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tabbies' Vou. 4, No. 10 - INDUSTRIAL MEDICINE Pope 565 , Sulfur diox. __ Syaovitla ------ 3 was due to inhalation of cement dust 1 (hiring a period of sever years. Tartaric acid -- 1 Anthracosis. as seen from its com Tetra ethyl lead Thinner ____ 2 position. is toe designation which _ 2 classifies pneumoconiosis contracted Trauma --------- Trichlorethylene 0 from breathing coal dust or micro i 1 scopic particles of carbon. These par Trisod- phosph. 7 5 ticles are present, of course, in the Turpentine -------- 12 7 atmosphere of-any populous center Unknown---------- __ 2 where coal consumption is heavy. Men Vamoline _------- who work in or about mines and coal Vegetable . 8 axe the logical victims of its at- Water ------- ----- 3 Zinc chloride __ 1 In general, however. It is preferable Zinc sulfide ------ "3 to use the generic term pneumociosis to label any form of dusted lungs. Per Total 610 866 haps It is well to emphasize the fact that silicosis can be contracted only by Dusty Death areatmng , microscopic parades ox sand or silica drub CUrtlcaQv and THERE is a sinister ghost that stalks medicolegally, silicosis has no distinct every industry -- a ghost whose cause or effect relationships with the name itself is forbidding. It is calledother forms of pneumoconiosis. "pneumoconiosis" and it Is Quite as Silirosis makes its' appearance dangerous as it sounds; dangerous in among workers in industries whose at more ways than one.* Pneumoconiosis is the general scien tific term applied to describe aU types mosphere contains microscopic partides of siltea. The word microscopic most be repeated frequently in this of dusted lungs. Its literal translation is "a dusted lung". As a generic or family appellation it embraces the dis eases which may result from Inhala tion of any sort of microscopic par ticles, common or rare. In industrial practice, of course, there are four principal sub-divisions of pneumoconiosis which occur with sufficient frequency to make them the subjects of tUs short general sympos ium. The first of these types, and perhaps the most commonly encount ered is silicosis- ' What is silicosis? It is a disease of the lungs in the progress of which there is a gradual replacement of the normal elastic by unyielding inelastic fibrous tissue. Its cause is the Inter mittent or continuous breathing of microscopic particles of silica dust or sand for varying intervals of time. This causes an increase in the volume of fibrous tissue in the lungs which, in turn, is marked by shortness of breath and decrease in lung expan sion with a resultant susceptibility to tuberculosis. Asbestosis is caused, as the name implies, by the inhalation of micro scopic particles of asbestos dust. This type of pneumoconiosis produces a de finite and general fibrosis of the lungs. That is to say, a large volume of fib rous tissue is developed in the lungs as the result of the chronic inflamma tory condition induced by the presence of asbestos dust The problem Of treatment becames involved because, instead of normal tissue which is dis eased, it is necessary to deal with tis sue chronically inflamed by this un usual causation. Fibrosis of the lungs set up by asbestos dust inhalation is as serious to the point of disability as silicosis but so far as our present clin ical experience goes, not nearly so frequent in occurrence. Cementosis is a vague term which I have been unable to discover in the literature of pneumoconiosis though it has considerable current lay usage. I am of the opinion that it originated in the minds of imaginative lawyers to enable them to bring action against a great industrial organization (Case 1). The physician employed by the attor ney gave, as his diagnosis, a statement to the effect that the man's condition text because it most aptlv defines these extremely minute insoluble hits. It is common practice to consider as haxmM only those particles which have diameters smaller than Id mm. Store a micromillimeter is equivalent to 1A25.00O of an inch, it will be seen they are so small that they must be counted or studied under the micro scope. A great deal of interesting and ef fective work has been done to industry to protect those employes who devote their entire time to shazpentog tools on grinding stones. It was thought, at one time, that water poured con tinuously over the stones would elim inate the free silica partides which result from such operations. Tests hare proved on toe contrary, that the application of water actually height ens toe hazards because the partides in suspense in the liquid are thrown to distances greater titan those attained by the ordinary resultant dust Probably the sand-blaster is the 1 worker who undergoes the greatest risk in following bis occupation. We have known for a long time that men so regaged must have protection against flying dust and scale. More recently we have realized that toe microscopic particles set free by sand blasting activities are really more dan