S *WeChhaipvPeingnospdrio"omf stioli'tahtienk" ita ^was Sodium silicate, according to Dr. Gardner, is certainly extremely toxic. Chairman McCurdy: It gives me great pleasure to have the-opportunity hhiiss 'ttolpnich f 'CConttrTol orf TOchcuerpaati"oan,a0lriDlyiseuapsTMe Ha"zards." who has selected as . V ' , B1mfieId' Sanitary Engineer, United States Public Health Ser vice, Washington, D. C. . 576 CONTROL OP OCCUPATIONAL DISEASE HAZARDS J. J. Bloomfield, Sanitary Engineer, United States Public Health Service, Washington, D. C. ... M5; BIoomfield: Mr. Chairman and ladies and gentlemen: Sitting here this afternoon and listening to the remarks of your chairman and your first speaker made me feel very much, I suppose, like the Finnish Army felt in heir recent campaign in Finland when they sat around and watched their ammunition being frittered away. I am thankful to Dr. McCurdy for hav- l!mited the discussion t0 the occurrence of occupational diseases. I still have a little bit of ammunition left. I want to say at the outset that I am very grateful to the Industrial Commission and to the members here of the state agencies for having given me this opportunity to come here and appear before you, because I think it is a rare opportunity to attempt to give you our viewpoint concerning the whole problem of workers' health. Now it appears that definitions have been the order of the afternoon. I won't disappoint you. I will also attempt some definitions. I can't say that I went to the dictionary for mine, but I have tried to give this subject a little thought and it occurred to me, after reviewing the entire subject of occupational diseases, that we were still in a rather chaotic state. Just think of the predicament in which a Large industrial concern must find itself, and I have noticed there are several people here affiliated with large concerns', large industrial concerns, mind you, that may have thirteen, fifteen, as many as one hundred plants scattered over these United States. In some of their plants they don't have to do anything at all about the problem, for instance, if they happen to be located in Arkansas or Mississippi, where there isn't even an accident law. Arkansas passed one, but it has to come up for referendum. In Michigan they have a schedule of 31 different types of occupational diseases. Again, you might be in Ohio, where your last Legis lature has practically created a condition which calls for an all-coverage law. Today you have only twenty-three states that compensate for occupational diseases, thirteen of which have a so-called scheduled law, varying from one for silicosis in West Virginia to thirty-one in Michigan, and ten have the all-coverage law such as in Connecticut and Ohio, and even in these, mmd you, you don't have any unanimity in definition, I suppose, because we shall have a lot to learn about the question of the nature and effect of occupational diseases. Just for example, let us look at some of these definitions. I want to go into that a little bit, if you will allow me, for the simple reason that I think we ought to understand, after all, so you will know what I am talking about and I will know what I am talking about. In Connecticut they say the word "occupational disease" shall mean a disease peculiar to the occupation m which the employee was engaged and due to causes in excess of the ordinary hazards of employment as such. It is not the intent to compensate for all types of ills. I think the legis latures have attempted to compensate for only these conditions that arise cut of the occupation. In Illinois you have practically the same wording. They said the word occupational disease" means a disease arising out of and in the course of employment, and they also, in addition, say ordinary diseases of life to which the general public is exposed outside of the em ployment shall not be compensable, except where such diseases follow as an incident of an occupational disease, as defined in this section I 577 So you see you have all types of ideas of definitions and practically no two are alike. If you were a personnel manager or a medical director or a safety engineer of a concern operating in several states, you would have to place this program more or less in each, because, as I have indicated, it isnt my intent to discuss compensation laws or discuss the relative merits of general coverage versus scheduled coverage. That isn't the point I am trying to make at all. We have authorities on this subject and I think some of them spoke on the subject this morning at some of the sessions. All I want to do is simply start out and tell you that we ought to de fine our subject, and secondly that I think--perhaps this will cause a lot of disagreement--perhaps we have over-emphasized the whole question of occupational disease, to the detriment of a far more important problem, and that is the health of the worker in general. __ Occupational disease is really only a part of the story. Accident control is only a portion of the whole problem of industrial hygiene. I am very grateful to you, Dr. McCurdy, when you started out in your opening remarks this afternoon and said perhaps we have been using the wrong terminology, and perhaps we should do what the public health people do and that is, consider the entire problem of adult health among workers. Therefore I would like, as a prerogative of a speaker, to more or less change my sub ject, instead of confining myself to the control of occupational disease haz ards, I would like to discuss the control of health hazards among workers. At any rate you are here, and those of you who don't want to hear me discuss this whole broad subject, I suppose, have the privilege to walk out on me. I am serving a warning now that I am not confining