Document p2M31x3zGwBozKLeR4ON01j8D

148 30th National Safety Congress Mental Hygiene. There arc frequent dis cussions regarding mental hygiene m in dustry, the general assumption being that industry docs nothing about it. The present seems an appropriate time to take stock and outline a program, if possible. This, the Federal Government is doing through a special Committee on Personal Relations, which sprang out of the joint action of the Xeuropsychiatric Committee of the National Research Council and the Subcommittee on Industrial Health and Medicine. The special committee has undertaken the study of tlte problem and is effecting suit able measures for initiating a practical mental hygiene program in industry- As in dicated by its name, the committee is de veloping its reseaich along lines ot personal relations. With such a sound approach, 1 feel optimistic of the results. All industrial physicians use mental hy giene methods to a considerable degree, either consciously or unconsciously, and in very much the same manner as does the general medical profession in the pursuit ot private practice. Every patient who consults a doctor has in some degree a mental hygiene problem. Although it may be only a very minor worry, it has considerable influence ut>oii the patient and the outcome of his ail ment. Usually, during conference between phy sician and patient, these worries come to the surface. It the patient has an appropriate opportunity to fell his whole story, the mere telling frequently serves to assist him in the solution. So one of the important func tions of the doctors in industry' is to listen sympathetically to theworkman who con sults them. This is being done more and more, and if the doctors are not too busy in serving workers of the defense industries, they will have an excellent opportunity to develop what seems to be a very practical approach to mental hygiene in industry. It is my opinion that they are doing this. ` Rehabilitation. The employment of handi capped workers and the rehabilitation of disabled workers is a perennial problem in industry. While most plant physicians, with the cooperation of employment managers, supervision, and other officials, arc doing a satUL ry job. methods are not yet on a scions5 i . basis. This is particularly important in connec tion with the defense program for the very obvious reason that workers are needed in defense industries. Figures released by the Selective Service System show that a rather high percentage of selectees are rejected, or accepted for limited service, because of physical conditions--some 40 per cent. True enough, many of these causes of rejection are of a minor nature and do not preclude employment in industry, but eventually many of them result in disabilities. Therefore, it is important in developing a rehabilitation program, that industrial doctors take steps for cooperation with the medical profession in the correction of remedial impairments. It is equally impor tant that they exercise great care in the recommendation of impaired individuals for employment. This does not necessarily im ply outright rejection of large numbers of workmen or prospective workmen. It does mean careful placemen!. As this function of industrial medicine is assuming importance in the national de fense program, there is reason to believe that the experiences will result in a proce dure that will function with justice to both workers and management. Physical Examinations. Because of the spread of interest in industrial health and the consequent recognition of Its importance by management and workers, as well as by the medical profession in general, the exam ination of applicants for employment and the re-examination of employees is assum ing a better status. In the first place, its importance is being recognised. In the second place, the value of more complete examinations is becoming apparent. Medical departments in industry are being equipped with x-ray apparatus for chest work, facilities for serological tests, and in some instances, for electrocardio graphic studies, metabolism studies, etc. In short, the standard of the physical examina tion is rapidly rising. Incidentally, this is symbolic of the status of industrial medicine. The general profes sion is coming to recognize it as an honor able and important specialty in medicine. Ipomen in industry. Women are gradually displacing men in the defense industries. That happened in the World Wai and it is Industrial Health 149 already happening at this emergency. Fifty per cent of the manufacturing in England today is done by women. They work in tool rooms, operate, cranes and electric trucks and various other types of machinery. They have become so skillful on these jobs that they are often more efficient than men were. In Canada, they are running trucks and operating gas stations and taxicabs. I am not prepared to discuss the wisdom of this practice, but as a physician. I am prepared to offer a word of advice. Sick ness absenteeism among women in industry is very high, a daily absence of 10 per cent is not unusual. Their annual rate exceeds that of the men by approximately 200 per cent and their disability periods by more than 10 days. They must be thoroughly examined before employment, which is not common practice, carefully placed, and have conscientious physical supervision. If this is done, their rate of sickness absenteeism can be brought down somewhat--but it is still very high. V/orking Ewinvimcnis. Thus far, the medical aspects of industrial health only have been considered. There are others of sufficient importance to mention, notably, general ventilation, heating, lighting, and other environmental conditions, all of which bear importantly on health. Fortunately, industry is progressing just as rapidly and as soundly in respect to these as it is in the purely medical