gerous and call for more studied de fenses than the visible. The dusts occasioned by grinding and sand-blasting operations may be divided into two general classes, sol uble and insoluble. It is needless to elaborate the divisions excepting to say that soluable dusts are relatively innocuous. Insoluable dusts, unfor tunately, are always present and al ways dangerous because they usually occur in highly concentrated propor tions--a fact previously mentioned, quite as evident when wet process grinding wheels are employed. It may be interesting to industrial ists to know what actually happens to inspired dust Remember, now, that we are concerned with these micromflliraetrie particles discovered only under toe microscope, this dust Is in haled through the nostrils and mouth into the trachea. Thence it passed Into the bronchi and from there into the air cells and the medisteinal * K- Rojuxsok Doit, in Cntt*f glands. Oatr'ut Mtfttint, Ffcru*nr, >jj. these glands are designed by nature -IF YOU BUY BOOKS -and Who.Doesn't? The American Public Health Association has been operating a Book Service for years. Its cus tomers are loud in their praises of its convenience. If you buy books -- any books--perhaps it can be useful to you as weUL The Book Service rend ers expert advisory help. It will recommend the most generally approved books, old and new, on any public health specialty, and in dustrial medicine is such a specialty. It will under take the furnishing--and guarantee satisfaction--of anything from a "Five-Foot Shelf of Health Books" to an entire library. . The Book Service ren ders its most valuable aid when it turns detective. It sleuths down the pub lisher, if you know only the title of the book you want, or it searches out the title and the author on such slight information as "some publishing house in New York brought out a book on occupational dis eases a few years ago." There is no charge for advice and detective work. Books are sold at publish ers' list prices; and the Book Service pays the post age if you send cash with your order. Use the Book Service for any book you want to add to your personal or,r pro fessional library. It will save time .and temper. You, too, will become a Book Service fan. '-f THE BOOK SERVICE AMERICAN PUBLIC HEALTH ASSOCIATION 5ft West 50th Street, New York, N. Y. -Page SS6 INDUSTRIAL MEDICINE October, 1935 THE BULLETIN servation to the Central Manufactur ing District within the past 18 months. Please do not misunderstand me. There may be many others which will be heard from in the future These --------rrrr^sof- ......r.. --r=- three I shall mention_have ripened into just the sort of cases with which The American Association of industry Increasingly is vexed. They are now in the courts. I ndustriaJ Physicians and Surgeons Case No. 1: Company "X": Mr. John Doe: . THE object of this Association la Vict-Prtt.; Da. Suom. R- BeseoKS, shall be to foster the study and discussion of the problems Alabama Bower Company, Birmingham, Ala, peculiar to the practice of indus trial .medicine and surgery; to 2nd Vice-Prea: Da. Donald GOThjue, Lehigh Valley Railway, Sayre, Pa. develop methods adapted to the conservation of health among Sepy-Trtes.: D*. Vourer S- Cheney, Armour and Company, Chicago, III. I received a request by telephone to call on the patient at once, upon ar rival I found him confined to his bed with a temperature of 103J5*. The his tory obtained described a slight chQl and pains in chest and abdomen. It was in late autumn. He had many rales, that is adventitious sounds, to his chest which indicated influenza. workers in the industries; to Upon tapping his chest and stetho- promote a more general under- 7- standing of the purposes and re* DIRECTORS^ 19J5-19J7 scopic examination there was found nothing that would indicate pneu monia but plenty of evidence typical ' suits of the medical care of employees, and to unite into one organization members of the medical profession specializing D*. Edward C. Holmblad, Railway Express Agency, Chicago, lit Da. Casstus H. Watson, of Influenza infection. The important point from the Stand point of the industry concerned was that of accident. Was the patient's condition produced or aggravated by in industrial medicine and sur American Telephone k Telegraph an accident of any kind, however, gery for the mutual advance Ox, New York, N.Y. trivial? To the questions put to this ment in the practice of their profession. Da. Aueeo H. Whrtajcer, Insurance Companies, Detroit, Mich. direction toe answers were negative. I instructed the family to place the man under the care of the family Volney S. Cheney, MJD. Da. Mdvoa Wooor, _ physician. Secretary-Treasurer, Chicago Standard Oil Company, ` Seven months later I was informed New York, N. Y. that suit had been Instituted against PUBLICATION COMMITTEE Da.. Andrew M. Harvey, . W. A. Sawyer, MJD. Crane Company, Chicago, IIL toe industry for $50,000, under the claim that the patient was a victim of cementosis. A portable x-ray machine Rochester, New York