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FILE NAME State of the Art Literature SAL DATE 1937 June DOC SAL025 DOCUMENT DESCRIPTION Proceedings of the 17th Annual Meeting of the Medical and Surgical Section - Assoc of American Railroads eeat y aVerts2, a om tA > oman mew de ed tee re PROCEEDINGS . 3ee '- SEVENTEENTH ANNUAL MEETING OF THE MEDICAL AND SURGICAL SECTION 4 t eys ve zsae aby ne cr ATLANTIC : . HOTELTRAYMORE | po WS ATLANTIC CITY N. JJ. . _ , JUNE781937 teak dicts Proceedings of Medical and Surgical Section 17 as wee on MONDAY MORNING SESSION June 7 1937 The Seventeenth Annual Meetinogf the Medical aunt Surgical Section of the Association of American Railroads convened it the Tray more Hotel Atlantie City New Jersey at nine flirty 4'clock Dr. D. B. Muss Chiz^rmiatipresiding The ChathmaN Merting Gentleneni we will now begin var Seventeenthi Seventeenthi Ainsi The first iteti on the jangkaut as albenheems ats skurke will her posso raber ! by the Seen tart oe Aumannremente ol THE SECRETARYT A few days motu Ereavivis Ereavivis the following following wife frian D r oe McCombe of the Canadian National Hafways dated , Tumento Tumento Vireally a regret owing to continued all lizdish amipre ils for me to altered atual tunt ing Section Regard Signed dule Mef Mandsch Da G. G. ~ ^wnall~ ^wnallIlluois Central Syztomiz be requested to wire Dr. MeCandy and carvey move that the Seen tary Gar esticine regiela at las unavoidable abes and our hope for his early recovery with lots of love eee The motion was seconded was jail to vote and usatuitously carried 0. The then wired Dr. MeCombe as follows Medicad Secretary and Surgical Section in convention assembled extremely regrets that illness Sra prevents yun from being present today Best wishes from all for a speedy recovery ra THE CHAIRMAN The next number on the program is an address by the Chairman I haven't an address but I have a few reo^-arksto minke on sub- ject which I think will become of increasing laterest to us as that is occupational disenses and I want to refer particularis law which was passed last year time goes by to the Minas OCCUPATIONAL DISEASES - THE ILLINOIS LAW By D. B. Moss M. The subyret of uncupational diseases tas berutne ,,m'atter of great inijsortance in the last two years and is of esteern to the employer the employe and the jbhe as well beenuse the bveldwood of so many citizens of the state depse depse nde upon the containing good health of employes working working in these recognized hazardous ureupestiones I chosen this subyret lur discussian discussian for the masel that for the past year have been a fiber of a committee known as the Ruiway Engineering and Shop Committee Thas committee was apponated by the e me e an n. 18 ve ee Assvention of American Railronds ee cee pecs ca nn cea ane te me rm ae oe ne rT ad Grueral Managers Assurintion of Chicago to make a survey of present practices and equipinent of the railroads operating within the state of Tilinois and submar recommendations which would serve to bring these railroads into substantial with the requirements of this new law There are 31 Class 1 cul- compliance within the state and considering short lines there are 74 roads operating railrund corporations more or less interested in the subject of neempational disense This investigation and the reports which will be issued will be of the Kreatest importance to these roads and may serve the interests of railroads in uther states because the imlications ure that such legislation by other states . will not be long delayed Trum time to time this committee committee has issued bulletins recommendblog pro- cedures designed to minimize the risk of expuisure in necupations necupations known to earty Forty a hazard and which are of unaidiste concern to the railroads six states now have Workmen's Compensation Acts which provide for compensation for secubental injury causing disability or death Recognition of the peinenile of compensation for occupational diseases has been slow and even now uniy l i states have any provisions for compensation for disability or death due to an this occupational disease Many of these states do not provide for complete coverage The Illinois Occupational Diseases Act was approved March 166 1936 to take effect October , 1936. Acentapinying Act were two others-- the Health and Safety Act and the Grinding Polishing and Bulfing Act This liter is a tenporary measure bridging over the period until the Industri Cisimmission establishes rules having the effert of law to replace all previous legislation in ortaintelds Section 6 of the Health and Safety Act provides that the Industrial Com- milsston may appoint an alvisory romanitree to suggest rules or changes in existing rules Representation on this cuentattes must be equdly divs iest between employer and employes is under tlas provision That time Railway Engineering and Sheep Committee nets in assisting the radway member of Ma nitier Section 2 provides that this Act shall apply to all einplovers stigaged in ans varempation knusinea ur enterprise in the state of Illinois and their etuplayts etuplayts The only exemption being the agricultural class Section 3 provides that it shall be the duty of every employer under this Aer to provide reasonable protection to the lives health und safety