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The Principles and Practice
of
INDUSTRIAL MEDICINE
Edited by FRED J. WAMPLER, M.D.
. Professor, Preventive and Industrial Medicine
MEDICAL COLLEGE OF VIRGINIA
CONTRII3UTORS
Otis L. Anderson
Robert A. Kehoe
R. N. Anderson
M. H. Kronenberg
Anna M. Baetjer
B. E. Kuechle
J. J. Bloomfield
Matthew Luckiesh
J. A. Calhoun
Willard Machle
J. M. Carlisle
R. W. McKee
George H. Cross
Sarah 1. Morris
Donald E. Cumming
Kenneth Morse
Charles F. Engel
Frank K. Moss
John H. Foulger
C. M. Peterson
Augustus Gibson
D. F. Robertson
T. Lyle Hazlett
F. S. Rossit.er
Albert Hemming
William A. Sawyer
F. F. Heyroth
Louis Schwartz
Joanna Johnson
Lorin A. Thompson
R. T. Johnstone
Fred J. Wampler
George Zur Williams
A William Wood Book
BALTIMORE
THE WILLIAMS & WILKINS COMPANY
1943
LIST OF CONTRIBUTORS
ANDERSON, OTIS L., B.Sc., M.D., F.A.C.P. SuMsrigoaenroynol,fanUVdne.niteerdeaSl tDatiesseaPseusb,liNc aHtieoanlathl ISnesrtviitcuet,eAosfsHisteaanltthC, hBieeft,heDsidvai-,
ANDERSON, RICHARD N., B.A., M.A. DiVtrieoircngtoinorifao.tfhteheVDirigviinsiiaonStoaftRe eDhaebpialrittamtieonnt, oSfpeEcdiaulcaantidonA, dRulitchEmdouncda-,
BAETJER, ANNA M., Se.D. BLOOAMsHFsIoeEcaLilDatth,e,J.iTnJh.ePhJyoshionlsogHicoaplkiHnysgUienniev,erSscihtyo,olBaolftimHyogreie, nMe aarnydlanPdu.blic
Sanitary Engineer, States' Relations
United States Public Section, Division of
Health
Service,
and
Chirf,
Institute
of
Health,
Bethesda,
Industrial Maryland.
Hygiene,
National
CALHOUN, J. A., M.D.
Medical ware.
Director,
American
Viscose
Corporation,
Wilmington,
Dela-
CARLISLE, J. M., M.D.
Medical Director, Merck and Company, Professor of Industrial Medicine, Tem
Rahway,
New
Jersey;
Medicine,
Philadelphia,
Pennsylvania;
ple University School of Executive Director, Bureau
of of
Industrial Health.
Health
and
Hygiene,
New
Jersey
State
Department
CROSS, GEORGE H., M.D.
CUMMAIsNGsGor,caidDauOteaNtAPeLrSoDcfehEso.so,ol1r3o.foSf.M*Oedpihctihnael,mCohloesgtye,r,UPneivnenrssyil~vyanoifa.Pennsylvania,
AsDosfoecIninvadteeur,sPtCrroioaflleosrHsaodyrog,.ieDneep, aUrtnmiveenrtsiotyf MofedCiocilnoera, daondScDhoiroelctoofr,MDedivicisiinoen,
ENGEL, CHARLES F., M.D.
Assistant Medical Director, Westinghouse ing Company, East Pittsburgh, Pen
Electric
and
Manufactur-
FOULGER, JOHN H., M.D., PH.D., F.A.C.P. nsylvania.
Medical Director, Haskell Laboratory of Industrial mington, Delaware; Associate Professor
Toxicology,
Wil-
Medical
College
of
Virginia,
Richmond,
of Industrial Virginia.
Medicine,
Deceased December, 1942.
ix
x
LIST OF CONTRIBUTORS
GIBSON, AUGUSTUS, M.D.
Physician, Merck and Company, Rahway, New Jersey. HAZLETT, T. LYLE, M.D.
Medical Director, Westinghouse Electric and Manufacturing Company; Professor, Industrial Hygiene, University of Pittsburgh, Pittsburgh, Pennsylvania.
