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568 Eighteenth Annual Safety Congress, drugs, poisons, toxins. as far as their effect on living aaimaU or patient* is con cerned, do not retard the glittering attractions of any tingle property as a rare index for the safety of the whole. If yon are physicians, mint drugs for treatment, always inquire into the Thera peutic Index. If you are chemists, bear in mind: "Margin of Safety." If you are lawyers, great executives, captains of industry, do not commit the glar ing fallacy of tire deductive logic, Son Setpntnr, which draws unwarranted coachsioos from minor premises to complex wholes; or, if you pride yourselves oo being scientific, beware, of making hasty generalization from insufficient data, a fallacy of the inductive method. If yon are philosophers consider actions of drug itt tout ensemble, not with an eye to single properties, hut on the whole. If yon are moralists, I beg yon bear in mind the famous dictum of the psalmist (Ps. 3*:1S), "Depart from evil'* first, and only after that "do gooff*; or patting it in other language. "The ends don't always justify the means." And lastly, if you are plain, honest men of business, I beg yon to maintain a balance 'twixt your gains and losses in terms' of toxicology. In handling chem icals and drags, 'tis wdl to keep yoor books on double-entry basis, for every drug is also poison; yon wide! a two-edged sword. This is the message winch Pharma cology brings to alt those who have inscribed upon their banners, SAFETY FIRST. Ckaoscak Wurtnasoax: Became of lack bf time this morning we shall tens the meeting over to general discussion of Dr. Madit's paper, at the same time that we discuss the next subject on the program. Mr. S. E. Whiting win talk to us on "Putting the Specialist's Ideas to Work in Our Plant-" Putting the Specialist's Ideas to Work in Our Plants By S. E. WHITING Assistant Chief Engineer, liberty Mutual Insurance Company, Boston Mr. Chairman and gentlemen: referring first to Dr. Macht's admirable: address, it if certainty going to take us a couple of more years to put all of this particular specialist's ideas to work in our plants. However, we have already gamed on tins first contact with him a much clearer understanding than we had of the funda mental factors governing the action of poisons upon human beings,--an rxreUeot basis for further progress in the safety man's fight against industrial diseases. . As some of yon know, it has been my function in this Chemical Section, moat inappropriately, to head up your Industrial Poisons Committee for several years.'' I do not assert that the subject itself does not justify yon in maintaining such a standing'committee, because the chemical industries themselves and certain prod-' nets they sell for use in other industries are probably responsible for their share in creating this type of harsurd in industry. Yon chemical safety men an as much concerned to avoid disabling a workman slowly through poisoning as yon arc to avoid disabling him quickly through traumatic injury and I feel sum your concern is no lea because of the fact that m certain states, the employer, strangely enough, is not legally liable for disability caused by occupational diseases. For one example cot of many, Pennsylvania does not require compensation for leadpoisoning. I do not know how Important this disease hazard is compared with the other industrial hazards. Because of its intangible quality compared with machinery accidents, falls, etc- and because of its typically slow onset, an occupational dis ease does not always jolt us into as prompt corrective measures as it should. By ** coo* - rare *be Then. t the |hr. *d coach]. * oa ban * filhcj t with an - Psalmist "" putting maintain ar chcmwcy dn PttainaHRST. nil tarn me time ' trifc to ints tot. iddress, rtieufar oa this ftmdaxdleat ex. By ~Chemical~SecHon pure chance I qoted a month ago one of the Haskin newspaper articks from Washington firing some Borean of Labor Statistic* data on this subject m`*round tisures." I should say they were distinctly round figures, poMtbiy tsomewhat in flated. It it asserted that the direct economic loss from occupational diseases is j'-out 12,000,000,000 per ananm. Indeed the Bnreaq goes father and by inrfodiag the loss of future earning power (derived from life apeeuacy factors) sets the innual loss at 08,000,000,000 and adds some two bfflions more for metical and hospital costs. Now, of coarse, no one is trying to pin H of these