of all persem^ persem^ employed by such employer The Industrial Cantiission shall from time to time uke protuulgate and pullish such reasonable rules as will effecrnate such purposes Section 4 provides that to effectuate the purposes stated in Scetion 3 the Industrial Cominission shall make rules for a Proper sanitation and ventilution of all places of employment to guard against personal injuries and diseases b The arrangement and guarding of machinery and the storage and placing of personal property to guard against personal injuries and diseases c The prevention of personal injuries und diseases by contact with any poisonous ur uleterious dusts vapors gases or fuines d The prevention of personal injuries or dissures caused by exposure to artlicial atmospheric pressure It is alas k meer baist thus The tupdosye TEISM SMILE HER ] JANAJES 2P~ , actionant fixes Untak at the papirsoviel papirsoviel wire expressly or mi whole or u Ton of the r empit ver This pertika Warktneu's A Tituly when ^ ur eserva^ureserva ^ ur eserva18 topomp y topomp y we se take such % ik modders under the c Health ami tatar vad surak in Jess than 4 atfence. Beng Beng naveins tha a Pt eee hey thee ie where than Ha taalers je ae ee Npucceatgs Cae t reer ee CS Neadateda th pow Pas that wo hiea ATTANEE 1're ation and less expe das virvviervelope lviroveploepe opposes tlus that they stan caplay~-n caplay~-n avipuire the 4t tion One of the The propuga propuga tom ie ae sewer mimes. Eien tention vat practiers Ad sE is und zubmit dk ** substantial + Class I ruil- l^,seuti 78 one Cfned tester .ot lan unf Pla Tandrude Tandrude an ular states states pote kok tekarty Tessas abides Oates fin parano parano ajaloo sof soos only 16 ht (= For 7125 ola* 16 ATR. ete ' 2 Ant This Industrid all previous -trial Comchanges in dis divided ne Railway arbor of the aged in any einployes der this Act all persons -te time tri vilretuate 4 the mi ventilne t Ue-rnseg, al placing 1 The idibus ut A persunit Ollry, Qe ProcTeeedings of Surgient ene e el er re Medical and ens mem ee eee Section wom ees ee 19 eee It is thas law for the prevention prevention of disease our best thought The or injury which urgently demands demands The employer may elect tWooorpkemreatne'sunOdcecrupitastional Discuses Act is optional with the industrial Commission provision by simply filing notice fitrited to the provisions of the AtcotthaTtheeffect in which rase las hability is utidier tar employer who chooses to retman 174 coatanod Isw tukers The tritete His halbty litauted ; aturant fixed by the jury after weighing all of vrily by the trial of the the evadesev presented in the vase except except that for death the provide ander the maximatio es 10,800 It is birth motzanoon kaw that at shali mid berze lberze edense that xpres ly xpressly or atpliitly atpliitly assumed the rack than the denser thke apljkaapljan n kapljan in whole or in part by the un diezathi stim cau e negligetirerad negligetirerad negligetirerad negligetirerad a follow servado servado tion of the rules of the Elemhh and Safety Art shall Also that when vandaa etuployer non titule migligeten migligeten of the conpitsation The primary purpose of the Workinen's Warktien's Cotupassition Act verapational Diseases Art like the is to jaovile security to the employe and lus futruly when he overtaken by the tennedy si disability death The purpose of the Mezzdeleaned Mezdeleaned Mezzdeleaned Safety Safety Safety Ner slanuggle slanuggle thus perhaalties perhaalties pirotruded forprfaarmlarnye toromgdy with its provisiotis provisiotis ^les volupe the emudisyer emudisyer to mistali sidduty or take such other action as will sidduty deviros Beit understood that protect the employee fruita arrident on diseases no employer whether under tjur under the conunion law is relieved of the connpitsacontnpiitsoatinon art or Health and Safety Act The beerssity of complying with the line of not less than penalty for that first failure upon convirtion is a 25 and not tauire than 100 nnd subsequent failures legs than 50 nor more than 200 offertise not Lach day of future constitutis a sepurate sepurate Referring again to the provisions of the Occupational Diseases provides that under the Act the Act Section 5 " necount of employer shall be liadife for compensation ou un vccupational disease which occurs within day of the fast one year after the last exposure to hazard where the liability extends except in cases of silicosis and asbestosis to three years Section 3 provides that the employer under the conition law is liable for three years after the last exposure to the hazards of the disease and that day of the list in case of death shall be every suele action for datmages employe and witlan commenced within one year after the death of such five years after the last day of the fast - hazards of the disease It is quite evident from these exposare to the ployer is not immediately quit of provisions that the em- service from any other cause an employe who resigns or who leaves the humane Prevention of occupational disease is of and less greater importance importance more expensive than the palliative of paying compensation compensation after hus developed The principle of this law is the disease opposes the idea of sound and believe believe that no person that the compensation for