Document qkdODB6900ZNXBKgRb80Zp61R

FILE NAME: National Safety Council (NSC) DATE: 1937 Oct DOC#: NSC165 DOCUMENT DESCRIPTION: NSC Transactions 2 6 th M a ti a & a l S a f e t y Congress ) N A T IO N A L S A F E T Y C O U N C IL, Inc. T H E Transactions of the Twenty-sixth National Safety Congress, 1937, are published by tbe National Safely Council in two volumes. This, the first, contains the general, the special subject, and the Industrial Section sessions. The second volume contains the sessions of the Child Education, Home Safety, Street and Highway Traffic, Commercial V e hicle and Transit Sections. .All'industrial members of the Council automatically receive Volume I. Volume II is sent to mem bers believed to be in te r ested chiefly in tbe sessions it covers. O th er Council m em bers, however, may obtain it upon request. Many members have found it worth while to distribute copies of the Transactions to supervisors, foremen, and others in an administrative or supervisory position who may make practical use of them for reference purposes. The fol lowing quantity prices are quoted on extra copies: 1 to 10 copies of the large volume (V olum e 1), $2 e ach; 11 copies or more, SI.75 each; copies of the smaller volume (Volum e 11), 75 cents each. T H E Transactions are published as a condensed record of the proceedings at the National Congress. The papers of each session or division of the Congress have been edited carefully to eliminate extraneous matter and to*abbreviale the less essential portions because of space limitations. Thus the m aterial herein presented is not a verbatim report of all the speeches presented at the Congress, but rather an abridged version made as compact as possible, yet without injur}' to the technical aspects of any address. The original m anuscripts are on file in the Council's I'ureau of I n f o r m a tion, where they are available for additional reference. W here illustrations were sent by the speakers to the Council, these also arc on file. The National Safety Council at its Congresses seeks to eliminate from discussion matters which are not pertinent to the aim of the Congress or which are contrary to Council policies. It cannot accept responsibility for the views ex pressed either in the papers presented or in the discussions based upon the papers. N A TIO N A L SAFETY 20 North Wacker Drive Chica go CO U N CIL, In c . Ckaim u s C ou n cil Officers and D i r e c t o r s ................................................. . 4 C ouncil P u rp o ses and P o l i c i e s ................................................. . '9 A nnual M e e tin g o f M e m b e r s ............................ .................. . 11 Annual B an q u et ............................................................................. . 31 Subject Sessions-- A f t e r W o rk A c c i d e n t s ....................................................... 33 A gricu ltu ral S a f e t y ............................................................. 41 C o m m u n ity S a fe ty O r g a n iz a tio n .................................. 51 F ire P r e v e n tio n ............................................................ 59 H e a lth S erv ice in I n d u s t r y ............................................... 71 Industrial D u sts ................................................................... 85 Industrial Fum es, Gases and V a p o r s .......................... 99 In dustrial S a fe ty L e c t u r e s ............................................... 109 M a in tain in g In terest in S a f e t y ....................................... 141 P ressu re V e s s e ls ................................................................. 157 . S a fe t y Fundamentals ......................................................... 173 S a fe t y In sp ecto rs ............................................................... 183 ,, S a fe ty Training .. ............................................................. 193 Safe U se o f A c i d s ..................................................... 1 ......... 201 A eron au tical S e c t i o n ................................................................... 211 A .S .S .E .-- E n g in e e r in g S e c t i o n ............................................... 221 A utomotive and Machine Shop-- Power Press Sections 225 Cement and Quarry S e c t i o n s ...................i ................................. 249 C hem ical S e c tio n ......................................i ................................. 271 i C onstru ction S e c t i o n ........ ...................... j .................................. 285 F o o d S e c t i o n ................................................................................... 307 Industrial N u rsin g ....................................................................... 323 Marine S e c t i o n ........................................... .................................... 341 M eat P a ck in g , T a n n in g and L eath er In d u stries S e c t i o n ........ 371 M eta ls S e c tio n ........................................................ M in in g S e c t i o n ......................................................................................... .401 Paper and P u lp S e c t i o n .............................................................................429 P e tr o le u m S e c tio n .....................................................................................489 P o w e r P r e s s S e c t i o n ...................................................................................535 P u b lic U t i l it i e s S e c t i o n ...................................................... Quarry S e c t i o n ....................................................................... R efr ig e r a tio n S e c tio n ...............................................................................559 Rubber Section- ........................................................................................... 577 S a fe ty E q u ip m en t S e c t i o n .......................................................................581 S team R ailroad M e e t i n g . .................................................... T e x t il e S e c tio n ........................................................................................... 601 Wood Products Section............................................................... 611 I n d e x ..................................................................................................................621 381 537 557 587 a&somskfi' C o u n c il, Isa s. HONORARY MEMBERS Assort vnoN <iu Ikon a n i> S teel E noint.khs Robert W . Cambreie L ew K. P aEMI.K OFFICERS (1937-1938) D. D. 1'e n x e u , President C. \V. D emeesy, Vice-President for Pittance and T r e a s u r e r H arry G uh.m-ikt, Vice-President fo r Mem bership F rank II. H akkison, Vice-President for Industrial Safety H on. H aroi.i) G. H offman, Vice-President for Public Safety W alter S. P aine, Vice-President f o r Engin eerin g A. V. Rohwkden. \'ice-P resident for Local Safety Councils A. W. W hitney, Vice-President for Education W. H. Cameron, Secretary and Managing Director EX EC U TIV E COM M ITTEE (1933-1938) H. W. A nderson, General Motors Corporation J. 1. If anasi i, Past President C. W . Hekcqltst, Past President H enry \V. Hoookss, Petroleum Section C. If. Boi.'U.t, ASSE-Engineering Section H. W. Boulton, Automotive and Machine Shop Section H arold S. liirn'F.NHEiM, T he American City Magazine W. H. C ameron, National Safety Council, Inc. R obert \V. C aniimieee, P a -t President R obert I. C a t u .v, Aetna Casually & Surety Company R. A. C haffin', Metals Section L ewis A. I'JeUlois, Past President C. \V. D emfesy, T h e Liquid Carhonic Corporation M arcus A. Dow, Past President D. D. F ennell, Consulting Engineer J ohn B. G ibson, W estern Electric Company H arry Guu.beki, T h e Puiiman Company F rank II. H arrison, International Harvester Company P. L. G. H asskakl, Lehigdi \ 'alley Safety Council H on. H arold G. H offman, Governor, State of N ew Jersey S. If. H orrell, Food Section W alter G. K inu., Past President 4 ii i O FFIC ER S A N D DIRECTO RS, Continued W m. C. K noelk, Milwaukee Safety Comm ission J ihlv E. L ong, P a st President Tim s. H. M acD onald, U. S. D ep artm en t o f A gricultu re W alter 15. M artin, Peoria Association o f C omm erce Safety Com I. W . M illard, Industrial Gloves Company H arold L. M iner, E. I. du P o n t de X em otirs & Co. P rof. R oger L. M orrison, S treet & H ighw ay Traffic Section E. J. O 'B rien', J r., Louisville Safety Council W ai.ter S. P aine, A etn a L ife & Affiliated Cos. L ew R. P almer, Past President C. E. P ettiuone, P ast Presiden t A i.hkrt S. Kkgui.a, Industrial Relations Counselors, Inc. Lt. Cot.. H enry A. R f.ningkr, P ast P re s id e n t A. V. Rouwedkr, Duluth, Missabe t Iron Range Railway Co. G eorge E. S anford, General Electric Co. C iiari.es B. S cott, Past Presid en t G en. J ohn H. S heriiuknf., M as sachusetts S afety Council ,, J udge L ee E. S keel, Cleveland Safety Council C. W. S mith, Standard Oil Company (Ind.) W ai.ter D ent S mith, Delaware S afety Council R. T. S olensten, Elliott Service Company C. P. T oi.man, Past President G eorge G. T raver, G reater Chicago S afety Council, Inc. D r. C. H. W atson, P a st President A. W . W hitney, National Conservation Bureau T. A. W ilson, Textile Section W. E. W orth, International H arvester Co. A rthur H. Yount., Past President D IR E C T O R S (1937-1938) G lokue J. A dams, Paper and Pulp Section H. W. A nderson, General Motors Corp. A. L. A rmstrong, Eastman Kodak Company H . H. B aii.kv, Chattanooga Safety Council J. I. B anash, Consulting Engineer C arl B arker, St. Louis Safety Council G. J. B arrett, Mining Section E rnest W. B eck, United States Rubber Products, Inc. C.. \V. Hekg<juist, Western Electric Co. E. E. B lank, Jones & Laughlin Steel Corp. H enry W. B oggkss, Petr oleum Section H. E. B olt, South Bend Civic Safety Council FF1CERS A N D D IRECTO RS, Continued C. B. B oui.i.t, A S S E - E n g in c e rin g Section H. W. Boulton, Automotive & Machine Shop Section E. S. Huuwn, Standard Accident Insurance Co. W. A. Brown, Safety Department, Nashville Chamher of Commerce W. T. lircKt'.Kmr.r., Employees' Publication Section S. W. B ui;atm ., Safety Department, Automobile Club of Rhode Island H arold S. Bui it:nhi:im, T h e American City Magazine B. J. C ai.i.aciian, Contra Costa County Safety Council W. 11. C ami.kon, National Safety Council, Inc. R ay C arni v, Kenosha Safety Council koiti.KV l. C vit.in, Aetna Casualty N Surety Co. R. A. Cu a iii.v, Metals Section KT.nnktu 1!. Cot.man, Seattle Traffic & Safety Council J. E. Ceu.iNiv, Bethlehem Steel Co. L kwis A. D l B i.uis, Consulting Engineer J ay E. D lcklk, Mason City Safety Council C'.. \V. D i:mit:sy, '1'he Liquid Carbonic Corp. J amf.s 1!. Douulas, T h e Philadelphia Gas W orks Co. D r. Lotas 1. D ublin, Metropolitan Life Insurance Co. O. M. E dwards, J r., S afety Div., Syracuse Chamher o t Commerce W. P. E lstln, I-'uhlii. Utilities Section . D. I). E lnnlll, Consulting Engineer D. L. E knnli.i., Kansas City Safety Council D onai.d A. E inkbli.nuk, Tole do Safe ty Council D r. I I art E. E isiii.r, Chicago Rapid T ransit Co. C hkstkr C. E isk, Berkeley Traffic Safety Commission H oward ]i. F onda, Burroughs Wellcome & Co. (U.S.A.) Inc. A llxandkr E ostlk, J r., Q u a r r y Section J ohn B. Gtnso.v, W estern Electric Co. H oward F. G ii.hkrt, Elizabeth S afety Council O n t o M. G kavks, T h e General Crushed Stone Co. W. A. G riffin, American Telephone & Telegraph Co. H arry G uiuii'.rt, The. Pullm an Co. I saiah H aim:, The Atchison, Topeka & S anta Fe Ry. Co. C. If. I I ari'i:r, Refrigeration Section J). '1'. H akkinoton, II. S. Bureau of Mines I ' kank H . H arrison, International Harvester Co. P. L. G. H assKarl, I.ehigh Valley Safety Council R. C. H avfn, Commercial Vehicle Section . G. T. H fllmuth, Chicago, N o rth Shore & Milwaukee RR. Co. C has. E. llir.i., New York Central Lines H on. H akoi.d G. H offman, Governor, Slate o f New Jersey E. C. Hor.nr.N, J r., Marine Section 6 O FFIC ER S A N D D IRECTO RS, Continued E verett Horn), Madison Comity Safety Council S. B. H orrell, h o o d Section Jd. C. H o w s.a.m, P o w e r P res s Section Fred Ii. H unt, Cement Section M ajor N orman A. I mrir, Columbus Safe ty Council k . 1). J ewett, Springfield S afety Council T homas P. K rakns, Industrial Commission o f Ohio Tims. I- K elley, Paterson Safety Council J. M. K errioan, Rubber Section VVm. C. K noki.k, Milwaukee S afety Commission VVm. S. K nihisen, Detroit Industrial Safety Council C. L. L.\ Fountain it, (ireat N o rth ern Railway Co. M illard C. L efler, Cbild Kducatioii Section B arney L kvv, J r., Rochester S a fe ty Council A. A ugustus L ow, Brooklyn Safety Council Tims. 11. M acD onald, U. S. Department of Agriculture W alter 13. M artin, P eo ria "Association o f Commerce S afety Council P. W. M atson, Minnesota Safety Council R. A. McA rthur, T r a n s i t Section M ii.i.er M cC i.intock, H a r v a r d University l. W. Mn.t.ARt), Industrial (doves Co. J ames K. Mn.i.f.k, G ran d Rapids Safety Council H aroi.i) L. M iner, E. I. du P o n t de N emours Nr Co. R. l '>. M ori.ev, Industrial Accident Prevention Assns. P rof. R ohkr L. M orrison, S tr eet & H ighw ay Trallie Section E rnest M ukitiy, Albany Safety Council E. J. O'Brien, J r., Louisville S afety Cotiueil Gkorok C. A. O/'P, The Detroit Edison Co. W alter S. P aine, Aetna L ife & Affiliated Cos. L ew R. P almer, T h e Equitable Life Assurance Society of the U. S. D avid A. P atton, N e w a rk Safety Council M rs. G. M. P ei.ton, Evanston S afety Council C harles W. P k.vdock, Safety Div. Milwaukee Association o f C o m merce C. E. P etti none, American M utual Liability Insurance Co. C i.n. G eorui: 1!. P illsrury, United States Engineer Office A rthur P ottertuv, Hudson County Safety Council A lbert S. R gula, Industrial Relations Counselors, Inc. L t. C ol. H enry A. R eninokr, I.ebigh Portland L im ent Co. B kstor R obinson, Easth av S a fety Council A. V. R oiiweder, Duluth, Missabc & Iron Range Ky. Co. W alter Rosenbaum, W estern Pennsylvania Safety Council G. E. S anford, General Electric Co. \ O FFICERS A N D DIRECTORS, Continued H enry G. S chaffner, Eric Safely Councilk .u u . G. S chokfeler, Rahway Safely Council H arry A. S chui.tz, United States Steel Corp. H. E. Seely, Wood Products Section E arl S. S hartzek, Utica Safety Council G en. J ohn H. Siierrurne, Massachusetts Safety Council D r. L. A. S uoudy, Bethlehem Steel Co. E rnf.st L. S imonds, New Haven Safety Council A. E. S inclair, Meat Packing, Tanning & Leather Industries Section J udge L ee E. S keel, Cleveland Safety Council C. W . S mith, Standard Oil Company (Ind.) E dwin C. S mith, Blackstone Valley Safety Council W'alter D ent S mith, Delaware Safety Council W. A. S now, Construction Section R. T. S oi.ensten, Elliott Service Co. E. C. S pring, Lansdalc, Pa. G eorge R. S tephens, Safety Bureau, Buffalo Chamber of Commerce J ohn S tii.wei.i., Greater New York Safety Council . A rthur M. T ode, Consulting Marine Engineer G eorge G. T kavkr, Greater Chicago Safety Council. Inc. _ M ajor R. D. T rimhle, Richmond Safety Council F rank E. Y itz, Superior Safety Council D k. C. H. W atson, American Telephone & Telegraph Co. H arry M. W ehiier, Wilmette, III. Dk. D avid E. W egi.ein, Baltimore Safety Council S. E. W hiting, Liberty Mutual Insurance Co. A. W. W hitney, National Conservation Bureau H oward R. W hitney, W orcester Safety Council T. A. W ilson, Textile Section \ \ . H. W inans, Union Carbide & Carbon Corp. I-. B. W inslow, Safety Div., Birmingham Chamber of Commerce W. E. W orth, International H arvester Co. E. J. Zauft, Safety Bureau, Duluth Chamber of Commerce G. L. Z wick, St. Joseph Safety Council The purpo- The throm preven plies t. direcil lation. Reecondii: diseas.accidetire in The profit. don. It hasentir, of tlu 400 fo: hershi indiv.' bers o; tions. cern^, th oil th ' ' and r. Tin tilo tirunder Iron ... wauki. Gong.. orgat; menila bersi,i; The grani minedeve: make Tlu expai. Industrial Dusts October 13, 1937 m ^ ' > ^ ^ ;lScaed to order by Chairdustriai ` RehUon ' ^ eci,l,Ye Secretary, In solations Counselors, Inc., New \ ork C,(y, and \'ice-President for Engineer- ------ u u i a t -'U S tS By SENIOR SURGEON R. R. SAYERS t-ruef, Division of Industrial Hygiene ir o p w ,, dusts evict .......... . . Hyglene>U-S-Pubhc Health Service m o s p h l e it hasXbeeeVeryWi'ere in the a t tunes th at workers T >gm2' d. f o r ) n - $S'd\n occupations are less liealthv dUSty so exposed Tl, ' e? - than those not <lus`y occupations comfdses o'n" is diftcu,^ t0 establish a comprehensive definition for /s.rtr dusts. Sollmann 3 after felt that > Vanoa3 definitions for poison w itcchf iwl Vill LnTotbb5e' dalfmfibtCiUg,ut ot0usgiivne saom^ ne ictaisoens but beheved that the following covers m o ot the points which must be considered in classing a substance as such : a i / m - e ' r ,,CnSi ,1S f I)articulate matter in "A poison is any substance which act ing directly through its inherent chemic Properties, and by its ordinarv action s capable of destroying life, or f seriously endangering health, when it is applied to f(ttoo 3sn0 Gr m'' .e)*.itnetrenranlalyll-yo."r in m o d era te doses the chiet diflercntiation is based on the size lie l i e a l d r ' s i " c . ln YCStf ' ltions by the Pub1 1 1 - ^ r \ u c ni dusty industries1 re vea ed that about 70 per cent of the a n particles examined were between 1 -,nd '3 Some dusts are known to be poisonous -h d c others, in the concentretioL usually encountered, are comparatively h=rmless h ' u ' n ' h i / , 1 may bU Stated " at C a t k i n , . ,lgh conccutration is not desirable css han 1 m"icCr' oUnn, 'yan"dI'0t1h'e1 2m0ePdCiarnccs,i,ztewweares 3 m crons. Industrial lusts are mainly Cs han o mero,is )n sjzc Howcycrt f h- ro^ justs m the a,r, such as asbestos, J ve been totintl ,0 contain particles as la g7 as 200 400 mircons in the greatest diameter * . , r , i , 0,h" - * z \VI"le generally speaking, according to Colh,. dusts arc more injurious as their chemical composition differs from that of the human body, or from the elements o which the body is normally composed,1 it It is now wen established that exposure ertam kinds of dusts, such as those con i' "nng considerable quantities of free silica rate from respiratory diseases. while J,C dl,sts- S1,ch as lead and its compounds, 85 i Ctiuy-sisin A aliiuia/ S a jc l y Conijrcss have been associated with general systemic poisoning." Dusts may be swallowed with saliva, water, or food, and direct poisoning has been traced to absorption by this method; other dusts may act as irritants and produce affections of the skin, irritate mu cous membranes of nose, eyes and throat, often causing inflammatory diseases of these organs.6 Some inorganic dusts arc able to pene trate the deep lung tissues and arc sufficiently insoluble to be retained there. Some of these may be active in the human tissues, causing definite and permanent in jury, while others are inert and may he retained for years, apparently without seri ous damage; some are gradually absorbed without causing pathological changes.1 All inhaled particles are soluble, at least to a small extent. If harmless, cell activity is stimulated so that phagocytes remove the dust. If the solute is toxic, the viability o f the phagocyte is affected and an ineffective accumulation results. At the same time, further solute may diffuse into neighboring tissues, setting up an irritation and subse quent fibrosis. The nature as well as' the solubility of the solute is an important' fac tor, hut of two substances of approximately equal toxicity, the inore soluble form causes the greater damage. However, sub stances of such low solubility as silica may ultimately produce extensive injury." Kettle has stated that harmful dusts, if inhaled into the lungs, may activate a latent tuberculous infection; the}' may exaggerate an active tuberculous lesion or a coincident infection. If sufficient quantities of a h arm less dust are inhaled, some of it remains in the lungs and causes a mild degree of librosis merely through mechanical irritation, htil such fibrosis is never sufficient to iulerlere with the function of the lung.'' Some writers stale that while the influ ence of ixuipnisnnoiis dusts on heallli is a , debatable subject, abnormally high deatli rales from bronchitis and pneumonia are sometimes attributed to chronic expomro to nniitoxic. dusts. I.arge amounts of dust are occasionally found in supposedly normal lungs, at autopsy* According to Drinker, there are four d if ferent types of reaction produced in man by the inhalation of dust. The first and most important are the pneumoconioses, such as silicosis and ashestosis, which cau-e specific lung pathology and often are followed by pulmonary tuberculosis. .The second type o f reaction is caused by toxic dusts like lead, cadmium, and radium. A third type of mal ady follows the inhalation of finely divided metallic fume particles such as zinc oxide, and is known as metal funic fever. The fourth reaction, allergic in character, is caused by breathing organic dusts such as pollen and certain types of pulverized wood and flour. In all four cases the sole cause o f the disability may be dust inhalation, hut the reactions from toxic dusts result from swallowing as well as from inhalation.'6 For various reasons it is difficult to set up an absolute classification for dusts. Opinion is rapidly changing regarding socalled inert or harmless dusts and further investigation may prove some of them to he injurious. Some dusts may have both a toxic and an irritant action; while on the other hand, the poisoning resulting from ex posure to a dust may he the combined effect of more than one mode of entrance into the body. However, the following classification of dusts, according to physical character istics and physiological effect, is used for convenience. I. Organic Dusts \ Organic dusts arc those which contain carbon, and were originally supposed to come from organized substances derived from animal or plant life. Living dusts come under this classification, and are thought to he of the same order of size as industrial dusts, with which they arc fre quently associated. Hacteria arc usually be tween 0.5 and 3 microns, except ju a few cases, such as the anthrax bacillus, which ranges from 1 to 1.25 micron in breadth and 4.5 to 10 microns in length and 10 or 12 microns in diameter. However, il is possi ble that the larger and heavier vaiirlirs, like the larger and heavier dnsl particles, settle due to gravity, and do not jemaiit suspended in the air. Many thousands ot organic substance-., carbon- containing, are made synt helical h by chemical processes, such as dyestufl-, explosives, etc. 1. X O X 'U F h X G OAY,\-/ Y t c D C S T S . As the name implies, these are comprised of nonviahlc particles, which may or may not he inherently toxic or irritant, hut which nevertheless produce untoward effects in the human organism. "Allergic" dn*ts, or those to which only certain person arc or may hiditslrial Dusts become hypersensitive, with resulting asthma, rhinitis, or other disturbances, are included in this classification. a. Toxic and/or Irritant. Toxic o r irritant dusts are all organic dusts which produce untoward symptoms, either systemic or local. Those producing local symptoms are usually described as irritant; those produc ing general or systemic symptoms arc termed toxic. A dust may be both toxic and irritant. In reported cases of injury or death fol lowing inhalation of dust from organic com pounds, among the chief offenders are paranitranilinc, the dinitrobcnzencs, chloroditiitrobcn/.cnes, trinitrophenol, and nitronaphthalcnc. Eye dam age due. to inflamma tion of the cornea has occurred among workers exposed to methyl violet dust. The dust from paraphenylcnc diamine derivatives is particularly irritating and dangerous, causing not only a severe form of derm a titis where the dust comes in contact with the skin, but also producing acute inflamma tion of the mucous membrane of the respiratory passages.4 T oxic dusts may be generated during the handling of powdered dyes and in preliminary dyeing operations, particularly the hydro-extractor process, where particles^-are disseminated in all di rections." Coar tar and indigo dyes are substances most frequently used. Cases of amblyopia have been reported from exposure to inhalation of tobacco dust.'" It has been found that inhaled t o bacco dust exerts a nicotine action on the organism fifteen times greater than that produced by the same quantity of smoked tobacco with an equal nicotine content.13 Severe dermatitis is experienced by many workers handling powder containing T.N.T., "Inch is used in making high explosives, l 'icric acid, which is also used for this p u r pose. requires drying, and in this latter state has been found to produce a dermatitis. I 'iciic acid is also the oldest synthetic: o r ganic dyestuff." Dermatitis occurs among handlers of silk with varying frequency. Sail; determined that a rash occurring among workers in a silk factory was due to dust from silk cocoons imported from Africa." 