Document bap9EKDVKBe4yVK8ykYkDjZXo

FILE NAME: Ford (FD) DATE: 1961 DOC#: FD256 DOCUMENT DESCRIPTION: Proceedings of the 13th Congress on Occupational Health with Donor List Proceedings THIRTEENTH INTERNATIONAL CONGRESS ON OCCUPATIONAL HEALTH LIST OF DONORS 1003 The following corporations, governmental agencies, labor unions, professional societies, and individuals contributed to the financial support of the Congress: AFL/CIO The Alcoa Foundation AMF Foundation Addressograph-Multigraph Corporation Allegheny Ludlum Steel Corporation Allis-Chalmers Manufacturing Company America Fore Loyalty Group American Brake Shoe Company American Can Company American Cast Iron Pipe Company American Cyanamid Company American Industrial Hygiene Association (Northern California Section) American Medical Association American Metal Climax Foundation, Inc. American Mutual Insurance Alliance American President Lines Ltd. American Telephone and Telegraph Company American Viscose Corporation Armco Steel Corporation Armour and Company Atlantic Refining Company J. T. Baker Chemical Company Bausch and Lomb Optical Company Baxter Laboratories, Inc. Bayuk Cigars, Inc. Bethlehem Steel Company Boeing Airplane Company Bristol-Myers Company Budd Company Burlington Industries, Inc. Burroughs Wellcome and Company California Texas Oil Corporation Campbell Soup Company The Carrier Foundation, Inc. Carson, Pirie, Scott and Company Caterpillar Tractor Company Celanese Corporation of America Champion Paper and Fibre Company Chance Vought Aircraft, Inc. Chase Manhattan Bank The Chemstrand Corporation Chesapeake Corporation of Virginia Chrysler Corporation Cities Service Company Clevite Corporation Colgate-Palmolive Company Columbian Carbon Company Consolidated Edison Company of New York, Inc. Continental Can Company, Inc. Continental Oil Company Corn Products Refining Company Corning Glass Works Crouse-Hinds Company Crown Zellerbach Foundation Cummins Engine Company Curtis Publishing Company Deere and Company Detroit Edison Company Dodge Manufacturing Corporation Douglas Aircraft Company Dow Chemical Company E. I. Dupont de Nemours and Company Dupont, Mr. Irenee East Ohio Gas Company Eastman Kodak Company Electric Storage Battery Company Endicott Johnson Corporation Equitable Life Assurance Society of U.S. Esso Standard Esso Research and Engineering Ethyl Corporation Fairchild Camera and Instrument Company Fawcett-Dearing Printing Company Federal-Mogul-Bower Bearings, Inc. Federal Paper Board Company, Inc. Federated Department Stores, Inc. Firestone Tire and Rubber Company Food 8c Drug Research Laboratories, Inc. Ford Motor Company The Garret Corporation General American Transportation Company General Aniline and Film Corporation General Dynamics Corporation General Electric Company General Foods Corporation General Mills, Inc. General Motors Corporation General Tire and Rubber Company Globe-Union, Incorporated Goldman, Sachs and Company 1004 list o f donors The B. F. Goodrich Company S TM S ;r0^ ,,andRubberCom^ Gulf Research and Development Company Miles Laboratories, Inc. Mine Safety Appliances Company Monsanto Chemical Company Harnischfeger Corporation Hazleton Laboratories, Inc Helm, Mr. Harold D. H. National Biscuit Company National Dairy Products Corporation National Institutes of Health, Public Health Hercules Powder Company, Inc 2 ? c h " 5 Chemical Hinman, Mr. John H. The Hoover Company Hoffman-La Roche, Incorporated Hope Natural Gas Company Geo. A. Hormel and Company Hughes Aircraft Company Humble Oil and Refining Company Industrial Medical Association Inland Steel Company International Business Machines Corporation International Harvester Company International Minerals and Chemicals Corporation International Resistance Company and w ; i t a r tmem ' ^ National Lead Company New Orleans Public Service, Inc. NN eeww yY0o"rkw LeiTfe%ISnhsuprbaUncIedmCogm&paDnryydock GoI ew Yorfc State Natural Gas Corporation TI h^e NewrkvYSotark,te4TiOmCeIes^ f Indllstrial Medicine The News, New York North American Aviation, Inc. Norton Company Ohio Oil Company Olm Mathieson Chemical Corporation Otis Elevator Company Owens-Corning Owens-Illinois Glass Company International Telephone and Telegraph Corporation Iranian Oil Consortium Pan-American World Airways, Inc. Paramount Pictures Corporation Pennsylvania Railroad Johns-Manville Corporation Johnson and Johnson S. C. Johnson & Son, Inc. Jones & Laughlin Steel Corporation Pepsi-Cola Company Pittsburgh Steel Company Piocter and Gamble Company Provident Life & Accident Insurance Co. Kaiser Industries Corporation Kennecott Copper Corporation Kimberly-Clark Corporation Koppers Company, Incorporated LaSalle Steel Company Legge, R. T,, M.D. LeTourneau-Westinghouse Company Lever Bros. Company Radio Corporation of America Raytheon Company Republic Steel Corporation Revlon Foundation, Incorporated Reynolds Metals Company R. J. Reynolds Tobacco Company Richfield Oil Corporation John A. Roeblings & Sons Corporation Liberty Mutual Insurance Company Life Extension Examiners Eli Lilly and .Company Thomas J. Lipton, Incorporated The Magnavox Company The Mead Corporation Medical Society of the State of New York Meigs, J. W,, M.D. Metropolitan Life Insurance Company Joseph E. Seagram & Sons, Inc. Shell Oil Company Simplex Wire and Cable Company Sinclair Refining Company A. O. Smith Corporation Socony Mobil Oil Company Sonoco Products Company Sperry Gyroscope Company Standard Oil Company (California) Standard Oil Company (Indiana) LIST OF DONORS 1005 Standard Oil Company (New Jersey) and affiliates Standard Oil Company (Ohio) Standard Railway Equipment Company Foundation Standard-Vacuum Oil Company Stauffer Corporation Studebaker Packard Corporation Sugar Beet Products Company Sun Oil Company Sunstrand Corporation Swift and Company Sylvania Electric Products, Inc. Tampax, Incorporated Tennessee Corporation Texas Company Texas Instruments, Inc. Tidewater Oil Company The Michael Todd Estate Trans World Airways The Travelers Union Bag-Camp Paper Company Union Carbide Corporation Union Oil Company of California United Artists Corporation United States Atomic Energy Commission United States Rubber Company United States Steel Corporation United Steel Workers of America Universal Oil Products Company Upjohn Company VAW--International Executive Board Washington Steel Corporation Weirton Steel Company Western Electric Company, Inc. Westinghouse Electric Corporation Wilson, Mr. Charles E. Wilson & Toomer Fertilizer Company Wiremold Company Woodard Research Corporation Wm. Wrigley, Jr. Company Zenith Radio Corporation THIRTEENTH CONGRESS ON July 25-29, i960 Copyright 1961 by the U. S. Executive Committee of the T hirteenth International Congress on Occupational Health ALL RIGHTS RESERVED Library of Congress Catalog Card Num ber: 58-32683 Public Health GIFT DESIGNED BY HARVEY SATENSTE1N MANUFACTURED IN TH E UNITED STATES OF AMERICA BY BOOK CRAFTSMEN ASSOCIATES, INC., NEW YORK /\C !b 3 A / (o l l (pD PuAi <0 HeaLi Hts L ib ra ry EXECUTIVE COMMITTEE Chairman .. .. . L. W a d e, M.D. V ice-C h a irm en .................. L . G r e e n b u r g , M .D . S. E. M il l e r , M .D . Secretary-General . R. E. E c k a r d t , M.D. Treasurer....................... H . E. T eb r o c k , M.D. Executive Secretary . ............ J. W. M u c k e l l E. R. A s t o n , D.D.S. C. U. D ern eh l, M .D . T . E l y , M.D. B. S. Fox J. L a u e r , M.D. H. L. M a g n u so n , M.D. H . B. N a c h t ig a l l , M.D. N . N elso n , P h .D . M. N . N e w q u is t , M.D. L. T . R o b e r t so n , M.D. I. R. T a b e r s h a w , M.D. S. P. W a g n e r , R .N . 340 10 REPORTS OF ORGANIZING COMMITTEES In addition, many others visited points of interest to them either before or after the Congress. When the debris had been cleared away and the hubbub had subsided by Saturday, July 30, the paid registrations figures for the Congress were as shown in the following tabulation. NUMBER OF REGISTRANTS -- BY COUNTRIES Country Afghanistan . . . Algeria ............ Argentina . . . . Australia . . . . Austria .......... Bahrein ........ Belgium ........ Bolivia .......... Brazil ............ British Guiana Canada .......... C h ile .............. Colombia . . . . C u b a .............. Czechoslovakia Denmark . . . . Finland ........ France .......... Germany . . . . Greece .......... I n d ia .............. Indonesia . . . . Iran .............. Ireland .......... Israel ............ Italy .............. Total 1 1 19 3 8 1 2 1 5 2 54 4 9 5 1 4 62 39 36 1 5 1 2 1 2 21 Country Total Japan ...................... Luxembourg .......... Mexico .................... Morocco .................. N e th e r la n d s ............ Netherlands-An tilles Northern Rhodesia Norway .................. Pakistan .................. Peru ........................ Philippines ............ Portugal .................. Romania ............... Spain .................... Sweden ............................................... 29 Switzerland ....................................... 6 Thailand ........................................... 1 Trinidad ........................................... 2 Union of South Africa .................... 9 United Kingdom .............................. 94 United States .....................................1040 Uruguay ........................................... 2 U.S.S.R.................................................. 1 Venezuela ......................................... 7 Yugoslavia ......................................... 4 Total .......................................... 1568 One hundred and ten people paid and registered but were unable, for one reason or another, to attend. Thus the total actually present, exclusive of wives or guests, was 1458. It is the impression of the Organizing Committee that the Congress was an overwhelming success. Certainly the number and quality of the scientific papers delivered was outstanding. Dr. Irving Tabershaw and his whole Program Committee deserve a special note of thanks for the hard work entailed in bringing such an excellent program to the Congress. It is the hope of the Organizing Committee that all those who attended, especially those from foreign lands, not only learned much from their attendance at the Congress but found our land and our people friendly and hospitable. We hope that new friendships were made, new understand ings reached, and that the memories of the Thirteenth International Congress on Occupa tional Health will linger long. Speaking for all members of the Organizing Committee, it was a pleasure and privilege for us to plan the Congress and welcome all who attended. k iv ilu o to 311 ml of the buffer described in Appendix 1, and continue as in Appendix 1. Normally for blood specimens the final washing must' be performed four times, instead of thrice as for urine specimens. APPENDIX 3-- COPROPORPHYRIN ESTIMATION To 5 ml freshly voided urine in a stoppered test tube add 0.2 ml 3 per cent hydrogen peroxide solu tion, 1 ml glacial acetic acid and 3 ml ether. Shake gentlv, release pressure, and place in a lightproof box overnight. Observe the red fluorescence under ultra violet light, and grade the specimen 0-+ + + + by degree of fluorescence. APPENDIX 4-- HEMOGLOBIN DETERMINATION Take 0.05 ml blood, and make up to 9 mis volume with 0.4 per cent ammonium hydroxide. Measure absorption on a colorimeter, using a standard filter (EEL 404), and convert the reading to hemoglobin percentage to the nearest even number from a pre pared calibration graph. APPENDIX 5-- PUNCTATE BASOPHIL COUNTS Make a thin blood smear on a slide of 0.8-1.0 mm thickness, fix for about one minute in methyl alcohol, allow to dry and stain for 30 seconds in Sellars stain (1 g methylene blue, 6 g sodium bicarbonate in 100 ml deionized water). Wash in tap water until the slide is a sea green color. Using a dark ground condenser and an Ehrlicn eyepiece set to a 6-mm square, count the ,punctate cells in ten consecutive fields. (Although in counting, the punctate cells are classified as large, medium, small, very fine, or polychrome, according to the size of the intra cellular structure, this differentiation is for further reference on an individual case, and normally only the total count is given.) Close the eyepiece to a 2-mm square, and count the R.B.C. in this square Repeat both counts five times on different parts of the slide, to give a punctate count of 50 large fields and an R.B.C. count of five small ones. Calculate punctate per 1000 R.B.C. NONOCCUPATIONAL ASBESTOSIS R aimo K iviluoto Roentgen Department of the Central Hospital of Northern Karelia Introduction Pleural reaction is very often observed in asbestosis In the advanced cases of this pneumoconiosis pleural fibrosis has been almost always found, and a clear correlation between pleural changes and the severity of the pulmonary fibrosis has been observed by severa investigators. Observations on the occurrence of pleural calcification in asbestosis have also been made. Reports of pleural calcification as a roentgenologic sign or complication of asbestosis have especially been made by the German authors (1). In addition to advanced cases of asbestosis, special cases have been presentec in which pleural calcification has been the chief finding (2). Except in asbestosis, pleural calcification has a so been observed among workers exposed to talc and mica (3,4) or to various dusts including a short exposure to asbestos (5). . . .. . A The diagnosis of pneumoconiosis is primarily based on occupational exposure to dust. Only very few re ports of pneumoconioses without occupational exposur may be found in the literature (6,7,8). In Northern Karelia, Finland, during few past years interest has been attracted by the high incidence of cases of pleural calcification showing a rather curious and characteristic roentgenologic picture, very similar to that observed in pneumoconioses. T he cases have been mainly found among the residents of a certain area, and in these cases no previous history of adequate pulmonary or pleural disease could be elicited. T he occupations of the patients showed no uniformity, and the main part of the patients had no clinical symptoms of pneu moconiosis. A study of the areal distribution of cases revealed that they were grouped round two anthophyl- lite-asbestos mines. Asbestos constituted the common external factor sought. Even from a solely roent genologic point of view, asbestos dust inhalation had been considered the most probable etiology. Pleural calcification resulting from hemothorax, tuberculosis, or empyema usually occurs unilaterally and is situated on the visceral pleura. In most cases marked pleural thickening and displacement of the intrathoracic organs is observed. The calcification re sulting from dust inhalation usually occurs bilaterally and is most often situated on the parietal pleura. In advanced cases calcium deposits are found in the lateral parts of the chest, basally and mediastinally. The calcium deposits take various forms large con fluent plaques, bizarre figures, or roundish spots. The Roentgenologic and Clinical Picture of Cases Observed in Northern Karelia In the advanced cases calcium deposits are found bilaterally in the central parts of the diaphragm; on chest walls, especially anterolaterally but also dorsally, and on the mediastinal surfaces. In the incipient cases the calcium deposit takes place either on the antero lateral chest wall, more often on the left, or in the central parts of the diaphragm, apparently more often on the right. Pericardial calcification is sometimes ^ The calcium deposits are located on the parietal pleura In a series of 150 cases no interlobar calcium deposits were observed. The parietal location has been demonstrated by diagnostic pneumothorax examina tions, and it has also been noted in some autopsied and surgical cases. Using a tangential roentgen beam, the parietal location of solitary plaques may be observed, these plaques having their bases toward the inner chest wall or toward the diaphragm. In advanced cases the lack of soft tissue mass between the calcium deposit 312 MEDICAL PRACTICES and inner chest wall due to the parietal location is apparent, and diagnostical pneumothorax examination is seldom needed. The majority of cases of pleural calcification de scribed above have been clinically symptomless. In a series of 150 cases the ordinary chest roentgen examina tion by P-A and lateral projections revealed pulmonary fibrosis, corresponding to the anteprimary or primary stage of pulmonary asbestosis in only about 14 per cent. Even the main part of these cases had no sub jective respiratory symptoms. The series mentioned above has been selected solely according to the roentgen diagnosis without reference to other factors. The concentration of the cases around two asbestos mines in Kuusjarvi and its neighboring communes has as yet been the only way to confirm the roentgen diagnosis. The majority of 25 cases living outside this area had previously lived there. According to these facts, any other etiology would be very dif ficult to credit. In very few cases a previous occupa tional exposure to asbestos dust has been observed, which lends slight support to the roentgen diagnosis. The diagnosis has as yet not been confirmed by other methods. In the sputum of 20 cases no asbestos bodies were found, and asbestos fiber in one case. Small amount of anthophyllite asbestos was found in the lung of an autopsied case and in the lung of a cow from the vicinity of the asbestos mine. Discussion The total number of cases of pleural calcification around the two asbestos mines amounts to over 800, as previously reported by the author. This number of cases was found in a mass survey of about 10,000 adult inhabitants and may include cases with previous occu pational exposure to asbestos dust. In the history of the main part of cases examined at the Central Hos pital of Northern Karelia