field and, incidentally, this progress is comparable with the progress in manufacturing methods. Effective Industrial Health Education By DR. J. J. BRANDABUK AaMtaat Supervising Surgeon, Chesapeake & Ohio Railway Company, Huntington, W. Vau One *- the greatest problems of any indus trial health unit if how to teach the groups for certain preventive measures arc necessary and bow they will be most effec tive. I shall attempt o show what measures we feel bare been effective in the education of the employees in our organization, namely --through the medium of the pre-employ ment and periodic physical examination, with a follow-up by his family physician. By this means there is a direct person-toperson relationship which is so necessary in order to make the public appreciate the-value of good health so that it will accomplish the most good and the palient will feel that he has not been misdirected because he has confidence iu his family physician. Briefly, health education is best accom plished by informing the employee or the public with relation to mailers of health and so to interest and motivate them that the results of our labors will be a change in conduct toward an ideal which we hope to attain. The primary object of all educa tion is not only to inform but to influence an individual. For example! it does not good for an individual to know that he has an abnormal heart condition if he is not in fluenced by bis family physician to conserve his energy by changing his habits of living or work so that he will not be a hazard to himself or his fellow employees. The average individual has a tendency to change back to old habits as soon as he begins to feel well, therefore the periodic physical examination is a constant reminder or check rein on hint. In the matter of the pre-employment ex amination, which some industries term place man examinations because the idea behind them is not to reject those with physical defects, but to place men at work for which they are physically fit. Those who are re jected arc turned down simply because their liarticuUr defect maker? them a hazard, therefore unsafe in that particular type of employment either to themselves, to their fellow- employees or to the general public. Very few of us who are perfect human specimens from a physical standard, there fore industry must of necessity accept Its share of less than perfect applicants and teach them to become perfectly useful em ployees. Naturally, therefore, you are interested m what means we use to make industrial health education effective. Because our system ex tends over a vast area we cannot have full 150 30th National Safety Congress time men; therefore like most small indus tries our examinations must be made by com petent medical men located anywhere along our right of way. The report of the exam ination is sent to our office and on review of the report the applicant is accepted or re jected* If he has a minor defect we mav qualify him temporarily and send a letter to him notifying Him about his defect and ask ing that he place himself under the care of his family physician and to be sure that he does this we request some type of answer from the physician whom he has consulted. In case he has a major defect which is remedial, if he is sufficiently interested he is notified regarding this defect and told to have ft corrected and we might then be able to quality him it he can come up to our stand ards : Example of Case REJECTION OF APPLICANTS Causes No. Defective vision............. 158 Abnormal Blood Pressure............................88 Abnormal Heart .......................... 85 Hernias ........................................................ 52 Diabetes potential ...................................... 29 Nephritis ...................................................... 24 Color Blind....................... 19 Luetic ..................................................... 15 Defective hearing....................................... 10 Gonorrhea .............................. 10 Tuberculosis ........... S Skull injuries...................................... 5 Deformities in extremities.......................... 4 Thyroid ........................................................ 3 Total 507 From 1934 up to Jan. 1941 out of 6.104 applicants 507 were rejected. An applicant was examined Jan. 17th. 1941. at which time it was found he had a hernia, he was notified regarding the defect which hi* temporary disqualification and Had the condition corrected and was re- irN&mined and qualified as soon as his condi tion permitted. In many cases we have found that this was the first examination these men had. and they had thought themselves to be in perfect health and were thankful for the defect hav ing been discovered. This matter of sending them a letter is more productive of good re sults than merely telling the applicant he has a defect and taking a chance that he will present himself to his physician, because he merely has to present his letter to his physi cian. and it is not necessary for the physician to do any guess work as regards his defects. In this way also he retains that personal contact with h5 family physician in whom he has utmost confidence and learns to know that the partiruJar industry is anxious to ac cept him if he is a good physical risk and not a hazard and it gives an opportunity for the physician to explain how important it is to be in good health in order to he most beneficial to himself, his family and the industry he represents. That the examination has its safety fea tures from the standpoint of our industry might well be noted from the accompanying chart: Ti primary point I wish to bring out heir `s the fact that the majority of these individuals-never lmev.' they had anything wrong with them, therefore were probably making no effort to overcomer the defect. Doctor Parran stated recently that it is wasteful for industry to train a highly skilled employee over long months, only to have him break down suddenly with tuberculosis, men tal disease or some crippling condition; there fore. the periodic examination at stated in tervals or examinations made at the request of the employee or HU supervisory officer are likewise of great value, in that they con tribute to the health and efficiency of workers in several wavs. 1st. Employees exposed to hazardous con ditions due to their type of work may con tract some occupational disease or due to an aging process develop a condition which makes them unsafe to the public, themselves or their fellow employees. . 