myself to the subject of occupational disease control alone, but I shall cover it. I don't want to minimize it at all. It is very important, as you will see, but I would like also to take this opportunity to call your attention to some of these other problems. Before I begin to discuss control, I would like to amplify a little bit what Dr. Smith has said and discuss some of the problems we have in this country. I am not confining myself to Ohio. I necessarily will try to dis cuss what information I have of the country as a whole. First, before we discuss control measures, I would like to discuss first the problems confronting us today. I should judge those problems that are common to a nation are probably just as prevalent in Ohio, to some extent anyway. Therefore I would like to have the lights turned out. Let us begin to talk from the slides. Before we do that, however, I would like to say this, that our aim in indus trial hygiene should be the protection and the improvement of the health of workers. You can take that as a definition if you like, although we don't need to be dogmatic about it. That is really our aim as industrial hygienists, plant engineers, safety engineers. Wherever we may happen to be, our first interest should be the improvement of the health of the worker. I am rehiinded of a slogan you have up here, "Safety is Better Than Compensation." That is just what I mean. May I have the first slide, please ? First I would like to indicate what we mean by industrial population in this country. As a rule when you speak of industry, it connotes manufacturing, mechanical or mining. Well, we have more persons working in some other pursuit than we have in manufacturing and mining alone. In these industries you have health hazards too. There are about fourteen million men in manu- 578 factoring and ten million in agriculture. If you think there aren't any prob lems in agriculture, you are mistaken. We have just completed a study, which cost something like one hundred and fifty thousand dollars, on the health of orchardists who use lime arsenic for sprays. We found a good deal of lead poisoning and arsenic poisoning among some workers, depending on years of exposure and dosage they were getting. So we have their problems. We have them in connection with cricket control and in connection with some of the other insects. Then of course we have accident hazards. You know about those, probably as well as anyone. Then we have about six million people in trade and we have four or five million in domestic and personal services, transportation, communication, four mil lion, mining, one million. Altogether we have close to fifty million persons. This is based on the 1936 Bureau of Census reports. I think we are not so very far off today. We have something like fifty million people in this country. We are directly concerned in Ohio with, I believe, two and a half million. We have on those, dependent upon them for a living, practically the entire nation. Really industrial hygiene should be of great concern to those who are en trusted with, let us say, the welfare of this nation and health of this nation. That gives you some idea of the magnitude of the problem, from the stand point of numbers. Now what about the magnitude and scope of the problem, from the stand point of health ? May I have the next slide, please ? I am going to show you one slide on accidents and that I am showing simply to indicate, according to the best information we have, only four diseases are in excess of accidents in their rate for both sexes. However, when you come to males, there, you have the majority. The majority of males are employed in industry. Only heart dis ease exceeds accidents in the number of deaths per hundred thousand. In fe males the accidents are 'way down the list, as you would expect, so accidents are still a problem in this country. We have made great strides. There is no question about it. You gentlemen have contributed to the advances that have been made in the control of accidents, but we still had, last year I believe, seventeen thousand occupational deaths in this country. I believe the last sta tistics give about the same figure. I think it is sixteen thousand five hundred. It is true that in 1913, when the accident movement came into being, we had something like thirty-five thousand deaths. If we had maintained that same level, we would have lost 300,000 more lives than we have, in spite of the fact we have more people working than we did in 1913. We still have a large number, at that. We still haven't gotten down to what is known as the irreducible minimum in accidents. We know that from special studies made by the Bureau of Labor Statistics in the steel industry, that contrasted acci dent frequency and severity in compliance with good practice as against the average. The rate for good practice plants was 8.1 in terms of man hours of exposure as contrasted to 18.1 in those plants that didn't have the best engi neering and other pratices, so you see we still have got a long way to go. So much for accidents. How about occupational diseases ? If I may have the next slide, you will see from statistics of Ohio, which I got from reports of the Ohio Division of Safety and Hygiene, from 1928 to 1937 you had close to 13,000 compensable occupational diseases reported in this period. You can see of course that the bulk of them were dermatitis, skin diseases, probably fifty to seventy per cent. Then you get some idea of the number of lead poisoning cases and how lead poisoning is still about the same as in 1937. As far as the report is concerned, mind you, this may only represent ten or fifteen per cent of all cases that may have occurred. I don't know. I am con- 579 fining myself to these statistics. You