Document jyLkaLO5gKYqD2mn01L9vQpJN

THE ACTIVITIES XV BTD0STEIAL HTOISHS AT TIE HAKVARD MEDICAL SCHOOL SXXCB 1918 and AT THE HARVARD SCHOOL OF PUBLIC HEALTH SISCE 1921* ha the spring of 1&18 Harvard University received temporary gifts* largely from Kew England manufacturers, in order to develop the subject of health in industr . Subscribers to this fund understood that the University would employ the money for research* for health education* and for the training of industrial physicians and others directly connected with health work in industry* The work accomplishad may be divided into three classesi 1* Special Problems 2. General Problems 5. : donation SPECIAL PROBLEMS A* X*nretlg&tion in the Jute Industry* A large manufacturer of jute products* in the neighborhood of Boston, re quested a thorough examination of dust conditions in the industry* together with a report to settle the question as to whether work upon jute products caused chronic fibrotie changes in the lungs. / dust survey was carried out by Dr. C. K. Reiman and Mr. H. M. Thomson, Medical and x-ray studies were made by Looters Aright, Tobejfc and Holmes. It was&!e^||blishd that dust conditions in the mills in qUC^Ifh do produce a slowly developing type of lung j Cv'' fibrosis. Methods for dust removaj '-.and 'physics,l*>-e*aaiination of employees were r''' recommended, which could be relied upon to alleviate the hnsard* Besides immediate utility to the industry, the study was an appropriate one for the University to enter* since it dealt with a much debated question - namely* whether a simple organic dust can produce lung damage. The finding in this ease, to & certain degree, supported the idea that organic dust io not harmless, tut, owing to contamination with crystalline material, dirt, et cetera, collected during peeking, tho results cannot bo considered conclusive, Z Manganese Poisoning. As a result of now pressure in smaiifaeturing, the Sow Jersey Zinc Company, in Way 1916, was compelled to ask the assistance of the industrial hygiene enterprise in ordar to deal with an extremely serious industrial dlsaaao that was affooting inoraaaing number* of their men in a largo plant, was costing heavily in pensions, and was prodaoisg threatoning unrett in tw working force, The mm affeotad wore assartnad aliaiaally by fir, C, K, Drinker, Thorough dust surveys ware made at this tins, and repeated at regular intervals subsequently, by Dr, C. & Reiman, Mr, R, M, Thomson, aid Mr, Philip Drinker, (The large knowledge of these sills now possessed by our department sokes it possible to use then as a wary excellent field station for testing new dust Maturing devtoea.) Manganese was present in large amounts in the dust, and the dust hasard was aaaslngly severe. Prolonged laboratory investigations of manganese poisoning in animals were earrled out, which eventually gave a complete picture of the action of the poisenj it being shown in collaboration with the Department of Heurology that nanganese affects certain of the basal ganglia specifically. It has proved possible to make reecnsaendations to the Mew Jersey Zinc Company which have completely abolished the Incidence of the disease In all their properties, ^Vfx ]-r" .>c.^ Ae a regult of this work* Dr, C, X, Drinker sees practically all eases of A. .O--' . manganese poisoning occurring In Idle eountry, and has been instrumental in the national Carbon Company in recommending plant changes to abolish the hasard in 3* their plants* whole experience to oounootica with manganese poisoning illustrate* to# need of continued relation* to dealing with any of th health problem* to Industry. Time i required not only to find out the nature of toe hasard but to gain toe eonplete trust end cooperation of toe authorities to carrying out to* change* necessary. S* fetrachlerethone Investigation* ' A single establishment near Boston had a severe hasard to totraehlorethane used os a solvent for eellulose acetate to making artificial silk, the instance ie rather a unique one because of toe speed with whleh Doctors Minot, Pansenter, and Smith sueoeeded to making toe operation safe, as against toe fact that Dr, Lege# of the British Home Office hod soon toe process, end to view of their extensive and grave experience with toiraehleretoane in airplane manufacture, and to other ways, said the hasard was uncontrollable, She plant in question was too small to lead the investigators into studies of other solvents, a logical continuance of the work so well started, this is, however, an important experi ence to two wayst 1. The process to valuable and stopping it would have wrecked a successful industry. 