2nd Employees showing evidence of oc cupational disease can thus be removed from exposure and appropriately treated and at the same time necessary steps trade to con trol the occupational hazard. The inclusion of the executive personnel is beneficial from two standpoints: a . . . You are prolonging the Itfe and efficiency of men who are harder to replace; Industrial Health Defects 1934 1938 No. Overweight .......................... ,277 Teeth (Pyorrhea,Dead teeth)..........,...3.13717 Tonsils ......................................... . S83 Glycosuria ..................................................... 33 Albumin .............................. .11339 Hernia ................... . 79 Abnormal Heart .... . 99 Blood Pressure ( abovenormal)...............442211 % 13.1 15,0 40 1-5 6.6 3.7 4.7 20.0 No. 116 162 10 33 32 30 78 268 This chart represents the results in a group consisting of approximately 2200 men. 151 % 5.5 7.6 03 1.5 1.5 1.4 37 12.6 b ... It has a psychological effect oi selling the benefits of the examinations to the other employees, therefore, aids in prov ing that the measure is not discriminatory. In this regard It should be stated that the records must be a matter of strict confidence between the members of die medical depart ment. AH that is necessary for the super visory officer to know is whether the em ployee is safe for hk particular work. also seeks to promote the health and prolong the life of the worker we are attempting to educate the employee to realize that good health Is an economic investment to himself --for instance--the man in poor physical cond/tior? is neither likely to do good work and therefore fails to merit promotion, cither because he does not ger along with other employees or because he is indifferent, tern- pcrmrntal, tactless or dissatisfied. It is diffi cult to evaluate just how effective any pro These are precisely the ideals followed in gram of health education is because we have our methods of carrying on the periodic no measuring stick as it were to note our physical examinations. progress in the matter of efficiency or ben The examination is earned out b> or* oi our examining surgeons along the nearest terminal point. The history form constitutes direct questions regarding any illnesses, in juries or operations. The physical examina tion proper covers all systems of the body. In this way most of the chronic illnesses arc detected that rank high as the causes of death among industrial workers. Unfortu nately this type of examination docs not al ways exclude some conditions which may produce sudden deall>---for example--such as may happen in coronary heart disease and for this reason some people arc apt to frown on tire results of these examinations, but these are rare conditions. How often have you taken your automobile to be checked before starting on a trip and then have some breakdown develop which was not anticipated. efits accruing to the individual. However, in the middle van* of tuc modftc&;ons m our mode of living and working are exacted by the laws of, nature. But being human beings most of us believe that nature will not take its toll oti us and we all carry on with increasing activity until some vital structure fails leaving some of us invalided if we are left to our own. Nature has endowed us with a physical reserve which enables us to carry on in the presence of the early stages of disease. For this reason defects have not been discovered until they have advanced beyond the possibilities of relief in this way producing man failure possibly at a critical moment. The periodic physical examinations are primarily for the purpose of discovering these defects m the early stages, when there is a possibility of cure or amelioration of the condithm so that the progress of any de In an effort to avoid this type of emer gency after the report of the employees ex amination is reviewed in our office a letter generative conditions delayed and the safety factor is thus augmented as well as tire economic activity prolonged- , is sent to the employee even on the slightest We feel that our program has been effec defect. tive if there has been an improvement along If his condition warrants it we may re quest an examination more frequently. these lines particularly. The accompanying chart shows that wc have effected some im provement m the health of our employees Since industrial hygiene is not limited to therefore the periodic examination is an effec the prevention of occupational diseases, but tive method of industrial health education. 