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FILE NAME: International Nickel Corporation (INC) DATE: 1968 Feb DOC#: INC002 DOCUMENT DESCRIPTION: Journal Article - Industrial Hygiene and Medicine e crash] y, N el 42 _ ilision i ; Harb wmen.1 causing] curred people : ord Twelv fork i they ral col! cen t: ft most y da >,000. n Syra 2, co esses J silic bei INDUSTRIAL HYGIENE AND MEDICINE Industry's new plague: Pulmonary disease Recent technological advances and the widening use of chemical products are posing a serious threat to em ployees' health. by JOJ&.M Gl FAGAN, Chairman Dept. of Industry, Labor & Hunan Relations State of Wisconsin Five years ago, the words pulmonary disease would have brought to mind such occupational diseases .is silicosis, asbestosis, tuberculosis. Today, we have to consider the broader term respiratory infections, <io/ elsewhere classified because o f our present inabil ity ft) separate the respiratory infections, caused by the new chemicals and processes, into neat categories. For example, we have the relatively new problem of T D I (toluene diisocyanate) w hich affects various parts of the respiratory system--sometimes it strikes the nose and throat, sometimes the bronchial tubes and/or lungs, and sometimes it involves the entire respiratory system. First, let's consider the older, better known pul monary diseases. In W isconsin, the law bringing oc cupational diseases under our Workmen's Compensa tion Act became effective in 1919. The single most costly occupational disease in W isconsin has been the pulmonary disease known as silicosis (we include silico-tuberculosis in this category). From 1919 through 1906, over 800 silicosis claims have been adjudged compensable or approved as compromises, w ith total indemnity and m edical expenses of almost seven million dollars. The spate of silicosis and other occupational dis ease claims during the depression period, although costly, created an awareness of occupational dis eases, This resulted in substantial efforts to control the known hazards. Plant sanitation and medical check-ups became commonplace. In W isconsin, we have now reached the point where we stress 00 percent education and only 10 percent enforcement. ( * * * * u a r y , 9*) Major pulmonary diseases The other major pulm onary diseases moconiosis (not elsewhere classified). Our statistical history of tuberculosi no significant variations in the numbi ce vo/ 0 5 1that crop up i Kittr EXHIBIT 1I year to year. M ost o f the cases have been incurred in hospitals and allied health services. Tw o hundred claims have been com pensated through 1986, w ith indemnity and m edical costs o f over $700,000. For the other four pulm onary diseases referred to above, our statistical history covers the years 1937 through 1968. T he number o f cases compensated and total indem nity and m edical aid were, respectively, pneumonia, 37 and $32,767; pneum onitis, 19 and $6,319; asbestosis, 11 and $198,764; pneumoconiosis, not elsewhere classified, 8 and $65,098. Considering all pulm onary diseases discussed above, the total known number o f cases was over 2,- 000; total known indem nity and m edical costs, al most eight m illion dollars. Silicosis accounted for al most 46 percent o f the cases and over 84 percent of the indemnity and m edical costs. The above sounds like a sm all am ount when one considers that in Pennsylvania, where miners dis abled by pneum oconiosis are paid from state funds, payments in fiscal 1968 totalled over 27 m illion dol lars. The common hazards o f silica dust and asbestos are pretty w ell known. How ever, how many are pre pared to measure exposure to crystalline free silica which may be used rather incidentally in an operation at a plant that is not norm ally considered to be a dusty industry? Silica flour is used, for exam ple, as a filler in some paint m ixtures. Talo and soapstone powders have been produce disabling pneumoconiosis in lesser trations than dusts made up of silicates, result that no more than 20 m illion particles per foot of air is considered safe. These two r often have some quartz content, sometimes ; as 20 percent; thus, exposure should be lim itec m illion particles per cubic foot o f air. Exposure to amorphous silica should lim ited to 20 m illion particles per cubic foot W hen subjected to a calcining operation, posure may have to be lim ited to 7 m illion per cubic foot o f air. It is not my intention to 1 on threshold lim its; the above was mentione emphasize the fa ct that we have a lot to le even about exposure to silica dusts. " Not elsewhere classified" Let's change the subject slightly--w hat about i respiratory infections, not elsewhere classified by Statistical D ivision? From 1937 through 1960, 800 cases cost alm ost a quarter of a m illion doll The m ajority o f the claim s arose from, contact toxic and noxious substances, such as dusts and ch| icals. i It w ill b e a different story from now on. W e ] a backlog o f unsettled cases w hich are costing m illions o f dollars--one self-insured em ployer, i has paid out more than one m illion dollars. GAS TIGHT! FOG PROOF! For in-plant emergencies* This Model 107-B is a fla t em ergency stretcher. , . and then som e. It may be quickly, easily converted into a wheel chair or a stair chair. It's com pact: folds to lust 39 Inches long for ease o f