disability or death whenever is clent immediate cause enne be attributed fika hazand which na employment The is associated associated with require the intelligent cpoorpoepreartaipopnloifcation of the how will be dilbraft and wall tion every agency concerned concerned in its administra- administra- administra- . One of the dangers lurking in the Workmen's the propaganda in the educational Occupationul Diseases Act sa program of the State Depurtinent of Labor ae we e 4 -- -- * es . Bey ay e 4 * aoe r) ' 4 a i : 20 Association of American Railroads ee er When this Act was approved a year ago thousands of pamphlets were printest and distributed throughout the state describing in fragmentary way the symptoms of varions ocetipational ocetipational diseases and the kinks of work which maky cause them The only juurpose served will be to create a fear complex ami every emplove who becoties ill will imagine that he has an urrupational urrupational disease or the one discharged or relieved will ammagine or malinger mmny of the symp symp toms of some ocrupational disease and a claim will resuir bebeve this is more apt to verur tanker the Act than under the cutumun law In the agitation which has led to legislation in the last two years sibersia sibersia has been emphasizerk altuent to the exelusion of other diseases which which may haves haves un veerupeational origin We may avept as axiomatin that dust from whatever source an excessive amount injurious A recent comment in the Journal of the A.M.A. states that only silica is capable of imbucing silensis but that other mineral dusts under prolonged and gross exposure nay culise sotne in- an erease in pulmonary fibrosis If the relative potential harm of silica is rated as 100 then other toxie mineral dusts may be rated only on the order af ^or 10. Dusts in industry are inemed by produces of abrasion gritudiner polishing blasting and the like Such lusts are not altered in any way but maintain the _ these sume chemical composition as the material from which they come the only difference being the particle size The smaller partieles are and the barsler and less s^'ublethey are the more apt they are to cause peri^-amentchanges in this pulmonary tissue There are two schools of thought in regard to the method by which silica causes siliensis one being that the hard particles of silica cause an irritation producing a defensive fibrosis and the other that the silica in the body undergoes a elemnied ehunger and becomes a cellular poison > The evidence appears to favor the first view Salien asbestos und lead are the principal ozlatanves generating toxic ibists Salien to w achnabway resplages resplages may exposed Tithe Tithe we may perhaps perhaps add co^l dust generated in festalling enak trom msar to evasi elaute or other emel^'sestemel^'sest places jacmpe this is exressively daty work A immint preliminary import Mask sted H"yth iS. Palder Health Service in study study of lavalth conditions mellubtag of p~-l~-ysical Vannination 2711 miete in three perpresentative matlagsents con mates Pen sylvania in PennsylvPaennnsylivanaia The presenerid presenerid aut hrano hrano salicusis salicusis ataing ataing the group was 23 Amoning a control group of bash mining etapleyes etapleyes where where dust exposure exposure Agta byss than 5 million particles per cui iti tai rases of antiarris antiarris were found 27 Manng employed more than 27 years invalist invalist qitainntagqitantag ^malleoni malleoni to 99 million partieles per eu ft with less tikate 310 salien 70 developed developed developed aan- thraenesinensis Where the dust contained anilion for 1919 suillien posutichs posutichs 8907 per 54 of the employes developed antiraco and with the dust evantaining in excess of 300 million particles per eu ft 8907 of the employos exposed developed anthraco Analysis of the data for the purpose of determining sufe limits of slust exposure indicates that eraphyment an atmosphere containing less than million pactirles per eu ft Winkl produce a negligible number of cases of anthruco when the quartz content of the dust was lesa thun 50 Where the silica content was about 13 a sufe linut appeared to be 10 million to 15 million partieles per cu It is obvious that avoidance of great exposure to toxic dusts and other poisonous substances sseuek coh vel et cun difiedam 1 slinece s. A Loses pre AS Peer - phattoe chasks t okus , Jak Salet Act a Balu die eifert meemeen n Uae operative operative elf Probessiona Probessiona Probessiona k demiestach demiestach vi Mencal en ext isitng isitng ++ sobeod da. rivet de bee laboratory IE setleteideael alt ITVOMEN saka Eu tore a^ ^ a altacie altacie prezarl~- It .s leg ployes when Sealtetaeres > Or ate trey ube beet lat re . Lapeer gothion j- kivan kivan OF Vee tee ^rsp ^rsp Sober are oat Pirate hee It Pae Ot s Re ttan an ' a 11 jin jin Pa a Ler 4 a! orbs! or in appled appled appled chose chose Substrulang Utglotre sol of ya) eae Tattler TH anse Pes protective e ee ee Proceedings of Medical and Surgical Secton t ~ ae To - eee eee uphlets uphlets were printed niedin, Komentary way the of work which may ** tear complex and entice cupational cupational cupational disease amay at the symp- to free this je morr used in or generated by manifueturing processes and of unfavorable unfavorable working