the lack of occupational ex posure has, however, been apparent. Some of the patients have not had any idea how the dust inhalation could have happened; the same cases have presumed that the dust rising on the roads might be responsible. In Northern Karelia the roads (highways) do not have pavement. Without minralogie examinations it is, of course, impossible to decide whether these calcifications are resulting from inhalation of anthophyllite-asbestos dust originating from the asbestos mines or from sur face deposits of other fibrous dusts, such as tremoliteasbestos, which is a very common mineral in Northern Karelia. The first alternative seems to be more prob able. In occupational pneumoconiosis some authors have called attention to the absence of pulmonary fibrosis besides the prominent appearance of the pleural calci fication (2,5); on the other hand, a clear correlation has been observed between the severity of pulmonary fibrosis and pleural calcification (9). In ncnoccupational asbestosis it is apparent that extensive calcification may occur without any roentgenologically detectable pul monary fibrosis. It seems possible that even very small amounts of asbestos fibers may cause pleural calcifica tions. Anthophyllite is more stiff than serpentine asbestos. In animal tests brittle mineral fibers have not caused pulmonary fibrosis (10), but fibrosis has been observed in workers exposed to anthophyllite-asbestos dust (11, 12). Further studies are needed to reveal the part possibly played by asbestos as an tiologie factor in pulmonary fibrosis among residents around the two asbestos mines. Some investigators have pointed out the difficulty of attributing the calcification to inhalation damage in view of its parietal location, few, if any, changes being observed in the lung or the visceral pleura (2,5). It seems possible that the asbestos fibers move with the lung and visceral pleura in relation to the parietal pleura, thus causing capillary hemorrhages on this only, as previously presented by the author. The hemorrhage coagulates and organizes, forming a col lagenous plaque which slowly calcifies. This theory could explain the course of the process resulting from inhalation of small quantities of fibrous mineral dust. T he clinical significance of the pleural calcification seems to be slight, the majority of cases showing no clinical respiratory symptoms. Further investigations on this point are needed. From roentgenologic point of view, this endemic pleural calcification is of some significance. The roent gen diagnosis is in typical cases easy but in some cases difficult. Early pleural changes on the anterolateral chest wall may simulate infiltrations, and large calcified plaques may cause difficulty in interpretation of pul monary changes by hiding infiltrations. T he high kilovoltage technique can hereby be especially recom mended. In chest roentgen examinations of workers of asbestos mines in Northern Karelia and of Outokumpu Copper mines located in the same area attention must be paid to the fact that even extensive bilateral pleural calcification does not have to be a sign of severe pulmonary changes resulting from occupational dust exposure. REFERENCES 1. Jacob, G,, and Bohlig, H.: Die rntgenologischen Komplikationen der Lungenasbestose. Fortschr. Rntgenstr., 83:515, 1955. 2. Muller, H.: ber schwere Formen der Asbestose. Die Staublungenerkrankungen, Band 3, Wissen- schaftl. Forschungsberichte 66. Dietrich Steinkopff Verlag, Darmstadt, 1958. 3. Siegal, W.; Smith, A. R.; and Greenburg, L.: Study of talc miners and millers. Indust. Bull., 22:434, 1943. 4. Smith, A. R.: Pleural calcification resulting from exposure to certain dusts. Am. J. Roentgenol., 67:375, 1952. 5. Fehre, W.: ber doppelseitige Pleuraverkalkungen infolge beruflicher Staubeinwirkungen. Fortschr. Rntgenstr., 85:16, 1956. 6 Eisenbud, M.; Wanta, R. C.; Dustan, C.; Stead man, L. T.; Harris, W. B.; and Wolf, B. S.: Non occupational berylliosis. Am. ]. Indust. Hyg., 31:282, 1949. . 7. Goyal, R. K.: Pneumoconiosis in the non-industrial population of Rajasthan. ]. Indian Med. Ass., 30:79, 1958. 8. Kiviluoto, R.: Pleural calcification as a roent genologic sign of non-occupational endemic antho phyllite-asbestosis. Acta radial., suppl. 194, 1960. 9. Bohlig, H.; Jacob, G.; and Muller, H.: Die Asbes tose der Lungen. Georg Thieme Verlag, Stuttgart, 1960. 10. Vorwald, A. J.; Durkan, T. M.; and Pratt, P. C.: Experimental studies of asbestosis. Arch. Indust. Hyg., 3:1, 1951. 11. Noro, L.: On the histology of asbestosis. Acta Pathol, et microbiol. Scand., 23:53, 1946. 12. Wegelius, C.: Changes in the lungs in 126 cases of asbestosis observed in Finland. Acta radio!., 28:139, 1947. 326 m ed ic a l practices * ^ PULMONARY - DISjEAiSES OsTHER l"A! S T " L eo N o r o , M.D. Finland 0 ,, knowledge rf Al the Twelfth InferMtional Congress Lional Health held He' s " nted a review of the French Professor Marchand p a,,d comprehen- subjecl mentioned in the t ^ j to his presentation, sive bibliography being , t lhis time asked me The Organizing Comm, tee ^ e c t from the last to present a review o ^ ^ lhat lhe compil- several years. It must at . has not been an ing of such a b io g r a p h ic h work has easy task. More than ever before, diseases. The been focused on occupation^ p and interna- problem has been discusse 0,,ly two months tional meetings, the last Swhich has been at ago in Milan. From ' X o s t 316 articles from the my disposal, 1 have fo u n d `^ t , and yet I cannot is already fairly cempiete. I asbestosis; t h o injuries, such as chlor " f 1" atute lung s , or viruses. Often diseases caused by baC^ 'rps\ ricfed, and the interpre- our knowledge is stil y ^ are difficult to make; tations in many in and chronic bronchitis, this is true of allergic diseases a ^ lhe whole, King cancer emphysema and especially of the: ro fessional environmen d Ofessional and pro^ / ^ ,, r e n c e . Vet we to Great Britain's ex- have, with specia apprmDOrtant evidence at our discellent vital statistics, imp 1 ^ occupation and posal of the relationship ^ dlronic bronchitis, certain pulmonary ' '" ' ,, ow fet us study the S " e SS S . d i ,, * d ** recent years dealing w des from this field pub- " io" .I..U begin -i-b S d l n r w c f l shall follow, with some excep Asbestosis vnnwledee concerning tions, Marchand's onset that the coh- T he major part of u r Pr" excellent German book There is reason to stat air we breathe to asbestosis is containe ago I)u. Asbestose der stant industrializing 1S u L0f,uted. Great masses of become more and mor P calied less-developed that appeared som .Mller. This book contains, people, even the peoples of th air through Lungen by Boh' 1| ' ,`1<f heir own cases, references to in addition to 700 of the Uerature in this field cthoeuinrtrmieosv, eamreenttbfarnogmUaf gJRcueaUlluyraalbtooutintdhuesthriuagleceinndteurss-, practically the entir nothing basically new I am here thinking sp Y taking place in India (asboomuet 6th50e ^pa^th^o"g"nteiss cinicinpfororgmnaotsioisn, aisn,dhopwreevveenr-, trialization process right orgag,,s and especially tion of this diseas o cUn;cai symptoms as a,,d China. But man * ^ S e t with hazardous in obtained about the .`* 3 brLchographic observations t o lungs, do not ^ e n v i r o n m e n t . T he most well as roentgenologic and dBn ^ th d r material fluences only m the working common pollutant of our re i air--wtoobrladccwo istmh otkhee from the authors caref between asbestosis and - i s rapidly triumphing U the efforts we of 700 cases. TM e * ^ n s Z fnde ermined. In spite rising standard of living, ? - danger. The auto lung cancer is still of This, "asbestos cancer exists, a the authors give doctors take to warn mankin ^ & 8 pid tempo to their own specification to l n0noccupational mobile industry is F odu" ' g d w ith the growing Does asbestos dust have This is a problem pollute the air of the use 0f fuel for population centers, and p utants enter the air affect as, for examp h ,,,,h the observations of 126 power and heating, more p ^ ^ organisms that has been "lificatio n cases (so-called nonoccupational pleura in the popu- Bacterias, viruses, sPonp ' Thus, the environment o ,,eighborhood cases) that had beesbesws have not disappeared either, l continuously, man, with reference to ungs, ischang is lation living around | iviluoto. According to this fished by the f i n i s h Dr. win prese,,t him- While the great cnc`" y diseases are arising, giving study, the details o w i 800 pleural calcifica- gradually disappearing, n .[ies chronic bron- new importance to 1*<= air "P ca,, cer are already self at this Congress TM ? L minute x-ray investigation chitis, asthma, emphyse t^ a,, tuberculosis in tion cases were found f , rlho never had of farmers, workmen, calcification was usually r .r 'r s ; ^ *"d a ,"1 aloncyateodcciunpaptiaornieatlalexppeousura, . uinsatlasnocemsoistt oocftceunrreind occupational asbes os . wajb Basal and medi- bilaterally on the inner cbe t epnrovbirloenmm, efnotr aelxsaomrpelcep.u.Tr he ddaangger ^of all^ergends.gaffseticvte- astinal calcification observed, a pula few cases. The ing organisms through organs" and the skin medicines, foods, Allergic reactions are i breathing organs an the air impurities. Many ,inuousiY increasing; new ^ ^ m o n allergens, ^ w co,, sider the obvious connection with he chronic occupational ater a long exposure monary fibrosis ^ 8 slowly. These roent- calcification was noticed to PP in' i nificant d.n- genologically n t ^ ^ ^ e ,,bservatUms make U evident ical symptoms. The ^ prevent the air pollm that measures must be the factories and tion of the environmen Dr. Kiviluoto's work diseases of the lung h J observing the signs time. We are gradually' h occupational groups are ^Kc^rvations. of these diseases among ^ " l e length of time. NORO 327 O ther iibrotic lung diseases and "benign pneum o coniosis" caused by silicates, mixed or non-silica dusts (Glass wool, sericite, sillimanite, talc, anthracol, carborundum, cement. Fuller's earth, china and ball clays, graphite, gypsum, kaolin, limestone, marble, mica, Thomas (basic) slag, etc.) I shall pass this group with a brief mention of talcosis and graphite lung, which are still objects of continuous research. W ith great enough exposure, un doubtedly, the dusts of this group have their affect in several cases. What factors effect in different conditions --acute, subacute, chronic; proteins, alcaloids, irritating mechanic factors, toxic, allergic, bacteria, the silica included--are questions that are still waiting to be answered. In addition, for example, the experience with byssinosis is still contradictory in different coun tries. T he interesting research results of Dr. Schilling of England make one think that this disease has not yet disappeared as has been contemporary thought in my own country. the occurrence of fibrosis. However, it is evident that with improved hygiene these types of pulmonary changes will become more and more rare. Infectious and parasitai pneumopathies (Amebiasis, anchylostomosis, anthrax, bilharziosis, brucellosis, hyda- titosis, leptospirosis, ornithosis, tuberculosis, tularaemia, Pneumopathies due to toxic chemicals and metals G ases, F u m es and V a pors (Cl, N 0 2, S 0 2, borans, desmodur, hydrocarbons, oils, kerosene, etc.) M etals (Aluminium, antimon, barium, beryllium, cadmium, chrom, cobalt, fluor, gold, iron, manganese, nickel, osmium, platinum, selenium, sulfur, tungsten, titanium, vanadium, wolfram, zirconium, etc.) etc.) With the diseases of this group there are continuous difficulties in etiologic diagnostics: when is the infec tion to be considered due to work and when not? The question is very important, for example, with tuber culosis. Of course, the relationship between tuberculosis and pneumoconioses is under constant study. The amount of toxic chemicals and metals influenc Lung cancer due to occupation (Arsen, asbestos, ing the lungs is continuously growing. Vanadium, chromates, isopropyl alcohol manufacturing, nickel, chrom, and beryllium have been subjects of research, especially in Sweden and in our host country, the radioactive substances, etc.) The Secretary General of our Congress, Dr. Eckardt, U.S.A. The importance of vanadium is especially in handles the role of working conditions in the occur creasing. It is necessary, however, to bear in mind rence of cancer in his book Industrial Carcinogenesis that with the expanding use of oil heating, the crude most variedly and with good criticism. Yet it is to be oil coming from various parts of the world contains suspected that in industry many other substances also vanadium in very different amounts. T he role of the have a cancerogenetic effect. Our knowledge in this acic sulfur compounds in the ashes is also to be field, however, is still very limited, and although ex remembered. For a detailed study of beryllium, I perimental cancer research has gone far, we still lack would refer you to the proceedings of the conference in practice necessary facts. It is hoped that the well- held at the M.I.T. in 1958 (A.U.A. Arch. Indust. endowed cancel organizations and research institutes Health); a comprehensive list of references on beryl will more than before concern themselves with the lium is contained in a publication on these proceed occupational aspects in the etiology of cancer. ings. We in Europe, to my knowledge, do not have the The results from the investigation by U.S. Public big problems with beryllium which seem to exist in Health Service concerning the hazards of radiations to the U.S.A. . miners are expected with great interest. Whether the It is impossible, in this short presentation, to name cases of Schneeberg and Joachimstal will get successors all the new chemicals with irritant effect on the lungs. in the very widespread uranium mining is a question We industrial physicians have special difficulties at that will presently be answered. tempting to evaluate the aftereffects of acute irritants to the lungs (nitrous fumes, Cl, S02, etc.), especia y Pneumopathies caused by radiation with reference to etiologic differential diagnostics in chronic bronchitis and emphysema. The influence of radiation as the cause of cancer has already been referred to above. Our knowledge about Pneum opathies due to organic dusts, allergens and pneum om ycoses (Actinomycosis, aspergillosis cocci dioidomycosis, cork (suberosis), cotton (byssinosis), drugs, dyes, feathers, flour, grain, gum acacia hair, hay (farmer's lung), histoplasmosis, jute, leather (cannabosis), linen, moniliasis, nocardiosis, sporotrichosis sugar cane (bagassosis),-tobacco (tabaccosis), tropical woods, etc.) . ,. m i T he agricultural population has received increased, attention during the last few years in the investigation of the relationship between work and health. ` Farmer s lung" and other pulmonary diseases found in agricul ture have proved surprisingly common upon closer investigations. Unfortunately, so far there have not been powers to investigate these conditions in the countries where the agricultural population works under the w orst hygienic conditions. W e have n 6 t enough k now l edge about the pulmonary diseases of the workers in the old Asian rice mills, for example. The effect mechanism of most organic dusts is still unclear, and we are also in a difficult field, where bacteriology and allergology will be of much help in the other effects of radiation on the lungs are very small. In connection with therapy, large doses (1000 2000 r.) have been found to cause changes in the lungs in the form of pneumonitis and fibrosis. From East Germany there comes the report of a chronic pneu monia case of a chemist, which led to death; the cause of death being considered the breathing of radioactive dust over a period of 20 years. Conclusion T o our present knowledge, we already have a foun dation for the technical prevention of these diseases. We are as yet in a weaker position as to their medical prevention: we know too little about why one person gets them and one does not. This question requires much research. We have already reached far in the roentgenologic diagnostics of the pulmonary diseases, and there we are making constant progress. We are also aware, however, of the difficulties therein as to several of the disease groups referred to above. Together with the roent genologic examination we must develop other clinical 328 MEDICAL PRACTICES examination methods, especially the physiologic lung function diagnostics. In its most advanced form, we hate to apply it not only in laboratories but, above all, in the field examinations to the examination of population groups exposed to different exposures. Above all, we need also in this field keen interna tional collaboration to solve our common problems and to exchange information so that each of us in his own country could apply in practice the knowledge we already possess to the betterment of our working population. BIBLIOGRAPHY General 1. Pneumoconiosis Abstracts, Vol. Ill, London, 1959. 2. Sance spciale consacrl l'tude des pneumo pathies professionelles (Silicose excepte). Arch, mal. prof., 75:253-354, 1957. 3. Albahary, C.: Les asthmes professionelles: prob lmes poss pour leur rparation. Arch. mal. prof., 15:41,633, 1957. 4. Altshuler, B.; Yarmus, L.; Palmes, E. D.; and Nelson, N.: Aerosol deposition in the human respiratory tract. A.M.A. Arch. Indust. Health, 15:293, 1957. 5. Anders, W.: Soziale Probleme bei allergischen Erkrankungen am Beispiel der Asthma bronchiale, Off. Gesd. dienst, 19:488, 1958. 6. Anderson, W. H., and Schmidt, W. F.: Evaluation of disability in coal miners with chronic pul monary disease. J.A.M.A., 171:145, 1959. 7. Antweiler, H.: Mastzellen und Histamin nach Injection von Staubsuspensionen. Arch. Gewerbepath., 16:607, 1959. 8. Baader, E. W.: Einige neue Probleme der Gewer bepathologie (Lungenemphysem, Kadmium, Des modur). Beih. z. Zbl. Arbeitsmed., Heft 3. Darm stadt, 1956, p. 172. 