storing and carrying. Best o f a ll, this versatile stretcher is easy to handle and m aneuver. G et rid o f fog w ithout rem oving goggles from face. A few drops of water sealed inside lenses make it quick and easy to do so w ith a nod or shake o f head. Protects eyes against paint spray, d ust, fum es, gas and sm oke. Fram es are soft and pliable for air tigh t fit . W ear w ith any respirator, Inexpensive. D urab le. See your safety equipm ent supplier or order a sample direct for only $2.50 (Regular glass) postpaid. Dept, c H .S . C O V E R B oa 2 8 0 8 , so u th Bend 14, Indian P ION EERS IN THE IN D U S T R Y SIN CE I8D4' Circi* # 17 an Rondtr'i Card, 1 The Model Combinali! Stratcfior Chair, $94.0. Writ* far fall ifrttehtr catalog. Ferno-W ashinglon male 21 d ifferen t stretchers Oran*ld, Ohio 43133 Circi* I on R*ad,r`i Card. 000289 'ust impossible to pinpoint in every case the exact of tilt; respiratory system involved; w e do know .it', in many o f the cases, the doctors are seeking to d out the long-term effect on the lungs, New chemicals and processes have brought about iis situation. Silica and asbestos have long been recgnized its cripplers and Jailers; but who> five years ago, would have been prepared to listen to a discus! ion of epoxy resins, m ethyl ethyl ketone plasticizers, luluonv diisocyanate {and other tongue tw isters), in oniuiK'llon with pulm onary diseases? The incidence o f silicosis was traditionally lim ited > a relatively few industries and occupations--in tart, in some industries a hacking cough was a sign ' at a man had a jo b . The now hazards can be mud in almost any industry, in alm ost any occupa;\mal classification--yes, even In the home. Progress wonderful, but the exotic new chem icals and 'o n . v1::! new pesticides are endangering the health and d\ lives-- of many of our workers, both on-theob .Hid oif-the-job. As one newspaper article put it: .Some people are really allergic to work--and it's not . ir fau lt* For the past few years, an extensive study has been '-Tried out by two doctors from the University of Wisconsin M edical School: D r, Louis W . Chosy, In d uctor of M edicine and Dr. John R ankin, Professor > Medicine. A N ational Institutes o f H ealth grant hi .T '"'"-' their research. W orking closely w ith aftccii'-i Wisconsin employers, they have personally treated several hundred cases involving respiratory conditions resulting from exposure to glues, insula tors, adhesives, foam plastics, etc. As explained by D r. Chosy, `T hese resinous com- ' pounds have been developed by m odem chemistry. Chem ically and sim ply speaking, scientists developed the new compounds by adding different chem ical in - ' gredients to a basic polym er m olecule under varying conditions. The m aterials Ore high ly reactive only w hile they ate first being used. A fter a glue dries, it is no longer reactive and therefore causes no one any trouble. There are many industrial uses of the new compounds. They are used, for exam ple, in ad hesives which can bind m etal or effectively encase electrical circuits," " In almost every case studied," said D r. Chosy, "the affected persons' ailm ents were initially diagnosed as sinus trouble, pneum onia, chronic bronchitis, or asthma--all of w hich may b e side effects of exposure to polymer com pounds. W ith added exposure, respi ratory problems may become more severe, resulting in ear infections, sinus inflam m ation, or bronchial pneumonia. The fu ll range of exposure effects Is not com pletely understood. The best treatm ent for ex posure is to keep aw ay from the compounds. This poses a special problem for the workman whose job requires contact w ith resinous m aterials. And com plete recovery may require prolonged absence from exposure. A nd, re-exposure, even after `recover/ starts the problem over again, often quicker than the Both must be handled with care... TThhfei hhuummaann eeaarr his iirrrrAenplalanceeaaMblpe aannrdi mmaaiy/ hbae piwemrmaannoenntttlvy destroyed by continual exposure to noise. For safety's sake wear Straightaway Hearing Protectors with ribbeddomes for greater noise attenuation. Models available with or without communications may be adapted to fit special requirements. Send for complete information today. HEAftffla PROTECTORS @)3)wffoO C l a r k cowant lNCOAPOMrtO SO FmMln St* W m nlir. Mix*., CISOS wot JCont Officii 1695 CinllfUll, Suit Z. , InjliwMi, Gil, 90302 / Clrl* 4* t i on Riadtr'i Cord. 000290 first tim e* `These polymers m ay be encountered by the scien tist in his electronics lab , the laborer in a lumber m ill, the sportsman repairing his fiber glass boat, or even the captive husband painting the house,* he said. Edueatlon and testing "Largely," said D r. Chosy, "the answer is education in the dangers o f indiscrim inate use of these ad hesives and resinous compounds as w ell as urging industry to give closer attention to the potential m edical problems o f their workers. In well-ventilated plants where resinous compounds are used, workers usually are not affected. Contact with these new ma terials could conceivably becom e an increasing prob lem for the man on the street. These compounds are used in a variety o f products--such as epoxy paints, enamels, lacquers and glues--prim arily designed for home use." Our safety inspectors have also been working closely w ith