conditions is the first essential in preveksling preveksling and eindroilings ovenpational ovenpational ; disetuses A large part of the problerus which will arise will relate to the qui stivan nat disability and will bus morheal problems consentiently the mendiral protesstundi partiendarly those wistare wistare interested in the invaustatal invaustatal phases of mediense mart - 4 Ver ate sibrosis solve them The probletts which will arise the appbcative in elissaran 3 Safety Act and the preventione anal anal control control ni vemagat vemagat vnal of the Heath Heath and elissaran will be en + barl~-may have ast finan whatever seat at the Joustad Joustad sherein sherein but that it cal~-s~-setter in- gimming foot the less it is atuportent atuportent that natural ota fate ... :: 6 the engineering dratures in orth to assess the peoper value between m Ld effect It apparent Heroin th"tprevs bitten and entret shetisch te ot Bh e- operative operative efeatz of the vaginevnar vaginevnar and the pushead pushead protowers 1 111 ben professions that industry and labor alike must look tea zaluatio en Ba pard Jenis which arise + 4 zdiva is tated as 31. 176 sister of 3 or zrazi kong pashashib^' inat Bantam 3 Bre Lit suplemahlinug sup lemahlinug Medied control coteists of careful premet~galoytoed koerspational koerspational Desirey oa i extinding extinding over a period og ikke vendre at kast and supplemahlinug supplemahlinug sofonia sofonia jtreeti ployment history a caretul phgorical examination pavatio pretfacich Fram te the ~ uly the burder i changes in m regard the - hand particles uf the other that the cellular pesisOJE de rakattuxie dusts nifeditiot be any signes andreaturar diseases on the basist in lung , adikaadika by zUA ead laboratory investigation investigation which tha physical findings tuny suggest The en vironment in which un empluyn may be required to work mackes peressary this 1 inquiry into the personal and occupational tis fury to tun that rivere is bas ae asevi bali history of previous exposure which may lave caused impairmutits atid ni endis dition present which may be made worse by the scempation It is important also that careful inquiry be munde intre the history of etu- ployes who come for aid if a correct diagnosis is to be made and a proper bulance struck between diseases which are unfavorably influenced by uerupa- --8 thaps add coal tion and other diseases in which occupation has no bearing Therefore periodie berenclosed places physical examination of all employes in so far as that is possible is important v report report was issued In occupations in which known hazards exist stel us where workers are ex- unikitanitis ineluding posed to lead or in sandidusting examination should fit funde annually rT sellaacite coul mines or nuare frequently whenever there appears to be indications for doing so with the group was 23 transfer of employes who mebecoming impaired to less hazardous work > re + dust Engineering is enneerausi ^fin investigating the necupational envirvadvent exposure was Braevosilicosis were estimating the hazards seentifically and instituting the proper methods in control and thereafter supervision to make certain that the safeguards whel She are -maining 5 million have beenadequaadet quae te nil their perfotnance effective Whether tha ot an ve7rm"idlleivoenlopparetdicalte-s comers mutter is removal of silica du roul dust or the dust or fumes of lead or zmie oh bed with the dust The lasie principle remains unchanged by a metland best adapted a si the employes meeting meeting the condition to be solved We have fun enusideration enusideration use of mechanical devices such exhanist 1 The a the purpose of as ventilating systetus applied to the sogdyment in su room or to the pkoit as a whide sir focal exhausts through a surtion lawat it would produce applied close to the point of dust generation 2 Changing the processes spiariz content of Substituting poisonous materials for those known to be poisonous substi- start 1392 a safe 11 11 obvious isotintas sulastances tuting wet grinding for diy gunding or changing from natural saladstate grinding wheels to artificial abrasiva wheel which are harder and codstain but littloen an free silica 3 Personal protection Controk hazard by of treates protective equipment furished the individual employe provided the desser ( NX ' 22 eon Association of American Railronda ee ee em - ee ke cate ee ree e memem OERE am eee om is effective and the employe can ba ih pended upon to wear it continuously continuously while at work Thereafter it is a matter of good housekeeping that the atmosphery is maintained in state which is not a ins card to the workmen All dusts and all poisonous fumes may not be cuniletery evadirated but they may be controllesh und restured to degree which is recognized by sunitarians and by experience to be hazardona This can be necomplished by fresquett dust rounts of the air at joint where dust is generated or chemical examina- won tion of air samples where deaud ar ullar poisonous materials are unei Sandblasting is perhaps the must shuigenius dust producing agency to which em- ployes may be exposed because the sand used is a pure silicu which produces a veritable dust fhaal Samllilasting has come into extensive uso on railronds in recent years In the shops is used