9. Berkson, J.: The statistical investigation of smok ing and cancer of the lung. Proc. Staff Meet., Mayo Clin., 14:206, 1959. 10. Berlin, Ragnar: Yrkespneumokonioser. Svenska Lkartidningen, 51:3157-31-71, 1956. 11. Bernard-Griffiths, Mm. C.; Champeix, J., and Baldi'ni, A.: Asthme professionel par contact avec des moisissures (a propos de 24 observations). Arch. mal. prof., 75:272, 1957. 12. Bugyi, B.: Beitrge zur Frage der Staubretentions fhigkeit der Lunge. Munkavdelem, 1:49, 1957. 13. Cancella, L. De C.; Baader, E. W.; Choux, J. De; Frouchtman, R.; Lffler, W.; Worth, G.; and Zorn, O.: Industrial diseases of the chest: a com mentary on current problems. Dis. Chest, 12:683, 1957. 14. Carstens, M.: Die asthmatischen Reaktionen der Bergleute. Arch. Gewerbepath., 15'Ab, 1956. 15. Carstens, M.: Zur Frage der Kausalitt von Emphysem und Bronchitis der Bergleute. Arch. Gewerbepath., 15:285, 1957. 16. Dautrebande, L.; Beckmann, H.; and Walken horst, W.: Lung deposition of fine dust particles. A.M.A. Arch. Indust. Health, 16:179, 1957. 17. Davies, C. N.: Deposition of dust in the lungs: a. physical process. In the Symposium on Industrial Pulmonary Diseases, ed. by King and Fletcher. London, 1960, p. 44. 18. D n n e r , L .: Klinisch-rntgenologische Differe ntialdiagnose der Lungenkrankheiten. Stuttgart, 1958, p. 362. 19. Dnner, L.: Emphysem bei Staublungenerkrankungn -- Emphysem als selbstndige Berufs -- krankheit. Zbl. Arb. med., 7:137, 1957. 20. Dnner, L.: Pneumoconiosen oder Staublungener krankungen der Lunge? Kritische Betrachtungen und Vorschlge zu ihrer Entschdigung. Zbl. Arb. med., 9:12, 1959. 21. Ferin, J., and Ulehlova, V.: Ueber die Selbst reinigung der Lunge von Staub und ihre Bestim mung in Tierversuch. Arch. Gewerbepath., 76:630, 1959. 22. Fletcher, C. M.: Disability and mortality from chronic bronchitis in relation to dust exposure. A.M.A. Indust. Health., 75:368, 1958. 23. Fletcher, C. M.: Radiological diagnosis of pneu moconiosis. In the Symposium on Industrial Pul monary Diseases, ed. by King and Fletcher. Lon don, 1960, p. 72. 24. Gernez-Rieux, C.; Balgairies, E.; Fournier, P.; and Voisin, C.: An often unrecognized manifesta tion of pneumoconiosis in miners: aseptic lique faction of pseudotumoral formations. Semaine hop. Paris, 54:1081-1089, 1958 (in French). J.A.M.A., 767:2140, 1958. 25. Gersing, R.: Die frhen Reaktionen der Lunge auf verschiedene Staubarten im vergleichenden Tierversuch. Beitr. Silikoseforsch., 42:1, 1956. 26. Glmme, J., and Swensson, .: Om andra pneumokonioser n silikos. Nord. Med., 58:1973, 1957; Non-silicotic pneumoconiosis. Proc. X II Congr. Indust. Health, 5:165, 1957. 27. Goetz, A., and Tsuneishi, N.: A Bacteriological Irritation Analogue for Aerosols. A.M.A. Arch. Indust. Health, 20:167, 1959. 28. Graubner, E.: Classification System of the Pneu moconiosis. Pracooni lekarstvi, 70:109, 1958. 29. Gronemeyer, W.: Das gewerbliche Asthma. Dtsch. med. Wschr., 55:30, 1958. 30. Gross, Paul: Current concepts of pneumoconiosis. Pathological aspects. J.A.M.A. 772:546, 1960. 31. Gross, Paul: An immunologic approach to the pneumoconioses. A.M.A. Arch. Indust. Health, 27:228, 1959. 32. Gross, Paul, and Smith, K. W.: The topographic distribution of mineral dusts in some pneumoconiotic lungs. Dis. Chest, 55:140, 1959. 33. Higgins, I. T. T.; Cochrane, A. L.; Gilson, J. C.; and Wood, C. H.: Population studies of chronic respiratory disease. A comparison of miners, foundryworkers, and others in Stavely, Derbyshire. Brit. J. Indust. Med., 76:255-268, 1959. 34. Holstein, E. (Herausgeber): Haublungenerkrankungen. Leipzig 1958 (Tagung in Erfurt, 1956). 35. Holt, P. F.: Pneumoconiosis. Industrial Diseases of the Lung Caused by Dust. London, 1957. 36. Hyde, Leroy: Diffuse pulmonary fibrosis. Post grad. Med., 26:208, 1959. 37. Jtten, K. W., and Klosterktter, W.: Die Stau blungenerkrankungen, Band 3. Darmstadt, 1958. 38. Khvapil, M.: Biochemical methods in assessing the effect of industrial dust on the organism. Higiena Truda, 4(4):28, 1960. 39. Khukhrina, E. V.: Methods used in the study of the pneumoconiosis incidence-rate. Higiena Truda 4(4):7, 1960. 40. King, E. J., and Fletcher, C. M. (eds.): A Sym posium on Industrial Pulmonary Diseases. The Postgraduate Medical School of London, 1957 and 1958. Churchill Ltd., London, 1960, (273 pages). 4L King, E. J., and Harrison, C. V.: Reaction of the lung to dust. In the Symposium on Industrial Pulmonary Diseases, ed. by King & Fletcher, Lon don, 1960, p. 37. 42. Kleinfeld, M,, and Giel, C. P.: Pneumoconiosis. J. Chronic Dis., 9:117, 1959. NORO 329 43. Klosterktter, W.: Tierexperimentelle Untersu chungen ber das Reinigungsvermgen der Lunge. Arch. Hyg., 141:258, 1957. 44. Kovnatsky, M. A.: Silicatoses. Moskva, 1957 (179 pages). Reviewed: Higiena Truda, 2(3):60, 1958. 45. LaBelle, C., and Brieger, H.: Synergistic effects of aerosols. II. effects on rate of clearance from the lung. A.M.A. Arch. Indust. Health, 20:100, 1959. 46. Lagze, M. P.: La maladie asthmatique et ses limites sur le plan mdicale. Arch. mal. prof., 18:255, 1957. 47. Lane, R. E.: Chronic bronchitis and occupation. Brit. ]. Tuberc., 52:11, 1958. 48. Lawther, P. J., and Waller, R. E.: Atmospheric pollution and lung cancer. Trans. Ass. Indust. Med. Off., 9:5, 1959. 49. Lupu, N. Gh.; Velican, C.; and Olinescu, V.: The action exerted by certain pneumoconiotic factors upon the acid mucopolysaccharide contents of pulmonary macrophages. Brit. ]. Indust. Med., 76:244, 1959. 50. Lblich, H.-J.; Koch, W.; Sffge, K. H.; and Nordmann, M.: Die Resorption einverleibten Staubes. Feinkrnige Stube (Kalkspat, Spateisen stein, Talk, Rutil). Beitr. Silikoseforsch., 50:1, 1957. 51. Lblich, H.-J.; Koch, W.; and Nordmann, M.: Die Resorption einverleibten Staubes. Die Au fnahme von Kieselgur. Beitr. Silikoseforsch., 50:11, 1957. 52. Marchand, M.: Pneumopathies professionelles non selrogenes. Essai de classification. Proc. X II In ternational Congress on Occupational Health, Helsinki, 1957, 1:157 (Bibliography post 1950, pp. 170-191). Vide: Marchand, M.: Les pneumopathies professionelles. Arch. mal. prof., 75:260, 1957; Les pneumoconioses non selrogenes. Arch. Hig. Rada 4:402, 1953; Hygine et securit du Travail, Fase. IV. Lille, 1955 (Bibliography pp. 28-54). 53. Marks, J., and Nagelschmidt, G.: Study of the toxicity of dust with use of the in vitro de hydrogenase technique. A.M.A. Arch. Indust. Health, 20:383, 1959. 54. Mayer, E., and Rappaport, I.: Bronchitis and Emphysema. J.A.M.A., 765:1227, 1957. 55. Morrow, P. E.; Mehrhof, E.; Casaret, L. J.; and Morken, D. A.: An Experimental Study of Aerosol Deposition in Human Subjects. A.M.A. Arch. Indust. Health, 75:292, 1958. 56. Motley, H. L.: Pulmonary function impairment in pneumoconioses. J.A.M.A., 772:1591, 1960. 57. Nagelschmidt, G.; Nelson, E. S.; King, E. J.; Attygalle, D.; and Yoganathan, M.: The recovery of quartz and other minerals from the lungs of rats. A.M.A. Arch. Indust. Health, 76:188, 1957. 58. Nesis, A. J.: Methods of x-ray examination in pneumoconiosis. Gig. Truda, 3:22, 1959. 59. Nordmann, M.; Koch, W.; and Mder, E.: Die Resorption einverleibten Staubes. Sptstadien rein er gemischter Stube: Kieselgur und Quarz. Beitr. Silikoseforsch., 65:21, 1959. 60. Orenstein, A. J.: Ultimas Investigaciones sobre Neumoconiosis. Medicina del Trabajo, 24:190, 1959. 61. Pemberton, J.: Chronic bronchitis, emphysema and bronchial spasm in bituminous coal workers. An epidemiologic study. A.M.A. Arch. Indust. Health, 13:529, 1956. 62. Pendergrass, E. P.: The Pneumoconiosis Problem with Emphasis on the Role of the Radiologist. Springfield, 111., 1958. 63. Princi, Frank: Status of the pneumoconioses. In troduction. A.M.A. Arch. Indust. Health, 75:361, 1958. 64. Rein, H., and Brinkmann, O: Bekommen Hohl glasblser ein Lungenemphysem? Berufskrank heiten in der keramischen Industrie, Heft 6. Wrzburg, 1959. 65. Sander, O. A.: Current concepts of pneumoco nioses--clinical aspects. J.A.M.A., 772:1587, 1960. 66. Sander, O. A.: Newer concepts of the pathogenesis of the pneumoconioses (The 1958 Ramazzini Ora tion). J. Occup. Med., 7:7, 1959. 67. Sano, T,, and Osanai, H.: Types of pneumo coniosis and their pathogenesis. Reports of the Inst, for Science of Labour (Tokyo), 55:27, 1959. 68. Sartorelli, E., and Scotti, P.: Studio sperimentale e statistico sull' incidenza della bronchite cronica e dell' enfisema polmonare nella popolazione operai di una miniera di pirite. Med. Lavoro (Milano), 45:704, 1957. 69. Schneider, H.: Untersuchungen zur Frage des berufsbedingten Emphysems und der berufsbedi ngten Emphysembronchitis der Glasblser. Berufskr. in d. keram. u. Glas-Ind., Heft 2. Wrzburg, 1958. 70. Schneider, H.: Die berufliche Erkrankung der Atmungsorgane, in F. Koelsch: Handbuch der Berufskrankheiten, 2. Auf!., Jena, 1959. S. 620 (Literaturverzeichnis S. 1109). 71. Schneider, H.: Die Staublungenerkrankungen in Bayern in den letzten 50 Jahren. Staub, 20:1, 1960. 72. Schrenk, H. H.: Status of the pneumoconioses, environmental factors. A.M.A. Arch. Indust. Health, 18:565, 1958. 73. Srmek, J. and Srtek, J.: Chronic industrial in flammations of the respiratory tract and pul monary emphysema. Prac. lek., 70:156, 1958. 74. Strecker, F. J.: Die intraperitoneale Gewebstreaktion auf Si2-freien Lungenkohlestaub und ihre Abwandlung durch geringe Quarzbeimengungen. Beitr. Silikoseforsch., 43:21, 1956. 75. Targamadze, K. S.: On the intracheal method of introduction of dust to animals. Gig. Truda, 2:56, 1958. 76. Worth, G.; Durben, H.-H.; Ellersick, W.; Gast haus, L.; and Nerreter, W.: Zur Frage von Bronchialspasmen bei Kohlenbergarbeitern im Untertagebetrieb. Beitr. Silikoseforsch., 43:1, 1956. Asbestosis, fibrotic lung diseases, and "benign pneumoconiosis" caused by silicates, mixed or non-silica dusts 1. Coal Workers Pneumoconiosis. A.M.A. Arch. In dust. Health, 75(6), 1957. 2. Adelbahr, G.: Lungenvernderungen bei einem Korundschmelzer (Berufskrankheit oder Suicid). Mschr. Unfallhk., 60:65, 1957. 3. Ahlmark, A.; Bruce, T.; and Nystrm, A.: Pneumokonios (talkos) vid bearbetning av tljsteri. Nordisk Medicin, 59:287, 1958. 4. Ahlmark, A.; Bruce, T.; and Nystrm, A.: Pneu moconiosis in iron foundries. Proc. X II Int. Congr. Occup. Health, Helsinki, 3:365, 1957. 5. Ahlmark, A.; Bruce, T.; and Nystrm, A.: Pneumokonios hos kiselgurarbetare. Nordisk Medicin, 59:289, 1958. 6. Alvisatos, G. P.; Pontiakis, A. E.; and Terzis, B.: Talcosis of unusually rapid development. Brit. J. Indust. Med., 12:45. 1955. 7. B o b ile v a , A . X . et at.: T h e A m o u n t o f D u s t in Residential Districts of Asbest and its Effect on the Childrens Health. Gig. i Lan., 23(9), 1958. 8. Bohlig, H.; Jacob, G.; and Muller, H.: Die Asbestose der Lungen. Stuttgart (Thieme), 1960 (166 pages). 330 MEDICAL PRACTICES 9. Bohlig, H.: Schwere Mischstaubsilikose bei einem Schwerspatmller. Proc. X II Int. Congr. Occup. Health, Helsinki, 3:310, 1957. 10. Bridge-Davis, S.; and Nagelschmidt, G.: A report on the absence of pneumoconiosis among workers in pure limestone. Brit. J. Indust. Med., 13.6, 1956. 11. Djuricic, I., and Savic, V.: La microhematurie des ouvriers dans une mine et une usine d asbeste. Proc. X II Int. Congr. Occup. Health, Helsinki, 3:324, 1957. . 12 Ehrhardt, W., and Heidemann, W.: Zur Klinier und Pathologie der Ockerstaublunge. Arch. Gewe- rbepath. Gewerbehyg., 17:504, 1959. 13 Fehre W.: Ueber doppelseitige Pleuraverkal' kungen infolge beruflicher Staubeinwirkungen. Fortschr. Rntgenstr., <35:16, 1956. 14 Gattner, H.: Die Russ-Lunge in ihrer Abgrenzung ' von der Anthrakose. Proc. X II Int. Congr. Occup. Health, Helsinki, 3:356, 1957. 15 Glmme, J., and Swensson, A.: Non-silicotic pneu ' moconiosis (Graphitosis, Kaolinosis). Proc. XII Int. Congr. Occup. Health, Helsinki, 3:166, 1957. 16 Gross P.; Westrick, M. L.; McNerney, J. M.; ' Schrenck, H. H.; and Srsic, R. P.: The pulmonary effects of synthetic silicates derived from diatomaceous earth. A.M.A. Arch. Indust. Health, 16:317, 1957. 31. Prosperi, G., and Barsi, C.: Slle pneumoconiosi dei lavoratori del cemento. Rass. med. indust., (Torino), 26:16, 1957. 32. Raiklin, N. T.: Materials characterizing the na ture of pneumoconiosis in the coal miners of the Karaganda Basin. Gig. Truda, 3(4):48, 1959. 33 Sadkovskaya, N. I.: A comparative hygienic evalu ation of the dust factors in plants producing dif ferent types of cement. Gig. Truda, 3(1):39, 1959. 34. Sander, O. A.: Roentgen Resurvey of Cement Workers. A.M.A. Arch. Indust. Health, 17.90, 1958. 35. Schmidt, K. G., and Lchtrath, H.: Die Wirkung von frischem und gebranntem Kaolin auf die Lunge und das Bauchfell von Ratten. Beitr. Silikoseforsch., 58, 1958. 36. Seeler, A. O.; Gryboski, J. S.; and MacMahon, H E Talc pneumoconiosis. A.M.A. Arch. Indust. Health, 79:392, 1959. 37. Sepke, G.: Zur Talkumstaublunge. Tuberk ulosearzt, 74:247, 1960. 38. Watson, A. J.; Black, J.; Doig, A. F.; and Nagel schmidt, G.: Pneumoconiosis in Carbon Electrode Makers. Brit. J. Indust. Med., 75:274, 1959. 39. Vyskocil, J.: Dynamische Vernderungen der Lungenfunktionen bei Zementarbeitern durch wiederholte Untersuchungen nach 5 Jahren erwie sen. Pracovni lek., 5:85, 1956. 17 Hudson I. H.: Dust from Cement Works. Med. O ffic e r s : 351, 1957: J.A.M.A., 166:1358, 1958. 18. Hbner, O., and Muller, G.: Mineralogische und physikalisch-chemische Untersuchungen an einer Talk-Staublunge und an Talk-Hautgranulomen. Arch. Gewerbepath., 440, 1957. 19. Kammer, A. G.: Occupational health problems of the bituminous coal miner. A.M.A. Arch. Indust. Health, 15:466, 1957. 20. Koelsch, F.: Zur Frage der '`Graphitstaublunge". Zbl. Arb. med., 5:1, 1958. Pneumopathies due to toxic chemicals and metals 1. Beryllium Disease and Its Control. Conference held at Massachusetts Institute of Technology Sept. 30-Oct. 1, 1958. A.M.A. Arch. Indust. Health, 19:91-267, 1959. 2. Amdur, Mary O.: The respiratory response of guinea pigs to sulfuric acid mist. A.M.A. Arch. Indust. Health, 75:407, 1958. _ . 3 Archangelskaja, L. N. & Borisenkowa, R. V.. ' Untersuchungen ber die hygienische Bewertung von Industriestaub aus Metall-Legierungen. J. 21 Koelsch, F.: Die Staubgefhroung durch Flusspat. Hyg. Epid. Microbiol. Immunol. (Prague), 7:441, ' Zbl. Arb. med., 9:153-157, 1959. 22. Kiviluoto, R.: Pleural calcification as a roent genologic sign of non-occupational endemic antophyllite-asbestosis. Acta Radiol., Suppl. 194, 1960, (67 pages). 23 Lchtracht, H., and Schmidt, K. G.: Ueber Talkum und Steatit, ihre Beziehungen zum Asbest sowie ihre Wirkung beim intratrachtealen T ier versuch an Ratten. Beitr. Silikoseforsch., 61, 1959. 24. Lblich, H.-J.; Koch, W.; Sffge, K.-H ; and Nordmann, M.: Die Resorption einver eibten Staubes. Feinkrnige Stube. Beitr. Stltkoseforsch., 50:1, 1957. 25. Massione, R., and Luvoni, R.: Silicosi da Mica? Ross. med. Indust., (Torino), 25:1, 1956. 1957. 4. Baader, E. W.: Lungenschden durch Isozyanate. Med. Sachverst., 52:128, 1956. 5. Baader, E. W.: Hartmetall-Lungen. In Die Stau blungenerkrankungen, Band 3. Ed by Joffe " Klosterktter, Darmstadt, 1958, p. 531; Zbl. Arb. med., 9:33, 1959. 6. Baader, E. W.: Neues ber die wichtigsten Beru fskrankheiten. Sichere Arbeit, 7:23, 1960. 7. Barth, G.; Frik, W.; and Scheidemandel, H.: Die Aluminiumlunge. Dtsch. Med. Wschr., 57:1115, 1956. 8 Becklake, M. R.; Goldmann, H. L; Rae-Bosman, ' ' A.; and Freck, C. C.: T he long-term effects of exposure to nitrous fumes. Am. Rev. Tuberc., 26. Meiklejohn, A.: Carbon and pneumoconiosis. Proc. X II Int. Congr. Occup. Health, Helsinki, 3:335, 1957. 75:398, 1957. . 9. Benoist, C. P., and Frant, R.: Medical experiences with argon-arch welding. Proc. X II Int. Congr. 27. Messite, J.; Reddin, G.; and Kleinfeld, M.: Pul Occup. Health, Helsinki, 3:387, 1957. monary talcosis, a clinical and environmental 10. Bister, F.; Klavis, G.; Khler, H.; and Wittgens, study. A.M.A. Arch. Indust. Health, 20:408, 1959. H.: Zur Gewerbetoxikologie von Anstrichsstotten 28 Mongelli-Sciannameo, N.: Su la patologia da auf Zinkchromatbasis. Arch. Gewerbepath., 76:567, polvere di cemento rilievi clinico-radiologici su 350 cementisti. Folia Medica, 42:469, 1959. 29. Nordmann. M.; Koch, W.; and Mder, E.: Die Resorption einverleibten Staubes. Sptstadien reiner und gemischter Stube: Kieselgur, Quarz, Kieselgur und Quarz. Beitr. Stltkoseforsch., 65.23, 1959. 30 Paule, R. E.; Wedd, G. D.; and Burgess F : The acute toxic effects of black smoke. Brtt. J. Indust. Med., 16:216, 1959. 1958. . ,. 11. Bloom, G., and Swensson, A.: T he reaction of the ' thrombocytes to intravenously injected suspen sions of submicroscopic particles. Acta Med. Scand., 762:423, 1958. . 12. Boccia, D.: Patologia de la soldadura electnca. Med. Trabajo, 23:16, 1958. 13. Bonnell, J. A.; Kazantzis, G.; and King, E A.: A follow-up study of men exposed to ^ cadmium oxide fume. Bril. ]. Indust. Med., 76.135, 1959. NORO 331 H. Brchner L. & Mautner, B.: Bronchographie pleikcatursrtem,of1 1p:2n3e3u,m1o95c9o.niosis in welders. Pracovni 5. Boot, A. C.: Vergiftung mit Vanadiumpentoxyd. Ned. Tschr. Geneesk., 101:2124, 1957. 16. Breslin, A. J,, and Harris, W. B.: Health protec tion in beryllium facilities. Summary of ten years 19:596, 1959.te' A M 'A - Arch- lndust- Health, 17. Buess, H and Lerner, R.: Ueber Asthma bron chiale und asthmoide Bronchitis in der chemischen Industrie. Z. Pr'aventivmed. (Zurich), 39, 1956. 18. Campbell, Irene R.; Cass, J. S.; Cholak, J.; and Kehoe, R. A.: Aluminum in the Environment of Man. A.M.A. Arch. Indust. Health, 75:404-406, 19. Cember, H,,- Watson, J. A.; and Grucci, T. B.: Pulmonary effects from radioactive thalliumactivated clay particles. A.M.A. Arch. Indust. Health, 75:449, 1957. 20. Cholak, J.: T he analysis of traces of beryllium. A.M.A. Arch. Indust. Health, 79:205, 1959. 