some of the employers who have had the misfortune of using a chem ical process without un derstanding the m edical problems that would ensue. W e have the power of increasing workmens com pensation benefits b y 15 percent, which the employer himself must pay, but we prefer to work with the em ployer to help him solve his problems, rather than shaking a big stick at him . This cooperation has in turn brought about more w illingness, on the part of the employer, to dig back into the absence records of his employees to see if tbeir absences were due to colds, or due to new production processes. Our largest workmen's compensation carrier has set up an industrial hygiene laboratory equipped with the latest electronic devices used in chem ical analysis. Analytical chem istry has been revolution ized in recent years by the development o f instru ments w hich have rendered obsolete the slow, laborious and costly methods o f classical quantitative analysis. Their senior industrial hygienist collects air sam ples with a m idget im pinger, w hich pulls a measured volume o f air through a chem ical solution that traps T D I fumes. T D I, an ingredient o f the polyurethane foam, can produce respiratory symptoms in very sm all atmospheric concentrations. H e measures the inten sity of the dye's color by using a visible light range spectrophotometer, which determines what percent of a beam o f ligh t is transm itted b y the dye solution. This is an indicator of the concentration of T D I in the solution. Our workmen's compensation records show that quite a few W isconsin employers have become aware of the problems of certain new production processes and have corrected the processes. In these plants, the affected workers were given the choice o f staying at their old job or transferring to a different part of the plant--many transferred. Som e sought jobs else where, on advice o f their physicians. Some ore still being paid workmens com pensation. W e have had cases where a worker who has transferred to another part o f the plant comes in contact with others who are working w ith the "clean" process--in lunch rooms, eta--and becomes disabled again. Once felled by T D I, some affected /orkers cannot stand a o f it; one such employee has claimed that workers bring it out on their clothes and back her old difficulties. N ot enough doctors are aware that these new j terials are causing respiratory problems. I f a doctor sees only isolated cases, he is apt to conrij his patient's illness as a chronic one, rather than due to his work, j . The most critical problem right now is th a t) of workers work for small companies that neither in-plant services nor on awareness o f _ tial hazards. In the United States, plants that en _ less than 500 workers (the kind h a t usually offerj health services) constitute 98 percent o f a ll work establishm ents, and employ two-thirds o f the ing force. Services that a 100,000-man company provide may cost a 500-man company much more i worker. As a result, smaller companies te n d , neglect m edical services, This is the biggest unsol problem in occupational health. The sm aller companies have no safety directors, i industrial hygienists. To whom can they turn they contem plate changing production process; W e are trying to change their thinking o f us as ` enforcement agency; we urge them to come to u s ; help. W e would far rather pursue preventive ures than w ait for our workers to come to us workmen's compensation. Inadequate labeling A t the present tim e, it is not always possible 1 determine from the label whether or not a poteg sensitizer, a corrosive, a primary irritant, or a ha less substance is included in the product. How me does it mean to the ordinary user to read on a la' "Use in a w ell-ventilated area," A t home, or in] small plant, one would think it enough to op few windows and place a few fans around, is the warning that the products can cause respire difficulty or derm atitis? Unless warnings and precautions ore dearlyt on labels, the manufacturers and, under some concj tions, the sellers o f proprietary chemicals are for injuries and property damage that result their use."H ow ever, this means little to the wc who is disabled or fatally injured through impr use of a chem ical--Improper use because the la did not state clearly what precautions should: But, we must face the fa ct that the potential' to the health and w ell-being of our workers has i been greater. Although industry is spending unpre dented amounts o f money to protect its empl< from all known hazards, today's technological vances are creating problems faster than w e | handle them . This is the challenge that faces us now. W e ; keep abreast o f all new developments; we must a way to help the sm aller plants; we must have be? labeling; the toxicity of each new chemical or proc must be established before it can be put into use.1 Fiodian article I n Wofkjnjwrv CasaStUlei Vnitt thi IFerfcm ptnuUton Aet of Whcondn, N w ., 1067. 