L. A. Shoudy, MJD. Da Daniel L Lynch, was taken to the home and efforts New England Telephone & Tele made to obtain pictures in bed. The graph Co, Boston, Mass. man's condition grew progressively Bethlehem, Pennsylvania J. Rolun French, MJD. Los Angeles, California T. R. Crowder, MJD. Chicago, Illinois E. C. Holmbiad, MJD, Chicago, Illinois j . * 1914-1916 Da Don 1. Lowe, B. F. Goodrich Company, Akron. Ohio Da A Gaura Cranch, National Carbon Company, Cleveland, Ohio Da Rom R. Sayeiu, - worse. He was removed to the hospital where consultation was requested and had immediately, futher x-ray photo graphs were taken and discovered a large abcess in toe apex of the upper portion of toe right lung. The patient died about two weeks later. The con sultant physician, a leading Chicago practitioner, was unable to affirm that OFFICERS , O. a Public Health Service. cementosis was in any way a causative Washington, D. C. factor in death. , Prtndtnt: Dr. Farm . SHArra. Bethlehem Steel Company, Sparrows Point, McL PrtMtni-EUct; Da Reran- P. Knaff, Cheney Brothers, ,, South Manchester, Coon, Da Loyal A SaotroY. Bethlehem Steel Company, Bethlehem, Pa Da William A Sawyer, Eastman Kodak Company, Rochester. N. Y. From the history and course taken by the illness, it was the typical end result of a very extensive and severe influenza infection, and developed no symptoms which would substantiate the claim of cementosis. (Note: The case has never come to trial- We have induced the attorney for the plaintiff to scale down the claim from $50,000 to attempt the protection of the lungs toe question in all minds whether or to $2,500, and I am under the impres against infection as well as foreign not a definite and positive diagnosis sion that the circumstances will keep bodies. Thus the body not only has could be made before toe subject was him concerned for a long time.) means to prevent a limited amount on the autopsy table Two things Case No. 2: Industry "Y": John Doe of dust from reaching the lungs but which live vividly in my mind really 2: also to expel some insoiuable particles constituted the bone of contention in This man. aged 42 years, worked In which may penetrate to them. When the discussibm the industry for about nine months. this limited capacity has been ex First, the x-ray roust be able to His record as an employee was un* ceeded, however, the lungs gradually demonstrate a definite fibrosis of the satisfactory and he was discharged. become clogged. The literature tells lungs, L e, an excessive amount of Four months later an attorney served us that this clogged condition is pro fibrous tissue which, as stated, would writs upon the Industry t6 inform it gressive and cannot be cured by pre result in shortness of breath and lack of the institution of a suit for $50,000. vention of further exposure to dust. of expansion with their concomitant Anthracosis was claimed as grounds A meeting of toe Chicago Tuber predisposition toward tuberculosis for damages. The case i? pending still culosis Institute in the summer of and death. Case No. 3: Industry "Z": John Doe 1932, held in toe Chicago Woman's Second, in the opinion of these au Club, and attended by men interested thorities, ail determinate cases of sil It was tola man's task to grind tools in the future welfare of industry, lis icosis have resulted to terminal tuber on a revolving stone. He was fur tened to a symposium of silicosis ren culosis which eventually caused death. nished an inhalator and instructed to dered by toe leading authorities in Perhaps this subject may be made wear it whenever the stone was to use. America. To illustrate the insidious to shed some of its technical prosaical- Obstinately indifferent, the worker nature of this dusty, death that, ghost ness and assume a more pertinent and became disgruntled over the fore like, stalks industrial ranks, it is true lively interest if I interpolate brief man's insistence that the inhalator that the net result of an entire eve- histories Of thlW* nf n-n**t*w/vvvn~ PDF 0033019 Vol, 4, No. 10 industrial medicine Page 567 and disappeared. Five months later suit was filed In his behalf for $50,000 under the claim of contracted silicosis. I ouote now from a Bibbing, Minne sota. dispatch published in the Chicago f Daily News on November 30: " A verdict of $22400 was returned United States by a District court jury to favor of James Golden, of Keewatto, who sued Lerch Brothers, Inc, of Bibbing, as a result of a rare disease alleged to have Bureau of Mines been contracted while to their employ as a chemist. The disease, pneu moconiosis, provoked considerable approves discussion among an array of medical experts who testified for both sides." As <well it might. Of the merits of Willson No. 40GL the Bibbing case I cannot speak. It just happens to offer a timely ex ample of a threat to industrial coffers which, authorities recently have esti Bag Respirator mated, now aggregates $300,000,000 to the United States. I have been told that a certain Illinois corporation