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FILE NAME Kohler KOH DATE 1932 Nov DOC KOH118 DOCUMENT DESCRIPTION Conference Proceedings - Industrial Commission of Wisconsin - Effects of Dusts Upon the Respiratory System 18 INDUSTRIAL COMMISSION OF WISCONSIN FRED M. WILCOX R. G. KNUTSON Commissioner Chairman Commissioner A. J. ALTMEYER Secretary VOTTA WRABETZ Commissioner HARRY A. NELSON Director of Workmen's Compensation Proceedings of Conference Concerning EFFECTS OF DUSTS UPON THE RESPIRATORY SYSTEM THE LIBRARY OF THE FEB 5 1934 -UNIVERSITY OF ILLINCIS Held at Medinah Athletic Club Chicago November 16 117932 PLAINTIFF'S EXHIBIT 0100 WEDNESDAY NOVEMBER 16 MORNING SESSION Page Fred M. Wilcox Chairman Industrial Commission of Wisconsin Preilmbory remarka Address of Dr. Leroy U. Gardner Directar of Baranac Labo- ratory for study of tuberculogia WEDNESDAY NOVEMBER 16 AFTERNoon Session Address of Dr. W. Irving Clark Medical Director of Norton Mamachusetts weer eneeneeeenane Company Worcester Discussion . . Continuation of address of Dr. Gardner Address of Donald E. Cummings Assistant Director of Sar- Tuberculosis anac Laboratory for Study of - Discussion 70 81 103 Thursday NOVEMBER 17 MORNIng Session Discussion of addresses of Dr. Gardner and Mr. Cummings 112 Address of Dr. K. S. Willi Pathologist of Wm H. Maybury Sanatorium Detroit Michigan - 124 Address of 3. 1. Bloomfield Engineer Health Service Sanitary U. Public 130 - . THURSDAY NOVEMBER 17 AFTEendon SessioN Address of Dr. Albert E. Russell Surgeon U. S. Bureau of Mines a=. 167 . Discussion 188 nacawce . APPENDICES ; ATTENDIX APPENDIX Biographical sketches ~------~-- ----------- List of persons who attended conference 164 as sandstone is also a harmless dosage may be good arithmetical reasoning but may lead one into a serious error My suggestion is that we should determine the permissible limit of dustiness for each individual dust In the interim for those dusts that we do not have any basic data of threshold dosage we can demand from industry that it maintain conditions in the workrooms equal to those already found in the best plants of a similar industry in actual operation I shall now be happy to answer any questions that may have suggested themselves to you during the course of my remarks DR SCHLOMOVITZ Did you make any study of the dust , in the air passing through respirators MR BLOOMFIELD We have conducted studies on positive pressure masks and helmets as used by sandblasters during actual work in a sandblast room but we have not conducted studies in the field nor in the laboratory on the efficiency of respirators Excellent work on respirators has been done by the United States Bureau of Mines and at Professor Philip Drinker's laboratory at the Harvard School of Public Health - DR SCHLOMOVITZ You don't happen to know the size of particles that pass through the mask MR BLOOMFIELD Last month Professor Drinker pre- sented a paper at the National Safety Congress in Washington in which he stated that a careful measurement of the size of dust particles entering and leaving respirators shows a slight but important reduction in average size of the dust particles In fact there are now respirators on the market which on testing by Professor Drinker were found to have efficiencies in excess of 90 per cent against silica dust of a size less than 2 microns So that apparently some respirators do filter out the small particles MR WILCOX Is there any recognized activity among these manufacturers of protective devices respirators and so forth to try to develop something that will give relief MR BLOOMFIELD Very much so The manufacturers of equipment and protective devices are quite active In _ sagemay be good arithone into a serious error i mine the permissible dua dust that we do not have any ve can demand from in- 3 in the workrooms equal st plants of a similar in- r any questions that may u during the course of ake any study of the dust ators nducted studies on pasias used by sandblasters it room but we have not in the laboratory on the ent work on respirators tes Bureau of Mines and oratory at the Harvard happen to know the size mask? Professor Drinker pre- ty Congress in Washing- eft Reasurement of the eaving respirators shows in average size of the now respirators on the sor Drinker were found 1 per cent against silica 18. So that apparently small particles ognized activity among devices respirators and ig that will give relief 10 The manufacturers s are quite active In 165 our sandblasting investigation we found equipment being sold today which is capable of keeping the dust count to a concentration of less than 2 million particles per cubic foot of air at the breathing level MR WILCOX That is where the air is fed by tubes MR BLOOMFIELD Positive pressure masks and helmets are now being sold which if properly maintained and supplied with a sufficient volume of free air will protect a worker fully inside a sandblast room and in addition there are now on the market sandblast cabinets tables barrels and other equipment which if maintained in a proper state of upkeep will also give ideal protection to a worker without the use of masks or positive pressure devices We have found such conditions during the course of our sandblast investigation MR KNUTSON Have you any suggestion to offer with regard to safety devices that might be used in connection with the sandblasting of castings weighing several tons MR BLOOMFIELD One sandblast such castings in large rooms exhaust the rooms properly and furnish the worker a good positive pressure respiratory device There are installations of the automatic type which do not neces sitate working inside the blasting zone but such equipment is not practical for huge castings BIBLIOGRAPHY W. .: Metallic Mineral Products Henry Holt BayleyCo. 1.2. Thompson L. R. Brundage D. K. Russell A. E. and Bloomfield J.J The Health of Workers in Dusty Trades I. Health of Workers in & Portland Cement Plant Public Health Bulletin No. 1928 176. Without 5. Hefferman Patrick Exposure to Silica Dust Without the Occurrence of Silicosia Journal of Industrial Hygiene Vol 8 No. 11 Nov. 1926 4. Russell A. E. Britten R. H. Thompson L. R. and Bloomfield J.The J.The Health of Workers in Dusty Trades II to Siliceous Dust Granite Industry Public Health Bulletin No. 187. 1929 5. Brundage Dean K and Bloomfield J. J.:The Pneumonia Problem in the Steel Industry Journal of Industrial Hygiene Vol 14 - No. 10 Dec. 1982 6. Bloomfield J. .: The Dust Content of the Atmosphere in Va- rious Dusty Industries Published Nov. 18 1982 in the United States Daily Washington D. C. 168 7. Owens J. .: Jet Dust Counting Apparatus Journal of In- April dustrial Hygiene p 522 1829 8. Hatch Theodore and Choate Sarah P Statistical Description of the Particle Size Properties of uniform Particulate Substances Journal of the Franklin Institute March 1929 9. Green Henry A Photomicrographic method for the Determination of Particle Size of Paint and Rubber Pigments Journal of the Franklin Institute Vol 182 No. pp 637 Nov. 1921 10. Moir .: Report on a Specimen of Dust from Silicotie Lung General Report of the Phthisia Prevention Committee Miners Pretoria 1916 Appendix The pp 11. Pitchford Visible of Mineral Particles 138 140 Situation Outline and Dimensions by Polarized Light in Sections of Silicotic Lungs mounted in Canada Balsam General Report Pretoria of the Miners Phthisis Prevention Committee Appendix 8 pp 135 186 1916 12. Drinker Philip The Frequency and Identification of Cer- tain Phagocytosed Dusta Journal of Industrial Hygiene Vol 7 No. 7 July 1925 Mavrogordato 18. A The Value of the Konimater Publication of the South African Institute of Medical Research No. 17 14. Fehnel William .: A Study of Silies Dust in Hard Rock Drilling in New York City Journal of Industrial Hygiene Vol 11 No. 2 Feb. 1929 16. Badham Bayner H. E. G. and H. D Broose of Charles the Sampling in Sydney Sandstone Industries Report Report Decem- of Public Health New South Wales Director General 1927 16. Greenburg Apparatus by _ Sampling Leonard and Bloomfield J. .: United The Impinger Dust as Used the United States Public Public Health Reports Vol 47 No. 12 March Health 17. Robert T. and Rosencrantz Esther Observations and Legge Studies on Silicosis by Distomaceous Silica American Journal of Public Health Vol 22 No. 10 October 1932 18. Winslow C.-E. A. and Greenburg Leonard A Study of the Dust Hazard in the Wet and Dry Grinding Shops of an Ax FactoryFactory Reprint No. 616 Public Health Reports October , 1820 . 19. Hatch Theodore Kelly George S. and Fehnel J. Williams Control of the Silicosia Hezard in the Hard Rock Industries II An Investigation of the Kelly Dust Trap for Use with Pnen- matic Rock Drills of the Jackhammer type Journal of Industrial Hygiene Vol 14 No. 2 Jan 1932 20. Bloomfield J. .: A Study of the Efficiency of Removal Systems in Granite Plants Reprint No. 1924 Public Health Reports Oct. 18 1929 21. Hatch Theodore Drinker Philip and Choate Sarah .: Control of the Silicosis Hazar^d in the Hard Rock Industries I. A Laboratory Study of the Design of Dust Control Systema for Use with Pneumatic Granite Tools Journal of Industrial Hygiene Vol 12 No. 3 March 1930 Apparatus ianritling Journal of In- .: Statistical Description of uniform Particulate klin Institute March 1929 graphic method for the Determina- nt and Rubber Pigmenta Journal fol 192 No.5 p 637 Nov. 1821 men of Dust from Silicotic Lung r Phthisis Prevention Committee 138 140 SituSatiiontuation Outline and Dimensions by Polarized Light in Sections of Canada Balsam General Report vention Committee Pretoria 1916 Identification equency and of Car- ournal of Industrial Hygiene Vol e of the Konimeter Publication ute of Medical Research No. 17 of Silica Dust in Hard Rock Drillmal of Industrial Hygiene Vol 11 E. G. and Broose H. .: Dust Report stone Industries Report fealth New South Wales of the Decem- mfield J. .: The Impinger Dust sed by the United States Public Ith Reports Vol 47 No. 12 March crantz Esther Observations and maceous Silica American Journal No. 10 October 1982 sburg Leonard A Study of the ad Dry Grinding Shops of an Ax . Public Health Reports October ge , and Fehnel J. Williams Le the Hard Rock Industries bust Trap for Use with Pneo- Jackhammer type Journal of No. 2 Jan. 1932 of the Efficiency of Removal Plants Reprint No. 1324 Public 1 ip and Choate Sarah .: Control the Hard Rock Industries I. A sign of Dust Control Systems for -cutting Tools , March 1930 Journal of Indus- vs omen 167 November 17 1932. Afternoon Session DR ALBERT E. RUSSELL Surgeon United States Public Health Service Surgeon U. Bureau of Mines It is a great pleasure to be here with you and to take part in the discussion of this very interesting and intricate subject What has gone before has been very interesting and seems to have brought us up now to a consideration of the physical condition of the worker and the clinical pictures produced by the effect of inhalation of dust It has been my pleasure to work in the public health service in a study of the dusty trades Beginning in 1924 we made observations in the cement industry the granite industry coal mining both bituminous and anthracite and other dusty trades We have found a number of very interesting things and two of these studies have been published in bulletins No. 176 and No. 187. In the report of cement study we made the statement that although in most of these dusty trades fibrosis of the lungs was produced we were of the opinion that this fibrosis even though it was similar to that produced by other dusts did not represent the same degree of disability I think our subsequent studies and observations of workers in other dusty trades have borne that out I will show you today a number of slides of rays from different industries showing reaction to dust as shown in rays and we will discuss it more at length at that time In doing our studies we started out with a program which would include dust counting and dust analysis records of absentees from work and finding out the reasons for absence We were greatly interested in the sickness and longevity and the amount of time lost from work due to sickness A complete physical examination with special attention given to the chest conditions was made on all employees where it was possible First I will take up ~ some of our findings in the morbidity records produced by exposure to dust Second you will recall that Mr. Bloomfield discussed that we had groups of people exposed to different concentrations of dust Our most extensive study . was made in the granite industry in Barre Vermont and it was my pleasure to be there and to have charge of this 168 study throughout its course Our sickness records and later our ray and other findings seem to divide the workers into certain groups according to results we were getting and later when Mr. Bloomfield made his dust counts we found a very close correlation of dustiness and the amount of sickness and disability and deaths in direct proportion to the concentration of dust With the first slide we will start considering the morbidity This slide see Plate 3 p 10 Bul No. 187 U. P. H. is a photograph of a man at work cutting stone You have heard a lot about different methods of dust counting but this will reveal the fact that the worker is exposed to quite a bit of dust which can be seen with the naked eye This tool is the hand pneumatic tool which vibrates very fast and in working on the hard granite rock he bends over looking at his work and brings his nose closer to the dust he is creating The general atmosphere in that plant was rather high and is not shown in the photograph nor do you get it in visibility unless there are direct rays of light shining in the plant You may walk through it and it does not seem to be very dusty That is where the dust counts tell more accurately as to the extent of the dustiness This slide see Fig 2 p 20 Bul No. 187 U. P. H. S. shows the different occupations that we had in Vermont These bars indicate the intensity of exposure Our groups divide themselves into the first and second group ten to twenty million then from twenty to sixty were the two second groups You can see the general plant atmosphere was about twenty million particles per cubic foot of air There were a number of occupations with comparatively low exposure Keep that in mind in considering the morbidity records which we will discuss later The South African standard of permissible dustiness is indicated in the black bar at the bottom The groups I told you about we called A B C andD This next slide See Fig 17 p 88 Bul No. 187 U. S. P. H. S. is a graph which shows the number of persons with and without silicosis in the four dust groups indicated in the other graphs by length of service The bottom line indicates length of service and each line indicates a certain group of workers Almost invariably by the end of fourteen 2. Our sickness records and ngs seem to divide the rding to results we were loomfield made his dust counts relation of dustiness and the sability and deaths in direct tion of dust With the first ng the morbidity .0 Bul No. 187 U. P. H. at work cutting stone You rent methods of dust counting that the worker is exposed to n be seen with the naked eye natic tool which vibrates very hard granite rock he bends d brings his nose closer to the neral atmosphere in that plant showinn the photograph nor nless there are direct rays of You may walk through it and justy That is where the dust 3 to the extent of the dustiness 0 Bul No. 187 U. P. H. ions that we had in Vermont ~fisity of exposure Our groups irst second group ten to to sixty were the two : general