21. Christensen, F. C., and Olson, E. C.: Cadmium poisoning. A.M.A. Arch, lndust. Health, 16:8, 22- Cotter, L. H.: Treatment of cadmium poisoning with edathamil calcium disodium. J A M A 166:155, 1958. ' v 23. Crepet, M., and Gaffuri, E.: A proposito della malattia da navadis nei pulitori di caldaie a nafta. Lavoro e. med., 10, 1956. 24. Curtis, J. K.; Bauer, Helene; Loomans, Sallie; and Rasmussen, H. K.: Pulmonary diffusion capacity studies. I. a simplified technique of carbon monoxide breath-holding. Am J Med Sei., 236:53, 1958. 25. Dalhamn, T.: Chlorine dioxide toxicity in animal experiments and industrial risks. A.M.A. Arch, lndust. Health, 75:101, 1957. 26. Deichmann, W. B.; Keplinger, M. L.; and Lanier, G. E.: Acute effects of nitro-olefins upon experi mental animals. A.M.A. Arch. lndust. Health, 75:312, 1958. 27. Drsche, H.: Zur Frage der Staubgefhrdung in den Sinteranlagen saarlndischer Eisenhtten werke. Arch. Gewerbepath. Gewerbehyg., 16:666, 28. Dnner, L., and Hardy, R.: Pneumoconiotic and non-pneumoconiotic lung lesions due to inhaling dust and SO, fumes from burning coke. Clinical, x-ray and morbid-anatomical studies. Arch. Gewerbepath. Gewerbehyg., 16:644, 1959. 29. Ehrlicher, H., and Pibz, W.: Industriehygienische und arbeitsmedizinische Massnahmen bei der Verwendung von Isozyanaten (Desmodur). Arbeits schutz, 216, 1956 & 7, 1957. 30. Fischer, R. E.: Gewerbliche Vergiftungen durch Cadmium, Quecksilber, Arsen und ihre Verbind ungen. Uebersicht ber die Verffentlichungen 1946 bis 1956. Clausthal-Zellerfeld, 1958. Schriften d. Gesellschaft Deutscher Metallhtten- und Bergleute e.V., Heft 6 (202 pages). 31. Friebel, H., and Gross, E.: Zur Toxizitt von reinem Phtalsureanhydrid und Rohprodukten aus der industriellen Phtalsauresynthese. Arch. Gewerbepath., 77:465, 1956. 32. Friebel, H., and Lchtrath, H.: Gesundheitssch den durch neuartige Lacke und Schaumstoffe. Dtsch. med. Wschr., 8 1 :980, 1956. 33. Friebel, H., and Stein, A.: Zur Genese des durch einfache Chemikalien hervorgerufenen Asthmas. Versuche mit p-Phenylendiamin. Arch. Gewerbe path., 76:620, 1959. 34. Friberg, L.: Edathamil calcium-disodium in cadTMy11X!TMOj 1P95"o*sonin8- A -M.A. A rch. Indust. Health, 3o. Friberg, L.: Deposition and distribution of cad mium in man in chronic poisoning. A M A Arch lndust. Health, 16:21, 1957. ' 36. Friberg, L.: Chronic cadmium poisoning A M A Arch. lndust. Health, 20:401, 1959. 37. Gage, J. C.: The toxicity of epochlorhydrin vapour. Brit. J. lndust. Med., 76:11, 1959. 38. Galy P.; Roche, L.; Bouvier, J.; and Perrin, L F.: Pneumonie chronique interstitielle diffuse ;i evolution mortelle chez un metalliseur au zinc Arch. mal. prof., 75:301, 1957. ' 39. Glmme, J,, and Lundgren, K.-D.: Health hazards from chlorine dioxide. A.M.A. Arch. lndust Health, 76:169, 1957. ' 40. Glmme, J., and Swensson, A.: Tierexperimentelle Untersuchungen ber den Staub in der Arbeit satmosphre von Ferrosiliziumwerken. Staub lungenerkrankungen, Band 3. Herausg. Ttten & Klosterktter, 1957. J 4L Glmme, J., and Swensson, A.: Cases of siderosis, alumiosis and pneumoconiosis in the tungsten carbide tool industry. Proc. X U lnt. Congr Occup. Health, Helsinki, 5:166, 1957. 42. Gombos, B.: Pulmonary nodulation by inhaling barium dust. Pracovni Lekarstvi, 9:399, 1959. 43. Gray, E. LeB.: Oxides of nitrogen: their occur rence, toxicity, hazard. A.M.A. Arch. lndust Health, 19:419, 1959. 44. Haglind, O.: Lung changes in electric welders. Proc. X II lnt. Congr. Occup. Health, Helsinki 5:169, 1957. 45. Hama, G. M.: Symptoms in Workers Exposed to Isocyanates. A.M.A. Arch, lndust. Health, 76:232 1957. 46. Hamlin, L. E.: Siderosis. J. Occup. Med 7-79 1959. 47. Hamlin, L. E.: Siderosis: additional observations over a period of eight years on sixty-nine foundry cleaning room employees. ]. Occup. Med., 7:79, 1959. 48. Hardy, H. L,, and Stoeckle, J. D.: Beryllium di sease. ]. Chron. Disease, 9:152, 1959. 49. Hasegava, K. (and Teisinger, J,, discussion): Diag nosis of chronic sulphur dioxide intoxication. Proc. X II lnt. Congr. Occup. Health, Helsinki! 5:271, 1957. 50. Husten, K.: Hartmetall-Fibrose der lunge Arch Gewerbepath., 76:721, 1959. ' ' 51. Iannacone, A., and Mazella di Bosco, M.: Intossi cazione acuta da anhidride maleica in lavoratori del porto. Lav. umano (Napoli), 5:404, 1956. 52. Johnstone, R. T.: Toluene-2.4-Diisocyanate. clin ical features, lndust. Med., 26:33, 1957. 53. Karpov, B. D.: Angaben zur toxikologischen Charakteristik von Methylchlorakrylat. Gig i San 22:144:74, 1957. ' 54. Kasparov, A. A.: Probleme der Arbeitshygiene bei der Herstellung von Vulkanisationsakzeleratoren (Tiuram, Kaptaks). Gig. truda, 7:24, 1957. 55. Klavis, G.: Ammoniakvergiftungen und ihre Fo lgen unter Bercksichtigung neuer Kasuistik. Arch. Toxicol., 77:155, 1958. 56. Klavis, G.; Khler, H.; and Bister, F.: Die Ursache der Thomasschlackenpneumonie unter besonderer Bercksichtigung der vanadin- und manganhaltigen Schlackenbestandteile. Arch. Ge werbepath., 75:355, 607, 1956-1957. 57. Kleinfeld, M,, and Giel, Ch. P.: Clinical manifes tations of ozone poisoning: report of a new source of exposure. Am. J. Med. Sc., 257:638, 1956. 332 MEDICAL PRACTICES 58. Koelsch, F.: Gesundheitsschden durch Metall karbide und Hartmetalle. Zbl. Tb. vied., 9.33, 1959; ]. prophyl. Med. Soz.-hyg., 5:1, 1959. 59 Kunkel, A. M.; Murtha, E. F.; Dikemus, H.; Stabile, D. E.; Saunders, J. P.; and Wills, J. H.: Some pharmacological effects of diborane. A.M.A. Arch. Indust. Health, 15:346, 1956. 60. Kutschera, W.: Ein eigenartiger Fall einer Vergi ftung durch Dissousgas. Mitt, osterr. San vertu., 57:228, 1956. 61 Lachnit, V.: Zur Therapie der Reizgasvergiftung. /Ml. Arb. med., 8:177, 1958. 62. Leicher, F.: Zur Differentialdiagnose zwischen A lu m in iu m lu n g e und Morbus Boeck. Fortschr. Runtgenstr., 84:571, 1956. 63. Levinskas, G. J.; Pollis, A.; and Novick, W. J,, Jr.: Distribution and excretion of poranes. A.M.A. Arch. Indust. Health, 14'.346, 1956. 64. Lewis, C. E.: The biological effects of vanadium. A.M.A. Arch. Indust. Health, 79:497, 1959. 65. Lindgren, S. A., and Swensson, A.: Yrkesmedicinska synpunkter pa framstllning och beaibetning av plaster. Sv. Lkartidningen, 55:2227, 1958. 66. Lingen, Marie-Louise, and Sundeil, C. G.: Lungfrndringar iakttagna efter inandning av oljehaltig luft. Nordisk M edin, 5AM974, 1957. 67. Lowe, H. J , and Freeman, G.: Boron hydride (borane) intoxication in man. A.M.A. Arch. In dust. Health, 16:523, 1957. 68. Machabeli, M. E.; Gdzeldze, E. G.; and Mgeladze, T. G.: Clinical picture and work capacity in manganokoniosis. Gig. Truda, 4:48, 1960. 69. Mann, B. T., and Lecutier, E. R.: Arc welder's lung. Brit. Med. ]., 2:921, 1957. 70 Marks, J., and Nagelschmidt, G.: Study of the toxicity of dust with use of the in vitro dehydro genase technique. A.M.A. Arch. Indust. Health, 20:383, 1959. 71. Massmann, W.: Experimentelle Untersuchungen ber die biologische Wirkung von Vanadinver bindungen. Arch. Toxicol., 16:182, 1956. 72 Massmann, W.: Tierexperimentelle Untersuchun gen ber die toxikologische Wirkung von Rauch en, die bei Schweissen mit kalkbasischen Ele ktroden entstehen. Arch. Gewerbepath., 14:291, 1956. 73. Massmann, W.: Untersuchungen ber die biologische Wirkung des Polyaerylmtrils. Z. exper. Med., 127:407, 1956. 74. Massmann, W., and Pilgrim, K.: Das Verhalten des Lungengewebes nach intratrachealer Injektion von Mangan-IV-Oxyd und Chrom-HI-Oxyd. Arch. Gewerbepath., 15:203, 1956. 75. McLaughlin, A. I. G.: Iron and other radio opaque dusts. In the Symposium on Industrial Pulmonary Diseases, ed. by King and Fletcher. London, 1960, p. 146. 76. Meiklejohn, A., and Posner, E.: The effect of the use of calcined alumina in china biscuit placing on the health of the workman. Brit. ]. Indust. Med., 14:229, 1957. 77 Melnikova, E. A.: Angaben zur Bestimmung des zulssigen Kadmium- und Vanadiumgehaltes der Luft in Industrierumen. Gig. i san., 21:25, 1957. 78. Mozentseva, N. V.: Hygienic characteristic of in dustrial aerosols of wolfram. Gig. i San., 22(4).25, 1957. 79 Minden, H.; Bruckner, Ch.; and Simon, J.: Bei trag zur Cadmiumvergiftung. Arch. Geweibepath. Gewerbehyg., 17:531, 1959. 80. Mitchell, J.: Pulmonary fibrosis in an aluminium worker. Brit. ]. Indust. Safety, 16:123, 1959. 81. Mittler, S.; King, M.; and Burkhardt, B.: Toxicity of ozone. A.M.A. Arch. Indust. Health, 15:191, 1957. 82. Mogilevskaya, O. Ya.: An experimental study of the effect of rare metals ore dust on the respira tory organs. Gig. i san., 25:30, 1960. 83. Moschinski, G.; Jurisch, A., and Reinl, W.: Die Lungenvernderungen bei S i n t e r h a r t m e t a l l Arbeitern. Arch. Gewerbepath., 16:697, 1959. 84. Molitor, L.; Mosinger, M.; Barthel, J.; Heyart, H.; and Perinet, G.: Recherches sur les poussires de laminoir et leur capacit pathogne. Les sidroses pulmonaires. Luxembourg, 1957 (127 pages). 85. Moschinski, G.; Jurisch, A.; and Reinl, W.: Die Lungenvernderungen bei Sinterhai tmetallarbei- tern. Arch. Gewerbepath., 76:697, 1938. 86. Nakaniski, S., and Namiki, S.: Symptoms in work ers exposed to isocyanates. Rdkagaku, 57:980, 1958. 87. Nebelung, W.: Akute Vergiftung mit Dimethylsulfat. Arch. Gewerbepath., 75:581, 1957. 88. Oyanguren, H.; Haddad, R.; and Maass, H.: Stannosis. Benign pneumoconiosis owing to in halation of tin dust and fume. I. environmental and experimental studies. Indust. Med., 27`ATI, 1958. 89. Penlver, R : Diagnosis and treatment of man ganese intoxication. Report of a case. A.M.A. Aich. Indust. Health, 76:64, 1957. 90. Portela-Gomes, F.: La reaction de l'alvole pul monaire quelques produits industriels. Proc. X II Int. Congr. Occup. Health, Helsinki, 5:311, 1957. 91. von Post-Lingen, Marie-Louise: Lungskador efter inhalation av olja eller oljehaltig luft. Nordisk M edin, 59:290, 1958. 92. Poteryaeva, G. E.: The toxic properties on anti mony pentachloride. Gig. Truda, 2:22, 1958. 93. Quilligan, J. J.; Boche, R. D.; Falk, L. H.; and Klotin, P.: The toxicity of ozone for young chicks. A.M.A. Arch. Indust. Health, 18:16, 1958. 94. Oettel, H.: Gesundheitsgefhrdung durch Kunst stoffe? Arch, exper. Path. Pharmak., 252:77, 1958. 95. Reinl, W.: Ueber die Erkrankungen durch T ho masschlacke, Vanadinschlacke und Vanadinver bindungen und ihre Ursachen. Staub, 75:143, 177, 1958. 96. Robertson, A. J.: Pneumoconiosis due to tin oxide. In the Symposium on Industrial Pul monary Diseases, ed. by King and Fletcher. Lon don, 1960, p. 168. 97. Rogers, W. N.: Chronic beryllium poisoning treated with corticotrophin. Lancet, 275:267, 1957. 98. Rohrs, L. C.: Metal-fume fever from inhaling zinc oxide. A.M.A. Arch. Indust. Health, 76:42, 1957. 99. Roschtschin, I. V.: Das Vanadium als industrielles Gift. J. Hyg. Epid. Microbiol. Immunol. (Prague), 2:492, 1958. _ . 100. Roschina, T. A.: An experimental investigation of the action of the chromomagnesite and mag- nesitochromite refractories dust on the body. Hig. Truda, 5:28, 1959. 101. Rosmanith, J.; Volf, J.; and Knpfelmacher, E.. Respiratory disease in workers producing sul phuric acid. Pracovni lkarstvi, 2:411, 1957. 102. Rosmanith, J., and Knopfeimacher, E.: A case of BaSO, pneumoconiosis. Prac. lk., 2:140, 1957. 103. Roush, G., Jr.: The toxicology of the boranes. J. Occup. Med., 7:46, 1959. 104. Rowe, V. K., et al.: Toxicity of propylene oxide determined on experimental animals. A.M.A. Arch. Indust. Health, 75:228, 1956. NORO 333 105. Ruiz, R. F., and Iribarren, R. R.: Neumopatias por querosn. The Medical Bulletin (Standard Oil Co., N.J.), 20:35, 1960. 106. Rumyantsev, G. T.: On the question of barytosis. Gig. i San., 25(4): 17, 1958. 107. Sarai, S., and Ueno, K.: Electron microscopic views of dust produced in electric steel melting. Proc. X II Int. Congr. Occup. Health. Helsinki, 5:325, 1957. 108. Schepers, G. W. H.; Durkan, T. M.; Delahant, A. B.; Redlin, A. J.j Schmidt, J. G.; Creedon, F. T.; Jacobson, J. W.; and Bailey, D. A.: The biological action of fiberglas-plastic dust. A.M.A. Arch. Indust. Health, 18:34, 1958. 109. Schneider, H.: Ueber Siderose. Zbl. Arb. med., 7:142,. 1957. 110. Schechter, W. H.: How toxic are high energy fuels? Nat. Safety News, 77:28, 1958. 111. Schler, P., et al.: Stannosis. II. clinical study. Indust, Med., 27:432, 1958. 112. Schler, P., et al.: Manganese poisoning. Environ mental and medical study at a Chilean mine. Indust. Med., 26:167, 1957. 113. Serenko, A. S.; Stanislavsky, Y. M.; Khazan, G. L., et al.: Sanitary conditions of work and peculiari ties of pneumoconiosis in workers at the Iron ore Aglomerating plants. Gig. Truda, 2:17, 1958. 114. Soriano, M.: Asthme exprimental par l'acroline. Sem. hp., 54:3213, 1958. 115. Sim, V. M., and Pattle, R. E.: Effect of possible smog irritants on human subjects. J.A.M.A., 565:1908, 1957. 116. Sjberg, S. G.: Vanadium dust, chronic bronchitis and possible risk of emphysema, Acta med. Scand., 554:381, 1956. 117. Sjberg, S. G., and Rignr, K. G.: Besvr fran luftvgar m.m. hos sotare i oljeeldningsanlggningar. Nordisk Medicin, 55:1973, 1957. 118. Smith, J. S., and Kench, J. E.: Observations on urinary cadmium and protein excretion in men exposed to cadmium oxide dust and fume. Brit. ]. Indust. Med., 14:240, 1957. 119. Smith, J. C.; Kench, J. E.; and Smith, J. P.: Chemical and historical post-mortem studies on a workman exposed for many years to cadmium oxide fume. Brit. J. Indust. Med., 14:246, 1957. 120. Tebrock, H. E., and Machle, W.: Advances in the management of chronic berylliosis. Proc. X II hit. Congr. Occup. Health, Helsinki, 5:167, 1957. 121. Thomas, D. L. G., and Stiebris, K.: Vanadium Vergiftung in der Industrie. Med. J. Australia, 45:607, 1956. 122. Thomas, M. D.; Hendricks, R. H.; Gunn, F. D.; and Critchlow, J.: Prolonged exposure of guinea pigs to sulfuric acid aerosol. A M .A. Arch. Indust. Health, 17:70, 1958. 123. Timokhin, D. I.: Problems of industrial hygiene in employment of magnesium-torium-cobalt catalyzer, Hig. Truda, 2:42, 1958. 124. Tur, J.: Liderosis pulmonum. Med. Pracy., 10:33, 1959. 125. Vallee, B. L.: Zinc and its biological significance. A.M.A. Arch. Indust. Health, 16:147, 1957. 126. Vorobjeva, R. S.: The question of the toxicity of cadmium oxide. J . H y g . R p i c l c i n i o l . M i c r o b i o l . Immunol. (Prague) , 2:244, 1958. 127. Zapp, J. A.: Hazards of isocyanates in polyure thane foam plastic production. A.M.A. Arch. Indust. Health, 55:324, 1957. Pneumopathies due to organic dusts, allergens and pneumomycoses 1. Bringhurst, L. S.; Byrne, R. N., and GershonCohen, J.: Respiratory disease of mushroom workers, farmer's lung. J.A.M.A., 575:15, 1959. 2. Bugyi, B., and Molnr, L.: Lungenschden durch Reisstrohstaub. Beitr. Silikoseforsch., 55:37, 1958. 3. Bugyi, B.: On Conionmycoses. Prac. lekarstvi, 10:200, 1958. 4. Chinachoti, N,, and Tangchai, P.: Pulmonary alveolar microlithiasis associated with the inhala tion of snuff in Thailand. Dis. Chest, 52:687, 1957. 5. DaSilva Horta, J., and De Carvalho Cancella, L.: ' Experimentelle Korkstaubkoniose (Experimen telle Suberose) . Arch. Gewerbepath., 55:319, 1957. 6. Dnner, L.: Pneumokoniosen durch Staub ton Getreide und Saaten. In Staublungenerkrankun gen, Band 3, ed. by Jtten and Klosterktter. Darmstadt, 1958, p. 541. 7. Dickie, H. A., and Rankin, J.: Farmer's lung, an acute granulomatous interstitial pneumonitis occurring in agricultural workers. J.A.M.A., 167: 1069, 1958. 8. Frank, R. C.: Farmer's lung--a form of pneumo coniosis due to organic dusts. A.]. Roentgenol., 79:189, 1958. 9. Frost, J., and Georg. J.: Taerskerlunge. Useskr. Laeg., 118:1383, 1956. 10. Groetschel, H., and Trense, E.: Tod eines Druck ers an Asthma bronciale nach Umgang mit Nasszerstubemitteln. Arch. Gewerbepath., 16 375, 1958. 11. Gupta, A. S.; Ferris, B. G.; and Rao, M. N.: Oxygen consumption of male Indian jute workers. A.M.A. Arch. Indust. Health, 20:96, 1959. 12. Klunker, W.: Zur Frage der tiologie und Path ogenese des sogenannten Bacher- und Mllerasth mas. Schweiz, med. Wschr., 57:714, 1957. 13. Kyung, V. A.: Dust of the kukkersite shale as an etiological factor of occupational pneumoconiosis. Gig. Truda, 5:44, 1959. 14. Lowry, T., and Schuman, L. M.: "Silo-filler's disease"--a syndrome caused by nitrogen dioxide. J.A.M.A., 162:153, 1956. 15. Murray, R.; Dingwall-Fordyce, I.; and Lane, R. E.: An outbreak of weaver's cough associated with tamarind seed powder. Brit. ]. Indust. Med., 14:105, 1957. 16. Pestalozzi, C.: Febrile Gruppenerkrankungen in einer Modellschreinerei durch Inhalation von mit Schimmelpilzen kontaminiertem Befeuchter wasser (Befeuchterfieber). Schweiz. Med. Wschr, 89:710, 1959. 17. Poliak, K.; Giithert, H., and Schanzenbach, H.: Experimentelle Untersuchungen zur Frage der Getreidestaublunge. Arch. Gewerbepath. Gewerbehyg., 57:519, 1959. 18. Roach, S. A., and Schilling, R. S. F.: A clinical and environmental study of byssinosis in the Lancashire cotton industry. Brit. J. Indust. Med., 57:1, 1960. 19. Schilling, R. S. F.: The epidemiology of byssino sis. In the Symposium on Industrial Pulmonary Diseases, ed. by King and Fletcher. London, 1960, p. 185. 20. Schilling, R. 5. F.; The epidemiology of byssino sis--adventure and misadventure. ]. Occup. Med., 5:33, 1959. 21. Stott, H.: Pulmonary disease amongst sisal work ers. Brit. J. Indust. Med., 55:23, 1958. 334 MEDICAL PRACTICES 22. Smetanin, N. I.: The maximal permissible con centration of the loess dust in the air of cotton spinning plants. Gig. Truda, 5:53, 1959. 23. Tiller, J. R.: An investigation of byssinosis in a rayon mill. Trans. Ass. Indust. Med. Off., 7:157, 1958. 24. Totten, R. S.; Reid, D. H. S.; Davis, H. D.; and Moran, T. J.: Farmer's lung, report of two cases in which lung biopsies were performed. Amer. J. Med., 25:803, 1958. 25. Tuffnell, P. G., and Dingwall-Fordyce, I.: An investigation into the acute respiratory reaction to the inhalation of tamarind seed preparations. Brit, ]. Indust. Med., 14:250, 1957. 26. Wassermann, M.; Bugeag-Mihail, G.; and Iosubas, S : Recherches experimentales concernant "la maladie des fileurs et des tisseurs de chauvre". Proc. X II Int. Congr. Occup. Health, Helsinki, 5.374, 1957. 