1`ersons engaged in the manufacture of quinine and quinine preparations suffer from skin phenomena, which occur for the most part on exposed parts of the body, and may lie caused by ingestion or by quinine dust, or powder form of the preparation, erting a direct irritating effect on' the sk: D ermatitis due to other vegetable dt: such as vanilla, powdered arnica, p> thrum, etc., have been reported." Dental lesions, of occupational o ne have been reported among workers in sue T h e gingivitis caused by sugar dust is cl. sified as purely mechanical, w i t h late developing caries. Digestive disordc resp irato ry conditions, and cutaneous cc ditions (especially of the face) were a f o u n d . 11 Dock workers, transporters of gra workers in grain and flour mills, etc. a exposed to dusts during their work. Dti from cereals may contain many impuriti which may cause an irritating action on ti respiratory passages, as well as inflamtn tion o f the skin. Digestive distiirbano dental defects, diminution in hearing, at conjunctivitis have been observed amoi millers, and have been attributed to the dus to which such workers are exposed." b. Allergic. Many apparently innocuoi substances may produce reactions in pc sons of peculiar personal susceptibility. T! term "allergy" is used to describe this cat dition of hypersensitiveness or susceptibillt4 and allergic phenomena most frequent manifest themselves in skin reactions. H oi ever, they may cause acute reactions els. where in the body. When the respirator tract is involved we have such well know diseases as hay fever or asthma. The diseases may develop as a result of liyp<sensitiveness to such substances as poller from plants, horsehair, rabbit's fur, fur feathers, etc. hoc instance, furriers, workers in clothin industries who arc exposed to wool duetc., may suffer from hay fever or asthma It is unnecessary for the otiending du-t 1 reach the depths of the limes -giant puller for example are reported to produce flier effect a lt e r being caught in the upper re piratorv passages. Should such an offendti substance he finely ground it could re.n the alveoli and as a result probably a physiologic reactions would he accelerated. In a survey of a plant where resin : mixed, ground, and molded, it was foun that 80 per cent of the occupational derm; titis there was due to hypersensitivity : hexamethylenetetramine and forinaldehyd contained in tiie dust to which the worker were exposed.''1 During the first prores'e Hty-t.liil .\nlu>nai o u jc ty cotton spinning, cotton-strippers are ex cel to (lust arising from cotton husks and iris, which produces a typical form of lima.5 irdinary wood dust lias been of interest e to its purely mechanical action, but II greater care is required in handling 'tain kinds, especially woods coming from road, because of the essential oils impreg:ing them, which when freed in the dust iy affect the health of the workers conrned. Some of the woods capable of using >kin lesions are brazil wood, satln>od. teakwood, cumaru o r tonka wood, ok ebony wood, W est Indian mahogany, nanese tagayasan, coccoloba, chestnutwood, vewood, California sequoia, etc. All p e r ns who handle these woods are not inred, only those particularly susceptible to e substances they contain becoming fected.55 2. L I l ' I X G O R G A N I C D U S T S . These ntain particles capable of exhibiting the lenomena of life2 (especially the property reproduction or multiplication), such as .cterin and fungi. T hey are usually found low concentrations and are associated :th nonliving dusts in the air. a. Bacteria. One o f the most im portant nong these is the anthrax bacillus, which contained in the dust from skins, furs, ool, and animal hair, horns, hoofs, bones, e. This disease may occur in two form s: 'ijucoif.c (in which the organism affects le skin), and 'uhnonary (when it is inhaled, - in the form of anthrax known as woolrters' disease).'5 Cases of tetanus, reported in connection ith jute manufacture, were traced to the iw material, the bacillus having been found i the factory dust.51 Diphtheria, tubercusis, smallpox, typhoid, or other bacillusoduced diseases, may result from exposure infected dusts. Bacterial sensitization can be the cause of iy of the allergic diseases, namely, asthma, rennial. hay fever, urticaria, angioneurotic lema, eczema, or migraine headaches.5* b. Fungi. Dusts containing the mycelia id spores of parasitic fungi give rise to moyance and discomfort. "Maltster's" itch cm the dust alone has been reported. In rovence, reeds used for ceilings are stacked hile still wet and undergo fermentation; ey become covered with a white powder i dry fungus of the Mucor famih : Sporo- t tic! ni in dermntodes), which is scattered when the bark is stripped off. T his powder is irritating to the skin and mucous mem branes. Mycelia and spores of moulds are commonly found to cause rashes: for in stance, the black powder coming from macerated sugarcane stalks. Among basketmakers, the mycelium and spores, in the form of a white mould (hyphomycete) from the rhattan canes used, get shaken out when the canes are split, hammered, and cut, causing painful fissures to develop on the skin where they alight.1* A form of asthma or spasmodic cough, suffered by cotton weavers and known as aspergillosis, has been considered due to in halation of spores of a mildew which some times occurs on the threads.51 In a study of silicosis among miners, made by the Public Health Service, a number of cases of typical miliary calcification were en countered. Unstained smears of those cases iexamined were positive for fungus, two types of Aspergillus fungi being identified. All of the subjects but one were farmers, teamsters, fcedmill workers, or residents of i small agricultural towns where grain is ; marketed. Farmers are exposed to fungi in I threshing wheat, baling hay, or handling various small grains.55 Some other fungus diseases such as actino mycosis and blastomycosis are associated with occupational exposure to dust. The former occurs among workers handling straw, hay, grass, vegetable dbris contami nated with mould, etc. Actinomycosis is likely to affect people engaged in commercial handling, storing, and cleansing of grain (grain distilleries, Hour mills, grain crush ing, breweries, and malting houses, etc.).5" II. Inorganic Dusts Inorganic compounds are ot mineral origin, not requiring a living organism to produce them.5' A number of dusts not usually classed as toxic may, under some conditions, produce untoward effects on the human organism. Classified under inorganic are toxic and/or irritant, fibrosis-produc ing, and nonfibrosis-producing dusts. a. T o xic and/or Irritant. Toxic dusts are those which are inherently toxic when in haled, ingested, or otherwise absorbed. Among those which produce systemic poi soning, some of which are also irritant, are the dusts from heavy metals and their salts, such as lead, mercury, arsenii , cadmium. 0> zinc, etc. Irritan t dusts arc injurious byreason of their strong irritative or corro sive properties. As a rule, inhaled irritant substances im mediately cause a reaction in the tipper respiratory tract of suclt severity that they arc prevented from reaching the lungs, al though they may cause lung damage by extension of inflammation if the mucous m em brane is corroded.1 Lime, calcium oxide, and the di-chromates are examples of irri tant dusts. An inorganic dust may possess both toxic and irritant properties, and the poisoning produced may be the combined effect of more than one mode of entrance into the body. Of the directly poisonous dusts, the most widely prevalent are those of certain lead compounds, particularly the oxide, carbon ate and the chromate. The dust is readily absorbed by the mucous mem brane; some dust passes into the stomach and is dissolved by the gastrir juice." According to Fairhall, perforated nasal septum is a common occurrence among workers with bi-chromate dusts.1 In a study made by the U. S. Public Health Service it was foijnd that continuous daily exposure to concentrations of chromic acid mist g reater than 1 milligram in 10 cubic meters is likely to cause definite injury to the nasal tissues." It is believed that a similar concentration of the dust would be equally toxic. In the case of poisoning from some heavy metals, exposure may be to both dust and vapor. For instance, investigations have shown the safe limit of total exposure to lead oxide dust and fumes to be less than 1.5 mg. per 10 cubic meters o f air, except for prolonged exposure.''' In exposure to mercury dust and vapor, it was shown that the incidence of chronic mcrcurialism in creases rapidly with increasing mercury concentration, after such concentration ex ceeds 2.0 mg. per 10 cubic meters.30 Alkalis and metallic oxides are common causes of dermatoses. Lye, potash and lime are known to cause irritation to plas terers, cement-makers, bricklayers, masons, stonecutters, modellers, and metal platers.1" Ulceration and perforation of the nasal sep tum occur among workers exposed to the dust of soda ash; systemic poisoning also occurs from inhalation of calcium cyanimide dust.31 Cases of dermatitis, scleroderma and can cer are reported to have been caused by exposure to dust of arsenic compounds. Certain aluminum salts are skin irritants and aluminum dusts may contribuli to the infection of skin and mucous memhrancs, through mechanical action.10 I). Fibrosis-Producing Dusts. T h e most important of these are the inorganic, slightly soluble dusts which cause fibrous changes in the lung tissues, some of which are seri ous, and some of which cause little or no disability.1 So far as is known, no inorganic substances other than silicon derivatives cause more than a very moderate degree of fibrosis of the lung. Moreover, there seems to be no evidence that any other constituent of ordinary dusts can influence so unfavora bly a pulmonary infection.5 Although other dusts, when inhaled in sufficient concentrations over a long period of time, have been shown capable of pro ducing a pulmonary fibrosis, nevertheless, the pneumoconiosis characterized by nodu lar fibrosis has to date been shown clini cally and experimentally to be associated only with the inhalation of dusts containing free silica. Since this dust, to exert its harmful action, must enter the finer divisions of the lung, the particle size of the atmospheric dust may bear a definite relationship to the in jurio u s effect produced. T h e silica must be present in the air in particles small enough to enter the finer air spaces and of such dimensions that the phagocytic cells may engulf them. The greater majority of p ar ticles found upon microscopic examination o f the lung fall within the limits of from 1 to 3 microns.31 Exam ples o f siliceous dusts arc granite, quartz, sand, pumice, slate, etc. In a recent study among anthracite miners, the correlations between exposure to du=t (which contained silica) and the evidene of constitutional changes left little doubt as to the etiological significance of the dust in the air breathed. Like correlations were found between the silica exposure and tinextent o f pulmonary changes.33 W hen the inhaled dust consists o f silica combined with bases, silicates, some degree of change in the pulmonary tissue may result. In this respect asbestos dust seems to be unique among silicates in the prevalence and se verity of the disease it causes." The chief distinction between silicosis an-1 conditions due to simple reactions can-' by other dusts is the active proliferates taction in the tissues which results in Dust may be entrapped at its source by .'rogressive undulation. Silicosis, when once suction devices and tints removed and col established, strongly predisposes the lungs lected. Familiar examples are exhaust hoods o infection, especially with the tubercle in grinding operations, and the devices used bacillus. Chronic interstitial pneumonia, in rock drilling. ironic bronchitis, and emphysema are frepicnt complications of advanced degrees of silicosis. Generally speaking, the exhaust ventila tion method, where applicable, is to be pre ferred in controlling a dust hazard. W ater The relation of the acute respiratory in- may he used to entrap dust and prevent its tections to the reaction due to dusts other dispersal, and under certain circumstances ban free silica has never been established, it may be of advantage to combine the use hough a heightened incidence has often of water and the use of suction. Sometimes evn shown statistically in workers in dusty a dusty process can he completely enclosed rades. It is fairly certain that a dust darn- in a sealed room or compartment. It must ;gcd lung, w hatever the cause, fares much he remembered, however, that any mechani .'.ursc if an acute infection does supervene cal device of this kind oilers adequate pro upon it.: tection only if it is properly designed, In a study, conducted by the U. S. Public installed, and maintained. Health Service am ong marble finishers in Vermont, it was found that marble dust when inhaled in the concentrations found in 'he examined plants produced a mild, bi lateral, linear fibrosis in some cases, but no i -erious lung changes were noted and there was no disability due to the dust, even after years of exposure.11 A great deal of attention lias been given the subject of individual protection from dust, and there are many types of respira tory protective devices now .'nailable. These are generally of two types: those which provide fresh air from an uncontaminated source and those which rely upon a filtering medium for removing dust from the air c. Nonfibrosis-Producing Dusts. These, are inert, that is, they do not cause fibrous lissuc to he produced, hut may become encapsulated or lie free in the tissues; or they are absorbed without production of fibrous tissue. Included among them arc aluiidum, coal, corundum, emery, limestone, magnesite, marble, plaster of paris fgyp-uni). and polisher's rouge. breathed. Where the use of such a device is indicated, only one of the types approved by' 11ic U. S. Bureau of Mines should he used. As a rule, it may he said that masks, respirators, or other such protective device should he used only where exposure to the dust is intermittent and brief, or where some unusual condition makes a more ade quate dust control impracticable.1. Dust Control W here bacteria o r other living dints in the air are associated with a process, steri Kngim cling and medical control arc the *wo most im portant factors in combating 'he industrial dust hazard, and are to a large ''tent complementary. lization methods such as increased tempera ture, ultraviolet radiation, and chemicals like chlorine or other bactericidal substances, may he of use. Pasteurization temperature (about 110 F.) will kill most organisms b.iigiiurcriiui Control. As Lanza1'1 has -tated in a recent paper, " it is a basic principle in dealing with a dust hazard that the dust should he attacked at its point of origin and thus prevented from being dis seminated into the atmosphere." After the dust has been spread throughout the air it is difficult to deal with it, and reliance must he placed on individual protection, which is never wholly satisfactory. except those hearing spores. Steam disin fection is used for horsehair, and [moves to be practicable if the tem perature docs not exceed 230 F. Wool fibres, however, lose their elasticity by steam disinfection, and tlie "P uckering" process now used in E n g land includes soaking of the wool in a form aldehyde solution, and drying in a current of air at a temperature o f 160 F .l: There are few occupations in which there would Lanza further cites various methods used ;n controlling dust. These will he reviewed he a sufficient concentration of dead bac teria to cause untoward effects in man. out briefly, since a paper dealing with the In the case of dusts producing external 'abject of dust control in detail, will follow irritation, auxiliary protective measures may on this program. include the use of 1 protective clothing, gloves, goggles and aprons; as well as pro tective salves, ointments, or other com pounds to delay or diminish the Irritant action. General rules for hygiene and good housekeeping should also be observed. Medical Control. Equally important, and closely interrelated with the engineering . phase, is medical control of occupational hazards. In addition to directing the proper placement of new workers, and guarding the health of all employees, medical control is a check on the efficacy of the engineering control methods already instituted, or a measure of the need for new protective de vices. It has been stated that "Industry has found that the best way to treat industrial injiuics and illness is to prevent them,""1 and medical control, through preemployment .and periodic physical examinations, is one of the most im portant factors in such pi <-\ration. The preemployment examination is made to determine the employee's physical and mental fitness for work. It serves to discl<nc the presence of any contagious dis ease. reveals any minor physical defects which might later become serious, or whether the examinee's condition precludes h is ,e m ployment in certain or in all types of work. It should be remembered that such preem ployment examinations arc not to be made for the purpose of eliminating an employee, hut rather for allocating him to the type of work for which he is physically suited. A worker should be given employment unless totally unfit, or unless his disability, even though slight, would cause him to he a haz ard to himself or his associates. Further more, the practice o f preemployment examinations should be extended to include, executives and officials of industrial organi zations. "The purpose of periodic physical examinations is to secure and maintain physical fitness and thereby lengthen work spans."" Reexamination of employees some times results in the discovery of defects and disabilities which were not observed at the time of employment. In such cases, an oc cupational adjustm ent should be made to provide continued employment, but remove the risk of permanent injury. Reexamination of employees is required by law in certain occupations in which the handling of poisonous or otherwise deleteri ous substances may result in the contraction o f disease.1' Since some occupational dis eases tend to clear up and recuc, records o previous occupations should be included ii the physical examinations. T he fnqucnc; of examinations should be determ ined b\ the medical director, unless otherwise spcci fied by law. Those exposed to known occu pational disease hazards may have weekly o r monthly examinations.11 " It should always be kept in mind that tin basic principle of physical examinations in industry is to keep men on the job and no' allow the physical exam ination to be merely a weeding out process."" References ' Illomiifirld, J. J. ami DallaV.ill.-, J. M. "'l l.DrWTtiiin.Ttion and C ontro l o f I n d u s tr ia l D u ^ r " U S. Pul.lie I Ir.tltli llu ll r ii n No. 217, April, 1935. J Collis, Edgar J " I nduM tia I PiH-uinocnninxr with special r e fe re n c e to D ust P h th isis ." Milr<> Lectures , 1915. IT. M .S .O ., L ondon, 3 Sollmann, Tornltl. "A Manual of Pharm . colony.'* W. B. S a u n d e r s & Co., Philadelphia. 19 > * F a i r h a l l , Daw r e ne e 'I". " T o x i c PtiM' an Fumes," Journal of Industrial Hygiene ami To\ cologv, N o v em b er, 1936. 5 Bloomfield. J. J. "T h e Sampling and Analyst of industrial Dusts." American Public Health As^e ciation, Yearbook, 1935-36. G ibbs, W. K. " D u s t H a z a r d in I n d u s t r y . " K m . P e n n , Ltd. Lo n d o n , 1925. 7 A ir H ygie ne F o u n d a tio n o f A meric a. Inc. " .Sdcosis ami Allied Disorders." Medical Series, nulltin No. 1. P it tsb u r g h , Pa. A pri l 15.1936. 8 Kettle, E. II. " T h e A c ti on o f H a r m f u l D n <-t- " Inst, of Mining and Metallurgy, London. Im u I 1934. 9 " Dusts. Fumes, and Smokes." Occupation a n H e alt h Series, I n te r n a tio n a l L a b o u r Office, Geneva !930. 10 D ri nke r, Philip. ``C a u s a ti o n o f P n r u m o r o n i osis." Journal of Industrial Hygiene and To\ colony, October, 1036. " " Dyeing," Occupation and Health Sen* In te rn a tio n a l L a b o u r ( )ffioo, G enev a, 1930. n Leene, Sir Thomas. " industrial. Maladie O xfo rd U n iv e rs it y Pr ess, L o n d o n , 193-1. 13 R urs te in, A. " N ic o tin e A c tio n from Inhale Tobacco Dust." Journal of Industrial Hvgione, D cember. 1927. 14 W h i t e , R. P r o s s e r . " T h e D e r m a t r r g o - r ; , < Occupational Affections of the Skin." H. K. Lewi & Co. Ltd., L o n d o n , 1934. 15 Schwartz, Louis. " S k i n H a z a rd s in America I n d u s t r y . " l \ S. Public Health Bu lletin No. 2* October, 1931. lB Downing, J. G. " I n d u s t r i a l D e rm a to se s : Tr-. ment and Legal Aspects: Review of Recent Lite: tu re ." J ourna l of In d u s tria l Hygiene a:. Toxicology, July , 1935. 17 " Occupational Lesions in W o r k e r s in S u g a r Belgium Letter, Journal of American Medical As ciation. Sept. 10, 1927. Aht. J o u r n a l of Imlu str. Hygiene, h e b ru a rv , 1928. ,s " F lour Mills." O ccupation and Health Seri; In te rn a tio n a l La bour Office, G eno va, 1930. 19 Mayers , M av R. "S u s c e p ti b ilitv to D e rm a ti ti s The In d u s tria l B ulle tin , A lb a ny, S'. V. Feb. 1937 vol. 16, no. 2. 20 D ri nke r. Philip, a n d H a tc h , Th eodore . " In d u trial Dust." McGraw-Hill Book Cotnpanv, In New York, 1936. 21 Schwartz, Louis. " Skin H a z a r d s in Ameri. . Industry. P art I I ." U . S. Public Health BullrNo. 229, Sept. 1936. 22 " Poisonous W o o d s . " O c cupa ti on and H e ad Series, In te rn a tio n a l L a b o u r Office. Geneva. 1930. 13 Hope, E. \V., Han na, \V\, a n d Stallybr ass , C. . ' `In dus trial Medicine a nd H ygie ne." Bailliere, mdall and Cox, London, 1923. 54 Brown, G. T. "T he Diagnosis o f Bacterial -llergy." Southern Medical Jour; al, Vol. 27, No. \ Oct. 1934. Savers, R. R. and MeFewether, F. V. "M iliary iing Disease Due to Unknown Cause. U. S. Public leafth Reports, Dec. 5. 1930. 34 "Actinomycosis." Occupation a n d H e alt h Series, nte rnatioual Labour Office, Geneva, t930. 37 Holland, J. \V. "Textbook of Medical Chem istry nd Toxicology." \V. B. S aunders Company, Phila- elohia, 1920. " Bloomfield, J. J. and Blum, \Vm. "H e alth Haz* rds in Chromium Plating." U. S. Public Health ervice Reprint No. 1245, W as hington, 1930. ^ Russell, Jones, Bloomfield, B ritten a nd Tliomp>n. " L e a d Poisoning in a Stor ag e B a t te r y P la n t. " S. Public Health Bulletin No. 205, J u n e , 1933. MNeal, Jones, Bloomfield, DallaValle and E d' ards. "A Study of Chronic Mercurialism in the Tatters' Kur Cutting Industry." U. S. Public L\i!th Bulletin No. 234, Slay, 1937. ** Sa yers, R. R. and Jones, R. *R. "Silicosis and Similar Dust Diseases." National Silicons Con fe rence, W as h in g to n , I). C., A pril 14, 1936. " Sayers, Bloomfield, DallaValle, Jones, p r e c i e n , Brumiage and Britten. "Anthraco-Silicosis among H a r d Coal M in e r s . " V. S. Public Health Bulletin No. 221, Decembe r, 1935. 83 M iddle to n, E. L. " I n d u s tr ia l P u lm o n a r y D is ease due to the Inhalation of Dust." The Lancet, J u l y 4 a n d 11, 1936. 