figures onto die chemical nr any other industry. They pretend to be all iodnshre and doubtless are. from anthrax in tanneries to Klieg eyes at Hollywood. They even mention what was historically probably the earfiest occupational disease,--what doctors call prepa tellar bursitis or boose-maid* knee. So far as Z can see, housemaids knees seem tore prevalent today than ever. Growing Recognition Practically speaking and coming right up to present date, I have gained the impression from discussions before this section and from my regular business connection that more and more recognition of these industrial poisoning cases is developing. As one specialist' recently expressed it in the American Medical Jcarnal, more new diseases are coating oat in this occupational exposure than "m any other field of medical endeavor'*. What does the doctor mean by that word "endeavor"? The newest disease that has been triumphantly discovered by our aperiaftstt is a real humdinger because the prognosis is extremely grave or in layman's language. the victim is sure to die. We bad one such case this summer and we don't yet know what the State Accident Board will think of it because, of coarse, industrial causatioa is alleged. This particular man looked the picture of health but several month* ago developed ring worm, a fungus skin disease of no great seriousness. He treated for it privately and cleared it up, bat it came back at him repeatedly, still nothing more than a nuisance to a perfectly ragged young man. Then he took some X-ray treatments for the skin lesions and promptly flared up with severe inflammation. He was sent to a hospital and they examinrri his blood and they looked for the various types of white cells and could not find anything bat lympho cytes. This meant nothing at all to the ordinary surgeon so we consulted a spe cialist, an internist they called him. He named the trouble right away.--agranu locytosis--and said this fine looking man would'die. I (fid not believe it bat, irr spite of transfusions and every other effort at the largest hospital in Maim chtoetts, he did die. What was the cause? Nobody knows; the specialists say the etiology of this disease is unknown. The man worked at 'spraying under good conditions of ventilation. The solvents were largely other than benzol which en tered the picture only as the denatnrant of the alcohol with which the pyroxylin sc wa* mnitfrard for safe shipment. What, if any, industrial causation or even in dustrial aggravation exists in this death case is up to the specialists and I await their decision with interest Changing Ideas of the Specialists Certainly this Chemical Section cannot be accused of failure in giving fore thought to these disease problems. For years your practice has been to seek authoritative medical men to address your meetings,--more so than any other Section of the whole Council. Yon have also initiated technical research ow particular poisoning hazards. By association with yon, I too have gained many ideas to put to work in our plants where a disease hazard might be present. My main trouble; however, has been to keep within sight of the procession of changing ideas our specialists are marshalling before ns. 570 ' ;s ' *.'`?l?H*. ,* 'l..J-~"---i ?1l'%.' ^* "* * * ?,*/ ,*Y7'"s3*> Take the treatment.. we were told by one specialist to aeatrafise; hicarixmate'.ofr-aadrlwaah?{oe^cidg^| bums. acetic acid .wash for aUcalis and ammonia fume*foc. nhpcwss'.fawe^rnlBibtioB.' The pmo*' was as direct as an inonaiiic chemical fonmda^Tlia^stopwnt'.tc ' 'fl Detroit and learned bom another specialist thatnentralirinc (oriskin' bermat least) ' was aU wrong and be proved it too by presenting Uw.testjmony of- the rats. thejn- selves who had undertaken this research. -.We indeed were happy 4fcen'became this greatly simplified oar plant first aid,--one nmversa!'wash for every'sort of'chemical bom. ordinary tap water. Farther research on eye bums arrived at the same ooodu- rioo. \ "''V.-,,.'