8. It demonstrates to* mbmM the diversity tof Cnii&fiiity ^seioiffiirp^nal to studying such problems os Ogiiiirfe to^ more restricted types q^vgOVSitoBiaftial1 piersonael. 1~" va4*1---" A variety of Departments were asked advice at toe start - Pharmacology, Physiology, Chemistry, Physios, et cetera, but toe epeoial clinical training of Dr. Minot at one* eaught the fact that oertato werimrs, (who proved to be toe susoeptlbles), showed, long before dangerous symptoms developed, a marked Increase (sometimes even to 4S) of the large mononuclear leucocytes* Such persons were afterward regularly removed early from the hasardous work, and no poisonings occurred 4. Load Investlgaticn, ta 1921 the American Institute of loud Mraaif&cturcrs spontaneously mad * grant f #81,000, which was used for a period of thr# years by Doctors Ante, Aim S. Minot, Fairha.ll and bheir associates, in an extensive analysis of lead poisoning, The lead manufacturers subsequently gave acre money, A large voluae of published work resulted, laid the facts brought out have had much to do with ohanging the point of view in treating lead poisoning ram in fully understanding the pathogenesis of the condition. Two years ago, while in Europe, I was much gratified to find that this lead work really dominated all that was being thought in cenaeotioa with lead poisoning or the use of lead as a therapeutic agent, Ifcs investigation resulted in ea intimate relation with the lead industry, most profitable both to the roaaafaeturers and to medical soienoe. The lead researches were practically wholly of a laboratory and hospital type. They did not deal with the probles of lead poisoning prevention and field work in general, Much might be done upon these two latter lines. JL Zlne Investigation, Xn 1928 on opportunity similar to that prodded by the lead Industry was presented by the sine industry under the auspices of the New Jersey Zinc Company, with large resources to investigate the J^^onic and medical significance of sine and define the conditions of Industrial poisoning if they existed. This work occupied the full time;,of Dr, Lawrence T, Fairhall, Dr, , y.i-- ' ,sti '.O Katherine B. Drinker, and several associates, during two years, and required the fairly constant cooperation of Hr, Philip Drinker and his engineering associates, in oosnsotion with problem* of dust measuremraat of a particularly difficult type. Owing to the fact that tine is a relatively innocuous material, the immediate eodioal Importance of the findings ms not so great. as in the lead investigation, hot the experimental work ms of high grad, and has resulted in a far better realisation of the importance of sine in biological processes than we have had in idle past. Indeed the results of the work were Of more importance for general biology than for industry unless* as is the case, ths dsusomstration that there is no aotual industrial sine hazard can be considered as of great practical importance, the investigation proved that sine oould cause a brief unpleasant experi ence, consisting of a chill and fever, if inhaled as freshly formed oxide, this reaction was demonstrated, however, to be non-specific, (although generally known as "brass founders * ague"), since similar symptons could be obtained from freshly formed magnesium oxide, and were shown to have occurred from copper and manganese compounds. Upon the general biological side sine w%s shewn to be a constituent of practically all plants and animals, and In the human being the amount wa practically as great as iron. Its possible function in the organism is not yet clear, but there are interesting indications regarding it. 6, Carbon Monoxide Investigation. In 1921 Dr. C, I* Drinker was asked to form a Corns!ss ion to investigate the best methods for treating carbon poisoning* The most important work of the Commission was doharby ?ro3F%||Srs Henderson and laggard of Tale, in the v i ; Alt development of the o^bon^dtoatilii'5''inhalation treatment of gas poisoning. Dr. C. X, Drinker, Mr. L, A, Shaw, Dr. Alfred ledfield, Dr. X. X* Drinker, and Dr. h, B, Cannon, collaborated in careful examination of existing resuscitation devices and in formulation of regulation* regarding their use* the final report of the Commission, from Dr. C. X* Drinker, has absolutely determined the policy of the iaericsn 8as Association in regard to treatment of gas poisoning and, since this Association domlaatos the whole field, the importance of the work ha# boon great* As a result of the interest this work aroused* Dr* c* K* Drinker has continued as advisor to the Gas Association* and recently to the National Electric Light Association, in regard to resuscitation from asphyxiation and publication of educational material in regard to it* this notorial* prepared wader his dirsction, has been