000291 tests is to measure how w ell the lungs are functioning by determining how much air is left in the lung's air sacs after a man exhales as m uch air as he can. I f the air sacs aren't o f good quality, possibly be cause of disease, there's more residual air left. Certain, lung function tests measure how well the membrane o f the lungs is doing its job of transferring oxygen to the blood stream and taking waste gases out An analysis o f a lungful o f air exhaled by the worker aftci ho inhales a certain extraneous gas helps determine if the membrane is functioning as efib ciontly as it should; in other words, if it shows any evidence of being dam aged in some way, possibly by industrial dust. By analyzing the volume of air the man breathes in and exhales, die scientists have been able to detect evidence of Jung disease earlier than X-rays can show it. When the spirometer tests are given, D r. Shapiro takes an intense personal interest in the way in which they are m ade. Each test is repeated two or more times, especially if a man seems to be nervous or tense, so that he may not be inhaling as much air us he can, or exhaling all he can squeeze out The man sits on a straight-backed wooden chair directly in front of the m achine. The tight-fitting mouthpiece o f a breathing tube is pressed up against his lips in such a way that all air exhaled by the worker w ill go directly into the tube and the measuring device. The worker grips the mouthpiece w ith his teeth. A nose clamp is put on his nostrils to close them, so no air enters or escapes through the man's nose. As the man begins his breathing test, D r. Shapiro asks him to exhale, "Is it all out?" he asks, "All out? . . , Good. Now inhale." D r. Shapiro watches the man inhale. The man's belt is unbuckled to keep it from restricting his breathing, H is hands are on his lap. "Hold it," says D r. Shapiro. "H old it. Now . . . Blow it out!" H e watches. "W onderful! That's very good, that's exactly w hat we want." D r. Shapiro takes a partially-inflated bladder looking like a collapsed football from the machine and gives it to M r. Xirschner for analysis on an electronic device he*s operating at the next table. The next stage for the worker is an electrocardio gram administered by M r. W olf. From die readings on the electrocardiogram die scientists can tell if there is evidence o f heart strain due to thickening o f lung tissue and breathing difficulty. After the electrocardiogram , the worker gives sev eral tiny samples o f blood. Blood samples are being analyzed because they m ay contain evidence regard in g individual sensitivity to lung disease. An unan swered scientific question is why some persons get lung disease and others don't. The entire examination takes about an hour. One immediate result of die Syracuse program w ill be a recommendation to M r. Dw yer for a type o f face mask asbestos workers can wear on. the lob to filter asbestos dust out o f the air they breathe. The lung-testing work o f the Division of Industrial Hygiene in BufFalo a couple o f years ago was achievement that sold the men o f Lo cal 30 on program. Am ong fewer than 200 asbestos workers tested at that tim e, the Division located 19 cases lung disease. M r. Dw yer said Local 30 is discussing the possi b ility o f follow ing through on the results o f the Syracuse study b y establishing a continuing study of its own. The union's primary concern is the health o f its m en. A continuing lung-testing program in which the men s lungs were tested at intervals would enable the group to discover evidence of illness early. "Perhaps." said M r, Dwyer, "this program could be set up through the union welfare fund in coopera tion with an institution such as a m edical center. W e know these are slow-developing diseases that can follow a man through his lifetim e. W e have to think about how his health is going to be 20 years from now," Photographs courtesy of the New Vorlt Slate Department of Labor. Dermatoses (from page 47) to chem icals that defat the skin. In these cases, using em ollients after the final washup o f the day is advocated. This applies to those engaged in custo dial services as w ell as to those in industrial work. Em ollients contain lanolin, glycerine, or other sub stances that make the skin pliable and prevent chap ping until the skin itself has had a chance to renew the secretions taken out by industrial exposure. Workers with dry, thin skin who are engaged in occupations requiring frequent immersion of die hands in soap and water or solvents should apply emollients after work. Education of employee It is not sufficient to provide workers with protec tive clothing, protective ointments, and industrial cleaners or cleansers. They must not only be supplied these items freely but also must be taugh to use them properly. This can be accomplished in a number o f ways. Posters can be placed in the workshops, wash rooms, and toilets that emphasize the importance of protective measures to prevent industrial dermatitis. The posters can be placards that enumerate the haz ards and demonstrate how to use the protective clothing, ointments, and cleaners or they can be pic tures showing how industrial dermatitis can be con tracted if protective measures are not taken. In addition, at regular safety meetings of depart ment heads, forem en, and workers, prevention of industrial dermatoses should be one o f the major topics. Periodic inspection of workers' hands is also desir able, Inspection not only discovers cases, but also brings to the workers' attention the possibility o f contracting industrial dermatitis and the necessity for using die protective d ^ ^ ^ su p p lie d by manage- 50 APRIL, 135