HEMMING, ALBERT, M.B., Ch.B. Physician, Merck and Company, Rahway, New Jersey.
HEYROTH, FRANCIS F., M.D. Assistant Professor of Research Physiology, Kettering Laboratory of Applied Physiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
JOHNSON, JOANNA, R. N. Supervisor, Industrial Nursing Division, Employers Mutual Liability Insurance Company, Milwaukee, Wisconsin.
JOHNSTONE, RUTHERFORD T., A.B., M.D. Director of the Department of Occupational Diseases, Golden State Hospital, Los Angeles, California; Formerly Assistant Professor of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
KEHOE, ROBERT A., M.D. Research Professor of Physiology, Director, Kettering Laboratory of Applied Physiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
KRONENBERG, MILTON H., M.D. Chief, Division of Industrial Hygiene, and Industrial Medical Supervisor, Department of Public Health, State of Illinois; Assistant Professor of Bacteriology and Public Health, University of Illinois Chicago, Illinois.
KUECHLE, B. E., A.B. Vice-President and Claims Manager, Employers Mutual Liability Insurance Company, Wausau, Wisconsin.
LUCKIESH, MATTHEW, D.Se., D.E. Director, Lighting Research Laboratory, General Electric Company, Nela Park, Cleveland, Ohio.
MACHLE, "rILLAIW, M.D. Associate Professor of Research Physiology, Associate Director, Kettering Laboratory of Applied Physiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
McKEE, R. W., PH.D. Instructor in Industrial Hygiene, School of Public Health, Harvard University, Boston, Massachusetts.
LIST OF C
MORRIS, SARAH 1., M.D., F.A.C.P. Professor of Preventive MedicJ sylvania, Philadelphia, Pem
MORSE, KENNETH, M.S. Industrial Engineer, Division Department of Public Heal
Moss, FRANK K., E.E.
Physicist, Lighting Research I Nela Park, Cleveland, Ohio
PETERSON, C. M., M.D. Secretary, Council on Industr tion, Chicago, Illinois.
ROBERTSON, D. F., M.D. Associate Medical Director, Jersey.
ROSSITER, FRANK S., M.D. Medical Director, CarnegiePennsylvania.
SAWYER, WILLIAM A., M.D. Medical Director, Eastman 1\
SCHWARTZ, LOUIS, M.D. Medical Director, United St: Dermatoses Investigation:> National Institute of HcuJtJ
THOMPSON, LORIN A., PH.D. Director, Population Study, mond, Virginia.
WAMPLER, FRED J., M.A., M.D., Professor, Preventive and IJ Out-Patient Clinic, Medica Southern Biscuit Compan~
WILLIAMS, GEORGE Zun, M.D.
Associate Professor of Pathu mond, Virginia; Member 0
CONTRIBUTORS
lany, Rahway, New Jersey. ouse Electric and Manufacturing ComHygiene, University of Pittsburgh, Pitts-
lany, Rahway, New Jersey. rch Physiology, Kettering Laboratory of ~e of Medicine, University of Cincinnati,
ng Division, Employers Mutual Liability ;aukee, Wisconsin. B.,M.D. of Occupational Diseases, Golden State 'alifornia; Formerly Assistant Professor if Pittsburgh School of Medicine, Pitts-
ology, Director, ~c of Medicine,
I(ettel'ing University
Laboratory of of Cincinnati,
\ Hygiene, and Industrial Medical Superblie Health, State of Illinois; Assistant and Public Health, University of Illinois
Manager, Employers Mutual Liability lsau, Wisconsin. Eo Laboratory, General Electric Company,
10.
rch Physiology, Associate Director, Ket)lied Physiology, College of Medicine, :incinnati, Ohio.
',iene, School of Public Health, Harvard
ahusetts.
~vF.(s ~~;~'" :
,.'\ / fl'
~m;,
~ ,
~'
~~" ('i;.
LIST OF CONTRIBUTORS ),,1
MORRIS, SARAH 1., M.D., F.A.C.P.
Professor of Preventive Medicine, Womans sylvania, Philadelphia, Pennsylvania.
Medical
College
of
Penn-
MORSE, KENNETH, M.S.