34 D rc ess en , W a l d c m a r C. " Effect o f Inhaled Marble Dust as Observed in Vermont Marble F inishers." U. S. Public Health Service Reprint No. 1630. 35 L a n z a , A. J . "C ontr ol and Pr ev enti on of Sili co sis/' Symposium on Silicosis. California Tuber* culosis Association, San Francisco, 1937. 3,1 N ewquis t, M. N. " Medical Serv ice in In d u s tr y a n d W o r k m e n 's Compensation Laws." American College o f Su rge ons, Chicago, 1934. 87 "M e d ic a l Care of Industr ia l W o rk e rs ." N a tional Industrial Conference Roird, Inc. New Vork, 1926. The Engineer's Part in Eliminating Dust Hazards By A R T H U R S. J O H N S O N Assistant to Manager, Engineering Department, American Mutual Liability Insurance Co., Boston, Mass. When one realizes that control of the dust '.azard depends upon the combined contribu ions of the physician and the engineer, he apTeciates that tiie solution requires scientific rcatment. By scientific treatment I mean the echnical analysis of the hazard to discover he causes which contribute to in jury o r ill ealth, and the development of control methnls which obey physical law and physiology, .nd which will he directed at causes that dmit of most immediate and economical reatment. T hat goes for handling the dust hazard in . given plant. It goes duiihlc fo r acquiring niowlcdgc to the end that the whole problem nay reach ultimate solution. Right now our .notvledge of the problem is in big chunks, oosely put together and largely empirical. There arc estimates only to judge the maglitude of the dust health problem, and it is so losely associated with other health problems hat a clean-cut estimate of it alone is imlossihle. We do know that it is great in the iggregate, and for the individual plant it may Overy bothersome and expensive. W hat actually makes quartz dust cause 'Icosts is not known. It does, so the air ireathed by workmen must not contain harmtil quantities of respirable quartz dust. Inex pensive methods for making the air clean are still in the realm of dreams. Much work must he done to know' more about silicosis and more how to make atmospheres safe i;n\r/v;isii'cly. As an accident prevention job. dust control lies almost entirely within the admin istrative responsibility. The control measures are capital expenditures of considerable size. A plant with a dust hazard is sick, it needs an expert diagnosis and scientific treatment, which may include expensive major opera tions. Home remedies are seldom much good, and supervision and employee safety con sciousness alone cannot accomplish anything. There may he observed in countless shops installations for exhausting dust which are derisively' called "tin knocker" jobs in which the horsepower dissipated is out of all pro portion to the air-borne dust moved. Tonnage efficiency of material moved may he the proper yardstick for pneumatic conveyors hut ii the material to be moved is air, contaminated with nearly weightless particles of dust, the entire health hazard can lie in the half of one per cent of material not moved. I do not mean that unless a du.-t supre<sioii job was engineered it can be no good. There are many good installations that were never figured at all but grew like Topsy. The re- suiting freedom from dustiness was so satis factory that efficiency held little interest to the owner. This is exceptional, however, and I otter the opinion that dust suppression jobs should he engineered. A dust-suppression installation is a safety device, designed and operated to provide pro tection against possible disease, and provide a sense of security which must be absolute. Its safety is nut rushing air and rattling chips but a minima! residual dustiness. T here is no more pathetic defeat for a dust control job than to find faith in its effectiveness so low that workers must wear respirators to find the reasonable safety that was expected from the hoods, ducts and fans. Diagnosis and Control Let us examine sonic of the features by which we recognize this dust hazard problem, leaving out the socio-legal aspects. In order to develop more fully the engi neer's place in this dust control program, it seems desirable to separate as sharply as we can the diagnostic considerations trom those which deal_ with control, fu the first c o m partment we can place all the analytical com ponents which describe the hazard and its ex p o su re ,\h e probability of its producing ill health and all the rest of the medical and industrial hygiene facts which make out a case against the existing dust. In the second compartment place the knowledge of physics and engineering necessary to plan the dust control program and so design it that when installed its performance follows prediction that the probability of industrial disease is reduced to insignificance. The Industrial Hygienist Our first feature of interest would naturally be the specific and relative toxicity of silica, silica-bearing and other dusts which make up the dust health hazard. Much might be said to advantage about the quality and quantity of hazard in many dusts. The acquiring of this knowledge has been, and must remain a medical problem. It involves gross and micro scopic pathology and x-rays, and experimental animals. Engineers do not talk that language, -industrial hygjcnists d o ; they arc a happy combination, half doctor and half engineer. Many of them are quite capable of handling the dust health hazard in all its phases of investigation and control. For the purpose of this discussion I throw their interest in with the doctors. I want to go so far in my opinion as state that the engineer should pot attempt define the quality of health hazard-in a giv plant or industry, nor should he establi threshold limits of safe or permissible dust ness. This may be debatable, but I shall co: tend that the engineer who writes the spec lirntiims of hazard and dust tolerance is real an industrial hygienist, and is using a ver much broader knowledge than engineerin alone. In the first case the quality of the heab hazard is an opinion arrived at after studyin all the environmental conditions including tl. general sanitation, occupational analysis an a scientific analysis of the dust exposure. In the exploration of dust exposures, th _ nature of dusty operations must be viewe from physical, chemical and mechanic;! aspects, the determinations of dustiness nius be not only counted and classified by particu late sizes, but chemically and mineralogiealb analyzed. The plant layout must be studio' with respect to dust production and distribu tion, and the housekeeping and existing dii.v control equipment evaluated. The presence o specific hazards, such as toxic gases, almor mal temperature and humidity conditions, etc. must he explored for their complicating effee upon the whole picture. This is distinctlv m industrial hygiene job, and some of the iuom critical data requires only medical viewpoint This is absolute in the case of tuberculosi study and the qualifying of men for employ nient. So far, not one atom of engineering t> suppress dust is involved. It is entirely anai ysis of hazard. The diagnosis must he thnthe dustiness is hazardous to health or that ' is safe. If it is hazardous, it must be brought clown to a specified residue. If it isn't, lcav> it alone. On the second point, if the hygienist can not specify threshold limits graduate'' upward for relatively less hazardous dust., let the engineer not worry about it. Tin diagnosis is dust which is harmful and to< much of it. The remedy is control of the dust The engineer designs controls which iw produce the lowest practical residua! du.-ti ness. He should not attempt to write his owi specifications of threshold limits or pertnis sible dustiness. This may be an irnportan goal in the study of dust health hazards.' Safe Limits A t the present time the medical men ai hygienists believe that quartz dust is sai below five million particles. They seem will ing to graduate upward to 20 million for medium silica and 50 million for low silica percentages, hive million particles is virtually dust free, and is very difficult and expensive to achieve and maintain. The declaration of safety of the installations must remain in the hands of the medical and hygiene groups in whose hands now lies the responsibility for determining the hazard. We now enter the chapter of our discussion intended to demonstrate that dust control is an engineering job, that it must be given srentiiic treatment, not guess work, applying engineering methods which are based upon a knowledge of physical law, the behavior of dust, the performance of air-moving machin ery, etc. Prerequisite Knowledge Let me recite briefly, a few of the things which, in my opinion, the engineer should know to do this job correctly. He must know how to make a survey. Surveys depend upon sampling, and sampling is not a cateh-ascatch-can proposition. It involves the place, the time, the frequency, the amount in a sam ple. and the number of samples so that maxi mum. minimum and average data mean some thing, so that credibility can be given them. 1'or the type o f sample involved he must know how to weigh or count respirable dust, as distinguished from large masses of noilrespirable dust which complicate the picture. He must know how to observe the sources of diut floods as distinguished from conditions of normal dustiness. H e must know the sources of dust and tile principles involved in the dispersion of dust. He must determine how murli dust enters flic problem because it is part of the material, and vvliat dust is created in the process b_\ the fraetnring of the material. Any less survey cannot tell the engineer what his task of dust control is. T o visualize that task intelligently he should know the physics of Hrownian motion, laws of resist, ance to the motion of particle:,, moving in air. both when the air is ill turbulence and for stream-line motion. He should know terminal velocities, movements due to centrifugal mo tion; flocculation and the effects of air motion and the effects of humidification on it. He must know all about the difficulties of wetting and what is known about overcoming these difficulties, li e should know the several elec trical phenomena which bear upon dust be havior. Those are all principles of physics which explain the behavior ot dust ami upon which engineering practice must be based. They must be understood and be taken into account. Dust control is not a matter only of general ventilation; the engineer must study the pro duction as well as the dispersion. Tile problem should be analyzed to determine the applica bility of segregation, enclosure, wetting, local exhaust and general ventilation. In some instances, substitution of non-hazardous material, or noii-dust-produeiug oper ations may have specific application, and they should he explored first. This implies plant engineering. I am convinced that many had installations are bad because plant engineering was not used. In the designing of exhaust systems installed to capture the dust at the points of generation, the physical behavior of air moving toward hoods and in ducts must he known, and that knowledge used. Iiaeli system must consist of collection hoods, pip ing, air-cleaning plant and a source of suction. Before selecting a hood for a job the engineer must know dust dispersion by dynamic pro jection as well as dust dispersion by air cur rents, and design the hood accordingly. Knowledge Needed The aero-dynamic characteristics of suction hoods appear to be little known because little thought was given to them in designing thousands of hoods which can he found every where in industry. All the possibility for entrapping dust and much of the efficiency oi the system lies in this factor. Air velocity, static suction, and rate of air flow are all related, and they must he known. It is essen tial to use high velocity of air in certain types of exhaust systems to entrap dust projected at high velocities as in the ease of a granite surfacing machine, and low velocities must be used in others, as in the ease of cleaning asbestos fibre of dust to prevent waiting material. Quantity of air and its velocity must he determined, then the piping should lie d e signed to take into account the behavior oi air-flow through pipes at low and high veloc ities. Where the problem is complicated by the large sized particles which go along with the fine dust, how these behave must be taken into account. Pressure losses arc very impor tant elements in the design of an exhaust system. Loss at the luxxls, loss at the bends, and loss in the ducts must not be guessed at. Pipe design must take into account the gage of the tnetal and reinforcing to withstand pressures and erosion. The selection of a fan and its motive power is a matter of calculation, not guess work. Power consumption in the system is calcula ble, fans follow certain laws, so the engineer must know the behavior of axial flow, p ro peller type, radial flow, paddle wheel and other fan performance. More physics and engineering calculation goes into the air-cleaning apparatus. The selection of gravitation, inertial or filtration method depends upon what the dust is, the calculation for any methods rcf|uires knowl edge of discharge through stacks, the deter mination of sizes of settling chambers; the behavior of cyclones. The use or non-use of a filter, and if so, what type, how it should perform, how big it should he, what kind of resistance and how much each kind offers, to say nothing of their proper location with relation to cleaning, accessibility, etc., are all items for accurate engineering determination. Apparatus to check the behavior of installa- \ lions must be known and used. Pertorinaix cannot be left to guess work. Supplying sufi cient air to be exhausted is part of the prol lent. The same may he said of heating Do I give the problem too severe a buih up? I think not. Remember these two thing 1. You are dealing with hazardous man rial so small in size and so little of it b weight that it is as invisible as the air the bears it. 2. Physical laws involved in tire behave, of dust and air do not permit incxpcusiV methods of control. I am acquainted wit budgets set up for this purpose which amour, to more than a quarter of a million dollar ami I know of many where 60 to 80 thou-ais dollars is involved. The need for this much engineering is rec agnized by men who know. Already nine: has been done tow'ard getting the knowlede into handbook shape. Perhaps the best ]>' of this sort to date is "Fundamentals Relatin to the Design and Operation of Exhaii-.Systems" developed under American Stand ards Association procedure. The Doctor's Part in Controlling Dust Hazards B y A. D. L A Z E N B Y , M.D., F.A.C.S. Chief Surgeon, Maryland Casualty Co., Baltimore, Maryland Considerable confusion has existed in the past as to ju st what is the physician's func tion in the prevention of dust diseases, and just what is the engineer's. It is very ol>viotis upon even casual thought that the two sciences must work hand in hand in their efforts to solve the problem. Die physician through his special training must be able to tell the engineer what dusts are dangerous and what are not. He must know how those dusts enter the body and the manner in which they do their harm, li e must be trained in the examination of per sons who are to be employed to work in dust, and to discover those who tire already diseased, o r are peculiarly susceptible to dust disease. He must be able to detect the first signs of disease in workers who arc exposed to dust, and must be prepared to recognize the disease when it is fully d> veloped. It is not necessarily the physician's fun c tion to analyze dust. That is a task for tin chemist and the petrographer. It is not tl;physician's function to count the particles o dust in a given industrial atmosphere. Thai in reality, is the function o f the engineer. I' is not the physician's function to devi-ventilating equipment for the removal o dust, nor even to he more than an .ulvi-i as to the means that must he adopted I render the atmosphere safe. The physician nevertheless must correlaP with his medical knowledge and with In studies of the industrial w o rk e r the fimlin of the engineer. A diagnosis o f silicosis, fo example, requires not merely charaeteristi occupational history and characteristic phy- cal findings, but the knowledge as well that the patient has been exposed to hazardous line's in dangerous concentrations. All dusts when inhaled in excessive quantities may be considered as harm ful, but only a few can be regarded as dangerous. From the standpoint of their dangerous properties, they may be divided into three general groups. 1. Those which arc dangerous because of their poisonous action, such as lead, arsenic, mercury, and similar substances. 2. Those which cause only irritation in the respiratory tract, resulting in such condi tions as bronchitis or local intknmnation; such substances as vegetable fibre, cork dust, Hour, starch, and other relatively innocuous organic or inorganic materials. 3. Those which tend to produce fibrosis ot the lungs, thereby predisposing to respira tory infections, especially tuberculosis, such dusts as asbestos, silica dioxide or mag nesium silicate. I shall confine my rem arks chiefly to dusts occurring in the latter category. It lias been generally believed tiiat the harmful effects of dusts inhaled into the lungs depended more upon their physical structure than upon their chemical. It was believed, Ior example, that silica dioxide, or quartz, was particularly harmful because of its crystalline structure, and the hardness and sharpness of its particles. This concep tion is now known to be faulty. T he dusts which cause their damage by mechanical in terference with function are the dusts which arc relatively innocuous, whose symptoms are transitory, and which subside upon re moval from exposure to the dust. Chemical Effect Is Harmful The disease of particular interest to us today, silicosis, owes its harmful effects very largely to a harmful chemical reaction oc curring between silica dioxide and the body tissues. It so happens that silica dioxide is decidedly a tissue irritant to the body, re gardless of the part of the body it invades, it causes local irritation, local destruction of tissue, and the replacement of that tissue by scars. Thus, given a dust containing silica diox ide in sufficient concentration, in sizes small enough to permit its entrance to the ultimate air spaces in the lungs, we have a situation which offers danger to the worker. We have no real knowledge as to true figures, but as a simple rule, we can adopt for practical purposes the thought that the human body can withstand success fully a concentration of dust containing 100 per cent silica dioxide in a particulate size less than 10 microns, in a concentration not in excess of 5,000,000 particles per cubic foot. If we decrease the percentage of silica dioxide present in the dust, we can correspondingly increase the concentration with comparative safety. W e must, of course, take into ac count the portion of the w o rk er's time spent in the dusty atmosphere. To arrive at a rough conception of a safe atmosphere, we mu 11iply the percentage of free silica in a given dust by the total num ber of particles per cubic foot. If (lie result is under 5,000.000 the condition may be co n sidered relatively safe. If the result is over 5,000,000 the condition must be regarded as unsafe. Bear in mind too that silicosis is essentially a disease of great chronicity. Except in a few exceptional instances it will require from seven to thirty years for a worker to develop advanced silicosis. It is evident too that coincident dusts may either retard the development of silicosis or hasten it. Recent research seems to indicate that the admix ture of aluminum dust to a silicious dust will greatly inhibit the reaction of the latter ; whereas a silicious dust combined with some alkaline coincident dusts may hasten the de velopment of silicosis. Much research is now under way in prob lems such as this. W e have never learned how to cure silicosis, but we are learning rapidly how to prevent it. O ur knowledge in this respect seems to lie limited to the removal of dust from the breathing zone of the worker. Later discoveries may show us how to modify existing dusts with contaminant dusts that will render silica dioxide innocu ous. Owing to its very great chronicity, it is only the rare case who actually develops disabling silicosis during his industrial life time. It is realized, o f course, that excep tional instances take place, but the coincident ravages of age usually keep pace with the effects of dust, so that much (lie dis ability usually attributed to silicosis is often, in fact, actually attributable to other dis eases or incapacities which advancing years bring in their wake. T o me the great peril of silicosis, the peril not only to the industrial worker himself, hut his family, co-workers and the public generally, is the accompany ing susceptibility to tuberculosis. Complicated by Tuberculosis Silicosis per se docs not kill. Tuberculosis as a complicating factor o f silicosis rarely recovers despite treatment, and the indi vidual so afflicted is not only totally dis abled himself, but a definite menace to all with whom be comes in contact, particularly the fellow worker who may have silicosis. So perhaps the most im portant places in which the services o f the physician in a dusty trade are necessary are-- first, along lines of discovering and barring from exposure to a silioious dust those persons who may al ready have arrested tuberculosis; and sec ondly, discovering those persons already ex posed to dust, possibly already silicotic, in whom tuberculous infections may have de veloped. It is well recognized th a t no individual should be exposed to dust containing silica dioxide until he has undergone a thorough physical . examination, including carefully made and interpreted x-ray films of his chest. It is likewise obvious to anyone fa miliar \Vith silicosis th at no person who is exposed to silicious dust should be denied the privilege of frequent physical examina tions and x-rays of the chest, not entirely to discover the existence of possible silicosis, but to discover a coincident tuberculosis if such exists. A man so diseased should, in protection to himself and to all with whom he comes in contact, be removed from industry. Let me emphasize the uselessness o f a physical examination, unless it be accompanied by properly taken x -r a y films, except in cases of gross tuberculosis. It is the function of the physician, there fore, to conduct in a thorough ami an intelli gent manner the pre-employment examina tion of all persons who are to he engaged in a dusty trade. T h e purpose o f this ex amination should he threefold. First, to discover and bar from employment in dust, any person who is suffering from tuber culosis in an active, a quiescent o r an a r rested state. A possible exception might be made in individuals suffering from a so called healed primary complex, or a healed childhood in fection. It is well known that exposure to silica dioxide is very likely to excite i. activity a turhereulous h -i<iti. w Inch jna> quiescent o r arrested, and m e such a lcis reactivated, the chances of recovery remote. The second problem which confrontphysician at the pre-employment physical animation is w hether a given individual by reason of secondary physical defe more susceptible to the development of cosis than a normal. Is lie suffering in diseases of the nose or upper respira! tract, such as chronic sinusitis, disease of lungs or air passages, or obstructions wh produce mouth breathing? We must remember that silica dioxide not dangerous until it reaches the lungs, a that the normal individual retains in ' nose and the upper a ir passages a laquantity of the dust inhaled from the atim phere. In instances where this nasal ret' tion is disturbed, e x p o s u r e to silica diox. dust may be dangerous to that individ: where it would not be to another. It is believed th a t certain diseases of heart and circulation, of the kidneys, pobly syphilis, chronic coincident diseases the lungs, all m ay rentier a man m o re s' ceptible to silicosis than normal. T he plr. cian at his pre-employment examination m follow certain established criteria m ' respect, and bar from exposure to danger dusts those persons who through exist: disease may be m o re ready prey to sihe:or tuberculosis. Re-Examination Needed After the applicant for employment successfully passed his physical examin.it and is engaged in a dusty trade, the d' of the physician is not yet ended. This wo man must be periodically re-examined, i to discover the early appearances of p monary fibrosis, hut what is even more portant, to detect the early evidences complicating tuberculous in lection. A man should not he dismissed from ployment in a dusty trade merely hecatts' has evidences ol non-disnld tig silic" W ork ers in dusty trades, especially SP cutters, moulders, pottery workers, : similar craftsmen, are usually highly skill ami it seems u n fo r tu n a te from a social economic point of view to b uy tin in ployment so long as they are physically to carry on, especially since the actual aiding qualities of silicosis are in doubt 9X / willy-sixth Xuliomil Safely Congress (Imsm- %,-wi I employment in a usn trade it that condition is found at I e-unplojm ent examination, but thev S 10l.lld Mot bu ljarrt;i1 from continuing ait g" aXgedd.y 'Oo ,tntcours'eV,hKm'h suthcChyin:lsrtanaclers< y^o'u ean< engineers must realize that you have failed ccause ,f you had kept the breathing zone ssiihiccois-is. WwOoruklMd ^not ,hferompre`s'e-nste roonu sphvdsuisctas examination. ^ - cai In this work of preventing dust diseases in industry, it should he evident that the closest and most intelligent cooperation between the P i.vsician and the engineer is necessar! The physician must, through his knowledge and resea, ch, tell the engineer what dusts, or or thru matter, what other substances used m industry are harmful. H e must tell the e n te r ! ! ' I ' i T '' CiuS,S r ther ' " t r i a l s w, 3 ^ h ^ ' y J i o w they leave the bodv and \ hat thev do in their passages through or their residence in the body. or Must Make Analyses The engineer must in turn tell the phvsi` ian ot the harm ml '(lusts and other sub stances surrounding his .workers. He must make chemical and petrographic analvses of Hie mists, and other indicated analvses of ti-e atmosphere in the workshop. He must make ' " ' l rolmt!