plant atmosphere articles per cubic foot of air cupations with comparatively mind in considering the mor- I discuss later ard of permissible dustiness is at the bottom The groups I B. C and D. This next slide 187 U. P. H. S. is graph of persons with and without troups indicated in the other B The bottom line indicates line indicates a certain group ably by the end of fourteen 189 years practically all of the workers in the higher dust counts had evidence of silicosis Some of it was rather alight in the ray and very little in the physical and other characteristics but with the ray there was almost invariably evidence of silicosis at the end of that period You have seen this slide See Fig 22 p 118 Bul No. 187 S..P H. before today when Mr. Bloomfield discussed it It carries out the line of thought the incidence of sickness or absences was lower in these groups of workers beginning with group C and D in the low exposure line and higher in groups A and B. The tuberculosis death rate for males in rural Vermont is indicated here Group D was less than that and is perhaps due to the small num- ber of people Group C is about the same but groups A and B are quite a bit in excESS This graph See Southern Med Journ Sept. 1982 pp 919-927 shows the frequency of disability lasting longer than one week on account of sickness exclusive of accidents or from respiratory diseases in industry The industries are specified The industrial groups the first group is gold mining in the Black Hills of South Dakota Their rate was 208. General manufacturing is shown and is more or less an average That includes industries in a number of northern states This would seem to indicate that that group of workers had that much sickness in ex- cess of what we might call the normal The respiratory disease the incidence of sickness in the lower part with granite cutting in Vermont heading the list Gold mining in the Black Hills second Portland cement third anthracite fourth with general manufacturing which we might say is about an average at this point you can see in those four industries the incidence of sickness is this much in excess of average I might say in relation to the gold mining in the Black Hillisn South Dakota that we do not know the extent of the exposure to dust because no dust counts were made We might compare it to dustiness in other mining but we don't actually know what it is there It is evident that there was an excessive amount of dust which was practically pure quartz The reason why we haven't as much tuberculosis among the gold mining I think is because of the fact that the labor turnover is 170 rather high and these workers develop silicosis and become partially disabled and go to their homes before developing tuberculosis The workers in Vermont remain at their homes inasmuch as granite cutting is a skilled trade The labor turnover in granite cutting is very little whereas in gold mining it was very high That will explain many differences that may follow The gold miners head the list in the incidence of influenza cement workers second anthracite coal mining third and granite cutting four and general manufacturing at this point In bronchitis acute and chronic anthracite coal miners head the list Portland cement second general manufacturing third which would indicate that the cement workers had a slight amount in excess of granite and anthracite coal miners had still more This is a continuation of the same group of workers Respiratory tuberculosis only is considered in the industries we have been talking about Granite cutting in Vermont heads the list gold miners in the Black Hills second I have explained that the reason why I think this isn't greater is because of the labor turnover anthracite coal mining third and general manufacturing at this point It would seem there is this pointing much in excess of tuberculosis in the three industries above In the iron and steel and Portland cement plant it seems to be about the same as general manufacturing In the incidence of pneumonia workers in iron and steel head the list granite cutters in Vermont second and general manufacturing third We would think that the excess was not as great as in some of the preceding diseases I might say a word about the economic conditions The iron and steel workers are not paid as well as granite cutters Their living conditions are not as high and that may be a factor in considering tuberculosis and other diseases particularly those of the respiratory tract The granite workers in Vermont made 1.00 an hour They worked eight hours a day forty hours a week this was the minimum wage at that time The highly skilled workers made more The ones able to carve and cut statues made up to 20.00 a day They lived well The best group of industrial workers I have ever seen The incidence of tuberculosis among them was not an economic factor ers develop silicosis and become ir > homes before developing ; Vermont remain at their cutting is a skilled trade The cutting is very little whereas high That will explain many W. The gold miners head the luenza cement workers second Ird and granite cutting four g at this point In bronchitis cite coal miners head the list general manufacturing third the cement workers had a slight : and anthracite coal miners had of the same group of workera only is considered in the incing about Granite cutting in gold miners in the Black Hills that the reason why I think : of the labor turnover anthra- | general manufacturing at this re is this pointing much in the three industries above In tland cement plant it seems to al manufacturing In the inci- in ters iron and steel head the second think that and general manuthe excess was not e preceding diseases I might omic conditions The iron and id as well as granite cutters not as high and that may be aberculosis and other diseases respiratory tract The granite : 1.00 an hour They worked jur hours a week this was the de The highly skilled workers e to carve and cut statues made lived well The best group of : ever seen The incidence of was not an economic factor 171 This brings us down to the petrographic analysis of the dust In silver polishing the total silica percentage varied according to different occupations and different materials used and the quartz content varied likewise Mr. Bloomfield showed a graph this morning in which the dust count in these particular occupations was quite low I think about five million particles at the greatest In cement industry the total silica is expressed as 21 in the raw cement but the quartz content of finished cement is less than one per cent It is stated to contain % before passing through the kilns but the burning process reduces the amount In coal mining the rock dust is quite high in quartz because the overlying stratum was sandstone Quartz content of coal is 1.2 In hard coal we have the same explanation here with 1.5 silica in the coal with 81 quartz in the rock dust The granite we have explained has a total of 70 silica with about half of it as quartz There is a point I wish to mention here In the United States most of the hard coal as anthracite is found in an area in a few counties in Pennsylvania Bituminous coal is scattered pretty well throughout the country In the state of West Virginia there are areas where overlying stratum is sand stone and others where different rocks make up the overhead rocks The silica content of these rocks varies tremendously in different localities which makes it impractiable to compare the results from the study of one group of coal miners to another The amount of silica in the rock dust to which he might have been exposed should be stated It is very difficult to say that one industry is comparable to another or that one part of the same industry represents the same conditions throughout We don't know until we have made careful analysis of the dustiness in the various occupationa This slide gives us an average dust count under ten microns in certain dusty trades of which we will speak later Cement dust averages about twenty million In granite cutting there are fifty million particles per cu ft for the upper two groups and sixteen million for the lower two groups and ^finanthracite coal mining one hundred twenty four million for the miners and 11,000,000 for attendant labor Bituminous coal mining has one hundred and two million and .172 million for the attendant labor In the silver manufacturing 4.1 million and 800,000 I think these dust counts are very interesting and we believe that they correlate well with our findings which we will bring out as we go along This is a graph See fig 8 p 53 Bull No. 187 U. P. H. S. expressing the incidence of sickness from all causes in these four dust count groups in the granite cutting industry in Vermont It is by length of service and the absences are eight days or more and the rate is per thou- sand Here we have a group with less than ten years ex- posure with the four groups starting at about the same point . Group C and D with lower exposure average about sixteen million As they grow older the total incidence of sickness seems to diminish The upper groups whose exposure to dust averaged about 50 million their rate of sickness increased in proportion to the length of exposure to dust This slide shows the prevalence of tuberculosis and we considered only active pulmonary tuberculosis by length of the service and dust count groups This is based on physical examinations and ray to determine the presence of the disease Here we have group C starting with a higher rate than groups A and B. We think perhaps there may be an economic factor here The attendant labor did not have as good living conditions as did groups A and B. Up to ten years exposure there isn't much significance but after ten years you see these two groups of workers having increased incidence of tuberculosis in direct proportion to the length of service After thirty to forty years exposure it seems to reach its peak taking for granted that a man is about twenty years old when be starts to work we would expect that the group of workers having tuberculosis would be around fifty years of age I believe that our average for the age at that particular study was a little over forty years . This slide I am showing is about an average chest Sometimes we get a very good presentation of this slide and it shows more than at other times due to illumination This is what is usually found in a more or less average per- son that is a person who has not had tuberculosis s^>licosis or any of the other chronic pulmonary diseases Those 5 In the silver manufactur- I these dust counts are eve that they correlate well ill bring out as we go along p 53 Bull No. 187 U. S. P. e of sickness from all causes oups in the granite cutting y length of service and the reand the rate is per thou- with less than ten years ex- starting at about the same lower exposure average about ow older the total incidence L. The upper groups whose -out 50 million their rate of on to the length of exposure Sence of tuberculosis and we nary tuberculosis by length t groups This is based on ray to determine the presence ve group C starting with a B. We think perhaps there ere The attendant labor did ions as did groups A and B. bera isn't much significance tuberculosis groups of workers f tuberculosis in direct pro- vice After thirty to forty reach its peak taking for > twenty years old when he et that the group of workers around fifty years of age I the age at that particular line years is about an average chest od presentation of this alide er times due to illumination n a more or less average per- is not had tuberculosis silitie pulmonary diseases Those 173 of you who are not physicians and not familiar with an average chest should bear this in mind as we go along and you will be able to follow changes indicated by ray Notice that the diaphragm curves with a regularity on each side This is the hilus of the lung of which Dr. Gardner has spoken and the light areas are the functioning portions ray No. 4 case No. 397 near p 92 Bull 187 U. S. P. H. I called your attention to the regularity of the diaphragm in the preceding one I want you to see the irregularity in this case You will notice that through the lung fields there are linear markings spreading out toward the periphery and we think that it was due to the inhalation of dust This man was a granite cutter who had cut stone about fifteen years In writing up our report of granite study in Vermont you will recall we didn't at- tempt to classify our cases of silicosis by the then existing one classification which was the South African one Our cases did not seem to fit into that classification This man since this picture was made in 1924 has developed tuberculosis and died of clinical pulmonary tuberculosis This is another granite worker who had been working about twenty years in cutting stone it shows an increase in the shadows with further evidence of disease You will note in this slide as in the ones which follow that there is more pathology indicated in the right lung That has been attributed to the fact that the right bronchus is a little larger than the left and it curves at an angloef about twenty degrees whereas the left bronchus bends at a little sharper angle and is slightly smaller You will notice in this case the diaphragm is fairly regular In the preceding one there were evidently pleural adhesions causing irregularity in the contour of the diaphragm It is possibly due to a latent tuberculous condition in addition to the effect of dust The next slide The two cases preceding have been cases of silicosis uncomplicated by tuberculosis You noted in those cases that the apex and upper portion of the lungs were fairly clear Most of the pathology was in the middle and lower portion . This case ray No. 48 case No. 195 Bull 187 U. S. P. H. S. is one of pulmonary tuberculosis in a granite 174 worker You will notice the apices are fairly clear There is quite a lot of pathology indicated by the markings in the lower portion of the lungs The man had a cavity at the base of the right lung We checked most of these cases for sputum analysis and almost invariably we found they were positive These granite workers all expected to have oe tuberculosis they were rather averse to having sputum analyses This ray No. 45 case No. 32 Bull 187 U. P. H. S. is another worker showing similar condition with an active tuberculous process determined by physical examination in the lower portion of the right lung The usual markings are present and he had the usual symptoms of tuberculosis The next slide This is still another granite worker This slide shows the thickened pleura in this area together with the usual reaction to dust and to tuberculous infection You will notice in the earlier cases the shadows were linear and that they spread out to the periphery from the hilum in each case The markings here are more conglomerate and less distinct in character This ray No. 40 Case No. 174 Bull 187 U. S. P. H. S. is a very interesting case in that there seems to be a pneumonic process here The man had clinical and physical signs of active tuberculous disease and he died a short time after this picture was made You will note a little irregularitiyn the diaphragm at this point and the con- tour of the diaphragm on the other side is not clear There seems to be an adherent mass at that point This ray No. 46 case No. 194 Bull 187 U. S. P. H. S. is a very interesting case He was working and developed a condition which is quite like pneumonia physically Quite a bit of pulmonary tissue became consolidated which on physical examination gave all the signs of pneumonia He was intensely