MossI,ndDFuResAptNrairKatlmKEe.nn, tgEion.fEeeP.ru, bDliciviHsieoanltho,f CInhidcuasghoi,aIlllHinyogisi.ene, Illinois State
Physicist, Lighting Research Laboratory, Nela Park, Cleveland, Ohio.
General
Electric
Company,
PETERSON, C. M., M.D.
Secretary, Council on Industrial tion, Chicago, Illinois.
Health,
American
Medical
Associa-
ROBERTSON, D. F., M.D.
Associate Jersey.
Medical
Director,
Merck
and
Company,
Rahway,
New
ROSSITER, FRANK S., M.D. Medical Director, Carnegie-Illinois Pennsylvania.
Steel
Company,
Pittsburgh,
SAWYER, WILLIAM A., M.D.
Medical Director, Eastman SCHWARTZ, LOUIS, M.D.
Kodak
Company,
Rochester,
New
York.
Medical Director, United States Public Health Dermatoses Investigations Scction, Divis
Service,
and
Chief,
National
Institute
of
Health,
Bethesda,
ion of Industrial Maryland.
Hygiene,
THOMPSON, LORIN A., PH.D.
Director, Population mond, Virginia.
Study,
Virginia
State
Planning
Board,
Rich-
WAMPLER, FRED J., M.A., M.D., M.P.H.
Professor, Preventive and Industrial Medicine, Out-Patient Clinic, Medical College of
and
Administrator,
Southern
Biscuit
Company,
Virginia; Health Richmond, Virginia.
Consultant,
WILLIAMS, GEORGE ZUR, M.D.
Asmsoocniadt,eVPirrogfiensiaso; rMoefmPbaetrhoolfoAgyrm, eMdeFdoicraclesC, oLltle. gCeoomf. VUir.sg.iNni.aM, .RCic.Rh-.
CONTENTS
I.
Notes on Fred J.
HWiasmt oprlyer.,. .M. .. D. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
II. MJe.thHJo.dasBzlEaomormdpfslioe.yl.d.e.d..i.n..t.h.e..A..p.p..r.a.i.s.a.l.a..n.d..Co..n.t.r.ol .o.f.I.n..d.u.s.t.r.ia..l .H..e.alth 7
III. InDduonstarlidalEA. cCcuidmemnitns:g,TBh.eSir. Cause and Prevention. . ......... .. 23
IV. MFedreicdalJ.SeWrvaimcepsleirn, MIn.dDu.stry and the Industrial Physician
35
V. The Lay-Out of the Medical Department....... Fred J. Wampler, M.D.
....................
43
VI. GoJv. eJr.nmBleonotmalfieAldgencies in Industrial Hygiene .. 48
VII.
Industrial Health Program C. M. Peterson, M.D.
of
the
American Medical
Association. . ..
65
v
VIII.
The Effects of Temperature Anna M. Baetjer, Sc.D.
and
Humidity on
Industrial
Workers.
. ..
69
IX.
The Effects of Abnormal Atmospheric Anna M. Baetjer, Se.D.
Pressures
............ .
I X. Light, Lighting and Seeing .................. .
Matthew Luekeish, M.D., and Frank K. Moss, E'.E.
101
XI.
Fatigue Lorin
.A. .. .T.h. o. .m.p.s.o.n. ,. .P.h. .. D. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
133
XII. ThFerePdhyJs. iWcaalmEpxlaemr, iMna.tDio. n. . . . . . . . . . . . . . . . . . . . . . . . . .. . ............ . 144
XIII. MeJdoihcnalHC. oFnoturolgleor,f MIn.dDu.strial Exposure to Toxic Chemicals. ....... 150
XIV. SuWrvilelyarodf MSuabchstlae,ncMes.Dw.,hiacnhd CFaruasneciOs cFc.u}pfaetyiroontahl, PMo.iDso.ning .......... 180
XV.