152 30th National Safety Congress Essentials of Healthful Industrial Environment By MYRON A. SNELL Supervising Engineer, Hanford Accident A indemnity Co-. Hartford, Conn. In 1940 occupational accidents were re sponsible for 17,000 killed, 16,000 perma nently disabled, and 1.330.000 temporarily disabled. Although the recognized diseases of occu pation are responsible for only a compara tively' small proportion of these industrial injuries, many other factors in industrial environment are partly responsible for them. The personal habits of the individual as well as the nature of his home environment must also be charged with their share of this responsibility. It is known that the incidence of the com mon diseases of life which are not due to the occupation h higher among industrial work ers than among the balance of the population. Consequently, the life expectancy of the in dividual employed in industry is approxi mately eight years less than for the wonindustrial worker. There is no doubt but tliat considerable improvement would result through the elimination of all of the unsatis factory conditions to which workers are ex posed in industry. The Metropolitan Life Insurance Com pany conducted a study which revealed that approximately 2 per cent of all workers are incapacitated all of the time on account of illness. This means that the estimated SO million workers in the United States lose four hundred million days annually cut ac count of injury and illness, resulting tn an average direct loss of wages at $5.00 per day of two billion dollars. The Air Hygiene Foundation of America are engaged in a study of "Sick Absenteeism in Industry*" Their records show that more than eight day* arc lost per male wage earner per year and more than twelve days per female wage earner per year because of sickness. A considerable proportion of this cost is assumed by the employer through low er production and poorer earnings. Many companies have already discovered that a large proportion of the employees with poor health records also had poor safety records. These employers are spend ing money to improve the health of the em ployees tlirough the elimination of unhcalthful conditions at home as well as on the job. They receive a large return on the invest ment, not only through the reduction of time lost from the job through sickness but also from the reduction in the cost of Industrial accidents and diseases. Industrial Health Although progressive employers recognize the importance to them of healthy, satisfied employees, it is unfair and unjust to impose upon them the legal liability for any illnesses or diseases among the employees that are iKit actually caused by the employment. Oc cupational disease laws should be carefully enacted and justly administered so that the employer .will not be expected to provide general health insurance for his employees. The industrial environment is actually re sponsible for only a small proportion of the time lost from the job by employees. Every employer should, of course, be re quired to provide his employees with a safe and healthful place m which to work. Such an environment can be achieved only through a study of every condition of industrial life followed by an adjustment of these condi tions to the health requirements of the indus trial worker. Atmospheric Contaminants Employees should not be subjected to the inhalation of atmospheric contaminants in sufficient concentrations to cause disease or poisoning. nor even in concentrations suffi cient to cause any marked degree of dis comfort. Polluted air is undesirable even though the foreign material in the air is net present in harmful quantities. Workers who are satisfied and contented with the working environment are not only happier and more efficient but healthier as well. Many indi viduals imagine all sorts of ill effects even from trivial industrial exposures, and may even worry themselves into an actual case of illness which was not caused by the en vironment but from the mental attitude of the worker. Industrial Health 153 Atmospheric contaminants in industrial plants may consist of solid disperseids, liquid dtspeasoids or gases or vapors. Solid dis perseids may be divided into dusts, fumes and smokes. Liquid dispersoids may be di vided into mists and fogs. Dost* Industrial dusts are mechanically generated by many different processes and operations. Typical examples arc drilling, blasting and crushing in mining and quarrying: polish ing, buffing and grinding in metal finishing and stonecutting, polishing and abrasive blasting in the granite and monument indus try. The dost generated in every case is of the inorganic or mineral variety. Animal and vegetable dusts axe known as organic dusts and arc generated by such operations as the processing of cotton, the working of wood, or the polishing of dons. From the health standpoint, industrial dusts of above ten microns in size arc of no importance beewne they are too large to be inhaled into the tangs themselves. Dusts below tea mka-oct* in size are not visible to the Raked tye tot cut be seen with a micro scope dowu so above two-tenths of a micron m size. Thai owoinmg sufficient percent ages oi free ilia sad asbestos may cause di)QM Irnwrct as wbenatt and asbestosU if mfrafrd in *ta* kfov ten microns in suffi ciently tag* cwrwtntioni over a great enough ytrl 4 tape. Ocher dusts, with the eutfUM f gw wrTiHii dusts, do not re sult m diiwu. tot --any of them do result in certain ctangrs -- the tangs which are tidudy me f great Importance. Nevertbrio*. -tartar* tonW nor be allowed to in hale high cani.Miof any kind of dust, ngartftr-- etf n* ewagoritina. PoniMbk ta--& or majusmim allowable cuoecwtraiaa-- tar these dusts have been estabbstod by vars--n organizations, but as yet there ta been su ectnpkte agreement for d--* turnerr--inaj m workroom atmos pheres. The .tacrioa Standard Safety Code for the hoxana of Heads, Eyes and Res piratory Organs recocniDends "that no worker be eaatsna^ttaly subjected without a protector to aa atmosphere containing any form of mineral dust tn quantity exceeding 50 mdhots panicles per cubic foot of a size less than 10 nacrous." The National Sili cosis Conference in 193? suggested that tbr maximum permissible concentration should be found by multiplying the percentage of free silica by the total dust count. If the result is under five million, the condition may be considered permissible. If the result is over five million, the condition may