for cleaning and polishing small articles It is al te used in removing paint from enes buildings and steel water tanks - preparatory to repainting Used indoors it is imperative that all employes be proterteil consequently a proof cabinet ur rooni fitted with a local exhaust system will be required Only the air pressure mask is safe for the em- ess plove engaged in hlasting cars or buildings and this work should be dune only when other employes are not required to work in the vicinity The air hose should be long enough to bring the air from outside the dust zone or the og air should be washed by being forced through a water bith ED ^ respiratur is a filtering device for removing particulate impurities from the air and is not effective against gaseous impurities Special masks for this purpose are manufactured The essentials of a respirator are a close fitting and proof face piece covering mouth and nose with a numimum of dead spare fu prevent accumulation of carbon monoxide the inhalation and exhalation es valves must not cause effort in breathing and must be proof the filtering device should have an exposed surlar mira large enough to pertent dive breathe zug the filter dises sluzuld be ensity removable for replacezaent and the ress pirator st^,ould fit comfortably and not obstruct vision and should permit of wearing spartacles on goggles There are various 13 p^soil respiators which mag lar useil f^...r un^flfoxie dusts or for short exposure la tesie dusts would revominend that only respirators and gas masks w ^chare approved by the 17. Bureau of Mines for furnish^sk to employei Silicosis atid sisbestosis are strictly dust diseases and can be contracted valy by breathing silin or astaistas dust Fru ponsuning is tinist frequently contracted by breathing the dust or fumes of leuit rarely by ingesting leak Prevention and content therefiar consists of protecting the employe against exposure by the weans birst adapted to preventing the generation and dispers sion of these harmful dusts THE CHAIRMAN We have received the following wire from Mr. J. M. Symes President Assorintion of American Railronds sure having been addressed to Dr. Bartle as Chairman of the Program Committee Washington D. C. June 3 1937 Dr. Harvey Bartle Your letter June recoil expected development here in Because of some pressing mutters of unWashington it will be impossible for me to wen altrat with y very 1 and te Tax Cu speaker Bie. Mes | pleasure to Last speak una vre Fustern Mr. R.t than first til ways been i Twarju Twarju at the sewal tur f^rmpa have be atuk they w da Luxu chebs th: tee Ot ob flore flore late spariching spariching spariching is 10 plate Tees Pray ratnikols an 1 11 pore Sadeete of themaginat themaginat themagint eUL Deets seneced in Cimgres Cimgres property property a 51.5 ist lanen state begrebe organized organized a simply start very ebseit atig listen i Man^voles reliva eee bo Few hh eee eet mee yee Remanceme ere ee Ich a number of con- 4 detail mention of on a a, . FIKIJITION Muss Chuirnteurs ander the Come test L rExo Chair- That as the reasoill the names of any Camditive on DisDo Uumlufter on Proceedings of Mediod and Surgical Sertion uh ASSOCIATION Circular M. & S. 190 OF AMERICAN re a oo ee ee RAILROADS MEDICAL AND SURGICAL SECTION ee rr me we REPORT OF COMMITTEE ON DISABILITY AND REHABILITATION a re nn ere Dr. J. D. Collins Maarians , Chiel Hawkward Air Lane Huilway Dr. 1. Uues Chief Surgial Rock zhund & l'actie Kaiwny Sarpoli Sarpooli Chicanen . , Dr. W. Lidicaster Sapevantsudeat ^Meli cal Director Helet Ikp^/rlinest Ikp^/rlinest Akinkis Akinkis Christ Tara Raitond Dr. Jo us Meth phe Ch Medical Omeer Canadian National Radwayn Radwayn Representative from Ostamite Ostamittee of Jurectom Jurectom Dr. 11. Guraer Chivi Burgrini Wentera Kanwas of Alufsuna Nis Young V. May 6 1937 To the MuDEM AND Surgical SecTION Your Committee regiris that is unadide to offer murl new material in flas An endeavor has been made to irview some of the previously dise report cussed subjects and bring them up to date We feel that in the future this Committee should undertake more research work in the rehabilitation of ente ployes who are disabled on acroaint of injuries and diseases The Committee Committee will welcome any helpful suggestiunes in this connection The Use of Sodium Chloride by Workmen Exposed to High Temperatures ; During the past thirty years numerous articles have been written on the * use of sodium clioride by workmen exposed to high temperatures following investigations by physiologists physiologists and various medical officers of industrial concerns It was noted by the investigators that exposure of human beings tos extreme heat causes both heat cramp and heat exhaustion These two conditionis are essentially different as regards symptoms treatment and prognosis In head crumps the etiological fuctor is a disturbance of the met salu t mb etu- b- olism whereas in heat prostration the cause lies in disturbance of the thermo regulating system In heal prostration the complaints are of weakness heudnche und vertigo all of which develop so suddenly that often the victim collapses at work In cases of heat prostration the worknun is usually fit to return to work within two days whilst in cases of heat cramp it takes four or five days for restoration of