still have iq*s diseases reported for lead poisoning against 180 ta 192? N k, . , Ccupatlonal OU can get it at the library probably, unless you want to spend ten dollar So we have accidents and we have occupational diseases. Now, what else we know about health problems of our workers ? Before we begin discussing sahds o f n h v s ic ir d * f e" mi"ulcs on this- W= h TM from hundreds of thou of physical examinations, made on workers (and we have made manv of them ourselves in the course of our investigations in industry over aT y e a r period) that those who work in heavy jobs, unskilled and semi-skilled have a class We'knTw f ? ^ thSe' Iet US Say' of the ^ite-collared ttuuttee tthwat oorn0e h; un"d,red thou'sanTd wtohrekeSrtusdwi6eSremaedxeambiynethde bliyfesoemxteennsiinone itnhsotui- nenol ^ 7 phyS1Cians over the country. If you divide the results on those more defertT ^ t H h yU ^ Peple in the laborinS classes have tions than do Tbo f two items, hypertension and eye-condi tions, than do the people who work on farms or, let us say, at clinical lobs or certain professional jobs. We know that to be true, from many studies that have been made. Where the job has something to with it, tL t has to b! tins condition, and I thinkv hweefaacrte iaslnlhienrteeryeosutedw in ma ygrsoiduep. oIf think you* a*re concerned. After all, you are interested in having a healthy worker, one who acrid + ase Spollage and cut down production, one who is not going to be accident prone and one who is not going to be suffering from occupational sseeaslei. rSo^ wTe a86rehclSonpcheyrSn1eCdalwCitohadtihtiaotnpmroabylePmr.edispose him to occupational di As Dr. Hayhurst brought out and as I shall bring out, your health exami nation is a very important step in the control of that situation. In other words them That tlT l PhySiCal Conditions are> before we can correct em. That is the next step m the correction of these various difficulties I raisin?thelev^r 'f T 58" 1? eXa" ple " the Ya`Ue of physical ammatiou in wW ? 7 CTS efflciency ta health. Mister in Chicago reported here he examined m about 1935 several thousand men and found a certain number of defects I have forgotten the number, but I believe it was 42 p ^ cent or thereabouts, that had certain physical defects. Those men that stayed on the job most of them went to their , private physicians and had some of their defects corrected, hernias patched up, eyes corrected, glasses given, teeth repaired and so on. Three years later Dr. Misler examined, I think, 508 of those older men and he found practically all of them had had their physical defects corrected. There were only, I think, three that they couldn't keep on the same jo because of old age, and the disease having progressed so far that they had to put them on some other work. So much for that part of it. (Let us have the next slide, please.) 580 We will now come to mortality rates. What do we know about occuoa ten states thart tthfe' "skTMilledJ wUorTkerThas the Ehigsthuedsyt mortabliytyWfrhoimtneayllncasoumsees ^ h*tre *? t0 tW hundred or a hundred and seventy-five per cent in excess of all the other occupations. Only when you come down to suicides do you have anything leading the list Of course, you can see why. Probably the depression had something to do with a good many of them jumping out of their windows because their stock went down or something else of that type. But practically or all these thseases of the heart, tuberculosis, respiratory system, cancer, nephritis and so on, skilled and semi-skilled workers have high occupational death rates. Ih is has to do with sickness. We have been collecting sickness statistics for many years from the public health service, from some of you gentlemen here. We analyze them and we find, after many years of data of this sort, the leading cause of illness is the respiratory disease. It is something like 42 per cent of all illnesses, of all lost time. Next is digestive disturbances at 13.12 and internal causes at 9.9. Those three diseases alone account for more than two-thirds of all the lost time due to sickness. (The next slide, please.) That gives you some idea of the accident record in this country, the occupational disease story, physical condition of men, mortality among industrial workers, morbidity or sickness among indus trial workers. What is the relative importance of all these things ? From limited studies that we have, such as this one here, the American College of Surgeons, such as our studies with the Boston Edison and some other public utilities, it appears for every day a man loses due to an accident or occupational disease, he loses fifteen days due to sickness. Dr. Newquist, in his study, put the amount of time lost at .59 due to indus trial injuries and non-industrial injuries at 8.85, a ratio of 15 to 1. Our study for the Boston Edison Company over a 20-year period shows a ratio of 14 to 1 Now to me this is very striking information. To me the implication is that if we are going to do a real job in industry in the control of health hazards among workers, we not only have to consider accidents, we not only have to consider occupational diseases, but we have to consider the general health status of the worker. Mind you, don't misunderstand me. I don't mean we have to compensate him when he has nephritis, which may be due to other external causes. We don't have to compensate him every time he has a cold. That isn't the question to us men who are interested in preventing whatever the man is suffering from. We ought to make some attempt to prevent that, prevent that loss of time, because it costs us money. How much money does it cost us.? As I told you earlier, we had in 1938, 17,000 occupational deaths, 75,000 permanent disabilities, 1,400,000 tempor ary disabilities. Medical and hospital services were estimated at a cost of about seventy-five million dollars in that one year and a quarter of a billion dollars for compensation. I think New York State alone pays out twentyfive million or so a year for compensation. Now if you add to that some of your costs of minor injuries, your many indirect costs, loss of wages, spoilage and decrease in efficiency and produc tion and so on, you had a staggering total. About five billion dollars a year it is costing the nation for this sort of thing. Now when you begin to talk in terms of billions of dollars, you are talking in terms of the national debt. Why don't we try to save some money by investing it in good preventative programs? Why don't we spend it as an investment that will bring re turns, as I will indicate later. 