dyspneic but had no temperature nor toxemia and as this cleared up bacilli appeared in the sputum about three weeks after I believe somebody said that we didn't have any case of mottling of the lungs similar to the South African cases among the Barre workers This is an exception It is the only case we had which presented this type of picture The apices are fairly clear There ated by the markings in the The man had a cavity at the : checked most of these cases jost invariably we found they workers all expected to have her averse to having sputum o 32 Bull 187 U. P. H. S. similar condition with an acermined by physical examinae right lung The usual markthe usual symptoms of tuber- still another granite worker e^ pleura in this area together lust and to tuberculous infec- earlier cases the shadows were out to the periphery from the rkings here are more conglom- .racter : No. 174 Bull 187 U. S. P. case in that there seems to be The man had clinical and phys- us disease and he died a short made You will note a little otherother this side point is not and the conclear There s at that point No. 194 Bull 187 U. S. P. ase He was working and de- 3 quite like pneumonia physi- 'rytissue became consolidated on gave all the signs of pneu- spneic but had no temperature red up bacilli appeared in the ter at we didn't have any case of r to the South African cases l'his is an exception It is the nted this type of picture The 175 linear shadows are not present as in your other cases of silicosis There is a great similarity in this picture to what we see in Africa in gold miners Just why this case has this same marking I am unable to explain He weighed about two hundred pounds and was one of the finest look- ing chaps I ever saw He had no symptoms except a little dyspnea on exercise I saw Dr. Pancoast after I had been doing that study and he showed me the only other slide like this of a granite cutter with this particular character- istic and he said it was given to him as being a typical granite cutter in Vermont This is the only one I have with these particular markings to the same intensity of exposure silica as the preceding case This man was exposed and same percentage of DR GARDNER For how long DR RUSSELL Twenty years This man was a Scotchman In Barre they have a nice variety of nationalities Italians principally the Northern Italians FrenchCanadians Scotchmen American and New England Yankees few Spaniards and quite a few Scandinavians and a few other nationalities A VOICE man What was the subsequent history of that DR RUSSELL I don't know Two years later he was still well I hope to go back and check up on some of these people this coming year This ray No. 63 case No. 18 p 182 near Bull No. 187 U. S. P. H. S. is a case of an Italian who cut granite twenty years Eleven years prior to the time this Xray was made he had been living on a farm in Vermont and the reason he came to me was that he was getting to be quite dyspneic and he was worrying about his condition We took rays and this is the picture He had been in free atmosphere eleven years on the farm His dyspnea increased and two years after this time he had a fulminating tuberculosis he was past fifty years of age This is another case ray No. 62 case No. 299 Bull 187 U. S. P. H. S. with a similar history This man was Irish cut granite 26 years thirteen years immediately prior 176 to the time this picture was made he had been a night watchman in an insane asylum a dust occupation You will note that he had deep markings in the bases of his lungs It has lost that linear character and is more the cottony or confluent type He was very dyspenic and was 64 years of age He found it quite difficult to do any chores around his home and his occupation was quite seden- tary no strenuous work to do and yet he was bothered with dyspnea The superintendent of the hospital was quite interested in him and very much interested in our work and about three years after this picture was made he wrote me that the man's dyspnea had increased and that he had toxic symptoms and tubercle bacilli in his sputum This ray No. 68 Case No. 839 Bull 187 U. S. P. H. S. is a case with a similar history a New England Yankee He cut granite 17 years then went to Oregon and cultivated apples and he had been out of dust about fifteen years He came back to Vermont and cut granite for one year and he began to have some difficulties and this is what the ray revealed He later developed a fulminating type of tuberculosis and like most of those granite cutters with tuberculosis he did not last so long This slide is of an ray of a potter The man had spent more than twenty years in the pottery industry I think potter's clay contains about 35 silica about the same amount we have in granite With a picture like this I think we can safely say that the man was exposed to too much dust The flocculent shadows are possible due to a imposed tuberculosis The next one is a case of a potter with earlier stage of the silicosis You will note that the markings are more of a linear type and spread out at the hilus toward the peri- phery and to this portion with the enlarged hilus glands There are a few calcified tubercleisn the area He had been a potter twenty years when this picture was made I don't know much about acute silicosis but I am presenting this slide as a case of early silicosia with rather short exposure This man's occupation was that of a foremsn of tunneling work and he was exposed to dust for about a year This tunnel went through pure quartz rock was made he had been a night Num a dust occupation markings in the bases of his near character and is more the He was very dyspenic and was and it quite difficult to do any 1 his occupation was quite seden- to do and yet he was bothered tendent of the hospital was quite y much interested in our work ... this picture was made he wrote ,,had increased and that he had de bacilli in his sputum se No. 339 Bull 187 U. S. P. imilar history a New England 17 years then went to Oregon he had been out of dust about ick to Vermont and cat granite In to have some difficulties and ealed He later developed a fullosis and like most of those ulosis he did not last so long of a potter The man had spent "the pottery industry I think ut 35 silica about the same te With a picture like this I the man was exposed to too adows are possible due to a of a potter with earlier stage of : that the markings are more of ut at the hilus toward the periwith the enlarged hilus glands tubercleisn the area He had years when this picture was it acute silicosis but I am pree of early silicosis with rather s occupation was that of a foreod he was exposed to dust for went through pure quartz rock 177 and he was in it quite often during the working hours You will note that he has quite an increase in the linear markings He had perhaps an old tuberculosis condition in this hilus with a few calcifications He had no disability This is another tunnel worker with rather extensive pul- monary fibrosis together with a little interlobar pleurisy at that point The exposure of this case was something of about a year I have seen autopsies from cases from that same tunnel with exposure of a year or less which pro- duced a fatal silicosis This is perhaps an acute silicosis This is a slide showing a man who had been a lens grinder grinding pure quartz lenses for a period of eight months and he was disabled with silicosis at the time the picture was made He was in a tuberculosis sanatorium and the staff physicians were unable to demonstrate the presence of tuberculosis The patient's complaint like most silicotics was that of shortening of breath The hiluses seem to be greatly choked up The shadows are rather dense and no doubt he has silica deposited in the lung He has not had time in the course of eight months to develop the fibrosis indicated in the preceding ray This brings us up to the consideration of pneumoconiosis of a different cause You remember what I said in the beginning that you couldn't look at fibrosis in one case and say that was comparable to that of another You will see this worker has quite a bit of lung markings and yet he has no disability or apparently not much to worry about in the ' future He was a soft coal miner This is another soft coal miner who had been getting a little rock dust We believe this irregularity and the markings are more of a linear character and more discrete than in the previous one I must admit there is very little path_ ology there I am showing it to contrast with the preceding one This is an ray of an anthracite coal miner Apparently the anthracite coal miners have more rock dust exposure than the group of bituminous workers at large This case is interesting because of the interlobar pleurisy shown at this point between upper and lower lobes It is the only one I have ever seen like that You will note that be has quite a bit of pathology indicated ^finboth lungs yet the 12 on e ce 178 ee ee character of the markings is different from that of silicosis ee which I have shown you before ck DR WILLIS Would you mind commenting on the drop heart DR RUSSELL We don't know so much about drop hearts but we have an idea that cases having drop heart have some remote old tuberculosis It has been the experience in South Africa that workers with drop hearts developed silicosis and tuberculosis much more rapidly than workers who did not have it You will note in the preceding case the heart had a greater curve to the left than this notice that the border of the heart in this case is almost perpen- dicular This is another anthracite coal miner showing different markings You will notice the contrast in this heart and the preceding one This case and the preceding case had miner's asthma This is another miner with still a little different picture You will note that the markings in these cases don't seem to be parallel You will note the character of these mark- ings are suggestive of the presence of silica because of the rather uniform distribution This is an ray of a cement worker a man who had been working in a cement plant about ten years You will notice that it has different characteristics Notice the light that seems to be coming through in this area with more or Jess clouding at the areas to the outer portion There are fine linear markings underneath I wish to call your attention to the fact that these workers were exposed to about one per cent quartz in their dust averaged 25 million particles The dust counts I think . Following this there will be some slides of marble work- ers Cement dust contains a lot of calcium or lime The marble workers were exposed to dust which contained about 88 calcium carbonate and 1 think the company's analysis . of the dust stated that it contained less than one per cent of quartz Our analysis was taken from quite a different place and we found practically no quartz in the marble dust This is an ray of a man who had been cutting marble twenty years You will note the increased shadows lifferent from that of silicosis and commenting on the drop w so much about drop hearts ases having drop heart have It has been the experience _ 3 with drop hearts developed h more rapidly than workers ill note in the preceding case e to the left than this notice in this case is almost perpen- coal miner showing different he contrast in this heart and and the preceding case had still a little different picture ags in these cases don't seem the character these mark- resence of silica because of -- -- ient worker a man who had nt about ten years You will aracteristics Notice the light in this area with more or outer portion There are ath I wish to call your at- about vorkers were exposed to 1st The dust counts I think : some slides of marble worklot of calcium or lime The about to dust which contained think the company's analysis ined less than one per cent of en from quite a different place iartz in the marble dust who had been cutting marble note the increased shadows 179 around the hilus and around the larger bronchi But you will note the light areas which indicate there is quite a lot of good functioning tissue He had absolutely no disability and no evidence of tuberculosis or any other chronic pulmonary condition You will note in these slides of marble workers there are quite a lot of calcifications This one hasn't as much as the other These workers were the same age as the granite workers occupations very much alike and . the dust concentration little less in the marble than granite plants We found no case of active tuberculosis among the marble workers Dr. Rogers of the Vermont Sani- tarium for tuberculosis stated he never had a marble worker as a patient unless they had also worked in granite These marble workers had quite a lot of calcification of the costal cartileges This is another marble worker You will note the cal cification of the hilus of the lung and some increase in fibrosis This case like the others had no disability will note the calcification here You Those pictures weren't as good as we would like to have had them but the best we could do out in field work Field work is quite different than in institutions We work under handicaps in so many places In this picture the calcifications are present with quite a degree of fibrosis The con- stant exposure to dust over a long period of time carrying bacteria in the lungs would produce fibrosis doubt but not necessarily a disabling fibrosis Marble dust does not seem to predispose to any chronic disease MR TARRELL Did you follow that patient up to see how soon it was he became disabled DR RUSSELL Did I say he was disabled MR TARRELL took the ray You said he was not disabled when you DR RUSSELL That has been a year ago and he was all right when we took it We haven't heard anything This is a marble worker and the calcifications of these costal cartileges are indicated in this picture I am showing this next slide because of the calcification of the cartileges with apparent calcification of the pleura 180 This man was a slate worker His history is that he lived in the area of this slate and that for most of his life aside from farming that had been his sole occupation The slate workers in one plant which we observed were not exposed to any quartz The plant adjacent to this mill had about % quartz in the slate it used You will note in considering slate that the silica content of slate varies in different areas so we can't say that slate has a definite amount of silica without determining it first The same holds true for granite There are certain granites which have much less than 35 I think most of the Vermont granite contains about 35 quartz You can see the futility of trying to compare rays of the lungs from workers in one industry to those of another This is an ray of a slate miller You will notice he has a few pulmonary markings with quite a bit of fine linear fibrosis We found in the group of slate miller workers one case who had an active tuberculosis He had been in this slate mill about six years and apparently the tuberculosis was just incidental and not a result of his occupation Other slate workers showed hilus thickenings with a few calcifications Still other slate workers showed a different picture but not extensive pathology This is an ray of another slate worker showing quite a bit of shadows in the lower portion of the right lung with a few calcifications - This is the ray of a man who had or has asbestosis His occupation was that of cleaning and restoring the asbestos on pipes in one of our government hospitals He had been working at the trade about six years I think and you will see he has fibrosis of both lungs The character of the