- check his counts at regular intervals, conferring with the physician in an cllort to discover whether, in the light of their joint knowledge, working conditions are dangerous. He must develop and install careltiliy designed ventilating equipment. He must arrange for modification of chemical anti other industrial processes, where such modification is possible, and must bend his efforts toward removing from the danger zone of the worker the oitending substance whatever it may be. ' Too many engineers construe this function loosely. They pass on to the physician as Ins responsibility certain functions which es sentially are theirs; such functions as dust analyses, dust counts, and similar technical duties. All too often it is considered ade quate merely to install a fan. Ventilating devices in dustv work rooms must he constructed only after careful en gineering study has given a knowledge of the physical properties of the air and of substances polluting it. It is possible to calculate to a very fine point the volume of an that must be removed from a given spot to-remove the dust originating at that place and the engineer must approach his task from just as scientific an angle as the physi cian approaches his. A ' I here is no room in in d u s tr y 'for hap hazard methods on the par: o f'either the pin Muan or the engineer. A/)J 0 V R N M E X T . -s >' checked and repaired me. and we will give it ""'Von. In addition. I sim- a man from each de" i , him in to onr safety rotating these men so : tally have them all meet these men a closer inety work and permit us to Mso, I will, until further sly meetings with all the we can make clear the ad it you men must assume, e to see that your men are our safety rules and the 1mployees. \ \ e can also -dividual* who do not seem one hundred per cent. dfety Work?* tephone Co., Chicago 1 difficult problems facing rti to the foreman his re nte safe doing of the job measures, we have taken tie must feel that the safe his responsibility and feel to do something about it. . is there an accident on a "^lered particularly haz- -sttme that the foreman or how to conduct tiie work be sure that he does and .ill a proper training pro- ume that a majority of all - accidents are directly or ihle to the failure of supericvel to function properly. >t that supervisory training :ding accidents is necessary. nt of a supervisory training h more difficult procedure "it of a technical or vocaursc. Apart from the tccholvcd. there does not seem !.d formula. There is, of Cement mid Quarry Sections 257 course, some similarity of procedure in di recting the work of any mail on any job; but dillerent industries employ such different types ot people, under such a wide variety of circumstances, and place such a diver gence of rei|iiirements upon them that the problem of supervisory training in its more comprehensive aspects is peculiar to each type of industry. The. general treatises on leadership give the groundwork, Imt the subject matter for .my supervisory training course for any par ticular industry lies within that industry. We must go out and sep how our job is being supervised now; analyze the procedure of every foreman and supervisor; compare them and select the best; look upon supervision as a process in itself, and see how best to direct the work of the people. It is a long, tedious, and costly process, but one which, carried through to completion, will pay dividends in the end. WEDNESDAY LUNCHEON SESSION October 13, 1937 The Wednesday Luncheon session of the Cement and Quarry Sections was addressed by Isaiah Hale, Superintendent of Safely, Atchison, Topeka and Santa Fe Railroad' .who spoke on "The Common Sense of Safety." The address was substantially thc$ same as another address by Mr. Hale before the Steam Railroad Meeting. The complete paper will be found in the Steam Railroad section of tin's volume. W EDNESDAY AFTERNOON SESSION October 13, 1937 . Work of the National Silicosis Conference By R. CAM PBELL STARR A ssistant Safety Engineer, U. S. Departm ent of Labor, Divi sion o f Labor Standards, W ashington, D. C. Sihcosis is strictly an occupational disease. Medical science has not reported silica dust as aliecting any individuals except those who, over relatively long periods of time, have worked in an atmosphere where the air which they breathe contained excessive con centrations of free silica. I he interest o f the U. S. Department of Lcdior in a broad social and economic prob lem such as this has its origin in the Organic Act, effective March 4, 1913, which created the Department. This act, among other things,^ gives the Department of Labor the duly ` lo foster, promote, and develop the wcl tare of the wage earners of the United States, to improve their working conditions, and to advance their opportunities for profit able employment." With this in mind, and believing that through joint effort of all concerned, much could he done to eliminate the hazard, the Secretary of Labor called together in Wash- inglou un February 2<i, 193b a group <>l about 75 men representing leaders in industrifs having a silica prnWem, labor loaders, and outstanding representatives of the medi cal, legal, and engineering professions, as well as insurance carriers and State adminis trators. After considering various phases of the silicosis problem, this group generally agreed that through a pooling of knowledge and a frank discussion through the conference method important advances could be made toward, first, overcoming the hysterical a t titude on the part of employers, labor, and others; second, after careful investigation, to consolidate in one place all known data with, regard to the preventive engineering methods; third, analysis and recommenda tions in connection with adequate standards of compensation for those workers disabled as a result of the disease. As an outgrowth o f this initial meeting, another group, similar in composition to Ihe first conference, hut expanded to include some 200 individuals, was invited to com? to \ \ ashiugton on .April 14, 193b to outline ways and means of attacking the problem. After hearing silicosis discussed from the stand point of the employer, labor, and the medical profession, by outstanding experts in the field, this large group endorsed the con fer ence method as proposed, and as a result four main working committees were ap pointed l>v the Secretary of Labor with the advice and consent of the group to investi gate and report upon the outstanding phases of the silicosis problem. These committees were; (1) Committee on the Prevention of Silicosis through Medical Control, (2) Committee on the Prevention of Silicosis through Kngineering Control, (3) Committee on the Hconomic, Legal and Insurance Phases of the Silicosis Problem, (-1) Committee on the Regulatory and Administrative Phases of the Silicons Problem. A fifth committee, known as the Correlat ing Committee, was named. It was under the chairmanship o f YV. H, Cameron, Managing Director of the National Safety Council, and consisted of the chairman of the four tech nical committees just mentioned and two ad visors, one on labor problems and one on mining matters. These committee members >ei ved without compensation and gave freely of their time and effort in studying the problem from their respective viewpoints. After nine mouths of careful and searching study, these commit tees advised the Secretary of Labor that they were ready to report. Consequently, on February 3, 1937 the Second National Silicosis Conference was called in Washing ton. At this time summary committee re ports were presented to the Secretary and considerable discussion was given them. Shortly after this second national confer ence the Department published, as IIn 1let in No. 13 o f Ihe Division of Labor Standards, the summary reports of the four committees referred to above, together with an abstract version containing the principal findings and recommendations written in nun-technical language. The full reports of the committees, com prising several thousand typewritten pages, arc now being ediled and will go to the p rinter very shortly. It is cxpeclcd that they will he issued in four separate volumes sometime during the fall or early winter. N ature and Extent of Silicosis Physicians generally agree that silicosis, in the layman's language, is a disease of the lungs, caused by breathing air containing silica dust, in which the normal lung tissue is replaced by fibrous or sear tissue. Silica dust is found in many industrial operations, but the hazard is acute only in such industries as metal mining; anthracite mining; quarrying, drilling, and tunneling in granite, gnnistcr,' and sandstone; smelting and refining; foundries; potteries; glass works; stone-products industries; grinding; huffing; and sandblasting. ()l the 49,000,000 workers in the United States, only 1,900,000, or 2 per cent, it is es timated, arc in any way exposed to the haz ard of silicosis. About half of tins number, or 1 per cent of the total number of winkers in the country, are exposed to a serious haz ard, and approximately 110,000 of these have silicosis in some degree. Medical examina tion of men actually at work indicates that between 4,000 and 5,000 workers are seri ously affected by the disease, in addition to L t mt II i (V,/i V those already permanently detached from tlieir employment by reason of disabling sili cosis. T h e status o f the 1,000,000 workers e x posed to the hazard of silicosis was analyzed thus by the committees making the survey: A percentage o f the 4,000 to 5,000 workers having silicosis are completely or partially disabled because of this disease and have their difficulties further com plicated with tuberculosis. T h e remainder of the 4,000 to 5,000 have silicosis and disability in some degree, but no tuberculosis. Approxim ately 105,000 have silicosis, hut no disability and no tuberculosis. Approxim ately 000,000 arc exposed to silica dust, hut have not contracted the dis ease. Contrary to popidar belief, silicosis is slow to develop. Usually it takes seven years or more of exposure to silica dust for a worker to contract the disease. A few cases that have been known to develop in as short a period as one and one-half years occurred under extreme, and unusual conditions:" On the oilier hand, many workers have labored under ordinary exposures to silica for more than JO years without demonstrating any trouble whatever that could he diagnosed as silicosis. gineers, insurance companies, legislators, ad ministrators, and others. The reports of the conference committee on engineering control and medical contre recommend specific procedures for attack ing the problem through those two avenue of prevention. A partial list of these recom mendations follows : Survey the w orking conditions to deter mine the severity of the hazard and indi cate w hat needs to he done to decrease it Secure information on best procedure. Design plant for dust control. Provide building ventilation. S tore d u sty materials in dusttiglit bins. Enclose material-handling equipment. Isolate dusty processes. Provide wet methods of operation.-- Water, oil, and o th e r liquids may be used effectively-- 1. T o suppress dust at the point of origin in such operations as rock-drilling; h a n dling, pulverizing, and milling rock and ore; grinding metal on grindstones; abrasive-wheel cutting of granite and sand stone. 2. T o prevent the redispersion of du -t that has settled on the doors, walls, and other surfaces such as in the granite in dustry and in foundries. Silicosis Prevention Silicosis can he prevented in three general ways: First, by preventing the creation of silica dust; second, by preventing the dis persion of dust into the atmosphere of a working area; and third, if it is impossible to apply the first two methods, by the use of personal protective equipment such as respirators, to prevent the inhalation of the dust. In carrying out a prevention program, many agencies must cooperate. In the view of the committees studying the problem, the employer is called on to do most of the work and to spend most of the money. But his work and money will never accomplish the maximum results unless the worker is will ing to cooperate and carry his share of the responsibility for helping to control dust and for using the personal protective equip ment. Design equipment to control dust. Establish good maintenance and house keeping procedure. Provide respirators. Instruct the workers. Responsibility of Workers . T h e cooperation o f the workers is neces sary if the h a z a rd of silicosis is to be r e duced to the minimum. The worker should realize that the safe practices recommended and the equipment provided arc designed to prevent injury to himself and to his fellow employees. T he equipment should he used as directed and every effort should he made to maintain it in good working order. Purlhormorc, the w o rk e r is frequently in a posi tion to observe faulty equipment and unsafe practices, and lie should make it a point to report all such conditions to his supervisor. Statutory Regulation In addition, physicians can play a definite part in prcventing*silicosis, as can also en While the primary approach to the prob lem must lie the prevention and diminution S ^ J iT S icS,fi l , T bc workers who now have thc d" W,pe<l 0,lt' 't r r is c o n y e r e ^ ' w e ^ c C^ n,nntteeS " f ,llt: -'li- thc ''ccomiiien'datioas i" to w a r d prevention, and i,, jl(. ,7 ' . " ' o r k 'R 1 regula tory p!n ' cs , y qua le w o r k m e n 's com, e o w a rd adc- readily u n d e rso ld '!! ^ " ll0 a prac- adequately take care o f i V f 'e 'r Ul" d l wiil lem, lc sdicosis prob- tionZ I T i In s u : sis in thc C " 'penSaTins coverage should he compulsory 48 S ta te s 'T h e l T r " operal|on with thc e l u d e d ITM* Lat, r ha" in ter dust diseases ^ ' . ng Slilcsis and simi- same o r ' s i m i l a ^ f t! ? bc.tw* the the Sf0"8 S tates, the laws! rules 'a n d 65 "] various several States should be a ? " f practicable. oe as 11111' orm as Should Be Insured A n S S S S i S i - " * *%.- insurance subject to ? tl,er thrngh self- `mate funds, or *with 'an 1'>0stl."i' ,of adc- surance institution. authorized m- tJlrce main sub-headings f-"'n int the preparation of m ^ * i ^ ssii>tancc in codes, rules anr SO!,ahlC and adequate methods of p r e v e n t i o n ^ T 8- Prescribin-? establishment of en '> f aSS,Sfance m Hie workmen's L ^ p e n ^ of Ployees disabled , 1 , those em- (3) a general e 1 resu ^ f the disease State officials, f a c S - v " ? Pr ffram amonS that thev will he V- 1,sl,ectors. etc. so knowledge concer method of prevention ^ 1 dlsease, its - n t under ,,,c w0r k m ^ ' t o m ^ a L ! ^ . ments as lo J)ro iio^ d r lhe , t,lc bt;itc rcquirc- and medical care. f rs C.shoidd om,,e,i.satn>n Payments Workers disabled f.- ... "id. tubercnhisis) s,1'1 ? ' ,cosis Ou.t he granted the same k ` 1011 1 "himalelv tio,, as those d ? a" jury. 1,>aMt,<i t f compensaaccidental i,,- Follows Two Lines Ibis application program now getting under u 1v 11 . illdl 1S J"st along two principal lines ( ! ) r \ Con,mc!,ccd of practical in fo rm a tio n ,.? 1 decompiling dust control instalhr ti?nccr>"ng actual hazardous plants `to`>ctlT |ty,,lca| s'lica lions as to cr t ; " t ,CT; nth PProxima- also.of n h S 2 c T ^ f,,nsta,Ia`ion, ''t ment in such plants - ( 2 ) ronlro1 c,imp- education s,, ,! ^ ? ,,a ^ 0<fran> visual " "! committee report of c ^ cosis C.onferenre h 1 L National Sih- hniitatioiV period b n - l l k m ' d - 11,m " " ' ' " " " I " 1 r - r , h ,, A n l r t t j o o M b . D e P,, . tm e,, t tliis field such m | i V a ? 7 ',tCm,>la(cd ,hat in 'hdcs, posters, illustrated Imllethi1-'''' ia" tcr" he utilized, b'urthcr in s' clt'- will varmus exhibits of d 'c various large expositions , r h as `"'I'- at meetings, labor -md . , . l, k assouat,,,,, meetings etc it is r `` '" " `'a1 organization ' . c riaw' 'i|,c j l ' s ` n " ' V aS s,afe'' -reTM ' u ^ - w , a u n f L m i ; : , c; : ! r ' t ? d ,,,a tm u d ' "ward wavs and mean- f ' hazard and of e s t a b S : ^ : TM ' ? " f `-Is 1 workmen's c o m p e l ^ , , a"d' hollowing the address bv \ i r g f ^ ta,"e d-- ' of o n t i h i g Steam Railroad Meetii i o \ WEDNESDAY AFTERNOON SESSION October 13, 1937 The session uas called to order |,v W \y Wood, ball,more and Ohio Railroad, Balti- ,, , ^ t L ^ V l n c l ' r ' 'reS" ,cd- ''Wociuci,,^ the I cake, s and directing t!,e discussion . The Past, Present and Future of Railroad Safety . B y J. M. SYM ES ; ' Vice President, Operations and Maintenance n American Railroads, W a s h i n f t o n ^ D ^ " 1' A sso c ia ti n f No imiustrv m the world requires more diversified study and more exacting" TM TM tion f safety principles than the stean^raiload industry. Picture a quarter of a pcndabihty; grades and curves have eliminated nr rA,, i . n e s iiave h * been network l n<1 1,ne covering in a virtual S aetess. Uo \ crr rthis neeXtPwanoSrCk arfc tollpeerUatneidteda h,ll,on tram miles annually. Vast varrt o, ` ternunal operations are necessary to make up lias cost the railTM- a nprfOVni,c,,lt Program Jars sihire b/ 2 T,i V bi,lion do'' But the engineer's job is newer done As -0011 as new equipment, new rail or other deuces arc installed the engineers go to mhls T1 dcv|C,0Y norC c,r,ci,'"t and safer S f ^ ^ r t s s s nul its way to a single locomotive or car . droad .-.itcty. During that period we have -con a complete remodeling and moderni'za T 0 !* > * ., 1 proper. " * , ! " have heen strengthened; bridges trestles and culverts reb u ilt; tracks have' >cen laid with heavier rail and with treated lies of greater service life and dc- for saT C 1,1 " 'ay lcssced the opportunity lor safe operation. Conversely, anv improve i'fafeitfv, orf ciPrcliacat?ion0 imomthecdri^ately com ms esnd;s carcVli Vfoar,lgrraedaterfficsCarfSetay" dwcilal ipcloonvtcincuse'Thsoe rmg as railroad transportation is used About a quarter of a century ago, the 587 w 11 : E sre b**aca: in u re s. sy c o zitti K<U' S i s t . & C 'ir bSWC--TJ :^w54tt3a=i;-:p.~ :*i- " =ncerJ tt'jm e jL i i :e-i casirt to --^ T tse pe-:?'e -ift*an la r v .n s must C fis s s T work. v.ho 5 e , ? c i ~-j>: r t f e tS=g> he Yce must iBis e arger be<8awxmces -rily jBx i/ rund. H repeated ntali tur. said : SEtesr a c<w way aaaf e same old ?tgea tod using 'S ie d ili KUilnxtrf M e e l u i t f SOS 1 THURSDAY AFTERNOON SESSION October 14, 1937 Safety, An Executive Operating Problem B y R. c. W H I T E . Assistant General Manager, Missouri Pacific R. R,, St. Louis, Mo. Saicty is an obligation of management. Without the constructive leadership and dayto-day urge from the executive and operat ing heads, the movement would lapse into a perfuntory activity. The safety movement is recognized In executive and operating officers as a medium tor building up and maintaining that rela tionship, that fellowship, which broadens our views, enriches character, and brings the bidden Rule into practical application. followed by a thorough analysis to find the direct and underlying causes and the pro cedure necessary to prevent a recurrence P ro o f of its sincerity will depend prinanly on whether management will make the first essential move in the program-- that is, authorize the expenditure of money necessary to make the maintenance and op erating plant a safe place to work. Management recognizes that our economic system must enable men to live on an.increasmgly high piane. It must enable them to fulfill their desires and satisfy their rea sonable wants, anri-glve them that feeling of seeunty which is essential to happiness and eiiicicncy. Having made the decision that safety is an executive problem and responsibility--that accidents must stop--it is then essential that management promulgate, and follow through, a plan that will definitely fix tills decision m the minds of all the individuals who collectively comprise the industry The follow through must he such that department heads, superintendents, and every member of the supervisory force will appreciate the need for a constant, active interest in safety; will understand that passive interest will no more produce results than would the sanie interest in production. Supervisors must he made to feel that the prevention of accidents demands the same type of heads-up super vision that is given to the other problems attecting cost and service. The executive must find a way to indicate directly that it is the responsibility of the department heads to carry out management's program, that authority is placed in each superintendents hands to put accident pre vention on the same basis as production. A complete, factual and descriptive report of each accident must be made. This must be Safety and Efficiency d u t r i - ! i SiS f the un? erl>'il>S causes of in d trial accidents and preventive measures to be applied has made i t increasingly appar ent that those factors which are producing accidents are very largely the same facto v neh tend to lower the quantity and quality ss-affeettvy0aUnCd10e,fifric.itexnpcyr c sasrced asin inas,e,optahrcarblewaivs, though one word. " In coupling safety with efficiency I have no minimized .it as an executive problem, but have endeavored to indicate that its solu- ion is an executive responsibility, both to is n,dividual industry ami to the employees' that make it a going concern. Rail transportation is a scientific business in winch laboratory research, expert emu neermg, trained builders,.and skilled workers share a part. One of the main factors is a group of empkiyees who are loyal-w ho appreciate that their railroad must give the kind of service that will stimulate and accelerate the development of the territory traversed. The successful solution of our problem de mands the type of aggressive individualism m executive leadership that will attract and command loyal, collective , cooperative effort on the part of all who produce rail transpor tation. '* O ur m ajor concern is leadership--leader- S BMgmWMWLf IUPlOIMWWM *<T*i *' * ; f a -1, C H IC A G O OCTOBER 10-14 1938 NATIONAL SAFETY j 'yn'sht, 1938, National Safety Council, Inc. Printed in the U. S. A COUNCIL, in c . T H K Transactions of the Silver Jubilee Congress and E x position of the X ational Safety Council, October 10-14, 1934, are published in two volumes. V olum e I contains the general and subject sessions and the sessions of the various Industrial Sections. Volume II contains the Street and Highway Traffic, the Commercial Vehicle, the Transit, the Child education, and the Home Safety sessions. Volume 1 is distributed automatically to all industrial m e m bers of the Council. Volume II is sent to members who are believed to be interested chicily in the sessions it contains. However, other Conned mem bers may obtain V olum e IT upon request. Many members have found it of benefit to distribute copies of the Transactions volumes to both executives, foremen and supervisors, who have used the practical information they contain in safety program s and for general reference p u r poses. Extra copies of the T ransactions may be obtained as follows; One to 10 copies of Vol. I, a t $2 each; 11 o r more copies, $1.70 each. E x tr a copies of Vol. II cost 73 cents each. T lll'i Transactions are a condensed record of the pro ceedings of the Silver Jubilee Congress. The papers and addresses have been edited to delete extraneous im iter, ab breviate the less important portions, and emphasize what may be of particular usefulness and value in promoting ef fective safety organization and other accident prevention measures. These volumes, therefore, are a somewhat abridged version, compact, practical and of particular value to the student and executive interested in achieving more thorough accident prevention success. The original m anu scripts are available for additional reference, if desired, in the files of the N ational S a fe ty Council. T H E Xational Safety Council, at its Congresses, seeks to eliminate from discussion matters which are not pertinent to the aims of the Congress or which may be contrary to the Council's policies. It cannot accept rcsponsibilitv, however, for all views expressed either in the papers which have been delivered or in the discussions based upon these papers. N A T IO N A L SA FETY CO U N ClLJnc. 