27. Wegmann, T.; Galletti, P.; and Amrein, H. P.: Baumwollstaublunge. Schweiz. Med. Wschr., 88:437, 1958. 28. Zannini, D. (and Wassermann, M,, Discussion) : A propos de la "Fivre des cereales" des travalleurs des silos. Proc. X II Int. Congr. Occup. Health, Helsinki, 5:386, 1957. Infectious and parasitai pneumopathies 1. Drankin, D. I., and Gerasimova, M. M.: Brucello sis and occupation. Gig. Truda, 2:8, 1958. 2. Gross, P.; Westrick, M. L.; McNerney, J. M.; and Pittsburgh, M. P. H.: Experimental Tuberculopneumoconiosis. A.M.A. Arch. Indust. Health, 19:320, 1959. 3. Harris, H. J.: Treatment of Brucellosis. J.A.M.A., 175:709, 1960. 4. Junak, G.: Leptospireninfektionen bei Kanalar beitern. Arch. Gewerbepath., 15:565, 1957. 5. Kthe, J.: Die Leptospirose als Berufskrankheit. Arch. Gewerbepath., 17:316, 1959. 6. King, E. J.: Recent Research in Infective Pneu moconiosis. Proc. X II Int. Congr. Occup. Health, Helsinki, 1:283, 1957. 7. King, E. J.; Yoganathan, M.; Harrison, C. V.; and Mitchison, D. A.: Experimental infective Pneumoconiosis. A.M.A. Arch. Indust. Health, 16:380, 1957. 8. Ramsay, J. H., and Pines, A.: Results of treat ment of pneumoconiosis complicated by tuber culosis. Brit. Med. ]., 2:345, 1959. 9. Schppert, R.: Lungentuberkulose als Beruf skrankheit bei Metzgern und bei in Landwirt schaft beschftigten Personen. Z. rztl. Fortbild., 52:417, 1958. 10. Spink, W. W.: Current status of therapy of brucellosis in human beings. J.A.M.A., 172:697, 1960. ' 11. Terzin, A. L.: Psittacosis--ornathosis--mam malian pneumonitis (POMP) viruses in man, mammals and birds. J. Hyg. Epid. Microbiol. Immunol. (Prague) , 2:129, 1958. Lung cancer due to occupation and radiation 1. Causation of Cancer. British Med. Bull. 14(2), 1958. 2. Ask-Upmark, E.: Bronchial carcinoma in printing workers. Dis. Chest, 27:4, 1955. 3. Azhbel, S. I.: On cancer diagnosis in patients suf fering from toxic pneumoscleroses. Hig. Truda, 5:11, 1959. 4. Barborik, N. et al.: Carcinoma of the lungs in electrolytic chromium plating. Prac. Lkarstvi, 50:413, 1958. 5. Baetjer, A. M.; Damron, C.; and Budacz, V.: The distribution and retention of chromium in men and animals. A.M.A. Arch. Indust. Health, 20:136, 1959. 6. Baetjer, A. M.; Lowney, J. F.; Steffee, M.D.; and Budacz, B. A.: Effect of chromium on incidence of lung tumors in mice and rats. A.M.A. Arch. Indust. Med., 20:124, 1959. 7. Bidstrup, P. L.: Occupational causes of lung cancer. Trans. Ass. Indust. Med. Off., 9:2, 1959. 8. Bohlig, H., and Jacob, C.: Die Hufigkeit des Lungenkrebses bei deutschen Asbestarbeitern. Proc. X II Int. Congr. Occup. Health, Helsinki, 5:308, 1957. 9. Braun, W.: Krebs an Haut und inneren Organen, hervorgerufen durch Arsen. Dtsch. Med. Wschr., 81:870, 1958. 10. Browning, Ethel: Harmful effects of ionising ra diations. Elsevier Monographs: Industrial Toxic Agents. Amsterdam, 1959. 11. Cember, H.: Bronchogenic carcinoma from radio active particulates. Second United Nations Con ference on the Peaceful Uses of Atomic Energy. Geneva, 1958. Paper A/Conf. 15/P/900. 12. Chiurco, G. A.: Lavoro e tumori. Archivo di Medicina Mutualistica, 4:Vo\. 14, 1959 (372 pages). Vide also: Proc. X II Int. Congr. Occup. Health, Helsinki, 147, (Fr.), 139, (Engl.), 1957. 13. Davies, D. F.: A review of the evidence on the relationship between smoking and lung cancer. J. Chron. Dis., 11:579, 1960. 14. Doll, R.: Occupational lung cancer. In the Sym posium on Industrial Pulmonary Diseases, ed. by King and Fletcher. London, 1960, p. 208. 15. Doll, R.: Occupational lung cancer: a review. Brit. ]. Indust. Med., 16:181, 1959. 16. Dvizkov, P. P.: Occupational cancer. Gig. Truda, 4(3):$, 1960. 17. Eckardt, R. E.: Industrial Carcinogens. New York and London, 1959. 18. Ellinger, F.: Medical Radiation Biology. Spring field, 111., 1957, p. 224 ff. 19. Espinos-Perez, D.: Cancer pulmonar y neumoconiosis. Med. y seg. trabajo, 5:5, 1957. 20. Finkel, Miriam P.: Internal emitters and tumor induction. Proc. Int. Conf. Peaceful Uses of Atomic Energy, Geneva, 1955, Vol. 11. New York, 1956, p. 160. 21. Gallego, J. D.: Pulmonary lesions in pneumo pathies due to dust. Proc. X II Int. Congr. Occup. Health, Helsinki, 5:378, 1957. 22. Goldblatt, M. W.: Occupational Carcinogenesis. Brit. Med. Bull., 14:136, 1958. 23. Grosse, H.: Mischstaubinduration der Hiluslymphknoten und Lungenkrebs. Frankf. Z. Path., 67:220, 1956. 24. Haddow, A. (ed.): Causation of cancer. Brit. Med. Bull., 14(2), 1958. 25. Harris, W. B.; Breslin, A. J.; Glauberman, B.; and Weinstein, M. S.: Environmental hazards associated with the milling of uranium ore. A.M.A. Arch. Indust. Health, 20:365, 1959. 26. Hueper, W. C.: Experimental studies in metal cancerigenesis. X. cancerigenic effects of chromite ore roast deposited in muscle tissue and pleural cavity of rats. A.M.A. Arch. Indust. Health, 18:284, 1958. 27. Irmscher, G.: Ueber einen Todesfall an chro nischer Pneumonie nach Inhalation von alphaund betastrahlenaktivem "Industriestaub" vor rund 20 Jahren. Das Deutsche Gesundheitswesen, 52:1732, 1958. NORWOOD S 35 28 James, W. R. L.: Primary lung cancer in South Wales coal-workers with pneumoconiosis. Brit. J. Indust. Med., 12:87, 1955. 29 Kennaway, E,, and Lindsey, A. J.: Some possible exogenous factors in the causation of lung cancer. Brit. Med. Bull., 14:124, 1958. 30 Koelsch, F.: Der Arsenkrebs. Zbl. Arbeitsmed., 5:129, 161, 1958. 31 McLaughlin, A. 1. G.: Iron as a Carcinogen. In the Symposium on Industrial Pulmonary Diseases, ed. by King and Fletcher. London, 1960, p. 162. 32 Puccini, C.: Le problema della cancro-silicosi. Med. Lavoro, if : 18, 1960. 38. Rinck, H.: Der Chromatkrebs der Lunge als Berufserkrankung. Medizinische, 342, 1956. 34. Sepke, G.: Zum Schneeberger Lungenkrebs. Zbl. Arb. Med., 7:114, 1957. 35. Smith, R. A.: Lung Cancer in Coal-Miners. Brit. }. Indust. Med., 76:318, 1959. 36. Sunderman, F. W.; Donnelly, A. J.; West, Bob; and Kincaid, J. F.: Nickel poisoning. A.M.A. Arch. Indust. Health, 20:36, 1959. 37. Sunderman, F. W.; Kincaid, J. F.; Donnelly, A. J.; and West, Bob: Nickel poisoning. A.M.A. Arch. Indust. Health, 76:480, 1957. TREATMENT OF PLUTONIUM DEPOSITION IN HUMANS WITH DTPA -- EFFECTIVENESS OF LONG-TERM ADMINISTRATION AND ORAL ADMINISTRATION* W . D a g g e t t N o r w o o d , M.D. Manager, Health Operation, H anford Atomic Products Operation, operated by General Electric Company for the Atomic Energy Commission Richland, Washington The recommended maximum permissible amount of soluble plutonium (Pu 239) in the human body is 0.04 microcurie -- 0.6 gg (1). Rigid control methods are necessary to limit body deposition to this extent. For instance, allowable concentrations in air are lower by a factor of millions than the comparable allowable concentrations of many of our most toxic chemicals. There will be increasing potential for exposure to such isotopes with the expanding use of such materials in industry, defence, and medicine. Hence it becomes most important to have the safest, best, and most con venient method possible for treating the individual who has accidentally acquired a deposition of Pu 239 which exceeds the maximum permissible limit. Treatment, here, of five employees who had har bored small quantities of Pu 239 for some years indi cated that intravenously administered diethylenetriaminepentaacetic acid (DTPA) was much the most effective agent discovered to date for increasing the urinary elimination of Pu 239 (2). The present study was made to improve knowledge of the effectiveness of DTPA in eliminating Pu 239 via the urine when treatment is extended over a pe riod of many months. It was also directed toward determining the effectiveness of DTPA in increasing elimination of Pu 239 via the urine and feces when administered orally. Long-Term Administration of DTPA An employee who had accidentally received a depo sition of about .4 microcurie of Pu 239 some 30 months previously was treated with DTPA intraven ously. Initially the daily urinary output of Pu 239 was about 665 disintegrations per minute per 24-hour specimen of urine (Table I). It was considered advis able to cautiously continue treatment over an extended period unless evidence of kidney irritation or other untoward effect appeared during the treatment. This *The DTPA for this study teas kindly supplied by Dr. Murray Weiner, Geigy Pharmaceuticals, P.O. Box 430, Yonkers, New York. R. H. Wilson was most help ful in coordinating sample collection and assisting in the inletpretation of results. G. D. Brown and staff performed the bioassays of the many samples. would serve the dual purpose of eliminating a fair amount of Pu 239 and indicating whether or not there was .a change in effectiveness of this agent when used over an extended period. T able I EFFECTIVENESS OF INTRAVENOUSLY ADMINISTERED DTPA IN INCREASING URINARY EXCRETION OF PU 239 WHEN GIVEN FOR MANY MONTHS W eek of Treatm ent Dose-- D T P A in Grams Per Week Average D aily U rin ary Excretion of Pu 239 Expressed as D isintegrations Per M inute 1 2 665 2 1.6 610 No treatment for period of 5 weeks 12 11-12 1.6 481 13-14 2 495 No treatment for period of 5 weeks 15 26 2 49 6 27 2 436 33 2 246 46 2 190 50 2 125 Effectiveness Expressed as % of Initial Effectiveness 100 92 72 74 74 66 37 29 19 Average daily elimination of Pu 239 for periods preceding and following the above treatment was 12 disintegrations per minute in 24 hours. Except for minor changes as shown in Table I, the employee was given 1 g of DTPA intravenously, in the Manufacturing Area Medical Center, on Monday and 1 g on Thursday of each week for three successive weeks. Such periods of treatment were alternated with periods of three weeks of no treatment. This was con- Ay, ten . , . 610 SOCIAL AND LEGAL ASPECTS element above the loss of wages the longer he was off work. This case illustrates how an individual deliberately perpetrates his disability on a subjective basis in order to increase the size of his monetary settlement. C a se No. 3 -- A 37-year-old trainman was injured while standing too close to a slowly moving train when his arm was struck by a grab iron, causing him to spin around and strike his head against the side of a car. He received a 5-cm vertical laceration across the middle of his forehead. The man was stunned but re mained on his feet. The laceration was repaired at the plant dispensary. X-rays of the skull were negative. There were no other injuries except for a slight con tusion of the right upper arm. Neurologic examina tion was entirely negative and remained so thereafter. No treatment was indicated other than analgesic medi cation for pain. The patient did not work his next turn and was seen again the following day. The previ ous night he had a mild headache but was now asymptomatic. Examination was again negative. The patient was seen again four days after the accident. The sutures were removed, and adhesive bridges were applied. His only complaint was occasional frontal headache which was relieved by aspirin. He had not returned to work; and when questioned as to why, he gave some vague complaints of soreness in his right arm and upper back. Examination was again negative for objective findings. It seemed to the physician that the man believed he could and should be working but for some reason had not done so. He was formally approved for work and was so advised. The patient returned to work six days after the accident and worked for several hours but then reported off because of headache. He was seen again the following day, complaining of headache, dizziness, and soreness of the upper back and right arm. The laceration was healing well. Examination results were negative once again. He apparently did not intend to work; he was treated symptomatically and seen again one week later, at which time his condition was unchanged. Fol lowing this visit he was not seen again for another two weeks. It was then 24 days since the injury. The patient had taken his vacation in the interim, for which he had received vacation pay. He offered no complaints, and the examination was again negative. The man finally returned to work 30 days after this injury and remained at work thereafter. He instituted litigation against the company, because he demanded compensation about seven times his actual loss of earnings, and the company refused to grant the claim. Each time this patient was seen during the 30-day period it seemed that he really believed he could work and that he actually wanted to. He was phys ically able and was not considered as having post traumatic neurosis. Why then did he not work? There appeared to be several reasons. While the patient was being treated in the dispensary shortly after the acci dent, a company representative remarked that it would be good if he did not miss work, since his work gioup had gone for an unusual length of time without a lost-time accident. This was interpreted by the pa tient and his fellow workers as company interest in avoiding lost time rather than the employe's welfare. Resentment was incited and led to deliberate lost time. The patient was also encouraged to miss work because he had a head injury which required suturing. Another factor which played a part was encourage ment j)y certain parties to deliberately perpetrate un necessary lost time for the purpose of establishing a claim against the company for income greater than his regular earnings. This case illustrates how management action, work group standards for lost time, and litigation practices in work groups interfere with the medical manage ment of the injured employe and create unnecessary disability leading to excessive monetary gain. Summary In summary, I have outlined certain socio-economic factors that have a negative influence on the disabled employee. The discussion has dealt with why and how such factors interfere with the individual's recovery from an occupational injury, with the thought that a clearer understanding must precede any effort to do anything about them. BASIC PRINCIPLES FOR PRECAUTIONARY LABELING E dward J. H ogan Vice-Chairman, Labels and Precautionary Inform ation Committee, M anufacturing Chemists' Association, Inc;; Packaging Coordinator, Allied Chemical Corporation, New York, N. Y. It is an honor and a privilege to speak to you, as a representative of the Manufacturing Chemists' Association, regarding one if its activities. The Man ufacturing Chemists' Association is an incorporated national trade organization composed of more than 180 companies engaged in the manufacture and sale of chemicals. These companies account for more than 90 per cent of the chemical production capacity of the United States. From Its founding in 1872, the MCA has been concerned with the many problems accompanying the growth of the chemical industry. Prominent among these has been the promotion of safety, and the Asso ciation is proud of its contributions to the record of chemical manufacturers in this regard, which is among the best in all industry. This achievement is the more notable in view of the inherent hazards in many of the industry's processes and products. The Association's interest in safety goes far beyond that of its members' employees to include those transporting, handling, and using its products. The objectives are promoted in a number of ways, but I shall discuss at this time only that phase concerned with the labeling of chemicals to instruct those hand ling or using them how to do so safely. In the early days of the industry both the chemicals distributed and the trades using them were limited in number and each had been long established. Cus tomers were so accustomed to the use of the existing compounds that specific instructions seemed unnec essary, and such warning labels as were used on industrial chemicals were limited to the stronger HOGAN 611 adds and alkalies, and extreme poisons. There were, of course, the 1927 Federal Caustic Poison Act and a number of state poison and pharmacy acts, but these were chiefly directed to the labeling of house hold packages. In most cases they were pointed toward the hazard of ingestion and relied solely on the word "POISON" to warn the user. The expansion of the industry and the broadened use of its products brought recognition of the need for more comprehensive labeling. One of the early steps in this direction came in 1934 and covered the uniform precautionary labeling of six products or product groups under a series of voluntary agree ments between the manufacturers of these products and the Surgeon General of the United States. These agreements served a very useful purpose until they were discontinued by the United States Public Healt Service in 1952 because specific labels for these pro ducts which had, in the meantime, been developed under the Manufacturing Chemists' Associations program were considered more appropriate. As chemical products, especially in the organic eroup, mulitiplied and grew more complex, the need for further steps became evident. This was emphasized by a survey conducted by the Association in 193b which resulted in distribution to its member executives of a printed book titled "A Confidential Report on Adequate Labeling--Its Importance to the Chemical Manufacturer." This report persuaded many com panies to embark upon their own warning label programs or to expand those already begun. World War II greatly accelerated the growth of our industry. Not only did established companies ex pand their production of well-known chemicals, but they developed innumerable new ones. Many porations from other segments of industry, as as completely new concerns, began chemical manu facture. And--most important of all, from *he P01 of view of precautionary labeling-thousands of in d vidual companies, large and small, and millions o workers began to operate processes - , n g ch m . s entirely foreign to any of their previous expcrmn ^ The need for a comprehensive program of education 7n the safe handling of chemicals was obviou. Early in 1944 MCA considered the p ro b le m at a meet g of its member executives. It was decided that the best m hod to reach the man in the shop using chemical products waSf by Informadon1'"committee" was accordingly authorized. The LAPI Committee, as it has since been popu ar^y railed met for the first time on May 17, 194 insure' A broad view of the problem, the members I srS I S ^ Guide For the Preparation of Warning Labels fo Hazardous Chemicals." This manual, ferred to as the "LAPI Manual," is now in the review stage, with a Fifth Revision scheduled for publica tion this year. I t m ig h t be a s s u m e d t h a t , h a v in g agreed upon the need for precautionary labeling, the writing of labels would be simple. All one need do, you would say, is to mark a hazardous product POISON and add the do's and don'ts. Unfortunately, the problem is more involved than that. What are the meanings of the terms used? Chemi cals may be harmful in a variety of ways. A product which may threaten your life solely by ingestion should not be labeled the same as one that may kill by absorption through the skin. Of course, there is also the matter of degree. How shall we distinguish between the vapor or gas which asphyxiates and one which causes cyanosis? What really is a "poison"? There is the difficulty of language. Statements must be brief but accurate. They must be expressed in terms that ordinary workmen understand. Not only must the statements help avoid accidents, but if such occur, first aid should not be delayed while someone hunts an interpreter. In the case of trade-named chemicals or proprietary compounds, what is our responsibility to the doctor who may be asked to treat persons injured by them? As a result of these and many similar questions, the following principles were adopted. These principles are set forth in detail in and comprise Part I of the LAPI Manual. 