fibrosis is quite a bit different from that of the granite workers He had disability and the government compensated him for it This is a graph showing classification of silicosis The first classification was made in South Africa They started out classifying their cases as primary and secondary stages and as they learned more about the disease they had to add to this classification They learned that they had a stage earlier than primary and it was called primary . His history is that he lived ^bu atfor his sale most of his occupation life aside The slate i we observed were not exposed adjacent to this mill had about ed You will note in considering of slate varies in different areas has a definite amount of silica . The same holds true for gran- aites which have much less than Vermont granite contains about the futility of trying to compare vorkers in one industry to those late miller You will notice he kings with quite a bit of fine I in the group of slate miller an active tuberculosis He had ut six years and apparently the dental and not a result of his ved h^>lusthickenings witha few late workers showed a different athology ther slate worker showing quite peter portion of the right lung ian who had or has asbestosis f cleaning and restoring the asour government hospitals He ade about six years I think and s of both lungs The character different from that of the gran- bility and the government com- : classification of silicosis The : in South Africa They started s primary and secondary stages about the disease they had to They learned that they had a and it was called primary 181 and as it developed there was still another condition before they could be considered as primary so they called that more fibrosis than usual They took an average chest of the average individual as more or less a standard and there were a number of cases having more fibrosis than the average person and yet not enough fibrosis to be placed in the classes mentioned When they diagnosed a case as having primary primary or secondary silicosis their arrangement is that the man is entitled to compensation and he is removed from his dusty occupation This is the original classification of silicosis In Australia they used a slightly different classification They called their chests normal instead of average In Dr. Moore's paper he gives the reason for cases having more fibrosis than usual tuberculosis that is latent tuberculosis or healed tuberculosis cardiac conditions and dust The stages are called early and advanced Their advanced cases seem to be considered more or less in two phases At the International Silicosis Conference this classification into first second and third stages was recommended The South Africans have their classifications written into their laws and they have to stick to it although they said a more workable or reasonable classification should be adopted and adhered to The classification of stages designated as negative or average chest more fibrosis than usual first second and third stages was recommended Tuberculosis complicating any one of these stages would automatically place it in third stage The first stage of silicosis with tuberculosis would therefore be considered as the third stage This slide represents a case which would more or less come under the stage of more fibrosis than usual However the density in here is getting a little beyond that stage but you will note that the slide illuminates well indicating that there is apparently quite good aeration of the lung He was a sand blaster working for the United States Government and he had been in this occupation for eight years He was a colored man and he had several masks He not only wore one but two masks neither of which were good I took this ray because a man working in the same place he was had died of tuberculosis They 182 had filed a claim with the employees compensation commission for silicosis for this deceased sand blaster There was an ray of him at the hospital where he had died and apparently he was entitled to receive compensation and it was so recommended This particular case had been working along with him This picture was taken in 1926 he later developed tuberculosis and died and in 1929 the widow filed claim for tuberculosis and silicosis This stage I consider more fibrosis than usual and if he had had tu- berculosis and more fibrosis at that time it would have been considered a third stage case This is a slide of a granite worker I'm showing to bring out the point that when a tuberculous infection exists the rate of progress of silicosis seems to be augmented I find that I have left out the slide that should follow but I believe that I can describe the stage In the right lung there is quite a lot of fibrosis more than in the left lung This picture was taken in 1925 last year in 1931 I rayed this man again This condition was about the same but he has apparently developed tuberculous infec- tion in this lung and there was undoubtedly much more fi- brosis in this lung than in the right lung Ordinarily and in the preceding cases the disease has seemed to develop a little more in the right lung than in the left . You have perhaps seen our beautiful Union Station in Washington This is the ray of the man who carved two of the five beautiful statues which surmount the entrances on the outside to the Union Station He was one of the most skilled granite workers This is the right lung He has quite a snow storm appearance in this portion lower right At the time this picture was taken he had rales after cough afternoon temperature and loss of weight positive sputum and the usual signs or symptoms of tuberculosis See Southern Medical Journal Sept. 1932 pp 919-927 for ray This next slide is from another case from Vermont The man had apparently in this spot an old smoldering tuberculosis This case is not typical of our other cases some of which I have shown you in preceding slides in that they have bilateral fibrosis He had this conglomerate affair with little pathalogy indicated in the other lung Because oH employees compensation com- sand blaster There e hospital where he had died itled to receive compensation This particular case had been his picture was taken in 1926 sis and died and in 1929 the ulosis and silicosis This stage n usual and if he had had tus at that time it would have : case e worker I'm showing to bring uberculous infection exists the seems to be augmented I find e that should follow but I bethe stage In the right lung is more than in the left lung 1925 last year in 1931 I This condition was about the y developed tuberculous infecwas undoubtedly much more fithe right lung Ordinarily and isease has seemed to develop a than in the left our beautiful Union Station in of the man who carved two Mich surmount the entrances 1 Station He was one of the S. This is the right lung He ^ earancein this portion lower icture was taken he had rales perature and loss of weight tal signs or symptoms of tuber- dical Journal Sept. 193 pp other case from Vermont The spot an old smoldering tuber- pical of our other cases some in preceding slides in that they : had this conglomerate affair ed in the other lung Because 188 it was different I observed him very closely for a period of and half years while there I visited in the place a year later and found that he had not been sick nor lost one day from work I was back in Vermont in 1981 and as I was interested in him we took an ray and this is the result This area has spread pretty well all the way to the periphery together with a tremendous increase of the amount of pathology in the other lung He was feeling pretty well except that he was very dyspneic because so much of the normal functioning lung had been displaced with fibrous tissue ray No. 14 Case No. 189 Bull 187 U. P. H. S. This is the man's photograph He doesn't look particu- larly bad As long as these cases do not have active clinical tuberculosis they look quite well This is an actual photograph Plate 17 Case 37 p 160 Bull 187 U. S. P. H. S. of the lungs of one of our cases in Vermont This is the apex of the lung at this point You will notice dark areas through there The lighter areas - at the bottom are tuberculosis I want to call your atten- tion to the density of the pleura The pleurs as you know is a very small mucous membrane many times likened to the mucous membrane of your lip was great thickening of the pleura In these cases there I believe it is due to the fact that we have an exposure lasting over a long number of years and the possibility that the majority of the cases have a smoldering tuberculosis along with it That is I believe that the tubercle bacilli is perhaps a factor in this tremendously thickened pleura I have seen a number of lungs of silicotic patients who had a shorter exposure to a much higher silica dust than were the granite workers and the pleura was not thickened to the ex- _ tent of the Vermont cases Pleurisy pain is one of the symptoms of silicosis which we will consider in the dis- cussion of the diagnosis of silicosis One of the few com- plaints which the workers have is pain in the chest It is more or less trivial and not usually disabling They seldom complain of it and don't often stop work It bothers them more in damp weather Pains in the chest with shortness breath is about all that these Vermont workers complained of in the course of silicosis until they 184 begin to develop signs of active tuberculosis that is tem- perature loss of weight increase in the amount of cough with productive sputum etc. This slide is one showing the death rate in rural Ver- mont from pulmonary tuberculosis beginning about 1900 In the granite industry in about 1894 they introduced the hand pneumatic tool which is activated by compressed air as an instrument for cutting granite You will note that about that time the death rate of granite cutters from tuberculosis began to increase We think that is caused by the excessive amount of dust which is generated in cutting of stone with this hand pneumatic tool Bull 187 U. P. H. S. . Fig 26 p 180 I might say a few words about the diagnosis of silicosis I am frequently asked to speak of the diagnostic points of silicosis It seems to be the practice of so many people to draw their own conclusions from the rays alone We believe that in the scientific practice of medicine all points should be considered in making a diagnosis and certainly this should be done when there is the matter of extent of - disability to be decided on In Vermont we had complete physical examination history of the case which included the entire occupational life and that with any symptoms he may have had As I said before very few of them have many complaints They even forget that they have a little hacking cough which is perhaps due to mechanical irritation of the upper respiratory tract Ordinarily un- less they have a cold or infection they do not produce sputum They complain of an occasional pain in the chest and usually of a slight shortness of breath One of them expressed it to me in this way am beginning to get so I can't get my second wind When the reserve is called upon they seem to be unable to get their second wind Another phase in the diagnosis of silicosia is the consideration of respiratory diseases they may have had I showed you in the slides that this particular group of workers had more respiratory disease than the usual indi- vidual The physical examination ofthesethese workers is frequently disappointing You may listen to the chest and hear very little and when you see the ray you are sur- active tuberculosis that is tem- ^ easein the amount of cough ng the death rate in rural Ver^rculosisbeginning about 1900 the _ about 1894 they introduced a is activated by compressed air ing granite You will note that rate of granite cutters from tuise We think that is caused by ust which is generated in cutting -neumatic tool Fig 26 p 180 silicosis is about the diagnosis of speak of the diagnostic points of the practice of so many people sions from the rays alone We points fic practice of medicine all naking a diagnosis and certainly ,,there is the matter of extent of - in In Vermont we had complete story of the case which included fe and that with any symptoms veryfew them I said before even forget of they mechanical They mechanical perhaps due to iratory tract Ordinarily un- breath produce One r infection they do not plain of an occasional pain in the light shortness of of . in this way- am beginning to second wind When the reserve i to be unable to get their second diagnosis of silicosis is the considdiseases they may have had I group les that this particular of ratory disease than the usual indi- examination of these workers is 1. You may listen to the chest and en you see the ray you are sur- 185 prised at the extent of pathology present but even so that is no reason for omitting the physical examination The chest expansion is almost invariably limited in these workers and we find it almost in direct proportion to their length of exposure and which would be of course according to the progress of the disease The granite workers were a husky robust type of people and you would reasonably expect them to be capable of at least 2to 3 inches expansion whereas most of them had one inch or less They seem to have an abdominal type of breathing rather than thoracic I found that examination by palpation was quite disappointing the fremitus was not usually increased in the same proportion that it is in fibrosis of tuberculosis Tuberculosis produces a more or less localized fibrosis whereas in silicosis it is more or less generalized and that may explain the difference in the fremitus in the two conditions The breath sounds in these cases in Vermont were not changed to any particular variety There seemed to be more softening of all the sounds The fibrosis of tuberculosis produces more definite changes in breath sounds than does silicosis I saw some cases of silicosis recently which had developed the disease after very short exposure and they had breath sounds which were quite different from the Vermont cases In the acute cases which I saw recently the principal portion of fibrosis and infiltration were in the upper lobes of the lungs The lower part of the lungs were emphyse- matous The upper portion seemed to be functioning very little In the silicosis cases in our Vermont study rales were not heard unless infection was present When tuberculosis complicates silicosis almost invariably rales can be heard after the patient coughs as in tuberculosis in silicotic people A great amount of fibrosis may con- ceal the presence of rales to a certain extent in silicotic patients Our cases in Vermont had very few signs symp- toms or complaints until they began to develop an active tuberculosis That was a very definite point with them They then complain of increased shortness of breath pains in the chest loss of weight afternoon temperature productive cough and the usual other signs of active tuberculosis These patients seemed to have pulmonary hemor- 186 rhages more than most cases of tuberculosis We had sev^'ral deaths from hemorrhage of the lung and the doctors there told me about other cases that had died there of it prior to our study One of them had died on the lawn of a doctor's office trying to get help Hemorrhage is the result of ulceration of these tuberculous greas One of the cases of acute silicosis was giving me his history recently and he was quite perturbed because after he had a coughing spell his chew of tobacco was gritty This is a new angle on the elmination of dust He didn't mind the cough but he didn't like to have his chew of tobacco spoiled I