body weight and of normal blood picture as far as haemoglobin and salt are concerned Heut cramps we also often called Miucts Crumps Musele Crumpa and sometimes wrongly called The Bends The condition consists in painful tonie spusius of any of the skeletal muscles but usually of these most actively in use Ur ae a Sty WETSae _ fe? PSPai t VIN QOMTNt wl TG a ue mt pee Lage * ef) le Rr ear e WG 2F5R a we. La wesgt ae i er 7s aE _Sameh pe eae ce or 1 woeeremaen: = 04 6 one m e sav = = a. -e- Sno oe Pre same: ey, tar oe 72 Association of American Railroads Railroads 9 Railroads tee ee Except in quite young employes the danger of dementia In any event if the employ ' begins to praecox is slight _ slovenly has occasional get seelusive alstructed inattentive investigated with the temper explosions anit has fanciful ideas he should he hand if his possibility of dementia pruceox in mind On the other change of personality is such that he is that he is persecuted will not listen suspicions accusatuty accusatuty feels difficulties to to argument and wants wants to carry las some high authority a trend toward the development may be suspected development of parameta There are other forms of nervous ami mental states which Taaving out mention of the dangers of aleokolism might be dismissed there is another danger of which we should be arute periodie or chroni~ mental state brought on by drug taking on the outlook and that is the among railroad and other hard Morphinism fortunately is rare in the habit of working men But what we do wish to imentiona taking all sorts of the easily obtainable depression drugs of the barbital and similar groups An employe who is found to habitually in any excess should at first be use these drings examined and cautioned and then if he persists in their frequent use he should be removed from dangerous positiun any potentially In the handling of mental cases it is udvisable to psychiatrist and also members of mental secure the assistance ni a care and rehabilitation institutions in order to provide proper We know that we have not of mental conditions in adequately discussed the occurrence and humelling on firm railroad employes hut two things we feel certain of and ground first that we can attack these problems with beneficial effect only at the price of eternal any hope of must be firm in seeing that the vigilance and secund that we from a suspected individual is immediately witlulruwu responsible position and put under psychiatrie care Paeumonoconiosis Pneunionoconiosis is the dust Silicosis is the reaction of the lungs to the presence of any kind of uf silicon reaction of the laity especially the lungs to the presence dioxide or silica in finely divited state It is During the last few widespread fibrosis industrial world years sdiensis has come to hold a prominent place in the because of legislative actions Silicosia is Cullis gives a very complete an ^,kt borase erates up to the inport on the literature from the time of Hippo- present Little was written on the subject until 1717 elen Ramazzini wrote his fanmis book Diseased Tradesmen The Committer on Pneumotionmiosis of the the American Public Health Industrial Hygiene Section of breathing air containing silieAnssSociiaOtiocnhadreafcitneerdizseidlicosis as a discuse due to fibrotic changes and the development of anatomically by general clinically by shortness of miliary nodulation in both lungs and for work absence of breath decreased chest expansion lessened capacity of which fever increased susceptibility to tuberculosis some or all There symptoms may be present and by characteristic ray findings are at least two distinct uente and chronic as early na 1713 may develop in two reported common type takes from 10 to 15 years or even less Chronic must years or more to develop wey Etiology The plumaty It has imetu fora into the lung barst muist in fact In djust potatrafzl~-k potatrafzl~-k a lust mayraakala terburquie terburquie ai du Stannkandizesh by measured in tra The probabil ' silien dust dje that des har TRI U 19 its quartz cute ous is that rangi particles renditiky of clust Wani preciprecsiselyeplreciysely as ther is also a duetur Servien waES JO Intet od alkovai.l of air for worker fummit would pure physsend characte characte tha length n^ata 1. S. Puolue H .. besaviest dust tin nach der four yea maze of sale sale aspe Pathology Aerosslang to k ants the durch at up run it rapistu rapistu speresz tty fea tae oe vee Ve Rhenty carer tee 1+ Crsmes, Yb M Degenerative Ki Ki increase in size 1 modules Fixe ... Symptoins The drar as description and is First stage >: indehnate indehnate Man / often with recurret ewe nme Theme tn 6 eee ee ox is alight mattentive . -l oulel fa te the other atory frela to carry his . paranda paranda . discussand za chatonie Abt ae tee Si y i tate be dune tens vera's ed the Mese drags sel then af i feataddy ca of a (~ trees aling and and and hopehope of at that w wathaliawn any kind of Le preseljen preseljen kad fibrosis pdate in the odel disease of Happ 1717 when Section of prese due to Ey yeu ral Jungs and .1 capacity clue or ult It dings to porteil Mingel Mingel ct a SAM Re oe oh RMB cweh ean te Fem d ee Home A ale ae ceadeben Ce nnle ae 5 i aA ee 2 Ost eae m2 . *. * lat. tw ere Proceedings of Medical and Surgical Sectione 73 Etiology The