581 *he " orkers ad problem of the health of thU e heaIth of the workers plays an imnorfcanf ^P.e 1 have convinced the disability, of dependency and p e r h a n s T f V " " the causatiTM of to do about it? What can a P baps secnty. What are we iroW is what you have asked me to talk^bout! 6 Cntr<)1 f heaIth hazards? That ground^ t ^ o p ^ o r t ^ t y ` ^ . f " 6, 40 give y" back- with what you are doing. Industry i h W d ' f COUrse you are familiar of these conditions. We are asked7 to g d deaI in the Prevention lems. Therefore I am not going to go nt i n t W y n these P*>^ is doing. Neither am I goL r tn Jf* ! harangue about what industry f industry nor the reasons why they are ' any left'handed compliments to the point. That is incidental In d ,ng these thins- That is beside f t f industriaI already told you the general aims are hygiene, I have the workers. That can be done if vmi 1 Pr0t.eCt and lmProve the health of first is medical and surgical rara to a Z o f f f three princiPle^ The and earning capacity following industrial"15118^ Pr mpt restoration to health is the prevention of disease or T n tfv r disease- The second proper control over industrial e n ^ L r a t ^ t h ^ ^ *StabIishment employees about healthful livine- ' a ' 6 tbird 1S the education of ment. Those are threfcardtaaf arise-T "I V "* f " " tafastrkI " TM as he is injured, p r e v e n t i n g f the " " ** aeon and then educating the employee as tn y f controlling the environment What are some of Z f u Z l J T ' " 1 as health. you can achieve these things? Well' I 7 ! "5 the ways in which am going to read them off e a whole list of them here. I Fourth, p r L p t\"n V e a ^ measures- i : s r h ying to s; u " " from needing attention, cooperating with f ^ J ^ d u a ls with conditions practical way to remedy the condition. ^ ^ hlS physician in every Eighth, 'impartial tyP6S f disability' trial Health of the S '^ e l^ L T o " ^ ^ health h a z a l * , ' " t " `n ^ C ntr<>1 f industrial a viewpoint just like they devellt / mdustry can d `o sort of develop trol. They say it is cheaper^^ 2 , f VleWPint concOTtaK accident con The same thing applies to health ha^rds control them than it is to nav fnr ti, !? > *" pay for " dnd 1S cheaper. to begin thinking about it and wantimr t f nCe J ? u get that dewpoint and going to get somewhere L r in tn ' abUt * ' then you are value of this sort o T v ^ n t th ^ " COnVhlCed f the thing, are not going to get far ' So vo 7^, a.re trying to accept some- ment. g to get far. So your first job is to convince the manage- 582 of 0Utli,led * you what a medicaI control program consists b i , r ,m f ssIUldre,s iabrout gernagmine*er?ing* *co*ntrol.1 wIMhidopieikeyo*u will bear in. i msind specific `details1T ' " 6- f r mC' " 1116 time alltled> t0 80 into various d esS nZ w " T * TM * I 't go into a discussion of hood tiontae and ? can 1 int<> a discussion of general ventilation, air condi- n- T w ^ l Can d' in the time Hotted to me is to hit slide pfease?) 18 1 PrP0Se to d* <May 1 have the TMxt a TM ! WS ne f .the firSt principles or one of the first things that I think iif ?it is ta hhar18mffuil agen6t, wisithdothIehacovnetrtoo1 uosfe htehaaltthagheanzta.rds should think of, TM ,, 3 irS\ ^ P ^ r o u s Poisoning was eliminated by using a harmless com pound instead of phosphorous compound. Here are some results of a study b lastin g m f 3i0, f PrbabIy SOme of your Plants> ^ connection with sand sting, a study made m cooperation with the National Safety Council You can see here exposure to workers, in sandblast rooms, using sand in con rast with steel. When you use sand, the amount of dust in the room itself is around a billion particles per cubic foot, and if you bear in mind, five to ten million is as much silica dust as one should tolerate, you can see ow excessive that is. No one would want anyone to work in this. That which is associated with silicosis is 42 to 98 per cent sand. On the other hand, when you use steel, the dust count is down 155 and counts only about o per cent, that comes off, adherent sand, from the casting. These are facts you can't sweep aside. By using steel abrasives instead 0...Sand' where you can, you decrease your dust concentration, decrease your si ica exposure, and you don't place as big a burden on your respirators and your protective devices. You still need your helmet, of course. (The next slide, please.) That is an example of substitution. We are not very fortunate in re sorting to substitutions. We can't always use it, but bear in mind that no matter what the hazard is it can be controlled somehow or other. There is some way of doing a job safely, no matter what the job happens to be. We are producing lead safely today without any lead poisoning. You all know what happened back in 1924 and 1925. Here is an example of isolation against sandblast. We show the ideal sandblast tables and cabinets. Here you can see a well enclosed sandblasting operation properly designed