think that it is the result of ulcerations and erosions of these silicotic and tuberculous lesions and dust was eliminated along with other debris The tuberculous complication of all the cases in Vermont other than the pulmonary type of tuberculosis were comparatively rare Most of these cases developed a fulminating type of tuberculosis and did not live so long as the uncomplicated case thereby lessening the chances of complications We had one man die ninety days after he quit work and most of the other cases died within a year We had only one man who lived two years after he stopped work I think that the comparatively short period of time they lived after developing tuberculosis would perhaps preclude the development of other tuberculous complications There were however a few cases of glandular tuberculosis one case of infection of the inguinal glands and a tuberculous elbow with adenitis of the axillary glands A few children in these families of granite cutters developed tuberculous meningitis I think you people are particularly interested in information relative to the point where a silicotic becomes disabled or where he should be compensated In our cases in Vermont we had no disability from silicosis unless they developed tuberculosis I don't recall and I don't believe we have recorded a single instance of a case with disability without the disease Our cases had from 15 to 30 and 35 years of exposure I don't believe that you can estimate the disability from the ray alone and that is why I urge that cases be studied not only by ray but by physical observations as well s of tuberculosis We had sev- of the lung and the doctors ses that had died there of it of them had died on the lawn > get help Hemorrhage is the tuberculous areas silicosis was giving me his hisuite perturbed because after he ew of tobacco was gritty This sation of dust He didn't mind e to have his chew of tobacco - the result of ulcerations and ad tuberculous lesions and dust ther debris tion of all the cases in Vermont ype of tuberculosis were com- ese cases developed a fulminatid did not live so long as the ' lessening the chances of comn die ninety days after he quit - cases died within a year We ed two years after he stopped paratively short period of time _ uberculosis would perhaps prether tuberculous complications cases of glandular tubercu- mutis inguinal glands and a mutis of the axillary glands A ies of granite cutters developed particularly interested in in- oint where a silicotic becomes { be compensated In our cases bility from silicosis unless they on't recall and I don't believe istance of a case with disability ases had from 15 to 30 and 85 believe that you can estimate 'yalone and that is why I urge nly by ray but by physical 187 This slide is a case of a man who was the lens grinder who had been exposed to silica only eight months and was disabled yet from the ray it didn't appear he had any disability but he was bedfast I believe I spoke of the fact that I have seen a number of disabled cases of silicoais recently The greatest amount of pathology was in the upper portion of the lung in these cases which is directly oppo- site to what we saw in Vermont Most of these recent cases were exposed to silica dust less than two years and have disability whereas in Vermont the workers were ; exposed over a period of many years There is one other thing I might speak of and I think Mr. Bloomfield touched on it this morning and that is about the called silicotic dusta There is one thing that Mr. Bloomfield didn't bring out that I wish to mention at this time The original report which started the discussion of silicotic properties of dust did not include dust counts to show that a hazard really existed There have been no scientific studies made on the subject but rather a lot of surmising If there is an antidote for silica dust we should make every effort to learn about it It would alleviate much suffering and save many lives as well as much expense to industry The author of this article did not show that enough dust was present to produce silicosis and because the workers didn't get silicosis he concluded the clay kept them from getting it He gives the analysis of this dust and the total percentage of silica in . the material was 88 or 84 the total percentage in silica in Vermont is 69 with much less quartz than his dusts seem to have had The following table shows that granite dust contains less silica and more of the called silicotic elements than what is found in the materials used in brickmaking 188 Analysis of Dork Barre Granite Silica ___.-...----------- 69.89 Alumina Iron oxide Sesquioxide Iron Sesquioxide Magnesia MgO Soda Lime Potash KO 4.29 Water uncombined H.O at 110 _W.-.-----.----. 0.81 0.81 combined Water 8,0 ig- nition ..--------.--... 0.23 Phosphorous P.Q. pentoxide Trace ...~...0.----.- Materials Used in Brickmaking Brick Contents Semple Factory A Silica _-.------ 88.90 Alumina ...... 7.472 .42 Ferric oxide Manganese mag- nesium and tin oxide ~--.... Soda ACLS 0.44 1.49 Lime ~.-----.. Water and Loss 0.00 2.49 Brick Factory B 84.90 9.88 0.10 ; 0.86 0.84 0.34 8.80 Report of Granite Area of Barre 1902. George I. Finlay State Geologist of Vermont ; Heffernan Journal of Industrial Hygiene November 1926 No study has been reported in which accurate dust counts were made and where it was shown that a silica hazard existed and has been a very definite curative or preventative dust mixed along with it thereby preventing the development of silicosis I hope that somebody will give us such a study I wish Dr. Gardner and Mr. Cummings much success in their endeavors along this line and I am sure if anything can be brought out as an antidote for silica they will do it There are perhaps a number of other things that will come up in the discussion I believe that is all for the present MR DOE Dr. Russell in your discussion of the surveys that you have made where there was a high silica content and where there was a low silica content you referred to the presence of fibrosis in both cases Yesterday I got the impression from Dr. Gardner that in the silicotic dusts there was no formation of fibrosis in the same sense that there was in the case of silicotic dusts Is it your view thatin the silicotic dusts the pathology is the same or different DR RUSSELL I think it is different In silicosis you have formation of silicotic nodules as shown by Dr. Gard- te Materials Used in Brickmaking Brick Brick Contents Factory Factory Sample A B OYIRNIA Silica 2....---- 88.90 OYIRNIA Alumina ...--- 7.42 84.90 9.88 OYIRNIA Ferric oxide 0.16 0.19 OYIRNIA Manganese mag- OYIRNIA nesium and tin OYIRNIA oxide ....--- 0.44 1.49 Soda OYIRNIA ____...-.- 0.85 0.84 OYIRNIA Lime _.--_.--- 0.00 Water and Loss 2.49 n 0.84 3.80 n 78 ce Heffernan 7 Journal of Indos ^ trial Hygiene November 1926 ported in which accurate dust ere it was shown that a s^>lica een a very definite curative or long with it thereby preventing is I hope that somebody will 1 Dr. Gardner and Mr. Cummings eavors along this line and I am brought out as an antidote for ober of other things that will I believe that is all for the in your discussion of the surveys re there was a high silica cona low silica content you referred in both cases Yesterday I got | Gardner that in the silicotic ion of fibrosis in the same sense of silicotic dusts Is it your view sts the pathology is the same or it is different In silicosis you nodules as shown by Dr. Gard- 189 ner In silicotic dusts the silicotic nodules are not present It is more of a generalized type of fibrosis MR DOE What I wanted to know was whether it was fibrosis or whether it was merely the presence of dust that was retained in the lung tissue . DR RUSSELL I think the ray penetrates most dusts I don't believe many shadows are recorded on the film due to dust particles MR DOE opaque You don't think that most dusts are radio DR RUSSELL I don't think that most dusts are MR DOE Are they radio opaque DR RUSSELL I think they are not MR DOE So that in the cases of marble workers that you showed the markings are not the dust in your opinion DR RUSSELL I think they are calcifications combination of fibrosis and lime That is MR Dog Then they are partially dust and partially a reaction of the tissues themselves DR RUSSELL losis Yes calcifications are present in tubercu- MR DOB When you have a silicotic dust such as marble dust for instance do you think Dr. Russell that the mere presence of those dust particles in the tissue in the manner that you have described have any predisposing effect in relation to tuberculosis DR RUSSELL Marble dust MR DOE Perhaps I don't mean to limit it to marble dust but to any silicotic dust DR RUSSELL I think that they might predispose to tuberculosis in this way not directly but indirectly In most dusty trades there is an increase in the amount of respiratory diseases and I think it is reasonable to presume that a repetition of respiratory infections certainly would tend to aggravate a smoldering tuberculous condition 190. Certainly the tuberculous condition would be better off without having these concurrent infections MR DOE If a man had a history of two or three pneumonias and a couple of pleurisies it might be significant DR RUSSELL Yes And influenza MR DOE Would there be any difference in that respect with regard to whether the man had an old tuberculous condition or never had had any tuberculosis DR RUSSELL I thought you said with an existing or latent tuberculosis MR DOE I am asking you the question both ways Whether it is in the one case or isn't in the other or whether both would be the same DR RUSSELL 1 think the incidence of respiratory diaeases of any kind a repetition of them a number of them more or less predispose to tuberculosis We have many patients giving a history of their break down from influenza etc. Of course we don't know in those cases whether they had latent tuberculosis or whether it is a new thing Most of us I think believe it is latent MR DOE case Is there any way of telling in a particular . DR RUSSELL Well the ray might reveal the pres- ence of it but it doesn't always show up on the ray It depends of course on the extent of the original infec- tion . MR DOE Well when you have an individual who has been exposed to silicotic dust who becomes tuberculous are there any means of telling whether the fact that he is tuberculous is associated with the dust DR RUSSELL I think different cases would vary a lot individually There might be some characteristics think it would be difficult to tell whether or not the case was associated with pneumoconiosis so to speak MR DOB In your studies have you made any comparison between the incidence of the disease of tuberculosis condition would be better off Arrent infections a history of two or three f pleurisies it might be signifi- id influenza de any difference in that respect ie man had an old tuberculous ! any tuberculosis it you said with an existing or ; you the question both ways case or isn't in the other or same the incidence of respiratory dision of them a number of them " tuberculosis We have many their break down from influenza know in those cases whether s or whether it is a new thing it is latent way of telling in a particular ray might reveal the presJays show up on the ray he extent of the original infec- ou have an individual who has c dust who becomes tuberculous ling whether the fact that he is ith the dust lifferent cases would vary a lot be some characteristics think 1 whether or not the case was josis so to speak es have you made any compariof the disease of tuberculosis 181 among the population of the locality and in the dusty trades I notice you had in the Barre survey the incidence of disease in rural Vermont In other studies have there been similar comparisons DR RUSSELL Not entirely similar We have in the anthracite coal the death rate for the county in which we made our study and the death rate from the coal miners in that area MR DOE And you had a high percentage of silica at least in the rock drilling didn't you DR RUSSELL Yes MR DOE Have you made any such comparison Doctor in the silicotic dust studies DR RUSSELL I don't believe we have there has been anything published I don't think MR DOE In the marble study there was no comparison of incidence of tuberculosis with the civil population DR RUSSELL Not in the report There were no cases of tuberculosis among the workers at the time we were there There is a low death rate from tuberculosis for rural Vermont MR DOE Are you satisfied that in the case of the marble study you made the incidence of tuberculosis was no higher than it was among the rest of the population DR RUSSELL I think it is quite conclusive that it was not higher among marble workers Ma DOE Would it be your opinion that that would also be true of other silicotic dusts DR RUSSELL I made the statement in the beginning that you couldn't compare fibrosis of one case of pneumoconiosis with that of another I think each one of these groups of workers is unique in itself I think with the marble workers whatever happens to them we couldn't say the same thing would happen to slate workers or any other group We might hazard a guess but one guess is about as good as another 192 MR DOE Do you believe that there is any marked difference between the silicotic cases and the silicotie cases in that regard DR RUSSELL Of tuberculosis MR DOE Yes DR RUSSELL Yes MR DOE Well you have made certain studies of non- ailicotic dusts One is marble and one is slate where silica content was nominal Is it your conclusion from those studies that the incidence of tuberculosis is as low as that of the rest of the population in the community DR RUSSELL I said it was for marble MR DOE What is the fact as to slate DR RUSSELL lation About the same The same as the popu- MR DOE How does the frequency of respiratory infection compare with that DR RUSSELL We didn't make morbidity studies of the marble workers nor slate workers According to our histories I think the slate workers have more respiratory disseases than marble workers I haven't the figures MR DOE But you wouldn't conclude from that that the tuberculosis rate would be higher DR RUSSELL The amount of tuberculosis we found among workers was not higher than that of the general population MR DOE Doctor will you tell us a little something about what you have found regard to secondary heart conditions in silicosis DR RUSSELL I don't believe we have any cases of sec- ondary heart conditions due to silicosis in Barre Certainly it was not indicated in the ray that there was undue cardiac enlargement particularly the right side of the heart MR DOE Did you form any conclusion as to whether that it is common or uncommon that there could be a e that there is any marked dif r cases and the silicotic culosis ve made certain studies of nonble and one is slate where silica it your conclusion from those e of tuberculosis is as low as ulation in the community was for marble fact as to slate same The same as the popu- frequency of respiratory infec- t make morbidity studies of the workers According to our hiskers have more respiratory dis18. I haven't the figures uldn't conclude from that that higher ount of tuberculosis we found igher than that of the general you tell us a little something I with regard to secondary heart elieve we bave any cases of seclue to silicosis in Barre Cerd in the ray that there was _ t particularly the right side of m any conclusion as to whether common that there could be a 193 secondary heart condition due we will say to third stage silicosis . DR RUSSELL I think it is possible Quite possible You have to take into consideration