1. Each chemical product presents a distinct prob lem and must be treated individually in the light of its own characteristics. Conclusions regarding the hazards of a product cannot safely be drawn either from the properties of the materials from which it is formed or by analogies based upon chemical struc ture. Mixtures of two or more chemicals may have properties that vary in kind or degree from those of the individual components; any warning label for mixtures should be based on the properties of the finished product. Impurities may contribute hazardous properties and should not be overlooked. 2. All statements on warning labels should be brief, accurate, and expressed in simple, easily under stood terms. 3. Precautionary labeling should be used only when and to the extent necessary. T he language should be practical, not based upon the inherent properties of a product alone, but directed toward the avoidance of hazards resulting from such use, handling, and storage as may reasonably be anticipated. The use of warning labels for relatively harmless products or the use of unnecessary words will develop a disregard for labels and defeat their purpose as surely as will failure to give adequate notice of hazards. 4. On labels of different products uniformity in lan guage to indicate the same hazards and same degrees of hazard is most desirable in order to gain greater understanding through standardization. 5. The following subject matter should be con sidered for inclusion on a warning label: (a) name of product; (b) signal word designating degree of hazard-DANGER!, WARNING!, or CAUTION! (c) Affirmative statement of hazards; (d) precautionary measures covering actions to be followed or avoided, (e) Instructions in case of contact or exposure where advisable (NOTE: under some laws antidotes are re quired when the word "POISON" is used.) Instruc tions for the handling and storage of containers should also be considered for inclusion on the label. This is information relating to characteristics of the con tainer as well as those of its contents.* 6. The inclusion of the word "POISON" and the skull and crossbones on a label should be limited to those cases where the product is a poison according 612 SOCIAL AND LEGAL ASPECTS to a definite toxicity standard or where such use is prescribed by law. When used, this legend should be in addition to the other label warnings and should not take the place of the words DANGER!, WARN ING!, and CAUTION!, which are designed to show the relative degree of hazard/)- 7. A nondescriptive code designation or trade name should not be used as the only identification of a hazardous chemical. If the complete name is not shown, the label should clearly state the type of chemical--e.g., "Corrosive Acid", "Lead Compound". 8. Warning statements should be grouped together in a prominent location on the label and should be printed in easily legible type which is in contrast by typography, layout, or color with other printed mat ter on the label. The label should be affixed firmly to and in a conspicuous place on the container. In accordance with the principles just stated the usual warning label includes: (a) a "signal" word-- "DANGER!", "WARNING", or "CAUTION"--to give a general indication of the severity of hazard; (b) a statement of hazard or hazards--such as "Vapor Extremely Hazardous", "Causes Burns," or "Rapidly Absorbed Through Skin"; (c) precautionary measures --such as "Do not breathe vapor," "Keep away from heat and open flame," or "Avoid contact with skin and eyes"; and (d), where appropriate, instructions in case of accident, as "In case of contact immediately flush skin or eyes for 15 minutes; for eyes get medical attention." Using these or similar statements, a typical label may read: ANILINE DANGER! HAZARDOUS LIQUID AND VAPOR RAPIDLY ABSORBED THROUGH SKIN Do not get in eyes, on skin, on clothing. Avoid breathing vapor. Use only with adequate ventilation. In case of contact, immediately remove all contaminated clothing, including shoes, and flush skin or eyes with plenty of water for at least 15 minutes; get medical attention. Wash clothing before re-use. POISON *Author's Note: The Manufacturing Chemists' Associa tion has available at its office, 1825 Connecticut Avenue, N.W., Washington 9, D.C., at nominal cost, a series of individual Chemical Safety Data Sheets on the properties and essential information for safe hand ling and use of 79 chemicals, Manuals on Standards and Recommended Practices on the use and handling of specific containers, and an outline of recommended general precautions for handling and storage of cer tain classes of containers in the MCA LAP1 Manual. These data will serve as excellent guides in the devel opment of applicable phrases for container handling and storage statements. j-Author's Note: The word "POISON'' has been used indiscriminately in the past, and its meaning has been ill defined. For labeling purposes the MCA Manual recognizes poisonings by three modes of entry--viz., ingestion, inhalation, and absorption through skin-- but limits use of the word to those cases where the toxicity has been demonstrated, either by human ex perience or laboratory animals tests, to exceed certain defined limits. Parts II and III of the LAPI Manual contain several hundred illustrative labels such as the one shown. Those in Part II are for industrial chemicals. Ex amples included are generally for those products most important commercially, and, as a whole, they take in a broad range of hazards. The labels in Part III cover the majority of pesticides sold in large volume. This section was added following the passage of the Federal Insecticide, Fungicide, and Rodenticide Act in 1947. The latter requires adequate warning labels for this important group of chemicals, and the MCA labels have the informal approval of the United States De partment of Agriculture and are consistent with its Interpretation 18, Revision 1. How successful is the LAPI Program? As may be expected, the LAPI principles have the broad support of MCA members, who, as stated earlier, represent 90 per cent of the U.S. production of industrial chemicals. In fact, chemical manufacturers, both in and out of the Association, fully supported these principles. The very fact that such a program exists and is supported exerts a persuasive force upon the manufacturer who might otherwise neglect proper labeling. The latter knows that, should he be called to court because of claimed injury by one of his inadequately labeled products, the opposing counsel would surely cite the warning statement used on similar competitive products. Within months after the organization of the LAPI Committee in 1944, its chairman was asked to serve as advisor to the State of California, which sub sequently became the first of several states to regulate the precautionary labeling of hazardous chemicals. Besides California, the ensuing years have seen sim ilar regulations or laws adopted by Connecticut, Oregon, Hawaii, Illinois, Texas, New Jersey, New York State and New York City. All have been based upon the MCA principles. Reference has already been made to the Federal Insecticide, Fungicide, and Rodenticide Act, and to the fact that LAPI labels comply with the regula tions issued pursuant to it. At meetings of the International Labor Organization, held in Geneva, Switzerland, the MCA's precaution ary labeling system was endorsed and much of its content adopted for ultimate use by ILO on a world wide basis. A committee of the International Association of Governmental Labor Officials, which consists of U.S. and Canadian state, provincial, and federal admin istrators, has developed a "Suggested Draft for Uni form Rules and Regulations relating to the Labeling for Use, Handling, and Storage of Containers Hold ing Substances Harmful to the Safety and Health of Employees." This draft adheres to LAPI principles and was the foundation for the current regulations in New Jersey and New York State and City. In this highly regulated era--when all of us, and industry particularly, are subjected to many restrictive laws and regulations--it is to the credit of the chem ical industry that its adequate labeling practices began as a voluntary program and that the labeling legis lation of recent years has been in support of the industry's principles rather than controverting them. Further evidence of the LAPI Committee's in fluence is the fact that definitions for "POISON" sub stantially identical with that of its manual were written into the regulations under the Federal In secticide Act and have also been substituted in the KLEIN 613 Interstate Commerce Commission Regulations for the former definition of "Class B. Poisons." Again, LAPI has been instrumental in obtaining the acceptance of the word "flammable" by ICC and other public agencies as less likely to be misunderstood than "inflammable." Its reputation has extended so far that in 1953 the Association of British Chemical Manufacturers, which is MCA's British counterpart, sent representatives to this country solely to study the LAPI program and subsequently adopted one par alleling it. __ This program is receiving additional impetus from other trade associations, which have been most gener ous in their cooperation. As already indicated, the LAPI objective is principally aimed at industrial chemicals. While the principles are generally accept able to all groups, their application may vary in detail for different segments. A committee of the Chemical Specialties Manufacturers Association has prepared a model law for the labeling of household products. Directions for use are usually an important addition to small household packages and may convey information for proper use which supplements the precautionary statements. Similarly, the American troleum Institute recently published a manual of pre cautionary labels for petroleum products as distinct from petrochemicals. Both associations support L A ri principles. T he common aim of all these groups is the adequate and uniform labeling of the hazardous substances which they produce. Uniformity is essential for the free flow of commerce and important in educating people to understand the significance of label warn ings. The public must be led to recognize that chemi cal products may, on occasion, be hazardous and re quire care in handling, just as experience teaches us that care in handling is necessary with edged tools and with electrical and mechanical devices. Unlike the latter, which seldom carry warning labels, chemicals will always require some precautionary labeling, because their properties can seldom be deter mined by visual inspection. In conclusion, I should like to emphasize that any precautionary labeling program based upon the prin ciples set forth by the Manufacturing Chemist s Asso ciation could not be considered experimental. The concept on which such a program was based has been time-proven and accepted in similar programs inter nationally. With such a program you have not only taken out insurance on the future of your products, but you have provided a necessary adjunct in the fundamental obligation to warn of the health hazard* involved in the use of either new or established Droducts. I thank you! THE CARDIAC CASE IN WORKMEN'S COMPENSATION I r v in K l e in , M.D. Medical Director, Workmen's Compensation Board, State of New York It is my great pleasure to be able to address this thirteenth International Congress on Occupational Health.' It is significant that common problems know no national boundaries, and together we have sough remedies in different countries of the world for over 30 years. It is apparent that this is the on y sun method by which we can solve these problems^ It is of additional significance that we are thus able: to set a good example of the way in which other matters may be disposed of. This afternoon we are to consider the cardiac case in workmen's compensation. To merely dismiss it with the wave of the hand is unworthy of he talent and intention of this organization. A search Into the causes and results in this area is necessary and important. There is a continuing and growmg interest in the cardiovascular episodes during and in the course of employment. Recently great attention has been paid to the increasing number of these cases which have come before the workmen s compen sation boards for evaluation and adjudication. 1 , New York State for the years 1947 to 1957 t h e T i * have risen from 167 compensated cases to 54j fo the first six months of 1960 up to 150 cases were closed without award for many reasons (failure to prosecute, withdrawal of claim, and failure to make out a proper case after trial). T he most frequent involvement has been the coronary arteries resulting in postocclusive angina, failure, pulse irregularities, and infarction. It is not necessary at this time to review the var ious skills involved in the diagnostic procedures, nor is it necessary to review the need for proper hist ry and record keeping. We can safely assume that the trained physician is fully aware of the need for these There remains, therefore, only the consideration of the relationship of the pathologic process to the work load and the proper rehabilitation of the pa tient. It is suggested that the exact mechanics involved in the closure of a coronary vessel and the resultant myocardial infarction are not fully understood. I must be further conceded that the sclerotic process begins fairly early in adult life and this, undoubtedly, plays a large part in the occurrence in industry. It has been the philosophy that the working man is hired for his abilities along with all of his dis abilities, whether manifest or hidden. It is therefore incumbent upon the physician to be the first to rec ognize this in industry. Others should be cognizant of this as well. It appears to me that no defenses can be set up on the thought that in a given case with any degree of sclerosis the clinical end result would have occurred in any event. We must recognize that this type of reasoning leads nowheres, since general izations have little value in this area. It is best to be prepared to take an attitude which appears rea sonable to ordinary analysis and be ready to review each case on its own merits. Recognition that * do not have a full explanation at this time should not preclude us from drawing a conclusion. P It is important to keep in mind that the legal process is the dominant factor when the cardiac case in industry is discussed. Too often the physician b e co m es involved in a case to a point beyond his medical sphere. At that point he attains the status of an advocate in the proceedings for which he is not trained, for which he is obviously ill prepared and 988 m a x im u m a l l o w a b l e c o n c en tr a tio n s i i o l 'T o " 'volume could be considered only lor was evident that a worm.. modifies it into t r x C o i ^ * . v >cM >nd te ''9, ;Lmd,Ip..p" e - r * J t v s -- = d nt i r : I TM -s especially U w. take." ^ " t m 'o T r icbl.r.rhyleue u ./E f r 'd t d - From our previous experiments, where ifp e rlL "" f i ' f ntration, s i a r s W * * ? * 8^ acid in mg to trichUirethykne m ^g i n 1 ' 0^ ^ ^ K^,,F i.o This ratio was decreasing wun ^ ^ ng concentration of trichlorethylene Several obser- various from practice bear " ^ ^ e ratio is the- o u r.'T n V " ^ "^ ^ , Bartonifek). I think oretically 1.1 (oouce accurate directions that it is not possible to give ^ n^ a^CCUTring in for practice, due to the great thihcultics o ct g the current hypnotic dose is 1 2 g, sr,, thal the American MAC is rather too is not - gh" .nnecresfsrar,y spend with 100 to 2W'Mg. ds wkh 100-200 Mg This concentration in air correspont *^*5*.*' values in the most important industna P<,lso" s e.e ought to be available a great number made observations in practice. absorption, investigate, in laboratory experiments, the P metabolism, d elimination .