--. This. I think; is a permanent step forward hot we most not . forget (bat the rinsing must be genuinely thorough- It may be the water should' be^vrarmed some what and may be some wiping action with a wet rag should he applied to secure this thoroughness. Nor should we forget that a few caustic chemicals are not water soluble and you most not then depend for saving the case upon a meregar- dcK free or shower bath. For example, carbolic acid is quite dangerous on the skin or in the eye and for this yon should rinse with alcohol,--if,you can place /our.hands on any -of k. Nor am I entirely sure that we can completely abandon the old idea of neutralization. Surely an antidote has essentially a neutralizing action and I find that Underhill of Yale in his hook on Toxicology issued in 1028 repeatedly suggests antidotes to counteract poisons. New Hospital Treatment for Boras As a side-issue in our chemical bum discussions, we brought out at die Detroit meeting some evidence that the hospital treatment of such cases was changing. In fact otar own speaker. Dr. E. C. Davidson, had developed a new method in Ins research at the Henry Font Hospital and mentioned it briefly; the application of wet compresses of 2 per cent to 5 per cent tannic acid for from 24 to 38 hours followed by dry treatment only. This -treatment precipitates the proteins in the burned area, eliminating toxic absorption and minimizing bacterial invasion as writ as reducing scar tissue deformities wonderfully. Of course this seemed to be none of our business as safety men, but we knew how often these extensive body boros bad proven fatal--whether rhcmical burns, fire burns, or scalds--and we naturally want to 'be sure everything possible is done to help save any injured man. whether by the plant first rid or by toe later hos pital treatment. I make no apologies for transgressing on these hospital grounds. The fact is that some of them have so few industrial cases they are glad to get the plant man's viewpoint. So I have watched the extensiod in use of this tannic arid treatment on extensive burns and have gamed the impression that more and more hospitals are standardizing on it, including some of the big metropolitan leaders in the field. I suggest you inquire of your own hospital as to their knowl edge and practice in respect to tannic acid,--the whole nutter is available to them in medical literature. ' Appropriate First Aid for Burns I come now to the real reason for this digression, the question of our own plant first aid technique for body burns. For years this practice has been largely the application of an oily salve or liquid to exclude the air and kill the pain some what. ' This was all right when the hospital would later use a- similar treatment of oily dressing, but is it all right if the hospital is going to use aqueous tannic acid? It seemed to me it would not be all right; that the oil or petrolatum or whatever you used would tend to interfere with the tanning action or at least to delay treat ment until the hospital surgeon had removed aU of your first aid,--a difficult and . .. , a . fc -1ire- sfe -'.!***i4.TI "' V. i ^, '' > .^A'W'.. :.-. . ;,fp. > /'<.. 'v r.v, , .-.I-, -'tp.i*; bmka!JSMiiQn K- cJafal proem. I have hem asking the :stugeocs about this,--Dr. Stwyc Eastman and others of the Confereaeeof Physicians in Industry and Boston i:roa and Dr. Davidson himself. A few see no great importance to the pa .-lied, but most of them do and concede that the first aid should be some .w miscible treatment if tannic acid is'to be die hospital treatment''; One snr <oes so far, as to ssy that the best'first .aid would be to wrap the patient, blanket soaked in tannic add itself. This may not be practicable because the . non is not I understand, a stable one.. There are severer bunr ointments !.oa die market, however, that are water-nnadble t1 Taaooid, Hydro-Pkric,'and'KY'Lsibrjctt'inj Jdiy. These are made by reputable coocerns and there may beiodsers available. I suggest yon check up this matter fully in your own locality,--unless yon are coorident yon have guarded infallibly against having one of these extensive burn cases that are so pitiful. Lead Poisoning Therapy Perhaps this section is not much interested'in the newer ideas regarding lead poisoning;--that almost classical subject. ' Yet some of you do use sheet lead m acid chambers and if so, yon should watch.out for this hazard .when'doing any welding or cutting of the sheet by flamc,--an exposure that' could 'easily lead to a dangerous acute attack of poisoning.' - Again.'' some of you doubtless manufacture lead compounds. I hope, indeed/your plant physicians already knowMbe-best treat ment for lead poisoning. This was brought out by the fundamental research that was made at Harvard some years ago by Aoh, Fairhall, etc;' under support from the National Lead Institute. As a remit we bore several practical ideas that you can put to work; in your plants where needed.';' The easiest"channel of absorption was found to be by