the person's previous condition his heart condition before the onset of silicosis A lot of people have a heart disease and it occurs in and out of dusty trades certain amount just like tuberculosis in the general population MR DOE You didn't feel in the Barre survey then that there was any evidence of a secondary heart condition that was attributed to the disease of silicosis DR RUSSELL No. MR DOE study Have you found any such factor in any other DR RUSSELL That was the most extensive silicosis study I have done I would rather you would consult the literature of others who have reported on that to give you their opinion : MR DOE From the studies you have made Dr. Russell what would be your opinion as to the advisability or inadvisability of continuing a man in a dusty atmosphere after the presence of silicosis is detected Suppose you had a more fibrosis than usual finding Would it be your judgment that that man should be excluded from a dusty occupation as soon as that was detected DR RUSSELL out very rapidly over If that were done it would take them You would have tremendous labor turn- . MR DOE Would it make any difference as to the number of years that he had been employed before the more fibrosis than usual finding was discovered DR RUSSELL I think it would MR DOE Would it be your view that all such cases should be excluded from dusty employment if possible I don't mean to state an impractical situation DR RUSSELL I think it would be better to clear up the dust than to have to be constantly thinning employes 18 A 194 out Dust can be prevented and you would have to take men in many dusty trades who are skilled operators At least they know their trades If you keep taking them out how would you retrain them for other occupations It is much cheaper and a better policy to eliminate the dust than to be constantly turning over employes because they , develop fibrosis MR DOE That might be the ideal situation if one could do that but assuming that after the best has been done that we are capable of in the present state of knowledge you take a man with more fibrosis than usual your idea would be that he should be gotten out of employment DR RUSSELL If there is an excessive incidence of tuberculosis in that particular occupation It depends a lot on the extent of silica in the dust I don't think I could or anybody else lay down a definite policy that would be applicable to all instances where you have silica ranging from one to one hundred per cent Some coal miners show more fibrosis than usual and yet history of bituminous coal is that they don't have excessive amounts of tuberculosis It would be folly to take those people out It would depend entirely on the industry involved and its past record MR DOE Well would the quantity of silica in the dust be the determining factor for instance if you had a marble worker with more fibrosis than usual would your recommendation be different than if he were a granite worker DR RUSSELL Yes it would be of course MR DOE Now then what you say would be a reasonably safe maximum and when I say safe I mean safe from the danger of tuberculosis complication first as to silica content DR RUSSELL I can only give you our experience in Barre I think it is the only dusty trade where that was well worked out Groups C and D were exposed to less than twenty million particles of dust the death rate from those people from tuberculosis was about the same as rural Vermont and the death rate in the groups exposed to more than twenty million particles was greatly in excess nd you would have to take you skilled operators At you keep taking them out o"ther occupations It is olicy to eliminate the dust over employes because they the ideal situation if one at after the best has been the present state of knowre fibrosis than usual your gotten out of employment an excessive incidence of occupation It depends a the dust I don't think I a definite policy that would where you have silica ranger cent Some coal miners and yet history of bitum- have excessive amountosf to take those people out e industry involved and its uantity of silica in the dust istance if you had a marble jual would your recomwere a granite worker be of course > do you say would be a when I say safe I mean rculosis complication first ive you our experience in lusty trade where that was ad D were exposed to less ? dust the death rate from ) was about the same as ate in the groups exposed ticles was greatly in excess 195 of rural Vermont I can give only my practical experience as approximately less than twenty million particles per cubic foot of dust containing 35 silica If a man has evidence of tuberculosis with more fibrosis than usual I don't think it would be advisable to continue even in that dust MR DOE Would that have a limitation as to the number of hours instance if you had an occupation that showed less than twenty million particles and say no greater silica content than you had at Barre would that employment be safe for that individual for an indefinite period of hours DR RUSSELL It seemed to be true there they continue in that occupation for many years MR DOE Nothing in the studies you have made since has effected that conclusion . DR RUSSELL We haven't done any studies since that time of silica dust Most were other types of dust What is applicable to the granite industry I can't say definitely would be applicable to other industries We believe how- ever that men can tolerate twenty million particles in that much silica 35 MR DOE Suppose you found a case in your marble survey of an individual who had been exposed to a dust containing a very nominal percentage of silica compared to the granite and that he had been exposed to that dust for a relatively short period of years say ten years and he developed tuberculosis would you say the development of tuberculosis in such a case was secondary to the employ- ment DR RUSSELL In the marble MR DOE Yes in the marble DR RUSSELL No I don't think so MR DOE Would there be any means of in the present state of our knowledge connecting a case where the exposure to silica was less than 35 and the number of particles less than twenty million any means in connecting a 196 up a tuberculosis with such a case with the industry that you know of DR RUSSELL I think it would be difficult You have to take into consideration a certain percentage of people have tuberculosis regardless of occupation MR DOE incidence That is in every community there is a certain DR RUSSELL Yes certain incidence of tuberculosis MR DOE Is there any criterion upon which those individuals in that community can be classified as to whether their disease is industrial or not if the silica content is lower than granite and less than twenty million DR RUSSELL I don't know of anything If we haven't the characteristic silicosis proceeding with tuberculosis I don't see how you can say positively that it is MR DOE What is the proper method of taking an ray to show the characteristic findings of silicosis ia there a proper technique as to under and over exposure being avoided can you tell us your views on that DR RUSSELL Personally I like ray of one character and other people of another character It is more or less a personal standard You realize that there is a big variety of ray equipment at the present time I am using a portable ray machine but I would much prefer to have a larger and better one a hospital unit The technique I use for this portable machine could not be used for a hospital I don't believe there is a standard technique for it although it has been urged that a certain technique be promulgated and used throughout the country but with the big variety of ray equipment I don't see how it can be easily carried out MR DOE In a hypothetical situation where you had say not a portable machine but a variety that might be available in the large centers you give us any criterion by which we can tell whether an ray is properly exposed not too little and not too much DR RUSSELL tell you that I think the ray picture itself would : rn weer perry h a case with the industry that it would be difficult You have a certain percentage of people ss of occupation erycommunity there is a certain tain incidence of tuberculosis criterion upon which those indican be classified as to whether or not if the silica content is s than twenty million now of anything If we haven't proceeding with tuberculosis I positively that it is e proper method of taking an teristic findings of silicosis is as to under and over exposure 1 us your views on that ly I like ray of one character er character It is more or less realize that there is a big variety e present time I am using a hospital would much prefer to have hospital unit The technique achine could not be used for a here is a standard technique for ged that a certain technique be ughout the country but with the ment I don't see how it can be etical situation where you had e but a variety that might be can you give us any criterion er an ray is properly exposed nuch the ray picture itself would 197 MR DOE What are the signs by which we would know DR RUSSELL If it is over exposed it is difficult to describe It is easier to demonstrate if you will the softer or less intense exposure brings out the finer shadows You can give more exposure and these fine lines are obliterated MR DOE Dr. Russell what is your view on the pathology of the higher incidence of tuberculosis in silicotics DR RUSSELL I think you had better refer to Dr. Gardner on pathology he has been discussing that yesterday and today MR DOE Suppose we accept Dr. Gardner's hypothesis at the moment that the phagocyte is killed and that ne- crosis sets in and that is something in the nature of poison which results in the tuberculosis do you give any comparable situation to that when the dust is silicotic in character DR RUSSELL I don't think it has been shown MR DOE Dr. Russell has the Public Health Service done any work in iron mines or has the Bureau of Mines done anything in iron mines with which you are familiar DR RUSSELL The Public Health Service hasn't and the Bureau of Mines hasn't reported anything MR DOE That is all MR TARRELL Dr. Russell in answering the question of Mr. Doe as to the standard or the given quantity of silica under which a man might work with safety you have reference to a group of men have you DR RUSSELL Yes MR TARRELL And in one section do you refer to any particular individual person DR RUSSELL No they were groups we studied MR TARRELL If a man has a breakdown of the upper respiratory tract a breakdown in the line of defense against the inhalation of dust particles should he work under conditions with twenty million particles in less than 35 silica 4 198 DR RUSSELL breakdown How are you going to determine the MR TARRELL Well it is a fact isn't it that the inhala- tion of dust particles tend to destroy the mucous membrane of the respiratory tract DR RUSSELL Yes MR TARRELL That has all been covered But if a man does have a breakdown and the mucous membrane is destroyed can that man safely work in an atmosphere of twenty million particles DR RUSSELL I don't think we said the mucous membrane was destroyed the ciliary action was limited The only way you can determine whether or not the cilia are gone is to get a section of the mucous membrane of the trachea to determine that MR TARRELL The resistive powers of some individuals ' differ from others DR RUSSELL Yes MR TARRELL Then there isn't any definite standard you can set up for separate individuals under which they may work DR RUSSELL No. The presence of tuberculosis predisposes to silicosia I told you about this case developing more fibrosis in the right lung and later having a tuberculous infection in the other lung and the rapidity with which the combined disease developed on that side Most of such cases in Vermont were the case of father and son the father had tuberculosis the son lived with him pre- sumably became infected These younger chaps in cases of that kind seem to develop silicosis more rapidly than the others MR TARRELL The amount of dust necessary to produce a nasal disease in one individual is not the same in all- individuals DR RUSSELL I think the upper respiratory tracts in different individuals vary a lot Deflected septum sinus disease chronic tonsilitis would alter the efficiency you going to determine the @ fact isn't it that the inhala- destroy the mucous membrane all been covered But if a man the mucous membrane is de- ly work in an atmosphere of ink we said the mucous memiary action was limited The * whether or not the cilia are the mucous membrane of the ive powers of some individuals e isn't any definite standard individuals under which they presence of tuberculosis preou about this case developing and later having a tuberdung and the rapidity with developed on that side Most re the case of father and son se son lived with him and preThese younger chaps in cases p silicosis more rapidly than t of dust necessary to produce idual is not the same in all 2 upper respiratory tracts in lot Deflected septum sinus ild alter the efficiency 199 MR TARRELL Does that statement apply equally as well to silicotic dust DR RUSSELL I think a person in a silicotic dust with a deflected septum would be more apt to have a res- . piratory condition than if he didn't have it MR TARRELL What influence would that have on the development of tuberculosis DR RUSSELL Well 1 think it would be indirectly as I spoke of before that that would perhaps have an undue amount of respiratory disease of different varieties and that in this way it might predispose to tuberculosis MR TARRELL And by respiratory disease you mean bronchitis pneumonia . DR RUSSELL Influenza . MR TARRELL Asthma and influenza DR RUSSELL Yes MR TARRELL That is all Dr. Ogden of the Illinois Steel Company Dr. Russell in all of your slides which showed a true pneumoconiosis other than asbestosis do you think that there was a possibility of ruling out silica as a determining factor DR RUSSELL You mean in all of them DR OGDEN Yes could it be ruled out as the determining factor causing fibrosis other than asbestosis . DR RUSSELL I don't think so DR OGDEN There was always free silica present in each one of those in varying degrees DR RUSSELL In practically all of them there was some silica present DR OGDEN It couldn't be ruled out as being the de- termining cause . DR RUSSELL No doubt the presence of silica with other dusts help to produce fibrosis The reaction to silica is much more violent than it is to other dusts Fee 200 DR OGDEN You didn't show any slides of true pneumoconiosis in which there was no silica with the exception of asbestos is that correct DR RUSSELL No I don't think so I think there was maybe one per cent in most of them That brings us up to the point of mixed dusts Practically all dusts are mixed Thes~ tunnel workers were exposed to almost one hundred per cent silica there were less of the other ele- ments with it DR OGDEN That cement slide DR RUSSELL That one per cent quartz was the finished product about DR BELKNAP Milwaukee Wisconsin I would like to ask if there is any known clinical functional test that you can give a man with a certain amount of pure silicosis by which you might determine his disability say he complained of a certain amount of dyspnea DR RUSSELL You mean like a tuberculin test DR BELKNAP pure silica No to get an estimate of disability from DR RUSSELL I don't know of any no I think in es- timating disability you have to take into consideration the whole picture the man's history and his background his present condition and the ray DR BELKNAF I meant definitely on dyspnea DR RUSSELL In our Vermont study