20 North Wacker Drive Chicago J Council Officers and D ir e c to r s........................................... 4 Council Purposes and P o l i c i e s ............................................ 9 Annual M eeting o f M e m b e r s ................................... 11 Annual Banquet . ...................................................................... 31 Special Subject Sessions-- Agricultural S afety ...................................................... 33 Dusts, Fumes, Gases and V a p o r s ............................... 45 Falls o f W o r k e r s........................................................... 59 Fire P r e v e n t i o n ............................................................... 69 Governmental Officials ................................................ 85 Health Service in I n d u s tr y ...........................................101 Industrial A ccident I n v e s tig a tio n s................... T. . 115 Industrial E xplosion H azard s...................................... 125 Industrial N u r s i n g ..........................................................139 Industrial Safety L e ctu r es...........................................163 Maintaining Interest in S a f e t y .................................. 185 Midwestern Rehabilitation M e e t i n g .........................201 Occupational D i s e a s e ..................................................... 211 Off-the-Job Accidents ................................................... 229 S afety F u n d a m e n t a ls ..................................................... 249 Safe Use of E le c tr ic ity ................................................... 257 Safe Use o f Petroleum P r o d u c ts ............................... 269 Aeronautical Section ..............................................................281 A. S. S. E.-- E ngineering S e c t io n ...................................... 295 Autom otive and Machine Shop S e c t io n ........................... 301 Cement and Quarry S e c t io n ...........i .................................. 313 Chemical S e c t i o n ...................................................................... 339 Construction Section ..............................................................373 Food Section ............................................... 385 Marine S e c t i o n ...........................................................................407 Meat Packing, Tanning and Leather Industries Section ..................................................................................... 455 Metals Section ...........................................................................473 M in ing Section .........................................................................521 Paper and P u lp -S e c tio n ..........................................................555 Petroleum S e c t i o n .................................................................... 613 P ow er Press S e c tio n ................................................................ 665 Public U tilities S e c t io n ..........................................................671 Refrigeration S e c t i o n .............................................................. 691 Rubber S e c t i o n ........................................................................... 703 Steam Railroad............................................................................ 733 T e x tile S e c t io n - .........................................................................753 W ood Products S e c t io n ..........................................................775 Safety E xposition-- List o f E x h ib ito r s ........................... 799 I n d e x ..............................................................................................805 jfio n W l lie ty C o u n c il, In c. HONORARY MEMBERS Association of Ikon AM) SlT.l.l. K ni'.inkkks Roi:| lit \ \ . Camit.hi.i, R. I'.M.MKK OFFICERS (1938-1939) I >. I >. Ft N\;.r: . PlcddcUt C. \ \ . Di \nu:sv, Vice-President tor Finance and T re a su r e r I'hxnk H. H akuison, Vice-President for Industrial Safety Du. Mn.i.ru MrCi.l.vrock", Vice-President for Public Safety \ \ Ai.n.u S. I'aini:, Vice-President for Ku.yineerini; A. V knnwiau.K, Vice-President, for Safety Councils R. T. Soi.i:nsti..v, Vice-President for Membership A. \ \ . W iiit.nky, Vice-President for education W. II. Camiusdn, Secretary and Managin.e; Director EXECUTIVE COMMITTEE (1938-1939) H. J. Ai.mticn, Spencer Kellottg iV Sons, Inc. J. 1. P.anasH, Past President C. \ \ . lii.ltoot isr, Past President II. \ \ . lioiaatss, Sinclair Prairie Oil Company C. II. IIot;i.i-;r, Wisconsin Public Service Corporation Roitret W. Camiuii.m., Past President W. II. Vamkkiin, National Safety Council, Inc. I. . C. Camimiki.i., Mining Section Robert I. Catt.in, Aetna Casualty N Surely Company I. i'.wis A. Didlt.ms, Past President C. W. Di miu.sy, T h e I.ii|uid Carbonic Corporation R. If. Donovan, ASSK-Fn;_;inecriug Section MAlters A. Dow, Past President W ai.tkk A. E vkksox, Lehigh Valiev Safety Council F.aki. If. CuovKit, Safety Council of the Columbus Chamber of C o m merce D. D. 1-t.xxi i.i., Consulting' Engineer Harry <iru.iii.i<T, The Pullman Company F rank II. I l.-utitisoN, International Harvester Company H aroi.ii Ci. llol lMA.N, Cnemploy incut Compensation Commission, New Jersey S. II. I loKittu.i, Food Section II. H. Kki.i.v, Interstate Commerce Commission I 4 OFFICERS A N D DIRECTORS, C on tin ued W ai.tkk G. K ing, P a s t President VV.M. C. K noki.k, Milwaukee Safety Commission J ohn If. Long, P a s t President Tuns. H. M acDonald, U. S. Department o f A griculture A ktiiuk \V. M agi:k, Commissioner of Motor Veliietes, N ew Je rsey D k. M i m .f.k M cC lintock, Yale University K. S. M ktzgi.k, Public Utilities Section I. VV. M ii.i.a k d , Industrial Gloves Company H akoi.d L. M inkn, IC I. du Pont de N emours N Company Knot Nr.ss, Director of Public Safety, Cleveland If. J. O 'Hrik.y, J k., Louisville Safety Council W ai.tt.k S. P aink, Aetna Life iK: Afiiliated Companies Lr.w R. P ai.mkk, P a st President C. If. Pi'.rnuoNK, P ast President H. O. P ickard, Marine Section Ai.inner S. R k.gui.a, Industrial Relations Counselors, Inc. I. T. Cm.. IlltNIiV A. Kkningkk, Past President If. A. Romans, Textile Section A. V. Roiiwkdkk, Duluth, Missabe & Iron Range Railway Company G kokgk If. S anford, General Electric Company C iiaki.ks 1!. Scott, P ast President P rank T. SlIKKTS, P ortland Cement Association C kn. J ohn H. S hkkbuknk, Massachusetts Safety Council C. W. S mith, S tan d ard Oil Company (Indiana) W ai.tkk Dicnt S mith, Delaware Safety Council \V. A. S now, Construction SecliJn R. 'I'. S oi.knstkn, Elliott Service Company I. i - in. I . Sokknson, City T rallie Engineer, Chicago Cm.. J ohn S tii.vvki.i., Consolidated Edison Company o f X. Y,, Inc. C. P. 'I'm.man, Past President G kokgk G. T kavkk, G reater Chicago Safety Council, Inc. Die 1!. L. VusntiKiai, (ieneral Electric Company Dk. C. II. W atson, P a s t President A. \V. Will i nky, National Conservation lurcau D. A. Iakkkt, Carnegie-Illinois Steel Company A ktiiuk H. Young, Past P resident DIRECTORS (1938-1939) II. |. A i.dkicti, Spencer Kellogg & Sons, Inc. A. L. A kmstkong, E astm an K odak Company J. I. Banasii, Past President C aki. Baukkk, St. Louis Safely Council I.h , II. Hk.u t .ac, Blackstone Valley Safety Council W. A. Bixiiu.i., A utomotive & Machine Shop Section Ificnk.st \V. Hkck, United Slates Rubber Products, Inc. 5 ICERS A N D DIRECTORS, C o n tin u e d C. \V. !!l.Ki',otllST, President E. R B lank, Jones 6c Langldm Sleet Corporation tl. W. Moiaa-tss, Sinclair l 'rairit: Oil Company IT. 1C Bolt, South llemt Civic Safety Council ` C. 1!. liom.ir, Wisconsin Public Service Corporation F. S. Iinown, Standard Accident Insurance Company I. II. IIkown*, Petroleum Section W. A. P.iiown', Safety Dept., Nashville Chamher o f Commerce K. A. Bullock, Rubber Section W. H. Cameron, National Safety Council, Inc. L. C. C amr hell, Mining Section R obert W . C.-vMfm.t-t., P a s t President R aymond A. C a Rev, E vansto n Safety Council K ay C arney, Kenosha Safety Council Robert I. C atlin, Aetna Casualty & S urety Company M aurice C iiaii.i.kt, Rahw ay S afety Council L. O. CtuatVEK, Employees' Publication Section W m. M. C i.ark, St. Joseph (M o.) S afety Council K enneth B. Colman, Seattle Traliic & Safety Council J. E. C ulmney, Bethlehem Steel Company F rank J. D ean, Kansas City Safety Council ' L ewis A. D eB i.ois, P a s t P re sident C. \V. D emi'LSY, T h e Liquid Carbonic Corporation R. E. D onovan*, A SS E -E nginccring Section J ames 15. D ouch.as, Tiie Philadelphia Gas W orks Company M arcus A. Dow, Past President D r. Louis I. Dutit.tN*, Metropolitan L ife Insurance Company O. i t . E dwards, J r., Safety Div., Syracuse Chamber of Commerce W'. A. E verson, Lehigh Valley Safety Council D. D. F e.n.veli., Consulting Engineer D onai.o A. Fi.vKiiEt.NEK, Toledo Safety Council Du. H art E. F isher, Chicago Rapid T ra n s i t Company C hester C. F isk, Berkeley Traffic Safety Commission H oward 15. F onda, Burroughs Wellcome & Co. (U.S.A.) Inc. A rthur C. F rey, W o rcester Safety Council J ohn B. G ibson, W estern Electric Company L yle H. G ift, Peoria Association of Commerce Safety Council H oward F. Gilbert, Elizabeth Safety Council E dgar H. CoKSb'ctt, Grand Rapids Safety Council W. A. G riffin, American Telephone & Telegraph Company E arl E. G rover, Safety Council o f the Columbus Chamber o f C o m merce H arry Guildert, T he Pullman Company C. H . H arper, Refrigeration Section D. T. H arrington, United States Bureau of Mines F rank H. H arrison, International H arvester Company 6 Kj OFFICERS A N D DIRECTORS, C ontinued ( has. L, 11 MX, N e w Y o r k C e n tra l Lines 1 i .\w>l.ii G . 1 Io f f m a n , U u c i t i p h l y i n r i i l ( V)in \ r t i 'g i I o n G o m m i s s i o n , New Jersey E verett I IdKi), M ad iso n C o u n ty S a f e ty Co uncil S. Ik 11oUKi.i.i., Food Section I'KKi) II. H u n t , C em en t iv O u a r r y Sectio n W.u. I'". J ames, T*1iilad ctjitiin S a f e ly Council 1'. H. J ohnson, C o m m e r c ia l Vehicle. S ection T homas I'. K earns, Industrial C om m ission o f Ohio fl. If. Kx u .y, In terstate Commerce Commission W alter G. K ing, P ast President W.\t. C. K noelk, M i l w a u k e e S a f e t y C o m m is s io n VV.\t. S. K nudsen, D etroit Industrial Safety Council O tto C. K uiikt, G reater Springfield Safety' Council C. L. L aF ountaine, G reat N o rth ern Railway Company J. Id. I . ke, Wood P ro d u c ts Section M ilhaud C. L f.feer, Child E ducati on Section J ohn E. L ong, Past President Titos. If. M acD unai.d, U nited States D epartm ent o f Agriculture. R obert A. M cA rthur, T r a n s i t Section a D r. M iller M cC u n t o c k , Yale University A rthur W. M agee, Commissioner of M otor Vehicles, New Jersey F. W. M atson, Minnesota Safely Council R. S. M etzger, Public Utilities Section I. W. M illard, Industrial Gloves Company H arold L. M iner, E. I. du P o n t de N em ours & Company R. B. M ori.ev, Industrial Accident Prevention Associations P rof. R oger L. M orrison, S treet & H ighw ay Traffic Section E rnest M urphv, Albany Safety Council C. L. M urray, Mason City-C erro Gordo County S afety Council E liot N ess, Director o f Public Safety, Cleveland E. J. O 'B rien, J r., Louisville S afety Council G eorge C. A. O ff, T he D etroit E dison Company W alter S. P aine, Aetna L ife & Affiliated Companies L ew R. P almer, P ast President D avid A. P atton, N e w a r k S a fe ty Council C. K. P eacock, Chattanooga S afety Council Charles W. P endock, Safety Division, Milwaukee Association of Commerce C. E. P etti bone, P a s t P re s id e n t B. O. P ickard, M arin e Section A lbert S. R ecula, Industrial Relations Counselors, Inc. D r. A. R. Reinke, C o n tra Costa County Safety Council L t. tot.. H enry A. R eminder, Past President Pint u p C. R hoads, M eat Packing, T a nning & Leather Industries Section 7 A N D DIRECTORS, Continued A. C. Risshekgek, Rochester Safety Council Marines Riteh, Paterson Safety Council E. A. Roberts, Textile Section , Bestor Roiiinson, Easthay Safety Council * I'. A. Roiiinson, Paper & Pulp Section P. E. Rockhoef, Pow er Press Section R.m.uu L,, Rogers, Ir., Chemical Section A. V. Kohwkokr. Duluth, Missabc & Iron Range Railway Company \Valter Koskn-haum. Western Pennsylvania Safety Council ' (r. E. S antoro, General Electric Company H kxkv G. S ciiaffnkr, Eric Safety Council H aku\ A. S chultz, t i n t e d States Steel Corporation of Delaware UiAui.its 15. S cott, P a s t President E arl S. S hartzer, Utica Safety Council. hitAN'K T. S heets, Portland Cement Association Gkn. J ohn H. SnEiim-ENE. Massachusetts Safety Council Du. L. A. S houuv, Bethlehem Steel Company It.m.vest I.. S imonds, New Haven Safety Council J udoe Lee E. S kekl, Cleveland Safety Council C. \ \ . S mith, Standard Oil Company (Indiana) W aiter Dent S mith, Delaware Safety Council W . A. S now, Construction Section K. 1. Soi.knsten, Elliott Service Company L ksi.ie J. Sorenson, City Traffic Engineer, Chicago I-. C. S i'kixc, Philadelphia, Pa. George R. Stephens, Safety Bureau, Buffalo Chamber of Com merce Cm.. J ohn S tii.wei.i., Consolidated Edison Company of X. Y. Inc. A rthur M. I ode, Consulting Marine Engineer C. P. 1oi.man, Past President Mixi. E. T rammell. Metals Section D eokge G. 1 raver. Greater Chicago Safety Council, Inc. Major R. I). T rlmiile, Richmond Safety Council 1-rank E. Vitz, Superior and Douglas Countv Safeiv Council Dr. B. L . Yosiiurgh, General Electric Company ' Dr. David E. W'egi.f.in, Baltimore Safety Council Dr. C. H. W atson, Past President G W ts,.; W kscott, Safety Dept., Auto Cluh of Rhode Island S. L. W hitint,, Libert}'Mutual Insurance Company A. W. W hunky, National Conservation Bureau Charles E. W ilson, General Motors Corporation I .1!. W inslow, Safely Div., Birmingham Chamber of Commerce W'. E. W orth, International Harvester Company A rthur H. Y oung, Past President ' E. I. Z auet, Safety Bureau, Duluth Chamber of Commerce G c Tiie t purpiwt The through prevent plies t< direct!} illation Koo>. conditi* disease' accident live in The pront, i lion. it !r rcM'ini.ut the 400 r\her^tniindivm oittciai linns, and ci\ are n: th<4 ninlr. c impuri . Tin tile fi: under Iron . wauhci taut ! the X in Xy. of nn liershi; Tin gram mincedevelm make ' have to ho a dual agencies and ways ng opportunities for >r the physically dis-t be summed up by ' o equal quantities of applicant's ability and add an unlimited perseverance, interest, work and success will Occupational Disease THURSDAY MORNING SESSION October 13, 1938 j 1he session for the discussion of out standing problems in the field of occupa tional disease was called to order by the Hon. P. I. ngsten, Chairman, the Illinois Industrial Commission, Chicago, who pre- sided. The Chairman emphasized the im portance of the selected subjects to be pre sented by eminent speakers, and promptly introduced the first scheduled speaker. Trend of Occupational Disease Legislation By H E N RY D. SAYER Manager of the Casualty Department, Association of Casualty and Surety Executives Let us consider the dillerences between the accidental injury and the occupational disease, bor these distinctions are important and must constantly be borne in mind when we consider cither legislation o n j h e sub ject of disease, or engineering methods of prevention or control. Generally speaking, accidents occur at a specilic moment in point of time, and, from the standpoint of fixing liability under any policy oi insurance, it is in the lu tu re; that is to say, at the moment of the acceptance of liability under any insurance contract the accident for which liability may be as sumed has util yet happened. T hat fre quently is not so with the occupational dis ease. Insurance by its very nature can only assume liabilities that have yet to arise--not those that have already accrued. Again, speaking generally, the industrial accident is something that can he seen_ even though unforeseen. It may be visual ized and described in words, setting forth specifically the time, place and manner of happening. It can then he determined, alter the happening of the event, whether it was preventable or inevitable; blame, if any, can he assessed; the worker involved, or his foreman or superintendent, can lie shown the fault, and effective measures can be taken to guard against a like future hap pening. But some will say, truly, not all accidents happen in the manner described; that not always are they held to occur nnlv at a spcci fie moment or under circumstances where they can he visualized and described, by administrative and court decisions, it is true in some jurisdictions that the definition of "accident" has been greatly broadened. We find the entrance of disease germs into the human system without visible trauma, with resulting sickness or death, and even the specific time and place not definitely known, except . that it is shown to have probably occurred in the employment, being held to he an accident. *Itiers vs. Hull, 17,S App. Div. Uil. i \ y 7r,;, an anthrax case; Vennrn vs. \ , a I.ell Lum per Co., ldl Wis. 370, a typhoid case; amt others.) Poisoning of the body through the effects of. a deleterious or toxic substance used in the employment, the dangers of which were unknown to the worker, the employer hav ing been negligent in safeguarding properly the use of such substance, has been held to be the result of an industrial accident. (Victory Sparkler & Specialty Co. vs. Francks, l-t; Maryland, 36S; and the very recent caseof black vs. Crcstnn Auto Co . Iowa Supreme Court, August S, 1938, 381, N.W. ISO.) And where negligence of the employer has been shown, an injury to health, even though not occurring through a happening at a given time and place, inti by repeated 211 <>tjr e < over months of time, has been to be an aceklent. ' . S Y i - l y w C.nli t u AOu-sios Co., .' nr,, X o n h -i<)in;i Y.S, a n n^lii-stosis ca>c.) u--c ami other cates I might cite arc exceptions ami not the general rule > what constitutes an accidental injury, ink we may fairly assume that the is of administrators of the law and courts have hrett directly inspired by belief in tin- necessity of finding a !y for an industrial ill for which no remedy had been provided by specific .age of the statute. May we consider as straws in the wind, showing a 1 toward industrial disease liability? ay observed that the tendency of the is is to construe the term "accident" more limited manner in those states e there is specific provision in the law dug occupational diseases. Thus, we d e a r instances of what has been d ``judicial legislation," that is, the s broadening the meaning of the law over situations not clearly included n the terms of the law by the duly con ed legislative authorities. : us now consider what we mean or inby the term "occupational disease." we find a more dilficult field--diilicult the standpoint of administration and al interpretation; and difficult from tandpoint of the doctor and the en- at is disease? W e think wc know, and -t to" laymen the term conjures up minds .something of a rather defitture. When we pause to consider it, rse, infinite tpialifications o f the term to us, and we are confronted with conditions that fall into the zone of -such as, for example, whether hera disease. At any rate, wc say it is lormal condition, and let it go at .vltcn wc come to add to the doubtn "disease" the even more indefinite cettpationar o r "industrial," we find ;s in an area jo t highlight surl by a vast and increasing zone of s>lading off into Erclnau night, w then shall wc define the term '.tonal disease"? diseases stand out in our minds as and definitely occupational. .As to have no great difficulty, either leg islatively or administratively. These include the well-known metallic amt chemical poi sons that are so definite and cliaract ristie a part of some industrial processes. Were the diseases arising from the use of these substances the only occupational diseases with which we need concern ourselves, the legislative difficulty would he largely re moved, and we could safely entrust the problem to the doctor and (lie engineer. lint we have seen that the legislative problem is not so simple. N or is it simple administratively. W e find ourselves floun dering in a veritable morass, either because of the inherent difficulties of the situation, or because we have not or cannot agree on onr objective. If all parties would rec ognize the difficulties and the limitations on what industry `can do, or can fairly he e x pected to do, we could much more con fidently face the future. If we could agree that, provision for "occupational diseases" is not synonymous with general health and life insurance for industrial workers at indus try's expense, then I am sure wc could get somewhere very definitely. Hut has there not been too much loose thinking on the subject? Wc are met with a curious situation. W c find the advocates of so-called "all-inclusive" statutory cover age deliberately seeking indefiniteness. This is unlike them, for when they know what their objective is, and are willing to dis close it. they have not refrained from press ing their advantage with definite and spe cific purpose, and with exact language to accomplish that purpose. That, at any rate, is correct legislative procedure. lint in this field, even where the liability of the. employer is made inescapable, the constant suggestion is put forth that it is futile for the legislature to attempt a defi nition or delimitation of occupational dis eases, and. therefore, words of the most general character should he employed, leav ing to the courts the interpretation of the law as they see fit. I submit that it is not the function of the courts to make up the legislative mind; that is the function and the right and the duty of the legislature. Nor .should the legislature seek to avoid and evade responsibility by transferring to courts and commissions the determination of questions of liability which the legisla ture finds too difficult for it to determine for itself. U l l .1 ' U i UJ / i Ui I Aw'. </.