for LEAD DUSTS would be reduced to dissolution were it to be required to pay the pneumo coniosis damages now claimed to pending suits against it I am informed on excellent authori The Bureau of Mines has approved No. 400L "for protection against ty there is an organization of lawyers and doctors of questionable reputa tion engaged to the exploitation of dusty death. The modus operand! is simple enough. Advertisements are broadcast which ask grinders to ap pear at the organization's employ ment office for jobs. Upon their appearance, lawyers ob the inhalation of mechanically generated dusts whose main harmful constituent is lead, such as lead dusts generated to manufacturing storage batteries; enameling; pottery making; rubber compounding; sandpapering and chipping painted surfaces; paint making; preparing lithoiransfers; and mining, milling and processing lead ores; and for protection against the inhalation of pneumoconiosis-produdng or nuisance dusts, as quartz, asbestos, iron ores, cement, limestone, gyp sum. coal, coke, charcoal, wood, cellulose, flour and aluminum." tain from the applicants very care The accumulated experience with bag respirators of our many good ful histories of past employments, user friends plus the findings of our own Research Laboratories, have conditions therein, and durations of made the bag respirator for lead dusts possible. In back of everyone such employments. The medical de partment of the clique then gives each applicant a scrupulous physical ex amination with especial attention that leaves the plant is'proof of worth built up by countless tests of materials and trials to various dust conditions to plants and factories of dozens of trades. focussed upon the lungs. In cases which seem to promise well for their nefarious ends, even extensive and Sealed Ait Pmame Low Service Cast careful x-ray photos are made of chests and lungs. From these applicants the organiza t dusts to sain entrance. long tion selects the men it considers best L*rw SttttUat Rtmstaac* Poxitrr* Action Into1* Vth/i adapted to its purposes and deliber ately places them in industries cal culated to assist their aims logically. After a given time, when circum Weighing only S* ounces and having 40 square inches filtering area, these respirators are comfortable and very easy to breathe through. Rcbrcathing of used -air is prevented by an Intake valve which closes auto matically the moment exhalation starts. stances appear propitious, the men are taken out of industry and into the courts, and presently the affected concerns find themselves the defend WILLSON PRODUCTS, Inc., ants in $50,000 (limit) suits for dam ages charged to silicosis contracted in their employ. Reading, Pa. k>pm3020 This article is not intended to round the loud alarum. The National Safety Council and other agencies for a tone time have, emphasized the luricinv risks of ptieumoccniosis and advocated the adoption of advanced at regular intervals thereafter will measures of prevention. In particu avoid many exploitations. Keep lar Dr. C. O. Saoptogton, formerly abreast of the scientific advances with Massachusetts Division at director. Division of Industrial respect to .control and treatment of Occupational Hygiene Health. National Safety Council, and pneumoconiosis, and rigorously insist a Joy Street Barton 0 now Industrial Hygiene Consultant, that workers shall observe occupa Mvima Bcm-wrc*, A-B- Director has contributed notably to the litera tional precautions prescribed. There Knvnr-B. Euuita, Ph-D- -Cbcmisf ture and research of the subject The are devices, . constantly improved, Eovcailo C. Ruxr. M.Sc.. sinister aspect of dusty death exploit which are essential The few dollars loom E. Sort***------- -StrimOttk ed at the hands of unscrupulous and thus invested are spent well. Other EvU.tx Biowa.......'..- -Junior Clerk unethical persons, however, has not wise there are the practice of plant "IT 5HAIX be the hrty of the Division been published sufficiently to ap sanitation which should be a matter to investigate condition* of occupation prise industry of its possible liabiliThere are, of course, the simple measures which ;industry should practice in any event in its own In terests. Knowing your employees is, perhaps, the first essential to prevent involvements. Physical examina- of practical pride as well as preven tion, and should be observed diligentfy. The fact that, as seen to the meet ing I described and the Bibbing dis patch quoted, medical talent itself is divided to the adjudication of pneu m__o_cao*_n_io:isisxi- c. asj*e_s__speaks.volumes for, with reference to hazards to health and to determine the degree of such hazards, to investigate and evaluate methods for the control of such hazards to assist to the prop&ratiQfs .at rules and regulations tor tmhned pterai . a_ nd. to ttionsl uccidcsit! cooperation with the deptrttae&t oft public health or otherwise, to promote ocxcuuppaattiioonal health and safety education."--Sec. 1IA of the law creating the Division. eCeetive 1331.