we recorded by use of the spirometer the vital capacity Our statistician said that we couldn't do much with it statistically but it seemed to me that these men when they had silicosis had a marked decrease in vital capacity and most dyspneic patients had a marked loss of vital capacity One of the slides I showed you I think the second one chest in- dicated quite a bit of pathology and he had one of the best vital capacities of the whole group because he was the best golfer in that area he had built up a reserve You can practice with a spirometer and increase your vital capacity show any slides of true pneumono silica with the exception of n't think so I think there was st of them That brings us up Bts Practically all dusts are ers were exposed to almost one here were less of the other ele- it slide is the finished product about e Wisconsin 1 would like to clinical functional test that you ain amount of pure silicosis by te his disability say he comit of dyspnea i like a tuberculin test it an estimate of disability from now of any no I think in es- to take into consideration the istory and his background his ray definitely on dyspnea ermont study we recorded by vital capacity Our statistician ach with it statistically but it n when they had s^>licosishad capacity and most dyspneic paof vital capacity One of the : the second one chest inogy and he had one of the best le group because he was the had built up a reserve You eter and increase your vital 201 MR WRIGHT In the cases that come for litigation the spirometer is of very little value because we need full and perfect cooperation of the patient in order to get true vital capacity You spoke of response to exercise didn't you or did you You spoke of chest expansion Do you put any stress on the movements of the diaphragm DR RUSSELL Well chest expansion and respiration is along the same line as result from the spirometer It is more or less voluntary MR WRIGHT But I find that very often in examining patients they may know about vital capacity they may not know what you are looking at when looking for the movement of the diaphragm in the dark room They may not know what you are getting at One thing is response to exercise and another thing is holding of the breath I find when you don't get cooperation in any of the other tests a man may hold his breath for a normal length of time which is a very valuable thing In other words wouldn't you use the same tests to determine the man's disability in this lung condition that you would in any other tests of his ordinary physical capacity DR RUSSELL would Exercise is quite valuable in determining vital capacity I think it is really more accurate than the spirometer I used to meet patients at a certain place and walk up the stairs with them to an office for Xray and I counted their respirations at the bottom of the stairs and the top It gave a rough index as to what we might find with the ray The stairway had a landing half way up and the more advanced cases of silicosis would stop there for a few extra puffs and that is something they can't control You can determine your own respirations before and after and compare them to his I think it gave a fairly good index and of course other exercise is similar MR DOE Dr. Willis asked for an opportunity to correct a portion of what he said this morning I would like to have him given that opportunity DR WILLIS This morning the question came up right at the last concerning the concentration of dust and dust counts which were the limits of safety I think I said 202 that I would recommend five million What I wanted to follow that up with was this That is pretty nearly a compromise between Dr. Russell's data which he held at ten million as I remember it in his publication from the granite industry and the earlier investigations in South Africa which made it anywhere from five to eight million MR DOE Dr. Willis when you refer to a safe limit are you assuming a certain silica content in the dust DR WILLIS That was a 35 level because there is really no other basis to go on except those two well es tablished figures MR DOE Is there any method of getting a combination classification for instance we will say that five to ten million of 35 silica is safe from the standpoint of any hazard of contracting tuberculosis Can we make any similar classification doctor with reference to other quantities of silica DR WILLIS You mean 50 or % MR DOE Exactly DR WILLIS Well it certainly sounds like you could logically but there is no established fact that you can It is perfectly logical to assume that it ought to require a higher concentration coniosis than it would which Dr. Russell has of 10 a 50 shown silica to produce pneumo- but aside from the range I don't know of any well worked out authenticated data MR DOE It is the general conception is it not Doctor that the higher the silica content the more rapidly the disease will occur DR WILLIS His work would certainly indicate that MR DOE But there is no definite graduated which one can apply DR WILLIS No there is no definite graduated which one can apply scale scale MR DOE Was it your view that in the classes C and D where the incidence of tuberculosis was not above that million What I wanted to dataThat is pretty nearly a comwhich he held at ten is publication from the granvestigations in South Africa . five to eight million 1 you refer to a safe limit are content in the dust 35 level because there is on except those two well es- ethod of getting a combina- nce we will say that five to safe from the standpoint of tuberculosis Can we make ctor with reference to other % or 10 tainly sounds like you could stablished fact that you can sume that it ought to require % silica to produce pneumo- , but aside from the range ^ don't know of any well ta ral conception is it not Doc1 content the more rapidly the would certainly indicate that no definite graduated scale is no definite graduated scale new that in the classes C and ^...berculosis was not above that | 203 of rural Vermont would you say that if one of those men exposed to the degree of concentration that was involved in those cases which as I recall was sixteen million had contracted tuberculosis would there have been any means of attributing that to the industry in your opinion DR WILLIS That is a hard question I believe that unless you can illustrate that the concentration was sufficient to produce silicosis that it is only an assumption that that had a deleterious effect on tuberculosis Again there is no absolute proof MR DOE Doctor in your statement this morning and now do you use in making a statement you just made the terms silicosis and pneumoconiosis as interchangeable DR WILLIS silicosis Yes Pneumoconiosis would in that case mean : MR DOE Assume a dust which contains less than % silica From what you have just said I assume that the concentration might be very much higher with safety than it could be if the dust contained 35 silica Can one classify dusts silicotic and silicotic dusts by say- ing that a dust that contains as little as less than % dust falls into the silicotic groups of dust Can you give us any guide as to the margin of safety in that group of dust containing less than % DR WILLIS We can only cite the data available for coal miners and cement workers In other words in coal miners the silica content is perhaps one and half per cent and in cement it varies from one to about five In cement work the count is terrifically high I think it was fifty million or so When the silica percentage is low the dust count must be extraordinarily high to accord a hazard that a low count with high percentage would accord MR DOE Has any work been done with which you are familiar that gives any comparable result to the Barre study of silicotic dust with relation to silicotic dusts DR WILLIS No except these several pieces of work that Dr. Russell has mentioned MR DOE There are here a series of rays 204 MR TARRELL I want to ask Dr. Willis his qualifications as a roentgenologist MR DOE I will ask you Dr. Willis how many chest films do you see annually DR WILLIS I suppose about 3500 MR DOE You are the director of a tuberculosis sana- torium at present DR WILLIS I am on the staff MR DOE How long have you been engaged in tuberculosis work as a specialty Dr. WILLIS Well 1 should say since 1920 MR DOE What did you do at Hopkins relating to this subject DR WILLIS Well did a fair amount of experimental work on the question of anthracosis and silicosis in animals and I also from time to time saw clinical cases of pneumoconiosis and I wrote a review on the subject of pneumoco- niosis particularly as it relates to tuberculosis As I raid I don't mean to qualify as an expert witness in ray work I thought this was just a question of opinion MR DOE Yes Now Dr. Willis what were the conclusions that you reached on the experimental work you did on coal miners DR WILLIS That inhalation of coal doesn't have any appreciable effect within the limits of experiments it does not produce any fibrosis of the lung and in animals so exposed are not more susceptible to tuberculosis than other animals not so exposed MR DOE Your other study DR WILLIS The other study was a study of silicon carbide produced by the factory which Dr. Clark represented yesterday That was an experiment in which animals were exposed to inhalation of dust over three years and the results were essentially the same as those with the inhalation of coal dust 1 didn't know that this was going to be _ taken as actual evidence in the case ask Dr. Willis his qualifica- Dr. Willis how many chest bout 3500 irector of a tuberculosis sana- > staff e you been engaged in tuber- Id say since 1920 do at Hopkins relating a fair amount of experimental racosis and silicosis in animals , saw clinical cases of pneumow on the subject of pneumocotes to tuberculosis As I said expert witness in ray work Jestion of opinion T. Willis what were the conin the experimental work you ition of coal doesn't have any limits of experiments it does the lung and in animals so tible to tuberculosis than other idy tudy was a study of silicon cary which Dr. Clark represented eriment in which animals were t over three years and the reime as those with the inhalanow that this was going to be the case ee 205 MR TARRELL Before I consent to have your statement I want to ask some more questions MR DOE I thought this might be of great interest to have him tell us MR TARRELL I thought I heard Dr. Willis say this morning or two of the other doctors that from ray alone you could not reach a conclusion Now I understand you proposteo submit an ray and have him reach a con- clusion on that MR DOE No I haven't asked him anything about any films yet Now with reference to this man Bruno Rhode his age was 42 his exposure was six years the silica con- tent of the abrasive wheels which he used as a grinder was 1.5 and the concentration was 1.1 millions this man undoubtedly has an active pulmonary tuberculosis Now have you anything to say whether there is any evidence on that picture of dust inhalation That is one of the series which cover an interval of roughly one year you care to you may look at the entire series DR WILLIS In the first place there is quite a good deal of diffuse fibrosis throughout the lung There is evidence of spotty infiltration in several places with questionable cavitation which would certainly indicate a tuberculosis These diffuse fibroses and shadows are not the common finding in an ordinary tuberculosis How old is the man MR DOE Forty DR WILLIS He has been occupied at the job six years MR DOE As a grinder DR WILLIS Before one could pass on that one would certainly want to know a good deal more about the man's previous occupation and previous history that would all come in The fact is as Dr. Russell brought out from the film alone you cannot arrive at an ultimate conclusion because it is one of several bits of evidence but it looks like there is tuberculosis there There is this interesting fact too that these shadows here in the course of a year haven't changed as much as you might have anticipated if that were tuberculosis superimposed on a silicosis The 206 two films are not quite comparable and that brings up also the question of absolute reliability of films MR DOE I show you another film Dr. Willis this was taken on March 10 1932 MR TARRELL Which case is that Mr. Doe MR DOE This is the Prahl case DR WILLIS In this first film there is very definite evidence of tuberculous infiltration with cavity in the left upper and with quite a bit of diffuse areas of presumably tuberculosis In a film like this here there might have been at an earlier time some other markings but the tuberculosis has supervened It is awfully difficult to pass on the other markings and I wouldn't want to make an absolute statement as to whether all this below and on the other side is tuberculosis or is an occupational infiltration MR DOE That is all MR TARRELL No questions MR DOE 1 would like to ask Dr. Gardner some more questions I would like to ask you Dr. Gardner whether in the case of inhalation of dust containing less than two per cent silica do you believe you can assist us any on the question of whether there is any necrosis such as described in the silicotic nodules DR GARDNER In none of our studies has there been any necrosis except in the case of free silica MR DOE Does that have any bearing on the conclusion of the relationship between silicotic dusts and tuberculosis in your opinion DR GARDNER It has always been my belief that the necrosis produced by silica was responsible for the sus- ceptibility to tuberculosis That is at the present time a hypothesis however and one on which we are working to attempt to prove this association MR DOE That is all -- Ly -able and that brings up also ane Jility of films come other film Dr. Willis this was matae e is that Mr. Doe ahl case film there is very definite eviation with cavity in the left of diffuse areas of presumably e this here there might have ne other markings but the tu- It is awfully difficult to pass I wouldn't want to make an hether all this below and on is or is an occupational infil- ions to ask Dr. Gardner some more ask you Dr. Gardner whether dust containing less than two you can assist us any on the Any necrosis such as described of our studies has there been ase of free silica ve any bearing on the concluveen silicotic dusts and tu- lways been my belief that the : was responsible for the sub- That is at the present time a ne on which we are working sociation 207 FRED M. WILCOX Chairman Industrial Commission of Wisconsin To have had an opportunity to give intensive and sustained consideration to a subject of this kind as we have done is just another demonstration of how much better it is than to have to submit these issues in court to a jury made up of the butcher the baker and the candle- stick maker I need not say more I urge upon you who represent industry you who represent insurance carriera and all those who are interested in the administration of workmen's compensation to keep in touch with the men who have been here and to remember the counsel of Mr. Cummings and Mr. Bloomfield and the doctors as to the many things we ought to have in mind when we make our studies When we do undertake a study let's tabulate everything that is available And there is another thing that wish to impress upon you because of the delicacy of the situation Families of . deceased workmen do not want post mortem examinations After all when death has overtaken an employe who has been exposed to a condition which may or may not produce s^>licosisor perhaps a superimposed tuberculosis we should