and maintained. I hat is important to get your dust concentration lowered. These figures ; f ei . inIdiCatmf ) I .don't have to read to yu- They are obvious. That is the, third principle in connection with dust, wet methods. (May I have the next slide, please.) . You will see a contrast between drilling dry or loading dry and drilling and ioadmg wet. This happened to be a rock drilling job in some mines we studied several years ago (indicating). You can see a decrease in dust con centration, silica dust. Even this is too high. With certain other types of dust, coal, anthracite coal, soft coal and some of your other dusts, this would be ample protection. So you can see what you can do with wet methods. I would like to show you pictures of wet methods. I would like to show you three slides. Here is a driller in a mine. This happened to be taken in South Africa, drilling dry. You can't see the driller, but he is there nevertheless. There is so much dust there. 583 T, I 1! ! nCXt picture shows yur same crew. Here is your darkey over here pleasl* 18 Cmmg m thrUgh the Part f the driH St6eL (The next slide> This slide shows the same operation with water coming out from ex- I Z T T Z T * frm th\ Utside- There is water pipe there (indicat- mg) That shows you what you can do with wet methods underground. ow perhaps the fourth principle--in general there are about five meth ods of control by engineering methods--perhaps the most applicable and universal type of control is that of exhaust ventilation, removing the sub stance at its source just as fast as it is being produced. Here you see a granite cutter using a tool with no control and you can see how much dust his nose is surrounded by. He is getting several hundred million dust particles. The next slide shows a control system. These are y courtesy of the Division of Safety and Hygiene of Massachusetts. This is for the same type of job. Flexible hoods, branch pipes, hoods, flexible pipes, main lines, certain amount of air moving through those hoods in a minute. I will show how much you can remove dust concentration because the air is safe. The next slide shows a granite cutter with a different type of tool. He is working outdoors and still surrounded with a great amount of dust. The same operation with an exhaust hood. It is not in place, but that is the type of hood you can use and remove dust as fast as it is being formed. This indicates another method of controlling dust in drilling operations. Whether outdoors or quarry excavation or building construction or what ever it may be, it shows you a so-called dust trap. That is the dust trap, this part over here (indicating). ' This is drill steel here (indicating). This is the exhaust hood (indicat ing). You can't see any dust at all. (The next slide, please.) That shows a picture of a dust controlling system in use. Here is where your dust is removed (indicating). Here is your fan (indicating). You are not; re-circulating dust, taking it away from one place and putting it someplace else. This shows one of the drilling operations, vertical drill ing (indicating). The next one is a job with a dust trap in place. They work quite well. You can keep the dust concentration on that job materially down to about five, million particles per cubic foot of air. This gives you some idea of the minimum air velocity which is required to give us dust. We have more data than that. This is all we can put on a slide. On granite cutting such as I showed you on that slide, 200 feet at the point of origin or 1500 feet at the hood will keep the concentration down to a safe level, determined by dust sampling analyses. 400 feet in quarry and mining, 600 feet on hori zontal drilling, 200 cubic feet on vertical drilling, that is the amount of air necessary to keep the concentration down to a safe level, and so on right through. I am not going to take time to discuss. That data is available. Now we come to respiratory protective devices. I hope every man, every company selling respirators, exhibiting them down here, will recognize theirs. We don't want to be partial. We attempted to show as many as we could that were approved by the United States Bureau of Mines. I think everyone is there. If we left you out, it is not because we meant to. We are not plugging for any one company. This will give you gentlemen some idea of the various types of respira tors now in use. If all these other methods I have indicated to you have 584 failed, perhaps you should try to resort . and protect the man against the material b v ^ T " ^ protecti* deTM<* necessary. That shouldnT be the first lino 7 f -USe of resPirators, when should use respiratory protective deviTM defense\ 1 don't think you do the job better with exhaust ventilation or si w - ? ! - What ^ is' if you can are some jobs of sandblasting, for exam e * ^ encIosure- There respirator at the present time Within S o i f / TM cant do without a gmeering knowledge, no matter how m , , , / hmitatlons of our present en- blasting room, you still have to have a r ^ f U move trou gh your sand test a helmet (indicating). This is a s k e tc T r ^ * o n ^ ^ W We is inhaTn^ ^ of dust that man " At the present me many states I T L u k ^ ' S much for codes dealing with the removal of nov- ' , you ^now' are developing have had c o L in e J s Z T tr ! San" s&t T " S' Alth^ h TM the last few years that our engineeringL ow Jd V t ' * iS nly within state where such codes may be develoDed on a S& baS -been brought to a what data we need. We have plentv of daf m<we SClentlfic basis- We have cupational disease hazards. There may b e a r TM W hW t0 COntro1 oc- time and we will work out a control for that TfTM6 UP' but give us control program, an engineering- enntv i ' ^ you resort to a medical you ought to be able