respiration of dusts or fumes.''The'other channels--ingestion and skin absorption are less important in dm usual types of lead exposure. The lead is disabling while in the blood stream and not wben stored in the bones. The storing of lead in die bones and its re-mobQizing in tbe biood stream vary with the rekinin metabolism, positive or negative. ^Any doctor now has'rdirect.guidance in heating such eases adequately if only he understands all that this research fats brought mb Yet I still find--years after die research findings were published -repeated cases where the attending doctor does not use the best .treatment. It is even quite conceivable is a ease of severe acute lead poisoning flat any unnwriude deleading treatment might precipitate a fatal outcome. Therefore, if any of you entuuntrr this hazard. I suggest you make sure your plant physician and also the staff of the hospital you use are acquainted with this new technique on lead therapy. With these newer Ideas too, .you will rmdrrstsnd how a man who has worked for years with out disability under a- slight lead exposure is not necessarily faking if he develops lend symptoms shortly after be gets laid off. Furthsr Study of Banzai I most pas* up benzol. We had this question settled once only to find, at our New York Congress luncheon, that certain high authorities (but not all of diem) fear dure is more to be learned about, it I am glad to see that further research . on the subject'is now. under way supported by die benzol industry itself, ; the logical procedure. ' With.die medical profession turning more and more to hcoaatology.'or. blood study for diagnosis of humanity's many aihnmfv, vrr need to be sure of our, basis for. holding any chemical substance respoes2>Ie far a lethal blood disorder. I do like also die attitude of this industry in giring its customers trdmical advice on ventilation based on direct plant tests with an interferometer. This service is free for the asking. ....... . * -* * ` ' .* t***'v*' * . v.-- ' . '. , /. , --'.>.. H..-...--r-..v- x'-^i-i.-` 572 'Eighteenth Annual "Safety Tongress Inhalation of Dusts Oa the dotty lung hazard, I suspect this section is not particularly' interests '. Other industries have the chief exposure to it The specialists give it a variety V'. names; sQxxxnt, anthraeosis, tideroius, asbestasis and pneumnnocomomt The posts' mean the insurance company has to pay for it I have been Seaming this, however, that we cannot depend on the chemist alone to tdl-ns whether or not'any particular dost is or is not dangerous. We lave to hire another specialist! that 'calls hansel: a petrographer. Yon see oar long specialist says die most dangeroos dost, h'free, silica, not combined silicates, and straight chemical analysis does` not-sake du- distinction. It makes a microscopic optical examination, necessary."' It 'was at oc.- Rocbester mid-year meeting dot 1 got die straight dope on this free 'silica, idea from Dr. Russell of die Public Health Service. The finer particles of free silica : (only a few microns in length) are breathed right into the air sae> of the lungs. Particles of other sabstanccv are similarly deposited but are then-gobbled np'hy C? certain white cells and carried away. The free 2iea is not, hot stays there and U walled op hr tissue. Some yean later the sitica becomes coOoided.. breaks through the wall and presents a nice culture medium of devitalized tissue for fadwralosh genu to breed in and there you are. So watch out for free silica dust or silicosis. Another test for the dangerousness of dusts was given me by Dr. Sayres of the Bureau of Mines. He has to approve the kind of rock that can be toed for rack dusting of coal mines. He injects a sample of the dust into the peritoneal cavity, of a guinea pig and in a week or so examines the peritoneum for fibrosis;'if any. the dust is unsafe; If none, it is O. K. which reminds me that one specialist asserted' we could get a fibrosis in the hmgs merely from swallowing sand. Except for die next specialist I met scoffing at his idea, I was all set to cut spinach off of my menu. * lapse in Indnatrial Poison Data Sheets Some inquiry has been made in this Section as to why your Industrial Prisons' Committee has quit on the job of getting out Industrial Prisons Data Sheets. While - v officially connected with these flyers of which the chief merit was brevity I hardly { dared to mention them,--they so quickly became obsolete under die onset of new ' ideas from die real specialists. Logically, I