Industrial Lead Exposure Robert A. Kehoe, M.D.
and
Lead
Poisoning..... , ......... , ...... ,
202
XVI. CaRrablopnh DWis. uMlfcidKee.e.,..P.h...D...,..a.n.d..J....A....C.a.l.h.o.u.n.., .M....D................... 241 XVII. ThJe. TMo.xCicairtylisolef, CMe.rDta.in Organic Solvents in Industry ............... 256
XVIII. CaFrrbaonnk MS.onRooxsisditeerP,oMis.oDn.ing ......... " ..... . 269
XIX. Some of the Poisonous Gases ..... . Frank S. Rossiter, M.D.
. ..... 278
xiii
xiv
CONTENTS
XX. Electricity..... ............... ..
Charles F. Engel, M.D.
28R
XXI. Occupational Diseases of the Skin... Louis Schwartz, M.D.
., .......................... 296
XXII. Pneumoconiosis (Dust Diseases of the Lung) George Zur Williams, M.D.
.. .. .. .. .... .. .. .
345
XXIII. OcScaurpaahtiIo.nMaonrdriTs,uMbe.Drc.ulosis. ........................
375
XXIV.
Venereal Disease Control Otis L. Anderson, M.D.
in
Industry ...............................
394
XXV.
Whitt Industry Can Do to Improve William A. Sawyer, M.D.
Nutrition ......................
409
XXVI.
Eyes in Industry: Care and George H. Cross, M.D.
Prevention of
lnj ury ....................
421
XXVII.
Traumatic Shock J. M. Carlisle,
and Burns. . . M.D., Augu
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
..
.
435
M.B.,
Oh.B., and D.
F.
stus Gibson, M.D., Robertson, M.D.
Albert
lIemming,
XXVIII. ThReutIhnedrufosrtrdiaTl. BJaochkn.st.o.n.e.,..M...D... .................................. 458
XXIX. ThJeoaNnunraseJoinhnIsnodnu, sRtr.yN............................................. .. 483
XXX. Compensation ...... .
B. E. Kuechle, A.B.
498
XXXI.
Vocational and Industrial Rehabilitation Richard N. Anderson, M.A.
..........................
507
XXXII.
Industrial Medical Service for Fred J. Wampler, M.D.
the Smaller Plant ....................
518
XXXIII. WMomilteonninHI. nKdruosnternyb.e.r.g.,.M....D...,..a.n.d..K.e.n.n..e.th..M..o.r.s.e., .M....S.............. 523
C NOTES
Fred J.
Industrial medicine is largely forty-three years-the machine a from before the Christian era. the development of our knowle, lined in this chapter.
In the early days labor was p. approach to our modern indus slaves would become proficient j would then contract for thi8 pa known to have been done in this could easily have followed this
Hippocrates (about 460-370 ] have been hookworm; those ::llli great intestinal disturbances am up until modern times made the] disease.
Other diseases described by 1-1 gists, fullers, tailors, horsemen, f the metal worker as being pale : tended, hard abdomen, large sp,
Pliny the Elder (23-79) clcse!' consisted of a bladder tied on!! sonmIS dusts and vapors. Plill) cabb!tge and bitter almonds !IS U He described poisoning with zi:
Galen (131-201), the founder erences to occupational diseases. of Cyprus and was nearly overco men who carried out a vitriolic] avoid death in the midst of tb scholars are exposed to a hazard were forced to use. Other OCCUI cerned runners, farmers, wrestle] who used their voices excessive]
372
PRINCIPLES AND PRACTICE OF INDUSTRIAL MEDICINE
There
is
VII. OTHER
considerable disagreem
PNEUMOCONIOSES
the exact inhalation
etiology other
of
certain
typeenst oinf tphuelmmoendaicryal fliibterorature concerning
are
the
most
impothrtazn,ntsiolifctahedsuestf.ibroAssebs.estosis,
siderosis,
sis due to dust and anthracosis
is
It
has
been
well
proven
that
Asbestosis a peculia
caused asbestos
by for
minute asbestos the manufac
fibers
r inhaled
type of linear by workers in
pulmonary industrie
fibrosis
afasbbreisctsosanitdserlof.pes, paints, truoroefionfg,firteiler,eseitsct.i,nagsmwaetlelraiasl,thiensmulaantiuofnsa,cutctuielrireztainoingf
Asbestos is magnesium mentally been proven
silicate
and
is
the
only
silicate
which
to silica.