to hit that occunaf PW>f by Sme means or other . Again I wffl say a good slog" ^ ^ 3 , ^ what that job is " We aro 1' 7 j b done safely, no matter are based on scientificfact Don't S Of this sort as a coniroi' control and all the other things T ha ' f ^ ' g.d PraCtiCe standards, that f mm"te- if you put * >U r n & examinations and engineering job is n , done ^ vigilance, constant maintenance of * g TM. will be able to have h e a lZ TM rtmT PT : ^ ^^ " to exercise constant educ!" ion, W ore you oned to you in my op en tg r e m S . " m'"ate `^ e conditions ! men to doBt t l 1 u X i Z T s P uC c H l : , r u Sme f * " - - e trying dustrial hygiene in the United Stat w 6rviCe to foster and promote in hold the burden, or t o r , T a n y W y "S t a f t f ^ its own problems, but it may be aided hv off' i industry has to solve All that an o ffic ii a g t v L d! t r agenc,es when " s" ^ ir e s . tr; &z rr " No "re s ^" e ^ r ^ c T t r it r had industrial hygiene services nrior t l o i ? mdl<'atmg' to yu where you to assist these people in rendering as good a s e r v ic e T " p tb fe Z u " * are advocatmg that these industrial hygiene units all o v T t t courtry Z in collaboration with other dustrial commissions, 585 . ^ ^ r , in needed c o ^ ^ T ^ L ^ e8c o i d i B;Plailt manaffement regarding relativeToxidtyTf SUpervisor as to the z tk r nsed it, and you don't know for t o o d n - ' I v material can be used Safel7and if I t hnw ,> be used without causing ski nd 1" T l * harmfu1' you never 7 ` find Ut whether `h"` b? used saiely- How can it recorT ' ^ ^ L z ^ i r r ^ o t L ^ r ing workers. ^ State 'agseunpceIervsisroergsa-rdpirnivgatiellnpeshs^ aifec"t-. Fifth, provision of necessary laboratory service of both ,, , , . physical nature, and y er ce oi both a clinical and a b"i ? r Y -- -- Health D epart^ntbw a^reb^^nize^^rom 13^ )3^t ^ Y T * 0" th eight. One of those d ivisT on fS T n oJn T s aduit h t i **o Director of that division, is in the audience and i / f Y Dr`f,KlStIer' the a little bit not quite to the noint h. ' 1 f 1 Say somethinS that is understand it, that adult hygiene division" Y e Y Y discussion- As 1 eases, responsible for venereal diseases responsible^ ^ CCUpationaI dis` tuberculosis or any disease that a ner<=' P f r cancer> pneumonia, adu,ts is subject J I th iS t t " ^ 7 ^ 7 S ^ strictly occupational disease control with other general health C&n !ntegraJ;e trol Co T tr hva` " indUStrial hyg`ene disease bt ctn i C b r in T a r o u g h T TMIy " "7 ' Specific t t "Patinal ration venerea, ^ 7 c t t r o f S ^ " and the whole gamut of mental hygiene dental hve-iena Y ! ' cancer Of adnu health, even including nursing services J On the environmental side with their emrineer<? in +>,Q / esbes- SS -- n,tnchnlL hS S r S e S " Y ` ^ In closing I want to say that any money, jrentlemen + w , or that you can get your company to invest in an indict i u Y gram will give you'distinct benefits. You will reap rewards h Y intangible kind and the tangible kind. By the intangible TY Y lie relations, better industrial relations. Those are very important;6 tangible I mean improved health of your workers and Z f efficiency of production and decrease in spoilage- in cash ben fit taxes due to decrease in relief expenditures and lowered comnensag iug costs. I wish I had rime to give you e x a u X a f ie T ^ p lT mVest' YY f the iL Y By ! JE 586 ammtorreemmmtnSdLedbeol?f 1th?e excei?llden"St trsytrigkaiinngedexthamropulgehs athaPtroM*rTM. Floeftcthheirs gsoarvte. aIt pravSt prevention m eetin g la s t faI1 w here he showed hundreds o f t v\ a comPa7 ^ ve<i " * program of industrial health They have decreased their labor turnover from hundreds of per cent down to three or four percent. They have saved all kinds of money. If you want figures of that sort, I will be glad to give them to you (Applause.) Chairman McCurdy: I am sure we are grateful to Mr. Bloomfield for his presentation of a subject that is vital to us all. You may now ask him questions or discuss it with him. Mr. Lisch: You spoke about infection from cutting compounds and nothing was said about the means of eliminating that. Will you speak on that just a minute? , Mr. Bloomfield: Well of course, in a way, that is a medical question that I would like to have one of my medical colleagues answer. In spite of the fact that I have had an honorary degree conferred upon me this after noon by your esteemed Dr. McCurdy, I am an engineer and not a doctor. There are various solutions. One of course is to use cutting compounds or oils that don't have some of these acids in them. For sensitive individuals, you can use protective clothing, gloves, protective ointment and so on. I would prefer however, that someone like Dr. Hayhurst or Dr. Smith or Dr. McCurdy, any one of these gentlemen, answer that question. Dr. Hayhurst: I could say that in 1916 or 1917 Dr. R. P. Albol, who is the medical director of the Fuller Corporations and interests in Cleveland, while he was then with the State Health Department, made a report, a very considerable study on the subject of these oils and cutting compounds and came to the conclusion the best way to control the external environment was to heat those oils, so that idea is nothing new at all. The trouble is that the infections get started in the workmen through cross-connections, if you want to call it that, contact with rags, towels and whatnot from one to an other. About ten years ago Dr. Sietz, of the White Motors in Cleveland, discovered he could control a large part of that sort of spread by the use of towels, giving every man an individual towel, a small towel slightly larger than a napkin, whenever he wanted to use it. There are some, par ticularly those containing sulphur, that have a high percentage of preventa tive