< " medical thinking " ' "m e. " animal. r - r - , '. " * . * " - " TM 't duced chemical substances. SCBK PRINCIPAL INDUSTRIAL TOXINS Ch a r l e s R. W il l ia m s , P h .D. Assistant Vice President, Liberty Mutual Insurance Company, Boston, Massachusetts , In the United States, hygienic nkanaards (tolenabU l.i.m....i.ts*) < i r : S c s- . .i a i . i,..;h->;-t2 ~ r s dr.n" dependent on the T V ' i f ' expSure which can be materials there are level P ndpai cxcep- tolerated without adverse e f f e c t . appUed ^ TM^ enee , - * !" " J T Z ? ;;rc ri L iy h. mum Allowable Concent,ration, whieh -ta the broadest usage; "Maximal A cc^ab te on," which has been u ^ by the A ^ Standards Association ZS7 ` J > the T h re sh o ld U m tt Values, ln d u s t r ial American Conterence basic lions to this Phl' s0'J >n a^ h materials. So little is to carcinogenic and sen itizJ ! and sensitiza- known of the processes of carcinogendJ that k v d s ^ know n'^ardnogeni^and Hygieni... (2). AllI of them " TM T ,W e . a .. ,,low.ble implicanon--namely a llncic which denotes a or acceptable or that th ,oxic As a matter of fine line between toxic and n" t0X1Cc he impUed fact, the users of these terms a^ mantiaP In connotations. The problem . s at the 9th I h R h ' r b f . o ^ a t d V industrial environment. term inology In order to avoid confusion it must be pointed out 1949 the Committee on CheI" 1.Ca SHealth (United Annual Congress n O c c u p a U ^ ^ H ^ ^ . . ^srs^s^^Jtiss: that there are differences in terminology with refer- WILLIAMS 989 "Hygienic Guide Series" using the term "Recom mended Maximum Atmospheric Concentration (8 hours)." In 1956 Smyth (3) proposed the use of "Hygienic Standards for Daily Inhalation." For some time the writer (4) has been urging the general accept ance of the concept of "Hygienic Standard" or Hygienic Guide," since these terms express much more accurately the actual purpose of the application of such criteria in the occupational health field. ORGANIZATIONS In the United States the establishment of hygienic guides is carried on by groups of competent indi viduals operating within existing organizations and utilizing available technical information. The Amer ican Standards Association, a private1 organization representing American industry, has been sponsoring development of standards in the occupational health field since 1941, chiefly through its Z37 Committee. These "American Standards" include the scope and purpose as well as general physical-chemical and toxic properties, "Maximal Acceptable Concentration," and sampling and analytical methods and references. Since their start 19 such standards have been pub lished, and the Committee is continuing to be ex tremely active in the field. The basis on which this Committee operates is set forth in the introductory statement provided with all of their standards, as follows: "The Meaning of Maximal Acceptable Concentration" (1) It is generally recognized that there are levels of concentration of atmospheric con taminants to which a person may be exposed without known ill effects or discomfort. In view of the impracticability of maintaining uncontaminated air in most industrial envir onments, it is necessary to establish accept able concentrations of atmospheric contam inants encountered in industrial operations. These concentrations in themselves do not represent a scale of relative toxicity; they represent the concentrations of contaminants below which ill effects are unlikely to be experienced by any but hypersusceptible indi viduals. These concentrations are usually based upon data obtained by one or more of the following procedures: (1) Laboratory tests on animals (2) Laboratory tests using human subjects (3) Environmental and medical investiga tions in plants A common feature of these procedures is that the experimental exposure shall cor respond . to the normal work pattern. This should be taken into consideration also in the application of maximal acceptable concentra tion values. Three criteria have governed the establish ment of these concentrations: (1) Organic or other tissue changes (2) Functional reactions which have no discernible untoward effects on health but cause impairments, such as in-co ordinations and increased proneness to accidents (3) Discomfort or adverse sensory effects In those cases in which the concentrations have been established on the basis of organic changes, it is logical to assume that repeated exposure to concentrations significantly in excess of the acceptable concentration prob ably would produce injury. When the level has been established on the basis of a func tional change or discomfort, it is logical to assume that exposure to concentrations not greatly exceeding the acceptable concentration would not produce materially injurious effects. Hence it is important to understand the cri teria upon which any such maximal accept able concentration has been established. Though the purpose of the acceptable con centration is to minimize health hazards, its immediate use is for guidance in establishing engineering procedures to prevent objection able concentrations of toxic or noxious ma terials from being present in the air of work places. Comparison of the results of air analyses with those concentrations indicates acceptable conditions or otherwise the need, extent, and urgency of control measures. Sampling and analysis should be carried out by competent personnel using an acceptable method which will provide a reliable measure of exposure. Air analyses in conjunction with acceptable concentrations of such atmospheric contam inants as are encountered in industrial opera tions serve as a measure of exposure--not as a means of diagnosis of occupational disease. Diagnoses should be based on a consideration of all factors including results of clinical and physical examination as well as of air analyses, means of assessing amounts of materials in the body, and a knowledge of toxicologic effects of the materials in question. In the application of the standards, it should be kept in mind that: (1) The acceptable concentrations serve as standards of good practice. (2) They serve as engineering guides. De sign and operation should aim at main taining all concentrations below the acceptable maximum. (3) They should be applied and interpreted by competent individuals with a full understanding of the basis and limita tions of the information from which the standard has been developed. (4) It is advised that these standards are considered to be guides toward good industrial hygiene and are not intended as legal requirements. (5) The levels are applicable only to ex posure to a single substance. In the case of exposure to mixtures, the effect may be increased or decreased, and con trols should be based on the specific situation. r The American Conference of Governmental Indus trial Hygienists began its work in the standards field in 1947. They publish annually a list of the materials, with values, which they call "threshold limits." The values which are given represent the concensus of a committee of qualified experts in the occupational health field. They are reviewed and brought up to date each year. The most recent published list dated 1959 (2) contains values for 169 gases and vapors; 71 toxic dusts, fumes, and mists; 11 mineral dusts; and a list of 21 so-called tentative values. The basic philosophy of this group is set forth in paragraphs preceding its listing of values: "Threshold Limit Values for 1959" (2) Threshold limits should be used as guides in the control of health hazards and should 990 MAXIMUM ALLOWABLE CONCENTRATIONS iYW> not be regarded as fine lines between safe and dangerous concentrations. They represent conditions under which it is believed that BASES FOR THE ESTABLISHMENT OF HYGIENIC GUIDES nearly all workers may be repeatedly exposed, day after day, without adverse effect. The values listed refer to time weighted average concentrations for a normal work-day. The amount by which these figures may be ex ceeded for short periods without injury to health depends upon a number of factors such as the nature of the contaminant, The establishment of numbers for "tolerable limits" in the United States is based primarily on two kinds of information: animal experiments and human ex perience. The scientific research which produces the basic data is carried on by private industry, univer sities, research laboratories, and governmental agencies. The results of such investigations are published in whether very high concentrations even for many United States technical and scientific journals. short periods produce acute poisoning, whether the effects are cumulative, the fre quency with which high concentrations occur, and the duration of such periods. All must be taken into consideration in arriving at a decision as to whether a hazardous situation exists. Special consideration should be given to the application of these values in the In some cases, particularly new chemicals, the tech nique of applying analogy with other well-known chemically similar materials has sometimes been used until valid data have been accumulated. The committees or organizations referred to above utilize all available published and unpublished data in arriving at their judgments as to the kinds of evaluation of the health hazards which may levels which will provide a basis for safeguarding be associated with exposure to combinations of two or more substances. employee health. Threshold limits are based on the best avail able information from industrial experience, Animal Experiments from experimental studies, and, when pos The technique of evaluating toxicologic and sible, from a combination of the two. These values are based on various criteria of toxic physiologic responses in animals as a means of pre 5 effects or on marked discomfort; thus, they dicting possible effects of toxic materials, physical I should not be used as a common denominator agents, or other environmental conditions on man has of toxicity, nor should they be considered as long been a routine tool in the occupational health the sole criterion in proving or disproving field. Irf spite of this, however, there has been little diagnosis of suspected occupational diseases. attempt made to provide a standardized approach to These limits are intended for use in the field of industrial hygiene and should be employed by persons trained in this field. They are not intended for use, or for modi fication for use, in the evaluation or control of community air pollution or air-pollution nuisances. These values are reviewed annually by the Committee on Threshold Limits for changes, investigative techniques in industrial toxicology. In many respects this is fortunate, for in dealing with the effects of a toxic material on a biologic system considerable flexibility is required in applying estab lished criteria. Usually early tests will indicate the course of further study. The magnitude of acute lethal doses and the effects on different organs will indicate the severity of the acute hazard and the revisions, or additions as further information importance of various routes of absorption. Corollary becomes available. The Committee welcomes the suggestion of substances to be added to the list and also comments, references, or reports of experience with these materials. information relative to species variability, sex, age, and possible synergistic effects can be obtained at this time. All of this information will then provide a basis for future, more extensive long-term studies. In addition to these two groups, the American Industrial Hygiene Association has, since 1955, been publishing the Hygienic Guide Series. To date guides have been published for 97 substances. In many respects this series is similar to the recommendations of Smyth in his report to the A.I.H.A. in April 1956. Information is provided for each material relative to the recommended maximum atmospheric concentra tions; severity of the hazards (both health and fire); the short-exposure tolerance; atmospheric concentra tions immediately hazardous to life; physical and chemical properties. In addition, under the heading of "Industrial Hygiene Practice," brief statements are given as to recognition, evaluation of exposures and recommended control procedures. Also, under the heading "Specific Procedures," brief descriptions are given of first aid, prophylactic measures, and special medical procedures. Finally, a list of references is given. It is also significant that in each case, under the heading of "Recommended Maximum Atmospheric Concentration," a statement is made as to the basis In the case of new substances, the first step which is generally adopted by toxicologists or industrial laboratories in the determination of toxicity is the utilization of screening tests on experimental animals. These are usually followed by detailed studies of acute effects resulting from single injection, ingestion, or inhalation experiments. In addition, irritating effects on skin and eyes are evaluated. In 1956 a complete compilation of acute toxicides for an extensive series of materials was published under the auspices of the Aero Medical Laboratory (5). The purpose of this volume was to bring together available data on "acute toxicity of various substances for several species of commonly used laboratory animals as determined by oral or parenteral admin istration, or inhalation, of fatal doses." In the intro duction to this volume the various significant con ditions influencing the acute toxicity for any given compound were discussed. These include the dose, the rate of absorption, route of administration, site of injection, and other influences, including disease, of the recommendation. This approach represents by environment, temperature, habit and tolerance, etc. far the most desirable way of dealing with the In addition, it was pointed out that the toxicity of problem of establishing hygienic standards. Mere lists chemicals will vary with species of animals and some of numbers leave much to be desired. It is extremely times even with different strains of the same species. i important that all available information relative to Within the same strain the toxicity may differ with the establishment of the standard be included with it. age, weight, sex, and general condition of the animals. 3 WILLIAMS 991 Because of all these variables it is virtually impossible to be certain that all experiments are conducted in precisely the same way. In fact, only rarely does one find detailed discussion of all such factors involved in an experiment. Following accumulation of data on acute effects, long-time chronic effects are then studied through inhalation, feeding, injection, and skin-absorption ex periments. The nature of these is determined by the results of earlier screening tests. At a conference on The Toxicological Basis of Threshold Limit Values in 1959 (6) V. K. Rowe and his coworkers presented an extensive summary of the kinds of observations which had been made over a period of more than 20 years by several industrial groups. This discussion summarized and tabulated observations on mortality, food intake, body weight, organ weights, gross pathol ogy, micropathology, hematology, blood urea nitrogen, clinical urine analyses, central nervous system, and cholinesterase. Tables I-IV summarizing the frequency with which particular effects were observed under various circum stances give an indication of the significance of sev eral biologic and biochemical determinations. The significance of growth studies and cholinesterase in Tables I and II and the significance of the liver and kidney in all of these studies are well demonstrated in Tables III and IV. The authors (6) point out that there is increasing pressure for more and more precise kinds of measurements in the biochemical and toxi cologic fields as a means of establishing valid threshold limits. They point out, however, that while this is an excellent objective and one toward which all should strive, it is essential that one make the most practical use of available manpower and funds to obtain the most meaningful information. The criteria which are set forth in this paper are those which are most widely used and certainly accepted by all workers in the field. The best hope for increasing our fund of knowledge derived from animal experiments must come from the development of new techniques and new criteria. In summary, the authors of this paper state: In spite of the fact that there are many new criteria being developed and tested today, the data presented herein emphasize the high value of certain of the older criteria. It would seem only prudent to make use of those studies which experience has shown to be most productive. This does not mean that only those criteria showing a high degree of efficiency in the series of investigations re ported herein should be used, but certainly it suggests that they should be basic to any toxicological study designed to determine a threshold limit for repeated exposure. One other set of criteria which is attracting more and more attention are those physiologic studies which can be made on animals as well as on humans. In the symposium mentioned above, Dr. John A. Zapp, Jr. (7) discussed the importance of utilizing physiologic observations such as systolic and diastolic T able I FREQUENCY W ITH WHICH A PARTICULAR EFFECT WAS OBSERVED AT THE LOWEST DOSAGE LEVEL AT W HICH ANY EFFECT WAS OBSERVED (6) Criteria of effect D ata from 1952-1959 Oral a % Vapor a % Data from last 22-25 years All routes a % Growth Hematology Clinical urines CNS Cholinesterase 64 (172) 37 16 (38) 42 152 (410) 37 1 (79) 1.3 1 (21) 5 5 (170) 2.9 1 (7) 14 0 (7) 0 2 (43) 4.6 4 (109) 3.7 1 (32) 3.1 5 (141) 3.5 8 (10) 80 8 (10) 80 Number of positive findings (num ber of observations) T able II FREQUENCY W ITH WHICH A PARTICULAR EFFECT WAS THE SOLE EFFECT AT THE LOWEST DOSAGE LEVEL AT WHICH ANY EFFECT WAS OBSERVED (6) Criteria of effect Oral a D ata from 1952-1959 Vapor % a % D ata from last 22-25 years All routes a % Growth Hematology Clinical urine CNS Cholinesterase 25 (172) 15 0 (79) 0 0 (7) 0 4 (109) 3-7 4 (10) 40 2 (38) 1 (21) 0 (7) 1 (32) 5 44 (410) 11 5 1 (170) 0.6 0 0 (43) 0 3.1 5 (141) 3.5 4 (10) 40 "N u m b er of positive findings (n u m b er o f observations) WILLIAMS 993 ww*iH**n i>iwnrct,l**i<*|| |" l***mn* |* ,,w** |>J '**,g**ll,***> terms of the significance of such information in application to humans. H um an Experience While animal data provide some basis for judgment about the possible levels of toxic materials which may be used safely in industry, they cannot be extrapolated to humans with complete confidence. The ultimate criteria must come from human experience. The validity of such criteria is based on the amount of experience in terms of both numbers of exposed people and time of exposure, on the methods of evaluation of the effects of the toxic material on people, and on the completeness of the evaluation of exposure levels in the environment and correlation of these levels with human exposure. Data with reference to human effects are obtained from both controlled experiments and industrial environment exposures. In the case of irritants, for example, such factors as odor detection, sensory response, and levels of exposure which are irritating to eyes, skin, and upper respiratory tract have been studied quantitatively in humans under controlled conditions. In general, such studies, combined with experience gained with actual plant use, provide an adequate basis for establishing or confirming hygienic standards for such substances. It is much more difficult to provide a sound basis of human experience for substances which require rela tively long periods of time before producing evidence of injury. Whereas the acute effects can be evaluated relatively rapidly and by simple procedures, long-time detailed studies of controlled groups of industrial workers are required to provide adequate evidence in the case of those substances which may produce chronic injury. T he kinds of information which are available from industrial experience with various chemicals fall into three basic categories. One of these is limited td com plaints associated generally with the sensory response or with more severe forms of acute irritation reactions affecting skin, eyes, or upper respiratory tract. The second kind of data result from clinical examination of exposed workmen. The third is the result of human toxicologic or physiologic studies. To be of value in establishing hygienic standards such medical informa tion must be correlated with adequate data relating to the concentrations to which workers have been exposed. In his paper "Improved Communication. Hygienic Standards for Daily Inhalation" Smyth (3) reviewed 238 values from the 1956 American Conference of Governmental Industrial Hygienists list, together with his interpretation of these values. He has also eval uated the nature of the supporting data--animal and human. An analysis of the four kinds of sources of human data indicates the role of such experience in establishing hygienic standards in the United States. Of a total of 238 values which were analyzed human data were utilized in 108*, distributed as follows: Clinical Examination of Workmen Was Correlated With Their Exposure 34 Industrial Complaints or Observations Less Quantitative Than Clinical Observations 33 Human Sensory Data 42 Human Toxicologic or Physiologic Data 10 *Of the 119 values distributed in the above tabulation there were 11 duplicates wherein the same material appeared under two or more headings; thus there were actually 108 separate substances analyzed. In such an extensive list as this there are many materials which are so little used that there is negligible industrial experience available to assist our standards people. For such materials reliance is placed primarily on animal experiments and the use of analogy as guides in setting limits. For the more common industrial chemicals many years of experience in using them has provided the necessary background to verify existing standards. Such experience is generally of a negative nature. Where it is supported by clinical or physiological data correlated with levels of exposure, as in the case of the ten-year study of butyl alcohol by Sterner and his colleagues (10), the information is most significant. Such medical programs are designed to evaluate the general physical condition of employees and to include specific physiologic tests which may be expected to provide early evidence of injury. Studies of this type are by far the most valuable for establishing valid hygienic standards. SUMMARY AND CONCLUSIONS In summary, it can be stated that hygienic standards for inhalation in the occupational health field in the United States are based on the application of the best known biochemical, toxicologic, physiologic, and pathologic techniques to animals and to human experience. Investigations are carried on by private industry, universities, research laboratories, and gov ernmental agencies. The analysis of such data and interpretation in terms of hygienic standards is done by standards groups composed of competent scientists representing every facet of the occupational health field. The validity of these standards is demonstrated by the low occupational disease attack rate in the United States. Verified cases of such injury are the result of exposures far above the established limits. Many approaches are being made to the problem of establishing hygienic standards in the occupational health field. It became obvious some time ago that research people in various parts of the world were in some cases utilizing varying techniques. As a result, values for some substances differ by as much as an order of magnitude. In an attempt to get some uni fication in the basic approach to the problem and to provide a mechanism to permit a much broader exchange of information and data among occupational health workers, the Permanent International Com mission on Industrial Medicine set up a Subcommittee to study this problem. This Subcommittee held a symposium on Maximum Allowable Concentrations of Toxic Substances in Industry in Prague, Czechoslo vakia, on April 14-17, 1959. The Transactions of the Symposium, which appeared in four sections, deal with general areas of agreement among the delegates. This statement of principles is an important first step in establishing international cooperation in this im portant field. On the basis of this work it is hoped not only that we can look forward to the development of a series of internationally acceptable hygienic standard values but that agreement can be obtained with regard to genera' principles and to methods and procedures which will be utilized in the establishment of such standards. T he present Symposium, which is the second under the auspices of the Subcommittee will, I hope, crystallize even further the thinking of those in the occupational health field concerned with establishing sound standards to be used in assuring safe industrial environments. Index o f Authors Adams, C. A., 93-98 A granoff, B arbara, 351-353 A hlm ark, A., 201-203, 653-656 A lbahary, C., 203-214 A nderson, W illiam H., 656-661 Ashe, W illiam F., 835-839 A shm an, George R., 351-353 Askey, E. Vincent, 62 Axelsson, B engt, 201-203, 977-980 Balkanyi, N., 465-466 Bambino, C. F., 281-283 Barhad, B ernard, 661-663 Baselga-M onte, M., 663-668 Bauer, Louis H., 85-86 Baughn, W illiam L., 668-672 Bayonet, N atalio, 214-217 Belding, H. S., 839-845 Belknap, E lston L., 217-226 Benitez, Julio Cesar, 531-532 Benoit, Joyce N., 266-270 Benton, Joseph G., 314-316 B erdan, C., 845-847 B ernath, Zoltn, 227-230 Bielecka, W., 795-798 Biggs, M. W., 147-150 Bissonnette, Grace, 230-232 Blatz, Hanson, 463-465 Block, Duane L., 678-679 Bloomfield, John J., 98-101 Bojin, S., 677-678 Bolis, L., 817-818 Bonjer, F rederik H., 672-675, 848-850 Bonnell, J. A., 93-98 Bordes, H. J., 850-857 Boudene, C., 209-214 Box, A rthur, 298-301 Brand, M orris, 603-605 Brandaleone, H., 937-939 B reitenecker, Leopold, 675-676 B rennan, M iriam C., 314-316 B rieger, H einrich, 720-725 B rinkm an, Geoffrey L., 678-679 Bronstein, Lewis H., 232-237 Brouha, Lucien, 857-862 Brown, J. R., 862-864 Brownlow, Jam es A,, 605-607 Bruce, T., 653-656 Brykalski, D., 800-801 Burger, G. C. E., 864-869 Burney, L. E., 63-64, 101-104 Cadariu, Gh., 237-238, 676-678 Cancella, Lopo de Carvalho, 56 Cataldi, R., 181-182 Cavagna, G., 770-772 Cavigneaux, A., 203-209 Charsha, R. C., 580-585 Churchill, A. G., 281-283 Ciuhandu, Gh., 237-238, 676-677 Coates, E. Osborne, Jr., 678-679 Cobo de Bias, Eliseo, 238-240 Collins, S. K., 281-283 Colonna, F rancis L, 241-242 Conrad, Reuben, 869-870 Cotabish, H a rry N., 544-551 Cracuin, 0., 679-681 Crisan, V., 237-238, 676-677 Cruickshank, W. H., 105-106 D ankner, A., 237-238, 676-678 Daw, H. T., 86-87, 106-110 Deichmann, W illiam B., 871-872 Dervillee, P., 242-243 Desoille, H., 209-214 Didonna, P ietro, 110-114 D inatale, P eter J., 244-245 Dinischiotu, G. T., 343-345, 679-681 Dohan, F. C., 182-184 D'Onofrio, V irgilio, 181-182, 958-959 D ossett, Burgin E., Jr., 656-661 Dror, K., 245-246 Duffner, Gerald J., 939-942 D u n la p , M . K ., 28 1-28 3 D unster, H. J., 114-118 D urham , Thelm a J., 246-249 Dutkiewicz, Tadeusz, 681-686, 795-798 [997] 998 E ckardt, R obert E., 7-10, 64-65 E ckhardt, W., 850-857 E lkins, H ervey B., 981-983 E rh a rd t, J . Th. G., 850-857 E stadella-B otha, S., 663-668 ' F abre, Ren, 686-692 Felton, J. S., 413-426 Ference, A nne M., 12-14 F erra n , G. H., 486-503 Fiandaca, S., 353-359 Finulli, M., 770-772 Fischer, R,, 872-876 Fisher, R. . W., 250-256 Folsom, M arion B., 72-82 Form nek, J., 714-721, 872-876 Fornells-M artinez, E., 663-668 Forssm an, Sven, 68-72, 257-258 F ortuin, G. J., 258-259 Fournier, E t., 694-698 F rad , G., 259-260 F ra n tik , E., 714-721 F rantikov, D., 872-876 F riberg, Lars, 201-203, 977-980 F riedland, I. G., 692-694 Gabor, Sylvia, 465-466 Gasque, Mac Roy, 260-263 G aultier, M., 694-698 Georgescu, A. M., 343-345 Ghosh, P. K., 426-427 Gillquist, B., 257-258 Glorig, A ram , 699-700 Goldman, Rose, 314-316 Goldstein, Bernard, 263-266 Goldstein, David H., 266-270 Gorospe, Alfredo A., 636-639 G radina, C., 700-702 G rant, E llsw orth S., 118-120 Greene, K atrine R. C., 314-316 G rimaldi, Jo h n V., 607-608 Grimlund, K., 703-707 Gross, Paul, 707-712 Gucciardi, G., 259-260 Guymer, R. F., 270-275 G uyotjeannin, Ch., 694-698 Gwozdz, B., 795-798 Hamilton, Gilbert L., 656-661 Hargreaves, Margaret S., 275-278 Harris, E . S., 281-283 Harris, William B., 466-472 Hatch, T. F., 839-845 Hayes, Wayland J ., J r., 120-122 Hertig, B. A., 839-845 Hinchcliffe, R., 712-714 Hine, C. H., 281-283 INDEX OF AUTHORS Hinkle, Lawrence E., Jr., 283-288 H ipps, John G., 608-610 Hogan, Edw ard J., 610-613 Holden, F. R,, 281-283 Holm, A., 257-258 Holm quist, Carl-Eric, 122-126 Holstein, E rn st, 278-281 Holtz, John, 783-785 Horiuchi, K azuya, 288-289 H orvath, M., 714-721, 872-876 H ueper, W. C., 473-486 Hughes, Jam es P., 879-882 H y att, E. C., 486-503 Inoue, Toshi, 289-290 In tern atio n al Labour Office, 721-724 International Symposium on Maximum Allowable Concentrations of Toxic Substances in Industry, 33-39 Iorga, M., 341-343 Jensen, C. R., 486-503 Juin, G rard, 942-947 Jullien, Georges, 724-726 K am m er, A. G., 427-428 K antor, M., 753-755 K azantzis, G., 290-298 K eatinge, Gerald F., 298-301 K eenan, R obert G., 503-506, 783-785 Kehoe, R obert A., 126-129, 433-436 Kesy, Irena, 726-730 Killens, Richard, 783-785 King, E ,, 301-311 K ingston, Jam es R., 911-917 K itagaw a, Tetsuzo, 506-512 Kiviluoto, Raimo, 311-312 Klein, Irvin, 613-615 K lutas, E d n a May, 428-431 Kopp, John, 783-785 K ruger, Daniel H., 615-621 K rger, P. D., 971-973 K ubota, Juko, 313-314 LaBelle, Charles W., 730-735 Lachnit, V., 947-950 Laham , Souheil, 686-692, 735-738 Lam mers, B., 876-878 Landry, A. S., 512-519 Lavergne, Rafael, 214-217 Lehm ann, Gunther, 878-879 Leoca-Radu, Mina, 349-351 Letavet, A. A., 431-433, 891-892, 983-987 Liber, A m our Fiscus, 738-740 Lieben, Jan , 316-319 Lienhard, Wendell F., 879-882 Lillis, R., 679-681 INDEX OF AUTHORS 999 Linch, A. L., 580-585 Lind, A. R., 882-887 Liniecki, J., 800-801 L ittler, T. S., 712-714 Lubin, Isador, 621-622 Lund, O.-E., 740-741 Lundervold, A rne, 887-891 Lutier, J., 401-402 Lutz, E arl F., 184-186 M cCallum, R. I., 741-745 M cClintock, R. S., 879-882 M cKerrow, C. B., 745-749 M cNerney, Jam es M., 707-712 M agnuson, H arold J., 129-131 M alysheva, A. E., 891-892 M anheim er, R obert H., 314-316 M atthew s, Jam es, 131-134 M atuoka, S yukiti, 893-902 Maxfield, M ary E ,, 857-862 M eiklejohn, A., 134-138 Meila, I., 677-678 M etzner, F ra n z N., 316-319 Michon, R., 902-904 M ihaila, I., 904-908 M ikaelian, Michel, 320-322 M ikisha, A., 714-721 Milijic, Bosko, 950-951 M iller, S. E ,, 937-939 Milox, M., 908-911 M inard, David, 911-917 Miskolczy, W ilhelm, 322-324 Mitchell, R. N., 486-503 Moise, Gh., 676-678 Molfino, F., 952 Monaco, A lfred, 749-753 M orris, G eorge E., 324 M orrow, C. S., 753-755 Moscovici, B., 341-343 Moss, N. H enry, 182-184 Motley, A rth u r W., 623-624 M ountain, John T., 783-785 Moyer, B urton J., 519-522 Muica, N ,, 679-681 M urray, R obert, 139-145 N adudvary, George, 465-466, 755-757 N aie, Thom as W., 625-628 N am ba, T atsuji, 757-758 N estorescu, B., 679-681 N ew nham , C. T., 324-325 Niebroj, I., 795-798 Nixon, Jam es, 699-700 Noro, Leo, 326-335 N orviit, Lem bit, 952-957 Norwood, W . D aggett, 335-338 N y stro m , A., 257-258, 653-656 ` Olloqui, F ernando F lores, 628-631 O yanguren, H ernn, 227-230 Pafnote, M aria, 845-847 P aggi, Edoardo, 758-767 P ancheri, Giovanni, 145-146, 767-768 P ark er, H. G., 147-150 P atrasc u , M., 465-466 Payne, W illiam W., 473-486 P en d erg rass, E ugene P., 768-769 P endergrass, H enry P., 768-769 P erales y H errero, N arciso, 631-632 Pernis, B., 770-772, 817-818 Pesce, Giuseppe, 958-959 Petrescu, Leonid, 661-663 P ettin ati, L., 348-349 Petrovic, Lj., 338-341, 368-371 Phillips, A. M., 553-556 Pietschm ann, H., 947-950 P ilat, L,, 341-343, 679-681 Piotrow ski, J., 780-782 P iscator, M., 201-203 Plum b, C arl S., 260-263 Plum m er, Norm an, 283-288 Poleti, D., 338-341, 368-371 P o tter, A. Lloyd, 150-155 Powles, W illiam E., 351-353 Pradel, J., 522-531 Preda, N., 343-345 Princi, F rank, 433-436 P u ertas, Benito N ogales, 633-634 Q uer-B rossa, S., 663-668 Quigley, J . A., 65 Radcliffe, J . C., 65-66 Rdulescu, I. C., 343-345, 679-681 Rae, S tew art, 772-776 R ainsford, S. G., 345-348 R asetti, L,, 348-349, 359-361 Raucher, K arl, 349-351 Reeve, A. Louise, 634-635 Renker, K., 917-921 Riedesel, M. L., 839-845 R iegrt, A. L., 819-825 R igner, K. G., 257-258 R isquez-Iribarren, R afael, 155-158 Rogan, John, 772-776 Ross, W. Donald, 351-353 Rossi, M ario, 960-961 Rossier, P. H., 776-780 R otta, C,, 353-359 Rubino, G. F ., 359-361 Rye, W. A., 361-364 Sakai, Yoshimichi, 158-162 Salmowa, J . 780-782 Sands, Frederick W., 531-532 S antillan, Jo se S., 636-639 Sarfeh, R,, 436-438 S aruta, Namio, 532-535 Savicevic, M., 338-341 Saw yer, W illiam A., 438-441 Scansetti, G., 348-349 Scheel, L ester D., 783-785 ' Schepers, G. W. H ,, 786-795 Schermerhorn, W., 850-858 Schiller, H ans, 961-962 Schindl, K arl, 364-365 Schmidt, H einz-Giinther, 365-367 Schmidt, M arjorie D., 367-368 Schmidtke, H., 921-923 Schulte, H. F., 486-503 Schunck, K arl-H ans, 377-378 Schw artz, Louis, 639-642 Seles, L,, 237-238 S erati, A., 963-965 Sherrill, S. S., 281-283 Shipm an, Thom as L., 642-645 Shoib, M. 0., 85, 162-166 Sick Absence Statistics Committee of nent Committee and International on Occupational H ealth, 40-55 Silverman, Leslie, 441-448 Simpson, H. M arjorie, 448-452 Simu, George, 755-757 Smith, P aul E., Jr., 857-862 Sodergren, David, 122-126 Sox, E llis D., 281-283 Spett, K., 795-798 Spiers, F. W., 535-540 Spioch, F. M., 795-798 Stankovic, M., 338-341, 368-371 Staskiel, L. J ,, 753-755 Steele, E a rl C., 371-373 Steele, M a rg a re t L., 66-68 Steiner, S. D,, 373-377 Stokinger, H erbert E., 540-544 Stopps, Gordon J., 857-862 Stowell, Thomas E. A., 186-191 S trange, John P., 544-551 Sumner, Philip, 314-316 Symanski, H.-J., 798-800 Szpakowa, T., 800-801 Szymczykiewicz, K., 801-805 the Perm a Association Vacher, J., 401-402 Valentin, H., 810-817 Van der Velden, W., 850-857 Van Liew, H ugh D., 911-917 V an Valzah, H. J., 678-679 Vigan, C,, 965-971 Vigliani, Enrico C., 87, 452-457, Viles, F rederick J., Jr., 556-563 Villarroel, Sergio, 227-230 Viola, P. Luigi, 818 Voelz, George L., 564-569 Vosburgh, B. L., 931-933 770-772, 817-818 Wade, Leo, 7, 61, 88 Wald, Neil, 569-572 W alker, Mildred L, 167-169 W alsh, Richard F., 645-648 W arnock, D orothy M., 402-404 W asserm ann, M., 572-580 W eaver, Neill K., 381-387 W echselberger, F., 191-194 Wells, R. Lomax, 170 W estrick, M arian L., 707-712 W etherhold, J. M., 580-585 W heatley, B. M., 585-587 W hipple, G. H oyt, 171-178 W hitney, L. Holland, 283-288 Wiecek, E,, 801-805 W ieland, H., 740-741 W illiams, Charles R., 988-994 W illiams, K atherine, 587-590 W illiams, May M., 194-197 W illiams, N ,, 819-825 W illman, Helvi, 404-405 W inter, K urt, 405-410 W orth, G,, 826-827 W yndham, C,, 924-931 Tabershaw , Irving R., 11-12 Taylor, Edm und W., J r., 182-184 Teisinger, J., 987-988 Teso, G. A., 359-361 T haxter, M. D., 147-150 Thom, W. F. J. M,, 379-381 Thoma, George E., 569-572 Thompson, A. R., 301-311 Thorpe, John J., 381-387 Tompkins, P aul C., 551-553 Tripsa, Rodica, 806-810 Troisi, F ortunato M aria, 387-397 T ru h au t, Ren, 33-34, 39, 209-214, Tucker, F. E,, 553-556 686-692 Y ingling, Doris B., 457-459 Yoder, John D., 590-592 Yoshimi, S., 827-828 Yount, H ubert W., 649-650 Zahorski, W itold, 828-832 Z anetti, Ennio, 767-768 Zannini, D., 971 Zielinski, John F., 592-600 Zorn, O., 971-973