primary cause of silicosis than is free cilien abuted in the form of dust It line been demonstrated that thus dust in order 12 gehieve its harmful effects un the lung tissue must be in fine state of subd's son that the dust purticles must in fact be less than 10 mierons in their gresiest dintueter Most of the dust penetrating the alveoli is less than 5 microns diameter It is therefore a dust invisible to the nuked eye and its estimation depends on a definite technique of dust sampling and counting This t^quelins been defined and standardized by the S. Public Health Servin Dust concentrations are measured in terms of mullion partieles per cubic svet The probability of noe arquiring siliereis dije als upone 1 Nature of sthea dust depends upon the mineral cotajwisitive < than dust Knopf states that the harmfulness harmfulness of a quartz containing dust issally issally is its direct ~fl raportuoti raportuoti - a ^finits quartz content 2 Size of purticles of due pruladdy the must dangers nus is that ranging from 2 to mucrose de amid beradise these imupartprzdile thes particles readily remain in suspension in the air 1. long time 3 Qautidy uf dust . According to Loriga Loriga the quantity of dus teressary cautiol li g ych precisely as there is more or less individual suses isalso factor From the results of study nurt bility Rate of respiration by the U. Public Healtre Service it was found practicable to suggest real tive standard for His uppes limait of allowable dust^>missdust^>miss between 10 and 20 24 particles per culje kont of air for wurkers exposed to dust resulting from granite cutting The same limit would presumably be applicable the case other dusts with the same physical characteristics particulaly with a quartz content of 35 per cent 4 Length of dust exposure In an investigation of the gratite industry the _ U. Public Health Service found that in group of workers exposed to the heaviest dust the first case of silicosis appeared after approximately two years and by four years all in this group seemed to have developed at least an early case of silicosis . 4 : Pathology According to Gurdner silica particles smaller flaum 10 microns are inhaled into the alveoli and are taken up by phagocytes which carry them immediately ' up the lymphatic channels from one node to amstfoer towards the hilum The speciul irritation of silica particles seems to enhance this movement After Joenting in various nodes the irritation continues and the same type cellular reaction occurs that is seen in tulerele formintion except the tuberele becomes caseous The exact cause of formation of this fibrotic nodule is still in doubt Degenerative changes take place in these joci and the hyalin indules increase in size by extension of their periphery nid enalescence of adjacent modules takes place and brings about involvement of further arens of the lung Symptoms The disease is divided arbitrarily into the stages for convenience of description and possible compensation purposess First stage Symptoms of uncuniplicated first stage are few and often indefinite Mun apparently well but has dortness of breath dry cough uften with recurrent colds are most usund symptoms Earliest Earliest specifie indien VOLENTAJ VOLENTAJ . VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ VOLENTAJ ated Saye ter arte ce TPS sis te SS PY at +, aes rtinan re i Ae ee se, -_ ee ee ee ie Ter cad Cra mt Am we e o Pore om. 74 Association of American Railroads A te Om Oe ne vem tne en ee ee ee tion is the ray appearance consisting of generalized generalized arborization thaoughout both lung fields with more or less discrete muttling This characteristic mot- tling is due to shadows enst by the discrete individual nodules of tibevis tissue in the lungs and is essential to the diagnosis of silicosis without this finding finding the diagnosts of silicosis is not sustained except by autopsy . Second stage Detim'e shortness of breath on exertion pain in chest dry morning cough sonwtimes with vomiting and recurrent colds more frequen dyspneie un exertion and chest expansion noticeably decreased ray appearance generalized medium sized mottling throughout bath Jungs Shadows of the individual nodules are discrete and well defined on a hackground of fibrous arborization but there may be some larger but limited npmcities due to irregular pleural thickening or aggregation of nodules Third stage Shortness of breath murked and distressing even on slight exertion Cough is more frequent expectoration is in most cases slight but may be copious _ Individual's capacity for work becomes seriously and permate nently impaired chest expansion is greatly decreased jusen flesh pulse rate increased and heart may become diluted ray appearance further accentuated mottling more intense nodules larger and take on conglomerate form so that large shadows are shown corresponding to areas of dense fibrosis Diagnosis For diagnosia a thorough and chronological occupational history is extremely valuable Evidence of exposure to silica dust or lack of such evidence umuust bo of significance The cardinal symptom of siliensis is shortress of breath and the cardinal sign is deerensed chest expansiu the earliest specific indication is the charae- teristic ray appearance The diagnosis however should be made only by the curvelation of