be considered too high. California, Connecticut and some other states allow uo more than five million partides of dust running high in free silica. New York State, in the Industrial Code adopted September 1, 1941, for the control of silica dust tn the stonecutting and stone fin ishing Industry, allow five million particles if the dust contains more than 70 per cent free silica, 10 million particles if it contains from 10 to 70 per cent, and 100 million partides if it contains less than 10 per cent free silica. The State of California has established a permissible limit of 5 million particles per cubic foot of air for asbestos dust. Metallic dusts may also be generated me chanically in such operations as weighing and mixing red lead and litharge in the manufacture of paints or storage batteries. The permissible limits for such toxic dusts are the same as for die fumes of these metals. Funiis and Smokes Inhalation of the freshly formed fume of any metal in sufficient concentrations may cause the condition known as "metal fume fever," also known as zinc chills or shakes. Although this condition causes a great deal of discomfort and may be alarming to those who are not familiar with it, it is actually not a disease and has no permanent effect on Ihc individual. The inhalation of the dusts or fumes of the toxic metals can also cause systemic poisoning if inhaled in sufficient quantities. As yet there are no definite standards established for most of the toxic metals. The American Standards Association's Sectional Committee on Allowable Concentrations of Toxic Dusts and Gases is developing stand ards for cadmium, chromium, lead and mer cury. They also propose to develop standards for antimony, arsenic, manganese and zinc. All of these standards will probably be avail able in die near future. The Journal of Industrial Hygiene and Toxicology in the June, 1940, issue published 154 30th National Safety Congress a "Code far Safe Concentrations of Certain Cowmen Toxic Substances Used in Indus try." This code was prepared by a group of live expert industrial hygienists and con tained a list of suggested permissible limits to be used as a guide until the tune that the American Standards Association's committee had completed the standards for the sub stances mentioned. The maximum allowable concentrations for certain of the toxic metals were as follows: Cadmium 0.1 mg. per cu. meter: Chromium 0.1 mg. per cu. meter; .Lead 0.15 mg. per cu. meter; Mercury 0.1 rng. per cu. meter, and Zinc 15.0 mg. per cu. meter. Very little work has been done on maxi mum concentrations of smoke which can be tolerated without impairing efficiency or causing marked discomfort, and no limits have as yet been established. Vapors and Case* While vapors are composed of the gaseous phase of substances which usually exist in the form of liquids under ordinary condi tions, gases exist only in the gaseous state under ordinary conditions. Vapors and gases are frequently but incor rectly termed "flanes." For example, "ni trous fames" instead of nitrogen oxide gases. A liquid organic solvent such as' carbon tetrachloride will evaporate from an open tank in a workroom and the vapors of car bon tetrachloride collect in the surrounding atmosphere. Thus the .carbon tetrachloride can exist under the ordinary conditions of the workroom citlier as a liquid or a vapor. On the other hand, the oxygen and carbon dtoxtde gases in the air of the workroom cannot exist under such normal conditions in any other state. Mists and 'Fogs Mists are formed by the mechanical dis integration of a liquid by such processes as spray coating of paints or vitreous enamels. They usually range in sire from about 50 to 100 microns. Fogs are formed by the condensation of vapors. They vary m size from 5 to about 50 microns. Wherever hot alkaline cleaning or pickling vats are operated in a workroom in which tiic temperature is quite cool, the water vapor is apt to condense in the form of a fog in the room in the same manner that ordinary fug is formed in the outdoors. A mist which may be inhaled in spray coating operations may be rather complex in nature. In the case of spraying paints, it usually consists of & mixture of organic solvents of a varying degree of toxicity together with solid matter in solution or in suspension. These fine droplets in the form of mist may hold in suspension lead oxide as a pigment or other particulate matter of a toxic nature. In the sptay coating of vitreous enamels a water vehicle is used but the particulate mat ter in suspension may contain toxic metals in the form of oxide, such as cadmium, lead and manganese. In addition, they sometimes contain finely divided particles of free silica ht the form of quartz or Hint. The maximum allowable concentration in inspired air containing mist is the same as that for the vapors, fumes or dusts of the substances contained in the mist. There are a vast number of organic sol vents in use m industry and lbe number is increasing each year through the discovery of new and better solvents in the industrial chemical laboratories. The extent of damage to the health of workers through die inhala tion of the vapors of many of these solvents is not known. American standards have been established this year for benzol of 100 parts per million parts of air, carbon disulfide 20 parts per million, carbon monoxide 100 parts per mil lion and hydrogen sulfide 20 parts per mil lion. The American Standards Association's Committee on Allowable Concentrations are at present engaged in the development of standards for acetone, carbon tetrachloride, diethyl ether, formaldehyde, hydrofluoric add, methanol, nitrous gases, detrachlorethane. tetrachiorethylene, toluol, trichlorethylene and xylol. Tentative suggested standards for these as well as for about 23 additional gases and vapors are given in the June, 