elements. In those controls, all said and done, I think there is not one of us that have entered into them, and that an epidemic which is present should be under medical supervision. Mr. Lisch: Several disinfectant companies attempt to sell you liquids which you put in your tank in very small quantities, which are supposed to eliminate any disease transferred. Is such a thing possible in a small quan tity ? Chairman McCurdy: I can't answer that question. Dr. Hayhurst: We found that practically all of the substances that are added, if they are effective, are too strong and will produce dermatitis, whether they produce infection or not. Mr. Bloomfield: I hope the next question is an engineering question. Mr. Henry: Would you give the upper safe limits of concentration of dust in foundries and the silicosis content? Mr. Bloomfield: There have been several studies made in foundries. There is a New York study which was shaped entirely on X-ray interpretation, no 587 o fzjrj::? " studied the health of foundry w o r k e r s r/ ^ Service itself hasn>t sand blasting- and so on. Thlse standardiv ^ T S ^ referen<* to silica. Most of them I think have a low l i m i o / f Wlth the amount of particles per cubic foot for certain l l Z of aroand ten r fifteen million tolerate some higher amount. It depends onthe act T * Perations the^ foundry dust. It is difficult to saVPin n l i f the actual composition of that exceed a certain limit and some Z Flr I T * Perations' won't the same all over. We know from our Hi* , *a"?e' gramte ls Pretty much ten million particles is ^ soon as you get over that ,, y . 6 shuId mhale per cubic foot. As to say ten or fifteen or twentv miTT Smg *, get in trouble. It is difficult would suggest that you consult the New^Y^k ^ beCaUSe conditions vary. I report, which are the only ones I know report, which have attemDted tA c f + then* by writing1 tt m,`hr for r - , Does that Mr. Bloomfield" 11Y es^ N tw Y oik They have set them no for r l k I n , o T a n T 0* ^ Nrth Carolina I " d Pssibly the Massachusetts X i ; onf you hke- 1 ^ m r e .Bet pp in those states. f tempte<i to "P standards, now they are doing one on foundries `" "" Mrtam ther excavations but ; m olrn fiefd ? r t a ili " With; h6(S" in 3teel f t foundries. It is a rathel eomprehensive^eport ^ A s ^ Z i ^ ^ f = t L T ^ r a dtea r tgen ^ StUdi- X- y a n T d i/n C n n L X ther^an^l^^es^^U ble^'concC Tninglheni0" haV6 bee" " you an exact reference*8 I ^ O W o ^ / S S Z k 0ffhand ^ gentlemen of the Industrial Commission for t W ? tlef. or some of the write the United States Public Health Service T h e re 'ta l"^ ' r y" ^ studies made, but I can tell von r,Vfc+ have been comparative them. For instance, We have m a d e f c o m p a r t study T t i e T - "T and we get consistent results until we get into Z J h i kommeter, then we get inconsistent results. From o tW l h gh concentration and in the past--we have gone into n o , comparisons we have made very thoroughly--but we can't Z & dU.St &nd Sand business very, and Lomb. If you get into verv small C0IJa?stent results with Bausch two is enormous. If you get down t T T partlcles ,tbe ratio between the On various types of dust we haven't h arSe.r part;ic^es' the ratio drops, have vast a m o u n ts o f^ We although I think it isn't awkward at all I used h ' m v L Z 7 awkward' teen years. It has proved to be a v i a b l e L d x T h e ? * T T " ' situation in respect to dust. d f th hazards of the Mr. Henry: How do you determine your amount of silica' samples fr o T fv a c J L ' c t l ^ M c V " T 7 * ' ^ t a t * * which there is as m Th t " as w can g it 1"! " " t " settled dust on rafters and beams and bring I t I t o the lah ? separate the various sited fractions of -" "3 to 588 and S e ? m fcTM s" Now we" kTMUd yU " n't -sure, up to five t 5S S otter minerals^ such " y we do it. ' i t ia a'job a t J * -unT e^ " fracti" " S S T ^ hf'l t o T T hS l th r - -- Mr! - c e , ten microns? nettle because of gravity. You will ref a,, Mr% d,rection- . I" the air they epecificX vM TM in S ^ O f c v T & r la r io ts a, i o ; . minute, or som ethln gT k eT at 7 '* Settle at th' fate of, I think hi"f o f r ewhere ia thc "^ x X f leusp d,on t h r ist taf the' PtobaMythe reason y o u l ^ Z 'Z ^ ^ '- " Mi:SsJSr t f i : a t e ^ Mr. Henry: I am " h " ^ tCrmil>aI P l a g e s , that have been asked me. Plnts out more on less from questions p r e c a t " `th: ' " ` ^ * t your opiuion is of the eieetrostatie D r 'S T flf : F orw ha` Purpose? Mr! W e ^ h f f" f tmr. of fumes, because the a p p a r a t u s 'f n lf ' preciP itat r only for the collec- such as lead fumes, m a g n e s ll f l s or T 7 7 i<>r * matter samples chemically. In collecting the dust T T " wh = we analyte' tests by the impinger apparatus It i s , J , , to run comparative dust you are fortunate enough to be able f pretty S001 instrument to use If hear a paper by Mr. Cafe on t t t verj sfbjecT * ^ tWa been P ofession, that examinations of everv o n f ng whether or not he had come ta vanous states, with many employers who h examination without first being obliged to them, from this small, little, iL g n lfifa,,t J you can point that out to them, J,,u ^ r e c They just say, "Oh yes, we will ,,ft e a ^ i f f - * that has ' esp.clalIy thse in the medical w ldeal. `W"- I was wendTM ^ vanou'" surveys in all the " stltute(J the general health T Wha` Was Orth to Th `" R a t i o n . After etc ,," a Per'dic " -nations. r i f . 