to
produce
a
pulmonary
fibrosis
has experiwithout exposure
FpraotTgahrleetsesorinmnsgientsialincdosicslinaincdal tchoeurssyemopftoamsbsesitnostihseislastiemilar to that of slowly
decompensatiaotnio, noristuubsuearclluylobsyis.complicating pneumor nsittaisg,ecsaardreioi-dveansctiuclaalr.
tnhoattdtihffeicruolet nttogedniofferentiate
from
The roentgenopathology silicosis. Gloyne and M
is
typical
and
as
a
general
lack
logical appearances of of translucency with
asbestosis
are
erewether state revealed typically
the characteristic ((ground glass" appeaarafinncee.pinThheaedfimlmottling. This is
tbaekceonmwpiatrhedthwe isthamaefielmxpoofsuarne.ormal patient and a film of a sislihcooutilcd paalwtieaynst
The diagnosis depends dust including sufficient
upon
a
definite
history
of
exposure
to
decreased
pulmonary
period capacity,
aonf dextphoesufirned, inroentgenological
asbestos appearance,
sputum of patients not asbestos bodies are well
yet
removed
from
g of asbestos exposure to the
bodies d
in
the
of clinical pathology.
described and usually The pathology may
illustrated
in
ust. most text
These books
be sum
fsitbartoesmiseonft tthheatluintgcso. nsTishtse offibaerps emrsistent, progressivem, adriifzfeudseinpetrhiaelvseinoglaler
to lie embedded fiber appears to
in
the
fibrous
ay walls
be seen on histological of alveoli and bro
examination
would
be
be expected,
encrusted by an in the later stag
iron-containing
nchioli and yellow pigment.
each As
massive.
es the fibrosis becomes confluent and
of
Siderosis
is
chiefly
a
red
Siderosis pigmentation of
menirtoanll-yc,ofnitbarionsiinsghadsusntotfrequently
found
the in
lung tissue hematite
due to inhalation miners.
been
produced
by
pure
iron
or
iron
Experioxide dust
PNEUM<
and only when fibrosis result.
mixed There
with
hazard(
siderosis
by
itself
is
fore, unles!:> tt
asymptomatic
clinical findings.
Black
pigmentation
of
the
Ant" lungs
types of carbon particles is comm
Tinhdeursetriisalsocmiteiesc.ontMroovsetrsmy acroknecdL'mbLi
carbon clusive
dust of itself experimental
can
produce
a
It
is
the
author's
evidence opinion that
that' all ~"
are due fibrosis
to an due
admixture to respir
of
!:>ilica
du~
produces
no
clinical
atory findings
diset1!"( or di~a]
American
Public
Health
REFE Association:
coniosis and the tional Diseases,
Committee
on
1{( Stull'
BELT,
T.
H.,
ImYI:-I,
Year D.,
Book,
1933,
p,
Jp.e, r3so4n(s2w): i1th25o-u1t3o3,cc1u9pA36aN.tDioKnla-'l<Gex, pEo,suJ:
BURHKEy,g.H, . 1E7.:: 2T7h, e1d9e3t5e. ction of mineral
COLE, L. G., AND COLE, 113: 1210, 1939
W.
G.:
Dyspne.
CUMMINS,
S.
L.:
. The
augmentation
tubercle bacilli.
DR
of at Brit, J. Exp. Path
INKER, P., ELLMAN, P.:
AND HATCH,
Pulmonary
T.:
Industrial
turcs,
and
associated
asbestosis: its, risk of tubercu
GARDNER, L. U.: 1240, 1033.
Pathology
of
so-callec
GARDNER, L. coniosis.
U.: The .T, A
pathology
and
rOt
GARFDeNbE.R,19L4.0.U.: R.ec1e1,nt.\d" ev1e1l4o:p5m35e-n5t4s51,1
GARDNER, L. F.: Studies of healing prim
OIl
experiment:,
carborundum
:lry tubercles ill the dusts. Am. Rev.
lu
GLOYNE,
S.
R.,
AND
MEREWETHER,
of 'It E. R.
HATCH, T., AND THO~!PSON, quantitation for
E.
W.:
A
rapi\
INTERNATIONAL
routine
LABO
plant
opera~
OR
reports,
series
F
OFFICE:
(Ind. Hyg.),
Pneum, No. 15,