1940. issue of the Journal of Industrial Hygiene and Toxicology, as already men tioned. Atmospheric Pollution The only definite method of determining whether or not a concentration of atmos pheric contaminants exists in the workroom that constitutes a licalth hazard is by means of collection and analysis of air samples. Industrial Health 155 These atmospheric pollution studies require the sendees of trained industrial hygienists and the use of proper field and laboratory equipment. Many private companies as well as individuals arc equipped to do this work for themselves or for others. In addition, there are at the present time 31 industrial hygiene units located in that many different states, who are prepared to do this work for industrial concerns at their request. In all but New York and Massa chusetts these units are operated by State Departments of Health in cooperation with U. S- Public Health Sendee. In addition to supplying tbe plant owner with an analysis of the health hazards in this plant, these units make invaluable suggestions for their correction or ttiminathm through the use of proper eagioceriag control methods. Ingmuioa of Toxic Substance* The vast majority of cases of industrial possoosqg occur through inhalation of the toxic stffittaaces rather than by ingestion or by absorption through skin, for two reasons. In the first phee, the principal exposure to toxic substances ia industry is through in halation and not ingestkxi or absorption- In the second place, ia those few cases where poisonous substances are swallowed, they are almost entirely eliminated through tbe ali mentary tract without being absorbed into the bloodstream and a Urge percentage of the small amount absorbed into tbe blood stream is further eliminated through the liver. Consequently very little of the in gested poison gets into the general circula tion to cause damage to tbe vital organs. In the case of an employee who is working with lead oxide m the manufacture of storage battery plates, he is inhaling any dust which may contaminate tbe working area at the rate of 16 times each minute during the en tire day. On the other hand, he usually eats but once a day on the job. In addition he may swallow at other rimes during the day an amount of lead which in itself could not cause poisoning. paratively rare and most of the known toxic substances do not readily enter die blood stream by sldn absorption. Approximately two-thirds of all occupa tional disease claims, however, are for derma titis and other skin affections. Industrial employees come m contact with a consider able nutnbtr of substances which invariably result m die development of a dermatitis condition. In addition, there are a great many other substances used in industry which cause abnormal skin conditions to develop in certain few individuals but not in others. This highly specialized subject has been given a great deal of attention ia recent years and much information has been pub lished about it. There are two methods of prevention available. The first involves the use of skin tests to determine individual reaction to sub stances which arc generally known to cause dermatitis. This is done before employment in the exposure, and employees who show a positive reaction are placed in other jobs. The second method consists of preventing contact between the individual and the harm ful substance through complete' enclosure, exhaust ventilation, die use of rubber gloves or other protective clothing, or protective skin cream. Personal cleanliness also is an extremely important factor in the prevention of industrial dermatitis. Infectious Diseases A considerable number of Industrial cases of anthrax, glanders, undul&nt fever and tularemia are reported every year. These diseases of animals arc invariably contracted by man through ignorance or negligence on the part of the employees or their super visors. Industrially they are cosily con tracted through contacts with infected hair or hides or the diseased animals themselves. Practically every such case could have been prevented either through sterilization of the animal parts themselves or through the use of protective clothing on the part of the employees. Skin Contact A tew of the organic liquids such as tetra ethyl lead used in leaded gasoline and benzol may cause poisoning by absorption titrough the skin Such cases, however, arc com MisceBanaous Disease* Thcie are miscellaneous conditions to which industrial workers may be exposed which are responsible for a considerable number of actual cases of disease. Com 156 30th National Safety Congress pressed air iUuess or caisson disease results from too rapid decompression after working under pressures greater than one atmos phere. Time and pressure tables have been established for maximum rates of compres sion and decompression which should be .fol lowed in all cases. In some states this Is required by fctw. Radiant energy when used in industry may result in serious consequences if adequate safety precautions are not taken. Workers should not be exposed to harmful amounts of radioactive substances or X-rays. In every case the protective measures published by the National Bureau of Standards should be religiously followed. ing customary winter clothes living in the broad geographical belts across the United States in which heating of the convection type is generally used during four to eight months of the year. It doesn't apply to rooms heated by radiant energy, rooms with excessive glass area or those with poorly insulated or cold walls. In densely occupied spaces somewhat lower temperatures may be necessary. Satisfactory comfort condi tions for men at work have been found to vary from 40 to 70* E. T. depending on the rate of work and the amount of clothing worn. In hot industries 80 . T. is consid ered the upper limit compatible with effi ciency