\P To effect coverage under the compensa tion law, therefore, by any such general and vague language. as the. term "any and all occupational diseases," or hy adding io the definition ol "accidental injury" the phrase "and shall include occupational dis eases," is to create an uncertain liability--- one that may require endless and perhaps disappointing litigation---before the meaning of the law is established; and will most certainly he a disservice to w orkers and employers. An excellent rule--a cardinal rule--in statutory drafting, is to use words of defi nite, certain and understandable meaning, used in their common acceptance, rather than to resort to vague, uncertain and meaningless words, or words the meaning of which may have the effect of distorting the objective that is sought. Controversy is bred hy uncertainty of language, and controversy leads to litigation in courts. Litigation is expensive for all parties; it causes delay; and it frequently causes bitter disappointment. It breeds rancor. It may even breed disrespect for the law and for orderly process of government. Why then shouhl there he this continuing demand for the all-inclusive coverage? Is it with the vague hope that satisfaction may result in some cases of misfortune to workers who fall victims of the disease that besets us till and lurks in waiting for us in onr play, in our homes, yes, and even in our shell, ns well as in our employment? Perhaps not--yet if that were the design, a more simple way of succeeding in it could not otherwise he contrived. Are we to understand that any disease of the most common and ordinary risk of life may become, an occupational disease if its source or supposed source had its origin in an incident o f the employ incut o r a co n dition there present, or if claim was made that a pre-existing disease had been ag gravated hy such condition? T h a t is a large order. It would mean that Industry would become liable tor any ordinary di>ease of life, provided that disease could he, with a show of plausibility, related to a condition or incident of the employment. Such diseases are almost too numerous to enumerate. But we know that claims have been made for tuberculosis and heart disease, the two most numerous diseases and the cause of more deaths than any two other diseases. Add to these pneumonia, asthma, arthritis, rheumatism, and a host of o th e rs; and we discern in this the beginning of a system of health insurance of the most costly typea system moreover that would discrim inate bitterly against the many millions who contract such diseases in perhaps ac tually the same way, hut who have no em ployment at all against which to assess lia bility. Should not the man who falls vic tim to a disease of ordinary life while searching for a job he just as much the con cern of the state as the man who becomes disabled from the same disease and who is so fortunate as to have a job? Let us he realistic about this thing called health ! Ill health is a deviation fro m the normal. But what is "n o rm a l? " H o w great a devia tion is abnorm al? Disease is of many and varying degrees. T o w hat extent does the mind affect the working status? Or what part in the situation is played hy "will power" ? These are not fanciful questions, they arc encountered and will obtrude themselves continually' in determination of compensation for disease where we depart from the known and characteristic occupa tional diseases. From these rem ark s perhaps some will say we arc opposed to coverage of occupa tional diseases under compensation laws. Not so! The stock casualty companies represented in the Association have not op posed and do not oppose the principle of compensation for occupational diseases, if thereby is meant compensation for those diseases that arise from a "trade risk," or from conditions that are normally and usu ally present in the particular employment, as distinguished from those ordinary hu man ills that beset all o f us. O ur view of it is that the policy o f coverage under the law is a matter of local concern, to be de termined hy local legislatures in the light of local demand and wilh due regard to local opinion of both labor and industry. No employer in this age can reasonably object to fair compensation for disease arising from such occupational risks, any more than he can object to reasonable com pensation for disabilities due to accidental injuries. This conception ol in d u s try 's obligation is, however, quite different from the con ception of a public obligation to care for id Silver Jubilee Safety Congress ul compensate lor all sickness and death idcr a form of health and life insurance, he latter obligation, it it he a valid one, the obligation of the slate and the nation ie.it the obligation of industry alone. The reason.tide, the intelligent, the sane ,iv for industry to disehar.ee its obligation its workers for condition* of health i< provide for the greatest reasonable reiircincnls lor industrial hygiene, and to ovide eoniiieiisai ion only for those con-. ions that arise from specific named dis-es that are truly occupational, charac:istie ol, and Iieeuliar to the processes in rich the worker is engaged. udustry will, 1 am sure, meet, the clialrye of the occupational disease problem, rt is presented under a law that prerbe; the liability of industry in underutdahle terms. In the early lays, the neral rule was to include occupational -eases in the compensation law by specify; the particular diseases or the particu conditions leading to diseases that are med to he occupational and contpcnsahle. ;s we call a "schedule" law. It is the lit in which compensation for occupanal diseases is covered in all o f the mtries of Kurope ami ot South Amcr- It is so simple; it is so sensible; it is easily administered, that the wonder is t the acceptance ot the principle is not t ersal. i we will keep ever before us the princ that a disease, to he deemed occttpaa', must he "characteristic of and peir to" the occupation, there should he jreat difficulty m arriving; at a proper itory setup for tire coverage of all true [rational diseases. Metallic poisonings characteristic of occupations in which metals are used. The diseases characic of chemicals, of acids, of alkalies. ; and fumes, are characteristic of ami iar to those occupations in which the ayccs are so exposed. The diseases of espiratory system, (lire to the inhala nt dusts, are the natural accompaniaud the characteristic effect of work h dusts, eti such clear and specific language is hie, why .should we he asked to use , broad terms, the use of which may lute the giving o f a blank check by ry? If the purpose is not to charge ry with diseases which are not char acteristically the obligation industry, why continually insist upon the use of lan - guage which is susceptible of misinterpre tation? He well assured, if legislatures do not perform their duly and lay down clear definitions of liability, industrial hoards and commissions cannot in the presence of the willows, orphans, and industrial cripples, he expected to exercise greater courage than the legislatures. The law in the hands ot such an administrative hotly will he scanned, and 1 fear scanned in vain, for limiting words or language to stay the hand ot industry's self-constituted almoner. The legislative trend, I am happy to re port, in recent years lias been toward the definite, rather than the indefinite. Despite tremendous pressure, no legislature has. in the past three years, adopted a blind, ``all-in clusive1' occupational disease law, except Mew York, of which I shall speak more in detail presently. Michigan, Rhode Island, Pennsylvania, Delaware, North Carolina, and Washington, among the states most recently enacting occupational diseases laws, have adopted the "schedule" or specific method ot coverage. Two years ago, Ohio amended its scheduled occupational disease law by adding dust diseases to its existing schedule. In two other states, namely, Illi nois and Indiana, occupational disease laws have been enacted in general terms. H ow ever, in identical language, these two states have undertaken to limit and define occupa tional diseases and have attempted therein to safeguard industry against liability for the diseases of ordinary life. Although doubtless familiar to many, the definition in the laws of those two states will hear repetition, as indicating the ex treme of difficulty in attempting to exactly define an occupational disease. "See. 6, In this Act the term 'Occupa tional Disease' means a disease arising uui of and in the course ot the employment. Ordinary diseases of life to which the gen eral public is exposed outside of the em ployment shall not be compensable, except where the said diseases follow as an in cident of an occupational disease as defined in this section. "A disease shall be deemed to arise out of the employment, only if there is apparent to the rational mind upon consideration of all the circumstances, a direct causal con nection between the conditions under which Occupational Disease 215 the work is performed and the occupational disease, and which can lie seen to have followed as a natural incident of the work as a result of the exposure occasioned by the nature of the employment and which can he fairly traced to the employment as the proximate cause, and which does not come from a hazard to which workmen would have been equally exposed outside of the- employment. T h e disease must he incidental to the character of the business and nrrt independent o f the relation of em ployer and employee. T he disease need not to have been loresecn or expected hut after its contraction it must appear to have had its origin in a risk connected with the em ployment and to have flowed from that source as a rational consequence." larder this definition no industrial m an ager can, with any assurance, be informed what his obligation is to his workman, and assuredly no workman suffering from dis ease can surely know whether he is en titled to compensation under that law. Of course, as is to he expected, litigation over the interpretation of tisis definition is al ready in progress in both of these states. And situations will arise constantly in the future where the facts will he such that only litigation in the courts will determine the liability of industry, or tire right of the worker to he compensated. The claims actually filed with the I n dustrial Commission of Illinois already include uudulant fever (a disease said to be commonly communicated by milk and meat products), tularemia, rheumatic fever, arthritis, rheumatic heart, heart disease, amebic dysentery, varicose veins, fiat feet, athlete's foot, cerebral hemorrhage alleged to he due to overwork, syringomyelia, and nerve disorder. I have not mentioned the claims for characteristic occupational disea-es, such as silicosis, carbon monoxide poisoning, and the various other toxic con ditions which clearly come under the Act. I have referred to the fact that New York, alone, has in recent years enacted a law covering occupational diseases in gen eral terms. New York was the first state, I believe, to enact an outright compensation law for occupational diseases. It did so in 19?0. The law was a schedule type law. (It so happens that I had the privilege of being one of those who collaborated in the draftW^ing of that law.) We were dealing with a new subject. We examined the existing laws in other countries and adopted (In form that seemed best adapted to our eon ditions, namely, the KriglLh law on occupa tional diseases. The schedule was, from time to time, enlarged as new industrial processes developed new disease-,. I'.y l'hM the schedule had been enlarged to include every disease that was a potential hazard to the workers in New York Slat', with the single exception of the dust diseases of the lungs. In order surely and certainly to bring such conditions within the p ur view of the law, there was enacted an a d ditional item in the schedule, reading '`any and all occupational diseases." The sched ule was not repealed, and the administrative provisions in the law with respect to the schedule were continued. One of the first questions th at arose under this new law was whether the new classification super seded the schedule and the limitations set forth therein, or whether it was an addi tion to the schedule and applied only to those, conditions not previously included therein. The legislature, having evaded the duty of defining the term "occupational disease," the Industrial Hoard, which administers the law, adopted a definition. That definition is well worth repeating: that the Hoard deems a disease to be occupational only when it is "characteristic of and peculiar to the trade, employment, or occupation" in -which a w o rk er was engaged. .This defi nition was adopted almost verbatim in the Rhode Island and Michigan Laws. The Appellate Division of the Supreme Court, however, declined to follow it, and by a vote of three to two, held that any disease that arises out of a condition incidental to the employment must be deemed to be an occupational disease. ( U i s h o p v s . C o m e r & P o ll o c k , J 31 AppellateDivision, 492; Gohlberg vs. 954 M arcv C o rp o ra tion, 251 A ppellate Division, 904.) The Goldberg case was appealed to the Court of Appeals--the court of last resort in New York. So completely do the facts in the Goldberg case bear out what 1 have said about indefinite liabilities under an allinclusive law-, th at they will bear repetition. Shirley Goldberg was employed to sell tickets in a moving picture theater. H er booth was on the sidewalks. It was kept heated, in cold weather, b y r ^ n a l l electric heater, operated from a '' (>ot 11. She contracted what she described s blotches or a rash o n her lees. The dutches or rash she claimed ere due to he alternate heating and chilling of lier ,-gs when she switched on o r off the heater, .'lu-y did not constitute a disability. Howver, on complaint to her employer, she was ild to see her doctor. W hile on her way 0 see lier doctor, on her own time, she. 'ipped on the sideualk and fell, fracturing n ankle. Although the flay was cold and c testified there was ice and snow oil the leivaik, die claimant alleged that she fell dely due to weakness resulting from wsc blotches, and the Industrial Hoard > found; and found that the cause of the ill was an occupational disease, charactertic of and peculiar to her employment. The Court of Appeals, in an opinion that ristles with logic and sound sense, struck :is free-for-all system from the language 1 the Me' York Act. They unanimously fused to concede that this was an occuuiotiai disease. To make every disease iat arose out of and in the course of emioyment compensable as an occupational isease, they said, would be to make the impeusation law "the equivalent of life id health insurance." The court further .id that to be "occupational," the disease ust be one which " results from the na:rc of the employment"; and that by nare of tbe employment is meant--conditions which all employees of a class are subject id which attach to the occupation--"a zard which distinguishes it from the usual n of occupations, and is in excess of h a zard attending employment in general." oUllicri' vs. 95 4 M.ticv C o r p o r n t i u n , d ec id e d a t u u i r y 11, 193S, a m i r e p o r t e d i n 276, N. V. 1.4 12 N\K . 2ml . M l . ) I'hus, after more than two years of at uncertainty as to the meaning of the , tbe Court of Appeals lias eliminated m the Xctv York Statute the diseases ordinary life which are only incidental speculatively related to the occupation, list a word about hernia as an occupalal disease. Never h eretofore regarded an occupational disease, but unite g a i ly recognized under certain circumccs as an accidental injury--the Occunnal Disease Law of Michigan, enacted year, specifically included hernia in schedule of diseases. N'ot all hcrniac, ever, are so included, hut only those -Ivgof recent origin, as to which dis ability follows immediately, and in which prompt report to the employer is made. This is not far different from the rule in regard to hernia as an accident. Hut in New York, du rin g the past yeyr, it has become somewhat the fashion to regard almost every hernia as either an accident or an occupational disease. This followed on a decision of the Court of Appeals, sustaining an award for hernia as an occupational disease herein the' In dustrial Hoard specifically found that no accident had occurred. In the case pre sented, the worker was required, in the course of his employment, at frequent intervals, to rotate Ills body on the hips. This man teas employed in a glass factory, lie gathered molten glass on the end ot a punny, which he, in turn, swung about and placed in a mold. The weight was not excessive, being only a matter of a feiv pounds. In affirming this award, the Court of Appeals said: "T h e finding, supported by evidence, is that the continuous gathering and lifting of glass from a furnace involved a constant twisting and straining of the body. This process, from gradual stretching, resulted in a hernia which is a disease (M atter of Alpcrt vs. P ow ers 223 X. Y. 97, 101.) T here is medical testimony th at claimant's occu pation would produce this disease and there are judicial decisions in other jurisdictions holding that hernia is an occupational dis ease (M arathon P ap er Mills Co. vs. Ind. Comm. 20.3 W'is. 17; Travelers Ins. Co. vs. Locke 56 Fed. (2nd) +43, +4+)." (F o s t e r vs. Callender B ro th e rs ln e., 27$ X. V. 34$ 16 X. E. 2 n d 360.) Perhaps the most controversial question involved in occupational disease legislation is the treatment of liabilities for dust dis eases of the lungs. In no class of cases is tbe marked difference betneen accidents arising at a given time and place and occu pational diseases more pronounced. In this category of cases, we find silicosis, anthracosilicosis, and asbestosis, all o f them forms of pncumoiioconiosf . While these diseases in some of their forms arc among the most ancient, their ravages having been rec ognized generations ago, little has been known until recent years of tlieir causation, of their pathology, and of their complica tions with other diseases, A vast fund of knowledge of these diseases has been gath ered in the past t a i years, and intensive i ' V n i / ' i O ' i i O / c - ! b.Vi studies of their etiology and pathology are still going forward. One fact stands out dearly, and that is, th at these diseases do not progress to the point of disability until after many years of exposure to dust. The length ot time, varying from five to twenty-five nr more years, is dependent in large measure upon the concentration of dust, the com position of the du-g, the time actually e x posed during working hours, and the in dividual susceptibility or resistance of 'the worker. A nother fact thtil stands out is that the fibrosis of the lungs, once ac quired, is perm anent and incurable, and, in uncomplicated cases is not susceptible to medical treatnicnt. Many thousands of workers today, under no law hut the common law, have been employed in employments exposing them to more or less heavy concentrations of dust for many years. In the event of the enact ment of an occupational rliseasc law in cluding those diseases, industry will find itself, at the stroke of a pen, liable for conditions already acquired through long years o f employment, and which may' be come disabling at any moment. In this sit uation, the best guaranty against disable ment is continuous and steady employment. Many a man, actually able to work and earn good wages, while he has a job, will he aide to demonstrate by x-ray and clin ical examination the presence of a marked degree of silicosis, when bis job stops because of depression or otherwise. Hence arises the question of the so-called "accrued liabilities!" This term which has come into common use is perhaps not an exact term, in that "liability" does not occur until disablement, and the liability - is only "accrued" at that time. W hat we have in mind when we discuss accrued liabilities is the condition of fibrosis of the lungs which has accrued and has been acquired over a period ot years. This condition, being permanent, remains with the worker, whatever and wherever may he his employment, l 'erhaps a more exact expression would he "potential liabilities," and yet they are more than potential; the condition giving; rise to them is actually existent. Industry tells us quite truly that it can not now pay full compensation out of cur rent income to all of the men employed in industry who may have in the past in curred some degree of fibrosis of the lungs. But if industry cannot assume th e s e liabil ities, how much less justification i-. there to call upon insurance, out of the premiums of next year, to pay' for disablements ac quired over the past fifteen years, and for which it received no premium? In this difficult situation, it has been found necessary in many stales, if em ployment is to he continuous and uninter rupted, and if men are eventually to 1. Compensated for the fibrosis acquired due to future exposures, to absolve, to a great extent, industry from the obligation of com pensation for past exposures, and to base compensation upon the extent of exposure after the enactment of an occupational disease law. Thus, there has come into acceptance in several states the principle of graduated compensation benefits for dust diseases, limited to future exposures, and eliminating in large measure the ex posures of the past. Under this system compensation for dis ability or death occurring during the first month under the new law would be only a nominal amount (it has been set as low as $500 to start w ith). A person disabled during the second or third month after the enactment of an occupational disease law will have been exposed, to a small extent at least, under that law. The e x posure is perhaps in itself insufficient to actually result in any harm. But the m ax imum benefits will be increased, mouth bymonth by small increments, until in the course of two or three years the full limit chargeable to industry in the. particuhir state will have been reached. This system is not so complicated as it might seem. The eftect ot it is rath er to postpone tingoing into effect of a dust disease law for a matter of two or three years, and experi ence under this law has demonstrated that lew claims arise where the compensation benefits are so limited, the workers .