Document nmOZovaQZ0VjRBLZZgMbe0Gz

284 Twenty-third Annual Safety Congress--National Safety Council When. therefore. an award nf $500 was made the Compensation Board imme diately set tip a pros|K*clivc reserve i*t oppression of an additional $11,500, with the result that we had an estimate*] liability to the end oi 1932 oi several million dollars, most nt which was outstanding. With the jiassngc of time h also liecanic apparent that the removal of the men from tmderyrotmfl employment in the early stages of silicosis di<l not have the results antieijiatwL The lavimiit of a lump sum award did not in most cases serve the end cxjiectcd. As a general rule this money was expended for other things ami the nun made little effort to relialulitatc lltemselves. A certain mmiluT oi men classified as silicotic continued in their undcrgnunid employment and we fotmd practically no difference in the rate of progression in those who continued as com pared with those who were taken out of the mines. S*ntc of this may have Iteen dne to the altered economic status. Init even ti the comontic status had remained the same, we were inreed to die cottchtsinn that there was little ii any Imtcfit ti the men ly removing them from ttndcrgrotmd work, tmless of course, there was evidence of an onset of tultcrculosis. It shonM. t course, Ik* understood tliat during this time active efforts were made hy the mines to improve ventilation and to allay dust. Without this the a!*ovc statement would not hold true. Slops were also taken hv the mines to proviile that men iti the early stages of silicosis were placed where the conditions underground were most favorable. Our exiuTiencc also indicated tliat tlic eorlv stages of silicosis *lo not necessarily mean an iuiimimuiU of working cajiactty. This is all the more inqMtrtant on ac count of the diffieolty of <liagnnsing silicosis in its early stages, as there is no sltarp line of demarration Iwtween the prc-antepriniary and the nnteprimary. or K-tween niUcprtmnry and primary stages, and as a matter nf fart, we lirlievc tliat there is a great <Ieal more uncertainty in the diagnosis of silicosis tlian the medical nun are willing to admit. Tlic determination is largely a ntaUer f porsinl judgment and therefore subject to error. A great deal of what may lie rend into an X-ray film depends ii|*in the technique in taking the film. Certain other diseases ami chest conditions will also give in tin* film an npjvnranee simulating tliat of silictsis and we believe it is safe to sav that without a definite knowledge f occupational history the diagnosis of silicosis in its earlier stages would lie practically imimssihlc. 1 it view of tltesc conditions, it was felt tliat tlic industry was carrying an unfair Imrdcn and in 1933 the Act was amended. The anteprimary ami primary classifica tions were delete*!, compensation was made payable only for disahility. which means actual int|<airnivnt of working capacity, men with a moderate degree of silicosis were allowed to continue underground work and the industry was relieved from unlimited liability in restart to progression hy providing tliat the claimant must nvtkc and estaldish his claim tor disahility within two years of leaving the employ ment at which he was exposed to dust, to entitle hint to compensation. As 1 said before, silioisis is essentially an employer's prolJcm. It is in many places an inumrtant item in his cost of production and to a considerable degree it is a owtmllahlc item of cx|H*nse. If the employer simply leaves the matter in the hands of the *!octors. he will liavc no one to hlante Intt himself over what it costs him. The opinion nf the ordinary prnclituwur and even of tle roent genologist aiul expert cliest and lung man mav lie of little value. Only the opinion { those l<dors who have had si>ccia) training in the diagnosis of silicosis from In'th clinical and X-ray examinations should Ik* accepted* and even those opinions cannot lie accepted in all eases. We do not say this with any intention of criticizing the ineinlicrs of the medical nrofosion. hut where tin* natter is so im|irtaut and costly to industry, where so little is actually known aN'irt tin* disease, and where there is still an element of inieertainty in the diagnosis of silicosis in its earlier stages, too much care cannot Ik* exercised, and the closest scrutiny hy industry which lias to nay tin* hills is nrnst necessary. The lx*st results can only lie obtained hy the employers and the doc tors working together, hut the employer must outsider it as one of liis particular problems. I have also stated tliat in the absence of any cure it is much more important Mining Section 285 to know how to reduce the incidence than to know the cause. We Ixdivvc the chici preventive measures arc as follows: !. Improvement in fundamental working conditions in tlic matter of ventila tion and allaying dust. 2. A rigid initial examination to keep out >i the industry those men whose physical condition would indicate a tytie most susceptible to silicosis and luln-rculosis. 3. (*fintro| of tuhcrctihttis not only among employees, hut also among those with wlumi they come hi contact. It goes without saying tliat if silicosis is caused !v the in!ialnii<m of du>t. the removal of dust will remove tltc cause. This means ventilation and lots of it. and where jKissihle the wetting down of dusty places. In mining operations tin* chief source of dust is liclievcd to tic from blasting, therefore the time interval before men return to a blasted face is im|ortaut. Ventilation and water will remove the visible dust front the air. Imt it is not the visible dust that causes the damage. It is the dust tliat ranges iKtwectt onehalf and five microns that is dangerous and is so difficult to remove, and the quan tity in the air can only he determined by sonic method of sampling. We would consider it a mistake to liavc either the type of sampling apieirattts or the |H.*rmissihlc dust count defined hy law. This may lie all right on the Knurl in South Africa where conditions arc more or less standard, luit it is not advisable in the United States nr Canada, where conditions vary so greatly. For rate thing, we do not knmv what constitutes liannful dust and there is no standard practice for the treatment of dust sample slides. Tito untreated slide of a sample taken near a carbide lamp in an otherwise dust-free atir.nsjihcrc. w'mild show an a]iparent very high dust count. Dust sampling, however, should Ik* a part ot the regular routine, using the type of apieiratus Ik*si snite*l to the ]iarticular conditions, amt this will sltmv whether the ntnwispltere is good. fair or poor. Xext to ventilation and the laying of dust, the most iniiortaiit measure is to carefully select the type of men to lie allowed to work in the industry. This re quires a rigid initial examination which slum!*] include a complete physical t-xamination and X-ray. Fly this means men with thr tytie of chest which would indicate their susceptibility to tulicrculosis and silicosis can Ik* eliminated. Tltc complete physical examination should also have a lK*neficial effect on the accident rate. Uncomplicated silicosis is not a big problem, hnl silicosis and tulicrculosis com bined represent a very real problem. Tlic measures for tltc control of tultrrrulosis are well known. Particular care should ho lakoti tlut imu with tulicrctdosis lie withdrawn from the industry and given pn*|KT care and treatment. Hares wlicre the employees live should also Ik* sni*ervised to see tliat tliev are not cx|tosed to tubercular contacts. Some Aspects of the Silicosis Problem By DR. H. H. MOORE and DR. M. J. KELLY Medical Staff. Hollinger Consolidated Gold Mines, Ltd., Timmins, Ontario, Canada The speaker said m part: In 1928 the Ontario Mining Act was amended to lirnvidc phvsical examination on employment and yearly thereafter, or twice yearly if indicateii. of all underground men. To he empinyed the workman must hold an official certificate good for twelve* months, stating tliat he is free from disease of the resnirafory organs. Tin's certificate must lie renewed at each annual examina tion. In the meantime, an amendment to the Workmen's Onnpcnsation Act itrovided fir the appointment of medical officers working under the supervision of the Compensation Hoard to conduct tltesc examinations. Cases of silicosis arising at these examinations are submitted to the Workmen's Coni|*cnsntion Hoard ii the total exposure to silica of five years in Ontario mines is verified. In addition to this routine with silientics. there is a close cheek kept on the possible undue progress in the fibrosis in any case and if necessary steps are taken to remove such a case from harmful contact with silica. *