1*'" and that ason usual. " s ^ ^ 7 disease thmg that starts the ball rolling" Mr. Bloomfield*: Dt ohofl; . P Un'eSS `here is "" Wnificant occupational To begin with, we have established^indu.trM V U S6VeraI interesting things S T ^ ^ 30 Stat6S- 1 haVe cently S S p t e " Hke 1 shTMed that type on 17,000 plants in 15 states ? * d a" anaIysis of surveys of - 3 One of the things we fo u n f out ^ 7 S T " d a haIf ^ dustnes are now doing in the practice of fad, , TM f? rmation m what fa- something like this: Only about 15 plr ceL of t , hf Bfiene prevention is per cent of the employees have full-time 589 medical services, only 29 per cent have full-time safety practices, only about one third have full-time.nursing services, and so on down the list. The little plant is the one that can't have them. That is why we are trying to estab lish industrial hygiene services in official agencies to impartially give them that service and help them control these conditions. Now you are quite right in saying that the opening wedge is through occupational disease control. For goodness' sakes, don't get the idea, in my talk this afternoon, that I was trying to minimize occupational disease con trol, not at all. We use that as a means of getting into a plant and selling them later on this whole program of adult hygiene, which is so important. You are quite right there, that the only way you can get in is when they have something wrong, such as silicosis, because the average industrialist and the average worker still thinks industrial hygiene means accidents alone. Mr. Phillip Carey: Can you tell me whether any of these companies also find it advantageous to try to carry out some constructive program in after working hours, to keep these people, say, out in the open, or something that would tend to help the conditions? Mr. Bloomfield: Let me give you some figures. I didn't want to take the time, but these are just two examples that might answer your question. One is in connection with a company-that had a lead poisoning accident in . a storage battery plant. These figures haven't been proved because, as I was telling you, it is all new. They used to pay three hundred to a thousand dollars per case compensation for lead poisoning. In 1920 they had twenty cases per hundred in their plant. In other words, it Cost them six thousand to twenty thousand dollars at that time for compensation for lead poisoning. They put in an industrial hygiene program, a complete program, both inside and outside the home, outside the work place, and their rate dropped down in 1929 to four cases per hundred. From 1934 on they haven't had a single case because of good engineering and medical control programs. Now then, here is this example that was reported by Mr. Fletcher,. I told you about. You will find it described in Occupational Hazards. I will cite you these figures, because it answers your question specifically. The firm employed 2500 people and had a labor turnover of 250 per cent a year. In other words, in order to maintain that 2500, they had to hire 6,250 men a year. The cost for such replacement was estimated at $250,000. Today this cost would be five times as great. At that time, even as far back as 1920, it cost a great deal. Today it would be about four or five times as high. It costs more to train a man today than it did in those days. By a good pro gram of employee health, the labor turnover was reduced in 1926 to 40 per cent and today it stands at 3.6 per cent. Among the conditions that were improved were the construction of a good water supply, better schools and improved housing, including a control of the working environment in the factory itself. Later physical examinations, both pre-employment and periodic were instituted, thus correcting any physical defects. In addition proper milk sanitation was also initiated. Of course that is possible where you have a one-industry town. It is also possible to a certain extent, even if it isn't a one-industry town. That is one of the things your official agencies can help you on, for example, your health department. Let them come in there and give you a program of immunization. Every once in a while smallpox will break out in a plant. I was citing a case at lunch today where an epidemic of smallpox broke out in a shoe factory. They im munized every worker there. Or let them give you something in connection 590 with the degenerative diseases, nephritis, heart, pneumonia, syphilis. Of course syphilis is not an occupational disease, except for certain types of occupations, that I don't need to go into. You would be surprised how many doctors and nurses report syphilis as a result of occupation. You see I wasn't thinking of the same thing you were. After all, it is very important both to industry and labor. As to the syphilis rating in industry, it runs, rrom our studies, between three and four per cent. Because that man is more accident-prone, more prone to all kinds of conditions, your health de partment is in a position to give you a good program of syhpilis control in industry. Principles have been enunciated whereby a man should not be dis charged, unless he is a menace to his fellow-worker. Under a physician's care, he can be made non-infective, after a certain number of treatments. If you have a very constructive policy on that point, you can do something about ^syphilis among your workers. By improving the home environment, furnishing swimming pools, recreation, all those things will help to decrease your loss of time and improve the health of the worker in industry. Do those things, because it is darn good business to do them. Let us not kid ourselves about that. Chairman McCurdy: I certainly think we have enjoyed our afternoon, and you have gotten a great deal of good knowledge from these two talks! The Industrial Commission is very grateful to Dr. Smith and Mr. Bloomfield for their illuminating discussions, and I am sure we are grateful to them for coming. I think: it is time now that we adjourn. The Occupational Disease Hazards Section of the Eleventh All Ohio Safety Congress then adjourned.