-. e ferring to stay at work as long a- tin;, can. It may he said that it works harshly in the case of the person who becomes really totally disabled in the early month:, of law. W hen measured by the liabilin with which the employer may fairly hi charged, it does not, in fact, work a hard ship, and when compared with the exist ing system in slates not now under oecu- 3 f!. i. <. .s u / r n l. i.i. -ationnl disease laws, it not only is not hardship hut is, in fact, a great boon. The principle of limited and graduated ability of the employer for dust diseases as been recognized by enactments in N ew 'ork, Michigan, Pennsylvania and Ohio, via unusual provision has been adopted in ic state of Washington, providing under leir schedule form of law that the cost f compensation for occupational diseases tall he divided equally between the tinloyer and his workers, and deductions lad he made from the employees' wages s contributions towanl the insurance miliums involved. Bill what, you may say, has all this to h with the safety engineer? It has imiih. The safety engineer can i) longer regard himself as doing his >b if he seeks only ways and means to minute the industrial accident. T he inustrial hygienist must become the colleague f the industrial engineer. Medical science nisi give intensive thought and study to termining the effects upon the human stem of various industrial processes, and eposure to various materials therein. All eposurcs cannot he eliminated and still ive industry perform its functions. Most lportant, therefore, is the medical deterination of what are safe limits in exisurcs--the so-called "threshold limits." he engineer cries aloud today for expert cdical guidance on this subject. Armed ilh such medical opinion and advice, the sk of the engineer then is to devise prac;al ways and means for attaining condini.i where such threshold limits apply. Every industry presents a problem or ries o f problems in itself. M i two inistries are exactly alike. W hat is tler ie in one may he intolerable in another, hat is good practice in one industry ly be totally inapplicable for practical lisons in another. T h e task o f the enicer then is to find how right principles iv he made applicable. Industry today, m o r e thin at any time its history, mlist bear the burden of sponsibility for the health as well as for : safety of tiie industrial worker, and if i health and his safety are adequately feguarded his happiness and the happiness those about him will he increased. Therere, it is of prime importance in the field safety that intensive and increasing in terest must be given to industrial health. The care for the health of the worker must not be confined to the guarding against those conditions that are mentionedspecifically- in the law. The engineer's re sponsibility is a broader responsibility than is the legal liability for compensation. T here can'be no doubt that the enumeration in the law' o f specific conditions for which liability is absolute will he of great ad vantage to the industrial engineer in seek ing to enforce proper health standards. It is far easier for him to obtain approval of his recommendations, if he can point out to management that the use of benzol or some benzol derivative is specifically men tioned, and point to the specific paragraph in the law that cites the liability of the employer for that condition. No argument is needed to convince management of its obligation in such a ease. T he same is true with regard to all of the metallic poisonings and all of the other wide range of chemical exposures. Psycho logically there is great [lower in the printed word, and even the most backward manage m e n t may be made to respond when the clear mandate is set forth in the law. Not so easy will it he, under a general, vague, and all-inclusive occupational disease statute, to convince management that it has specific duties with regard to the elimination of health hazards. Thus, we sec there is an other and potent argument for the schedule law, rath er than the all-inclusive law. There is perhaps yet another and even more compelling reason for applying the rule of sanity and common justice to leg islative mandate in the complex field of occupational disease. Shall employment he limited to those who are physically per fect? All humans are not examples of physical perfection, nor can we by legisla tive fiat reverse the laws of nature which immutably decree that we shall grow older with the passing years. We have seen and discussed the dangers inherent in the all-inclusive theory of stretching the law to cover every sort and condition of disease, and to try to make them employment-related. When that stretching is complete, when administrators of the law find it easy and possible to burden industry with the responsibility of health insurance under the guise of an occupational disease statute what of those who, wanting employment or seeking to re tain it, are not physically perfect yet c e r tainly arc not disabled? Much is heard today of the dread fortyyear-line for employment. Whatever the facts may he as to that, is it not possible-- if not probable--that industry, in despera tion and against its desire, will he forced eventually to accept only those among whom the health hazards arc least uncer tain--the physically perfect, the young and the strong? W e tuav well pause to con- s' / sider the devastation such a situation won hi produce. ' - In the interest of all workers, the young and the old, the perfect and the imperfect, let us not embark upon legislatife policies that can lead only to enlarging the field of unemployment, and to closing the door of industrial opportunity to those skilled and faithful workers who, having passed the meridian of life, are subject to those natural infirmities and ills of the flesh to which all men, in time, must how. Handicaps in the Diagnosis of Occupational Diseases By CAREY P. M cCORD, M.D. Detroit, Mich. It is a popular medical belief that occupa tional diseases are far more difficult to rec ognize and precisely to class as such than any other type- of disease state. So firmly is this idea rooted in the minds of some physicians that they argue that occupa tional diseases never should he made com pensable because of extraordinary diag nostic dilliculties. Lately, Kelterinfl has said, "The doctors tell us there are certain diseases that are incurable. Do you know what an incurable disease is? It is one that the doctors don't know anything about. The disease has no objection to being cured at all." This may he paraphrased by saying : There are no luidiagnosable occupational diseases. The only ones, that appear uudiagnosable are the ones the physicians have not learned how to diagnose. No occupa tional disease has ever offered any resis tance of its own to being diagnosed. The disease is perfectly willing to be diagnosed. At least one-half of all occupational di seases are almost self-diagnosing, particu larly when arising in g ro u p s; the remaining half present no greater difficulties than attend the diagnosis of some other classes of diseases. To maintain that occupational diseases are beyond the diagnostic skill of the physician is pure defeatism. W ith equal propriety, it might be suggested th at all neurology he abandoned because the ma jority of conditions arising in this field may not he diagnosed with case. While it may be said that there arc no uudiagtiosable occupational diseases, il mu-: he recognized that many remain undiag nosed, or more often misdiagnosed. Tin prime reason for this is that the tisiia physician sees only small numbers of an; one type of occupational disease. Taking Ohio as a typical industrial stale, the total number of occupational diseases, compell able and otherwise, reported to the Stat-. Department of Health during the year ION was 1,001). Oil the other hand, there tire : this slate 9,201) physicians. Tims, only urn occupational disease arose for every ?,.; doctors in the slate. H ere then is the foremost handicap tthe recognition and diagnosis of occupn tional diseases and at the same time back-handed compliment to industry. I>. dustry, because of its prevention achiei, incuts, has so limited the number of o. cupational diseases that day by day thphysician is ordinarily not spurred to tl possibility that any w orker who seeks in professional guidance may have a disease > occupational origin. Here, too, is the fund:: mental reason why more medical sclio. d do not develop training departments in th: field or organize special hospital service for the care of occupational disease p . tients. While there arc reasons for rejoicing the there are comparatively so few occupation diseases, we should recognize diet th. are specific situations which introduce di. nostie. difficulties. A number of these .: now presented, as separate entities. Definition and Terminology Mlicit confusion is caused !>y lack of miforinity ami clarity in definition Scarcely ny two states in tlieir statutes accept the ..line definition o f an occupational disease, a a few states, hernia is by law specified - an occupational disease. However, in the' nujority of states it is, when related to inhistry as a cause, classed as a traumatic ujury. In a few states, the definition of if occupational disease provided hv statute such that certain items later appearing on rhcdules themselves do not conform to he definition furnished. Well meaning legislators might enact a uv declaring that two and two make seven, at the mathematical facts still might rcinin otherwise. So with legislation in-, oleing occupational disease diagnosis, there 'ay he demands for legal acceptance of :rtaiu conditions as occupational diseases, hen elementary medical facts point othcrisc. One group of physicians may reserve c term "in jury " for exclusive use in con- lion with trauma, while another with 'oprictv may assert that occupational disi es of many natures represent "injury" * the same extent implied by the term r unuatUm." I.et im consider, for example, the occurnec of an accidental injury o r the one ml and a clear-cut occurrence o f an oopational disease on the other, both caused mi one and the same substance, hut under Tercnt circumstances. It might come nit in a given factory that a workman red a tank car, lately emptied o f ben, and in the absence of suitable protec; and precautionary measures might, bin ten minutes, become asphyxiated as esult of breathing benzol vapors. Mnn- tlv, such an occurrence as this would accepted as an accidental in ju ry and no ipcnsatiou hoard would ever raise a -.ion that such was not the case, n the other hand, this same benzol, i, from this tank car, might he utilized his same factory in some productive ation, giving rise to benzol vapors. Day ay, another workman might inhale some hose vapors. In due course, this work isurc might produce the usual and icteristic features of that occupational sc known as benzol poisoning. Here i it is most unlikely that any physician mipi'iisation hoard would entertain any uncertainty that this condition represents a characteristic occupational disease. Between these extremes, there is some point at which difficulties would arise in distinguishing occupational diseases from accidental injuries. This same situation ap plies to many other Substances and many other occupational diseases. There is per haps no w arrant for any attempt at a hard and fast demarcation in terms o f time, in dicating where an accidental injury expo sure leaves oil and an occupational disease exposure begins. However, there may he some justification for the practice of many physicians, who hold that if the exposure leading to damage is less than one work period, the ensuing injury should he recognized as an accident. Conversely, if the exposure period extends for more than one work period, then the resulting damage may with propriety be ac cepted as an occupational disease. In gen eral, it may he claimed that one of the disturbing handicaps to uniformity, clarity, and precision in connection with occupa tional disease diagnoses stands in relation to awkward legal situations, inadequate defi nitions, unsuited classifications and such. F a l l a c i o u s M e d i c a l H i s t o r.yi e s As a result of careful training, every physician is disposed to attach significance to the history statements given by a pa tient or members of his family with re gard to any disease. The less a phy-ician may know about the possible ctiologic facts in any situation, the more consideration he is likely to give to history statements. It is human nature to associate all of our ills with some particular happening or series of happenings. A cold may he associated with a particular period of sitting in a draft. A "astro-intestinal upset is prone to he associated with some particular alco holic bout or food engorgement. Til the case o f industrial workers, there is an especial proneness to associate any bodily ailment with some aspect ot work. Inasmuch as almost every workman hopes, openly or secretly, that any and all dis eases from which he may suffer may he laid at the door o f his employer, he is most likely to stress and emphasize the high probability that this condition unfailingly was produced by the chemicals, gases, va pors, dusts, etc. that attend his work oper- CA'i tll'iilt-itul / h.v</.i, ations. This docs not necessarily repre sent dishonesty or cupidity on the part of the patient and only may involve those hu man frailties shared by all o f us. Xo less, the history statement may un duly' iullnenee the physician in his diag nosis, may lead to misdiagnosing, may pave the way for unwarranted claims or law suits without any evil intent on the part of the physician. It is most unfortunate that the physician is all too often unable to appraise the worth of/Work history statements pro vided by a patient. Let us, for the moment, assume that a specialist in ear diseases is visited by a patient on account of deafness. In connection with the history, the physi cian may record that this patient is a drop forge operator. The physician may go ahead and make many careful examinations, looking for the cause of the deafness, from infection, from syphilis, from heredity, etc. If, however, he had obtained a complete work history', and was in position to evalu ate this w ork history, he might come at once to know' th a t this drop forge operator is perhaps exposed to as much noise and con cussion as ever arises in ordinary' indus trial'' work and that the deafness present clearly is an occupational disease, resulting from sustained noise exposure. It may be asserted that well meaning physicians, without any' evil intent, through their misunderstanding of patients' descrip tions of work operations have become re sponsible for a high percentage of the large number of unwarranted suits that have flooded the country in recent years. In short, one of'the handicaps to the proper diagnosis of occupational diseases is to be {omul in the attaching of undue significance to the patient's statements as to work con ditions, when the physician himself is un able to appraise their reliability and merit. Some physicians need to make themselves more remote to the fallacy that just because a workman is employed in a dangerous trade, inevitably any ailment must neces sarily be the result of work exposure. There still may be a few persons who may believe that lead poisoning may arise from work in making lead pencils. Tim e as a Handicap in Diagnosis Too often the physician well qualified in the field of occupational diseases, does not see the patient or claimant whose condition is to be appraised until long after that time within which the disease might have been diagnosed with precision. _ Without any purpose of condemning or finding fault, the fact must be faced 'that in many in stances the decision of a patient to blame his ailment on work causes was not made within that period when some or all of the characteristic manifestations were pres ent. Then, at some later time, a physician qualified in occupational disease work m;u be called upon to examine the claimant or to reach a decision based upon the exam nation of inadequate records of another physician who himself did not carry out any examinations with particular reference to that occupational disease for which a claim later has been filed. T h is is asking too much of the diagnostic ability of any good physician. On the witness stand, the charlatan al ways makes the better impression on a jury, because he is unhampered by the caution and reserve that guide the up right witness. Being positive is often merely a matter of being wrong in a loud voice. S The point is that the time to make a diag nosis of an occupational disease is that period during which the disease exists. Otiierwise, the most accomplished physi cian may be placed in an unfortunate po sition in the reaching of his decisions. Insufficient Training and Experience An outstanding drawback to the proper diagnosis of occupational diseases may he found in inadequate training in medical schools for this aspect of medical work. This is not a thrust at the doctor, nor may any complaint be made against medical ed ucation today. It may not be expected that medical schools will markedly enlarge an already' over-crowded curriculum to p ro vide extensive instructions with reference to occupational diseases when the number of cases yearly is so small as to piovidc only one for every five or six physicians. Realizing his own shortcomings in this field, a good general practitioner may hon estly shun this type ot work, but this step on his part may eventuate in even more undesirable situations. The patient, instead of being referred to a better qualified physician in this field is given no advices, whereupon he grav: S i/i'cr Juliini- .'nijL-ty C o u yrcss itcs toward an inferior physician, less cortriu-d with the lack of qualifications. The .tent to which lack o f qualifications in octpational disease work may go is reflected the fact that recently a duly licensed ivsician in the State of Michigan reported, i.testinal peristalsis" as a diagnosis of an ccupational disease. While the unwillingness of a physician to ccpt responsibility for pathologic, slates 1ill which he is not conversant is conicndablc, there still remains a duty to d i r t his patient into channels wherein alie nate services may he procured. Industrial Terminology One of the most annoying handicaps in itahlishing the exact etiology of a possible ccupational disease resides in the wideiread practice of industry in using code minds in the designation of its substances, m inquiry, the patient may state to his ivsician that his work consists of filling nitainers with "11-72." But, inquires the uysician, "W hat is B-72?" T h e patient intitules, "11-72 is a mixture o f M-20 with '-10 and 1.-07." Completely the physician left in the dark, but ii the truth were rown it might he shown that this patient as engaged in the filling of cans with a irnish remover, which consists of a mixre of wood alcohol, benzol and a syn d ic wax. Such situations may heenme so coniiisr that it may he almost impossible for : physician to obtain proper information to work exposures. Medical, safety, so1 service or insurance departments all iy have difficulty in obtaining full inmation as to actual chemicals and m ix es of chemicals designated in production rations only by code numbers. The Absence of Records "he majority of industrial plants fail maintain sufficient medical and work rrds to serve the physician properly in nection with occupational disease work, a given instance an alilicted workman give as bis occupation some innocujob as "elevator operator" He may reibcr that the job before that was as ruck driver." There his memory may His work record may show no items ;o transfer within the factory o f his employment and no record of any pres employments. Although the x-ray of the chest of this workman may strongly suggest the possibility of silicosis, nowhere on the w ork record may it be shown that for a period of seven years at some much earlier time this workman was employed as a laborer in a pottery, In this same connection it should be em phasized that one of the many handicaps to the physician in making an accurate diagnosis is to he found in the widespread practice of hospitals, of clinics, insurance records, etc., in merely naming the trade of a workman rather than describing his exact occupation. It is quite insufficient for m e d ical purposes for a record merely to show, for example, that the patient was employed as an "automobile worker." Under this heading, there are perhaps not less than 200 different and dissimilar types o f e m ployment leading to different exposures; such for example as to silica in the foundry, cyanide in the heat treating room, chromium in the plating department, lead in body fin ishing, and on and on. Lack of Library Facilities . 1 W ith some temerity the statement is inade that regardless of many hook publi cations in Ihe field of industrial hygiene and occupational diseases, special maga zines, and articles appearing in general medical magazine publications, there is, at this time, no condensed, informative m a terial on occupational diseases well sailed to the needs of the family practitioner. It is o f course impossible and undesirable that any attempt should he made to reduce all of the lore of occupational diseases to some thin hook to which the practitioner may refer and with certainty obtain all the guidance needed in the treatment and m an agement of occupational diseases. Granting all this, there still is occasion to assert that a real need now exists for a hook publica tion on occupational diseases designed for services to the neighborhood physician who in the aggregate sees far more occupational disease cases than the small number of specialists in this field. A ttitude Toward Industrial Medicine In times long ago, when mine workings, sawmills, and-railroad construction camps were established in remote sections of the country, far removed from the usual sources of medical services, it became necessary that the management bring into these iso- 'V L i ' l i l 1 1i.'. M ' latcd work places a physician who might New Chemicals carry out all manner of medical services. These physicians set the broken arms of injured miners; delivered the babies of the miners' wives; treated the miners' children for measles and mumps and otherwise at tempted to meet the medical needs of these detached communities. Usually the com panies contributed to the income of these physicians and every family and every single man was taxed a stipulated sum each month hr---o rd er to cover the physician's salary. Thus arose the term "Contract Physician." This perhaps did not always represent the best of medicine and not in all instances were these contract physicians of the highest type. Later some of these communities became larger towns, or cities, and other physi cians sought to gain a livelihood, only' to find that the contract physician was in the saddle. This gave rise to complaint and out o f this "P a n d o ra 's box" have come in numerable evils that even to this day a t A further deterrent to accurate diag nosis of occupational diseases is linked -up with an almost endless flow of new chem icals into industry's processes. Year by year, a far greater number of new chem icals arc introduced than the number of investigations referable to their toxicity. It is often true that nowhere in the entire literature concerned with industrial tox icology may any word be found aiding the physician in determining if a given chemical might be responsible for a series of objec tive and subjective symptoms in any patient. . One of the most desirable changes needed in connection with worker health protec tion is the requirement that no new sub stance he introduced into industry on a production basis until it shall have been established to the extent possible, through animal experimentation, that such a sub stance is without dangerous potentialities. Significance of Handicaps in Diagnosis tend the highest type of industrial medical supervision under the most ethical and commendable circumstances. It has be come' a tradition on the part o f many of the medical profession to blame almost any maimer of their economic dfficulties upon industrial physicians. So real is this dis affection that some organized medical groups have sought to legislate against al most any form of industrial medical prac tice and in some instances to deny m em bership in medical societies to industrial physicans. As a result, industrial physi cians in some respects have been branded with a scarlet letter. A recital of the type just presented might be continued almost indefinitely, but perhaps without profit. The entire situa tion may he summarized by stating that 9 whereas occupational diseases themselves are probably as diagnosable as any other difficult class of diseases, just about every stumbling block that may be produced is laid at the door of the physician sincerely seeking to acquire sufficient evidence upon which to make exact diagnostic decision. The greater number of these stumbling blocks represent no willful desire to hamper the physician, but instead arise from the results of peculiar circumstances that in This queer situation, strange to say, some measure separate industrial diseases may serve as a handicap in the diagnosis from the general run of afflictions. of occupational diseases, since some of the best physicians, and particularly the more timid ones, fear lest they may become be smirched by cooperating in this type of medical endeavor and to some extent slum any close affiliation that might lead to lifted eyebrows by those regarded as the leaders of the profession. As a consequence, large numbers of un warranted diagnoses of occupational dis eases have been made and are being made. Scores of suits have been instituted and some have been won by claimants whose claims possess no whit of merit, chiefly be cause well meaning physicians unhappily implanted the seed