distributed to over eight million persons in this country and Canada* Investigation for bettering the treatment of asphyxiation has continued steadily in the laboratory* and has resulted in better knowledge in regard to carbon monoxide treatment* and tbe recent reoommdation of a higher concern* tration of carbon dioxide than that advocated in the original report* X* Klofcnl Investigation, In 1924 the International nickel Coagamy* contemplating the utilisation of sheet nickel for cooking utensils* asked for. information as to its possible effect when in contact with foods* and finally* on reeoisaand&tions from our group, requested a oareful examination of the situation, A monograph analysing the clinical and biological literature upon nickel* and a considerable volume of experimental work here ia the laboratory* resulted from attention to this problem* The International Hickel Company has in its turn kept in constant ooBBaunication with the lboratoj^|^o during the present summer has again entered investigation'^.lf^^tcry id regard to tha effect of nickel chromium and molybdc'nUift'd^oh' l*&od stuffs* this investigation being carried out for their information as to the possibility of using stain less steel alloys for oooking utensils* This second investigation is under the guidance of Dr. L* T. Fairhall* and is now in progress. 8S>.* zino iMTT mKW.,*i2jmfm -FSmoSomdSsSi.* Baring the present year the tine industry, owing to the growing nee of sine fell wrappers for foods* has asked for information as to feed contendnation fren sueh wrappers} a natter that required direst laboratory investi gation, The work in question has been finished and reported in the Journal of Food Industries, this researeh end the one severing nickel chromium and molybdenum have been dene in cooperation with the Bureau of Chemistry of the united States Department of Agriculture, this is a particularly fortu nate alliance, since findings having tbs combined approval of the Federal Department and of the enterprise here at Harvard carry an authority which apparently is regarded as praetieally final. Members of the Bureau of Chemis try now consult us hears frequently, and Dr, Fairhall and Dr* C, E, Drinker are in constant ooasnunioation with them in Washington, and there is a definitely established mechanism as to methods of cooperation, investigations of Dr, Alice Hamilton, In 1921 Dr, Hamilton, with Pr Wads Wright, Hr* Philip Drinker, and others, carried out an examination Of poisoning due to mercury in the felt hat indus try. Dr, Hamilton has written many papers on industrial poisoning due to lead, aniline compounds, and^er subject* of |ff$i$ate importance in labor administration. Her value as a general influence in the field of industrial health cannot be overestimated,'" Her opinion is sought constantly by many large organisations, and her decisions result in decisive action, 10, Poisoning due to Radium. In 1924 Dr, C* K. Drinker, Dr, X. R* Drinker, and Dr, W. B. Castle, were requested by the Company, and wore the first individuals given a thorough opportunity, to investigate the interesting eases of necrosis of the jaw due to radium which occurred in Orange, Bw dersey* The work done ms brief, but toe report made to Ids Company, and eventually published, ha* been proved to tore toes, correct* The ^arluw was the single instance wo tore tod of failure on the part of tho University organisation to Impress a company with the necessity of following a counts of notion recosmended, The failure probably would tore occurred with any organisation undertaking the work on account of the smallness of the plant end the severe financial strain it was under at the time 'the work was done, 11* Investigation of Health of Store Employees* In 1919 Ur* Arthur B* teams was placed in charge of a gensr&l investi gation of the health of store employees* This investigation was financed by a group of large department stores in Boston and in other cities* Retrospective ly the largest usefulness of the study seems to have been the fact that the very existence of the work caused store executives to pay more attention to the importance of health conditions amongst their employees, and they tore continued to maintain Health dapartash^s of 'to>rvd character. It is wortk'%Eile' 't toe type of problem illustrated by this '!'ni'??