and whenever possible the should be reduced to 70* E. T. or less. Both ultra-violet and infra-red rays have certain beneficial effects on human beings if they are absorbed by the body In moderate amounts. Light rays produced industrially, however, may have a serious effect upon the health of workers if proper personal protec tion is not provided- Cataract may result from exposure to the heat and glare of molten glass. Serious eye and skin bums may result from undue exposure to the bright arc produced in electric welding. The use of goggles with properly colored lenses, face shields, gloves, and proper clothing afford adequate protection. Pressure, Motion and Shock Synovitis, or tcoosynvitis. or bursitis, or cellulitis ot any oi the joints of the body may result from any occupation involving con tinual or repeated trauma, vibration, pres sure or friction. Examples are the diseases suffered by workers who spend many years in handling pneumatic tools used in such operations as riveting and drilling. -If pos sible the employees of concerns engaged in such operations should be rotated so that no one individual is exposed to the harmful ef fects of conditions such as these for long periods of time. ' Temperature and Humidity The average comfort zone in the winter time is from 63 to 71* K. T. (Effective Temperature). CO* E. T. is the most popu lar effective temperature as adopted by the American Society of Heating and Ventilat ing Engineers for individuals at rest wear In the rummertime the average comfort zone Is from 66 to 75* E. T. with 71* E. T. as the popular average. This is 4 to 5* higher average than in the wintertime. The temperature differential between in doors and outdoors which should be main tained debends on a number of factors. A drop in temperature of 10* F. or more may be extremely harmful if it occurred suddenly, especially when the skin and clothing are wet with perspiration. No standard has been established for the proper amount of humidity. It may vary front 30 to 70 per cent without discomfort. The air should be dry rather than damp. The common belief that dry air in itself ex erts a harmful effect on the skin and mucous membranes has never been proved by con vincing evidence, although there have been numerous investigations on the subject. The addition of moisture to the air of occupied rooms by any practical method has not been shown to have any beneficial effect upon health and comfort. Experiments have shown that the respiratory membranes oi industrial workers exposed to hot, moist air are dis tinctly more abnormal than those of workers exposed to hot, dry air. The maximum air movement should be 50 feet per minute with sot less than 10 cubic feet per minute per occupant oi the room taken from an outdoor source. Mr. Yaglow states that uan air movement of not over 40 f.p.m is permissible under present engi neering practice, when the temperature of the air current is 2* F. or less below ordi nary room temperature. Current velocities as high as 200 f.pJU. may prove desirable Industrial Health IS 7 in hot industries, but velocities much higher than this are uncomfortable and irritating and may Mow dust off the floor." Work in the hot industries may be respon sible for a number of physiological derange ments, the best known of which is heal ex haustion or heat cramps. The conscientious use of salt tablets by the employees in such industries has largely etiaumted the dis ability and discomfort which were prevalent a few years ago. Since the amount of rise in body tem perature of employees zn bot atmospheres has been shown to indicate disturbances in physiological equilibrium, the American So ciety of Heating and VcutHating Engineers has suggested an average "temperature rise of one-halt degree m the average worker qualified by physical teaktup and experience to work in hot industries, or a one- and onehalf degree rise in an occasional worker" as the limiting factor. The A.S.H.V.E. sute that "the thermal environment cannot be properly adjusted to the requirements of human health and com fort without control of all the four baste factors concerned--temperature (true air temperature free from radiation effects) movement of the air, humidity of the air, and mean radiant temperature of liie sur rounding surfaces." Their research labora tories are at the present time engaged in a research program with the aim of establish ing minimum requirements for air condi tioning for industries which would be ac ceptable to everyone concerned. Miscellaneous Conditions Abnormal noise levels have a profound effect upon industrial workers and may re sult in deafness or other pathological ear conditions. The A.S.II.V.E. 1WI Guide con tains a table giving the acceptable noise levels under various conditions. These noise level* vary from 10 to 100 decibels depend ing on the source and location. Dr. Kxrudsen reported that "long exposure to rounds above a level of 80 to 90 decibels or a brief ex posure to more intense noises invariably im pairs hearing. Other results are vestibular disturbances, mental fatigue, loss of effi ciency, and extreme nervousness which can be traced to excessive noise. Some persons are more susceptible to excessive noise than others, bat no one is immune to long con tinued intense sound. Noise has become more than a nuisance--it is a menace impairing the hearing of millions, robbing them of quiet leisure, restful sleep and taking a toll of the general nervous system of mental work ers, neurotics, hospital patient* and others who are noise sensitive." Noise reduction at the source may be accomplished by insula tion, absorption or by reducing the noise from machinery and equipment. Most em ployees object to wearing ear stoppers but Dr. Kmxiscn has devised an ear defender providing an Insulation of 35 to 40 decibels which is very effective. Tobaeco Smoke and Body