of possibility that hU Now that the American Medical A sso disease might have been caused by work ciation is somewhat alert to this situation and that the responsibility might be laid and has organized a Council on Industrial at the door of the employer. While the re Health, including some members with in sults may have appeared to work an in dustrial medical experience, it is to be justice and monetary loss upon the em hoped that after all the industrial physi ployer, in the long run the interests of cian may become respectable. the worker himself are not served by these r\ 224 Silver Jubilee Safety Conyress. spurious claims predicated upon improper medical advices. The usual trial of an oc cupational disease case is a travesty. The bombastic statements of some physicians, unattended by any iota of fact, bring into disrepute the entire medical profession and take aw ay its time honored traditions of integrity and skill. A further significance in the misdiagnosis of occupational diseases on the part of plijsiciaus is to lie found in unw arranted hardships imposed upon employers. Re cently a physician made a diagnosis of silicosis in two workmen in a given depart ment. As a result, widespread apprenhensions arose among the remaining workers, strikes were threatened, talk developed as to demands for high wages because of un usual exposures and the expectancy or a short work life. The employer was com pelled to spend some S.yOOO in the installa tion of an elaborate dust control system. As a matter of fact, these two workmen did - not suffer from silicosis, were not in any wise disabled, had never been exposed to silica; no silica or any other harmful dusts were created. There was no need for the expensive installation made and contrariwise other departments did present practical exposures (or which this $S5,000 might have been spent to better advantage in procurement of needed protection. T h e R oad to B etterm en t This entire discussion would be without any value if present day practices and sit uations only were condemned. More ac curate diagnoses as to occupational diseases arc badly needed. These bciter diagnoses will come in proportion to the extent that the changes now listed are brought to ac tuality. (a) The general level of knowledge occupational diseases on the part of the medical profession should be increased through the introduction into medical col lege training of a practical amount of in struction on industrial hygiene and occu pational diseases furnished by men who have had first hand experience in this field and are not wholly dependent upon textbook lore. However, it is emphasized that in undergraduate medical training this form 'jgf instruction necessarily must be sharply limited because of a crowded curriculum, but conversely more extensive instruction is badly needed under postgraduate auspices. (b) In every industrial community, or at least in every industrial state, there should be available for cooperation with the general medical profession a number of much experienced and highly skilled occu pational disease consultants, who, through limiting their^protcssional activities to this one aspect of medicine, may become highly proficient in the solution of occupational disease enigmas. (c) In every state and in some of the larger industrial cities, there should he maintained public institutions devoted to industrial hygiene and occupational dis eases whose technical services may he avail able to the physician in charge of patients who may be suffering from occupational diseases, and these public bureaus should serve as fact finding bodies, equally inter ested in the worker and his employer. (d) Much will be gained if all physicians responsible for the health of industrial workers in any capacity may make greater effort to obtain precise work histories, both present and past, and may seek to gain an adequate understanding'as to the work en vironment, its materials, machinery and possible exposures. (c) Controversies should be eliminated in the largest possible measure from occu pational disease work. Many abler physi cians eschew all connections with this t3'pe of medical practice because of the sad ex perience that nearly every case may be so involved in controversy, litigation, disaf fection, until the good physician may feel that he may be degraded. (f) A need exists for greater disclosure to physicians of the chemical nature of work materials to the harmful nature of ofwhich employees may be subjected. In dustry may have excellent reasons for bid ing the nature of some of its chemical ma terials under code terms, but more often these c o d e . terms arc designed only for convenience and not for secret formulae purposes. A greater degree of cooperation on the part of the manufacturer will even tuate in the hotter health protection of his workers through the more intelligent min istrations of the patient's physician. (g) Lastly, it may be pointed out that better diagnoses of occupational diseases will conic when the general medical pro- Oi l Hdl I '..M' li Ji. IcssioM, through its organizations, shall alter its attitude toward industrial medi cine, shall recognize this type of work as just the antithesis of the undesirable as pects of state medicine, and may come to realize that industry, under the guidance of able medical directors, is the meritorious source of numerous cases to he referred to almost every specialty in medicine. '1 organized medical profession whole-hcr. etlly should render its approval and supp. to the efforts of the physicians earne seeking to jjrotect w orkers fro m the m;. dangers connected with ind ustry's thousai of substances and work conditions. Necessity for Uniform Absenteeism Record In the Industrial Health Program By M IL T O N H. K R O N E N B E R G , M.D. Chief, Division of Industrial Hygiene, Departm ent of Public Health, State of Illinois, Chicago You are all aware of the value of acci dent statistics. You know that without fre quency and severity rates there would be no solution of the safety problem and we would he groping in the dark. But, since they are available, we know where correc tive measures are needed and this affords us an opportunity to correctly judge the value of one method of prevention over another. Today, the %;rip o f statistical methods is closing down upon industry, medicine, public health and safety. Vital statistics, however imperfect, are one of the chief means now available for measuring health, longevity and the progress of medical services in the battle against diseases. So well recognized is this fundamental principle that the effectiveness of a city or state health department is judged, in a large measure, by the accuracy and com pleteness of its morbidity and mortality reports and records. The same principle obviously should hold true for the g rou p s Q.f workers employed in a factory, mine, quarry, public utility or department store. These records are of value not so much to indicate what has been done, although this is important enough in demonstrating to management the value of certain work and, therefore, the advisability of contin uing it, as they are to chart future action. Insufficient data have thus far prevented the recognition of some healtIi problems peculiar to wage-earners and there is ample evidence to indicate that morbidity and mortality rates are higher for some groups. These excessive rates are especially u able for unskilled workers as shown the accompanying table. These death rates could only have L prepared by statistical methods of ana sis and, therefore, clearly point out wt: one phase o f our problem lies. I f ; nothing more than this we would he. plenty to do trying to uncover the mean to health among the unskilled group Q workers. The morbidity and mortality data down by uniform and adequate report of cases can also serve as a basis for j vention and health education among w.. ers, the same as is and has been done accidents. It may interest you to know that Eastman Kodak Company, Edison Ele. Illuminating Company, Hood Rubber C panv, Westinghouse, Metropolitan Life, . oral Motors, and several others have years made sickness studies with the of statistical methods. In this way were able to evaluate the different sic! problems confronting them and those mg attention, and at the same time these sickness records properly appr and evaluated, the> were able to ei . their employees regarding digestive eases, colds, pneumonia, tuberculosis, cer, skin disorders, as well as other merits. Furtherm ore, studies conducted in cific industrial undertakings have sliov value of statistical methods in row the incidence of such diseases as monia, tuberculosis, and degenerative Jo Silver Jubilee Safety Congress D eath R ates by Occupation Occupation I'rmtVsiit.nal men Slallvd worker Semi-skilled \v >rker Unskilled worker All Causes 670.5 823. 9 1009..* 1417 7 Tuberculosis of the Lungs >6.2 72. 1 102.1 184.9 Cneuntonia .*8.8 59.7 71.6 1.15.9 Cancer and Tumors 7 0 .i 85.4 90.8 106.6 Rate.' per 100.0(10 occu pied im lt- '. ba s e d o n t S C e n s u s d a t a in t e n s ele cte d S ta t e s . .a-cs to bo higher than tho average tor e entire industrial population. T h is was a-arly demonstrated in a pneumonia study ultra" steel workers which was conducted \ the U. S. Public Health Service. Drury, sonic years ago, was able to show high rate of tuberculosis among workers :i the ax-grinding industry, and the Barre, .'ermont, study revealed a high tubercusis rate among granite workers. X'o doubt, liter occupational under takings would reeal data for prevention, control and eduation were it possible to have adequate tatistical records as revealed in the slide i-t shown you. Hr. Selby of General Motors, in calling (tentiou to his statistics shows that about .0 of a day per annum is lost due to oeupational injuries and that includes occualional diseases as well, whereas, eight, ine or ten days per year is the total ist time from all illnesses. In Dr. X'ewaist's report for the American College of urgeons, the figures are about the same, his shows us that our industrial illness oblem is approximately fifteen times the ze if our accident problem. It is evident that industry could well lord to concentrate on illnesses among ige-earners, other than the occupational 'eases, because they are the ones that use the greatest amount of absenteeism d are the biggest drain on industry, lit the recent National Conference on :alth Conservation, it was estimated that : nation's bill tor illness am! prem ature tths amounts to approximately ten bil!, dollars annually, and that on every rage day about four million persons in United States are incapacitated by 11No doubt many industrial workers in that last figure. 'lie industrialist of today should recoge that a sick worki r is prone to ac c i dents, the ,/iuality of his work is of a lower grade, team work is disrupted, fac tory processes are dislocated, undue burdens are placed on other workers and the worker himself become.-- dissatisfied. If lie is oc cupied with weighty matters of policy and production then someone in that organiza tion must assume the leadership and ac quaint him with the problem by understand able and intelligent facts and figures. There are progressive industrial organ izations who may and have spent large sums of money for the improvement of working conditions and for the care of workers who become ill, hut without c u r rent plant information about the human factor much of this money and effort has been spent on "general principles" or per- ' haps concentrated upon the elimination of only one or two publicized health hazards, and only from the standpoint of existing compensation laws, as for example, sili cosis. But tlie extent of the health problem in a plant necessarily may not end here. With the progress of industry cspcrialh oil the chemical side, new health problems will arise resulting in physiological and pathological upsets. The effect on health will, therefore, have to he measured and evaluated. We must have data in order for one to judge the efficacy of methods employed to combat disease, so we must first know where health is being menaced, the relationship of occupation to these dis eases and the causative factors responsible T h e records you keep will he a guide to ac tion as well as a record of action. Therefore, I say, prove your value to industry since many a skilled industrial medical department has been limited in it' budget and activities because it overlooked the necessity and value of absenteeism re ports and record-, which could have been used to enlighten manage: .cut tegardit its O c cu/>atio u D scuse health problems. Perhaps in some cases the industrial establishment may find it d if ficult to undertake a complete record system of absenteeism. I do urge you, though, to make a start somewhere. It need not be too elaborate. 1 have heard it said that the best way to detect illnesses which are causative of absenteeism from work is by periodic phys ical examinations. I am not fully in accord with this type of prevention. It may be helpful where the illness lasts longer than a week or ten days, but something should be done about the frequent one, two or three day absences, ami I fear that periodic physical examinations will not help tre mendously. This, of course, does not mean that industrial medical services should aban don or minimize that phase of health serv ice. The industrial hygiene divisions of State Health Departments and that of the United State Public Health Service are urging the ' employment and use of a uniform code for recording and reporting absenteeism of the worker due to sickness. Forms and meth ods have been developed after a study' of some twenty years by the Public Health Service and also as a result of the recent National Health Inventory of chronic dis ease affecting workers. The aforementioned health agencies will gladly assist and co operate with industries desirous of setting up and maintaining records of sickness their particular plants. An analysis a evaluation of these reports an-! reco rd ' another service offered by them to tnanae ment. Before showing you a form on which collect your absenteeism data, and which c he termed the "master sheet," 1 should lb to acquaint you with several import: items that must he had for your recur before they can lend themselves to analy and evaluation. The form is self expla; tory except for a few general remarks. A card should be made out for each a; every employee on the payroll, regard!' of whether he or she gets sick or not. T1 is necessary in order to ascertain the ra: of those sick to the number on the payro The workers' age, sex, color and occupati are important to record since they will h a . to be related to the specific exposed po| lation. Under "occupation" state the work which the employee was engaged when i sickness began. The "date disability bega: should only be recorded for one full d: or longer. In the column "work days lowe refer to calendar days and this is neev sary to put lost lime on a comparable lufor all employees. F o r "diagnosis" o: should list the sickness or injury when tlv niteiy known; if there is any doubt aU the correctness of the diagnosis, a stateim Sickness Record Form A`a/ne. or Cloek A'<> Ih-pt. Oaat Ration -in; S ex Color Dale Disability Date Di.',ability Ended U'or* Day: . Lost {Caleudar days) t -- .... Dint;uosis IS? Whom Diasnosed 1 j ' lertnntaii | o/Cuxc \ 1 ) ' i ; ! i i l 1 228 Sik'cr Jubilee Safely Congress i !C, T " Vtums ^ I 'crienced by (lie patient s iu d be recorded. The point is that facts should be recorded and not guesses. It is given -disease for the entire plant, individual departments or occupations. niore important, for example, to know that 2. The time lost due to any given dis m r \ cn ,a ? ivcn occupation were dis ease or to all diseases combined in the en i;;i abled by `pam m tlie stomach" than to get tire plant or by departments, or occupation. ten different guesses of the disease or ail ment causing the pain. Another item of 3. The mortality rate. importance on the record is "by whom diagnosed," and should show whether the diagnosis was made by the family phys ician, plant physician, nurse or the patient 4. i he case fatality rate, expressed as the percentage of cases of a given disease which terminates fatally. himself. Under "termination" of case, one I he intelligent application of preventive should record whether the illness terminated measures, of control of health preservation in recovery, death, relapse or ended in a must have statistics and they will always, chrome condition. he an integral part in the solution of any The following statistical information and data are, therefore, possible if the Sterns listed in the slide just shown you are care fully prepared. _ 1. The frequency or severity rate of any problem. That it holds true in industrial hygiene is represented in my next slide which shows that the strength of any wheel is dependent on each and every spoke and each is dependent upon the other, otherwise your structure is unbalanced or collapses. ADJOURNMENT Ill mi mm mm Tli c . TU ESD A Y A FT E R N O O N SESSION WO(c-ctooDbeer 11, 1938 Steam K a lr " ^ 1S S(i f .deIcSa,cs to the order by Afr. w ^ \ v \ 'Vas called to .;Safe[y and Welfare ? n *>l,Pcrilendcnt ka,,road c -- <a Hidden Causes" President C ^ ^ ^ SARGE^ f *' Ch,-c--ags.0- aiud iN\oorrth VW estern P a -, jave seen the evolutionarv -ro .tl of accidlent prreventioonneV,O__!Uip nar'y *g>rroo"\\'tt|l)> siteenardiiNly-, ` *(ij.l_e C u. m . p* a n y ' ^C`hiixccadggo ' ccption, as applied , l ' rk frorn its in- ; TMads; A fa n y " f ,,s j ` Amc.rican rail : C. R ifla rd s intimately a n T d ' M r' Ka|l>h " o r k has progressai a n T e v ' ? " ,f Safet-' <a-v it has become -, ,, , vcd l,mil todrawing to its caiKC , MWI<Ie ^ ti v i n - : ^ a " `> nmhi,ions T ,0l,R'h he met from tin : cot,raging results ' tl,SCl,!i?ed ^ , frC(luentlv. lo " me "'th dis- l" ,cf t characters ,,'JCSt m',nds a`>d the iAt"n' |d` with "th"iss, hgreeaatteerr interest'h, ZslTM"c"tu'"re. 11 ,las 'on hot a. , L' T V M, ,,'e " W k scPc, theory and ro , " ' ,hat 'he whole -should gradually " 2 , " f `,le uder- l t the country. TM " t / ` soc`.il structure of ; S 7 ' In tiic beginning and p, ? reccnt `"es, the greates U.ntl1 rat,lcr ? "pun working rules and h P K1S,S u'as laid 1 f plant and facilities " '''" P 1 renditions ' " fc Place t d * u S ` a-,', " a'r " o r d s, a ; -'on m the world why t h e ^ " aS cvcry r ea- should he |)|-i(.(.,i ' Rfcatest emphasis ; v i r i ; 1" f f " e can afford lo le sse n o far `hat i tetauon lo these matters t " o r t': with have enlarged their r ,an'V' " f ll,c radroai, ni,d have come to t h e T e a ? ':' 0'-1 f t,,is u'or "',rk '`volves not i , * " S ' 0" lhat safet. and structures, and safe ' Saf wa' involves likewise a.ul u.f;;n '01,n<li''g.S hu ' a" CC' tilc 'c r y physical /' W,Ua' iml,('r- tmn and attitude of'the , ' " 0' " al Cl>"di. lumself. \ v i(h this , n , '/,l0-VC or mhcer -- a , ,,1 " 7 ^ >... bsuurrKg,ecoanl organil)zlaattion f frIom" .1`at,WoUt o-Cf h<iue"f' i 1er they were injurjeV " r " '`i'" 1 " 0," c" ;* conception has I,ecu e ,, h r o ' ,rad,l,all-v this # m|o a broader field and f,mK and changing $ 1 greater service s ^ CCtlcr service, if ; i " cnt no longer h a s V " ' ' lc' 1his depart healing ^ J * - ,,,, ,, / ,, t " 1' S ' , " ' hvrause if men are to J I" ' P 'rector," k,1w that they d accidents ue ^ le d with safe w?, ;d-V st.r- " orking conditions , k""n ' ^ a n d safe u,st '>c P h y s i c a l l y KV , `''emselve* 'e so -,,llec M ,;nm^ !a,|y :u,d "td ever present ,,,, s C,a" c"t. always "cd Hath if wc .^e 0^ / ? " Sta,,l!-v he reek- 733 , to View (on ra ilro ad rigid ot be perm itted w hen feasrcm o v ed . Jing should be given of rains by sounding the m accordance with the law I regulations. ' of these requirements will i-clves stop crossing acci only an airi to a general l' R esp o n sib ility S are involved in 90 per mg accidents. Since there automobiles and 232,902 'ade, the opportunitv for ; is apparent. The public, > definite responsibility in a and enforcement of such ' result in : rection of motor vehicles , '' cars will be barred from 'dation of the licensing of those mentally and phys- il and those with a record ng will not be permitted to i the highways not only als at grade crossings but tnsclves that the way is lpting to cross the tracks. 1e a r l y show that the railas their opportunity per'' S f t u a l progress in rcducIts. However, they have rfe motorists and thev are reach in an effective m an . it is necessary that the the cooperation of state attic oihcers in policing the T o s sin g s in connection with dies on the streets and plan of this nature--he als and the public--would t effective means of checkund reckless driving over The railroads as a rule taxpayers in the cities and 'Inch they operate and are operation. ties in education and law hicalion is merely a method Stcum Railroad 743 o i t i c S TM ; " " , , 11'0 Pl,Wic aS t0 t!le umber , u c , ' s' lheir cnil?es and how thev mav of d oornt,CVauitiotm^ oUbriiletlllaSccihdmenittcsdofaPail)lIickaitniodns ffifi-sr ss IS mtperativc that a similar ptocednrc be Sintkicrcnt im! c"erVta`irne mfotCoUrrbdr^iverrs c c k S J Nmety-tivc per cent of the motor drivers It isHt o Cr tr>;,arC Compcte,u ;lnd refill. t h e e n f 1h e m t h a t w e a p p c a l t o a i d US in .he entorcement of such rules and regulat' is as arc necessary to eliminate from our highways the one and one-half million drivers who are reckless and incompetent THURSDAY AFTERNOON SESSION October 13, 1938 Safety and Public Relations B y R O B E R T S. H E N R Y "1h"e tasMaiet,v0 m' hotvePmr Cen!t' d ",,m,miA. "__0_, i.,.,. 1 . n oonneI ooVt tthhfeetypro,nu0d.evset,nec!hlta'ptwerhs`chof cAonmsetirtiuctaens industrial achievement, naturally falls into 'vo main d,visions. Safe conditions n u t . .. e ' D ' uc aannd thhneir succefssoSUrsCCdeSidS' thHeojwob 'visel1tol^de yin he statistics of declining accident rates o hves and limbs saved. ' he aaTlssoo ccre'atIe11d, "a'6safit-reStstPaitaeCeo'f bmuitndd.iere must In these latter years, American industry `No doubt the pioneers of the safety s faced with the need for another sort of movement encountered industrial managers 'thing enough to install safe equipment nit skepttcal as to the need or , V value innssttiilTl s^aler w,a0yns ao"t-i Cth,Xin,,k0irntgat.io"Evnecrcydedmatno mt o ,andl rR f d conpcration on the p a n t only of those employed but of the "hole public which our industry serves. In the short space of little more than a century our American scheme of enterprise aanndd " mmbon1e3y' `anTd suhul>enrinwgi,l1 tchoesste hismkepttiimcse ias settled and civilized a continent. It has made possible a standard of material plenty t o l r V r 1,to "hat'Stheusc of Sin< a' n'da 'h-b'*e1n"igrhuln,knaonwd nunbkenfoorwen inelsthewe hheirse take care of himself !` him S ' e '11 in the world tudav. We are -,M r n i ,, third of the people of the nation are'ill-fed' tl m s a TM v c!- ; ; h' p i.< * ^ realized . ' ` - a - `lier ot the minds of in-housed ami iii-ciad, but a .j .i b- borne in mind that when this \ ; r t -- u -> ami - ,nat!er 'Xad!-cs. ot enterprise k c a n to function 'centum fi* did - r i n ^ n n r 'L ^ l ^ make a sare man. They fought their bat he tor saiety on both i r o m s - s a f e condi- tlir o u e l l e ^Ut( s a l c .dIlnhingas well, achieved through constant aeration and reiteration 01 simple principles. and a nah ago. practically the .;. !e pon'. um.ion was ill-tYH. ill-boused and according to our modern standard-. Mis take.- have been made, perfection a Ion" a y olf, but there is in the record o? achievement much solid ground for pride The early leaders of the safety moveiHeiit pioneered in a flcld broader ^ loday, as never before, tire host opera tion, the safe functioning, t h c \ , - r v exist ence of the vast and varied organization of safety " t 01 K al promotinS Personal rnrin a y pio,,ccrcd in hie field of se curing and organizing the wide-spread un- tlmir mCr and roo hcration without which their movement must have failed of its our economy of free enterprise, depend upon pubhc understanding and appreciation ' ' hat 11 ls' " h a t it docs, how it works what it means to all of us. ' I h e safety movement is built upon safe