*;( j department store enterprise is for more difficult than toe defined variety of problem presented by the action of a definite poison* During the infancy of toe Industrial health enterprise which has been conducted in the Medical School and the School of ublio Health, we never considered it wise to enter situations which did net have two otoraoteristiesi 1, They must present problems worthy of University attentioni that is, there must be an element of abstract, scientific interest in every instance, which could net be net without the utilisation of the distinctive type of individual found in the best university laboratories, 2, The problem must give reasonable prowlas of being susceptible of solution* It our feeling that the survival of the Harvard enterprise depended upon demonstrable success at tho start* It is possible this period has been passed, and that m should nor be less cautious in mr selection of field tasks* 12. iKTOsti^atioBs on the Effect of Tesg>erature and Humidity* these fall into two categories! (a) Mr* C. P Yaglcu has continued the valuable work begun by hist at the Bureau of Mines station in Pittsburgh* and has recently completed a most thorough analysis of working efficiency at high md low temperatures with varied humidity. There Is no doubt that the experiments carried on with the rather perfect laboratory equipment which the School possesses could be trans ferred almost bodily to certain industries. (b) Messrs* Yaglcu and Drinker were given opportunity to construct a constant taaper&tupi and humidity rdoSPfor the treatment of premature infants at the Infants :, Thep; *wcis; 4a question required a high degree of engineering skill* since it Ws found that present methods of holding temperature constant in large rooms were wholly inadequate* The results have been very gratifying clinically* and rooms of the same sort are being constructed under the di rection of Mr. Yaglcu at four other hospitals. There is little doubt that such rooms will become an essential part of the <juipt of infants' hospitals. Important experimental results Have been obtained by Dr. Blackfan and his associates* especially showing the remarkable effect of optimum humidity upon the nutrition of infanta, and the striking effects of optimum humidity and temperature upon convalescence from acute gastro-inteatia&l infections in young children. Bsas&Em &satsiss& Hr* Philip Printer, since joining the industrial enterprise, has busied himself steadily with the problem of devising new netted for 'nteNorlac the ea&tmt of particulate materials in the sir* Starting with & nsdlftsstion of the water collecting type of apparatus, he passed a to the development of an electrostatic devise which Is now need la this country. South tearlea, Australia, and South Africa, At the present time, In collaboration with Mr, Hatch of the Engineering school, experiaents are being tee to ascertain the best typo of hood construction to control silieious dusts, - The prohlaaa encountered have been physical and mathematical to a large degree, but it is doubtful whether the physicists and m&thematlolans could have boon induced to pay the slightest attention to them ted the work not been done in a dapartaiant devoted to h& interests through medicine and hygiene, It seems probable It will be possible to construct a type of hood that will eliminate silieious dust as s problem in many industries, 14, Artificial Respiration, As a result of experiments of a general character being carried out by hr, Louis A, Stew, the idea occurred to Mr, Shaw and Mr. Drinker that a new type of respirator might be constructed, in which the body of the subject was inclosed In a steel box with tec tend protruding through an ingenious rubber collar at the ea<l**SKd by saaking pcg^fp end negative pressure in the box artificial reapite^fe^ljt ***** *** provided by the Liability Insurance Fund of the COatelids^bbd das Company of Hew York, The apparatus was constructed and proved to be highly satisfactory. It offetc in the natural manner, and as long as desired# respiration of any depth, A second machine was then constructed and placed in the emergency ward of Bellevue Hospital, Hew York. Within the past two leatmthe four eases, three of then apparently falte hopeless, have been resuaeiated through use of the apparatus* One of these retired twelve hours practically aontimious oper ation of the machine before natural breathing was safely established* la one hospital here It has been used for as long as five days OOatlaaously with success so far as respiration was concerned, but In that ease the disease was fatal. It Is an interesting fact that slnee the publication of details of the device a sonth ego* twelve of the mmhima have been ordered, -and it Is certain they will be in general operation throughout the country within the next year* The appliance is elaborate and expensive, but is so certainly efficient as to sake Its way, 'She occasional grave respiratory disturbances of the new-born* which are likely to disappear if the infant can be tided over a few days, has led to experiment6.1 work, new in progress, to produce