do our best to dissuade the family from the feeling that they have and prevail upon them in the interests of a better understanding of this whole subject to consent to a limited post mortem examination least of the lungs Too often when these matters are in issue we play on the feelings of the families to induce a settlement of a case by compromise Rather than go through the post they settle It should be approached from an entirely different point of thine terest of all in a better understand- ing of the effects of our employment We have just got to take a firm yet sympathetic stand Thanks again for your attendance and your contri- butions TEE areueee - 208 Appendix A BIOGRAPHICAL SKETCHES Dr. Leroy U. Gardner was graduated from Yale Col- lege and from the Yale School of Medicine receiving de- grees of B. A. and M. D. in the years 1912 and 1914 re- spectively He spent three years in graduate study of pathology under Dr. F. B. Mallory at the Boston City Hospital and during the last two years of this period he was also ranking instructor in pathology at the Harvard Medical School He then accepted a position as assistant professor of pathology at the Yale School of Medicine when it was being reorganized by Dr. M. C. Winternitz After a brief period of teaching there it was necessary for him to come to Saranac Lake As soon as his health would permit he became associated with the Saranac Laboratory for the Study of Tuberculosis In 1919 they started experimental investigation of the study of the inhalation of dust as a predisposing factor in the production of tu- berculosis These studies have been in progress since that time In 1928 he was made Director of the Saranac Laboratory and since that time they have expanded their work in the field of pneumoconiosis associating themselves with others in various parts of the country who have been similarly interested Today the whole Laboratory is organized for the investigation of this problem and they are devoting the major portion of their time to it Mr. Donald R. Cummings was graduated from the U. S. Military Academy in 1920 and entered a School for the Instruction of Officers as a first lieutenant immediately following his graduation He remained in this school for one year at the end of which time he resigned and entered the Massachusetts Institute of Technology He was gradu- ated from this institution in 1923 with the degree of B.S. in chemical engineering He then accepted a position as instructor in the Massachusetts Institute of Technology under Dr. Warren K. Lewis It was then necessary for him to come to Saranac Lake and after recovering his health he became an instructor in physics and chemistry wT" eo . SKETCHES graduated from Yale Col1 of Medicine receiving de- he years 1912 and 1914 re- ars in graduate study Mallory at the Boston City two years of this period he " pathology at the Harvard pted a position as assistant ale School of Medicine when r M. C. Winternitz After .e it was necessary for him s soon as his health would with the Saranac Laboratory . In 1919 they started ex- the study of the inhalation tor in the production of tu- > been in progress since that ectorof the Saranac Labora- have expanded their work in associating themselves with country who have been simi- ple Laboratory is organized blem and they are devoting ie to it vas graduated from the U. S. ad entered a School for the first lieutenant immediately remained in this school for time he resigned and entered Technology He was gradu1923 with the degree of B.S. : then accepted a position as etts Institute of Technology It was then necessary for ke and after recovering his tor in physics and chemistry 209 in the high school at Saranac Lake for two years in order to assure his complete recovery Early in the year 192B he became associated with Dr. Gardner in research work dealing with pneumoconiosis in the Saranac Laboratory He has been made Assistant Director of the Saranac Laboratory and has continued research work in pneumoconiosis until the present time He has been a Consultant in the U. S. Public Health Service under Dr. Leake and at present an instructor in the Trudeau School of Tuberculosis He is a member of the National Tuberculosis Association American Chemical Society and a special committee of the American So- _ ciety for Testing Materials He has had an opportunity to make several field investigations in industries having a known dust hazard Dr. H. S. Willis graduated from the University of North Carolina in 1914 obtained his M.D. at Johns Hopkins University in 1919 and his M.A. at the same University in 1920. From 1919 to 1922 he was Assistant and Instructor in Medicine from 1922 to 1928 was Associate in Medicine from 1928 to 1929 was Associate in Clinical Medicine from 1929 to 1930 was a lecturer in Clinical Medicine at Johns Hopkins University In 1929 Dr. Willis was placed in charge of Dows Tuberculosis Laboratory of the Johns Hopkins Hospital and during the period of his connection with the University was Assistant Visiting Physician and Dispensary Physician at the Johns Hopkins Hospital From 1928 to 1930 he also conducted a general practice in the City of Baltimore In 1930 he came with the Wm H. Maybury Sanatorium which is the Detroit Municipal Tuberculosis Sanatorium at Northville Michigan as -- pathologist He has done a volume of clinical work in internal medicine and tuberculosis and several years of experimental work on tuberculosis and pneumoconiosis He has made numerous publications on these subjects in the American Review of Tuberculosis and in the magazine Medicine At the present time he retains his connection with the Maybury Sanatorium where he is still pursuing clinical work in pneumoconiosis in conjunction with his other duties 14 o 210 Dr. W. Irving Clark received his medical education at Columbia University New York City where he received the degrees A.B. and M.D. Following this he served as interne at the Roosevelt Hospital New York City from 1904 to 1906 Moving to Worcester he became connected with the Worcester City Hospital where he worked on tuberculosis in the patient department and later became the Secretary of the Worcester Tuberculosis Relief Association which carried on active field work among the tubercular pa- tients in Worcester He was later appointed assistant surgeon at the Memorial Hospital Worcester and in his private practice he did considerable chest work dividing his time between this and general surgery - During the war he served overseas with the American Red Cross and later as Captain of the Medical Corps of the United States Army . In 1911 he was appointed in charge of medical service of the Norton Company Worcester a large manufactory of artificial abrasives grinding wheels and grinding machines He has been connected steadily with this institution until the present time and has made a special study of the effects of the inhalation of abrasive dusts on the lungs of the workmen These studies have been published in . four papers on the Dust Hazard in the Abrasive Industry Dr. Clark has also written an article on the effect of inhaling artificial abrasive dusts for Occupation and Health Encyclopedia of Hygiene published with the International Labor Office Geneva Switzerland He has also published an article on Industrial Medicine in the Oxford Medicine and a similar article for the Nelson Loose Leafe Medicine Since 1919 he has been connected with the Harvard School of Public Health first as an instructor in Industrial Medicine and for the last two years as assistant professor in the same subject Mr. Bloomfield was graduated from the University of New Hampshire in 1920 with the degree of Bachelor of Science in Engineering and immediately after graduation 211 ' became affiliated with the United States Bureau of Mines at the Pittsburgh Experiment Station During the threeyear period at the Bureau of Mines Mr. Bloomfield conducted extensive studies on problems related to toxic gases fumes and dusts A considerable portion of this time was devoted to the development of protective devices for use in contaminated atmospheres From April 1923 to the present date Mr. Bloomfield has been attached as Sanitary Engineer to the Office of Industrial Hygiene and Sanitation of the United States Public Health Service devoting his entire time to probJems dealing with the industrial environment as related to its effect on the health of the worker The health hazards associated with radium dial painting lead storage battery manufacture the use of tetraethyl lead gasoline chromium plating and the pneumonia problem in the steel industry are a few of the problems which Mr. Bloomfield has been engaged on during the past ten years The largest portion of his time however has been devoted to studies of the dust hazard in various industries Mr. Bloomfield has conducted detailed studies of the dust ex- posure of workers in connection with every one of the many dust studies carried out by the United States Public Health Service and is author of the Bulletins issued to date on the studies of the health of workers in the cement and granite cutting industries He was also affiliated on the study of the dust hazard in the sandblasting industry which was conducted jointly by the United States Public Health Service and the National Safety Council In addition to the studies concerned with the nature and - concentration of dusts in industry Mr. Bloomfield has also made many studies on the efficiency of dust removal devices and other equipment used for the protection of the worker Mr. Bloomfield is author or author of more papers on various subjects pertaining to health in industry than 30 hazards Following the graduation of Dr. Albert E. Russell from Medical School he became Resident Physician of the Waverly Hills Sanatorium at Louisville Kentucky in 1918 212 which position he held until 1919. He then entered the employment of the United States Public Health Service as a member of the Staff of Service Hospital No. 26 at Greenville South Carolina where he remained in service specializing in the treatment of tuberculosis during 1920 and 1921. From 1922-23 inclusive Dr. Russell acted as Assistant Chief of the Tuberculosis Hospital Section of the U. S. Veterans Bureau From 1924-30 he was in charge of field studies as to the health of workers in dusty trades for the United States Public Health Service In 1930 he was appointed as official representative of the United States at the International Silicosis Conference at the League of Nations at Johannesburg South Africa of which he acted as Chairman In 1930 he became Chief Surgeon of the U. S. Bureau of Mines Dr. Russell has made numerous contributions to medical magazines and has written many reports for the U. S. Public Health Service covering particularly the field of pulmonary diseases and more specifically those diseases. resulting from the inhalation of dust 1919. He then entered the emPublic Health Service as ervice Hospital No. 26 at where he remained in service t of tuberculosis during 1920 inclusive Dr. Russell acted as berculosis Hospital Section of J. From 1924-30 he was in the health of workers in dusty * Public Health Service In official representative of the ational Silicosis Conference at ohannesburg South Africa of airman In 1930 he became Bureau of Mines jerous contributions to medical 1 many reports for the U. S. ering particularly the field of ore specifically those diseases on of dust 218 Appendix B ; LIST OF PERSONS WHO ATTENDED CONFERENCE CON CERNING EFFECTS OF DUSTS UPON THE RESPIRATORY SYSTEM HELD BEFORE THE INDUSTRIAL COMMIS SION OF WISCONSIN AT CHICAGO ILLINOIS ON NOVEMBER 16-17 1932 Nume Address Andrews Aso ..Chicago Busines Profession Connection Lumbermens Mu- 2 2 . .. ....-----. tual Casualty Co. Atkinson F. Milwaukee Wis ..Liberty ..Liberty Mutual . Casualty : Augst R. M ontreal Wis... - ee 002-0 Montreal Mining Banyai Dr. A. Milwaukee Wis Physician ._..... Clinic Director : Muirdale San Belknap E. L. M.D.281 W. Wis Ave. Medical Director Globe Union Mfg Milwaukee Wis Co. Bellis Dr. Wa uwatosa W is Supt Muirdale San Berlin Dr. Chicago Ill Augustine Hosp Biever Kobler Wis -__. Me ch Engineer Ko hler Company . Bloomfield J. Wash ington D. S . Publi c . : Health Service Britton Dr. J. Chicago IllMedical IllMedical Director International Harvester Co. Brown Wm | M ilwa ukeeWis Lawyer . Chalmers Mfg Co. ClaDr r.k W. Irvine Worcester Physician Norton Company Harvard School Cottingham M. Kohler Medical Director Kohler Company N.Y ______ Ass't Director ... Saranac Lab DeBlois Lewis York " ._..--...00.--- eece neces DicksoLn. Chicago Ill 22... eee .Standard .Standard Equip- ment Co. Dobbins Dr. Thos Kenosha .Nash Motors Co. Doe Arthur ...... ...... 825 N. Broadway Lawyer - Employers Group Milwaukee Wis Earlywine J. Chic Illa . 2g ..o . gee eee eee eee weeceee French G. Chicago BL.. 1 LibertyLiberty Mut Cas Ford Dr. W. Mi lwaukee Wis . Physician Chief T. B. Div Health Dept. 74 214 Business Nome Address Profession Cannettion Gandrey Alfred R. Milwaukee Wis Lawyer City Atty Nowak A. Chicago Ill Indu .Ill Is ndusCom T.S. W. ieee O'Malley Dr. T.S. 238 Wis Ave. Surgeon ...ccncssenecnnenee Milwaukee Win : Ogden Chicago III 2. we eeee III SteeClu Utlen C. J. Milwaukee Wis Attorney ..Liberty Mutual Ins Co. Parrish L. .. Milwaukee Wis . Pierport Dr. C. Ironwood Mich . ae O. Smith Corp. vec Plekands Mather Co. Raid ... Hurley Wis .... cece eee asecae Montreal Mining Co. & Odanah Iron Co. Reynolds Paul F ... Cleveland Ohio .... eee ee MontCor. eal Mining Ringo Dr. H. ..... Montreal Wia 0,2... eee eas Montreal Mining e Russell Dr. A. E Washington D.C. Surgeon wecwe .U.S .U.SPublie Health Sander Empire Bldg 0.02. Employers Mut Milwaukee Wis Chicago Consultant Med Sappington Sapington Sappington : ++ an Ill a : Ho Leas 7 oo Schlomovat W. cee Benj ....... ..210 Empire Bldg Interniat Milwaukee .Mllwaukee Wis Sexton James .5- vo Y ca eee . EmployeMrust Story H. ... Milwaukee Wis .ccceeeee +++ Alils Chalmers Tarrell L. Milwaukee Wis Attorney a eaeeneene Tharinger E. ... Milwaukee Wis Pathologist 0005 coclee eoee . Warfield Dr. Louis ... MilwaWisuIknteerniest . 22. ccneescensesanceces White Wm ..... Cleveland Ohlo2. .aeeeee ++. Montreal Mining Wileos F. .. Madison Chairman Wie Indua Com Will Detroit Public H. Detroit Mich 0... ......- we Health Dept. Goldschmidt W.J. Milwaukee Wis Attorney _ Graves Dr. Chicago Medical Director III Indus Com A. Wu Milwaukee Gray 121 E. Ave. Wis . Practies 215 Name Address Guillers F. .., Chicago Bun Profession Connection n . ae .Eye .Ey e Shield Co. Guire Peter Jr. Chicago Ill Commissioner III Indus Com Milwauke ce.ee HaDrb .J. be Wis Roentgenologiat 0 122. case a Hensel O. Chicago Ill .Safety Director .Youngstow.n .Youngstown Sht & Tune Co. 4 Cement ee Hush Gordon C. ..Chicago Jt... coe beeen Universal . Atlas Co. e Ireland Walter Kahler Wis Employment Mgr.Kohler Co. Janzer W. Milwaukee Wis Seaman Body Corp. es Knutson R. Gladison MemberWin Inous Com ^ nsuranes ......... B. 32 yes Kuechle Wausau any ......... Employers Mut ec Kuhn Dr. Leroy P. Chicago Ill PO rmsemsencences Lumbermens Mut Cas Co. . Lavich LChicago 0 Lumbe rmens Mut Cas Co. Lots Oscar ..... 324 E. Wis ve Medical Private Practice Milwauker W. Meintyre M. Cleveland Ohio oo loses eee PiCcok.ands Mather McLaren Dr.J.B. Appleton Wis Physician . | Chief Surgeon Kimberly Curp Wis Mellum H. ~ Keremba Wh ve Nash Motors Cu . Dr. MilosL lavich PatholPaothgoliogsistt wee ory Nelson Harry .. Madison Director Work- * , Compe Wis Indus Com Wrabels Voyta .Madison Wis.empor Wis Indus Com Wright C. Minneapolls Minn I n tercnelseaekteee cerncceeen | Fickands Zinn R. Ironwood Blick Mather Co.