all the furts symptoms signs necupational history and Iuboratory und ray observations observations ere In autopsy according to MeNally MeNally any hung containing over 2 mng of silicon dioxide per gram of dried tissue indicates undue expozure to a dusty afinos sphere ; Prognosis Silicosis in an incunable disease but the prognosis in the early stages is gina if the patient can be removed and pluced in the open but with the advance of the discuse the prognosia becomes less favorable principally on account of the lability of tuberculous infection Treatment ChangChangee of occupation to op open en air work ; high dry warm elimate best Prevention The use of various mechanical incans of elimination of dust both the forma tion and its removal Employes entering service should be questioned carefully in order to obtain complete history especially of any exposure to adieu dust also a careful phyne exam Tissue fis^dragi da odd orbergel arul of 4 tepolarte~pola-r~- The State i effective bacte The battinghis 45 nie ma ludi It diemmas diemmas Mi the same watch wages in vitluri vitluri Siis compartis within 4462 yea djvuza mXP ||||| a sl^rstusduda shay of the in Devupad { of the empode anxpaveik anxpaveik vanakrach sund shisen en li A danse danse 1 upparit ta th start cared . formes and 48 us a mattend at nature si abe ... es Boe pres ean et sabitan sabitan E CULES Toafi tage e be relatiu v~ omg THON Gm oad Sore trek tected national caus Aiiactensts yay at first Si 045 And that's WNeeeliiecadang v. Stinger d'atach d'atach lo 81 months in In all other and surgiral therafter In cure from the secuti secuti his val 6 Temjwa 7.00 nukkuGA 3 chugai chugai a | i rr? ar me tee oy At interns rw pon ao. (Ob emeg TS STM ee meee ee ee me uk ke ee oe , 1 ughout je fijate is tissue linding kat dry L quent, ad _ wag Proceedings of Medical and Surgical Section 75 _ - oath . . ae -. physical examination abould be aude including ray film of chest for lung f tissue for diagnosis and future record aug A cee old employes working in dust periodical examination should be munde and if symptoms uro present change in occupation . ie 2 . The State of Illinois has passed a Workmen's Occupational Disenses Act effective occupational a ; - October , 1936 for disabilities resulting from discusca es The highlights of the Act especially as it has reference to silicosis and asheslin . x4s ute us follows it with ** tunited - light rt but ja stints rule - - cetauly Joust ardinal ebarne- a yby 1. Al salen vat thites Kond chure of of the . . It defines Disablement as meaning disabled from curing full wages at . the same work which caused the disense and with the same employer or equal wages in other employment , No emmpensation payable for occupational disense unless disalite ientaveurs within one year after the lust day of the last exposure to the hazardly of the disease except in occupational disease caused by inhalation of silen dust or ( usbestos dust where the time limit for disablement is three years after the last . . day of the last exposure . Occupational Disease is defined us a disease urising out of and the course of the employment Orduary diseases of life to which the general publie is exposed outside of the employment shall not be compensabile except where the said discuses follow us an incident of un occupational disease as defined A disease shall be deemed to urise out of the employment employment unly if there is apparent to the rational mind upon consideration of all the circumstances a . direct causal connection between the conditions under which the work is per; formed and the occupational disease and which can be seen to have followed . , A oO as a natural incident of the work as a result of the exposure occasioned by the nature of the employment and which can be fairly traced to the employment as the proximate cause and which does not come from u huzurd to which work- . | men would have been equally exposed outside of the employment The disense . - o>.) inust be incidental to the character of the business und not independent of the ; relation of employer and employe The disease need not to have been foresren } or expected but after its contruction it must appear to have had its origin in * _ risk connected with the employment and to have flowed from th"stource n al - rationul cousequence ; Amounts payable in case of death are minimum 1,000.00 and a muxinist : . of fruin 1,000.00 to 5,500.00 . . Amounts payable for disability a In silicosis or asbestosis or either v complicated with tuberculosis employer must provide first aid medical and , surgical und hospitul services to cure or relieve the diseases but not exceeding r six months from date of disablement -taaa obtain n ~ancful e In all other cases the employer shall provide the necessary first aid medical und surgical services and all necessary medical surgical and buspital services thereafter limited however to that which is reasonably required to effect a cure from the effects of the disease The employe may in any case elect to secure his own physicsun surgeon and hospital services at his own expense expense b Temporary total disability six days conipsensation ^ainanuta 7.50 nuximum 15.00 weekly to be paid and retroactive tu first day after 30 days , : ( t 3 NM ? . , ome Oe Ei * oy x H | *| ] s} oS Pa sq , Al 3