m apparatus of this sort feasi ble of biso%ith.iiiifaA^ Experiwmts also growing; out of this are now under way with the purpose of preduoing an apparatus designed to sdadnister high oxygen content, by inexpensive but effective neons. In the various types of disease in which it nay be clinically serviceable. mmRAL FKSBLEMS An enterprise of the sort which Isas developed hero in the School of Public Health cannot exist on the basis of praotiOSl interests alone. Xn jay experi ence, the reason why a University can do the sort of work which has been done here in the past ten years, is because a University laboratory can give opportunities for mental growth attractive to the sort of young men who if celled upon can solve practical problems rapidly and effectively* In order to give man of such caliber the setting they desire, it is preeminently essential that the laboratory should conduct a large amount of abstract solentifio work* In order to illustrate what is meant, certain instances my be giveni l* Silicosis* Dr* Wallace Fean, now Professor of Physiology at the Rochester Medical School, spent three years in these laboratories working on the problem of phagocytosis of different type* of inert particles* Bis work, which was of the most general physiological nature, and which ms published in the Journal of general Physiology, demonstrated certain of the reasons why silioious dusts cause damage* Dr*. Ken^ouM hardly he thought to be especially interested in thela^ter problem, His.work, however, is of great practical impertsnse in understanding, one, f#4the^aa^or haserds in industry throughout the world, and has been so recognised in the literature on the subject. It has had a definite effect upon the field work in lung fibrosis carried on in the Department, J2* Investigation of Circulation and Respiration* Out of Interests arising in 1920 through experiments designed to explain certain of the distressing symptoms occurring in advanced heart disease. Dr, C* K* Drinker, with Dr, K. D Churchill, Dr, Hermann Blumgart, Dr. A. H. Turner, and others, passed through a long scries of experimental examinations upon the heart and circulation, which have required the devising of new methods and have been important not so much for the results obtained as for the interest they have stimulated to examine the circulation in certain novel ways* Dr* Turner is now making an extensive series of studies upon the circulatory efficiency of women, end is slowly attempting to develop standards upon which college women my be graded in this p*tieular* the interest in these studies is meet important tor the general proMem of physical education* Qm student* working for a Doctorate in Physical sdueatien, is now engaged in a second series of studies upon the affect of posture upon circulatory conditions! posture in this instance being reduced to very simple terms by sensing the subject to rest on a tilted table and rotating Mm slowly from the horizontal to the vertioal* Different individuals apparently show pulse and blood pressure alterations at diffsrsnt and characteristic angles* (This and other work coordinates Intimately with the work of Henderson, Book, and Dill, in the Fatigue Laboratory*) Two other workers, with the seme general interest, have just completed a careful examination of the offset of breathing the same concentrations of carbon dioxide* It has been demonstrated that subjects react to carbon dioxide very differently, and that the same subject does not behave the same cm successive days* This experiment has proved not only important for the possible determination of physical efficiency in the individual, but has thrown light upon the use of carbon dioxide in certain cases requiring resusel~ tatlon* The interest In pure physiology which the laboratory has steadily maintained, has resultedip a <aastSmt inflow of students working for the Doe tor of Philosophy in Physiology, and it is from this type of individual that ', ; . .\V- 9 the most useful members Of Svich a group as has been developed here must be recruited* Were the laboratory devoted wholly to investigations of practical field problems, it is quite eertain that mental starvation would slowly snuff out the whole enterprise* 8. Skin Metabolism* During the past two years Mr* L* A* Shear has developed unique methods for measuring the passage of gas through the skin, and the metabolism of the skin 14** itself, The results make It possible t study glds disease* in * mew wmamv, and one which may be productive of the greatest usefulness. Arrange ments are new being a&de to place the apparatus devised in the skin clinic at the Massachusetts General hospital. 