am now dropping myself out- of this activity (bring Chairman of your Nominating Committee) and leave the issuance of further sheets in the capable hands of your retiring sectional Chairman, Dr. Oreenbutg1. Of course, also, there is now a Health Section of the Council and Dr. Sappington is going to press every month or so with up-to-date articles of the same general type. I might mention the subject that finally stalled us two years ago on the run of data sheets: chlorine. The Poisons Committee could not agree as to whether chlorine was a poison or was not The toxicologists said it was, the manufacturers said it was not The real' answer probably was a quanti tative one. as Dr. Macht. has just printed out to you in discussing drags m general. The manufacture's finally said that their case was proved by die fact ' that President Coolidge cured his cold by inhaling chlorine. Ever since we have been waiting to hear front President Hoover. If the toxicologists win out, the country will have to go into mourning. New Treatment for Nitrons Fumes I do want to trespass a bit more upon, your time to mention nitrous fumes. The air seems to be clearing on this subject. I do not recall how many expert chemists in your industry have tried to persuade me that this hazard was exaggerated, that process were the really toxic fames generated,--some higher oxide like NtQ* or "ordinary" nitrous fumes were harmless, that only in the rare disorder of a nitrating CJxctaicalJuction...... I hesitate about going into the detail* of tins new therapy for nitrons fame poixxuug. Your doctors sboatd themselves study the medical literature oo the sub ject. As Mr. Armstrong has mentioned, oar section has jost issued a Chemical Safe practices Pamphlet on "Nitrons Fames.** .This includes the new hospital treatment and you will note that the old passive method is replaced by a new ag gressive treatment. As before, and this is within the safety man's functions, all dodbtftd cases must be- followed np over night because of the delayed onset of the really serioas symptoms. It is safest to allow no exercise at all and to send the case in an ambulance to a hospital for observation. Absolute rest and warmth are called for with prompt study of the blood (hourly hemoglobin 'estimations) to detect any increase in concentration. At the first hint that'tbe blood is thickening, radical steps to bold it down ate advised by the spe cialists. There are two ways to accomplish this and present authorities appear to differ slightly as to priority between them. The one is water or saline solution intake of from four to eight liters per day, intravenously if necessary. The other Is venesection or bleeding to the extent of 350 to 800 cubic centimeters, depending on the severity of the case- (and also, I suppose, on the heft of the individual in volved). "Now' our pamphlet on the subject and also, I understand. Dr. Underhill, placed fluid intake ahead of blood discharge, whereas the Chemical Warfare Service report on the Cleveland Hospital Disaster gives priority to bleeding "for incipient or advanced** cases of this type of edema from gassing. The Warfare Service feels that the blood remaining after venesection will then withdraw fluid from the tissues to restore the whole volume to normal. If this means a. reduction in lung fluid, it would seem to the layman an important distinction, especially since in critical cases oxygen administration is advised. Perhaps this question of sequence is not of importance since both treatments follow each other closely or are even given at the same time. If a certain sequence is important, however. I hope oar specialists will advise us definitely as soon as they can, because we all want to conquer this fame hazard if possible. Of coarse, the question as to quantity inhaled still remains a factor in determin ing the damage dene. It is stated by Henderson that nitrous fumes do not cause a spasm of the glottis (as strong chlorine docs) and no particular pain accompanies their, deep inhalation. This makes than all the more dangerous. Shallow breath ing as a protection is talked about by practical men but I would be more inclined to train the workmen, in case of a spill or fume off, to hold their breath and beat, 'or any direct handling of the exposed nitrating liquid should always include ade quate respiratory protection, whether you think there is aery danger or whether you it for the great outdoors. All necessary repair work in vats, on pipelines, etc, don't.