Odors, with the exception of toxic atxaosplieric contaminant?, are the principal factors to be considered relative to comfort and efficiency. Such odois are not harmful but nevertheless have a profound effect on individuals. In the same manner other disagreeable odors ad versely affect the efficiency of workers. The amount of outdoor air needed for body odors should be somewhere between 10 and 30 elm. per person depending on age, socioeconomic status, air space in cubic foot per person, outside and inside temper atures and humidity. The minimum air change requixements for tobacco smoke has not yet been definitely determined but prob ably should be m the neighborhood of 5 to 15 cXm. per person. These air require ments are in addition to those needed for indoor recirculation in order to maintain the humidity and temperature at the proper levels. Space Allotments Cor industrial workers are of questionable value and minimum re quirements feu* them cannot be given at the present time because this factor is so closely associated with many others, principally that of the ventilation problem. Illumination of the proper intensity for the type of work to be performed should be provided for all Industrial workers. The equipment providing illumination should be of the proper type and installed &o as to give maximum efficiency with a minimum amount of glare, eyestrain, or other adverse effects. Improper lighting may be responsible for ac tual diseases of the eye in addition to eyestrain and eye fatigue. Improper iUumi- 158 30th National Safety Congress nation may not only result in poor efficiency but also in a high accident frequency. The number of foot-candles foe proper industrial illumination varies up 10 a point beyond 100. They are published in table form for various occupations in Safe Practices Pamphlet No. 22 o*i "Industrial Shop Lighting" Other Factors which should be considered in the subject of industrial health are work ing postures, ami the proper kind of floor covering- Standing or walking on concrete or other hard surfaces produce fatigue and mav even be harmful to some individuals in prolonged exposures, T1k Gifbrcth Inter national Committee on Industrial Fatigue place great stress on the harmful effects of improper posture among industrial workers. The use of proper chairs eliminates fatigue and greatly improves efficiency. The comfort and efficiency of industrial workers are also affected by the color scheme of the environment, the length of the work ing hours and the rest periods used in con nection with them, the general housekeeping conditions and cleanliness ol the plant, locker, washroom, sanitation and eating facilities, medical facilities, and by proper provisions for recreation. Most of these, however, have little or no important effect upon the actual health of the industrial worker. ADJOURNMENT Industrial Nursing WEDNESDAY AFTERNOON SESSION October 8, 1941 Presiding--D*. M. H. Kronesbekc. Chief, Division uf Industrial Hygiene, Illinois Depart ment of Public Health, Chicago. Employee Health Education By D. IRENE BIGLER Industrial Nurse Consultant, National Organization for Public Health Nursing, New York City Why are we interested in health education programs for industrial workers? I dare say the real impetus ties in the fact that industrialists, industrial hygienists, members of the medical and nursing profession as well as the employees themselves are becom ing increasingly interested in stemming the vast industrial waste which research figures show occurs yearly because of general illness. Before we can accomplish much, we need to stimulate the thinking and to gain the understanding and whole hearted willingness to cooperate of those whose health we set out to improve, by presenting its value from the point of view of all who are concerned. We need to bring out the fact that the loss brought about by absenteeism Is not a loss for the manufacturer alone; but it is the workers' loss as well. It is accompanied by their own physical and mental suffering and through shortages in their own salary leads to additional suffering on their pan because through it they will be denied better food, better living conditions, better education for their families and other privileges such as recreation that go to make up the more abim dant Hie. But lit addition to all this, absentee ism is a national loss--a toss that we can ill afford today. Industrial managers are aware that healthy, emotionally stable workers aic us ually happy, loyal, safe, efficient workers. Supervisors who are responsible for the production and smooth running of tbetr de partments also need to understand that healthy workers mean men on the job; that man is .affected by his environment; that there is a direct lelationship of physical and mental health to efficiency and happiness; that while production of goods is the explicit function of industry, it Also provides a way of life for the people in it and if this way of life is satisfactory the morale and effi ciency of the workers are high. The foreman is still another with whom much time should be spent in interpreting the whys and wherefores of health and safety programs. Normal, work output is a good indication of health, hence the foreman should be first in line to note whether a worker is or is Dot up to par. The foreman needs to be made aware that what helps the workers helps his department and the company. Foremen with an intelli gent -view of health and a kindly under standing willingly grant rather than intimi date workers by inferring that they are ""sis sies'* when they ask lor momentary relief to care for a seemingly trivial injury or illness. Foremen should be especially well informed on the policies of health programs ; because they are the first to be consulted, they are in a strategic position to steer work ers in the right direction. 159