1* Journal of Industrial gygleao, the Journal of industrial ^rgiens wan started in 1919 as a joint enter prise with eertaln of our English colleagues who were interested in the subject. It has slowly attained, and holds, a subscription list of about 1,000, It has been a strong asset in ttjtf harvard industrial health work, affording a eon- t' ^ vealent medium for centralising our publications and providing the single journal devoted bo industrial hygiene* Qa several oooasions t have felt it would be "\ well to divert the money we devote to the Journal to other activities in the School, but the further I go into the subject, and the more Isee of the practical field, the more I fool that the Journal should not be curtailed but should, if anything, be somewhat enlarged and made acre useful through extension of the abstract department and the occasional publication of monographs. It should also be remembered, if the activities of the School were to enlarge, that in Miss Marion Shorley we have an extraordinarily efficient editorial worker* Should it be necessary to contemplate anything like a general editorial office, it would be very difficult to find a woman with the training, accuracy, ability to read foreign languages, and general reliability she possesses. 2, Teaching, The supposition that a number of industrial physicians would wish to cone yearly to loam dotal18 of industrial, medical practice has proved wrong. Industrial physicians come for brief periods of time to learn how to mot some special hazard, hut there is as yet no fully developed art of industrial medlo&l practice as distinguished from general medical practice, and though men undoubtedly need what eould be gained here in a short time, they are unable to visualise just what their needs are. It is probable that for the next ten years we shall oontinue to train individuals In the special technique of dust measurement, gas analysis, effect of carbon monoxide and electric shock. effects of high and low pressures, and many specialised topics, but it seems improbable that we shall very soon have much demand for the general training of industrial physicians. .X .' -V- AglffPIHa SXAgBMBM It ii^Hard ytd, evaluate ade<|Uately the cooperation which has been necessary in* in earrying out the projects which have been listed. We now have close affiliations with the Engineering Sehool} with three students working for the Doctor of Science In Industrial Sanitation and registered in the Engineering Sehool but working here with us. We eall upon members of the Engineering and Physios Departments quite constantly, and it is a matter for gratification that they are beginning to call upon us. For example, some years ago it became necessary for ms to investigate the possible action of the magnetic field in relation to a purely nervous disease, the Physics Department was able at once to help me with the installation of apparatus and the standardisation of tho experiment. It would have required many months to have learned the things they were able to tell me in a few minutes. In the other direction. The School of Engineering now recognises the experience and skill of Mr. Philip Drinker in the measurement of dusts and fumes and air, and the probability that advances la thin field will fe more apt to come trm bin than to com from the . Engineering laboratory. Problems of swoke removal era brought him fey the Engineering Faculty, It was thought at the outeet that the Industrial work would probably result in relations with the School of Education, Until recently, in connection with physical education, this has not feesn true* It has begun in that, however, and may soon develop further, wing to the fact that tide whole activity has bean housed in and near the Medical School, it has bes^^bsslble to call upon a very large nus&er of medical U ooxtnoc&io'n ,,Uh tb. P*bU. Iho > :J- notabU > perhaps been t\hat ov'f tvh- e' &*1?s'dloal olinle at th Massachusetts General Hospital, but the of- Eaurology, Biochemistry, Bacteriology, and Vital Statistics, are called upon incessantly. Perhaps the most interesting feature of the problems which arise in connection with industrial health, is their very varied and unexpected type, A university 1s peculiarly adapted to attack such problems because of the diversity of information available, due to the many different departments making up the whole organization. The work at the Graduate School of Business Madnietrstion, undsr Dr, Kayo and Dr, Henderson, has, of course, close interest in relation with this work, and leads to valuable discussions and mutual suggestions; especially, in the nature of it, the work of Dra, Henderson, Book, and Dill, Future opportunities will obviously come for increasingly intimate cooperation with Business School activities and problems.